目的 比较经皮扩张气管切开术（PDT）和开放式气管切开术（OT）在成批吸入性损伤患者中的应用效果。 方法 采用前瞻性随机性研究方法，将2006年1月－2010年12月收入三峡大学人民医院重症医学科的4批34例吸入性损伤患者，分为PDT组（n=17）和OT组（n=17），比较两组的手术时间、出血量、并发症，观察手术前后的平均动脉压（MAP）、心率（HR）、呼吸频率（R）、动脉血氧分压（PaO2）和动脉血二氧化碳分压（PaCO2）。 结果 PDT组与OT组手术时间分别为（7.0 ± 1.9）、（18.0 ± 11.4）min，差异有统计学意义（P=0.000）；PDT组与OT组出血量分别为（7.0 ± 4.4）、（19.0 ± 12.1）mL，差异有统计学意义（P=0.001）；两组患者气管切开前及切开后的MAP、HR、R、PaO2和PaCO2差异无统计学意义（P＞0.05）；PDT组发生出血并发症1例，OT组发生出血、皮下气肿、纵隔气肿及切口感染等并发症共6例，PDT组并发症发生率低于OT组，差异有统计学意义（P=0.034）。 结论 PDT在救治成批吸入性损伤患者时比OT更快地建立人工气道，而出血量、并发症发生率均低于OT，值得推广应用。
ObjectiveTo analyze the feasibility of using triangular-sail technique that allows intermittent two-lung ventilation during minimally invasive coronary artery bypass grafting (MICS CABG).MethodsThe clinical data of 207 patients with MICS CABG in our cardiac center from January 2019 to November 2020 were retrospectively analyzed. These patients were divided into two groups. A group OLV included 111 patients who underwent one-lung ventilation during surgery, while a group TLV included 96 patients who underwent intermittent two-lung ventilation. The triangular-sail technique was used in the group TLV. This simple technique isolated the operative field from lung lobes with the traction of pericardial adipose tissue. The preoperative data and perioperative clinical data of the two groups were compared and analyzed.ResultsThere was no statistical difference in basic preoperative data between the two groups. The operation time in the OLV group was shorter than that in the TLV group (296.7±57.3 min vs. 334.1±87.0 min, P=0.000), and the duration of postoperative mechanical ventilation and ICU stay were not statistically different between the two groups. There was also no statistical difference in the incidence of pneumothorax or atelectasis between the two groups.ConclusionThe triangular-sail technique is simple and easy to implement. The technique allows intermittent two-lung ventilation during MICS CABG procedure.
ObjectiveTo establish a hereditary deafness genetic screening cohort and conduct prospective follow-up to evaluate the effectiveness of the Nantong newborn genetic deafness screening program. MethodsA study based on traditional screening of newborn hearing was conducted from January 2016 to June 2021. Newborns in six hospitals in Nantong were screened for 15 hotspot mutation loci in four common deafness genes. Cohort follow-up was conducted. ResultsA total of 40 403 newborns were included, with a carrier rate of 39.5 per 1 000 for the four common deafness genes. In total, 168 children with hearing loss (HL) were identified at screening and follow-up, of which 56.5% (95 cases) had severe or very severe HL. The detection rate of HL was significantly higher with combined screening than with traditional screening (3.0‰ vs. 3.9‰, P<0.001). All four carriers of pathogenic mutations with normal hearing developed late-onset HL within 2 years of age. At the end of follow-up, six of the polygenic heterozygous mutation carriers had congenital HL and five had late-onset HL. Carriers of polygenic heterozygous mutations were more common as compared to other carrier mutation populations (2.1% vs. 68.8%, P<0.001). In addition, 525 carriers of the SLC26A4 mutation and 118 carriers of the MT-RNR1 mutation were identified and their parents were counselled during the combined screening, and no children with HL was identified during the follow-up period. ConclusionGenetic screening for deafness improves the detection of HL at birth. It is recommended that carriers of pathogenic mutations with normal hearing at birth be followed up every 3 to 6 months until the age of 2 years. Carriers of polygenic heterozygous mutations should undergo extended screening for deafness genes and have their hearing monitored more intensively for early detection of late-onset or progressive HL.