The effects of preoperative selective arterial perfusion chemotherapy (PSAPC) in the treatment of 20 cases of histologically confirmed gastric cancers is reported in which 12 patients were operated on, and a comparison with that of general chemotherapy in 10 cases of gastric cancers (as controls) was made. In the PSAPC group, besides the improvement of clinical symptoms and singns, the cancer cells of lesions in situ and metastatic lymph nodes have different degrees of degeneration and necrosis. This result show significant differences in two group comparison (Plt;O.01). We conclude that the PSAPC has good short-term effect and little side-effect. It can improve the resection rate and radical resection rate, and prevent the iatrogenic metastasis and implantation during operation, and decrease the postoperative recurrence of the patients with gastric cancer.
ObjectiveTo observe the effect of different preoxygenation methods for emergency intubation in severe patients in intensive care unit (ICU). MethodsProspective randomized study was performed in the intensive care unit between June 2013 and January 2014. Forty patients were randomly divided into 4 groups:group A (control group, n=10), group B (bag-valve-mask preoxygenation group, n=10), group C (noninvasive ventilator-mask preoxygenation group, n=10), and group D (invasive ventilator-mask preoxygenation group, n=10). Standardized rapid sequence intubation was performed without preoxygenation in group A; preoxygenation was performed by using a bag-valve-mask rose pulse oxygen saturation (SpO2) to 90% before a rapid sequence intubation in group B; preoxygenation was performed by using noninvasive ventilator through a face mask rose SpO2 to 90% before a rapid sequence intubation in group C; and preoxygenation was performed by using invasive ventilator through a face mask rose SpO2 to 90% before a rapid sequence intubation in group D. We recorded the time when SpO2 was more than or equal to 90% in group B, C, and D, and arterial blood gases and complications were observed. ResultsThere was no significant difference in the basic indexes before preoxygenation among the four groups (P>0.05). The time of the patients in group D and C was significantly lower than that of group B. The arterial oxygen saturation (SaO2) and arterial oxygen partial pressure (PaO2) in the group C and D were higher than those in group B after preoxygenation (P<0.05). After intubation, SpO2 in group B, C and D was significantly higher than that in group A (P<0.05). At the same time, SpO2 in group C and D was higher than that in group B (P<0.05); PaO2 and SaO2 in group C and D were higher than in those in group A and B (P<0.05); SaO2 in group D was higher than that in group B (P<0.05). The incidence of abdominal distension in group D was significantly lower than that of group B and C (P<0.05). ConclusionFor emergency tracheal intubation in critically ill patients in the ICU, preoxygenation is more effective than the rapid sequence intubation without preoxygenation in improving oxygenation indicators. Invasive ventilator-mask preoxygenation efficacy and safety are superior to other methods.
Objective To analyze the risk factors of treatment failure by noninvasive positive pressure ventilation (NPPV) in patients with acute respiratory failure (ARF) due to acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and explore the best time that NPPV be replaced by invasive ventilation when NPPV failure occurs. Methods The data of patients with ARF due to AECOPD who were treated with NPPV from January 2013 to December 2015 were retrospectively collected. The patients were divided into two groups: the NPPV success group and the NPPV failure group (individuals who required endotracheal intubation or tracheotomy at any time). The Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ score was analyzed; the Glasgow Coma Scale score, respiratory rate (RR), pH value, partial pressure of oxygen (PaO2), PaO2/fraction of inspired oxygen (FiO2) ratio, and partial pressure of carbon dioxide were also analyzed at admission, after 2 hours of NPPV, and after 24 hours of NPPV. Results A total of 185 patients with ARF due to AECOPD were included. NPPV failed in 35.1% of the patients (65/185). Multivariate analysis identified the following factors to be independently associated with NPPV failure: APACHEⅡscore≥30 [odds ratio (OR)=20.603, 95% confidence interval (CI) (5.309, 80.525), P<0.001], RR at admission≥35 per minute [OR=3.723, 95%CI (1.197, 11.037), P=0.020], pH value after 2 hours of NPPV<7.25 [OR=2.517, 95%CI (0.905, 7.028), P=0.070], PaO2 after 2 hours of NPPV<60 mm Hg (1 mm Hg=0.133 kPa) [OR=3.915, 95%CI (1.374, 11.508), P=0.010], and PaO2/FiO2 after 2 hours of NPPV<200 mm Hg [OR=4.024, 95%CI (1.542, 11.004), P=0.010]. Conclusion When patients with ARF due to AECOPD have a higher severity score, have a rapid RR at admission, or fail to improve in terms of pH and oxygenation after 2 hours of NPPV, the risk of NPPV failure is higher.
Objective To summarize the blood supply to the sources and characteristics of advanced breast cancer，and explore the method，efficacy，and clinical applications of preoperative super-selective arterial catheterization chemoembolization under DSA for it. Methods Sixty patients with advanced breast cancer confirmed by the aspiration biopsy from February 2007 to October 2011 in this hospital were selected. Seldinger method was used，distributing of the tumor blood supply artery was identified and intubated the target artery by super-selective arterial catheterization via the femoral artery puncture under the DSA. Then，pirarubicin 60 mg plus paclitaxel 120 mg of two chemotherapy drugs was injected into slowly the target artery and the intervention infusion chemotherapy was performed，finally the tumor blood supply artery was embolizated by gelatin sponge particle. Results A total of 112 conclusive blood supply artery in 60 patients with DSA were found，including eight cases of single blood supply artery，52 cases of multiple blood supply arteries，mainly in the lateral thoracic artery and （or） internal thoracic artery-based. The complete remission rate was 25.0% （15/60），partial remission rate was 73.3% （44/60），stable disease rate was 1.7% （1/60），the total effective rate was 98.3% （59/60）. There was no progression disease. The median remission duration was 19 months，median survival time was 40 months. Conclusions The location of the original foci of breast cancer is closely related to blood supply arteries. The tumor in the lateral of the breast mainly dominates by the lateral thoracic artery blood supply. The tumor in the inner breast mainly dominates by the internal thoracic artery blood supply. The preoperative super-selective arterial catheterization chemoembolization under DSA can obviously improve the therapeutic effect，long-term survival，and the target of interventional chemoembolization.
Objective To investigate the current situation of salivation in patients with orotracheal cannula, and to systematically analyze its influencing factors. Methods Patients who underwent tracheal intubation treatment in 47 tertiary comprehensive medical institutions were selected between October 10th and 20th, 2023. A cross-sectional survey method was used to conduct an online survey of the patient’s salivation status. The patients were divided into the salivation group and no-salivation group. Results A total of 565 questionnaires were collected and 561 were valid, with an effective recovery rate of 99%. Among 561 patients, 284 were males (50.62%) and 277 were females (49.38%), with an age of (59.80±10.96) years; 159 cases of salivation occurred, with a total static saliva flow rate of (7.21±3.15) mL and the incidence of salivation was 28.34% (159/561). There were statistically significant differences in age, education level, body mass index, primary disease, number of concurrent functional impairments, concurrent oral diseases, smoking, intubation days, intubation depth, intubation process, sedation and/or analgesia days, and enteral nutrition treatment between the two groups (P<0.05). There was no statistically significant difference in other indicators between the two groups (P>0.05). The results of multivariate logistic regression analysis showed that body mass index, neurological diseases, number of concurrent functional impairments, concurrent oral diseases, smoking, intubation days and intubation process were independent risk factors for salivation in patients with oral catheterization. Conclusion The incidence of salivation in patients with orotracheal cannula is 28.34%, which is directly related to body mass index, neurological diseases, number of concurrent functional impairments, concurrent oral diseases, smoking, intubation days and intubation process.
Objective To evaluate the clinical features and complications of bedside tracheal intubation in intensive care unit ( ICU) , and explore the suitable strategy of intubation. Methods In this retrospective study,42 patients who underwent bedside tracheal intubation in ICU during September 2008 and March 2009 were divided into a schedule group ( n =24) and an emergency group ( n =18) . The time to successful intubation, number of intubation attempts, and complications were recorded. The schedule group was defined as those with indications for intubation and fully prepared, while the emergency group was defined as those undergoing emergency intubations without full preparation due to rapid progression of disease and accidental extubation. Results The success rate for all patients was only 57. 1% on the first attempt ofintubation. The main complications during and after induction were hypotension ( 45. 2% ) and hypoxemia ( 50. 0% ) . Compared with the emergency group, the schedule group had fewer attempts to successful intubation ( 1. 71 ±1. 12 vs. 2. 67 ±1. 75) , higher success rate on the second attempt ( 87. 5% vs.61. 1%) , and lower ypoxemia incidence ( 29. 1% vs. 77. 8%, P lt; 0. 05) . Conclusions The tracheal intubation in ICU is a difficult and high risk procedure with obvious complications. Early recognition ofpatients with indications and well preparation are critical to successful bedside intubation.
ObjectiveTo explore the safety and feasibility of the establishment method and management strategy of prolonged support model with veno-venous extracorporeal membrane oxygenation (V-V ECMO) under dual lumen cannula (DLC) in conscious sheep.MethodsThree adult male sheep were selected. An Avalon Elite DLC was inserted into the superior vena cava, right atrium, and inferior vena cava through the right jugular vein and was connected with centrifugal pump and oxygenator to establish the extracorporeal membrane oxygenation circuit. All the 3 sheep were transferred into the monitoring cage after operation and were ambulatory after anesthesia recovery. Hemodynamic parameters and extracorporeal membrane oxygenation performance were measured every day.ResultsAll three sheep survived to the end of the experiment (7 days). In the whole process of the experiment, the basic vital signs of the experimental sheep were stable, and no serious bleeding or thrombotic events occurred. During the experiment, hemoglobin concentration and platelet count were relatively stable, plasma free hemoglobin was maintained at a low level, extracorporeal membrane oxygenation flow rate was stable, and oxygenation performance of oxygenator was good.ConclusionProlonged V-V ECMO model in conscious sheep under DLC is feasible and stable.