Obesity is a big problem which is growing. Thus clinicians and surgeons are likely to treat obese patients more frequently. Obesity can affect medical practice in a number of ways. In order to protect ourselves from p...Obesity is a big problem which is growing. Thus clinicians and surgeons are likely to treat obese patients more frequently. Obesity can affect medical practice in a number of ways. In order to protect ourselves from potential litigation, we need to focus on risk management efforts on creating a safe environment for patients of all sizes. The aim of our study was to review the risk management strategies of obese women prior to surgery, perioperatively and following surgery. We then identified the strategies and have brought them forward in our article.展开更多
A cross-sectional exploratory assessment of the needs and challenges of petroleum industry in Nigeria, in assessing process safety cumulative risk for major accidents prevention was investigated. A purposive cum rando...A cross-sectional exploratory assessment of the needs and challenges of petroleum industry in Nigeria, in assessing process safety cumulative risk for major accidents prevention was investigated. A purposive cum random sampling technique was used in this study, among selected petroleum companies operating in Nigeria. Survey questionnaires were received from 216 participants made up of asset integrity engineers/operators, process safety experts, production safety professionals in the petroleum industry in Nigeria. Data analyses were carried out to cover descriptive and inferential statistics. Overall, the study recognized that assessing process safety cumulative risk is not a simple process due largely to the changing nature of safety critical barriers degradation data. The study result showed four main challenges faced by petroleum industries in Nigeria, in assessing process safety cumulative risk: 1) the study showed that 94% of the respondents agreed that there is limited accessibility to safety critical barriers degradation data (little automation). Also 2) 94% of the respondents accounted for poor knowledge of process safety cumulative risk is and agreed it to be of low rating. The result further showed that 3) 90% of the respondents demonstrated that there are no guidance and procedures in assessing process safety cumulative risk and finally 4) 92% of the respondents reported that there is no real-time risk visualization model/ tool. Addressing these issues and challenges by the petroleum industries in the study area, will lead to successful assessment of process safety cumulative risk, thereby reducing the risk of major accidents.展开更多
目的探讨脊柱手术围手术期心血管并发症的发生率和危险因素。方法选择2015年1月~2020年12月在该院接受全身麻醉下脊柱手术的1508例患者作为研究对象,记录患者性别、年龄、体质量指数(body mass index,BMI)、美国麻醉医师协会(American s...目的探讨脊柱手术围手术期心血管并发症的发生率和危险因素。方法选择2015年1月~2020年12月在该院接受全身麻醉下脊柱手术的1508例患者作为研究对象,记录患者性别、年龄、体质量指数(body mass index,BMI)、美国麻醉医师协会(American society of anesthesiologists,ASA)分级、血红蛋白(haemoglobin,Hb)、内生肌酐清除率(endogenous creatinine clearance rate,Ccr)、伴随疾病、手术原因、手术状态、手术方式、融合节段、术中事件、手术医师等等资料,观察围手术期(本研究定义为患者住院期间及术后28 d内)发生的主要心血管不良事件(major adverse cardiovascular events,MACE)发生率。根据是否发生MACE将患者分为两组,采用单因素(卡方检验、t检验)和多因素分析观察影响MACE的风险因素。结果本研究中,共22例患者在研究定义的时间内发生MACE,发生率1.46%。单因素分析显示,MACE和非MACE患者的BMI、Hb、高血压、中风、阻塞性睡眠呼吸暂停、甲状腺疾病、慢性肺疾病、手术状态、手术方式、术中高血压等资料比较,差异均无统计学意义(P>0.05);MACE和非MACE患者的性别、年龄、ASA分级、Ccr、糖尿病、慢性肾脏疾病、慢性心力衰竭、手术原因、融合节段、术中低血压、术中输血等资料比较,差异均存在统计学意义(P<0.05)。多因素Logistic分析结果显示,手术原因为脊柱侧凸、术前有慢性心力衰竭史、术中发生低血压均是影响术后MACE的风险因素(P<0.05)。结论脊柱手术患者围手术期MACE发生率为1.45%,影响MACE发生的风险因素可能包括术前慢性心力衰竭史、脊柱侧凸手术和术中低血压。展开更多
目的:探讨与退变性腰椎疾病患者经后路腰椎融合手术后发生心脏不良事件可能相关的因素。方法:回顾性分析2018年1月~2023年7月因腰椎退变性疾病在北京安贞医院接受后路腰椎融合手术的96例患者临床资料,其中男性53例,女性44例,平均年龄64....目的:探讨与退变性腰椎疾病患者经后路腰椎融合手术后发生心脏不良事件可能相关的因素。方法:回顾性分析2018年1月~2023年7月因腰椎退变性疾病在北京安贞医院接受后路腰椎融合手术的96例患者临床资料,其中男性53例,女性44例,平均年龄64.1±10.1岁。依据腰椎融合术后1年内是否出现心脏不良事件(心脏骤停、新发或是加重心律失常、急性心肌梗死或是心绞痛及心力衰竭)进行分组,比较两组患者一般情况[查理森共病指数(Charlson comorbidity index,CCI)、美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级、改良心脏危险指数(revised cardiac risk index,RCRI)等]、术前检查(血红蛋白、血浆白蛋白、心脏超声射血分数等)、手术参数(手术有创性Mirza分级、手术时间、术中估计失血量等)以及术中监测指标(基线平均动脉压、术中尿量、自体血回输量等)的差异。结果:腰椎融合术后未发生心脏不良事件组患者CCI、RCRI、超声心动E波最大流速、术中估计失血量、基线平均动脉压以及术中自体血回输均明显小于发生心脏不良事件组(0.9±1.0 vs 1.6±1.5;1.5±0.7 vs 2.0±0.8;70.3±18.2 vs 82.6±36.9;705±560.6 vs 1193±1332.9;103.6±15.9 vs 112.1±12.1;399.5±368.3 vs 637.6±470.5),差异均有统计学意义(P<0.05)。多因素回归分析提示CCI和术中估计失血量与术后发生心脏不良事件存在统计学相关性(OR=1.968,P=0.007;OR=1.001,P=0.023)。结论:退变性腰椎疾病患者经后路腰椎融合术后发生心脏不良事件可能与患者查理森共病指数及手术失血量密切相关。展开更多
文摘Obesity is a big problem which is growing. Thus clinicians and surgeons are likely to treat obese patients more frequently. Obesity can affect medical practice in a number of ways. In order to protect ourselves from potential litigation, we need to focus on risk management efforts on creating a safe environment for patients of all sizes. The aim of our study was to review the risk management strategies of obese women prior to surgery, perioperatively and following surgery. We then identified the strategies and have brought them forward in our article.
文摘A cross-sectional exploratory assessment of the needs and challenges of petroleum industry in Nigeria, in assessing process safety cumulative risk for major accidents prevention was investigated. A purposive cum random sampling technique was used in this study, among selected petroleum companies operating in Nigeria. Survey questionnaires were received from 216 participants made up of asset integrity engineers/operators, process safety experts, production safety professionals in the petroleum industry in Nigeria. Data analyses were carried out to cover descriptive and inferential statistics. Overall, the study recognized that assessing process safety cumulative risk is not a simple process due largely to the changing nature of safety critical barriers degradation data. The study result showed four main challenges faced by petroleum industries in Nigeria, in assessing process safety cumulative risk: 1) the study showed that 94% of the respondents agreed that there is limited accessibility to safety critical barriers degradation data (little automation). Also 2) 94% of the respondents accounted for poor knowledge of process safety cumulative risk is and agreed it to be of low rating. The result further showed that 3) 90% of the respondents demonstrated that there are no guidance and procedures in assessing process safety cumulative risk and finally 4) 92% of the respondents reported that there is no real-time risk visualization model/ tool. Addressing these issues and challenges by the petroleum industries in the study area, will lead to successful assessment of process safety cumulative risk, thereby reducing the risk of major accidents.
文摘目的探讨脊柱手术围手术期心血管并发症的发生率和危险因素。方法选择2015年1月~2020年12月在该院接受全身麻醉下脊柱手术的1508例患者作为研究对象,记录患者性别、年龄、体质量指数(body mass index,BMI)、美国麻醉医师协会(American society of anesthesiologists,ASA)分级、血红蛋白(haemoglobin,Hb)、内生肌酐清除率(endogenous creatinine clearance rate,Ccr)、伴随疾病、手术原因、手术状态、手术方式、融合节段、术中事件、手术医师等等资料,观察围手术期(本研究定义为患者住院期间及术后28 d内)发生的主要心血管不良事件(major adverse cardiovascular events,MACE)发生率。根据是否发生MACE将患者分为两组,采用单因素(卡方检验、t检验)和多因素分析观察影响MACE的风险因素。结果本研究中,共22例患者在研究定义的时间内发生MACE,发生率1.46%。单因素分析显示,MACE和非MACE患者的BMI、Hb、高血压、中风、阻塞性睡眠呼吸暂停、甲状腺疾病、慢性肺疾病、手术状态、手术方式、术中高血压等资料比较,差异均无统计学意义(P>0.05);MACE和非MACE患者的性别、年龄、ASA分级、Ccr、糖尿病、慢性肾脏疾病、慢性心力衰竭、手术原因、融合节段、术中低血压、术中输血等资料比较,差异均存在统计学意义(P<0.05)。多因素Logistic分析结果显示,手术原因为脊柱侧凸、术前有慢性心力衰竭史、术中发生低血压均是影响术后MACE的风险因素(P<0.05)。结论脊柱手术患者围手术期MACE发生率为1.45%,影响MACE发生的风险因素可能包括术前慢性心力衰竭史、脊柱侧凸手术和术中低血压。
基金国家自然科学基金资助项目(72274087)国家社会科学基金资助项目(20CGL053)+2 种基金兰州大学中央高校基本科研业务项目(lzujbky-2023-28)甘肃省人民医院优秀硕/博士生培育计划(22GSSYD-6)2020 China Medical Board Open Competition Program(#20-374)。
文摘目的:探讨与退变性腰椎疾病患者经后路腰椎融合手术后发生心脏不良事件可能相关的因素。方法:回顾性分析2018年1月~2023年7月因腰椎退变性疾病在北京安贞医院接受后路腰椎融合手术的96例患者临床资料,其中男性53例,女性44例,平均年龄64.1±10.1岁。依据腰椎融合术后1年内是否出现心脏不良事件(心脏骤停、新发或是加重心律失常、急性心肌梗死或是心绞痛及心力衰竭)进行分组,比较两组患者一般情况[查理森共病指数(Charlson comorbidity index,CCI)、美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级、改良心脏危险指数(revised cardiac risk index,RCRI)等]、术前检查(血红蛋白、血浆白蛋白、心脏超声射血分数等)、手术参数(手术有创性Mirza分级、手术时间、术中估计失血量等)以及术中监测指标(基线平均动脉压、术中尿量、自体血回输量等)的差异。结果:腰椎融合术后未发生心脏不良事件组患者CCI、RCRI、超声心动E波最大流速、术中估计失血量、基线平均动脉压以及术中自体血回输均明显小于发生心脏不良事件组(0.9±1.0 vs 1.6±1.5;1.5±0.7 vs 2.0±0.8;70.3±18.2 vs 82.6±36.9;705±560.6 vs 1193±1332.9;103.6±15.9 vs 112.1±12.1;399.5±368.3 vs 637.6±470.5),差异均有统计学意义(P<0.05)。多因素回归分析提示CCI和术中估计失血量与术后发生心脏不良事件存在统计学相关性(OR=1.968,P=0.007;OR=1.001,P=0.023)。结论:退变性腰椎疾病患者经后路腰椎融合术后发生心脏不良事件可能与患者查理森共病指数及手术失血量密切相关。
