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肥胖患者头高位喉镜下气管插管的随机、对照、等效性研究

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麻醉与镇痛 2010年第1期6卷 35-41页

作者： Srikantha L. Rao Allen R. Kunselman H. gregg Schuler Susan DesHarnais 周全红(译) 江伟(校) department of Anesthesiology College of Medicine M. S. Hershey Medical Center Pennsylvania Office of the Vice Dean for Research and graduate Studies College of Medicine M. S. Hershey Medical Center Pennsylvania department of Public Health Sciences Pennsylvania State University College of Medicine M. S. Hershey Medical Center Pennsylvania 不详

背景在直接喉镜镜检前，合适的体位对方便气管插管是一重要的环节。通常认为，在肥胖患者的肩部和头下放置毛毯或其他装置使头或背部抬高25°比仰卧位更有利于喉镜下气管插管。头高位还可以通过倾斜手术床的方法来达到，即将正常平位手... 详细信息

背景在直接喉镜镜检前，合适的体位对方便气管插管是一重要的环节。通常认为，在肥胖患者的肩部和头下放置毛毯或其他装置使头或背部抬高25°比仰卧位更有利于喉镜下气管插管。头高位还可以通过倾斜手术床的方法来达到，即将正常平位手术床的躯体-大腿相连处弯曲，同时使躯体部分抬高。调节手术床的方法不需要额外而昂贵的体位装置，还减少了气管插管完成后移去这些设备时可能对患者或医护人员造成的损伤。本研究对手术床倾斜法与垫毛毯法下气管插管所需时间进行了比较研究。方法在一家教学医院，85例体重指数（BMI）〉30kg／m^2的择期手术患者，在签署同意书后入选这一前瞻性、随机、等效研究。采用队列组法随机化使入选患者平均分入两组。一组使用毛毯，另一组使用手术床倾斜法。两组的最终体位是使入选患者的外耳道与胸骨切迹在同一水平。所有体位的放置由同一位麻醉医生完成，喉镜镜检和气管插管则由不同级别的受培训人员来完成。常规静脉诱导和气管插管。记录数据包括：从意识消失到气管插管后测得呼气末CO2的时间，面罩供氧的有效性以及喉部暴露程度。结果毛毯纽气管插管的平均时间（SD）为175（66）秒，手术床倾斜组为163（71）秒。假设等效界限为-55，55秒，采用双尾检验进行等效性比较显著性为0．05时，本研究得出的95％可信区间在-36.22和13．52秒之间。两组的喉镜镜检次数（P=0．21）和气管插管（P=0．76）的时间均没有显著差异。结论肥胖患者麻醉诱导前，采用头高位可以通过在肩下放置毛毯或调节手术床使头部抬高的方法，这两种方法对喉镜镜检以及气管插管的作用是相似的。

关键词：气管插管直接喉镜肥胖患者等效性头高位随机化择期手术患者呼气末CO2

Cohort study to assess geographical variation in cholangiocarcinoma treatment in England

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World Journal of gastrointestinal Oncology 2023年第12期15卷 2077-2092页

作者： Sophie Jose Amy Zalin-Miller Craig Knott Lizz Paley Daniela Tataru Helen Morement Mireille B Toledano Shahid A Khan Health Data Analysis Health Data Insight CICCambridge CB215XEUnited Kingdom National Disease Registration Service National Health Service EnglandLondon SE18UGUnited Kingdom department of Executive AMMF-The Cholangiocarcinoma CharityEssex CM241QWUnited Kingdom MRC Centre for Environment and Health Imperial College LondonLondon SW72BXUnited Kingdom Mohn Centre for Children's Health and Wellbeing Imperial College LondonLondon SW72BXUnited Kingdom Liver Unit Division of Digestive DiseasesImperial College LondonLondon SW72BXUnited Kingdom

BACKgROUND Outcomes for cholangiocarcinoma(CCA)are extremely poor owing to the complexities in diagnosing and managing a rare disease with heterogenous *** curative surgery,which is only an option for a minority of patients diagnosed at an early stage,few systemic therapy options are currently recommended to relieve symptoms and prolong *** insertion to manage disease complications requires highly specialised *** is lacking as to how CCA patients are managed in a real-world setting and whether there is any variation in treatments received by CCA *** To assess geographic variation in treatments received amongst CCA patients in *** Data used in this cohort study were drawn from the National Cancer Registration Dataset(NCRD),hospital Episode Statistics and the Systemic Anti-Cancer Therapy Dataset.A cohort of 8853 CCA patients diagnosed between 2014-2017 in the National Health Service in England was identified from the *** curative surgery for all patients and systemic therapy and stent insertion for 7751 individuals who did not receive surgery were identified as three end-points of *** probability models assessed variation in each of the three treatment modalities according to Cancer Alliance of residence at diagnosis,and for socio-demographic and clinical characteristics at *** Of 8853 CCA patients,1102(12.4%)received potentially curative *** mean[95%confidence interval(CI)]percentage-point difference from the population average ranged from-3.96(-6.34 to-1.59)%to 3.77(0.54 to 6.99)%across Cancer Alliances in England after adjustment for patient sociodemographic and clinical characteristics,showing statistically significant *** 7751 who did not receive surgery,1542(19.9%)received systemic therapy,with mean[95%CI]percentage-point difference from the population average between-3.84(-8.04 to 0.35)%to 9.28(1.76 to 16.80)%across Cancer Alliances after adjustm

关键词： Cholangiocarcinoma Biliary tract cancer Liver cancer Treatment surgery Systemic therapy Chemotherapy Stent England

Analysis of Nosocomial Infections in Selected teaching hospitals, Qazvin, Iran

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Health 2014年第18期6卷 2425-2432页

作者： Fereshteh Farzianpour Ahad Bakhtiari Mohsen Mohammadi Omid Khosravizadeh Hoda Mossavi Mohammad Mohseni Mohammad Mahboubi Health Care Management Department of Health Management & Economic School of Public Health Tehran University of Medical Sciences Tehran Iran Healthcare Management School of Public Health Tehran University of Medical Sciences Tehran Iran Healthcare Management Kermanshah University of Medical Sciences Kermanshah Iran Healthcare Management Health Management and Economics Research Center Iran University of Medical Sciences Tehran Iran Healthcare Management Ahvaz Jundishapur University of Medical Sciences Ahvaz Iran Abadan School of Medical Sciences Abadan Iran

Introduction: hospital infections prolong patient hospitalization, necessitate additional treatment, increase mortality rate, raise hospital expenses, and even reduce the level of health in the society. The purpose of this research was to study hospital infections in selected hospitals of Qazvin. Methods and Materials: This was an analytic-cross-sectional study. The research population consisted of 25,628 hospitalized patients in the first eight months of 2012 in three selected hospitals of the Qazvin Province. The algorithm of reporting hospital infections, the National Program of Controlling hospital Infections, and 223 patient files hospitalized due to hospital-acquired infections were used to collect information. The collected information was analyzed using the SPSS V. 17 software;the descriptive statistics was used to analyze the qualitative variables;and the descriptive statistics together with chi-square and t-test were employed for the quantitative variables. Results: The ICU units had the most cases of hospital infections. Respiratory pneumonia and urinary infections topped the list of hospital infections. The most invasive treatments carried out on patients with hospital infections were surgery, urinary catheter, and venous catheter, respectively. More than 50 percent of patients with hospital infections were hospitalized for 2 to 21 days. Results and Conclusions: Because of the high rate of hospital infections, especially in the ICU ward, authorities must give top priority in their plans to designing suitable educational programs to inform hospital staff and patients of hospital infections and to provide suitable resources for dealing with this problem.

关键词： Nosocomial Infections teaching hospitals

皮肤恶性肿瘤的治疗:我们应依赖临床诊断至何种程度?

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世界核心医学期刊文摘（皮肤病学分册） 2006年第9期2卷 34-34页

作者： Brown S.J Lawrence C.M 李政霄 department of Dermatology Royal Victoria Infirmary Newcastle-uponTyne United Kingdom [Dr.

Background: Cutaneous malignancy forms a major part of the dermatologist’ s workload. Clinical diagnosis is an important factor in facilitating the urgent excision of squamous cell carcinomas (SCC) and malignant melanomas. Objectives: To identify the numbers and types of malignant skin tumours managed in an NHS teaching hospital and to assess the diagnostic accuracy. Methods: Data were collected on every histologically proven malignant skin lesion over a 6-month period. Results: One thousand one hundred and ninety-five malignant skin tumours were identified: 78% were basal cell carcinomas, 14% were SCC, 6% were malignant melanomas and the remaining 2% included Merkel cell tumours, malignant adnexal tumours and lentigo maligna. Eighty-one per cent of the tumours were managed by dermatologists. The correct clinical diagnosis had been made by the secondary care clinician in 84% of cases but an incorrect clinical diagnosis was given in 32% of SCC. Of the 1195 tumours, 916 (77% ) had a primary excision and 92% (843 of 916) of these were completely excised. Conclusions: The majority of skin malignancies (968 of 1195, 81% ) were managed by dermatologists. Where primary excision was attempted, this was complete in 91% (767 of 916) of cases. The correct clinical diagnosis was made in 84% of all tumours, but 32% of SCC were not correctly diagnosed prior to surgery.

关键词：皮肤恶性肿瘤临床诊断治疗 Merkel细胞癌恶性皮肤肿瘤皮肤科医师医师工作量恶性黑素瘤

荷兰地区经阴道无张力尿道悬吊术并发症的前瞻性研究

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世界核心医学期刊文摘（妇产科学分册） 2005年第11期1卷 3-3页

作者： Schraffordt Koops S.E. Bisseling T.M. Heintz A.P.M. Vervest H.A.M. 朱国栋 department of Obstetrics and gynecology Meander Medical Center Ringweg Randenbroek 110 3816 CP Amersfoort Netherlands Dr.

Objective: The intra-and postoperative anatomic complications, frequency, and influence of risk factors of the tension-free vaginal tape are described. Study design: This was a prospective cohort study of 809 patients. Results: The total intraoperative complication rate was 6.2% . Previous prolapse surgery was a risk factor for complications (odds ratio, 2.86; 95% CI, 1.15-7.11). We found more intraoperative complications in patients with general anesthesia than with local analgesia with sedation (odds ratio, 4.14; 95% CI, 2.01-8.53). In teaching hospitals the postoperative complication frequency was higher than in non-teaching hospitals (odds ratio, 0.55; 95% CI, 0.35-0.85). The learning curve is short, and more postoperative complications were found in the second 10 patients who underwent operation by 1 surgeon (odds ratio, 1.94; 95% CI, 1.14-3.29). Spinal analgesia gives fewer postoperative complications than local analgesia with sedation (odds ratio, 0.35; 95% CI, 0.13-0.92). Conclusion: Tension-free vaginal tape is a relative safe procedure; concomitant pelvic surgery can be performed safely. Several risk factors for complications were identified: menopausal state, previous prolapse surgery, mode of anesthesia, teaching hospital, and the second ten procedures of each surgeon.

关键词：阴道脱垂盆腔手术教学医院全身麻醉患者外科医生手术危险局部麻醉前瞻性队列研究脊髓麻醉学习曲线

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子宫肌瘤在两种子宫切除术式的临床回顾分析

广州医药 2002年第6期33卷 28-31页

作者：王素敏邵斌黄胡信江苏省南京市妇幼保健院南京医科大学教学医院210004 Data manager Division of Women’s&Child HealthLiverpool Health ServicesLiverpool2170Australia Professor&Medical Director Department of Obstetric&GynaecologyUniversity of New South WalesLiverpool Health ServicesLiverpool2170 Australia

回顾比较了 87例用LAVH或VH手术治疗子宫肌瘤的病例。分析了决定术式选择和影响手术时间的因素。结果发现 ,LAVH组平均子宫重量为 2 71g明显大于VH组 15 7g(P 4 0 0g时 ,手术时间延长的机会高出 2 5倍 (P 15 0min可能性增加 2 6倍 (P <0... 详细信息

回顾比较了 87例用LAVH或VH手术治疗子宫肌瘤的病例。分析了决定术式选择和影响手术时间的因素。结果发现 ,LAVH组平均子宫重量为 2 71g明显大于VH组 15 7g(P gistic回归分析表明 ,重量 >4 0 0g时 ,手术时间延长的机会高出 2 5倍 (P 15 0min可能性增加 2 6倍 (P <0 0 5 ) ;普通妇科医师手术时间延长的机会高出内窥镜医师达 33倍 (P <0 0 0 1)。

关键词：子宫肌瘤全子宫切除腹腔镜手术时间 LAVH手术 VH手术对比分析

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子宫肌瘤栓塞失败的分析

世界核心医学期刊文摘（妇产科学分册） 2006年第4期2卷 24-24页

作者： Huang J.Y.J. Kafy S. Dugas A. T. Tulandi 李跃萍 Mcgill University Department of Obstetrics and Gynecology 687 Pine Avenue West Montreal Que. H3A 1A1 Canada Dr.

Objective: To assess the outcomes of patients who underwent uterine fibroid embolization (UFE) and to evaluate factors associated with failure of UFE. Design: Retrospective study. Setting: University teaching hospital. Patient(s): Two hundred thirty-three consecutive patients who underwent UFE from November 1997 to February 2004. Intervention(s): Uterine fibroid embolizations were performed by three interventional radiologists using 355-500-μpolyvinyl alcohol particles. Main Outcome Measure(s): Hysterectomy rate, myomectomy rate, and repeat UFE rate. Result(s): With a mean follow-up of 13 months, a total of 22 patients underwent surgery after UFE (9.4%); 16 had hysterectomies (6.9%), and 6 had myomectomies (2.6%). This included 3 patients who underwent repeat UFE and subsequently required surgical intervention. The mean (±SEM) time interval between UFE and subsequent treatment was 12.5 ±2.0 months. Among patients who required surgery, 13 (59.1%) presented with recurrent menorrhagia, and 5 (22.7%) complained of persistent abdominal pain. Histopathologic examination revelead concomitant findings of adenomyosis in 25%of hysterectomy specimens. Patients who failed UFE were more likely to have had a previous myomectomy (13%vs 2.4%) and significant reduction in the uterine size 6 months after UFE (57.1%vs 25.2%). Conclusion(s): The overall failure rate of UFE is 9.4%. Failure is mainly due to persistent menorrhagia and abdominal pain. Shrinkage of the uterus after UFE does not necessarily correlate with long-term success of UFE.

关键词：子宫体积子宫切除术病理学检查子宫切除率大学教学医院月经过多子宫腺介入放射学平均间隔时