Objective To investigate the current status and influencing factors of the awake prone position in patients with mild and moderate acute respiratory distress syndrome (ARDS). Methods A total of 210 patients with mild to moderate ARDS admitted between December 2022 and January 2023 were investigated by general information questionnaire and self-made prone position knowledge questionnaire. The daily prone position time during hospitalization was recorded. The influencing factors of awake prone position were analyzed by univariate and multivariate linear regression. Results The 210 mild and moderate ARDS patients had an average daily prone position length of stay of (4.97±3.94)h/d, showing a low level. Multiple linear regression analysis showed that prone position knowledge score, age, waist circumference and BMI were the influencing factors of awake prone position (P<0.05). Conclusions Daily awake prone position length was at a low level in mild and moderate ARDS patients. Healthcare workers can prolong the time in the prone position by developing an individualized treatment plan for the prone position, improving the patient’s perception of the prone position, and resolving the discomfort from the prone position.
目的 探討丙泊酚復合瑞芬太尼在患者清醒狀態下實施無痛腸鏡法的可行性。 方法 2011年7月－2012年7月，將160例行無痛腸鏡檢查的患者隨機分為兩組: A組用芬太尼復合丙泊酚麻醉,其中男38例，女42例，平均年齡（48 ± 16）歲，平均體重（53.37 ± 9.5）kg；B組以阿托品0.25～0.5 mg緩慢靜脈注射，繼而以瑞芬太尼+丙泊酚復合液緩慢靜脈滴注，使患者保持清醒狀態，其中男43例，女37例，平均年齡（49 ± 15）歲，平均體重（54.26 ± 8.3）kg。觀察兩組患者檢查中血壓、心率、呼吸、血氧飽和度變化，檢查中體動反應，檢查后蘇醒時間、定向力恢復、行走時間、離室時間，以及對檢查過程的記憶情況。 結果 兩組患者均能順利完成檢查，術中記憶率均低，差異無統計學意義（P＞0.05）。A組患者循環改變、心動過緩、低氧血癥、以及體動反應明顯高于B組（P＜0.05），B組患者蘇醒時間、定向力恢復、行走時間、離室時間，明顯短于A組（P＜0.05）。 結論 瑞芬太尼-丙泊酚復合液伍用阿托品能夠安全應用于患者清醒狀態下實施的無痛腸鏡檢查，具有良好的臨床推廣價值。
ObjectiveTo study the feasibility of using propofol and remifentanil for tracheal intubation in patients who are awake, and investigate the influence of tracheal intubation on such vital signs as blood pressure and heart rates. MethodsEighty ASA I-Ⅱ patients who underwent general anesthesia in our hospital between December 2012 and April 2013 were randomly divided into two groups. Patients in group A received fentanyl-propofol, while patients in group B received remifentanyl-propofol-lidocaine. There was no significant difference between the two groups in gender, age, and body weight (P>0.05). Conventional intubation induction method was used for group A:0.05-0.10 mg/kg midazolam, 4 μg/kg fentanyl, 1.0-1.5 mg/kg propofol, and 0.6-0.9 mg/kg atracurium were given and tracheal intubation was performed after muscle relaxation. Group B patients were treated with remifentanyl propofol-lidocaine compound liquid slow intravenous injection, and compound cricothyroid membrane puncture method before endotracheal intubation. We observed the two groups of patients for vital signs before and after induction, and choking cough reactions. ResultsPatients in both the two groups were all able to complete tracheal intubation. Circulation change and incidence of tachycardia in patients of group A were significantly higher than those in group B (P<0.05). The rates of bradycardia, hypoxemia, and choking cough response were low in both groups with no statistically significant difference (P>0.05). ConclusionRemifentanyl propofol-lidocaine compound liquid can be safely used for implementation of endotracheal intubation in patients who are awake, and the hemodynamic stability can be maintained.
Objective To explore the value of wide-awake local anesthesia no tourniquet (WALANT) technique in the treatment of acute Achilles tendon rupture. MethodsIn a prospective randomized controlled trial, 48 patients with acute Achilles tendon rupture who met the criteria between March 2020 and October 2020 were randomly divided into two groups according to 1∶1 distribution, with 24 cases in each group. The study group used WALANT technique and the control group used epidural anesthesia with tourniquet for channel-assisted minimally invasive repair (CAMIR). There was no significant difference between the two groups in gender, age, injured side, cause of injury, distance from broken end of Achilles tendon to calcaneal tubercle, and time from injury to hospitalization (P>0.05). The operating room use time (from patients entering the operating room to leaving the operating room), intraoperative blood loss, hospital stay, and the highest pain score [using Numerical Rating Scale (NRS)] during operation and at 1 day after operation were recorded and compared between the two groups. The tourniquet adverse reactions in the control group were recorded. The functional recovery was evaluated by the scoring method of American Orthopedic Foot and Ankle Society (AOFAS) at 12 months after operation. ResultsThe operation was successfully completed in both groups. The operating room use time and hospital stay in the study group were significantly less than those in the control group (P<0.05), but the difference in the intraoperative blood loss between the two groups was not significant (t=0.429, P=0.670). There was no significant difference in the highest NRS score during operation between the two groups (t=1.671, P=0.101); the highest NRS score in the study group at 1 day after operation was significantly lower than that in the control group (t=?6.384, P<0.001). In the control group, 13 patients had different degrees of tourniquet adverse reactions, including tourniquet regional pain, local swelling, blisters, thigh numbness, and discomfort. The patients in both groups were followed up 12-18 months, with an average of 13.9 months. The motor function of all patients returned to normal at 12 months after operation. The difference in AOFAS scores between the two groups was not significant (t=0.345, P=0.731). There was no complication such as sural nerve injury, local infection, and secondary rupture in both groups. ConclusionThe application of WALANT combined with CAMIR technique in the treatment of acute Achilles tendon rupture has good anesthetic and effectiveness, avoids the adverse reactions of tourniquet, and reasonably saves social medical resources.
ObjectiveTo investigate the effectiveness of partial anterior cruciate ligament (ACL) suture repair with wide awake local anesthesia no tourniquet (WALANT) technique.MethodsBetween July 2017 and July 2019, 18 patients with partial ACL injury were admitted. There were 10 males and 8 females, with an average age of 40.5 years (range, 22-57 years). There were 5 cases on the left knee and 13 cases on the right knee. Forteen cases had a clear history of trauma or sports injury, and 4 cases had no obvious cause. The time from injury to operation was 1-6 months (median, 3 months). Partial ligament was sutured using WALANT technique under arthroscopy. The operation time, total hospital stay, and postoperative hospital stay were recorded. Lachman test and anterior drawer test were performed to evaluate the knee joint stability after treatment, and Lysholm and International Knee Documentation Committee (IKDC) scores were used to evaluate the knee function. Five-point Likert scaling were used to evaluate postoperative patient satisfaction.ResultsThe operation time was 30-100 minutes (mean, 64.2 minutes). The total hospital stay was 2-12 days (mean, 4.5 days). Postoperative hospital stay was 1-4 days (mean, 1.8 days). All incisions healed by first intention after operation, and no surgery-related complications occurred. All patients were followed up 12-36 months (mean, 19.1 months). Lachman test and anterior drawer test were negative after operation. Lysholm score and IKDC score at 6 and 12 months after operation were significantly higher than those before operation, and at 12 months after operation were higher than those at 6 months after operation, the differences were significant (P<0.05). At last follow-up, according to five-point Likert scaling of patient satisfaction, 7 cases were very satisfied, 10 cases were relatively satisfied, and 1 case was general. The total patient satisfaction rate was 94.4% (17/18). MRI scan showed the good ligament tension.ConclusionUsing WALANT technique to repair partial ACL injuries under arthroscopy can retain the patient’s own ligament tissue to the maximum extent and achieve satisfactory short-term effectiveness.
ObjectiveTo study the feasibility of using propofol and remifentanil for reduction of shoulder joint dislocation in the conscious elderly patients, and compare its efficacy with brachial plexus block anesthesia. MethodsSeventy elderly patients (American Sociaty of Anesthesiologist physical statusⅠ-Ⅱ) who underwent shoulder dislocation reduction in our hospital between August 2011 and December 2013 were randomly divided into two groups, each group having 35 cases. Patients in group A received brachial plexus nerve block anesthesia downlink gimmick reset, while patients in group B received the use of remifentanil-propofol and lidocaine compound liquid intravenous drop infusion for anesthesia downlink manipulative reduction. After successful anesthesia, two groups of patients were treated with traction and foot pedal method (Hippocrates) to reset. We observed the two groups of patients in the process of reduction, and recorded their hemodynamic changes, reset time, discharge time, postoperative satisfaction, intra-operative memory, breathing forgotten (breathing interval was longer than 15 seconds) and visual analogue scale (VAS) scores, and then comparison was made between the two groups. ResultsPatients in both the two groups successfully completed manipulative reduction. Compared with group A, patients in group B had more stable hemodynamic indexes during the process of reduction, shorter reduction time, better anesthesia effect and higher postoperative satisfaction degree, and the differences were statistically significant (P<0.05). There was no significant difference in terms of time of leaving the operation room between the two groups (P>0.05). VAS score was higher in group A than that in group B (P<0.05). The occurrence of intra-operative memory amnesia and breathing forgotten phenomenon existed in part of the patients after operation in group B, but they did not occur in patients in group A. ConclusionRemifentanyl propofol-lidocaine compound fluid can be safely used in conscious elderly patients for shoulder joint dislocation reconstructive surgery, and it functions quickly with complete analgesia and stable hemodynamic indexes.