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.
Objective
To compare the feasibility and safety of video-assisted thoracoscopic surgery (VATS) under non-intubated, intravenous anesthesia with spontaneous ventilation.
Methods
A total of 80 patients undergoing VATS (48 wedge resections, 8 sympathectomies, 24 pleural biopsies) between January 2015 and June 2017 were included. Those patients were randomized into two groups. The 40 patients were enrolled as a treatment group (19 males and 21 females at age of 23.3±10.2 years) and received surgery under non-intubated intravenous anesthesia with spontaneous ventilation. And the other 40 patients were enrolled as a control group (21 males and 19 females at age of 22.2±9.9 years) and received surgery under routine intravenous anesthesia with intubated ventilation.
Results
Comparing with the control group, the patients of the treatment group had lower white blood cell count (5.8×109±2.4×109 vs. 7.3×109±3.6×109, P<0.001), lower gastrointestinal adverse reaction rate (7.5%vs. 27.5%, P=0.002), lower sore throat rate (5.0% vs. 30.0%, P<0.001), lower cough grade (0.9±0.3vs 2.1±0.5, P<0.050), shorter drainage time (1.8±1.6 dvs. 3.7±1.8 d, P<0.050) and shorter hospital stay (2.3±1.8 dvs. 5.8±2.3 d, P<0.050).
Conclusion
Video-assisted thoracoscopic surgery under non-intubated, intravenous anesthesia with spontaneous ventilation is safe and feasible, which also has certain advantages in reducing the postoperative complications and promoting patients' quick recovery from surgery.
ObjectiveTo investigate the application value of noninvasive ventilation (NIV) performed in patients with unplanned extubation (UE) in intensive care unit (ICU).MethodsThis was a retrospective analysis. The clinical data, application of NIV, reintubation rate and prognosis of UE patients in the ICU of this hospital from January 2014 to December 2018 were reviewed, and the patients were assigned to the control group or the NIV group according to the application of NIV after UE. The data between the two groups were compared and the application effects of NIV in UE patients were evaluated.ResultsA total of 66 UE patients were enrolled in this study, including 44 males and 22 females and with an average age of (64.2±16.1) years. Out of them, 41 patients (62.1%) used nasal catheter or mask for oxygenation as the control group, 25 patients (37.9%) used NIV as the NIV group. The Acute Physiology andChronic Health EvaluationⅡ score of the control group and the NIV group were (18.6±7.7) vs. (14.8±6.3), P=0.043. The causes of respiratory failure in the control group and the NIV group were as follows: pneumonia 16 patients (39.0%) vs. 7 patients (28.0%), postoperative respiratory failure 7 patients (17.1%) vs. 8 patients (32.0%), chronic obstructive pulmonary disease 8 patients (19.5%) vs. 6 patients (24.0%), others 5 patients (12.2%) vs. 4 patients (16.0%), heart failure 3 patients (7.3%) vs. 0 patients (0%), nervous system diseases 2 (4.9%) vs. 0 patients (0%), which showed no significant difference between the two groups. Mechanical ventilation time before UE were (12.5±19.8) vs (12.7±15.2) d (P=0.966), PaO2 of the control group and the NIV group before UE was (114.9±37.4) vs. (114.4±46.3)mm Hg (P=0.964), and oxygenation index was (267.1±82.0) vs. (257.4±80.0)mm Hg (P=0.614). Reintubation rate was 65.9% in the control group and 24.0% in the NIV group (P=0.001). The duration of mechanical ventilation was (23.9±26.0) vs. (21.8±26.0)d (P=0.754), the length of stay in ICU was (34.4±36.6) vs. (28.5±25.8)d (P=0.48). The total mortality rate in this study was 19.7%. The mortality rate in the control group and NIV group were 22.0% and 16.0% (P=0.555).ConclusionPatients with UE in ICU may consider using NIV to avoid reintubation.
ObjectiveTo evaluate the short-term result of proximal lengthening grafted stent and modified innominate artery cannula for Stanford A aortic dissection. Method We retrospectively analyzed the clinical data of 21 patients with Stanford A aortic dissection in our hospital between December 2012 and January 2015. There were 16 males and 5 females at a mean age of 57 years. All 21 patients underwent total arch replacement with proximal lengthening grafted stent and modified innominate artery cannula invented by our center. Result The mean operation time of 21 patients was 187.0±31.1 minutes, the mean cardiopulmonary bypass time was 116.0±32.0 minutes, the mean aortic block time was 87.0±23.0 minutes, the mean selective cerebral perfusion (SCP) time was 23.0±3.9 minutes, the mean breathing machanical ventilation time was 19.0±6.0 hours, and the mean intensive care unit stay time was 3.0±0.9 days. All patients had a good recovery after surgery. There was no death or severe complications.
ConclusionThe technique of total arch replacement with proximal lengthening grafted stent and modified innominate artery cannula for Stanford A aortic dissection is effective, easy, and safe. The short-term result is satisfying.
ObjectiveTo investigate the therapeutic effects of thrombolysis infusion via microcatheter on the treatment of central retinal artery occlusion(CRAO). MethodsUrokinase (UK) was directly infused via ophthalmic artery (OA) by microcatheter (6 patients) or via intravenous (7 patients) to dissolve the thrombus. The patency of the artery was evaluated by fundus fluorescein angiography (FFA), and the effect of fibrinolytic activity on the systemic changes was observed by blood biochemical examination simultaneously.
ResultsIn 6 patients in the microcatheter group, 5 had completely and 1 had partly reopened OA on the morrow of UK infusion with the patency rate of 83.33%, while in 7 patients in vein group, 3 completely reopened, 2 partly reopened and 2 obstructed OA were found with the patency rate of 42.86%. The difference between the two groups was significant. No obvious change of index of blood coagulation system was found in catheter group, which had great disparity compared with the vein group.ConclusionUrokinase infusion via microcatheter in CRAO has better therapeutic impact and smaller effect on systemic action. (Chin J Ocul Fundus Dis, 2005,21:16-19)
