General anesthesia with endotracheal intubation ensures the quick removal of magnetic foreign bodies:A case report

BACKGROUND The incidence of ingestion of magnetic foreign bodies in the gastrointestinal tract has been increasing year by year.Due to their strong magnetic attraction,if multiple gastrointestinal foreign bodies enter the small intestine,it can lead to serious complications such as intestinal perforation,necrosis,torsion,and bleeding.Severe cases require surgical intervention.CASE SUMMARY We report a 6-year-old child who accidentally swallowed multiple magnetic balls.Under timely and safe anesthesia,the magnetic balls were quickly removed through gastroscopy before entering the small intestine.CONCLUSION General anesthesia with endotracheal intubation can ensure full anesthesia under the condition of fasting for less than 6 h.In order to prevent magnetic foreign bodies from entering the small intestine,timely and effective measures must be taken to remove the foreign bodies.

Cardiopulmonary prognosis of prophylactic endotracheal intubation in patients with upper gastrointestinal bleeding undergoing endoscopy

BACKGROUND:It is controversial whether prophylactic endotracheal intubation(PEI)protects the airway before endoscopy in critically ill patients with upper gastrointestinal bleeding(UGIB).The study aimed to explore the predictive value of PEI for cardiopulmonary outcomes and identify high-risk patients with UGIB undergoing endoscopy.METHODS:Patients undergoing endoscopy for UGIB were retrospectively enrolled in the eICU Collaborative Research Database(eICU-CRD).The composite cardiopulmonary outcomes included aspiration,pneumonia,pulmonary edema,shock or hypotension,cardiac arrest,myocardial infarction,and arrhythmia.The incidence of cardiopulmonary outcomes within 48 h after endoscopy was compared between the PEI and non-PEI groups.Logistic regression analyses and propensity score matching analyses were performed to estimate effects of PEI on cardiopulmonary outcomes.Moreover,restricted cubic spline plots were used to assess for any threshold effects in the association between baseline variables and risk of cardiopulmonary outcomes(yes/no)in the PEI group.RESULTS:A total of 946 patients were divided into the PEI group(108/946,11.4%)and the non-PEI group(838/946,88.6%).After propensity score matching,the PEI group(n=50)had a higher incidence of cardiopulmonary outcomes(58.0%vs.30.3%,P=0.001).PEI was a risk factor for cardiopulmonary outcomes after adjusting for confounders(odds ratio[OR]3.176,95%confidence interval[95%CI]1.567-6.438,P=0.001).The subgroup analysis indicated the similar results.A shock index>0.77 was a predictor for cardiopulmonary outcomes in patients undergoing PEI(P=0.015).The probability of cardiopulmonary outcomes in the PEI group depended on the Charlson Comorbidity Index(OR 1.465,95%CI 1.079-1.989,P=0.014)and shock index>0.77(compared with shock index≤0.77[OR 2.981,95%CI 1.186-7.492,P=0.020,AUC=0.764]).CONCLUSION:PEI may be associated with cardiopulmonary outcomes in elderly and critically ill patients with UGIB undergoing endoscopy.Furthermore,a shock index greater than 0.77 could be used as a predictor of a worse prognosis in patients undergoing PEI.

Evaluation of Risk Factors for Arytenoid Dislocation after Endotracheal Intubation: a Retrospective Case-control Study

Objective To investigate the risk factors for postoperative arytenoid dislocation. Methods From September 2003 to August 2013, the records of 16 patients with a history of postoperative arytenoid dislocation were reviewed. Patients matched in terms of date and type of procedures were chosen as the controls(n=16). Recorded data for all patients were demographics, smoking status, alcoholic status, preoperative physical status, airway evaluation, intubation procedures, preoperative laboratory test results, anesthetic consumption and intensive care unit stay. For arytenoid dislocation cases, we further analyzed the incidences of the left and right arytenoid dislocation, and the outcomes of surgical repair and conservative treatment. Categorical variables were presented as frequencies and percentages, and were compared using the chi-squared test. Continuous variables were expressed as means±SD and compared using the Student's unpaired t-test. To determine the predictors of arytenoid dislocation, a logistic regression model was used for multivariate analysis. Results Sixteen patients with postoperative arytenoid dislocation were enrolled, with a median age of 52 years. Most postoperative arytenoid dislocation patients(15/16, 93.75%) received surgical repair, except one patient who recovered after conservative treatment. None of the postoperative arytenoid dislocation patients were smokers. Red blood cell(P=0.044) and hemoglobin(P=0.031) levels were significantly lower among arytenoid dislocation cases compared with the controls. Conclusions Non-smoking and anemic patients may be susceptible to postoperative arytenoid dislocation. However, neither of them was independent risk factor for postoperative arytenoid dislocation.

Endotracheal intubation in patients with COVID-19 using an ultrathin flexible gastrointestinal endoscope

Pneumonia caused by severe acute respiratory syndrome coronavirus 2 occasionally becomes severe and requires endotracheal intubation.Endotracheal intubation is usually performed using a laryngoscope;however,the operator needs to be in close proximity to the patient’s face during the procedure,which increases the risk of droplet exposure.Therefore,we simulated fiberoptic endotracheal intubation on a mannequin representing the patient,using an ultrathin flexible gastrointestinal endoscope as an alternative to the bronchoscope,in order to maintain distance from the patient during the procedure.We performed this procedure 10 times and measured the time required;the median procedure time was 6.4 s(interquartile range,5.7-8.1 s).The advantage of this method is the short procedure time and distance maintained from the patients.The flexible tip-steerable control and length of the gastrointestinal endoscope contributed to shortening the procedure time and maintaining distance from the patients.In addition,this method can handle difficult airways without risk of misplacement of the endotracheal tube.However,it is necessary to consider the risk of aerosol generation associated with this procedure.In the pandemic setting of coronavirus disease 2019,this approach may be useful when a gastrointestinal endoscopist is in charge of endotracheal intubation of patients with coronavirus disease 2019.

Clinical Criteria for Airway Assessment: Correlations with Laryngoscopy and Endotracheal Intubation Conditions

Difficult intubation, inadequate ventilation and esophageal intubation are the principal causes of death or brain damage related to airway manipulation. The objective of this cross-sectional study was to correlate a preanesthetic evaluation that may be capable of predicting a difficult intubation with the conditions encountered at laryngoscopy and endotracheal intubation. Eighty-one patients submitted to general anesthesia were evaluated at a preanesthetic consultation according to the modified Mallampati classification, the Wilson score and the American Society of Anesthesiologists (ASA) difficult airway algorithm. Findings were then correlated with the Cormack-Lehane classification and with the number of attempts at endotracheal intubation. No statistically significant correlations were found between the patients’ Mallampati classification and their Cormack-Lehane grade or between the Mallampati classification and the number of attempts required to achieve endotracheal intubation. Laryngoscopy proved difficult in four patients and in all of these cases the Wilson score had been indicative of a possibly difficult airway, highlighting its good predicting sensitivity. However, the specificity of this test was low, since another 24 patients had the same Wilson score but were classified as Cormack-Lehane I/II. Moreover, two patients who had a Wilson score ≥ 4 were also classified as Cormack-Lehane grade I/II. The study concluded that the Wilson score, although seldom used in clinical practice, is a highly sensitive predictor of a difficult airway;its specificity, however, is low.

Simulation and Acquisition of Endotracheal Intubation Skills by Medical Students—A Pilot Study

Introduction: Endotracheal intubation is a vital life-saving skill required by physicians in life-threatening situations in and out of the hospital. Medical students are exposed to these procedures mainly as they rotate through the department of Anaesthesia, in their subspecialty posting in Surgery. In this study, we sought to assess the ease of learning endotracheal intubation by medical students in the skills laboratory using an adult-sized (Laerdal Medical) manikin. Methods: This was a prospective descriptive study assessing the ability of medical students at endotracheal intubation during their 12-week rotation in the Anaesthesia Department during their subspecialty posting from August to October 2019 in the Skills Laboratory. An adult-sized manikin (Laerdal Medical) intubating head was used for the study. This was preceded by a detailed lecture and demonstration in the skills laboratory after successful passage of the endotracheal tube and connected to a self-inflating ventilation (Ambou) bag. Adequate chest movement meant proper placement, while the fullness of the stomach meant oesophageal intubation. Results: All the 500 level (45) students in the class were recruited for this prospective study. 30 (66%) had successful endotracheal intubation at the first attempt, 7 (14.4%) at the second attempt, 5 (11.1%) at the third attempt, 2 (4.4%) students at the fourth attempt and 1 (2.2%) had successful endotracheal intubation at the fifth attempt. Attempts were made to reinforce information on the practical procedure by a repeat performance by the instructor after each set of successful attempts was separated from the pack of unsuccessful candidates. In the end, however, we had 100% successful endotracheal intubation, but after 5 attempts by the last medical student. Conclusion: Endotracheal intubation skills can be learned with some level of ease when done after detailed information and training of medical students. More so when not under undue stress and life-threatening situations in the skills laboratory. By extension, this increases the confidence of medical students in the live patients in the Operating Theatre, after repeated attempts in the skills laboratory. This has the benefit of improving the chances of acquisition of endotracheal intubation in real-life situations.

Difficult Endotracheal Intubation -Scales and Causes

The aim of the study is to assess the possibility of intubation in each patient, the lyche to be difficult intubation, to fred all the causes of the difficult intubation, to fred and apply appropriate scales for difficult intubation, to estimate the frequency of difficult intubation. Endotmcheal intubation is the basic reanimation procedure performed both in hospital and out-of-hospital settings. It is carded out whenever chest movements and spontaneous respiration are compromised. Respiratory arrest may occur for a variety of reasons （such as cardac arrest, coma of any origin, poisining） or direct damage to the airways, e.g. in various traumas （damages to the face, oropharynx, larynx, trachea, chest）. The basic endotracheal intubation kit contains： laryngoscope, endotracheal tubes, connectors （tube and Ambu bag connectors）, complete Ambu kit （face mask and bag）, 20 mL syringe for cuff inflating, suction apparatus, stylete, and Magill forceps. In order to assess the successfulness of endotracheal intubation, it is necessary first to identify patients who need to be intubated. With the aim of identifying such patients, numerous screening tests and scales have been created to predict difficult intubation. The best known and most commonly used are the Mallampati and Wilson classifications as well as the LEMON airway assessment method. Nevertheless, difficult intubation accounts for 1% of cases. It usually occurs when manipulation of the laryngoscope blade is not possible in obese patients and patients with short neck, in congenital restricted mouth opening, limited neck movement as well as limited temporomandibular joint mobility; in cases of edema, fibrosis and lesions of the tongue, pharynx and larynx; when there are anatomical variations and congenital malformations of the oral cavity, pharynx, larynx, head, neck and chest.

Effects of dexmedetomidine + propofol intervention during general anesthesia induction on endotracheal intubation

Objective:To investigate the effects of dexmedetomidine + propofol intervention during general anesthesia induction on endotracheal intubation.Methods: A total of 218 patients receiving tracheal intubation general anesthesia in the hospital between January 2017 and December 2017 were divided into the control group (n=109) and the dexmedetomidine group (n=109) by random number table method. Control group underwent routine propofol anesthesia induction and dexmedetomidine group underwent dexmedetomidine anesthesia induction on the basis of propofol. The differences in the severity of inflammatory response and stress response were compared between the two groups of patients after general anesthesia induction (T0), 1 min after endotracheal intubation (T1), 5 min after endotracheal intubation (T2) and 10 min after endotracheal intubation (T3).Results:At T0, there was no statistically significant difference in serum levels of inflammatory factors and stress hormones between the two groups. At T1, T2 and T3, serum inflammatory factors CRP, IL-1, IL-6, IL-8 and TNF-α levels of dexmedetomidine group were lower than those of control group;serum stress hormones ACTH, Cor, NE, AngⅠ and AngⅡ levels were lower than those of control group. Conclusion: Dexmedetomidine + propofol general anesthesia induction can effectively reduce the inflammatory stress response caused by endotracheal intubation.

Endotracheal intubation sedation in the intensive care unit

Endotracheal intubation is one of the most common,yet most dangerous procedure performed in the intensive care unit(ICU).Complications of ICU intubations include severe hypotension,hypoxemia,and cardiac arrest.Multiple observational studies have evaluated risk factors associated with these complications.Among the risk factors identified,the choice of sedative agents administered,a modifiable risk factor,has been reported to affect these complications(hypotension).Propofol,etomidate,and ketamine or in combination with benzodiazepines and opioids are commonly used sedative agents administered for endotracheal intubation.Propofol demonstrates rapid onset and offset,however,has drawbacks of profound vasodilation and associated cardiac depression.Etomidate is commonly used in the critically ill population.However,it is known to cause reversible inhibition of 11β-hydroxylase which suppresses the adrenal production of cortisol for at least 24 h.This added organ impairment with the use of etomidate has been a potential contributing factor for the associated increased morbidity and mortality observed with its use.Ketamine is known to provide analgesia with sedation and has minimal respiratory and cardiovascular effects.However,its use can lead to tachycardia and hypertension which may be deleterious in a patient with heart disease or cause unpleasant hallucinations.Moreover,unlike propofol or etomidate,ketamine requires organ dependent elimination by the liver and kidney which may be problematic in the critically ill.Lately,a combination of ketamine and propofol,“Ketofol”,has been increasingly used as it provides a balancing effect on hemodynamics without any of the side effects known to be associated with the parent drugs.Furthermore,the doses of both drugs are reduced.In situations where a difficult airway is anticipated,awake intubation with the help of a fiberoptic scope or video laryngoscope is considered.Dexmedetomidine is a commonly used sedative agent for these procedures.

Study on Effect of Laryngeal Mask Anesthesia and Endotracheal Intubation Anesthesia on Elderly Patients Undergoing Laparoscopic Gallbladder Surgery

Objective:To analyze the effect of laryngeal mask anesthesia and endotracheal intubation anesthesia in elderly laparoscopic gallbladder surgery.Methods:100 subjects of the experiment came from elderly patients with gallbladder stones admitted from September 2016 to September 2019 in our hospital.There were group A and group B of 50 cases each,and were used tube anesthesia and laryngeal mask anesthesia,then comparing the anesthesia effect.Results:Statistical significance(P<0.05):Air pressure and end-respiratory carbon dioxide partial pressure index changes when immediately after insertion,immediately after removal,3 minutes after removal;heart rate,mean arterial pressure,airway pressure,and end-expiratory carbon dioxide index changes when 3 minutes after insertion and immediately before removal;blood glucose and cortisol changes when after insertion,immediately before removal and min after removal.No statistical significance(P>0.05):Changes in heart rate,mean arterial pressure,airway pressure,and endexpiratory carbon dioxide indexes before insertion;changes in blood glucose and cortisol indexes before insertion.Conclusion:It is more ideal for elderly patients with abdominal cavity and gallbladder surgery to have laryngeal mask anesthesia,which can effectively keep blood circulation stable and have promotion value.

Evaluation of Google Glass^(■) with Camera Adaptor and GoPro^(■) as Teaching Tools for Endotracheal Intubation in the Austere Medical Environment

Objective: Endotracheal intubation (ETI) is a life-saving emergency procedure, but it is a complex skill that is difficult to teach. Recent studies have shown that video laryngoscopy is effective in teaching ETI to learners at various levels of medical expertise;however, it has proven to be costly and provides images of inconsistent quality. In this educational proof of concept feasibility convenience sample pilot study, we aim to explore and compare the effectiveness of using modified Google Glass? (GG) and GoPro? (GP) technologies to visualize and teach ETI to critical care physicians in the austere medical environment of a low-income country. We propose, based on our findings, that this inexpensive technology could teach lifesaving ETI to pre-hospital providers in the austere medical environment, medical students, rural emergency physicians, critical care physicians in low-income countries, far forward military medical providers, and other learners. Methods: A case series of twenty-five patients, five in the United States (US) at Memorial Hospital in South Bend, IN and twenty at Saint Luc’s Hospital in Port Au Prince, Haiti, is presented. These patients were collected from November 1st 2015 through February 1st of 2016. The anesthesiologist and the emergency physicians in the United States utilized GG to intubate five patients in the US prior to the twenty patients intubated during two separate trips to Haiti. On the two separate trips to Haiti, the GG was trialed and modified to obtain better exposure. These adaptations resulted in the final collection of twenty patients studied with the adapted GG system and GP. Physicians graded airway visualization based on LEMON and Cormack-Lehane scores. Previously published parameters for the assessment of failed intubation risk and passage of the cords were used as data points for analysis using a Likert-Scale analysis for each parameter. The data were analyzed by averages of Likert-Scale scoring with their respective standard deviations. Results: The results show that the GP is superior to GG for assessing the LEMON scoring system until visualization of the oropharynx, while the GG is markedly superior for calculation of Cormack-Lehane score (cord visualization) and passing of the endotracheal tube. Conclusion: A review of the twenty-five cases demonstrates that while GP allows for better visualization for the parameters that require a wider view of the patient, the modified GG allows for superior visualization in the parameters that require a more focused view of the cords. GG can serve as an effective educational tool in the ICU for physicians and other providers in the austere medical environment who require effective ETI training. In addition, we propose that these techniques can serve as an inexpensive yet effective means of teaching hands on endotracheal intubation skills to learners of varying levels of clinical experience.

The ED_(50)of Remazolam Toluenesulfonate Combined with a Subthreshold Dose of Esketamine for Inhibiting Cardiovascular Response to Tracheal Intubation in Elderly Patients

Objective:To explore the half-effective dose(ED_(50))of remazolam toluenesulfonate combined with subthreshold amounts of esketamine for inhibiting cardiovascular response to tracheal intubation in elderly patients.Method:We included 42 patients,aged 65-75,who required general anesthesia and single-lumen endotracheal intubation for elective surgery.The first patient was administered remazolam toluenesulfonate at a dose of 0.20 mg/kg.Once the patient lost consciousness,their alertness/sedation score(OAA/S score)was≤1,and their BIS score was≤60,and a subthreshold dose(0.3 mg/kg)of esketamine was given.The subsequent doses were adjusted using a sequential approach based on the cardiovascular response to tracheal intubation observed in the previous patient.The dose was modified in increments or decrements of 0.01 mg/kg.The ED_(50)and 95%CI of remazolam toluenesulfonate were calculated using the Dixon and Massey sequential distribution test method.Result:The inhibition of endotracheal intubation response was positively correlated with the dose of remazolam toluenesulfonate,and the depth of sedation could not be achieved when the amount was≤0.22 mg/kg.The ED_(50)of remazolam toluenesulfonate combined with a subthreshold dose of esketamine in inhibiting cardiovascular response to tracheal intubation in elderly patients was 0.30(0.28,0.33)mg/kg.There was no statistically significant difference in blood pressure between the induction of anesthesia and before the operation.Conclusion:When compounded with 0.3 mg/kg esketamine,the ED_(50)of Remazolam toluenesulfonate in inhibiting cardiovascular response to endotracheal intubation in elderly patients was 0.30 mg/kg(95%CI0.28-0.33 mg/kg).

智能报警气管导管防滑脱装置的设计及应用

目的:设计智能报警气管导管防滑脱装置,并评价其临床应用效果。方法:选取2022年4月-5月镇江市某三级甲等医院恢复室收治的172例全身麻醉手术病人作为研究对象,将2022年4月的86例全身麻醉气管插管病人作为对照组,将2022年5月的86例全身麻醉气管插管病人作为观察组。对照组按照常规的气管插管方法协助置管及护理,观察组应用智能报警气管导管防滑脱装置协助气管导管固定。对两组病人气管导管移位或脱出情况、病人面部皮肤情况、病人咽喉痛发生情况及护士满意度进行比较。结果:观察组病人气管导管移位或脱出风险小于对照组,面部皮肤并发症发生率、咽喉痛程度低于对照组,护士满意度高于对照组,差异均有统计学意义(均P<0.05)。结论:使用智能报警气管导管防滑脱装置可减少病人气管导管移位或脱出,降低病人皮肤并发症发生率、咽喉痛程度,提高护士满意度。

BURP手法在改善声门视野中的应用

直接喉镜解决困难气管插管时,BURP手法能改善声门视野,提高插管成功率,但也有研究表明BURP手法会使声门视野恶化。随着视频喉镜的广泛应用,BURP手法的临床价值再次引起争议。本文就BURP手法的定义、方法、基本原理、应用喉镜时改善声门视野的作用等方面进行综述,以期为解决困难气管插管提供参考。

气管插管患者拔管后吞咽障碍研究热点的可视化分析

目的 分析气管插管患者拔管后吞咽障碍相关研究的热点及发展趋势。方法 系统检索中国知网、Web of Science数据库中关于气管插管患者拔管后吞咽障碍的研究,运用CiteSpace 5.8R3可视化软件对文献进行分析。结果共纳入中文文献119篇,英文文献408篇,发文量总体呈上升趋势。关键词分析发现,研究热点主要集中在并发症、风险因素、筛查与管理等方面,中文文献形成吞咽障碍、危险因素、气管插管、误吸、营养、吞咽评估共6个聚类,英文文献形成dysphagia(吞咽障碍)、airway management(气道管理)、management(管理)、endotracheal intubation(气管插管)、muscle skeletal(肌肉骨骼)、aspiration(误吸)、cardiac surgery(心脏手术)共7个聚类;关键词突现分析发现,并发症管理和症状评估是拔管后吞咽障碍的研究前沿。结论 气管插管患者拔管后吞咽障碍聚焦于重症、心脏外科术后及颈椎骨折的患者,中英文文献的研究主题及类型存在差异,护理在拔管后吞咽障碍管理中起到重要作用。我国护理工作者今后应借鉴国外经验,以提升患者经口进食的安全性、促进早期恢复经口进食为目的,开发具有特异性的评估工具,制订规范化拔管后吞咽评估与管理流程。

小型猪气管插管时异氟醚半数有效剂量的探索

目的本研究拟探讨小剂量舒泰(1.5 mg/kg)肌注复合异氟烷吸入用于保留自主呼吸的小型猪气管插管时50%和95%有效的异氟烷最小肺泡气浓度(50%and 95%minimum alveolar concentrations effective inhaled,MAC EI50and MAC EI95),为小型猪提供安全的麻醉插管方法。方法44例全身麻醉的巴马小型猪,肌注舒泰镇静后,面罩吸入异氟烷进行麻醉诱导,监测心率、血压、呼吸、体温、氧饱和度、呼末二氧化碳浓度和呼末异氟烷浓度。初始呼末异氟烷浓度设置为2.0%,采用Cooper’s评分评价气管插管满意度,采用Dixon’s改良序贯法测算剂量-效应关系。Probit回归法计算MAC EI50和MAC EI95及95%可信区间(confidence interval,CI)。结果小剂量舒泰复合异氟烷吸入诱导直接喉镜气管插管时,小型猪肺泡气浓度的MAC EI503.10%(95%CI 2.79%~3.56%),MAC EI953.77%(95%CI 3.41%~6.42%);在做好监测和气道管理预案的基础上,肺泡异氟烷浓度3.10%~3.75%,均能保证小型猪生命体征稳定。结论舒泰复合异氟烷吸入用于保留自主呼吸的小型猪气管插管是建立小型猪经口气道较好且安全的麻醉方法,具有推广价值。

直立床预康复训练对ICU气管插管患者撤机效果的观察

目的探讨直立床预康复训练对ICU气管插管患者撤机效果的影响。方法回顾性分析2022年2月至2024年1月福建中医药大学附属第二人民医院收治的60例气管插管住院患者临床资料,根据其不同干预方法进行分组,将实施常规撤机干预患者30例纳入对照组,将在常规撤机干预基础上实施直立床预康复训练患者30例纳入试验组。比较两组干预前后的超声下膈肌增厚率、血氧饱和度、氧合指数,观察两组呼吸机使用时间、入住ICU时间、撤机后48 h再插管的比例及两组撤机后并发症发生率。结果干预后,试验组超声下膈肌增厚率高于对照组(P<0.05);撤机后,试验组血氧饱和度、氧合指数高于对照组(P<0.05)。试验组呼吸机使用时间、入住ICU时间、撤机后48 h再插管的比例均低于对照组(P<0.05)。试验组撤机后并发症发生率低于对照组(P<0.05)。结论采用直立床预康复训练可增厚患者膈肌,改善肺通气功能,提高血氧饱和度、氧合指数,为成功撤机提供有利条件,进而缩短呼吸机使用时间、入住ICU时间,还可降低撤机后并发症发生率。

缺血性脑卒中患者院内合并肺部感染的影响因素分析

目的分析缺血性脑卒中患者院内合并肺部感染的影响因素。方法回顾性分析2020年3月至2022年2月期间在南通市第三人民医院治疗的214例缺血性脑卒中患者病历资料。根据《中国成人医院获得性肺炎与呼吸机相关性肺炎诊断和治疗指南》分组,未合并肺部感染患者作为对照组(n=104),合并肺部感染患者作为观察组(n=110)。对患者性别、年龄、发病至入院时间、合并基础疾病、鼻饲饮食、美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分、格拉斯哥昏迷量表(Glasgow Coma Scale,GCS)评分、气管插管、呼吸机辅助通气等临床资料进行调查,分析缺血性脑卒中患者合并肺部感染的危险因素。结果观察组男56例,女54例,年龄(73.59±8.21)岁;对照组男45例,女59例,年龄(65.32±5.62)岁。单因素分析结果显示,观察组患者年龄、鼻饲饮食、NIHSS评分、GCS评分、是否气管插管、是否呼吸机辅助通气与对照组比较差异有统计学意义(t=8.511、χ^(2)=11.622、t=5.721、t=4.282、χ^(2)=6.868、χ^(2)=6.145,P均<0.05)。多因素Logistic回归分析结果显示,鼻饲饮食(OR=5.447,95%CI:2.477~11.976)、NIHSS评分(OR=8.339,95%CI:2.598~26.768)、GCS评分(OR=7.660,95%CI:3.369~17.413)、气管插管(OR=6.184,95%CI:2.447~15.628)、呼吸机辅助通气(OR=4.302,95%CI:1.830~10.110)是缺血性脑卒中患者合并肺部感染的独立危险因素。结论鼻饲饮食、病情严重程度、意识障碍、气管插管及呼吸机辅助通气是导致缺血性脑卒中患者发生肺部感染的独立危险因素,因此在患者入院时应及时评估,有针对性地实施预防措施。

基于3D打印模型的案例教学方法在气管插管教学中的应用

目的探讨基于3D打印模型的案例教学方法(case-based learning,CBL)在气管插管教学中的应用效果。方法采用整群抽样方法,选取2019年1月—2022年1月在浙江省丽水市人民医院进行临床实习的温州医科大学2015级、2016级、2017级五年制临床医学专业80名学生为研究对象。采用随机数字表法,将80名学生分为试验组和对照组,每组40名学生。试验组学生采用基于3D打印模型的案例教学方法,对照组学生采用传统教学方法。教学结束后,通过理论知识、操作技能考核成绩和问卷调查结果,比较两组学生各自教学方法的实施效果。两组学生按照不同级次分批进行教学和考核。结果理论知识考核结果显示,试验组学生成绩[(45.23±2.66)分]优于对照组学生[(40.94±3.41)分],其差异具有统计学意义(P<0.05);操作技能考核结果显示,试验组学生成绩[(48.26±2.33)分]优于对照组学生[(42.89±3.25)分],其差异具有统计学意义(P<0.05)。问卷调查结果显示,在学习兴趣、学习效率、主动的互动、知识掌握程度、总体教学满意度5个方面,试验组学生的评分均高于对照组学生,其差异均具有统计学意义(均P<0.05)。结论基于3D打印模型的案例教学方法,与传统教学方法相比,可以为学生带来全新的立体视觉感受和模拟体验,有助于提高学生的学习兴趣和效率,有助于学生将理论知识和操作技能掌握得更加牢固,教学满意度更高,值得进一步深入研究与推广应用。

新型气管插管固定装置的应用效果评价

目的探讨新型气管插管固定装置在神经外科气管插管患者的临床应用效果。方法选取2021年4月-2023年3月我院神经外科120例气管插管患者,按照入院时间先后,分为常规固定装置组(2021年4月-2022年3月我院神经外科气管插管的60例患者)和新型固定装置组(2022年4月-2023年3月我院神经外科气管插管的60例患者)。比较2组患者气管插管固定效果、每日固定气管插管次数、固定气管插管耗时、口腔黏膜压力性损伤情况。结果新型固定装置组在气管插管固定效果、每日固定气管插管次数、固定气管插管耗时及口腔黏膜压力性损伤情况(患者口腔黏膜无损伤、红肿及破溃发生率)与常规固定装置组比较差异均有统计学意义(P<0.05),但是在口腔黏膜出血及溃疡方面2组患者差异无统计学差异(P>0.05)。结论新型气管插管固定装置提高了神经外科经口气管插管患者气管插管固定效果,降低了护士每日固定插管次数和更换气管插管耗时,减少护士工作量,降低了患者口腔黏膜红肿及破溃发生率,值得在临床推广应用。