中国实用医刊杂志   部级期刊

摘要：目的 总结成人法乐四联症根治术的外科治疗经验.方法 对2007年6月至2009年8月收治的22例18岁以上成年法乐四联症患者进行手术根治.所有病例均经右室切口疏通右室流出道(RVOT),同时修补室间隔缺损.跨瓣环RVOT补片13例,单纯RVOT补片6例,肺动脉与RVOT分别予以补片1例.结果 术后室间隔残余分流2例,重度低心排1例,经抢救无效死亡,病死率4.55%.结论 根据成人法乐四联症特点,合理设计手术方案,成人法乐四联症根治术可取得良好效果. Abstract： Objective To summarize the experience of radical treatment of tetralogy of Fallot in adults. Methods Between June 2007 and August 2009, 22 patients over 18 years old with tetralogy of Fallot underwent total surgical correction.Longitudinal or oblique right ventriculotomy was used to ensure complete release of right ventricular outflow obstruction and complete ventricular septal defect closure. Transannular patches were used in 13 cases, right ventricular outflow tract(RVOT)patches in 6 cases. Both pulmonary artery and right ventricular outflow tract(RVOT)patches in 1 case. Results Two cases had residual ventricular shunt, one case died of low cardiac output syndrome with a fatality of 4.55%. Conclusions By careful surgical management, total correction of tetralogy of Fallot in adult patients may results in good effects.

摘要：目的 探讨颅脑创伤的发生规律和临床特点,为制定预防和控制措施提供科学依据.方法 对3960例颅脑创伤患者的年龄、性别、职业、受伤机制、时间分布、伤情资料、治疗方式及治疗结果等临床资料进行回顾性分析.结果 患者男女比例为3.5∶1,高发年龄20～49岁,工人(35.3%)、农民(26.4%)和学生(9.8%)是前三位高发人群.1月和12月为高发时间段,公路(52.3%)、工地(25.9%)和家中(9.9%)是颅脑创伤主要发生地点,交通伤(58.1%)、高处坠落伤(17.7%)和击打伤(11.4%)为主要致病原因.合并伤以颌面部(33.6%)最多,其次为四肢(16.8%)、体表(13.4%)和胸部(10.9%)合并伤.创伤以轻型(54.8%)颅脑创伤多见,其次为重型(23.9%)和中型(21.3%),重型颅脑创伤的病死率为20.9%.结论 颅脑创伤发病群体以青壮年男性为主,主要致病原因为交通事故伤害.应根据不同人群和职业特点,因地制宜地采取预防和控制措施,以有效降低其发病率. Abstract： Objective To explore the incidence and clinical features of traumatic brain injury (TBI) so as to provide some reference for making preventive and control measures. Methods Influence factors of 3960 TBI patients, such as age, sex, occupation, injury mechanisms, time distribution, injury information, treatments results and so on were retrospectively analyzed. Results Among 3960 cases, males to females ratio was 3.5∶1, the major TBI victim was 20-49 years old, workers (35.3%), farmers (26.4%) and students (9.8%) were the top 3 incidence occupations. TBI mostly happened in January and December, and mostly happened on road (52.3%), at work place (25.9%) and at home (9.9%). The major causes were traffic accidents (58.1%), falling from high (17.7%) and violence (11.4%). It could also had the rate of 33.6%, 16.8%, 13.4% and 10.9% to get Maxillofacial region injury, limbs injury, body surface injury and chest injury happen together, respectively. Light injury (54.8%) was seen more frequently than severe

摘要：目的 探讨单侧颈动脉重度狭窄甚至闭塞的患者的围术期处理,寻找使患者安全平稳度过围术期的措施.方法 选择我院自2008年1月至2009年3月收治自康复科和神经内科转入我科并伴有神经功能缺陷的患者,按指定标准选入34例行颈内动脉内膜剥脱术(CEA)手术.结合脑血流监测,探讨围术期对血压控制、转流管应用、抗凝及脱水治疗等方面的综合处理措施,注意全程脑保护.结果 34例患者中,除1例术中血压波动较大,估计远处栓子脱落,术后CT及MRI证实术侧多发梗死灶,1例患者未使颈内动脉再通,余患者术后恢复满意,NIHSS评分均有所下降.结论 病情稳定患者,越早手术干预颈动脉重度狭窄甚至闭塞的患者,可能对患者带来越大的收益.围术期平稳控制血压是全程脑保护的中心问题,对颈动脉重度狭窄甚至闭塞的患者尤为重要. Abstract： Objective To explore the perioperative management of patients with unilateral carotid artery severe stenosis or occlusion in order to carry the patients through the perioperative period safely.Methods In our hospital from January 2008 to March 2009,patients were treated in Rehabilitation Division and department of Neurology and transferred to our department, accompanied by neurological dysfunction in patients selected according to specified standards into the thirty-four cases CEA surgery. Combination of cerebral blood flow monitoring, to explore perioperative blood pressure control and shunt applications, anticoagulation and dehydration treatment in a comprehensive treatment measures and pay attention to whole brain protection.Results Thirty-four patients, except one case of intraoperative blood pressure fluctuations, the estimated distance off emboli, postoperative CT and MRI confirmed the surgery side of multi-infarct foci, one patient did not make the internal carotid artery recanalization, the rest patients after satisfactory recovery, NIHSS scores have been reduced.Conclusions The

摘要：目的 探讨胃癌术后早期肠内营养支持的临床意义,并观察肠内营养对胃肠功能恢复、营养状况以及免疫功能的影响.方法 将40例行远端胃大部切除胃癌患者随机分为两组,20例术后行肠外营养治疗(PN组),20例术后早期行肠内营养治疗(EN组).PN组术后每日行完全肠外营养支持直到经口进食;EN组术后第1天以静脉支持为主,第2天开始经鼻营养管滴入肠内营养制剂,逐步加大用量并减少静脉支持.观察两组术后排气、排便时间,并发症发生率,平均住院费用、住院时间.结果 EN组术后排气、排便时间,并发症发生率和平均住院时间、费用均少于PN组.结论 胃癌术后早期EN支持可促进小肠功能恢复,提高免疫力,减少住院时间.肠内营养是胃癌术后营养支持的首选途径. Abstract： Objective To investigate the clinical significance of early enteral nutrition support after operation of gastric cancer.The recovery of gastrointestinal function,nutritional status and immune function were observed. Methods Forty patients with distal subtotal gastrectomy were randomly divided into two groups, 20 patients received parenteral nutrition(PN group), 20 patients were supplied with early enteral nutrition(EN group).Patients of parenteral nutrition(PN) were given total parenteral nutritional supports as routinely from the first postoperative day until oral feeding.Patients with enteral nutrition(EN) were given parenteral nutritional supports routinely on the 1st postoperative day,and then with nutrition through naso-duodenal infusion, gradually increasing the dosage and reducing the venous support.The observation indexes including flatus and defecation time,complication rate,the average hospital costs and duration.Results The time of flatus and of bowel movement, complication rate,hospital duration and costs after operation in the EN group was lower than that of the PN group.Conclusions Early postoperative enteral nutrition support can promote the recovery

摘要：目的 探讨静脉及鞘内联合用药加腰大池引流治疗颅脑手术后颅内感染的疗效.方法 选择34例符合条件的术后重症颅内感染患者,在全身及鞘内应用抗生素前提下行腰大池引流并评价其疗效.结果 引流10～54 d,平均21 d;鞘内注射5～16次,平均9次.34例患者颅内感染均痊愈,2例高龄患者颅内感染控制,其中1例死于严重肺部感染、肺功能衰竭,1例死于多脏器功能衰竭.32例存活患者随访1～6个月,无一例再次发生颅内感染.结论 静脉及鞘内联合用药加腰大池引流治疗重症颅内感染,疗效确切,能显著提高治愈率. Abstract： Objective To investigate the effect of lumbar continuous drainage in addition to intravenous and intrathecal administration in the treatment of the serious intracranial infection. Methods Thirty-four cases of postoperative serious intracranial infection were treated with lumbar continous drainage and intravenous and intrathecal admixture services, and the curative effects of the treatment were analysed. Results After 10 to 54 days of drainage, average 21 days, and 5-16 times intrathecal administration,average 9, the intracranial infection of all the 34 cases were cured, 2 advanced age cases died,one of lung complication,the other of MSOF(multiple system organ failure).The rest 32 cases without intracranial infection after 1-6 months follow-up. Conclusions The effect of lumbar continuous drainage in addition to intravenous and intrathecal administration in the treatment of the serious intracranial infection is determined,and the cure rate is increased.

摘要：目的 探讨心外管道全腔静脉-肺动脉连接术(TCPC)的手术适应证、手术方式的细节改进及尽量减少术后并发症的发生.方法 回顾性分析12例复杂先天性心脏病患者的临床资料,全部采用CORE-TEX管道行心外管道TCPC,手术在体外循环辅助下进行,心脏停跳3例,不停跳常温并行循环9例.结果 全组无死亡病例,2例出现顽固性胸腔积液,1例上腔吻合口狭窄伴颈内静脉血栓形成,全组患者血氧饱和度由67%～87%增加至93%～97%,术后随访6个月～2年,无死亡病例,生活质量均明显改善.结论 全心外管道TCPC手术难度低,操作简便,减少了手术风险,手术效果满意. Abstract： Objective To evaluate the operative indication, improvement in operative method,and reducing the post-operation syndrome mostly. Methods Twelve patients with complex congenital heart disease were reviewed.All patients were operated in extracardiac conduit total cavopulmonaru connection with CORE-TEX tube under cardiopulmonary bypass, 3 cases with heart arrested and 9 cases without heart arrested. Results There were no death,2 cases had refractory pleural effusion,1 case had stenosis of the connection of superior vena and pulmonaru artery with thrombus formation of internal jugular vein,the oxygen saturation increased from 67%-87% to 93%-97%,all patients were followed up for 6 months to 2 years with no late death of them,the quality of life was improved in evidence. Conclusions Extracardiac conduit total cavopulmonaru connection is simple and effective,can minimize the operative risk factors and has good early results.

摘要：目的 探讨左旋布比卡因单用或复合肾上腺素腰段硬膜外麻醉的药效学. 方法将60例ASA Ⅰ～Ⅱ级择期拟行下肢手术的患者随机分为三组:Ⅰ组0.75%左旋布比卡因用量1.8 mg/kg,Ⅱ组和Ⅲ组0.75%左旋布比卡因1.8 mg/kg分别加肾上腺素2.5 μg/ml和5.0 μg/ml,每组20例.三组均经第1～2腰椎间隙穿刺行硬膜外麻醉,确认穿刺成功并注药后,观察并记录三组注药后的感觉和运动阻滞情况,评价麻醉效果,观察并记录注药后不同时点血流动力学和心电图变化以及麻醉期间的不良反应发生情况.结果 三组感觉和运动阻滞特征相似(P>0.05),麻醉效果均评定为优,麻醉期间血流动力学均较稳定,不良反应发生率均较低.结论 0.75%左旋布比卡因应用于腰段硬膜外麻醉安全有效,加入1∶40万或1∶20万肾上腺素对左旋布比卡因的药效学均无明显影响.