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新生儿先天性Ⅲ型食管闭锁的护理   总被引:1,自引:1,他引:0  
张春梅 《护理学杂志》2001,16(3):155-156
先天性食管闭锁是新生儿消化系统的一种严重的先天性畸形 ,在国内发病率为 1 /2 0 0 0~1 /40 0 0 [1] ,男性高于女性。在其病理解剖分类中以 型最多见 ,占 85%~ 90 % [2 ]。手术是治疗本病的唯一途径 ,而患儿的一般情况及合并病变如吸入性肺炎等是影响治疗成功的关键。我科 1 996年 1月至2 0 0 0年 6月收治新生儿先天性 型食管闭锁 1 2例 ,现将护理体会介绍如下。1 临床资料1 2例中 ,男 8例、女 4例 ,入院时年龄为 1 1 h至4d,手术时年龄 1 .5~ 1 6 d;体重 1 .9~ 3 .5kg。经食管碘油造影、胸腹 X线摄片而确诊。均有不同程度的口吐泡沫…  相似文献   

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先天性食管闭锁(esophagealatregia,EA)患儿伴或不伴食管气管瘘的治疗.是外科医生关注的热点。80%以上的先天性食管闭锁患儿中.食管两盲端之间的距离是比较近的,这些患儿总体手术效果令人满意。但食管两盲端的距离在2~3cm或更长时.其手术效果不甚满意。笔者通过回顾文献并结合自身的临床经验,谈谈有关长间隙食管闭锁的治疗以及胸腔镜治疗先天性食管闭锁的体会。  相似文献   

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先天性食管闭锁 (esophagealatresia ,EA) ,多数合并气管食管瘘、误吸性肺炎和低氧血症 ,1/3病例属于早产儿或低体重儿 ,半数病例可并存其他先天性畸形 ,麻醉处理较困难 ,兹将我院近 10年中对先天性食管闭锁纠治手术的处理和体会报告如下。资料与方法一般资  相似文献   

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目的 探讨先天性食管闭锁Ⅰ期根治手术治疗的效果.方法 1994年11月至2008年6月收治先天性食管闭锁113例,其中接受Ⅰ期根治术41例,均为Ⅲ型,其中B型38例,A型3例.手术治疗率36.28%(41/113例).手术先行胃造瘘术,后行食管闭锁根治术.结果 术后近、远期死亡6例,死亡率14.63%(6/41例).长期生存35例.2007年以后手术12例全部生存.术后常见并发症包括吻合口狭窄、吻合口瘘.吻合口狭窄行食管扩张术治愈.吻合口瘘5例,放弃治疗死亡2例,再次手术2例,保守治愈1例.结论 手术治疗先天性食管闭锁疗效肯定,吻合口瘘是死亡高风险因子,但不是决定因素.提高手术疗效的关键在于早诊早冶,加强围术期监护.  相似文献   

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食管闭锁(esophageal atresia,ET)是以食管连续性中断为特征的先天性发育畸形,可伴有或不伴有气管食管瘘,ET最常见的类型是近段食管闭锁并远段气管食管瘘,占总数的86%[1].食管闭锁的发生率为2500~4500个活产儿中1个[2].其严重危及患儿生命,需要急诊手术矫治.自1943年Haight和Towsley报告了第1例Ⅰ期食管吻合成功的病例至今已有近70年.早期的手术死亡率高达30%~50%.由于手术技术、麻醉和新生儿监护水平的不断提高,死亡率越来越低.Spitz[3]报告体重>1500g,不存在严重心脏畸形的患儿如今的手术成活率达到98%.  相似文献   

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先天性食管闭锁伴气管食管瘘是一种消化道出生缺陷(大约1/3000),接近一半的食管闭锁患儿有其他器管系统的畸形,而心血管系统是最常涉及的.虽然食管闭锁的治疗效果及生存率有了极大的提高,但是有关其胚胎发生学的机制直到最近才有部分的揭示.  相似文献   

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目的:探讨先天性食管闭锁的临床特点及治疗。 方法:回顾性分析食管闭锁患儿18例临床资料,其中5例放弃手术治疗,余13例均行手术治疗。 结果:13例行一期食管气管瘘结扎+食管闭锁切除端端吻合手术治疗的患者中,存活11例,4例发生吻合口狭窄,给予球囊扩张治愈;2例发生吻合口瘘,1例保守治愈,1例再次手术治愈;1例再发气管食管瘘再次手术治愈。死亡2例,分别于术后第3天和第6天死于呼吸衰竭、吻合口瘘及心衰。 结论:早期诊断、并发症的预防和积极处理是提高食管闭锁手术治疗效果的关键。  相似文献   

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目的 探讨预防先天性食管闭锁术后并发吻合口狭窄的措施与临床效果.方法 对49例新生儿先天性食管闭锁患儿在手术中预先留置双腔气囊导尿管做食管支架,术后早期做引流,然后做营养管及预防性扩张用,观察预防吻合口狭窄的效果.结果 49例新生儿先天性食管闭锁术后3个月内发生吻合口狭窄6例,发生率12.24%,未增加其他并发症的发生.结论 术中预先留置双腔气囊导尿管用于预防食管闭锁术后吻合口狭窄具有良好的效果,减少第二次手术率,降低了患者费用,提高患儿生存质量.  相似文献   

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先天性食管闭锁(congenital esophageal atresla,CEA)是一种严重的食管发育畸形,发病率为1/40001/2000,男性高于女性,由胚胎前8周原始前肠分化气管和食管时分隔或空化不全引起。其中90%~95%可合并食管气管瘿(tracheoesophageal fistula,TEF)。自2002年来我院共收治5例食管闭锁患儿,现将其麻醉手术情况报告如下。  相似文献   

10.
先天性食管闭锁(oesophageal atresia,OA)是一组少见而威胁生命的食管先天畸形的总称,包括食管闭锁合并或者不合并气管食管瘘,以及单纯的食管气管瘘。流行病学研究表明,其发病率大约为3000~5000活产婴儿中有1例”,发病无性别倾向,目前大多学者认为其为散发性疾病,家族性食管闭锁非常罕见,病例不足1%,但在双胞胎其发生率会上升2~3倍。  相似文献   

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Postoperative nausea and vomiting (PONV) causes patient discomfort, lowers patient satisfaction, and increases care requirements. Opioid-induced nausea and vomiting (OINV) may also occur if opioids are used to treat postoperative pain. These guidelines aim to provide recommendations for the prevention and treatment of both problems. A working group was established in accordance with the charter of the Sociedad Espa?ola de Anestesiología y Reanimación. The group undertook the critical appraisal of articles relevant to the management of PONV and OINV in adults and children early and late in the perioperative period. Discussions led to recommendations, summarized as follows: 1) Risk for PONV should be assessed in all patients undergoing surgery; 2 easy-to-use scales are useful for risk assessment: the Apfel scale for adults and the Eberhart scale for children. 2) Measures to reduce baseline risk should be used for adults at moderate or high risk and all children. 3) Pharmacologic prophylaxis with 1 drug is useful for patients at low risk (Apfel or Eberhart 1) who are to receive general anesthesia; patients with higher levels of risk should receive prophylaxis with 2 or more drugs and baseline risk should be reduced (multimodal approach). 4) Dexamethasone, droperidol, and ondansetron (or other setrons) have similar levels of efficacy; drug choice should be made based on individual patient factors. 5) The drug prescribed for treating PONV should preferably be different from the one used for prophylaxis; ondansetron is the most effective drug for treating PONV. 6) Risk for PONV should be assessed before discharge after outpatient surgery or on the ward for hospitalized patients; there is no evidence that late preventive strategies are effective. 7) The drug of choice for preventing OINV is droperidol.  相似文献   

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The purpose of this review is to outline methodology for assessing body composition utilizing anthropometric and densitometric techniques. The objective of body composition assessment is to measure body fat and lean body mass. The quantity of these components varies due to growth, physical activity, dietary regimens, and aging. Anthropometric techniques incorporate selected skinfolds, circumferences, skeletal widths, or other variables to estimate body composition within k2.0-4.0%. These techniques are adequate for field testing of groups or individuals, but are population specific. Densitometry measures body volume irrespective of physique, sex, or age. This laboratory technique estimates body composition within 1.0-2.0%, is more difficult to administer, but is not population specific. Some limitation exists with any present technique due to biological variability and incomplete research of reference body composition in children, females, and the aged. J Orthop Sports Phys Ther 1984;5(6):336-347.  相似文献   

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Subramaniam B  Pomposelli F  Talmor D  Park KW 《Anesthesia and analgesia》2005,100(5):1241-7, table of contents
We performed a retrospective review of a vascular surgery quality assurance database to evaluate the perioperative and long-term morbidity and mortality of above-knee amputations (AKA, n = 234) and below-knee amputations (BKA, n = 720) and to examine the effect of diabetes mellitus (DM) (181 of AKA and 606 of BKA patients). All patients in the database who had AKA or BKA from 1990 to May 2001 were included in the study. Perioperative 30-day cardiac morbidity and mortality and 3-yr and 10-yr mortality after AKA or BKA were assessed. The effect of DM on 30-day cardiac outcome was assessed by multivariate logistic regression and the effect on long-term survival was assessed by Cox regression analysis. The perioperative cardiac event rate (cardiac death or nonfatal myocardial infarction) was at least 6.8% after AKA and at most 3.6% after BKA. Median survival was significantly less after AKA (20 mo) than BKA (52 mo) (P < 0.001). DM was not a significant predictor of perioperative 30-day mortality (odds ratio, 0.76 [0.39-1.49]; P = 0.43) or 3-yr survival (Hazard ratio, 1.03 [0.86-1.24]; P = 0.72) but predicted 10-yr mortality (Hazard ratio, 1.34 [1.04-1.73]; P = 0.026). Significant predictors of the 30-day perioperative mortality were the site of amputation (odds ratio, 4.35 [2.56-7.14]; P < 0.001) and history of renal insufficiency (odds ratio, 2.15 [1.13-4.08]; P = 0.019). AKA should be triaged as a high-risk surgery while BKA is an intermediate-risk surgery. Long-term survival after AKA or BKA is poor, regardless of the presence of DM.  相似文献   

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The traditional view that organs have only limited regenerative capacity has been challenged in recent years as adult bone marrow stem cells as well circulating progenitor cells have been identified to retain the plasticity to participate in neovascularization, a process so far believed not to be possible after birth. An organ that is damaged by ischemia causes the release of cytokines; these act via the flowing blood and stimulate the bone marrow, which then mobilizes progenitor cells to the blood and directs them to adhere to and migrate into the damaged organ. Thus, these progenitor cells most likely constitute a natural repair mechanism that counteracts degenerative or aging processes. On the basis of encouraging experimental data, first clinical trials have been established to demonstrate the safety and the feasibility of progenitor cell therapy in case of peripheral artery disease or myocardial infarction. Trials investigating injection of bone marrow or circulating progenitor cells into the coronary artery after an acute myocardial infarction not only demonstrates safety of the procedure but also gave hints toward efficacy. Nevertheless, these findings have to be validated by subsequent larger, prospective, randomized, controlled trials. There are also potential topics in nephrology, where modification of progenitor cell activity might be of benefit, such as renal ischemic disease, glomerular disease, and renal transplant vasculopathy. Finding a way to integrate the principle of progenitor cell action into therapeutic efforts might provide a completely new therapeutic strategy that not only attempts to retard disease progression but furthermore targets to regenerate damaged organs.  相似文献   

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