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1.
目的:介绍腓肠神经-小隐静脉逆行岛状肌皮瓣的局部血管解剖研究与临床应用经验。方法解剖3个成人小腿灌注标本,观察腓肠神经-小隐静脉血管轴与腓肠肌内外侧头肌支和肌皮穿支之间的吻合关系,根据观察结果设计以腓动脉肌间隔穿支供血的逆行岛状腓肠肌皮瓣修复4例足踝部创面,皮瓣面积10~16 cm ×6~9 cm。结果在腓肠神经穿出深筋膜前,腓肠神经-小隐静脉血管轴与两侧的腓肠肌肌支间各有2~4个吻合。在穿出深筋膜后,与两侧的腓肠肌肌皮穿支间各有2~3个吻合。在腓肠肌腱腹交界(约为小腿中点)的近侧2~4 cm 内,有1~3支肌皮穿支血管与腓肠神经血管轴相交通。据此设计的肌皮瓣完全成活。结论腓肠神经-小隐静脉逆行岛状肌皮瓣血供可靠、转移方便,较传统的腓肠神经营养血管皮瓣可切取面积更大,是修复足踝部组织缺损的好方法。  相似文献   

2.
目的 探讨腓动脉穿支蒂腓肠神经营养血管肌皮瓣修复足踝软组织缺损及骨髓炎创面的临床疗效。方法采用腓动脉穿支远端蒂腓肠神经营养血管肌皮瓣修复足踝软组织缺损及骨髓炎创面18例。其中,足后跟软组织缺损伴骨感染4例,跟腱部缺损3例,内踝部缺损3例,外踝缺损伴死腔8例,皮肤缺损范围9 cm×4 cm~16 cm×9cm。皮瓣切取面积10 cm×6 cm~18 cm×10 cm,携带的深层腓肠肌肉面积4cm×3 cm~9cm ×6cm。供区直接拉拢缝合7例,游离植皮11例。 结果 术后18例肌皮瓣完全成活,创面Ⅰ期愈合。随访5~14个月,无并发症,皮瓣质地优良,外观满意,行走正常,术后皮瓣感觉恢复欠佳。 结论 腓动脉穿支远端蒂腓肠神经营养血管肌皮瓣,血供可靠,转移方便,是修复足踝部软组织缺损及骨髓炎创面的好方法。  相似文献   

3.
小腿血管穿支蒂皮神经营养血管皮瓣的临床应用   总被引:23,自引:12,他引:11  
目的报道应用胫后动脉穿支蒂隐神经营养血管皮瓣及腓动脉终末穿支蒂腓肠神经营养血管皮瓣修复小腿下段及足部软组织缺损的临床效果。方法以胫后动脉穿支或腓动脉终末穿支发出点为血管蒂,沿隐神经或腓肠神经轴线切取皮瓣,逆行修复小腿下段及足部皮肤缺损。其中,胫后动脉穿支蒂隐神经营养血管皮瓣13例,面积5cm×4cm-15cm×8cm,腓动脉终末穿支蒂腓肠神经营养血管皮瓣16例,面积16cm×8cm~30cm×10cm。结果临床应用29例,术后皮瓣全部成活,随访12—28个月,皮瓣质地良好,外观及功能恢复满意。结论应用小腿血管穿支蒂皮神经营养血管皮瓣,修复小腿下段及足部皮肤缺损,可获得较好的临床效果。  相似文献   

4.
骨感染     
医用硫酸钙人工骨在脊柱结核手术中的应用;一期病灶清除同种异体骨移植治疗胸腰椎结核;不典型脊柱结构的临床特点与诊疗体会;手术治疗脊柱结核伴截瘫的疗效分析;抗感染活性骨治疗开放性骨损伤;腓动脉穿支远端蒂腓肠神经岛状筋膜肌皮瓣修复足踝骨髓炎创面;[编者按]  相似文献   

5.
远端蒂腓肠神经营养血管肌皮瓣的临床应用   总被引:13,自引:2,他引:11  
目的报道应用远端蒂腓肠神经营养血管肌皮瓣修复填充小腿下段及足踝部创伤性软组织缺损、骨髓炎创腔的临床效果。方法以远端蒂腓肠神经营养血管肌皮瓣修复小腿下段及足踝部因创伤致组织缺损、骨髓炎22例,皮瓣面积最大17 cm×15 cm,最小10 cm×8 cm,肌瓣最大为10.0 cm×7.0 cm×2.0 cm,最小为6.0 cm×5.0 cm×1.0 cm。结果修复小腿下段16例皆获成功,伤口Ⅰ期愈合。修复足踝部6例,皮瓣边缘坏死3例,换药治愈。肌皮瓣坏死1/4,行植皮者1例。肌皮瓣坏死1/3行邻近筋膜皮瓣治愈1例。结论应用远端蒂腓肠神经营养血管肌皮瓣修复小腿下段及足踝部创伤性软组织缺损、骨髓炎创腔是有效可行的,但对携带的肌瓣究竟切取多大面积是安全的以及肌瓣的血运机制等问题仍有待进一步研究。  相似文献   

6.
自1992年Masquelet等[1]报道远端蒂腓肠神经筋膜皮瓣修复小腿下1/3和足踝创面的成功经验以来,该皮瓣已获得了广泛的应用[2-3].我院自2010年5月至2011年6月,应用腓动脉穿支蒂腓肠神经营养血管肌皮瓣转位修复小腿下段和足踝部软组织缺损伴有骨髓炎、骨不连创面27例,取得良好的效果.  相似文献   

7.
目的报道腓肠神经营养血管皮瓣修复足部远端软组织缺损效果。方法皮瓣设计以外踝上6cm附近腓动脉穿支处为旋转点,上界可达腓骨小头下2cm,依创面大小将皮瓣设计成倒水滴状。应用逆行腓肠神经营养血管皮瓣修复创面远端达趾蹼平面附近的足部软组织缺损14例,皮瓣大小为24cm×10cm~23cm×7cm。结果14例中13例皮瓣术后成活良好,1例远端少许表皮坏死,经换药后愈合。结论应用腓肠神经营养血管皮瓣可以修复趾蹼平面附近以内的任何足、踝部创面并可获得良好的临床效果。  相似文献   

8.
目的 报道应用带皮神经腓动脉穿支皮瓣修复足踝部创面的临床效果.方法 临床设计切取以带皮神经的腓动脉穿支血管为蒂的逆行皮瓣修复软组织缺损和骨髓炎感染的小腿下段1/3及足踝部创面8例.行腓肠外侧皮神经与受区神经端端吻合,皮瓣切取面积10 cm×6 cm~20 cm×12 cm.结果 8例带皮神经的腓动脉穿支皮瓣全部成活,外形与功能良好.随访6个月~1.5年,皮瓣色泽、质地、感觉恢复良好,骨髓炎愈合好.结论 带皮神经的腓动脉穿支皮瓣逆行转移修复小腿及足踝部缺损,其血供可靠、转移方便、操作安全、成活率高,是修复小腿下段1/3和足踝部创面的好方法.  相似文献   

9.
目的 报道应用带皮神经腓动脉穿支皮瓣修复足踝部创面的临床效果.方法 临床设计切取以带皮神经的腓动脉穿支血管为蒂的逆行皮瓣修复软组织缺损和骨髓炎感染的小腿下段1/3及足踝部创面8例.行腓肠外侧皮神经与受区神经端端吻合,皮瓣切取面积10 cm×6 cm~20 cm×12 cm.结果 8例带皮神经的腓动脉穿支皮瓣全部成活,外形与功能良好.随访6个月~1.5年,皮瓣色泽、质地、感觉恢复良好,骨髓炎愈合好.结论 带皮神经的腓动脉穿支皮瓣逆行转移修复小腿及足踝部缺损,其血供可靠、转移方便、操作安全、成活率高,是修复小腿下段1/3和足踝部创面的好方法.  相似文献   

10.
目的 报道应用带皮神经腓动脉穿支皮瓣修复足踝部创面的临床效果.方法 临床设计切取以带皮神经的腓动脉穿支血管为蒂的逆行皮瓣修复软组织缺损和骨髓炎感染的小腿下段1/3及足踝部创面8例.行腓肠外侧皮神经与受区神经端端吻合,皮瓣切取面积10 cm×6 cm~20 cm×12 cm.结果 8例带皮神经的腓动脉穿支皮瓣全部成活,外形与功能良好.随访6个月~1.5年,皮瓣色泽、质地、感觉恢复良好,骨髓炎愈合好.结论 带皮神经的腓动脉穿支皮瓣逆行转移修复小腿及足踝部缺损,其血供可靠、转移方便、操作安全、成活率高,是修复小腿下段1/3和足踝部创面的好方法.  相似文献   

11.
Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI2) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI2), TXB2 (stabile metabolite of thromboxane A2) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI2 release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB2 (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI2 release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A2, presumably contributing to hemodynamic stability within 30 min after MT.  相似文献   

12.
Don Dame 《Artificial organs》1996,20(5):613-617
Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.  相似文献   

13.
Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.  相似文献   

14.
Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.  相似文献   

15.
Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H2O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg−1 followed by 0.15 mg · kg−1 · h−1, n=8) or verapamil (0.1 mg · kg−1 followed by 0.3 mg · kg−1 · h−1, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.  相似文献   

16.
Abstract Immunoadsorption (1A) therapy with tryptophan (TR-350) or phenylalanine (PH-350) adsorbents has been used to reduce the concentration of serum antibodies in human lymphocyte antigen (HLA)-immunized patients. Other forms of plasma purification have been reported to reduce the level of fibrinogen, which affects the blood properties. In this study we investigated the effects of IA therapy using both adsorbents on plasma fibrinogen and immunoglobulins G and M in 13 patients (8 patients were treated with TR-350, and 5 patients were treated with PH-350). During each session 1 plasma volume (2.8 ± 0.4 L of plasma) was processed through the immunocolumn and then returned to the patient together with the blood cells. Compared with the pretreatment values, the plasma fibrinogen, IgG, and IgM concentrations were significantly reduced after IA therapy (p < 0.01 for TR-350; p < 0.04 for PH-350). There was a positive correlation between the degree of reduction of plasma proteins and the number of IA treatments given. A nonpara-metric test (Wilcoxon's signed-rank test or the Mann-Whitney test) was used for statistical analysis. We conclude from our study that IA therapy effectively lowers the plasma levels of fibrinogen, IgG, and IgM and thus can be considered a valuable alternative to other blood purification methods.  相似文献   

17.
Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.  相似文献   

18.
Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.  相似文献   

19.
Background: The duration of action of muscle relaxants is poorly correlated to the rate of decay of their plasma concentration. The plasma concentration of mivacurium may rapidly decrease below its active concentration because of the extensive hydrolysis of mivacurium. By inflating a tourniquet on one upper limb for 3 min after the administration of atracurium, mivacurium or vecuronium, we studied the influence of the initial decline of their plasma concentration on their effect. Methods: In 50 patients anaesthetised with thiopental, isoflurane and fentanyl, the effect of bolus doses of 0.15 or 0.25 mg . kg?1 mivacurium (MIV 15, MIV 25), 0.3 or 0.5 mg . kg?1 atracurium (ATR 30, ATR 50) and 0.06 or 0.1 mg . kg?1 vecuronium (VEC 06, VEC 10) were measured on both arms (evoked response of the adductor pollicis to train-of-four stimulation every 12 s), a tourniquet being applied on one arm just before and during 3 min after the muscle relaxant bolus. Results: Tourniquet inflation of 3 min almost abolished the neuromuscular effect of mivacurium. In the vecuronium groups and in the ATR 50 group, tourniquet inflation did not modify the maximum degree of depression of the twitch response. Also, the duration of action of vecuronium was unaffected by the tourniquet. In the ATR 30 group, times to return of the twitch response to 25% (duration 25%) and 75% (duration 75%) of control response were significantly shorter in the cuffed arm, 23 min vs 27 min, and 41 min vs 45 min, respectively. In the ATR 50 group, only duration 25% was significantly shorter in the cuffed arm (41 min vs 45 min). Conclusion: The results suggest that the rate of decline of the plasma concentration of mivacurium is so rapid, that a very low and almost clinically ineffective concentration is present as soon as 3 min after its administration. The results also indicate that the recovery from a mivacurium-induced neuromuscular blockade is not influenced by the rate of decay of its plasma concentration in patients with genotypically normal plasma cholinesterase.  相似文献   

20.
Abstract: Membrane processes play a pivotal and enabling role in modern replacement therapy for acute and chronic organ failure and in the management of immunologic diseases. In fact, virtually all contemporary extracorporeal blood purification methods employ membrane devices, and the next generation of artificial organs and tissue engineering therapies are almost certain to be similarly grounded in membrane technology. In this short essay, we comment on the similarities and differences among synthetic membranes and their natural counterparts and also provide a critical overview of the demographics and technology of hemodialysis, hemofiltration, apheresis, oxygenation, and emerging membrane technologies and applications.  相似文献   

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