Fentanyl and sufentanil are commonly used analgesic drugs in clinical practice, most of which are administered intravenously instead of intranasally. Based on the experience of nasal application of opioids in the medical security work of the Skiing Competition in the 2022 Beijing Winter Olympic Games and the Winter Paralympic Games, this paper reviewed the current situation and progress of nasal application of fentanyl and sufentanil for the treatment of trauma and emergency pain, intraoperative and postoperative pain relief, cancer pain relief, and sedation and analgesia in children.

Objective To retrospectively analyze the safety of day surgery for colorectal polypectomy in gastroenterology department of our hospital. Methods 168 patients underwent day surgery for colorectal polypectomy in our hospital, and 238 patients underwent colorectal polypectomy through general hospitalization from June 2019 to February 2020. The efficacy, safety and hospitalization expenditure of the two groups were compared. Results The incidence of postoperative bleeding was 1.19%（2/168）. There was no significant difference in the incidence of postoperative bleeding between the two groups for polyps larger than 1cm（p=0.777）. The average length of stay and the average cost of hospitalization in the day surgery group were significantly lower than those in the patients with general hospitalization during the same period. Conclusion Day surgery is safe and effective for endoscopic resection of colorectal polyps larger than 1cm, which can reduce the medical burden of patients.

During the Alpine skiing competition of Beijing 2022 Winter Olympic and Paralympic Games, Chinese ski doctors took to the international stage for the first time and successfully completed medical service tasks together with international ski doctors from different countries. It should be noted that anesthesiologists occupied a high proportion and played an essential role. Through the medical service at Alpine skiing competition of Beijing Winter Olympic and Paralympic Games, the role and advantages of anesthesiologists at on-site rescues during skiing competitions were summarized.

OBJECTIVE:To compare the completion time of endotracheal intubation and laryngeal mask implantation in operating room and on slope of ski resort, and to discuss the optimal method of estab-lishing artificial airway on slope of ski resort. METHODS:The simulator was placed with the head under the feet on slope of ski resort. The artificial airway was established by tracheal intubation assisted by video laryngoscope (endotracheal intubation group) and laryngeal mask placement (laryngeal mask group) respectively by an anesthesiologist who wore full set of ski suits, helmets, goggles, gloves and ski boots. Each method was repeated 5 times, and the operation time of artificial airway establishment was recorded. While the simulated human was placed flat on the operating table in an operating room of a hospital, and the artificial airway was established by the same anesthesiologist using the same methods. Time was recorded and repeated for 5 times. The completion time of endotracheal intubation and laryngeal mask placement in the operating room and on the ski slope were compared. RESULTS:The operating time of tracheal intubation in the operating room was longer than that of laryngeal mask placement [(79.8±10.4) s vs. (53.4±2.7) s, P=0.005], and the operating time of endotracheal intubation on the ski slope was longer than that of laryngeal mask placement [(209.2±32.7) s vs. (72.2±3.1) s, P=0.001]. The time of endotracheal intubation group on the slope of the ski resort was longer than that in the opera-ting room(t=-7.851, P=0.001). The time of laryngeal mask group on the slope was longer than that in the operating room (t=-19.391, P < 0.001). CONCLUSION:On ski slope, both of tracheal intubation assisted by video laryngoscope and laryngeal mask placement can quickly complete the establishment of artificial airway, but the time required is longer than that in the operating room. The time of laryngeal mask placement to establish artificial airway is shorter than that of tracheal intubation assisted video laryngoscope, which may have a certain advantage in ski rescue.

结肠溃疡为消化科常见疾病,病因包括感染、免疫、药物、肿瘤等.部分病例病因鉴别困难.因粪便培养阳性率有限,感染致结肠溃疡的病原学常难以明确.本例患者为免疫功能低下老年人,表现为血便、关节囊肿合并感染,肠镜可见结肠溃疡,最终通过血高通量检测明确为豚鼠气单胞菌感染,抗感染后好转.本病例提示临床医生怀疑结肠溃疡为感染所致时,除沙门菌、志贺菌、大肠埃希菌外,应考虑到豚鼠气单胞菌可能,可采用高通量检测方式进一步明确病原.

Objective:To explore the diagnosis of colorectal polyps/adenomas by colonoscopy and its influencing factors.Methods:Patients who underwent colonoscopy at Peking University International Hospital from January 1, 2017 to December 31, 2019 were selected as study subjects. Gender, age, anesthesia, intestinal cleanliness, time of admission, examining physician, and diagnosis of polyps/adenomas were recorded. Univariate Chi-square test was used to analyze the relationship between the detection rate of polyps/adenomas and the above factors, and then the independent risk factors affecting the detection rate of polyps/adenomas were identified by Logistic multivariate analysis.Results:A total of 6679 patients were included in the study, including 3297 males and 3382 females, aged 55.98±9.79 years. The detection rate for colon polyps was 47.25%, and the detection rate for colorectal adenomas was 30.93%. Univariate analysis showed that gender, age group, anesthesia, intestinal cleanliness, time of endoscopic examination, and experience of examining physician affected the detection rate for colorectal adenomas. Multivariate analysis showed that gender, age, intestinal cleanliness, time of endoscopic examination, and experience of examining physician were factors affecting the detection rate of colorectal adenomas.Conclusion:The gender and age of patients are related to the detection of colon polyps/adenomas. It is necessary to make good bowel preparation and improve the experience of examining doctors, so as to improve the detection rate for colon polyps/adenomas.

患者,男,35岁,于2020年1月8日因"抑郁间断发作3月余,加重2 d"就诊.现病史:3个月前因离异出现心境低落,兴趣减低,对周围事物缺乏信任感,多疑,不愿与外人打交道,无端惶恐,如人将捕之,影响正常的工作和生活.于北京中医药大学东直门医院心理科就诊,诊断为适应障碍合并抑郁,予口服中药和抗抑郁药物(具体不详)治疗后有所缓解,但每谈及家庭时抑郁症状仍有发作.

Background Skiing is a high-risk winter sport, and the rate of injury fatality is the highest compared to other winter sports. During skiing rescue, the harsh natural environments will increase the difficulty of artificial airway establishment. There has been no research focusing on the establishment of the artificial airway during skiing rescue site. This study aims to simulate the real-world scenario, calculating and comparing the operation time of different artificial airways on the cold slope, and to explore the optimal method of establishing artificial airway on the cold slope, sharing our experience, technical notes, and pitfalls we encountered, hoping to help establish a standard operating procedure in advanced airway management on the ski slope. Methods The simulated human was placed on the cold slope with the head under the feet. Artificial airway was established by the same anesthesiologist using endotracheal intubation (endotracheal intubation group), LMA Supreme laryngeal mask (LMA group), and I-gel laryngeal mask (I-gel group). Each method was repeated 5 times, and the operation time and whether it was successful by one attempt were recorded and compared between groups. Results Three groups of artificial airway were successful by one attempt.. The bite block dropped and drifted away for one time in the endotracheal intubation group. Operation time is 209.2 ± 32.7 seconds in the endotracheal intubation group, 72.2 ± 3.1 seconds in the LMA group, and 52.6 ± 4.2 seconds in the I-gel group. ANOVA showed that there was a significant difference in the operation time among the three groups (p < 0.001). Tukey's post hoc test showed that there were statistically significant differences between the endotracheal intubation group and the other two groups in operation time, p < 0.001, while there was no significant difference between the LMA group and I-gel group (p=0.275). Conclusion The artificial airway can be completed by endotracheal intubation and LMA and I-gel laryngeal mask insertion on the cold slope. Artificial airway with the I-gel laryngeal mask takes the shortest time in this study. Extra caution should be paid to slippery and drifting.

OBJECTIVE:The key point of anesthesia management in carotid endarterectomy (CEA) is to maintain adequate cerebral perfusion during carotid artery occlusion. Placement of shunt is one of the common surgical methods. This study analyzed the effects of different shunt strategies on cerebral infarction after carotid endarterectomy.METHODS:A total of 443 patients who underwent CEA under general anesthesia within 2 years were divided into imaging group (based on preoperative imaging data as the basis for shunt) and stump pressure group (based on intraoperative stump pressure as the basis for shunt). The preoperative demographic data, past medical history, degree of cervical vascular stenosis, blood pressure at each time point during the perioperative period, vascular blocking time, whether to place the shunt, postoperative hospital stay, cerebral infarction during hospitalization, and other adverse events were collected and compared between the two groups. On this basis, the preoperative and intraoperative conditions with significant differences were matched with propensity scores, and the influence of different shunt strategies on postoperative cerebral infarction was analyzed.RESULTS:In the study, 268 patients in the imaging group and 175 patients in the stump pressure group underwent CEA under general anesthesia. There were statistically significant differences in basic conditions and blood pressure at each time point between the two groups. After matching the propensity scores, 105 patients in each of the two groups were matched. The basic conditions of the patients before surgery and the difference in blood pressure of the two groups at each time point were not statistically significant. There was no significant diffe-rence in the incidence of postoperative cerebral infarction between the two groups (1.9% vs. 1.0%, P>0.999). The intraoperative shunt rate in the imaging group was lower than that in the stump pressure group (0 vs. 22.9%, P < 0.001). The postoperative hospital stay in the imaging group was 8 (7, 8) days, which was longer than the stump pressure group 5 (4, 6) days (P < 0.001).CONCLUSION:The rate of the shunt was lower according to preoperative imaging examination than that according to the residual pressure in our hospital. There is no significant difference in the incidence of cerebral infarction during the postoperative hospital stay. The effect of different shunt strategies on cerebral infarction needs further study.

消化道颗粒细胞瘤十分少见。报道1例食管颗粒细胞瘤的诊治过程，结合文献对其内镜下形态特点、病理诊断及治疗进行讨论。

高山滑雪是冬季奥林匹克运动会中一项风险性较高的竞技比赛项目,其比赛环境相对极端(低温、陡坡),损伤机制复杂,可能出现多部位的联合损伤,对医疗救援提出了更高要求.我国高山滑雪医疗救援经验欠缺,并且缺乏具有高山滑雪医疗救援能力的专业医护人员.作者简述了高山滑雪的损伤风险、可能损伤部位、医疗救援团队构成、医疗救援流程以及我国高山滑雪医疗救援面临的问题和挑战.

OBJECTIVE:The incidence of cerebral infarction and myocardial infarction is higher in patients with carotid endarterectomy (CEA). Based on the concept of coprotection of heart and brain, this study attempts to screen the related factors of early cerebral infarction and myocardial infarction after CEA with the method of machine learning to provide clinical data for the prevention of postoperative cerebral infarction and myocardial infarction.METHODS:443 patients who received CEA operation under general anesthesia within 2 years were collected as the research objects. The demographic data, previous medical history, degree of neck vascular stenosis, blood pressure at all time points during the perioperative period, the time of occlusion, whether to place the shunt, and the time of hospital stay, whether to have cerebral infarction and myocardial infarction were collected. The machine learning model was established, and stable variables were selected based on single-factor analysis.RESULTS:The incidence of cerebral infarction was 1.4% (6/443) and that of myocardial infarction was 2.3% (10/443). The hospitalization time of patients with cerebral infarction and myocardial infarction was longer than that of the control group (8 (7, 15) days vs. 7 (5, 8) days, P = 0.002). The stable related factors were screened out by the xgboost model. The importance score (F score) was as follows: average arterial pressure during occlusion was 222 points, body mass index was 159 points, average arterial pressure postoperation was 156 points, the standard deviation of systolic pressure during occlusion was 153 points, diastolic pressure during occlusion was 146 points, mean arterial pressure after entry was 143 points, systolic pressure during occlusion was 121 points, and age was 117 points.CONCLUSION:Eight factors, such as blood pressure, body mass index, and age, may be related to the postoperative cerebral infarction and myocardial infarction in patients with CEA. The machine learning method deserves further study.

Objective:To investigate the diagnostic value of Japan NBI Expert Team (JNET) classification with blue-laser imaging magnifying endoscopy (BLI-ME) for colorectal neoplastic lesions.Methods:Data of 40 colorectal neoplastic lesions in 34 patients that received BLI-ME from September 2016 to December 2018 in Peking University International Hospital were reviewed and endoscopic images from those lesions were selected. Four senior endoscopists analyzed and classified these images according to the JNET criteria and determined the possible pathologic type. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of JNET classification under BLI-ME system were calculated with final pathologic results as the golden standard.Results:Of all the 40 lesions, there were 3 non-cancerous lesions, 20 adenoma, 10 high grade intraepithelial neoplasia/submucosal-superficial lesions and 7 submucosal-deep lesions. The accuracy of 4 endoscopists was 75.00%-87.50%, and 65.38%-95.89% for different JNET types. For each JNET type, the sensitivity was 60.71%-91.67%, specificity was 84.17%-97.73%, PPV was 63.46%-95.89%, and NPV was 88.51%-99.31%. For the 4 endoscopists, the assurance rate of surface pattern was 73.08%-100.00%, 80.77%-100.00% for deciding vascular pattern, and 67.31%-100.00% for deciding final JNET type. The Kappa value between any two endoscopists was 0.630-0.887, and the interclass correlation coefficient for all results was 0.880. Conclusion:JNET classification shows significant diagnostic value under BLI-ME system for colorectal neoplastic lesions.

目的 探讨二甲硅油联合聚乙二醇电解质(polyethylene glycol electrolyte,PEG)在结肠镜肠道准备中的有效性及安全性.方法 采用随机、单盲法,将2019年1～4月结肠镜检查270例随机分为二甲硅油组及生理盐水组(对照组),分别采用PEG+二甲硅油或PEG+生理盐水的清肠方案,评价肠道清洁度及祛泡情况、进退镜时间、息肉检出率以及服药耐受性.最终纳入251例.结果 与对照组比较,二甲硅油组进镜时间更短[(6.0±3.4)min vs.(7.8±5.2)min,t=-3.246,P=0.001],退镜观察时间更短[(8.1±2.0)min vs.(9.7±3.0)min,t=-4.910,P=0.000].二甲硅油组右半结肠的肠道清洁度评分低于对照组,左半结肠、右半结肠的祛泡评分低于对照组,差异均具有显著性(P=0.035,0.000及0.000).二甲硅油组息肉检出数、1～5 mm息肉检出数及Ⅰs型息肉(扁平息肉)检出数均高于对照组,差异均具有显著性(P=0.016、0.004及0.011).2组肠道准备耐受方面差异无显著性(P>0.05).结论 二甲硅油联合PEG较单纯PEG肠道准备存在优势,有利于改善视野,提高息肉检出数量尤其是微小息肉及扁平息肉的检出.

颈动脉内膜切除术(carotid endarterectomy, CEA)是治疗颅外段颈动脉狭窄的有效手段,可以有效改善脑血流供应,预防缺血性脑卒中[1].但是作为一种有创治疗方式,颈动脉内膜切除术本身存在一定的围术期死亡、缺血性卒中和心肌梗死等不良事件风险,这些事件的发生不仅使围术期安全性受到威胁,也影响手术对脑缺血事件的预防效果.

Objective: To compare the effect of cold snare and hot snare on the resection of small colorectal polyps, and to explore the clinical value of cold snare technique in removing colorectal polyps. Methods: From September 1, 2017 to January 31, 2018, 206 cases of patients with colorectal polyp resection in the Department of Gastroenterology of Peking University International Hospital were studied. During this period, according to the standard, 103 cases of patients (158 polyps) were in the cold snare group, and 103 patients (180 polyps) were randomly selected as control group from patients of the hot snare group. The related clinical data were analyzed retrospectively. The location, shape, size, polypectomy time, pathological type, complete resection rate, specimen recovery rate, complications and related costs of the two groups of polyps were compared. Results: The polypectomy time of the cold snare group was shorter than that of the hot snare group.The difference was statistically significant (Z=-11.727, P<0.001). The related cost of the perioperative period of the cold snare group was lower than that of the hot snare group.The difference was statistically significant (Z=-12.680, P<0.001). There were no statistically significant differences in the number of polyps/case, size, shape, pathological classification, complete resection rate, specimen recovery rate, and perioperative complications of the patients in the two groups(P>0.05). Conclusions: The operation time of cold snare technique in colorectal polyps (6-9 mm in diameter) is shorter and the cost is lower, which is worthy of clinical promotion.

1978年Landres等〔1〕第一次对嗜酸粒细胞性食管炎(EoE)进行文献记载,它是发生于食管的过敏反应介导的慢性炎症性疾病,以食管功能障碍及食管黏膜嗜酸粒细胞浸润为特征.本病在东、西方国家人群中患病率有较大差异,西方国家人群患病率在(43.0 ~56.7)/10万〔2~4〕,针对亚洲人群大型流行病学研究较少,日本的一项前瞻性研究显示,在常规进行食管胃十二指肠镜检查的患者中,EoE 的患病率为17.1/10万〔5〕,Ma等〔6〕的流行病学研究显示上海地区人群患病率为0.4%.目前认为EoE是由食物及空气中的过敏原导致的局限于食管的慢性炎症状态,过敏原诱导的Th2迟发应答在EoE发病中具有重要作用〔7〕.

Objective To determine the resistance patterns of Helicobacter pylori ( H.pylori) strains isolated from patients in Beijing and to explore the influencing factors of antibiotic resistance. Methods From April 2013 to March 2014, Helicobacter pylori culture from mucosa samples of gastric antrum and body of stomach was carried out in 820 RUT positive patients examined by gastroscopy.Resistance to amoxicillin, clarithromycin, metronidazole, levofloxacin, tetracycline, and rifampicin was tested. Results Of the 820 specimens, 700 were positive (85.4%).The overall antibiotic resistance rates of isolates obtained were 63.9%(447/700), 54.4%(381/700), 50.1%(351/700), 18.0%(126/700), 7.3%(51/700), and 3.7%(26/700) with respect to metronidazole, levofloxacin, clarithromycin, rifampicin, tetracycline, and amoxicillin, respectively.Multiple drug resistance rate of susceptible to all tested antibiotics was 9.9%(69/700), with a mono resistance rate of 27.1%(190/700), double resistance rate of 29.6%(207/700), triple resistance rate of 24.3%(170/700), quadruple resistance rate of 7.4%(52/700), quintuple resistance rate of 1.6% (11/700), and sextuple resistance rate of 0.1% (1/700), respectively.Single factor analysis showed that the resistance rate of clarithromycin in patients with non ulcer dyspepsia was significantly higher than that in patients with peptic ulcer (χ2 =11.619, P =0.001, OR =1.834, 95%CI:1.366 -2.424).The resistance rate of metronidazole in female patients wassignificantly higher than in male patients (χ2 =5.674, P=0.017, OR=1.486, 95%CI:1.176 -1.824).The resistance rate of levofloxacin in middle-aged and elderly patients was significantly higher than that in young patients (χ2 =6.731, P=0.035, OR=1.204, 95%CI:1.076-1.385), and in female patients was significantly higher than in male patients (χ2 =6.693, P=0.010, OR=1.502, 95%CI:1.181-1.786).The results of the multivariate analysis confirmed that the above factors can be considered as the factors affecting the change of resistance rates. Conclusion H.pylori resistance level is very high to metronidazole, clarithromycin, and levofloxacin, high to rifampicin, and relatively low to tetracycline and amoxicillin in Beijing.Multiple drug resistance is at high prevalence.

Objective To analyze the differences in the clinical characteristics,endoscopy,pathology and therapy between the patients with new onset ulcerative colitis(UC)in the elderly versus youth and middle-aged patients.Methods A review analysis was carried out in the 178hospitalized patients with UC in Third Hospital of Peking University from 1994 to 2010.The patients were divided into two groups according to the age of onset:UC onset at age of 60 years and older were enrolled in elderly

Objective To investigate the therapeutic effects of targeted nursing for university students with gastric cancer.Methods One hundred university students with gastric ulcer were randomly divided into 2 groups,50 cases in each group.Control group was given conventional nursing,while observation group given targeted nursing based on the treatment of control group.The total nursing effective rate,incidence of adverse reactions,improvement of clinical symptoms and psychological status were compared in 2 groups.Results The total effective rate of observation group was significantly higher than that in control group.The incidence of adverse reactions in observation group was significantly lower than in control group.After nursing,the improvement of symptoms like abdominal pain,heartburn,acid regurgitation and psychological status in observation group was superior to that in control group.Conclusion Targeted nursing has better application effects on university students with gastric ulcer,it can obviously improve the total clinical effective rate,reduce the incidence of adverse reactions,and ameliorate clinical symptoms and psychological status significantly,so it should be promoted in clinical nursing and application.