【摘要】 目的 探讨密闭式吸痰和开放式吸痰两种方式对预防心胸外科术后机械通气患者呼吸道感染的效果。 方法 2009年9月－2010年8月，将86例心胸外科术后机械通气患者随机分为两组，试验组应用密闭式吸痰法，对照组采用开放式吸痰法。观察两组患者术后机械通气治疗即刻及至拔出气管插管后48 h内每日痰培养结果、每4小时监测一次体温、血常规检查及胸片结果、呼吸机相关性肺炎（ventilator associated pneumonia，VAP）发生情况。 结果 两组患者在年龄、性别、病种方面差异均无统计学意义（Pgt;0.05），但痰培养结果阳性率、VAP发生率差异均有统计学意义（Plt;0.05）。两组发生VAP患者的痰培养病原菌检出情况:试验组均为G-菌；对照组以G-菌为主，余者为真菌-白色念珠菌。 结论 密闭式吸痰法预防心胸外科术后机械通气患者呼吸道感染效果较开放式吸痰法好。G-菌和真菌-白色念珠菌耐药性强，治疗难度大，临床中应重视呼吸道感染的预防。【Abstract】 Objective To evaluate the effects of closed endotracheal suctioning (CS) and open endotracheal suctioning (OS) on the prevention of respiratory tract infection in mechanically ventilated patients after cardiac surgery. Methods From September 2009 to August 2010, 86 mechanically ventilated patients after cardiac surgery were randomly divided into two groups. CS and OS were provided for patients in the experimental group and the control group, respectively. The sputum culture result, body temperature every four hours, blood routine examination and chest X-ray result, and the development of ventilator-associated pneumonia (VAP) were observed and compared between the two groups at the admission to the ICU and once a day thereafter. Results There were no significant differences between the two groups in sex, age, or kinds of diseases (Pgt;0.05). There were significant differences between the two groups in the positive rate of sputum culture results and the incidence of VAP (Plt;0.05). The pathogens isolation in sputum culture of VAP patients were all Gram-negative bacteria in the experimental group, and mainly Gram-negative bacteria followed by fungi-Blastomyces albicans in the control group. Conclusions CS is more effective than OS in the prevention of respiratory tract infection in mechanically ventilated patients after cardiac surgery. The drug resistance of Gram-negative bacteria and fungi-Blastomyces albicans is b, and the treatments of those bacteria are difficult. Thereafter, we should pay more attention to the prevention of respiratory tract infection.
ObjectiveTo introduce economic evaluation methods for anticancer-drugs with basket trial design, and to provide references for related research and decision-making. MethodsA case analysis was conducted on economic evaluation methods for anticancer-drugs with basket trial design, which was issued by Canadian Agency for Drugs and Technologies in Health (CADTH) in the Economic Guidance Report. Moreover, both the advantages and disadvantages of the methods were analyzed in accordance with the characteristics of basket trials. ResultsPooled analysis and tumor-specific analysis were two methods frequently employed in the case analysis. However, great uncertainties were available in both of them. The uncertainty of the former was mainly reflected in the heterogeneity of the targeted population, while the uncertainty of the latter was mainly shown in the insufficient sample size of the subgroup. ConclusionCurrently, economic evaluation methods for anticancer-drugs with basket trial design are immature. Thus, researchers are required to explore the methods of innovation evaluation with lower uncertainty; reimbursement decision-makers should fully consider the uncertainty of evaluation results and enterprises should collect the real-world data for the demands of evaluation to promote the reasonable allocation of healthcare resources in China.
ObjectiveTo investigate the effectiveness of the modified great toe fibular flap using the distal artery pedicle as reflux vein for repairing distal phalanx finger wound.MethodsBetween June 2018 and January 2020, 15 patients who suffered tissue defect of the distal phalanx finger were treated, including 12 males and 3 females, the average age was 40.2 years (range, 24-56 years). All of them were caused by machine crush injury. There were 2 cases of thumb, 6 cases of index finger, 3 cases of middle finger, 3 cases of ring finger, and 1 case of little finger. The defects ranged from 1.7 cm×1.3 cm to 3.0 cm×2.0 cm. The time from injury to admission was 0.6-4 hours, with an average of 2.3 hours. The medial fibular proper digital artery was further dissociated to the distal end and anastomosed with the recipient vein as the reflux vein. The area of flaps ranged from 2.0 cm×1.5 cm to 3.2 cm×2.2 cm.ResultsAll the flaps survived without vascular crisis, and the wounds healed by first intention. Except for 1 case that the suture was too tight, the incision was partially split after the stitches were removed, and it healed spontaneously after dressing change, the other patients had good healing of the donor site incision and normal foot function. All 15 patients were followed up 3-18 months, with an average of 9.3 months. The appearance of finger pulps were satisfactory with full and threaded. The color, texture, and elasticity of the flaps were good, and the two-point discrimination was 6-8 mm at last follow-up. The flexion and extension of fingers were normal. At last follow-up, hand function was evaluated according to the upper limb function evaluation trial standard of the Chinese Medical Association Hand Surgery Society, and the results were 13 cases of excellent and 2 cases of good.ConclusionModified great toe fibular flap using the distal arterial pedicle as a reflux vein can improve the venous drainage of the flap and contribute to increase the success rate of the flap without additional injury.
ObjectiveTo review the research progress of the clinical application of the medial sural artery perforator flap (MSAPF).MethodsThe relevant domestic and abroad literature on the clinical application of MSAPF was extensively consulted, and the research progress were summarized and analyzed in aspect of its definition, anatomical characteristics, clinical application, surgical resection and improvement, and advantages and disadvantages of flaps, etc.ResultsMSAPF has the advantages of relatively constant anatomical position, thin flap texture, long vascular pedicle, large vessel diameter, no sacrifice of main blood vessels, concealed donor site, no hair, and fewer complications; it can carry nerves, tendons, and muscles to construct chimeric flaps to repair three-dimensional wounds; and can also repair wounds with high aesthetic and functional requirements such as hand, foot and ankle, head and neck, etc.ConclusionThe MSAPF is a versatile, various forms, functional diversification, and three-dimensional flap donor site with various application forms and ideal repair effectiveness.
Currently, as the key raw material of artificial biological heart valve, bovine pericardium is mainly depend on import and has become a “bottleneck” challenge, greatly limiting the development of domestic biological heart valve. Therefore, the localization of bovine pericardium is extremely urgent. In this study, the pericardium of Sichuan yak was compared with that of Australian cattle in terms of fundamental properties and anti-calcification performance. The results demonstrated that the appearance and thickness of yak pericardium were more advantageous than the Australian one. Sichuan yak pericardium and Australian cattle pericardium had comparable performance in shrinkage temperature, mechanical test and anti-calcification test. This study preliminarily verifies the feasibility of substitution of Australian cattle pericardium by Sichuan yak pericardium and promotes the progression of bovine pericardium localization with data support.