目的持续记录甲状腺手术和乳腺手术中气管导管套囊压力值,评估并对比患者术后咽痛咽干程度。方法选取华中科技大学同济医学院附属同济医院2016-03/2016-04期间经排除标准筛选后50例甲乳外科手术患者入组,按手术方式分为甲状腺手术组(n=...目的持续记录甲状腺手术和乳腺手术中气管导管套囊压力值,评估并对比患者术后咽痛咽干程度。方法选取华中科技大学同济医学院附属同济医院2016-03/2016-04期间经排除标准筛选后50例甲乳外科手术患者入组,按手术方式分为甲状腺手术组(n=23)和乳腺手术组(n=27),ASA分级Ⅰ～Ⅱ级。甲状腺手术组,女性,年龄24～66岁,体质量指数(BMI)18～30 kg/m^2;乳腺手术组,女性,年龄30～67岁,BMI 17～30 kg/m^2。麻醉诱导并顺利插管后将气管导管套囊压力充气至20 mm Hg(28 cm H2O),持续观察套囊压力变化,每5 min记录实时压力值。术后24 h随访评估患者咽痛视觉模拟评分(VAS)和咽干分级。结果甲状腺手术组的平均套囊压力比乳腺手术组高(P<0.05),同时,术后甲状腺手术组患者咽痛VAS更高(P<0.05)、咽干分级更高(P<0.05)。结论在起始气管导管套囊充气压力相等的条件下,与乳腺手术相比,甲状腺手术术中气管导管的套囊压力更高,患者术后咽痛咽干程度更重。展开更多
AIM： To compare the results and complications of early pre-cutting technique with standard technique. METHODS： From January 2003 to December 2004, a total of 426 consecutive therapeutic biliary ERCP procedures were ...AIM： To compare the results and complications of early pre-cutting technique with standard technique. METHODS： From January 2003 to December 2004, a total of 426 consecutive therapeutic biliary ERCP procedures were performed by one endoscopist （T.A.）. Data were retrospectively collected according to procedure indication and results. Of these, 293 procedures （70.4%） were done with standard technique （group A） and 223 procedures （29.6%） with early pre-cutting technique in case of difficult cannulation （group B）. The results and complications of ERCP were compared. RESULTS： Success rate of first attempt cannulation was 98.0% in group A and 87.8% in group 13. The overall incidence of post-ERCP pancreatitis, hemorrhage, perforation and cholangitis was 0%, 0.2%, 0.5% and 0.5%, respectively. Morbidity rate was not significantly different. No procedure-related mortality was occurred. CONCLUSION： For an experienced hand, the early pre-cutting technique for biliary cannulation is safe and effective as standard technique.展开更多
Peripherally inserted central catheter(PICC)is extensively used in critical care settings,because it plays a vital role in providing safe central venous entry.However,PICC is associated with several complications,whic...Peripherally inserted central catheter(PICC)is extensively used in critical care settings,because it plays a vital role in providing safe central venous entry.However,PICC is associated with several complications,which should be detected to shorten the duration of patients'improvement,reduce health care cost,and lessen the incidence of various PICC-related complications.Therefore,this study aimed to outline current literature on PICC procedures,potential complications,and measures for prevention.Understanding evidence-based guidelines regarding insertion technique,early detection of complications,and care bundle of PICC is significant in complication prevention.Implementation of education,training,and appropriate multidisciplinary approaches on PICC care among nurses and caregivers is the key to preventing complications.Thus,the strict care of indwelling PICC lines,the targeted and reasonable PICCassociated complication prevention,and nursing care have a major clinical significance in reducing the occurrence of potential PICC complications.展开更多
Portal vein cannulation is a rare complication of endo-scopic retrograde cholangiopancreatography(ERCP).It has been reported that it usually occurs after endo-scopic sphincterotomy,whereas in cases without prior sphin...Portal vein cannulation is a rare complication of endo-scopic retrograde cholangiopancreatography(ERCP).It has been reported that it usually occurs after endo-scopic sphincterotomy,whereas in cases without prior sphincterotomy,the presence of portobiliary fistulas has been shown.Here,we present a case in which cannulation of the portal vein occurred despite careful wire-guided cannulation and the absence of sphinc-terotomy.Although fatal cases of cerebral and pulmo-nary air and/or bile embolism have been reported in patients with combined portal and hepatic vein trauma after ERCP and sphincterotomy,isolated portal vein cannulation,as in the current case,does not usu-ally result in mortality or serious morbidity.However,awareness of this rare complication is important so that no further intervention is performed.展开更多
Five cases of arytenoid dislocation after intubation under general anesthesia are reported in this article. The anatomical and anesthetic causes of this complication were studied restrospectively, and the methods of t...Five cases of arytenoid dislocation after intubation under general anesthesia are reported in this article. The anatomical and anesthetic causes of this complication were studied restrospectively, and the methods of treatment were discussed. The result showed that the incidence of arytenoid dislocation was about 0. 09% (5/5 826). Hoarseness, dysphonia and difficulty in feeding were the prevalent symptoms, and poor mobili- ty of the vocal fold was the most common sign. The treatment included closed reduction of the displaced arytenoid under local anesthesia, steroid and physical therapy. The possible causes of arytenoid dislocation were summarized as follows: (1) trauma produced by the blade tip of laryngoscope, (2) the use of stylet, (3) overstretching of aryepiglottic fold and vocal cord during laryngoscopy and intubation, and (4) cough- ing and movement of the endotracheal tube on the larynx during the endotracheal tube in place. It was sug- gested that correct technique and gentle manipulation during intubation could reduce the incidence of the complication. Timely postoperative follow-up and early reduction of arytenoid cartilage should be empha-sized in the diagnosis and treatment of the complication.展开更多
Continent ileostomy can be defined as a surgical procedure that facilitates planned intermittent evacuation of a bowel reservoir through an ileostomy.It was devised by Nils Kock in 1969.Subsequently,continent ileostom...Continent ileostomy can be defined as a surgical procedure that facilitates planned intermittent evacuation of a bowel reservoir through an ileostomy.It was devised by Nils Kock in 1969.Subsequently,continent ileostomy (or Kock pouch) became a viable alternative in the management of patients who had traditionally required an end ileostomy.Kock pouch appeared to provide substantial physical and psychosocial benefits over a conventional ileostomy.The procedure became popular until ileal pouch anal anastomosis (IPAA) was introduced in 1980.Despite its benefits,continent ileostomy had many short term complications including intubation problems,ileus,anastomotic leaks,peritonitis and valve problems.Operative mortalities have also been reported in the literature.Most of these problems have been eliminated with increasing experience;however,valverelated problems remain as an "Achilles' heel" of the technique.Many modifications have been introduced to prevent this problem.Some patients have had their pouch removed because of complications mainly related to valve dysfunction.Although revision rates can be high,most of the patients who retain their reservoirs are satisfied with regard to their health status and quality of life.Today,this procedure is still appropriate for selected patients for whom pouch surgery is not possible or for patients who have failed IPAA.Both the patient and their physician must be highly motivated to accept the risk of failure and the subsequent need for revisional operations.展开更多
Successful cannulation of the common bile duct may be difficult in patients in whom the papilla is located entirely within a diverticulum.In this study,we report successful biliary cannulation in three patients follow...Successful cannulation of the common bile duct may be difficult in patients in whom the papilla is located entirely within a diverticulum.In this study,we report successful biliary cannulation in three patients following intubation of the distal tip of the duodenoscope into the duodenal diverticulum and locating the major papilla.No complications occurred during the operation or during the postoperative period.This method didn't need second incubation an endoscope and might lower the burden of patients.So this skill is useful to deal with the papilla hidden inside the large diverticulum because of its safety and convenience.展开更多
文摘目的持续记录甲状腺手术和乳腺手术中气管导管套囊压力值,评估并对比患者术后咽痛咽干程度。方法选取华中科技大学同济医学院附属同济医院2016-03/2016-04期间经排除标准筛选后50例甲乳外科手术患者入组,按手术方式分为甲状腺手术组(n=23)和乳腺手术组(n=27),ASA分级Ⅰ～Ⅱ级。甲状腺手术组,女性,年龄24～66岁,体质量指数(BMI)18～30 kg/m^2;乳腺手术组,女性,年龄30～67岁,BMI 17～30 kg/m^2。麻醉诱导并顺利插管后将气管导管套囊压力充气至20 mm Hg(28 cm H2O),持续观察套囊压力变化,每5 min记录实时压力值。术后24 h随访评估患者咽痛视觉模拟评分(VAS)和咽干分级。结果甲状腺手术组的平均套囊压力比乳腺手术组高(P<0.05),同时,术后甲状腺手术组患者咽痛VAS更高(P<0.05)、咽干分级更高(P<0.05)。结论在起始气管导管套囊充气压力相等的条件下,与乳腺手术相比,甲状腺手术术中气管导管的套囊压力更高,患者术后咽痛咽干程度更重。
文摘AIM： To compare the results and complications of early pre-cutting technique with standard technique. METHODS： From January 2003 to December 2004, a total of 426 consecutive therapeutic biliary ERCP procedures were performed by one endoscopist （T.A.）. Data were retrospectively collected according to procedure indication and results. Of these, 293 procedures （70.4%） were done with standard technique （group A） and 223 procedures （29.6%） with early pre-cutting technique in case of difficult cannulation （group B）. The results and complications of ERCP were compared. RESULTS： Success rate of first attempt cannulation was 98.0% in group A and 87.8% in group 13. The overall incidence of post-ERCP pancreatitis, hemorrhage, perforation and cholangitis was 0%, 0.2%, 0.5% and 0.5%, respectively. Morbidity rate was not significantly different. No procedure-related mortality was occurred. CONCLUSION： For an experienced hand, the early pre-cutting technique for biliary cannulation is safe and effective as standard technique.
文摘Peripherally inserted central catheter(PICC)is extensively used in critical care settings,because it plays a vital role in providing safe central venous entry.However,PICC is associated with several complications,which should be detected to shorten the duration of patients'improvement,reduce health care cost,and lessen the incidence of various PICC-related complications.Therefore,this study aimed to outline current literature on PICC procedures,potential complications,and measures for prevention.Understanding evidence-based guidelines regarding insertion technique,early detection of complications,and care bundle of PICC is significant in complication prevention.Implementation of education,training,and appropriate multidisciplinary approaches on PICC care among nurses and caregivers is the key to preventing complications.Thus,the strict care of indwelling PICC lines,the targeted and reasonable PICCassociated complication prevention,and nursing care have a major clinical significance in reducing the occurrence of potential PICC complications.
文摘Portal vein cannulation is a rare complication of endo-scopic retrograde cholangiopancreatography(ERCP).It has been reported that it usually occurs after endo-scopic sphincterotomy,whereas in cases without prior sphincterotomy,the presence of portobiliary fistulas has been shown.Here,we present a case in which cannulation of the portal vein occurred despite careful wire-guided cannulation and the absence of sphinc-terotomy.Although fatal cases of cerebral and pulmo-nary air and/or bile embolism have been reported in patients with combined portal and hepatic vein trauma after ERCP and sphincterotomy,isolated portal vein cannulation,as in the current case,does not usu-ally result in mortality or serious morbidity.However,awareness of this rare complication is important so that no further intervention is performed.
文摘Five cases of arytenoid dislocation after intubation under general anesthesia are reported in this article. The anatomical and anesthetic causes of this complication were studied restrospectively, and the methods of treatment were discussed. The result showed that the incidence of arytenoid dislocation was about 0. 09% (5/5 826). Hoarseness, dysphonia and difficulty in feeding were the prevalent symptoms, and poor mobili- ty of the vocal fold was the most common sign. The treatment included closed reduction of the displaced arytenoid under local anesthesia, steroid and physical therapy. The possible causes of arytenoid dislocation were summarized as follows: (1) trauma produced by the blade tip of laryngoscope, (2) the use of stylet, (3) overstretching of aryepiglottic fold and vocal cord during laryngoscopy and intubation, and (4) cough- ing and movement of the endotracheal tube on the larynx during the endotracheal tube in place. It was sug- gested that correct technique and gentle manipulation during intubation could reduce the incidence of the complication. Timely postoperative follow-up and early reduction of arytenoid cartilage should be empha-sized in the diagnosis and treatment of the complication.
文摘Continent ileostomy can be defined as a surgical procedure that facilitates planned intermittent evacuation of a bowel reservoir through an ileostomy.It was devised by Nils Kock in 1969.Subsequently,continent ileostomy (or Kock pouch) became a viable alternative in the management of patients who had traditionally required an end ileostomy.Kock pouch appeared to provide substantial physical and psychosocial benefits over a conventional ileostomy.The procedure became popular until ileal pouch anal anastomosis (IPAA) was introduced in 1980.Despite its benefits,continent ileostomy had many short term complications including intubation problems,ileus,anastomotic leaks,peritonitis and valve problems.Operative mortalities have also been reported in the literature.Most of these problems have been eliminated with increasing experience;however,valverelated problems remain as an "Achilles' heel" of the technique.Many modifications have been introduced to prevent this problem.Some patients have had their pouch removed because of complications mainly related to valve dysfunction.Although revision rates can be high,most of the patients who retain their reservoirs are satisfied with regard to their health status and quality of life.Today,this procedure is still appropriate for selected patients for whom pouch surgery is not possible or for patients who have failed IPAA.Both the patient and their physician must be highly motivated to accept the risk of failure and the subsequent need for revisional operations.
基金Supported by National Natural Science Foundation of China,No. 30900671Shanghai Natural Science Foundation,No. 09ZR1419700
文摘Successful cannulation of the common bile duct may be difficult in patients in whom the papilla is located entirely within a diverticulum.In this study,we report successful biliary cannulation in three patients following intubation of the distal tip of the duodenoscope into the duodenal diverticulum and locating the major papilla.No complications occurred during the operation or during the postoperative period.This method didn't need second incubation an endoscope and might lower the burden of patients.So this skill is useful to deal with the papilla hidden inside the large diverticulum because of its safety and convenience.
