ObjectiveTo investigate the screening value of cervical fluid-based cytology test (TCT), high-risk human papillomavirus (HR-HPV) test, and colposcopy for cervical intraepithelial neoplasia (CIN) and cervical cancer in high-risk populations. MethodsA total of 466 patients between January 2013 and January 2015 with a history of intercourse bleeding were enrolled in this study, and the screening value of TCT, HR-HPV test and colposcopy for CIN and cervical cancer were retrospectively evaluated. ResultsIn the 466 patients, 165 were diagnosed with cervical inflammation, 116 with CIN, 182 with grade 2-3 CIN, and 3 with cervical cancer. The colposcopy had the highest sensitivity (84.1%), the lowest specificity (59.4%), high false positive rate (40.6%), low false negative rate (15.9%), and the highest negative predictive value (67.1%). The TCT had the highest specificity (84.8%) and the lowest false positive rate (15.2%). The indicators of HR-HPV were between those of TCT and colposcopy. There were significant differences in terms of these indicators among the three methods (P < 0.05). And the positive prediction value of HR-HPV was the highest (84.5%), while the negative prediction value of colposcopy was the highest (67.1%). There was a significant difference in the predictive value among the three methods (P < 0.05). The consistency of either TCT or HR-HPV alone with pathological diagnosis was poor (K=0.213, 0.343), while that of colposcopy was moderate (K=0.446). Combination of TCT and HR-HPV could significantly improve the diagnosis sensitivity (93.0%) with a lower false negative rate (7.0%); Youden index was 0.736, and the consistency with pathological examination was high (K=0.748). ConclusionsFor high-risk population with a history of intercourse bleeding or other abnormal cervical disorders, the screening sensitivity of TCT and HR-HPV alone for CIN and cervical cancer is low with a high false negative rate. Colposcopy has a high sensitivity and a low specificity. By combination of TCT and HR-HPV, the validity, reliability and predictive values can be improved significantly, and the sensitivity is high with a low false negative rate and a high consistency with pathological examination.
ObjectiveTo explore the efficacy and safety of different sedative and analgesic methods in emergent endotracheal intubations in RICU. Methods110 cases of tracheal intubation in critically ill patients were divided into 5 groups randomly: ① control group(given no sedative or analgesic drug before intubation); ② fentanyl group(given intravenous fentanyl 2 μg/kg before intubation,followed by fentanyl 2 μg·kg-1·h-1 maintenance); ③ dexmedetomidine hydrochloride+fentanyl group(given dexmedetomidine hydrochloride 1 μg/kg+fentanyl 2 μg/kg before intubation,followed by dexmedetomidine hydrochloride 0.5 μg·kg-1·h-1+fentanyl 2 μg·kg-1·h-1 maintenance); ④ midazolam+fentanyl group(given midazolam 0.05 mg/kg+fentanyl 2 μg/kg before intubation,followed by midazolam 0.05 mg·kg-1·h-1+fentanyl 2 μg·kg-1·h-1 maintenance); ⑤ Propofol+fentanyl group(given propofol 1 mg/kg+fentanyl 2 μg/kg before intubation,followed by propofol 0.4 mg·kg-1·h-1+fentanyl 2 μg·kg-1·h-1 maintenance).The mean arterial pressure(MAP),heart rate(HR),respiratory frequency(RR),PaO2/FiO2,Riker sedation score and agitation were monitored before,during and after intubations.The one-time success rate of intubation and severe arrhythmia (sinus bradycardia,frequent ventricular premature,ventricular fibrillation,and cardiac arrest) incidence rate were recorded. ResultsThe one-time success rates of intubations of the propofol+fentanyl group (95.4%) and the midazolam+fentanyl group (90.9%) were higher than that in the dexmedetomidine hydrochloride+fentanyl group (86.4%,P<0.05),while one-time intubation success rate of three groups were higher than that of the fentanyl group (45.4%) and the control group (31.8%,P<0.05).5 minutes after intubation,the PaO2/FiO2 index of 5 groups of patients were higher than those before intubation,but the PaO2/FiO2 index of the control group and the fentanyl group were lower than those in the other three groups(P<0.05).The occurrence of serious arrhythmia rate in the dexmedetomidine hydrochloride+fentanyl group (0%),the midazolam+fentanyl group (9%) and the propofol+fentanyl group (9%) were lower than that in the control group (13.6%) and the fentanyl group (18.2%).The MAP during intubation and 2 minutes after intubation of the propofol+fentanyl group and the midazolam+fentanyl group were lower than that in the other three groups(P<0.05).The proportion of patients with Riker sedation and agitation score≤4 at intubation in the dexmedetomidine hydrochloride+fentanyl group (68.2%) was lower than that in the propofol+fentanyl group(90.9%) and the midazolam+fentanyl group (86.4%,P<0.05),but higher than those in the fentanyl group(22.7%)and the control group(18.2%,P<0.05). ConclusionPropofol,midazolam or dexmedetomidine hydrochloride with fentanyl are all effective and safe methods of sedation and analgesia in emergent endotracheal intubation in RICU.Dexmedetomidine hydrochloride with fentanyl is an ideal sedative relatively with less influence on cardiovascular system and less myocardial oxygen consumption.