目的:分析以眼睑下垂为首发症状的甲亢性眼肌病的误诊原因。方法:对我院10例不典型的甲亢性眼肌病进行系统分析。结果:误诊为重症肌无力5例、颅内动脉瘤2例、颅底炎症1例、脑干腔隙性梗死1例、糖尿病性周围神经病变1例。结论:以眼睑下垂为首发症状的甲亢性眼肌病极易误诊,加强对该病的认识及尽早进行甲状腺功能检查,可有效减少误诊机会。
objective To observe the differences between four- and single-channel recording of normal multifocal visual evoked potential (mfVEP). Methods mfVEP of 35 health individuals (70 eyes) were detected by both four- and single-channel recording with VERIS apparatus. The root mean square (RMS) value of reactive amplitude was obtained from the results of the two kinds of recording. Each stimulated patch was analyzed to compare the variational degree of each patch between the two recording methods. Responase sasymmetry coefficient (RAC) was introduced to evaluate the symmetry property between the two eyes in an individual. Results Compared with the single-channel recording,the responses of the stimulated patches of the four- channel recording were increased statistically, with most of the patches below the horizontal meridian and some of patches in the upper field, and there was distinct symmetry property between the two eyes in the same individual recorded by four-channel recording. Conclusion The four-channel recording is better than the single one and could be clinically applied and popularized.(Chin J Ocul Fundus Dis，2004，20：156-159)
Abstract: Objective To investigate the clinical results of the coronary artery bypass grafting (CABG) for coronary artery disease (CAD) patients with completed hypothyroidism. Methods Twentyone CAD patients with hypothyroidism (hypothyroidism group) operated by a single surgeon from September 2002 to June 2009 in our department were enrolled in this study. Among them, there were 6 males and 15 females. Their average age was 60.4 years old. Three patients underwent CABG with onpump beating heart; one underwent CABG with onpump arrested heart; and 17 patients underwent CABG with offpump beating heart. All patients on thyroxine replacement therapy underwent CABG after free triiodothyronine（FT3）,free thyroxin（FT4）, thyroidstimulating hormone（TSH）, total triiodothyronine（TT3） and total thyroxin（TT4） were obviously improved. At the same time, twenty CAD patients without hypothyroidism were chosen as the control group (control group). Among them, there were 6 males and 14 females with an average age of 62.1 years old. The data of thyroid gland function and clinical prognostic indicator were observed after the operation. Results For the hypothyroidism group, one patient with pericardial effusion, heart failure and low thyroxine before surgery died during the onpump operation. Among the 20 survivors who had undergone CABG with beating heart, 17 were offpump CABG patients. Followup was done for 230 months. Postoperative eject factor of the survivors were significantly higher than their preoperative eject factor (55%±21% vs. 48%±17%). Twenty patients in the control group all survived. There was no significant difference in cardiac index ［2.7±1.4 L/(min·m2) vs. 2.8±1.5 L/(min·m2), t=0.530, P=0.530］, hospital stay (12.2±4.7 d vs. 10.1±3.9 d , t=0.170, P=0.170), or mechanical ventilation time (17.6±9.1 h vs. 15.1±13.7 h, t=0.120, P=0.120) between the hypothyroidism group and the control group. Perioperative thyroxine examination showed that there was no profound impact on thyroxine by offpump CABG. Conclusions With full preparation made before operation, CABG with beating heart is comparatively safe for CAD patients with hypothyroidism. The key of the treatment is perioperative thyroxine replacement therapy. There is much risk to perform onpump CABG on patients with severe hypothyroidism.
ObjectiveTo investigate the occurrence of indwelling urinary catheter in patients receiving thoracoscopic lobectomy and relevant risk factors.MethodsWe retrospectively reviewed the clinical data of the 737 patients who received thoracoscopic lobectomy in our hospital and analyzed the risk factors of indwelling urinary catheter during postoperative hospitalization using univariate analysis and multiple-variate logistic regression analysis between December 2018 and May 2019. There were 253 males and 484 females at median age of 57 (50, 64) years.ResultsA percentage of 14.4% (106/737) of the patients adopted postoperative indwelling urinary catheter. Univariate regression analysis showed that gender and postoperative bedridden time were risk factors for indwelling urinary catheter in the patients after thoracoscopic lobectomy (P<0.05). Multiple-variate logistic regression analysis showed that male gender (OR=2.018, 95% CI 1.316-3.096, P<0.001) and postoperative bedridden time >18 hours (OR=2.298, 95%CI 1.502-3.516, P<0.001) were the independent risk factors for indwelling urinary catheter.ConclusionMale gender and those with longer postoperative bedridden time are high-risk population to indwell urinary catheter. Positive measures should be taken to reduce the chance of indwelling urinary catheter.
Objective To study the disinfection effect of hand disinfectants containing alcohol after heating, and the comfortable feeling of using warm disinfectants among the medical staff in operation rooms. Methods Between November 2016 and January 2017, we analyzed the disinfection effect of two alcohol-containing hand disinfectants after heating in operation rooms through on-the-spot disinfection and inspection. Questionnaire was used to investigate the comfortable feeling of using warm hand disinfectants. Results After standing for 7 days at a temperature of 37℃, the major content of the two disinfectants decreased by less than 10%. Three minutes of disinfection by using the two kinds of disinfectants had an average natural-bacteria killing logarithm higher than 1.00, and they both had a qualified disinfection effect. Moreover, 96.7% of the medical personnel believed that warm disinfection products were more comfortable. Conclusion After heating, the two kinds of alcohol-containing hand disinfectants are effective in hand disinfection and more comfortable to use, which can improve hand hygiene compliance in surgical staff.
目的 分析多功能空气消毒机在普通内科病房的动态消毒效果，为病房空气质量的控制提供参考依据。 方法 2010年9月－2011年4月对普通内科病房在动态状态下进行细菌检测并使用多功能空气消毒机消毒，并就消毒前后的空气细菌菌落总数进行分析比较。 结果 在动态状态下，病房关门关窗并开启空调机时，使用多功能空气消毒机消毒前的空气细菌菌落总数显著高于消毒后，差异有统计学意义（P＜0.05）；病房在开门开窗时，使用多功能空气消毒机消毒前后的空气细菌菌落总数比较，差异无统计学意义（P＞0.05）。 结论 普通内科病房在关门关窗并开启空调机动态状态下，使用多功能空气消毒机可以降低空气细菌菌落总数，改善房间空气质量。
Objective To investigate the current status of control preference in the surgery of lung cancer patients and explore its correlation with perceived social support. MethodsGeneral information questionnaire, control preference scale, and perceived social support scale were used to investigate the lung cancer patients who underwent surgery in Beijing Cancer Hospital from February to May 2022. Results A total of 360 survey questionnaires were distributed, and 344 valid questionnaires were collected, with an effective rate of 95.6%. The expected participation style of patients was passive in 145 patients (42.2%), while the actual participation style was more inclined to be active in 154 (44.8%) patients. The compliance rate of patients’ expected and actual participation styles in the treatment control preference process was 61.9% (Kappa=0.437, P＜0.001). The results of the analysis of influencing factors showed that the level of cultural education was an influencing factor in the actual participation of lung cancer patients in surgery control preference (P=0.029). The results of Spearman's correlation analysis showed that the actual participation of lung cancer patients in surgery control preference was positively associated with perceived social support (r=0.159, P＜0.01), and its dimensions including family support (r=0.152, P＜0.01), friend support (r=0.133, P＜0.05), and other social support (r=0.142, P＜0.01). ConclusionPatients’ expected control preference style is generally consistent with their actual control preference style, which is influenced by their cultural education and positively correlated with perceived social support. Medical and nursing staff should pay attention to the participation style of patients taking surgery decisions, develop decision aids according to different education levels, and develop individualized interventions from the perspective of improving social support initially, to improve patients’ treatment compliance and treatment care satisfaction.
ObjectiveTo evaluate the degree of psychological pain for cancer patients undergoing surgical treatment and analyze the contributory factors to provide the theoretical basis for psychological intervention for cancer patients with surgical treatment.MethodsThe clinical data of 455 cancer patients who received surgeries in our hospital from November 2020 to January 2021 were retrospectively analyzed, including 225 males and 230 females aged 53.80±13.50 years. By applying the method of convenient sampling, a cross-sectional survey was carried out by gathering the general information of the patients and evaluating their mental condition with the distress thermometer. The contributory factors were discussed by logistic regression analysis.ResultsThe score for the psychological pain of the patients was 4.11±2.49 points. The main factors contributing to the psychological pain were physical problems, emotional problems and family matters. The logistic regression analysis showed that the main factors related to the degree of psychological pain were cancer types (P=0.023), religious belief (P=0.046), number of niduses (P=0.016), respiratory status (P=0.004), medical expense (P=0.007), grief (P=0.001) and anxiety (P=0.040).ConclusionNearly half of the patients have been subjected to apparent psychological pain, and emotion and physical problems are the main factors. It is crucial to pay attention to the patients’ mental problems, seek convenient tools for psychological evaluation, and take actions to deal with the psychological problems and physical symptoms.
ObjectiveTo investigate the incidence, severity and longitudinal trajectories of symptoms at various time points in the perioperative period of lung cancer patients, and to provide scientific basis for clinical staff to implement predictive nursing and dynamic management of symptom clusters. MethodsA prospective longitudinal investigation was conducted. The patients with lung cancer who underwent thoracoscopic lung surgery in four wards of the Department of Thoracic Surgery in our hospital were investigated by face-to-face and telephone follow-up before surgery, 1-2 days after surgery, on the day of discharge and 2 weeks after discharge. The investigation tool was the revised Chinese version of MD Anderson Symptom Inventory lung cancer specific module. Results A total of 192 patients with lung cancer were included in this study, including 59 males and 133 females, with an average age of (55.68±11.01) years. There were two symptom clusters (respiratory-gastrointestinal and emotional/psychological-disturbed sleep symptom clusters) before surgery, three symptom clusters (respiratory, gastrointestinal, and emotional/psychological-disturbed sleep symptom clusters) 1-2 days after surgery, three symptom clusters (pain-fatigue-emotional/psychological, respiratory, and gastrointestinal symptom clusters) on the day of discharge, and two symptom clusters (pain-fatigue-respiratory and respiratory symptom clusters) 2 weeks after discharge. The composition of symptoms was different in each time point during perioperative period. ConclusionThere are four symptom clusters in patients with lung cancer during perioperative period, which are pain-fatigue-disturbed sleep symptoms, gastrointestinal symptoms, respiratory symptoms and emotional/psychological symptoms. The symptom clusters of lung cancer patients at different time points are relatively stable, but the symptoms within the symptom clusters show dynamic changes. Medical staff should attach great importance to and continuously monitor the dynamic changes of perioperative symptom groups of lung cancer patients, do relevant education and nursing in advance, and timely adjust the management plan according to the symptom group evaluation results.
Objective To investigate the management during offpump coronary artery bypass grafting (OPCAB) for patients with ascending aorta atherosclerosis and to find appropriate treatment for minimizing the postoperative cerebrovascular accidents. Methods 236 patients with ascending aorta atherosclerosis were retrospectively analyzed underwent OPCAB in this hospital from Sep.2004 to Dec.2007, 4 of them received “No-touch” technique, 35 of them had the proximal anastomoses with the Enclose assistant, and 197 of them had the proximal anastomoses with the assistant of Heartstring. Hemodynamic indexes were consecutively monitored, blood streams of grafts was monitored by transit time flow measurement (TTFM) to evaluate the quality. Results Distal anastomoses 881，proximal anastomoses 267, the blood stream of 881 grafts was monitored, the mean flow was 16.2±18.7 ml/min, and the pulsatility index (PI) were 4.9±2.3, indicating the good quality of all grafts. The change of hemodynamic indexes including mean artery pressure (MAP, 78.1±10.4 mmHg vs. 80.9±8.1 mmHg）, pulmonary capillary wedge pressure (PCWP, 11.9±3.6 vs. 10.9±2.1 mmHg）, mean pulmonary artery pressure (MPAP, 17.3±4.3 mmHg vs. 15.3±2.8 mmHg）, cardiac output (CO, 4.2±1.2 L/min vs. 4.5±1.6 L/min）, center vinous pressure (CVP, 9.2±2.3cmH2O vs. 9.3±1.8 cmH2O）, heart rate (HR, 71.4±14.0 beats/min vs. 73.4±16.5 beats/min）, there were no statistically difference between before and after proximal anastomoses (Pgt;0.05). Two patients died of low cardio output during operation, 4 patients with transient ischemic attack were improved by 2 months medical therapy, and others had no postoperative complications as perioperative myocardial infarction etc, and the time of stay hospital was 10.5±4.2d. Followup 3-24 months for 185 patients, all living patients had no myocardial or cerebrovascular accidents, the symptoms were alleviated and myocardiac function improved. Conclusion Assessing the degree of the ascending aorta atherosclerosis sufficiently before and during the operation, choosing different operational strategy, and decreasing the manipulation of aorta can decrease the incidence of cerebrovascular accident and get better clinical result.