Search Results

Objective To compare the efficacy and safety in patients received paravertebral block and epi-dural block for postoperative rehabilitation pain after unilateral ureterolithotomy.Methods 120 ASA Ⅰor Ⅱ patients were randomly allocated into research group (n =60)and control group (n =60).After operation,the research group received paravertebral block performed with peripheral nerve stimulator,the control group received epidural block.All patients received patient -controlled intravenous analgesia (PCIA)in the same time.The operation time,amount of bleeding,postoperative hospitalization time,operation completion,number of press PCIA,occurrence rate of postopera-tive adverse reaction in 48 h,and visual analog scores (VAS)at 4,8,16 and 24 h after surgery were recorded. Results The patients of the two groups were completed the stone surgery,there was no cases of conversion to open surgery.There was no significant difference in operation time,bleeding volume,postoperative hospital stay between the two groups (all P >0.05).But the PCIA times of the research group was (2.14 ±0.45)times,which of the control group was (4.20 ±0.68)times,the difference was statistically significant (t =4.27,P =0.029).The postoperative VAS scores of the research group[4 h (2.68 ±0.480)points,8 h (2.68 ±0.48)points,16 h (2.81 ±0.43) points,24 h (2.88 ±0.49)points]were significantly lower than those of the control group[(3.12 ±0.53)points, (3.37 ±0.58)points,(3.42 ±0.52)points,(3.39 ±0.55)points],the differences were statistically significant (t =2.68,3.13,306,311,all P <0.05).Of the research group,the nausea and vomiting occurred rate (23.33%), hypotension rate (0.00%),skin itching (5.00%),the incidence of decreased muscle strength (0.00%)were significantly lower than the control group(43.3%,31.6%,28.33% and 8.33%),the differences were statistically significant(χ2 =5.40,22.57,11.76,522,all P <0.05 ).Conclusion Nerve stimulator guidance for thoracic paravertebral nerve block for upper ureter incision to take stone surgery patients can significantly reduce postoperative pain and the PCIA analgesia drug dosage and the incidence of adverse reactions.

9.A retrospective analysis of clinical features and death factors of infants and young children with severe pneumonia

Maoxia LI ; Chaomin WAN

Chinese Pediatric Emergency Medicine 2015;22(2):113-118

Objective Through retrospective data analysis,we tried to further understand the epide-miological characteristics,clinical feature and death factors of infant and young children with severe pneumo-nia. Methods The study objects were inpatients( age between≥28 days and≤3 years) who were diagnosed severe pneumonia from 1 January,2011 to 31 December,2013 of the Chengdu Women′s and Children′s Cen-tral Hospital. We used retrospective case study to understand the epidemiology,clinical feature,death factors of infant and young children with severe pneumonia. And we used chi-square test and Logistic multivariate regression analysis to analyze the death factors of infants and young children with severe pneumonia. Results (1) Among 1 411 cases of severe pneumonia,the ratio of male and female was 1. 8∶1,and the ratio of urban and rural areas was 1∶3. 62. The proportion of less than 3 months old infant was 46. 00%. And 62. 93% infant and young children with severe pneumonia occurred in the spring and winter. (2) Average hospitalization time was (9. 99 ± 6. 27 ) days, longer than the hospitalization time of mild pneumonia patients. ( 3 ) A total of 64. 21% of infant and young children with severe pneumonia had basic diseases. (4)A total of 91. 99% of the infant and young children with severe pneumonia had complications. (5) The most common etiology of infant and young children with severe pneumonia was bacteria,the second was virus. (6) In all cases,there were 44 cases died. The mortality of infant and young children with severe pneumonia was 3. 12%. And 72. 73% of the death cases were infants less than 3 months old. (7) The results of Logistic multiple regression analysis showed that there were significant differences in age, congenital heart diseases, repeating infection history, multiple drug-resistant strains infection, surgical history, multiple organ dysfunction, internal environment disorder. Conclusion Infant and young children with severe pneumonia have the following characteristics:most of them occurred in the winter and spring, and come from rural more than from the city. The smaller the age, the incidence of a disease is higher,and the mortality is higher. Most of infant and young children with severe pneu-monia have basic diseases. Most of the infant and young children with severe pneumonia have complications. If having one of the following high-risk factors:less than 3 months old,congenital heart diseases,repeating infec-tion history,multiple drug-resistant strains infection,surgical history,multiple organ dysfunction,internal envi-ronment disorder,the infant with severe pneumonia should be intensively monitored and actively treated.