目的:探讨COPD(慢性阻塞性肺病)并自发性气胸的临床特点、治疗及预后。方法:对2001年1月至2008年12月间本院收治的48例COPD并自发性气胸患者进行临床分析。结果:48例COPD并自发性气胸患者临床表现多样,首次确诊率不到80%,死亡率8.25%,单纯抽气治愈10例,胸腔闭式引流治愈22例。胸腔闭式引流+负压吸引治愈15例,手术治疗1例。肺复张平均天数单纯抽气10天, 胸腔闭式引流9天, 胸腔闭式引流+负压吸引7天, 手术治疗15天.结论:COPD并自发性气胸治疗多需排气减压术,复张时间较长,治疗以胸腔闭式引流+负压吸引为宜。
ObjectiveTo explore an individualized treatment program to prevent the initial bleeding of a patient with cirrhosis and esophageal varices by the methods of evidence-based medicine. MethodsOne patient with cirrhosis and esophageal varices was admitted into our hospital on November 2, 2013. After evaluating the patient's condition adequately, we proposed the problem according to the PICOS principles. Then, we assessed the clinical evidence from the Cochrane Library (1990-2012), Medline (1950-2012), Embase (1991-2012), VIP (1989-2013), and CBM (1990-2013). The individualized treatment plan was made through doctors' experiences and analysis of those high-quality evidences from the databases. ResultsEight studies (randomized controlled trials and 5 meta-analysis) were included. We evaluated a series of associated problems:whether we should take measurement to prevent initial bleeding of esophageal varices; which one (β-blockers or ligation of esophageal varices) was the best method to prevent the initial bleeding based on efficacy, complication and cost-effectiveness. Then, according to the evidences and the patient's view, we gave non-selectiveβ-blocker as the primary prevention. After one-year followed-up, the initial bleeding of the patient did not occur. ConclusionMaking the prevention plan for a patient with cirrhosis and esophageal varices can not only find out the individualized program, but also push the patient to make decision for their own health.
ObjectiveTo investigate the influence of different temperatures of distilled water on the general sensation of patients during endoscopic ultrasonography (EUS) examination. MethodsSixty patients who received EUS examination were randomly assigned to trial group and control group. The trial group used (40±1) ℃ distilled water, while the control group accepted 26-28℃ distilled water. The operating time and the grade of discomfort symptoms such as general discomfort, abdominal pain, nausea, vomiting and terror were observed. ResultsSignificant differences in general discomfort, nausea, vomiting and terror were found between the two groups (P ＜ 0.001) . Abdominal pain was not found in either group. The examination time in each group did not show any significant difference (P ＞ 0.05) . ConclusionDifferent distilled water temperatures significantly influence the sensation of patients during the EUS examination, and distilled water with a temperature of (40±1) ℃ is able to relieve the discomfort of patients.