目的基于麻醉及围术期指标分析老年患者艾司氯胺酮全麻术后发生急性中重度疼痛的相关影响因素。方法回顾性分析2023年12月—2024年9月于新乡医学院第一附属医院进行艾司氯胺酮全麻手术的127例老年患者临床资料,根据其术后疼痛发生情况...目的基于麻醉及围术期指标分析老年患者艾司氯胺酮全麻术后发生急性中重度疼痛的相关影响因素。方法回顾性分析2023年12月—2024年9月于新乡医学院第一附属医院进行艾司氯胺酮全麻手术的127例老年患者临床资料,根据其术后疼痛发生情况分为中重度疼痛组与轻度疼痛组,收集两组患者临床基本特征,将两组中存在差异的项目纳入logistic回归分析,分析老年患者艾司氯胺酮全麻术后中重度疼痛的主要影响因素。将logistic回归分析中具有统计学意义的变量作为预测因子,构建老年艾司氯胺酮全麻后急性中重度疼痛列线图风险预测模型,并对模型进行验证。结果127例患者中36例患者艾司氯胺酮全麻术后发生中重度疼痛,占比28.35%,纳入中重度疼痛组,91例患者轻度疼痛,占比71.65%,纳入轻度疼痛组,两组在性别、穿刺操作、术前是否使用非甾体抗炎药(nonsteroidal anti-inflammatory drugs,NSAIDs)、美国麻醉医师协会(American society of anesthesiologists,ASA)分级及手术时间方面差异具有统计学意义(P<0.05);上述指标均未存在共线性问题(方差膨胀因子≤10,容忍度≥0.1),并通过logistic回归方程计算可知,女性、术前未使用NSAIDs,动脉穿刺置管、ASAⅢ级及手术时间超过120 min均为老年患者艾司氯胺酮全麻术后中重度疼痛的主要影响因素。基于logistic建立上述五项预测因子在内的预测模型,画出对应列线图,并绘制决策曲线及校准曲线,阈值范围中预测模型的净获益率较高,表明该预测模型准确性良好。结论老年患者艾司氯胺酮全麻后急性中重度疼痛与女性、术前未使用NSAIDs、动脉穿刺置管、ASAⅢ级及手术时间超过120 min有关,临床需依据上述因素及时识别高危患者,采取对应干预措施,降低中重度疼痛发生风险。展开更多
A colluvial landslide in a debris flow valley is a typical phenomena and is easily influenced by rainfall. The direct destructiveness of this kind of landslide is small, however, if failure occurs the resulting blocki...A colluvial landslide in a debris flow valley is a typical phenomena and is easily influenced by rainfall. The direct destructiveness of this kind of landslide is small, however, if failure occurs the resulting blocking of the channel may lead to a series of magnified secondary hazards. For this reason it is important to investigate the potential response of this type of landslide to rainfall. In the present paper, the Goulingping landslide, one of the colluvial landslides in the Goulingping valley in the middle of the Bailong River catchment in Gansu Province, China, was chosen for the study. Electrical Resistivity Tomography(ERT), Terrestrial Laser Scanning(TLS), together with traditional monitoring methods, were used to monitor changes in water content and the deformation of the landslide caused by rainfall. ERT was used to detect changes in soil water content induced by rainfall. The most significant findings were as follows:(1) the water content in the centralupper part(0~41 m) of the landslide was greaterthan in the central-front part(41~84 m) and(2) there was a relatively high resistivity zone at depth within the sliding zone. The deformation characteristics at the surface of the landslide were monitored by TLS and the results revealed that rainstorms caused three types of deformation and failure:(1) gully erosion at the slope surface;(2) shallow sliding failure;(3) and slope foot erosion. Subsequent monitoring of continuous changes in pore-water pressure, soil pressure and displacement(using traditional methods) indicated that long duration light rainfall(average 2.22 mm/d) caused the entire landslide to enter a state of creeping deformation at the beginning of the rainy season. Shear-induced dilation occurred for the fast sliding(30.09 mm/d) during the critical failure sub-phase(EF). Pore-water pressure in the sliding zone was affected by rainfall. In addition, the sliding L1 parts of the landslide exerted a discontinuous pressure on the L2 part. Through the monitoring and analysis, we conclude that this kind of landslide may have large deformation at the beginning and the late of the rainy season.展开更多
文摘目的基于麻醉及围术期指标分析老年患者艾司氯胺酮全麻术后发生急性中重度疼痛的相关影响因素。方法回顾性分析2023年12月—2024年9月于新乡医学院第一附属医院进行艾司氯胺酮全麻手术的127例老年患者临床资料,根据其术后疼痛发生情况分为中重度疼痛组与轻度疼痛组,收集两组患者临床基本特征,将两组中存在差异的项目纳入logistic回归分析,分析老年患者艾司氯胺酮全麻术后中重度疼痛的主要影响因素。将logistic回归分析中具有统计学意义的变量作为预测因子,构建老年艾司氯胺酮全麻后急性中重度疼痛列线图风险预测模型,并对模型进行验证。结果127例患者中36例患者艾司氯胺酮全麻术后发生中重度疼痛,占比28.35%,纳入中重度疼痛组,91例患者轻度疼痛,占比71.65%,纳入轻度疼痛组,两组在性别、穿刺操作、术前是否使用非甾体抗炎药(nonsteroidal anti-inflammatory drugs,NSAIDs)、美国麻醉医师协会(American society of anesthesiologists,ASA)分级及手术时间方面差异具有统计学意义(P<0.05);上述指标均未存在共线性问题(方差膨胀因子≤10,容忍度≥0.1),并通过logistic回归方程计算可知,女性、术前未使用NSAIDs,动脉穿刺置管、ASAⅢ级及手术时间超过120 min均为老年患者艾司氯胺酮全麻术后中重度疼痛的主要影响因素。基于logistic建立上述五项预测因子在内的预测模型,画出对应列线图,并绘制决策曲线及校准曲线,阈值范围中预测模型的净获益率较高,表明该预测模型准确性良好。结论老年患者艾司氯胺酮全麻后急性中重度疼痛与女性、术前未使用NSAIDs、动脉穿刺置管、ASAⅢ级及手术时间超过120 min有关,临床需依据上述因素及时识别高危患者,采取对应干预措施,降低中重度疼痛发生风险。
基金funded by International S&T Cooperation Program of China (ISTCP) (Grant No. 2013DFE23030)the Fundamental Research Funds for the Central Universities (Grant No. lzujbky-2014-273 and lzujbky-2015-133)
文摘A colluvial landslide in a debris flow valley is a typical phenomena and is easily influenced by rainfall. The direct destructiveness of this kind of landslide is small, however, if failure occurs the resulting blocking of the channel may lead to a series of magnified secondary hazards. For this reason it is important to investigate the potential response of this type of landslide to rainfall. In the present paper, the Goulingping landslide, one of the colluvial landslides in the Goulingping valley in the middle of the Bailong River catchment in Gansu Province, China, was chosen for the study. Electrical Resistivity Tomography(ERT), Terrestrial Laser Scanning(TLS), together with traditional monitoring methods, were used to monitor changes in water content and the deformation of the landslide caused by rainfall. ERT was used to detect changes in soil water content induced by rainfall. The most significant findings were as follows:(1) the water content in the centralupper part(0~41 m) of the landslide was greaterthan in the central-front part(41~84 m) and(2) there was a relatively high resistivity zone at depth within the sliding zone. The deformation characteristics at the surface of the landslide were monitored by TLS and the results revealed that rainstorms caused three types of deformation and failure:(1) gully erosion at the slope surface;(2) shallow sliding failure;(3) and slope foot erosion. Subsequent monitoring of continuous changes in pore-water pressure, soil pressure and displacement(using traditional methods) indicated that long duration light rainfall(average 2.22 mm/d) caused the entire landslide to enter a state of creeping deformation at the beginning of the rainy season. Shear-induced dilation occurred for the fast sliding(30.09 mm/d) during the critical failure sub-phase(EF). Pore-water pressure in the sliding zone was affected by rainfall. In addition, the sliding L1 parts of the landslide exerted a discontinuous pressure on the L2 part. Through the monitoring and analysis, we conclude that this kind of landslide may have large deformation at the beginning and the late of the rainy season.
