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1.
目的总结肝切除术中肝创面的处理经验。方法回顾性分析121例肝切除,其中,大网膜直接覆盖法18例,基底大网膜填塞 对拢缝合法25例,单纯对拢缝合法62例,医用生物胶喷涂 止血纱布覆盖法16例。结果术后腹腔引流血量分别为434±269ml、305±194ml、288±175ml、359±217ml。术后因出血再次手术1例,因出血及肝创面血肿保守治愈1例,胆漏4例,肝周感染7例,死亡3例。结论对拢缝合法适用于局部肝切除以及左肝切除。而医用生物胶喷涂 止血纱布覆盖法适用于肝创面较大的右肝切除及难以对拢缝合的肝切除,尤为适合贴近下腔静脉的肝切除。  相似文献   

2.
目的:研究巴曲亭在腹部疾病患者围手术期的止血作用.方法:随机将患者分为治疗组(140例)和对照组(124例),治疗组术前、术中、术后给予巴曲亭,对照组在相同时期给予常规止血药物.比较术中出血量、术后静脉血D-二聚体(D-D)以及术后血性引流液量的变化.结果:治疗组术中出血量为(312.1±30.3)ml,对照组为(521.5±29.2)ml(P<0.05);治疗组术后静脉血D-D为(0.6 712±0.071)ng/L,对照组为(0.9841±0.054)ng/L(P<0.05);血性引流液量在治疗组为(320±28)ml,对照组为(531±16)ml(P<0.05).结论:巴曲亭在腹部外科手术中的止血作用快,优于常规止血药物,术后使用能明显减少术后血性引流液重.  相似文献   

3.
腹腔镜1914例分析   总被引:1,自引:0,他引:1  
目的 :总结腹腔镜诊治腹部疾病的经验。方法 :回顾分析 1914例腹部疾病患者行腹腔镜手术治疗的临床资料。结果 :LC1810例 ,中转手术 8例 (0 .4 4%)。手术并发症 13例 (0 .72 %) ,胆管损伤 2例 (0 .11%) ,迷走胆管漏、术后腹腔出血、皮下气肿、剑下切口疝、脐部肉芽肿、下肢深静脉血栓形成各 1例 ,切口感染 4例 ,均手术或保守治愈。胆囊造瘘 2例 ,肝囊肿开窗引流 4例 ,阑尾切除 4 0例 ,十二脂肠溃疡穿孔修补 6例 ,肠粘连松解 2例 ,腹腔镜辅助小肠切除或肠修补 4例 ,脏器挫裂伤电凝止血引流 8例 ,腹腔镜联合手术 2 3例 ,其他手术 15例 ,全组无手术死亡病例。结论 :腹腔镜胆囊切除术治疗胆石症安全、可靠。腹腔镜探查术有助于提高诊断率 ,降低阴性剖腹探查率  相似文献   

4.
立止血在烧伤整形手术中的临床应用   总被引:2,自引:0,他引:2  
目的观察立止血在烧伤整形手术中的止血效果。方法将40例烧伤整形手术病人随机分为两组,立止血组(20例),采用术前15min静脉注射立止血1kμ,术中加用含(1-2)kμ立止血的生理盐水纱布覆盖创面;对照组采用术前15min常规静滴止血敏1.0mg,术中采用肾上腺素生理盐水纱布覆盖创面。比较两组术中出血时间(s)、创面单位面积出血量(g/cm2)。结果立止血组和对照组平均出血时间分别为(120.3±38.7)s、(158.8±37.6)s,平均出血量分别为(94.5±16.2)g、(146.3±17.4)g,单位面积出血量分别为(02±0.1)g/cm2、(0.3±0.2)g/cm2,立止血组均明显低于对照组(P<0.05)。结论在烧伤整形手术中,术前静脉注射结合术中局部应用立止血止血时间短、出血量少,安全有效。  相似文献   

5.
蛇毒血凝酶在腹部手术中止血作用以及对凝血功能的影响   总被引:47,自引:0,他引:47  
Zhu M  Cao J  Jia Z  Duan Z  Liu G  Wei J  Long H 《中华外科杂志》2002,40(8):581-584
目的:评价蛇毒凝血酶在腹部手术中的止血作用和对凝血功能的影响。方法:采用前瞻,随机、双盲,对照和多中心的方法,将180例腹部手术患者分为血凝酶组(60例),立止血组(60例)和甘露醇组(60例),3例患者具有可比性,术前2次分别注射相应药物,对手术切口出血的止血时间,出血时,单位面积同血量以及机体凝血功能(BT,CT,PT,APTT和PLT)等方面进行观察。结果:3组患者给予不同的药物后,血浆酶组的平均止血时间为121.6s,切口出血量为9.6g,单位面积出血量0.2g,与立止血组结果相似(P>0.05),而与甘露醇组结果(分别为159.2s,12.5s,0.3g)相比,2组差异有显著性(P<0.05),另外,血凝酶和立止血组均能缩短术后30min和术后1d的出,凝血时间,与甘露醇组相比差异有显著性(P<0.05),结论:蛇毒血浆酶对腹部切口毛细血管出血有较好的止血作用。  相似文献   

6.
目的探讨国产超声刀在普外科开放手术应用中的有效性及安全性。方法将2008年9月至2010年2月60例行开放手术的患者,随机分为试验组和对照组,各30例。试验组运用国产BBT超声手术系统,对照组运用美国强生超声刀,观察并比较两组患者组织切割时间、血管凝同时间、术中出血量、术后住院天数、术后腹腔引流管引流量等指标。结果试验组和对照组之间术中出血量无明显差异[(89.50±27.65)mlvs5(95.23±22.95)ml,P=-0.298],而且术后住院时间【(17.3±8.8)dvs(16.1±9.9)d,P=0.6041及术后腹腔引流[(180.6±61.0)ml口s(174.9±44.4)ml,P=0.674]在两组之间差异均无统计学意义;但与对照组相比,试验组的组织切割平均时间[(6.95±1.41)s vs(4.32±1.11)s,P〈O.05]和血管凝同时间[(6.00±0.314)s vs(2.68±0.123)s,P〈0.001]要长。结论国产BBT超声手术系统安全有效,符合临床使用的要求,可以在临床推广运用。  相似文献   

7.
目的探讨可吸收止血膜在颅脑肿瘤切除术中的止血效果及安全性。方法选择2009年1月-2011年9月我科颅脑肿瘤手术116例,将116例颅脑肿瘤交替入组依次分为2组:实验组,肿瘤创面常规加应用可吸收止血膜止血;对照组,肿瘤创面采用常规电凝、脑棉等方法止血,比较2组术中止血有效率、术后24h出血量。结果对照组止血有效率为65.5%(38/58),显著低于实验组96.6%(56/58)(Z=-3.997,P=0.000)。实验组术后24h内出血量(25.1±3.4)ml,显著少于对照组(120.5±6.3)ml(t=-101.488,P=0.000)。结论可吸收止血膜在颅脑肿瘤手术中有良好的止血效果。  相似文献   

8.
目的:探讨椎体内注射医用生物蛋白胶减少松质骨创面出血的有效性与安全性.方法:10只成年家犬全麻下前路暴露L2~15椎体,其中6只动物L2~L5椎体随机分为实验组与对照组,每组每只2个椎体.实验组椎体内注射医用生物蛋白胶,对照组未注射给药.给药30s后同时于L2~L5椎体前方作直径8mm、深6mm的骨缺损,记录骨创面的控制出血时间、止血时间、出血量及各组10min内止血百分比.另4只动物L2~L5椎体内注入医用生物蛋白胶与欧乃派克混合物.给药30min后行CT扫描计算椎体内药物扩散体积百分比,观察药物局部渗漏及静脉渗漏情况.所有动物实验前后检测血浆凝血酶原时间(PT),术后3d拍胸部X线片后处死,剖胸探查有无肺梗死灶.结果:实验组和对照组的控制出血时间分别为97±48s和417±101s(P<0.001),止血时间分别为291±167s和890±237s(P<0.001),出血量分别为0.80±0.67g和4.39±1.84g(P<0.001),10min 内止血百分比分别为91.67%和16.67%(P=0.001).药物扩散体积百分比为72.1%±11.2%.药物造影组CT扫捕未发现静脉渗漏,椎间孔渗漏1个(6.25%),椎管内渗漏5个(31.25%).所有动物实验前、后PT转异率无显著性差异(P=0.628).所有动物术后未发现神经损伤症状,胸片未见肺梗死征象,剖胸探查末发现肺梗死灶.结论:成年家犬椎体内注射医用生物蛋白胶可明显减少松质骨创面出血,安全性较好.  相似文献   

9.
目的探讨腹腔镜技术在低位直肠癌保肛手术中的应用价值。方法回顾性分析85例低位直肠癌患者的临床资料,其中腹腔镜手术组45例(实验组),开腹手术组40例(对照组);分析对比实验组和对照组患者的手术实施时间、手术出血量、手术体表的切口长度、手术后肛门恢复排气时间、术后腹腔引流量、术后并发症(吻合口瘘、切口感染)等指标。结果实验组手术时间(169±40)min,长于对照组(120±50)min(P0.05),实验组术中出血量(56±23)ml,较对照组(248±92)ml显著减少(P0.05),实验组切口长度(4.0±1.3)cm,短于对照组的(15.0±3.2)cm(P0.05),术后肛门恢复排气时间实验组(37±11)h,较对照组(73±12)h快(P0.05),术后引流量实验组(31±15)ml,较对照组(385±65)ml显著减少(P0.05),实验组术后吻合口出血并吻合口瘘1例(2.2%),较对照组4例(10%)少(P0.05),实验组无切口感染,较对照组4例(10%)少(P0.05),并发症发生率实验组为2.2%,显著低于对照组的20%(P0.05)。结论低位直肠癌的腹腔镜前切除术具有更小的手术创伤、更少的术中出血、更快的术后恢复、更少的术后并发症等优点,治疗效果确切,值得临床应用推广。  相似文献   

10.
腹部手术后腹腔内出血的诊断和治疗   总被引:2,自引:0,他引:2  
目的:总结腹部手术后腹腔内出血的诊断和治疗经验。方法:回顾性分析1981年1月至2000年12月腹部手术后24h内腹腔内出血超过300ml的病人15例,均为男性,脾切除加断流术5例,肝癌切除术4例,腹膜后肿瘤切除术3例,胰头十二指肠切除术2例,直肠癌Miles手术1例。结果:7例再手术治疗,8例非手术治疗。死亡5例。结论:提出腹部手术后腹腔内出血的概念和再手术适应证。生命体征稳定,可在严密监测下非手术治疗,术后24h内出血量<600ml或累计出血量<1000ml可作为非手术治疗的参考指标。创面广泛渗血或不能清楚显示出血部位,长国压迫止血是有效的方法。  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.
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   

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: 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   

16.
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   

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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