Objective To investigate the effects of cryoanalgesia for post-thoracotomy pain on the intercostal nerves. Methods Two hundred and eight patients suffering from thoracotomy were divided into three groups, according to different analgesia received respectively. Cryoanalgesia group （n = 80）： cryoanalgesia on the intercostal nerves, intercostals nerves was freezed at -55 ℃ for 90 seconds ; patient controlled analgesia by vein （PCA group, n= 80）： patient controlled analgesia was practiced intravenously, and control group （n = 48）： Dolantin given irregularly intra-muscularly and/or tramadol orally. Severity of pain was graded by visual analogue scale. Forced expiratory volume in one second（FEV1.0） was measured and pulmonary complication after operation was compared. Results There was a statistically significant improvement in postoperative pain scores and an improvement in respiratory function tests for patients in cryoanalgesia group（X2 = 74.93,15.04,P〈0. 05）. FEV1.0 in cryoanalgesia group was significantly higher than that in control group（1. 97±0.27L vs. 1. 39±0. 14 L,P〈0. 05）. Pulmonary complication in cryoanalgesia group after operation was lower than that in control group （6. 25% vs. 31. 25%, P〈0. 05 ）, Conclusion Cryoanalgesia on post-thoracotomy pain is very effective and may improve the respiratory function after operation.
Abstract The narrow pedicled intercostal cutaneous perforater (np-ICP) thin flaps were successfully used for reconstruction of hand deformity from scar contraction. This flap was designed with a narrow pedicle (3～5cm in width) which included ICPs of 4th～9th intercostal spaces, and with awide distal part (the maximum is 15cm×15cm) which covered the lower chest and upper abdomen. The thickness of flap was cut until the subdermal vascular networkwas observed. The pedicle was divided between the 7th～14th days after operation. Sixteen flaps in 15 cases were transferred for covering of the skin defects at the dorsum of the hand. The perforators which were included in the narrow pediclewere mostly from the 7th intercostal spaces in 9 flaps. Fifteen of the 16 flapswere survived almost completely, except in one case there was necrosis of the distal portion of the flap. It seemed that this flap was more useful than the conventional methods, not only functionally but also aesthetically. Moreover, the operative techinque was more simple and safer than the island or free intercostalflap due to without the necessity to dissect the main trunk of the intercostalneurovascular bundle. Gentle pressure on the thinning portion of the flap for a short time after operation was important.
OBJECTIVE: To compare the effect of several types of rib rings with intercostal muscles for the replacement of trachea in thorax. METHODS: The surface layer of the third rib of dogs were ripped off and curved into triangular, quadrilateral and polygonal form. These three types of rib rings with intercostal muscles were used to replace a segment of trachea in thorax. RESULTS: The stability of triangular rib ring was very well, but stricture of ring were often happened because of its smaller internal diameter. These stability of quadrilateral rib ring was the worst. The polygonal rib ring presented the biggest diameter and good stability compared to the other two kinds of rings. If silicone tube was supplemented in the polygonal rib ring, the quality of artificial trachea was excellent. CONCLUSION: The rib rings with intercostal muscles are successfully used for replacing the defect of trachea in canine thorax. The polygonal rib rings have the best quality in the three types of rib ring for tracheal replacement.
Objective To study the analgesic effect of intercostal nerve crush after thoracotomy. Methods Model of forceps crushing of intercostal nerve in 20 rabbits was made pathological changes and repairing process of the nerve were observed in order to identify the best forceps crushing degree that could be used clinically. Prospective double-blind randomized trial in 210 patients who had undergone thoracotomy was carried out from February 1996 to June 2002,and were divided into three groups. Intercostal nerve forceps crushing group (group A):before closing chest,4 routes of costal nerves(incision,above and below incision, and one for inserting drainage tube)were dissected and squeezed with forceps. Intercostal nerve forceps crushing with anaesthetic drugs infiltration group (group B):based on intercostal nerve forceps crush, the intercostal nerve in the chest tube location was infiltrated with bupivacaine hydrochloride 5ml, and control group. Postoperative incisional pain was recorded by visual analogue scales (VAS) including recording the dosage of dolantin needed, arterial oxygen saturation (SaO2) on 3,7,15,and 30 d after operation. Results Pathological changes of the axons and myelin sheaths progressed by the degree of crushing, but recovered in 4-6 weeks. The blood vessel microhemostat was locked to the third teeth and lasting for 30 seconds, the effective analgesia and quick recovery were provided. The clinical use of nerve crush was made with the same procedure which showed b analgesic effect in both group A and group B. The total effective rate in 3 d after operation was 97.1%,98.6% and 0% in group A, B, and the control group respectively, and group A, B was significantly higher than that in contral group (Plt;0.001, 0.001); dosage of dolantin administration in group A,B and control group was 40.20±4.12mg, 35.42±3.31mg and 135.10± 8.17mg respectively (Plt;0.01). There was no statistically difference in SaO2 for three groups (P=0.475). Conclusion The intercostal nerve crush is an available and lasting analgesic procedure to relieve postoperative pain of thoracotomy. The technique is simple and can improve respiratory function and accelerate sputum to be coughed up. It can also decrease the opportunity of pulmonary infection. Intercostal nerve may regenerate and recover its function although if it is temporary contused.
Objective To evaluate the efficacy of long-term inhaled salmeterol / fluticasone combined with low-dose oral erythromycin in patients with bronchiectasis. Methods Sixty-two patients with bronchiectasis after exacerbation and maintained stable were randomly divided into three groups. Group A was treated with low-dose oral erythromycin, group B inhaled salmeterol/fluticasone, and group C inhaled salmeterol/fluticasone plus low-dose oral erythromycin. The study duration lasted for 6 months. The clinical symptoms, dyspnea scale, exacerbation frequency, and pulmonary function parameters were measured and compared. Results Fifty-four patients completed the whole study and 8 cases withdrew. The results showed that 6 months of low-dose erythromycin therapy can improve the clinical symptoms, whille exacerbation frequency was also decreased. Inhaled salmeterol/fluticasone improved lung function, however, had no effect on cough, expectoration and exacerbation frequency. Inhaled salmeterol/fluticasone combined with erythromycin was more significantly effective in improving lung functions as well as symptoms. Conclusions Long-terminhaled salmeterol/fluticasone combined with low-dose oral erythromycin can improve the clinical symptoms and lung function, decrease the frequency of exacerbation in patients with bronchiectasis. It may be as an alternative to the maintenance treatment of bronchiectasis.
Objective To investigate the medical charge of in-patients with diabetes and its influencing factors for effective hospital costs controlling. Methods The inpatients with diabetes (the first diagnosis was diabetes; the first three ICD-10 codes of which were between E10 to E14) in Fifth Peoples' Hospital of Chengdu during January to September of 2014 were analyzed for their hospital costs with descriptive statistical method, ANOVA and multiple linear regression method. Statistical analysis was conducted by using SPSS 18.0 software. Results A total of 1 389 cases of diabetes were included. The median of total medical costs and daily costs were 4 554.45 yuan and 446.46 yuan, respectively. The differences of total medical costs and daily costs between diabetes patients with different amount of complications were statistically significant (P<0.001). The factors including age, the way of the medical expense, the number of complications, with acute complications, CCI score and the hospital-stay length were proved to be significantly correlated to total medical costs of diabetes inpatients (P<0.05). Conclusion Age, the way of the medical expense, the number of complications, with acute complications, CCI score and the hospital-stay length are influence factors of medical costs of diabetes inpatients.
ObjectiveTo analyze the safety and effectiveness of minimally invasive small incision through the right third intercostal and standard aortic valve replacement.MethodsThe clinical data of 123 patients with the first simple aortic valve replacement in our hospital from June 2013 to May 2020 were retrospectively analyzed. The patients receiving aortic valve replacement through the right third intercostal small incision were allocated to a minimally invasive group, and patients receiving aortic valve replacement through the median sternal incision were allocated to a common group. The clinical outcomes of the two groups were compared.ResultsThere were 40 patients in the minimally invasive group, including 11 (27.5%) females and 29 (72.5%) males, aged 54.60±9.98 years with the body mass index (BMI) of 23.16±2.48 kg/m2. There were 83 patients in the common group, including 27 (32.5%) females, 56 (67.5%) males, aged 58.77±9.71 years, with the BMI of 24.13±3.13 kg/m2. Compared with the common group, the aortic cross-clamping time, cardiopulmonary bypass time, and operation time were longer (P<0.05), the ventilator support time was shorter (P<0.05), and the blood loss, postoperative 24 h chest drainage volume and total expense were less (P<0.05) in the minimally invasive group. The ICU stay, postoperative hospital stay, and total hospital stay were not statistically different between the two groups (P>0.05).ConclusionThe aortic valve replacement through the right third intercostal small incision is safe and effective, with less blood loss, 24 h chest drainage volume and invasiveness.
ObjectiveTo investigate constitution and financial burden of disease in the West China Hospital of Sichuan University during 2011-2012. MethodsThe data of in-patients (who had been discharged from the department of endocrinology and metabolism or discharged after being transferred to other departments for diagnosis and treatment in the West China Hospital from January 2011 to April 2012) were collected from the Hospital Information System (HIS) of the West China Hospital, including basic information, discharge diagnosis, hospital costs, the information about whether the patients had been registered the insurance in hospital, etc. We classified diseases according to ICD-10 based on each diagnosis when the patients were discharged on the first page of case reports. The data were input using Excel 2010 software, and statistical analysis was performed using SPSS 13.0 software. Resultsa) During 2011-2012, in the department of endocrinology and metabolism, the top five commonly-seen diseases of in-patients were:diabetes, followed by hypothalamic-pituitary-adrenal/gonadal disease, diseases other than endocrine disorders, thyroid disease, and metabolic bone disease. b) The diseases of the top five average hospital stay included:diabetes, followed by malnutrition, metabolic bone disease, diseases other than endocrine disorders, and hypothalamic-pituitary-adrenal/gonadal disease. c) The diseases of the top five total costs of included:diabetes, followed by metabolic bone disease, diseases other than endocrine disorders, malnutrition, and other nutrients deficiency. ConclusionDiabetes and its complications are the major disease as well as the major cause of the burden of disease in the in-patient department of endocrinology and metabolism of the West China Hospital of Sichuan University.
ObjectiveTo investigate the variations in patient hospitalization expenses before the enforcement of the centralized procurement policy, after the implementation of the drug centralized procurement policy, and after the introduction of the consumables centralized procurement policy. The efficacy of the centralized procurement policy will also be examined. MethodsThis retrospective study utilizes data obtained from the medical records homepage of the Health Information Statistics Center under the Health Commission of Gansu Province. It included 32 938 inpatients who underwent PCI surgery for coronary heart disease in Gansu province between January 1, 2018, and December 31, 2022. A double-breakpoint interrupted time series model was employed to analyze the fluctuation trends in hospitalization costs among patients across various stages of the centralized procurement policy's implementation. ResultsThroughout the three phases of implementing the centralized procurement policy, the average total hospitalization costs were RMB 46 149.49 yuan, RMB 46 629.12 yuan, and RMB 28 771.76 yuan, respectively. After the centralized procurement policy with a focus on drug volume was initiated, there was an immediate reduction in average total hospitalization costs, drug costs, consumable costs, and medical service fees by 4.64%, 5.62%, 18.12%, and 8.85%, respectively. However, there was a subsequent increase of 25.28% in average medical service fees. Following this phase, average out-of-pocket costs, treatment costs, and other expenses exhibited a consistent upward trajectory, increasing by an average of 2.23%, 1.51%, and 1.21% per month. Upon the introduction of the centralized procurement policy for consumables, there was an immediate surge of 23.75% in average medical service fees, while average total hospitalization costs, out-of-pocket costs, consumable costs, treatment costs, and rehabilitation costs experienced a gradual decline. ConclusionThe enforcement of centralized procurement policies for drugs and consumables has effectively managed to reduce hospitalization costs for patients undergoing PCI surgery due to coronary heart disease, thereby easing the financial burden on patients. However, changes in consumable costs and average medical service fees were relatively modest. Going forward, it is essential to refine the centralized procurement policy concerning consumables, improve the compensation mechanism for medical service pricing, and enhance the overall value proposition of medical services.
Objective To Provide statistical references for disease-based payment reform with Diagnosis Related Groups (DRGs). Methods Based on 1 969 stroke inpatients from two hospitals in Chongqing city, we used classification and regression trees (CART) of decision tree to establish classification regulations of the case-mix model for stroke inpatients, and multivariate statistical model to evaluate whether the case-mix could provide a satisfactory prediction to costs for stroke inpatients in comparison with the foreign model. Results ① The classification nodes of our model were surgical procedure, nursing care degree, and hospital infection respectively by which 1 969 stroke inpatients were divided into 5 groups. The classification nodes in foreign model were surgical procedure, age≥50 years, and whether patients would refer to other institutions after leaving the hospitals by which 1 969 stroke inpatients were also classified into 5 groups. ② For medical institutions and the third payers, we found that the data from our model could explain 80.46% of the total costs and 16.58% for individual inpatient, which were higher than that of foreign model (76.87% for medical institutions and the third payers, 9.13% for individuals ). Conclusions Compared with foreign model, our model is more suitable for the situation in China. The study is only based on 1 969 stroke inpatients from south west part of China, so the conclusion needs further studies to confirm.