Zhonghua yi xue za zhi
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Zhonghua yi xue za zhi · Jul 2020
Randomized Controlled Trial[Application value of non-invasive ventilation combined with high flow nasal cannula oxygen therapy in sequential treatment of patients with chronic obstructive pulmonary disease after mechanical ventilation].
Objective: To investigate the value of non-invasive ventilation (NIV) combined with high flow nasal cannula oxygen therapy (HFNCO) in sequential treatment of patients with chronic obstructive pulmonary disease after mechanical ventilation. Methods: Chronic obstructive pulmonary disease with acute exacerbation (AECOPD) patients with invasive mechanical ventilation (MV) and successful withdrawal admitted into Huxi Affiliated Hospital of Jining Medical College from January 2018 to December 2019 were enrolled for perspective study. The patients were divided into treatment group (n=40) and control group (n=33) by random number table method. ⋯ The average duration of NIV treatment time [(7.5±1.2) vs (9.3±2.6) h] in the treatment group was significantly shorter than that in the control group (P<0.01). There were no statistically significant differences in PaO(2), PCO(2), re-tracheal intubation rate and the mortality rate of 28 days. Conclusion: NIV combined with HFNCO sequential therapy can effectively relieve diaphragm fatigue and promote recovery of respiratory muscle strength, and it's better than NIV alone.
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Zhonghua yi xue za zhi · Jul 2020
[Clinical study of Youngswick versus distal oblique osteotomy in the treatment of grade Ⅲ and Ⅳ hallux rigidus].
Objective: To investigate the clinical outcomes and effects of distal oblique osteotomy and the Youngswick osteotomy in the treatment of grade Ⅲ and Ⅳ hallux rigidus. Methods: Totally 29 patients (33 feet) suffered from grade Ⅲ and Ⅳ hallux rigidus who received the distal first metatarsal osteotomy in Ningbo NO.6 Hospital from May 2013 to December 2018 were analyzed retrospectively. Among them, there were 10 males and 19 females. ⋯ But compared with it in the first distal oblique metatarsal osteotomy, the joint space with the Youngswick osteotomy after the operation was larger ((2.4±0.3) mm vs (2.1±0.4) mm, t=2.2, P=0.04). Conclusions: The oblique metatarsal osteotomy and Youngswick osteotomy can effectively relieve the pain of the hallux rigidus, increase the dorsal extension activity and joint space of the first metatarsophalangeal joint, sink the first metatarsal head, and improve the living conditions of the patients. The results of the distal metatarsal osteotomy and the Youngswick osteotomy in the treatment of stage Ⅲ and Ⅳ patients with rigid are similar, which can delay the progress of the disease.
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Zhonghua yi xue za zhi · Jul 2020
[Application of urethral pressure profilometry in artificial urinary sphincter implantation].
Objective: To investigate the changes of maximum urethral pressure (MUP) and maximum urethral closure pressure (MUCP) after artificial urethral sphincter (AUS) implantation and their prognostic value. Methods: The clinical data of patients who had undergone AUS implantation in multiple medical centers between March and July 2019 were retrospectively analyzed. Data of urethral pressure profilometry, pad usage, related scores and complications related to surgery were collected and compared. ⋯ All patients met the social continence (0-1 pad/d) criterion. No complications were reported during the follow-up. Conclusions: The relationship between the range of intraoperative urethral pressure and the effect of urinary control can be gained by measuring the specific values of MUP and MUCP during AUS implantation and the post-operative effects, which provides as a data basis for standardizing AUS implantation.
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Zhonghua yi xue za zhi · Jul 2020
[Clinical value of early bedside ultrasound measurement of quadriceps femoris in diagnosis of ICU-acquired weakness].
Objective: To explore the correlation between quadriceps thickness (thickness of rectus femoris and vastus intermedius), cross-sectional area (cross-sectional area of the rectus femoris) and the strength score of the Medical Research Council (MRC) in critically ill patients, and to explore the changes in the length of hospital stay in the intensive care unit (ICU), and to determine the diagnostic value of muscle changes in the ICU-acquired weakness (ICU-AW). Methods: Patients admitted to the Department of Critical Care Medicine from March to October in 2019 who were expected to stay for more than five days were enrolled in this study. The cross-sectional area of the rectus femoris, the thickness of the rectus femoris, the thickness of the vastus intermedius on the first day of the ICU (D(1)), day 3 (D(3)), and day 5 (D(5)), day 7 (D(7)), out of ICU (D(ICU)), and the MRC muscle strength scores on the day of out of ICU prospectively were collected in all the patients, and the correlation and the regularity of quadriceps changes were analyzed. ⋯ The cross-sectional area, thickness of the rectus femoris muscle, and the vastus intermedius thickness were positively correlated with the MRC score (r=0.452, 0.411, 0.402, all P<0.05), and the changes were all negatively correlated with the MRC score (r=-0.682, -0.740, -0.734, all P<0.05). On the 3rd day after ICU admission, the best cutoff value of rectus muscle cross-sectional area atrophy rate for discrimination of ICU-AW was 6.0%, with a sensitivity of 66.7% and a specificity of 77.8%; on the 5th day, the best cutoff value of rectus femoris thickness atrophy rate was 14.5%, with a sensitivity of 77.8% and a specificity of 66.7%; on the 7th day, the best cutoff value of vastus intermedius thickness atrophy rate was 19.9%, with a sensitivity of 70.6% and a specificity of 87.5%. Conclusion: Bedside ultrasound measurement of the quadriceps femoris cross-sectional area and thickness has certain diagnostic value for ICU-AW, and can identify patients with ICU-AW early.