电视腹腔镜胆囊切除皮下气肿致呼吸心跳骤停1例

患者男 ,5 2岁。患结石性胆囊炎。既往史中无心肺疾病史 ,术前检查心肺皆无异常。在持续硬膜外麻醉下行电视腹腔镜胆囊切除术 ,切除胆囊顺利 ,术中出血约 10ｍｌ,术中患者生命体征平稳。清洁腹腔时 ,患者出现全身广泛皮下气肿继而呼吸骤停 ,紧急解除气腹 ,停止手术 ,胸外按压 ,正压给氧 ,气管切开 ,皮下穿刺排气。 1ｍｉｎ后心肺复苏 ,局部麻醉下辅助小切口取出胆囊术毕。术后 3ｄ皮下气肿完全消失 ,术后6ｄ痊愈出院。讨　论　此例呼吸心跳骤停的直接原因是广泛皮下气肿不排除纵隔气肿。皮下气肿是腹腔镜手术并发症之一 ,致呼吸心跳骤停尚属…     

气肿性肾盂肾炎3例报告并文献复习

目的探讨气肿性肾盂肾炎的临床诊治特点。方法总结3例气肿性肾盂肾炎患者的临床资料。本组均为糖尿病患者,均有腰腹痛症状、白细胞增多和不同程度肾功能损害,CT扫描见患。肾增大、肾实质及（或）肾周围有大量气体。结果3例患者均静脉使用抗生素。1例手术引流、1例内引流、1例先行脓肿引流最终行肾切除,病情均得到改善。结论CT可助早期诊断气肿性肾盂肾炎,抗生素联合。肾周引流术治疗效果好,必要时需行肾切除术。     

气肿型肾盂肾炎合并2型糖尿病1例报道

目的气肿性肾盂肾炎在临床实践中比较罕见。它是一种严重的危及生命的急性暴发性肾脏感染性疾病,其主要特征是产气致病菌产生的气体在肾脏集合系统内、肾实质内及肾周围形成并集聚。气肿性肾盂肾炎的预后通常比较差,现报道本院诊治的气肿性肾盂肾炎合并2型糖尿病1例并进行文献回顾。方法患者女,51岁,因"高热3 d,腹胀伴呕吐2 d"急诊入院。术前CT示右肾形态失常、实质欠连续,内见多发积气影,似累及肾盂、肾周间隙、肾旁间隙及下腔静脉周围散在积气,邻近肠壁稍显肿胀。由于保守治疗疗效不佳,患者最终于全麻下行右肾全切除术。结果患者恢复良好并于术后1周出院。结论气肿性肾盂肾炎在临床上少见并且病死率较高。由于其临床表现缺乏特异性而容易误诊和漏诊。腹部CT是目前确诊气肿性肾盂肾炎的首选影像工具,它可以帮助确定感染的程度并指导治疗。在疾病早期可以采用肾穿刺引流和强效抗生素的联合治疗方案。然而,如果肾无功能,患者病情恶化或者存在预后不良因素,临床医师应该立即采用肾切除术来有效治疗气肿性肾盂肾炎。     

血浆置换抢救脂肪栓塞综合征一例

最近我院血液净化中心应用血浆置换(PE)技术成功抢救1例因行抽脂减肥术致脂肪栓塞心跳呼吸骤停患者,报告如下.     

高海拔地区胆心反射致术中心跳骤停的防治探讨:附三例

我科近2年里胆囊切除术中发生3例由于胆心反射致呼吸、心跳骤停的病例，现报告如下。     

经尿道前列腺切除术并发高钾血症及心跳骤停

经尿道前列腺切除术(transurethral resection of prostate,TURP)综合征是因术中大量非离子化溶液连续冲洗吸收入血,可引起低钠血症,低渗透压,水中毒而导致呼吸衰竭.在此报道1例73岁男性患者因前列腺增生及膀胱肿瘤实施TURP及膀胱肿瘤切除术突发心跳骤停的诊治过程.术中患者因高钾、低钠血症等诱发室颤并发生心跳骤停,经心肺脑复苏高级生命支持等治疗后,患者病情得以稳定.通过对该综合征发生的病理生理改变分析,探讨其预防和治疗措施.     

气肿性肾盂肾炎的临床诊治及文献回顾

目的探讨气肿性肾盂肾炎患者的临床表现及诊治。方法分析3例气肿性肾盂肾炎患者的临床资料并回顾文献,患者行CT等检查确诊后积极抗感染并行经皮肾穿刺引流。结果 3例患者均为女性,年龄35~64岁之间,2例既往患糖尿病多年且血糖控制较差。均因"发热伴腰痛"入院,病情危重,CT提示肾脏及肾周气性脓肿病变,3例患者均在行经皮肾穿刺引流及抗生素抗感染后治愈出院。结论气肿性肾盂肾炎是一种累及肾实质及肾周的急性坏死性产气性感染,病情危重,CT为其主要诊断方法,多采用抗生素加经皮肾穿刺引流治疗。     

皮下和纵隔气肿三例报告

皮下气肿临床上并不少见,其本身对机体不产生严重影响,但常和其他严重并发症并存。本文报告三例发生在心肺复苏及术后的广泛性皮下气肿,并对其可能发生的原因和形成机制加以讨论。病例摘要例1 男,9岁。颅骨缺损修补术,术后2h循环骤停,急行心肺复苏,持续行胸外按压和用呼吸器控制呼吸,心跳恢复。30min后发现颈部、前胸及腹部皮下气肿,按之有“捻发音”,检查气管及纵隔无移位,双侧呼吸音清晰。怀疑有气管损伤,重新插管控制呼吸,减小     

喉癌切除术的麻醉诱导与气管内插管

喉癌切除术的麻醉诱导与气管内插管孙刚，蒋静敏喉切除术需在术前行气管造口后，置入气管导管。一般在局麻下进行，置管时常因刺激而引起不适，偶可导致心跳骤停，因此改进麻醉诱导方法十分重要。我院１９８２～１９９４年共行喉癌切除术１７４例，其中男１６５例，女９例...     

肺栓塞致心跳呼吸骤停溶栓成功2例

例1女，63岁，因右胫骨平台骨折行手术钢针固定。术中顺利，于缝皮时，患者突发心跳呼吸骤停，立即行气管插管人工呼吸、胸外心脏按压。数分钟后心跳、自主呼吸恢复，但血压为40／0mmHg(1mmHg=0．133kPa)。在不间断心肺复苏的同时将病人转入ICU，继续行心肺复苏，给予多巴胺、间羟胺升压药静点。收缩压最高升至60mmHg、舒张压始终为0。     

Emphysematous pyelonephritis complicated by liver cirrhosis and diabetes mellitus: a case report and a review of the literature

A case of emphysematous pyelonephritis is presented and a review of literatures is made. A 67-years-old woman with diabetes mellitus, complained of severe left flank pain and high fever and was referred from the department of gastroenterology. A computed tomography film demonstrated gas in the left renal parenchyma and a diagnosis of emphysematous pyelonephritis was made. She was in a state of shock and died after 4 days of conservative treatment. Emphysematous pyelonephritis is a rare, life-threatening disorder and 85 cases in the world have been reported to date. Our case is the 18th one in Japan. Its etiology, symptomatology, treatment and prognosis are discussed.     

Emphysematous pyelonephritis. Two cases

The emphysematous pyelonephritis is a rare and severe renal infection characterized by the presence of gas in renal parenchyma and its perirenal spaces. We report two cases of emphysematous pyelonephritis in two diabetic women (53 and 50 years old respectively). In the first case, the treatment was based on nephrectomy because of the presence of a septic shock and three risk factors, which are acute renal failure, hematuria and thrombopenia. In the second case, the treatment was only medical. The evolution was favorable in the two cases. We insist in this article that this diagnosis should be considered in every female diabetic patient having severe acute pyelonephritis resistant to a well-conducted medical treatment.     

La pyélonéphrite emphysémateuse bilatérale à Candida glabrata : une entité exceptionnelle

Acute emphysematous pyelonephritis (AEP) is a severe form of urinary tract infection. It occurs usually in diabetics. The most concerned agents are the Gram-negative bacilli. We report a first case of bilateral AEP due to Candida glabrata, occurred in a 64-year-old diabetic woman. The clinical presentation started with fever and abdominal pains, without signs of urinary tract infection. Within six hours, the patient had developed a septic shock with renal failure and ketoacidosis. The diagnosis was confirmed by CT scan and the pathogen was isolated in urine. Despite antibiotic and antifungal treatment, she died from a septic shock. Acute emphysematous pyelonephritis due to Candida species is rare. However, the addition of antifungal therapy seems justified if a severe emphysematous pyelonephritis is associated with risk factors of Candida infection.     

Bilateral emphysematous pyelonephritis

Emphysematous pyelonephritis is a severe infection found almost exclusively in diabetics, characterized by the presence of gas within the renal parenchyma. The diagnosis is established radiographically. An additional case is added to the 52 cases reported in the literature; we believe this is the fifth reported case with bilateral emphysematous pyelonephritis. If appropriate diagnostic studies demonstrate no evidence of either perinephric abscess or urinary obstruction, intensive medical management should be the initial therapy for this condition. Surgical intervention is necessary in patients without prompt response to medical therapy.     

A case of emphysematous pyelonephritis--review of 32 cases in Japanese literature

A case of emphysematous pyelonephritis is presented. A 66-year-old woman with diabetes mellitus was hospitalized for sudden pyrexia and left abdominal pain on January 13, 1987. She had shown preshock, pre-disseminated intravascular coagulation, hyperglycemia and renal dysfunction. Plain X-ray films of the abdomen and abdominal computer tomographic scanning showed a gas shadow in the left kidney. Retrograde pyelography demonstrated the left complete ureteral obstruction. A diagnosis was made of emphysematous pyelonephritis associated with diabetes mellitus and ureteral obstruction. Left nephrectomy was performed on January 17, 1987, and the pus obtained from the kidney yielded E. coli. After the operation, she has been doing well with diabetes mellitus under good control without insulin therapy. Thirty two cases of emphysematous pyelonephritis in the Japanese literature including our case are reviewed.     

A case of emphysematous pyelonephritis combined with xanthogranulomatous pyelonephritis

A case of emphysematous pyelonephritis, xanthogranulomatous pyelonephritis histologically, is reported. A 49-year-old female patient was referred to our department from the department of internal medicine because abdominal ultrasonography demonstrated left renal swelling with gas echo. Computed tomographic scan showed much emphysema in the left kidney. Although aggressive treatment with broad spectrum antibiotics and immunoglobulin had been performed, subfever and left lumbago continued. Thereafter, she underwent left nephrectomy, and histological findings revealed xanthogranulomatous pyelonephritis. In the Japanese literature 27 cases of emphysematous pyelonephritis have been reported. Many cases are in middle-aged females and 85% of these cases complicated with diabetes mellitus. E. coli and Klebsiella was the main causative organism. The mortality of this disease was 26%. This report is the first case combined with xanthogranulomatous pyelonephritis in Japan. We recommend adequate chemotherapy and timely surgical treatment for good results.     

Pyélonéphrite et cystite emphysémateuses : une complication exceptionnelle chez un transplanté du rein

Emphysematous pyelonephritis is a rare and severe infectious complication characterized by the presence of gas in the renal parenchyma, excretory cavities and surrounded tissues. It is due to the development of non-anaerobic gasifier bacteria. We report a new rare case of emphysematous pyelonephritis in a kidney transplant recipient, particular by its occurrence in a non-functional graft and its exceptional association with emphysematous cystitis.     

Complication rare de la transplantation rénale : la pyélonéphrite emphysémateuse

Emphysematous pyelonephritis is a necrotizing infection of the renal parenchyma and peri-renal tissues, characterized by the presence of air within the parenchyma of the urinary tract and peri-renal space. This is a severe complication, which involves the functional prognosis of the kidney and the patient's prognosis. The emphysematous pyelonephritis is a rare complication of renal transplantation. Its gravity is linked particularly to the fragility of immunosuppressed patients. The authors report the case of an emphysematous pyelonephritis having occurred 9 months after transplantation in a patient 58 years. The evolving risks and therapeutic modalities will be outlined and discussed.     

Emphysematous pyelonephritis: a case report

In this study, a case of emphysematous pyelonephritis has been reported in a 70-year old diabetic male with a non-functional contralateral kidney. In spite of appropriate medical treatment and surgical drainage, the outcome was negative. The case in question concerned a rare form of the disease, i.e., emphysematous pyelonephritis, a severe and necrotizing infection which is characterized by the presence of intraparenchymal gas produced by anaerobic bacteria, and the rapid development of acute sepsis or septic shock. Medical treatment alone is seldom sufficient, and surgical intervention, in most instances consisting of radical nephrectomy rather than surgical drainage, is advocated due to the extent of the necrotic lesions.     

Emphysematous pyelonephritis caused by Candida albicans

We report a case of emphysematous pyelonephritis that was proved by histological examination and culture to be caused by Candida albicans. The fungal infection caused ureteral obstruction. Nephrectomy alone resulted in complete recovery.