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1.
Ⅰ期扩张修复头部外伤性颅骨外露10例分析   总被引:4,自引:3,他引:1  
目的 总结皮肤软组织扩张术在Ⅰ期修复外伤性颅骨外露中的应用经验.方法 对10例外伤致颅骨外露的急诊患者,在伤口周边置入扩张器,经扩张头皮后Ⅰ期修复颅骨外露.结果 所有患者均成功修复缺损区,无颅骨坏死,无扩张区感染及创面严重感染的发生.随访6~12个月,毛发生长良好,修复效果满意.结论 应用皮肤软组织扩张术Ⅰ期修复外伤性颅骨外露,既治疗了疾病又避免了秃发,同时未增加扩张术的并发症,是一种良好的修复方式.  相似文献   

2.
目的:探讨皮肤软组织扩张术与肿胀技术相结合,修复头皮缺损伴颅骨外露的外科治疗效果.方法:将皮肤软组织扩张术与肿胀技术相结合,修复头皮缺损伴颅骨外露8例患者,与以往9例未采用肿胀技术的病例在术中出血、术后早期疼痛及术后血肿发生率进行比较.结果:应用该方法为8例患者修复头皮缺损伴颅骨外露,术中出血少,术后早期疼痛减轻,术后血肿发生率低.经术后3个月~2年的随诊,疗效满意.结论:肿胀技术下皮肤软组织扩张术治疗头皮缺损伴颅骨外露是一种安全可靠实用的方法,值得临床推广应用.  相似文献   

3.
自体颅骨粉一期修复颅骨缺损的临床应用   总被引:4,自引:1,他引:3  
目的探讨用自体颅骨骨粉一期修复颅骨缺损的临床应用. 方法 1999年10月~2002年12月,采用自体颅骨骨粉加医用黏合剂原位黏合,对128例重型颅脑损伤、急性颅内血肿、颅骨肿瘤及脑肿瘤并颅骨侵犯开颅术后行一期再植成形术,术后随访3~24个月,通过CT或X线片观察骨质生长情况. 结果一次完成减压及成形术,时间较常规手术延长5~l0分钟,修复颅骨外观正常,无凹陷、突出,术后12个月再植骨与正常颅骨完全融合,类似正常颅骨形态.再植修复成功123例,占96.1%,5例因骨粉量少成形欠佳,但未见脑搏动和缺损综合征,均不需二期修补. 结论自体颅骨骨粉加医用黏合剂一期颅骨再植成形术,能够有效避免传统的二期颅骨缺损修补术和并发症.  相似文献   

4.
目的探讨早期颅骨缺损修补术对病人神经功能修复的改善作用。方法颅骨缺损病人60例,随机分为对照组和观察组,每组各30例,对照组采用传统时间颅骨缺损修补术(术后3~6个月),观察组采用早期颅骨缺损修补术(术后1~3个月),比较两组病人术后疗效、日常生活能力(ADL)评分、Fugl-Meyer评分及神经功能缺损评分、生活质量评分。结果采用早期颅骨缺损修补术的病人的优良率93. 33%,显著高于对照组的66. 67%(P 0. 05);采用早期颅骨缺损修补术的观察组病人的术后ADL评分、Fugl-Meyer评分均显著高于对照组(P 0. 05);且观察组病人的神经功能缺损评分显著低于对照组(P 0. 05);观察组病人的SF-36量表除躯体疼痛维度评分均显著高于对照组(P 0. 05)。结论早期颅骨缺损修补术能够帮助颅骨缺损病人提高临床疗效,并提高病人日常生活能力、生活质量、运动功能及减少病人躯体疼痛及术后神经功能缺损程度,临床效果显著。  相似文献   

5.
小儿颅骨缺损不仅阻碍脑功能韵恢复,而且影响美观及安全,又可造成家长及患儿恐惧心理,并给患儿的生活带来诸多不便。传统认为。小儿颅骨缺损需待成年后修补为宜,因其颅骨尚处于成长发育阶段.需发育结束停止后才能手术。但小儿颅骨缺损可随发育而变大,缺损边缘外翻.凸出的脑组织呈进行性萎缩及囊变.影响脑组织的正常发育。本院自2000年2月至2006年4月,对16例颅骨缺损患儿早期施行术前钛板塑形颅骨修补重建术。  相似文献   

6.
头皮缺损颅骨外露的修复   总被引:1,自引:0,他引:1  
我科1980~1991年收治外伤性或颅面部肿瘤切除后头皮缺损颅骨外露9例,分别应用吻合血管的游离大网膜结合中厚皮片移植、游离皮瓣或轴型皮瓣转位结合皮片移植修复。讨论了修复时机、修复方法以及手术注意事项。认为双侧股前外侧游离皮瓣是修复全头皮缺损颅骨外露的可取方法,而吻合血管的游离大网膜移植修复颅骨外露的方法应尽量避免。  相似文献   

7.
我科1980~1991年收治外伤性或颅面部肿瘤切除后头皮缺损颅骨外露9例,分别应用吻合血管的游离大网膜结合中厚皮片移植、游离皮瓣或轴型皮瓣转位结合皮片移植修复。讨论了修复时机、修复方法以及手术注意事项。认为双侧股前外侧游离皮瓣是修复全头皮缺损颅骨外露的可取方法,而吻合血管的游离大网膜移植修复颅骨外露的方法应尽量避免。  相似文献   

8.
头皮缺损颅骨外露的修复   总被引:14,自引:0,他引:14  
我科1980-1991年收治外伤性或颅面部肿切除后头皮缺损颅骨外露9例,分别应用吻合血管的游离大网膜结合中厚皮片移植,游离皮瓣或轴型皮转位结合皮片移植修复。讨论了修复时机,修复方法以及手术注意事项,认为双侧股前外侧游离皮瓣是修复头皮缺损颅骨外露的可取方法,而吻合血管的游离大网膜移植修复颅骨外露的方法应尽量避免。  相似文献   

9.
使用有机玻璃经颞肌上修补外伤性颅骨缺损   总被引:1,自引:0,他引:1  
目的 探讨使用有机玻璃经颞肌上修补外伤性颅骨缺损的手术技巧及术后并发症的防治方法。方法 对2001年1月~2005年2月郧阳医学院附属太和医院神经外科收治的43例使用有机玻璃经颞肌上修补的外伤性颅骨缺损患者的临床资料进行回顾性分析。结果 43例中,术后5例出现不同程度的皮下积液,1例发生癫痫,1例发生感染,并发症发生率为16.28%。结论 经适当改进,使用有机玻璃经颞肌上修补外伤性颅骨缺损操作简单,取材方便,并发症少,颅骨成形效果满意。  相似文献   

10.
目的:探讨数字化外科技术制造的钛合金补片修复颅骨缺损的术后护理方法及体会.方法:回顾性分析2008年4月-2011年2月31例利用CAD/CAM技术制造的钛合金补片修复颅骨缺损的术后护理.结果:术后31例患者伤口均I期愈合,随访6个月至1年,缺损区颅骨外形恢复满意.结论:利用CAD/CAM技术制造的钛合金补片修复颅骨缺损效果理想,方法简单,修复精确.加强术后观察及实施有效的护理措施,可有效减少并发症的发生,提高治愈率.  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 : 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   

14.
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   

15.
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   

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: 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   

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.
Abstract: Photopheresis is a technique in which peripheral blood mononuclear cells, in the presence of a photoacti-vatable compound, are exposed extracorporeally to ultraviolet A light and reinfused, inducing a host autoregula-tory immune response. Experimental work and ongoing clinical studies are helping to define the role of this novel, safe, and non-toxic immunomodulating technology in the field of transplantation.  相似文献   

20.
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