摘要:目的:分析与比较七氟醚吸入麻醉和丙泊酚静脉复合麻醉应用于三聚氰胺致婴幼儿输尿管结石手术的麻醉效果。方法:60例输尿管结石患儿随机分为七氟醚(Sev)组(n=30)和丙泊酚(Pro)组(n=30)。观察并记录诱导时间、气管内插管时间、苏醒时间、拔除气管插管时间、PACU滞留时间。记录麻醉诱导和苏醒期的不良反应。另外记录两组病人诱导前、插管前、插管后3 min、5 min、15 min、30 min时点的血压、心率、脉搏血氧饱和度(SPO2)。结果:七氟醚组诱导时间(63.2±6.9)s长于丙泊酚组(38.2±12.7)s,七氟醚组拔除气管插管时间(11.9±4.7)min短于丙泊酚组(15.6±8.2)min,两组相比有统计学意义(Plt;0.05)。七氟醚组躁动发生率53.3%显著高于丙泊酚组13.3%(Plt;0.01)。七氟醚组在插管前、插管后各时点的血压、心率与诱导前相比,差异无统计学意义(Pgt;0.05),丙泊酚组插管前、插管后3 min、5 min与诱导前相比血压、心率显著降低(Plt;0.05),与同时间点七氟醚组相比血压显著降低(Plt;0.05)。结论:两种麻醉方法均可安全有效用于婴幼儿输尿管结石手术,七氟醚组血流动力学更平稳,但躁动发生率较高。Abstract: Objective: To analyze and compare sevoflurane with propofol for anesthesia in infants with Melamineinduced ureteral stone surgery. Methods: Sixty infants who were to undergo Melamineinduced ureteral stone surgery were randomly divided into sevoflurane (Sev) group (n=30) and propofol (Pro) group (n=30). Observe and record the induction of anesthesia time, intubation time, awakening time, time to extubation, time to stay at PACU. Record adverse effects during induction of anesthesia and the awake period. In addition, recorded BP, HR, SPO2 of two groups before induction and intubation, after 3min、5min、15min、30min after intubation. Results: Induction time ［（63.2 ± 6.9） s］ in sevoflurane group was longer than propofol group ［(38.2±12.7） s］,but extubation time ［（11.9 ± 4.7） min］ was shorter than propofol group ［(15.6 ± 8.2） min］, there was significantly different between two groups (Plt;0.05). The incidence of restlessness in sevoflurane group 53.3% was significantly higher than propofol group 13.3% (Plt;001). In sevoflurane group the BP, HR before intubation compare with after intubation has no significant difference (Pgt;0.05). Compared with before induction,the BP, HR before induction, after intubation 3 min, 5 min, decreased significantly (Plt;0.05) in propofol group.when compared the same point with sevoflurane group, blood pressure decreased significantly (Plt;0.05). Conclusion: Both propofol and sevoflurane can be used effectively and safely for anesthesia of ureteral calculi stone surgery in pediatric. The hemodynamics is more stable but restlessness is more common in sevoflurane group.
目的:探讨经尿道输尿管镜腔内气压弹道碎石治疗肾盂结石的疗效。方法:回顾分析7例肾盂结石经尿道输尿管镜腔内气压弹道碎石术式治疗的临床资料。结果:5例术后复查出现大小不等上尿路残余结石,分别予经皮肾镜碎石,经尿道输尿管镜碎石,体外振波碎石治疗后复查无残余结石。结论:肾盂结石经尿道输尿管镜腔内气压弹道碎石治疗需要根据结石的大小、形态及位置严格掌握适应症。
Objective To explore the advantages of postoperative chest drainage with 16F urinary catheter for video- assisted thoracoscopic surgery (VATS) lobectomy. Methods Data of 102 patients (October to December 2015) who under- went VATS lobectomy of lung disease with insertion of catheter (16 F urinary catheter or 28 F chest tube) were analyzed. The patients were divided into two groups including a 16F group (49 patients, with 16 F urinary catheter) and a 18F group (53 patients, with 18F chest drainage tube).The following post-operative data were evaluated: primary healing of tube inci- sion, chest X ray abnormalities (pneumothorax, pleural effusion, subcutaneous emphysema, and hematoma), drainage time, re-insert the drainage tube, and wound healing at the site of insertion. Results Both groups were similar in age, gender, co-morbidity and pathological evaluation of resected specimens. After adjustment, no statistically significant difference was found between the two groups in pulmonary complications (30.6% vs. 28.3%, P=0.102), subcutaneous emphysema (60.0% vs. 6.7%, P=0.011), required intervention (2.0% vs. 5.7%, P=0.048). The average total drainage volume in the 16F group (587.3±323.7 ml) was less than that of the 28 F group (824.1±444.3 ml, P=0.000). The rate of primary healing at the site of insertion in the 16 F group (100.0%) was higher than that in the 28F group (58.5%, P=0.014). A significant difference was found in the drainage time and post-operative length of stay between the two groups (54.2±28.6 h vs. 95.6±65.5 h，4.2±1.4 d vs. 6.5±3.0 d). Conclusion Since 16F urinary catheter has advantage in fast track rehabilitation and low risk of pulmonary complications, the use of 16F urinary catheter is appropriate after VATS pulmonary lobectomy.
摘要:目的:探讨后腹腔镜输尿管切开取石术治疗嵌顿性输尿管结石的临床价值和技术要点。 方法:2006年12月至 2009年3月,对58例嵌顿性输尿管中上段结石采用后腹腔镜输尿管切开取石术,术中取石后于镜下直接置入双J管,间段缝合输尿管切口。 结果:58例手术均获成功,无中转开放手术,结石清除率100%。术后创腔引流液量少,3～5d拔除引流管,1周出院,术后3周膀胱镜下拔除双J管。随访1～27个月,B超复查显示肾积水明显好转或消失,无结石复发。 结论:后腹腔镜输尿管切开取石术治疗嵌顿性输尿管结石具有创伤小\疗效好、术后恢复快等特点,明显优于开放手术及其它手术,值得推广应用。Abstract: Objective: To summarize our experience and evaluate the outcome of retroperitoneal laparoscopic ureterolithotomy of the upper ureter impacted stone. Methods: Between December 2006 and March 2009, 58 patients underwent retroperitoneal laparoscopic ureterolithotomy of the upper ureter. After removal of the stones, the double J was put in and interrupted suture was performed for upper ureter. Results: Retroperitoneoscopic ureterolithotomy was successful in all patients, there was neither ureteral stricture nor recurrent calculus, the blood loss ranged from 510 mL, without urine leakage occurred.The mean hospital stay was 7 days, after 3 weeks double J was removed by cystoscopy. With 127 months followup, the hydronephrosis relieved and no recurrence of ureter calculus founded. Conclusion:Retroperitoneoscopic ureterolithotomy is a safe and effective minimally invasive operation, and worth to generalization.
ObjectiveTo evaluate the effect of postoperative no indwelling urethral catheters in lung operation. MethodsIn this prospective cohort study, we recruited 100 patients who were scheduled for pulmonary lobectomy under general anesthesia in a single institution of Thoracic Surgery Department in West China Hospital between April and December 2014. These patients were divided into two groups including a no indwelled urethral catheter group (NIUC, 50 patients) and an indwelled urethral catheter group (IUC, 50 patients). The clinical effect was compared between the two groups. ResultsThere was no statistical difference in incidence of postoperative urinary retention or urinary tract infection between the two groups (P=0.433, 0.050). However, the comfort degrees(0 degree) of patients in the NICU group was significantly higher than that of the ICU group with a statistical difference (P=0.002). While postoperative hospitalization time in the NICU group (P=0.023) was shorter than that in the ICU group (P=0.004). Prostatic hyperplasia was the high risk factor for the lung postoperative urinary retention (P=0.056). ConclusionPostoperative no indwelling urethral catheters in lung operation has the benefit of improving the comfort degrees of inpatients and increasing the postoperation urinary retention.
ObjectiveTo evaluate the risk factors for postoperative indwelling catheter following enhanced recovery after primary unilateral total knee arthroplasty (TKA) under general anesthesia.MethodsPatients who underwent primary unilateral TKA under general anesthesia between January 2017 and August 2018 were enrolled in the study. Among them, 205 patients who met the selection criteria were included in the study, and the clinical data were collected, including gender, age, body mass index, preoperative range of motion, Hospital for Special Surgery (HSS) score, American Society of Anesthesiologists (ASA) score, disease type, comorbidity, hemoglobin, hematocrit, blood volume, length of operation and operation time, whether to keep drainage after surgery, intraoperative blood loss, total blood loss, and preoperative, intraoperative, postoperative fluid infusions, and total fluid infusion on the day of surgery, urine volume on the day of surgery. Univariate analysis and logistic regression analysis were used to screen the risk factors for postoperative indwelling catheter. Length of stay and incidences of complications (intermuscular vein thrombosis, deep vein thrombosis, pulmonary embolism, incision swelling and exudation, electrolyte disorder, nausea and vomiting, and urinary tract infection) were compared between the patients with or without indwelling catheter.ResultsIndwelling catheter occurred in 41 (20%) of 205 patients. Single factor analysis showed that the influence factors were age, gender, keeping drainage after surgery, total fluid infusion and urine volume on the day of surgery (P<0.05). The multiple factors analysis showed that the males and more urine volume on the day of surgery were the significant risk factors for indwelling catheter after primary TKA (P<0.05). In addition, postoperative length of stay was shorter and the incidence of urinary tract infection was lower in non-indwelling catheter group than in indwelling catheter group, showing significant differences (P<0.05).ConclusionThe male patients with more urine on the day of surgery have higher risk for indwelling catheter after primary unilateral TKA under general anesthesia with an enhanced recovery program.
Objective To explore the emergence agitation resulting from postoperative indwelling urethral catheters in patients of thoracic surgery. Methods In this prospective cohort study, we recruited 140 patients who were scheduled for thoracic surgery under general anesthesia in West China Hospital from January through April 2014. These patients were divided into two groups including a control group and a trial group with 70 patients in each group. The patients in the control group had indwelled urethral catheter routinely. The catheter removed after the surgery at operation room in the trial group. Intraoperative urinary volume, emergence agitation (EA) occurrence, postoperative urinary retention, and urethral irritation were recorded. Results There was no statistical difference in postoperative urinary retention rate between the control group and the trial group (1.43% vs. 2.86%, P=0.230). However, the urethral irritation rate in the control group was significantly higher than that in the trial group (12.86% vs. 0.00%, P=0.012) . And there was a statistical difference in adverse event rate (2.86% vs. 0.00%, P=0.039) between the two groups. There was a significantly higher incidence of urethral irritation in male patients (20.51%, 8/39) than female patients (3.23%, 1/31, P=0.033).The rate of EA in the control group was significantly higher than that in the trial group (28.57% vs. 12.86%, P=0.010). There was a significantly higher EA rate in the patients who had urethral irritation by postoperative indwelling catheters compared with those without indwelling catheters (45.00% vs. 12.86%, P=0.043). Conclusion This study suggests that postoperative EA is a result from urethral irritation than local pain, and the EA rate can be decreased by removal of catheter before anaesthetic recovery.