OBJECTIVE:To explore the application and clinical effect of wide awake local anesthesia no tourniquet technique in the surgery of bilateral carpal tunnel syndrome.METHODS:From March 2016 to August 2018, 20 patients (40 sides) with bilateral carpal tunnel syndrome were treated by wide awake technique. All patients were female, aged from 32 to 56 (50.8±6.4) years old. The anesthetic, intraoperative and postoperative pain and anxiety were evaluated, operative field bleeding in operation were assessed, postoperative skin healing of surgical area and anesthetic complications were observed, and Kelly grading were used to evaluate recovery of function.RESULTS:Twenty patients were followed up from 6 to 9 months with an average of 7.8 months. There was light anxiety before injection (NRS score rangedfrom 1 to 3), slight pain occurred during injection on the first poke (NRS ranged from 2 to 3);no pain and anxiety during operation (NRS score was 0);mild or moderate pain (NRS score ranged from 1 to 6) without anxiety(NRS score was 0) after operation was occurred. Surgical skin healed well at the stageⅠwithout side effect of anesthetic. At final follow-up, according to Kelly grading, 30 sides got excellent results, 8 sides good and 2 sides fair.CONCLUSION:Wide awake technique is safe and effective in treating neurolysis of bilateral carpal tunnel syndrome, and could receive good clinical effects.
目的:探究自我效能感在领导支持感与护士创新绩效之间的中介效应.方法:采用一般自我效能感量表、领导支持感量表和创新绩效量表对安徽省某三级甲等综合医院的1 135名护士进行调查.结果:领导支持感与护士创新绩效呈正相关(r=0.653,P＜0.01),领导支持感与自我效能感呈正相关(r=0.487,P＜0.01),自我效能感与护士创新绩效呈正相关(r=0.630,P＜0.01).自我效能感在领导支持感与护士创新绩效间起部分中介作用,中介效应占总效应的30.4％.结论:自我效能感在领导支持感与护士创新绩效间起部分中介作用.建议护理管理者可通过提高护士的自我效能感,从而提高创新绩效水平,推动护士创新.
目的:探讨复发性卵巢癌的预后及相关危险因素.方法:选取2015年1月～2017年12月弋矶山医院初次收治的卵巢癌患者,筛选出经治疗达临床缓解6个月后复发者,通过病历系统及电话随访收集患者临床资料,总结患者复发的时间、复发伴随的相关情况、复发后的诊治情况及生存预后,分析影响其预后的危险因素.结果:筛选出临床病理资料及随访记录完整的患者94例,中位生存时间为24个月,单因素分析提示,复发距离末次化疗时间、复发部位、复发伴低蛋白血症、复发伴腹水、二次肿瘤细胞减灭术、靶向药物、化疗疗程均为复发性卵巢癌患者预后的影响因素(P＜0.05);且多因素COX回归分析提示,复发时伴腹水(HR=6.473,95％CI:3.162～13.250)与化疗疗程短(＜6次)(HR=3.289,95％CI:1.596～6.777)是影响患者生存时间的危险因素(P＜0.05),而实施二次肿瘤细胞减灭术(HR=0.298,95％CI:0.155～0.574)与复发部位在盆腔内(HR=0.479,95％CI:0.287～0.800)是影响患者生存时间的保护因素(P＜0.05).结论:复发部位、复发伴有腹水、复发后行二次肿瘤细胞减灭术及化疗疗程是否足量是影响复发性卵巢癌患者预后的主要因素,临床医师需充分评估患者病情,制定合理、规范的治疗方案,尽量延长患者生存期.
目的:探索不同高度重力喂养对早产儿喂养期间报警事件与喂养并发症的影响,为临床早产儿重力喂养安全高度设置提供理论参考.方法:本研究为前瞻性观察研究,共收集25例早产儿3种高度(15、20及25 cm)重力喂养的1 516次重力喂养事件,喂养前、喂养期间与喂养后护士按照《重力喂养患儿一般信息与喂养观察记录表》记录喂养高度、喂养奶量、喂养开始时间、喂养结束时间、患儿性别、胎龄、Apgar评分、分娩类型、出生时体质量、研究时体质量、父母年龄,喂养前30 min、喂养期间与喂养后严重心肺报警次数、喂养后呕吐、腹胀、胃残留量情况.比较3种高度重力喂养平均喂养速度,3种高度重力喂养前30 min、喂养期间与喂养后30 min内严重心肺报警事件的发生率及3种高度重力喂养后并发症发生率.结果:15、20、25 cm 3种高度重力喂养平均喂养速度差异有统计学意义(P＜0.05);3种高度重力喂养前30 min患儿严重心肺报警事件发生率差异无统计学意义,喂养期间至喂养后30 min内严重心肺报警事件的发生率差异有统计学意义(P＜0.05),25 cm高度时报警的发生率高于15、20 cm喂养高度;3种高度重力喂养后并发症的发生率差异无统计学意义(P＞0.05).结论:15、20 cm高度重力喂养可有效减少早产儿喂养期间严重心肺报警事件,可推荐15、20 cm为早产儿临床重力喂养安全高度.
目的:探讨风湿性多肌痛(PMR)与晚发强直性脊柱炎(LOAS)患者临床特征的异同,为鉴别诊断提供线索.方法:收集弋矶山医院风湿免疫科单中心注册研究中24例PMR患者的临床资料,并选择同期住院的50岁以后起病的LOAS患者32例作为对照组,比较两组患者临床特征和实验室数据.结果:①PMR组女性发病率及发病年龄高于LOAS组,PMR组中位病程短于LOAS组(P＜0.05);PMR组出现肩、颈、髋部同时受累者高于LOAS组(P＜0.05);②PMR组血沉及C反应蛋白高于LOAS组,PMR组单核细胞绝对数低于LOAS组(P＜0.05);③PMR组患者贫血发生率(70.83％)高于LOAS组(40.63％)(P＜0.05),且为轻度正细胞正色素性贫血.结论:与LOAS相比,PMR患者起病时间短且血沉、C反应蛋白升高更显著,易合并贫血,常出现颈、肩、髋同时累及.
