目的 比較經皮擴張氣管切開術（PDT）和開放式氣管切開術（OT）在成批吸入性損傷患者中的應用效果。 方法 采用前瞻性隨機性研究方法，將2006年1月－2010年12月收入三峽大學人民醫院重癥醫學科的4批34例吸入性損傷患者，分為PDT組（n=17）和OT組（n=17），比較兩組的手術時間、出血量、并發癥，觀察手術前后的平均動脈壓（MAP）、心率（HR）、呼吸頻率（R）、動脈血氧分壓（PaO2）和動脈血二氧化碳分壓（PaCO2）。 結果 PDT組與OT組手術時間分別為（7.0 ± 1.9）、（18.0 ± 11.4）min，差異有統計學意義（P=0.000）；PDT組與OT組出血量分別為（7.0 ± 4.4）、（19.0 ± 12.1）mL，差異有統計學意義（P=0.001）；兩組患者氣管切開前及切開后的MAP、HR、R、PaO2和PaCO2差異無統計學意義（P＞0.05）；PDT組發生出血并發癥1例，OT組發生出血、皮下氣腫、縱隔氣腫及切口感染等并發癥共6例，PDT組并發癥發生率低于OT組，差異有統計學意義（P=0.034）。 結論 PDT在救治成批吸入性損傷患者時比OT更快地建立人工氣道，而出血量、并發癥發生率均低于OT，值得推廣應用。
ObjectiveTo analyze the feasibility of using triangular-sail technique that allows intermittent two-lung ventilation during minimally invasive coronary artery bypass grafting (MICS CABG).MethodsThe clinical data of 207 patients with MICS CABG in our cardiac center from January 2019 to November 2020 were retrospectively analyzed. These patients were divided into two groups. A group OLV included 111 patients who underwent one-lung ventilation during surgery, while a group TLV included 96 patients who underwent intermittent two-lung ventilation. The triangular-sail technique was used in the group TLV. This simple technique isolated the operative field from lung lobes with the traction of pericardial adipose tissue. The preoperative data and perioperative clinical data of the two groups were compared and analyzed.ResultsThere was no statistical difference in basic preoperative data between the two groups. The operation time in the OLV group was shorter than that in the TLV group (296.7±57.3 min vs. 334.1±87.0 min, P=0.000), and the duration of postoperative mechanical ventilation and ICU stay were not statistically different between the two groups. There was also no statistical difference in the incidence of pneumothorax or atelectasis between the two groups.ConclusionThe triangular-sail technique is simple and easy to implement. The technique allows intermittent two-lung ventilation during MICS CABG procedure.
ObjectiveTo establish a hereditary deafness genetic screening cohort and conduct prospective follow-up to evaluate the effectiveness of the Nantong newborn genetic deafness screening program. MethodsA study based on traditional screening of newborn hearing was conducted from January 2016 to June 2021. Newborns in six hospitals in Nantong were screened for 15 hotspot mutation loci in four common deafness genes. Cohort follow-up was conducted. ResultsA total of 40 403 newborns were included, with a carrier rate of 39.5 per 1 000 for the four common deafness genes. In total, 168 children with hearing loss (HL) were identified at screening and follow-up, of which 56.5% (95 cases) had severe or very severe HL. The detection rate of HL was significantly higher with combined screening than with traditional screening (3.0‰ vs. 3.9‰, P<0.001). All four carriers of pathogenic mutations with normal hearing developed late-onset HL within 2 years of age. At the end of follow-up, six of the polygenic heterozygous mutation carriers had congenital HL and five had late-onset HL. Carriers of polygenic heterozygous mutations were more common as compared to other carrier mutation populations (2.1% vs. 68.8%, P<0.001). In addition, 525 carriers of the SLC26A4 mutation and 118 carriers of the MT-RNR1 mutation were identified and their parents were counselled during the combined screening, and no children with HL was identified during the follow-up period. ConclusionGenetic screening for deafness improves the detection of HL at birth. It is recommended that carriers of pathogenic mutations with normal hearing at birth be followed up every 3 to 6 months until the age of 2 years. Carriers of polygenic heterozygous mutations should undergo extended screening for deafness genes and have their hearing monitored more intensively for early detection of late-onset or progressive HL.