Objective To investigate the effects of cryoanalgesia for post-thoracotomy pain on the intercostal nerves. Methods Two hundred and eight patients suffering from thoracotomy were divided into three groups, according to different analgesia received respectively. Cryoanalgesia group （n = 80）： cryoanalgesia on the intercostal nerves, intercostals nerves was freezed at -55 ℃ for 90 seconds ; patient controlled analgesia by vein （PCA group, n= 80）： patient controlled analgesia was practiced intravenously, and control group （n = 48）： Dolantin given irregularly intra-muscularly and/or tramadol orally. Severity of pain was graded by visual analogue scale. Forced expiratory volume in one second（FEV1.0） was measured and pulmonary complication after operation was compared. Results There was a statistically significant improvement in postoperative pain scores and an improvement in respiratory function tests for patients in cryoanalgesia group（X2 = 74.93,15.04,P〈0. 05）. FEV1.0 in cryoanalgesia group was significantly higher than that in control group（1. 97±0.27L vs. 1. 39±0. 14 L,P〈0. 05）. Pulmonary complication in cryoanalgesia group after operation was lower than that in control group （6. 25% vs. 31. 25%, P〈0. 05 ）, Conclusion Cryoanalgesia on post-thoracotomy pain is very effective and may improve the respiratory function after operation.
Objective To systematically analyze and compare the research literature of thoracic surgery simulation-based medical education (SBME) at home and abroad, and provide ideas for the future development of thoracic surgery SBME in China. Methods Using word frequency analysis and cluster analysis as analysis methods, CiteSpace visualization software and Excel statistical software as tools, the domestic and foreign SBME literature retrieved from PubMed and CNKI databases were visualized and statistically analyzed respectively. Results A total of 2 491 domestic and foreign literature on SBME in thoracic surgery were included. The annual number of foreign publications showed an increasing trend. The top three countries in terms of number of publications were the USA (n=581), Canada (n=105) and Germany (n=57); "cardiac surgery", "medical knowledge medical knowledge" and "medical education" are the hotspots of research in the direction of thoracic surgery simulation, while "lung cancer", "surgical training" and "3D printing" were still in the process of explosion. The core research themes were endoscope simulation trainer, scenario-based simulation teaching methods, standardized patients and virtual reality models. Conclusion Domestic SBME in thoracic surgery should learn from foreign development experience, keep up with the frontier and integrate cutting-edge technology, innovate the curriculum and offer non-technical skills teaching, and improve the system and focus on software construction.
Quality control of general thoracic surgery contains many links including the qualification and technical conditions of medical institutions, preoperative diagnostic system, surgery, postoperative management, pathological diagnosis and follow-up. Standards of quality control should be based on evidence-based medicine, and general rules with detailed criteria. As one of the core concepts of quality control, fine management is ought to strictly follow clinical practice guideline of thoracic surgery, to be clear with quality standards of each key link in clinical pathway, and to improve the clinical quality control system that combines self-evaluation and supervision and inspection.
目的:分析与研究“5·12”汶川大地震所致成批胸外伤患者的特点及护理措施,为灾难性胸外伤护理方法提供有益的经验与措施。方法:回顾性分析“5·12”汶川大地震发生后10天内四川大学华西医院胸心外科普胸病区收治的75例住院患者资料,总结护理方法与效果。结果:75 例患者均有不同程度的皮肤挫裂伤和擦伤(100％),血胸75例(100 ％),血气胸24例(32％),肋骨骨折75例(100％),锁骨骨折6例(8％),肩胛骨骨折11例(14.7％),肺穿刺伤3例(4％),右主支气管断裂1例(1.33％),左侧膈肌破裂2例(2.7％),肺不张29例(38.7％)。同时伴有其它部位损伤:四肢骨折10 例(13.3％),脊柱损伤2 例(2.7％),脑损伤2例(2.7％),脾破裂2例(2.7％),胃破裂1例(1.33 ％)。住院期间死亡1例,其余患者均康复。结论:“5·12”地震胸外伤以血、气胸和肋骨骨折为主,合并严重的脏器损伤和复合伤是其主要特征,通过精心护理,可以降低死亡率和并发症的产生,促进患者康复。
ObjectiveTo investigate the clinical effects of early enteral nutrition in severe thoracic trauma patients requiring mechanical ventilation. MethodsWe randomly allocated 60 patients with thoracic trauma requiring mechanical ventilation into two groups by drawing lots including an early enteral nutrition (EEN) group and a parenteral nutrition (PN) group in our hospital between January 2013 and September 2014 year. There were 30 patients in each group. We compared the recovery results of the patients between the two groups. ResultsAfter the treatment of 7 and 14 days, indicators in the EEN group were better than before significantly and better than those in the PN group; diarrhea rate average days of ICU and the average days of hospital decreased significantly with statistical differences (P<0.05). There was no statistical difference in ventilator-associated pneumonia or the incidence of stress ulcer between the two groups (P>0.05). ConclusionEarly enteral nutrition in severe chest trauma patients requiring mechanical ventilation may promote protein synthesis, improve the nutritional status of patients, correct negative nitrogen balance, reduce inflammation response, reduce the complications.
Objective To investigate the learning curve for da Vinci robot-assisted mediastinal tumor resection (DRMTR). Methods A total of 50 consecutive patients received DRMTR between March 2011 and September 2012 in our hospital. Clinical data of the 50 patients were collected and analyzed. There were 23 males, 27 females aged 46.9(17–80) years. The learning curve was evaluated by using the cumulative sum (CUSUM) analysis. Results The mean operation time was 124.6 min. The CUSUM learning curve was best modeled as a third-order polynomial curve with the equation: CUSUM=0.046×case-number3–4.681×case-number2+127.508×case-number–237.940, which had a highR2 value of 0.868. The fitting curve reached the top after the 19th case, which suggested that the surgeons master the technique after they finished 19 cases. As a cut-off point, the 19th case divided the learning curve into two phases, in which there was statistical diffference in operation time (P<0.01), intraoperative blood loss (P<0.01), the postoperative duration of chest tube drainage (P<0.01 ) and the rate of postoperative complications (P<0.05 ). Conclusion The DRMTR identified by CUSUM analysis represents two characteristic stages of DRMTR: the learning stage and the mastery stage. It is suggested from our data that the surgeons need finish about 19 cases to master DRMTR.