剖宫产术后168例蛛网膜下腔阻滞麻醉与硬膜外麻醉镇痛效果比较

目的:探讨蛛网膜下腔阻滞麻醉与硬膜外麻醉在剖宫产产妇术后的镇痛效果。方法:将行剖宫产手术168例产妇随机分为蛛网膜下腔阻滞麻醉组与硬膜组,观察两组在镇痛效果等方面的不同。结果:麻醉起效时间、痛觉完全消时间及术后6 h、12 h咳嗽及按腹压疼痛VAS评分等比较,蛛网膜下腔阻滞麻醉组均显著优于硬膜组,差异有统计学意义(P<0.01)。结论:蛛网膜下腔阻滞麻醉组剖宫产术后镇痛效果好,产妇痛苦小,值得临床推广应用。     

硬膜外阻滞出现硬膜下阻滞效应2例报告

我院近年来在硬膜外阻滞麻醉下手术或封闭治疗出现2例硬膜下麻醉效应,报告如下:1　病例介绍例1:患者男性,14岁,36公斤,ASAⅠ级。因急性阑尾炎在连续硬膜外麻醉下行阑尾切除术。入手术室,开放静脉通路,测血压16 /10kpa ,SPO2 98% ,取左侧卧位T12 -L1间隙穿刺,负压显著,头向置管3     

乳腺癌根治术硬膜外加肌间沟阻滞麻醉效果分析

目的 评价硬膜外加肌问沟阻滞与单纯硬膜外阻滞用于乳腺癌根治术麻醉效果.方法 选择ASAⅠ～Ⅱ级乳腺癌患者,随机分成硬膜外加肌间沟阻滞(Ⅰ组),单纯硬膜外阻滞(Ⅱ组).观察麻醉因阻滞平面过高或阻滞不完全辅助镇痛药物对呼吸系统、心血管系统的影响.结果 根据观察指标,Ⅰ组患者呼吸、血压、心率比较稳定,麻醉期间易于管理.Ⅱ组患者为达到手术需要平面,平面过高影响呼吸、循环系统.平面达不到,用辅助镇痛药物,但镇痛药对呼吸有抑制作用.结论 硬膜外加肌间沟阻滞围麻醉期生命体征平稳,镇痛完全,效果满意.     

乳腺癌根治术硬膜外加肌问沟阻滞麻醉效果分析

目的评价硬膜外加肌间沟阻滞与单纯硬膜外阻滞用于乳腺癌根治术麻醉效果。方法选择ASA Ⅰ-Ⅱ级乳腺癌患者,随机分成硬膜外加肌间沟阻滞（I组）,单纯硬膜外阻滞（Ⅱ组）。观察麻醉因阻滞平面过高或阻滞不完全辅助镇痛药物对呼吸系统、心血管系统的影响。结果根据观察指标,Ⅰ组患者呼吸、血压、心率比较稳定,麻醉期间易于管理。Ⅱ组患者为达到手术需要平面,平面过高影响呼吸、循环系统。平面达不到,用辅助镇痛药物,但镇痛药对呼吸有抑制作用。结论硬膜外加肌间沟阻滞围麻醉期生命体征平稳,镇痛完全,效果满意。     

下胸段硬膜外间隙阻滞防止气管插管时心血管反应的临床研究

目的　观察采用 0 5 %利多卡因 10ml进行下胸段硬膜外间隙阻滞对气管插管时心血管反应的预防作用。方法　 10 0例上腹部择期手术患者随机分为C组 (硬膜外间膜阻滞 +全身麻醉复合组 )和G组 (全身麻醉组 ) ,各 5 0例患者。C组在硬膜外间隙阻滞 2 0min后 ,再实施全身麻醉诱导 ,在全身麻醉诱导 15min后进行气管插管 ,麻醉维持采用硬膜外间隙阻滞复合全身麻醉。G组除了不进行硬膜外间隙阻滞外 ,其他操作均与C组完全相同。观察和记录两组患者气管插管前后的血压和心率。结果　两组患者的基础血压和心率无差异。C组在硬膜外间隙阻滞后血压和心率均轻微下降 (P >0 0 5 )。全身麻醉诱导后两组患者的血压和心率均明显下降 (P <0 0 5 ) ,全身麻醉诱导后两组患者的血压和心率均明显下降 (P >0 0 5 )。气管插管即刻G组血压和心率较基础水平明显升高 (P <0 0 5 ) ,而C组为无明显变化 (P >0 0 5 )。两组患者在气管插管后 5min时的血压和心率均接近麻醉诱导前水平 (P >0 0 5 )。结论　采用 0 5 %利多卡因 10ml进行下胸段硬膜外间隙阻滞可减轻全身麻醉诱导后气管插管的心血管反应。     

硬膜下间隙阻滞复杂表现1例报告

硬膜下间隙阻滞是硬膜外阻滞中少见的意外 ,有关文献报道少 ,现报告 1例硬膜下间隙阻滞复杂临床表现。患者 ,14岁 ,女 ,体重 38kg,身高 155cm。因转移性右下腹剧疼诊断为急性阑尾炎 ,在连续硬膜外麻醉下行阑尾切除手术。入院时术前检查与既往史未发现特殊异常。术前评价为 SAS1- E。麻醉经过 :术前半小时肌注胃复安 5mg,鲁米那纳 50 mg。取 T11～ T12 椎间穿刺 ,确认在硬膜外后 ,置入导管 ,穿刺及置管顺利 ,回吸未见脑脊液或血液 ,注入麻醉药 (1.3%利多卡因 0 .13%的卡因 )试验量 5ml后 ,患者各项生命指征无异常。继续注入麻药10 ml,8…     

硬膜下间隙阻滞麻醉5例报道

目前我国临床麻醉方法中 ,仍以硬膜外阻滞麻醉为主 ,占 60 %左右 ,边远地区 ,特别是地县级医院 ,硬膜外麻醉几乎高达 90 %～ 95 % ,如果发生硬膜下阻滞麻醉时 ,未能及时发现 ,轻则引起循环、呼吸抑制 ,重则发生呼吸、心跳骤停 ,虽为罕见 ,但应引起临床麻醉医生的高度重视 .我院近 5年施行硬膜外麻醉 1 65 40例 ,发生硬膜下腔阻滞麻醉 5例 ,占0 0 3 % ,现报道如下 .1　临床资料5例患者 ,男 3例 ,女 2例 ,年龄 3 6～ 83岁 ,体重5 6～ 80kg ,ASA 2～ 3级 .其中胆囊切除术 3例 ,全髋置换术 1例 ,右侧输尿管切开取石术 1例 ,均在连续硬膜外麻…     

咪唑安定复合异丙酚防治硬膜外阻滞内脏牵拉反应的观察

咪唑安定复合异丙酚防治硬膜外阻滞内脏牵拉反应的观察如下。 资料与方法 一般资料：连续硬膜阻滞麻醉下上腹部手术病人，将麻醉效果良好，阻滞平面T3-4～T11-12的100例，随机分为4组，每组25例。     

腰-硬膜联合麻醉与硬膜外阻滞麻醉用于分娩镇痛的临床疗效对比

目的:观察对比腰-硬膜联合麻醉与硬膜外阻滞麻醉在分娩镇痛中的临床效果。方法:将196例分娩镇痛产妇随机分为治疗组103例和对照组93例。对照组给予硬膜外阻滞麻醉,治疗组给予腰-硬膜联合麻醉,观察两组产妇的各项麻醉指标及镇痛效果。结果:镇痛效果治疗组总有效率为74.76%高于对照组的56.99%,差异有统计学意义(P<0.05)。结论:腰-硬膜联合麻醉较硬膜外阻滞麻醉用于分娩镇痛,可快速阻滞交感神经、感觉神经以及运动神经,起效较快,阻滞较为全面,并可连续给药,值得在临床中推广与应用。     

在下腹部及下肢手术中应用蛛网膜下腔-硬膜外联合阻滞的体会

<正>蛛网膜下腔-硬膜外联合阻滞(CSEA)是一种新型的麻醉方法,具有蛛网膜下腔阻滞(SA)和硬膜外阻滞(EA)的双重优点,已广泛用于下腹部以下的手术麻醉[1]。我院自2005年起,在下腹部手术和骨科下肢手术中应用CSEA,并与连续硬膜     

Subdural collections due to non-typhi Salmonella infections in two Malaysian children

Subdural collections caused by Salmonella infection are rarely encountered in children. We present two cases caused by non-typhi Salmonella, one a four-and-a-half-month-old boy presenting with subdural effusion, and the other, a 16-month-old boy with empyema. The diagnosis was confirmed on blood and subdural pus cultures. One patient had status epilepticus following focal fit, and the other had prolonged fever without any localising signs of infection on admission. They responded well to prompt surgical drainage and prolonged systemic antibiotic therapy. Contrary to previous reports, both patients showed favourable outcome in terms of neurological sequelae.     

大脑镰旁硬膜下出血CT和MRI对比研究

目的探讨和分析CT与MRI两种检查在大脑镰旁硬膜下出血诊断中的价值。方法回顾分析我院2011年6-2015年9月经临床证实的53例大脑镰旁硬膜下出血CT与MRI表现,按出血厚度将患者分为三组:3MM以下组,3-5MM组,5MM以上组,比较CT与MRI两种检查结果。结果对3MM以下组少量硬膜下出血CT基本漏诊;3-5MM组中硬膜下出血的显示MRI明显优于CT;5MM以上组硬膜下出血的显示MRI与CT基本一致。结论 MRI对大脑镰旁硬膜下出血的显示极佳,尤其是对厚度越小的硬膜下出血的显示MRI的优势越明显,可作为大脑镰旁硬膜下出血诊断的金标准。     

颅骨内板下硬膜下出血CT与MRI对比研究

目的：探讨分析CT与MRI两种检查在颅骨内板下硬膜下出血诊断中的价值。方法回顾分析我院2011年6-2015年9月经临床证实的176例颅骨内板下硬膜下出血CT与MRI表现,按出血厚度将患者分为三组：5mm以下组,5-10mm组,10mm以上组,比较CT与MRI两种检查结果。结果对5mm以下组少量硬膜下出血的显示MRI明显优于CT;5-10mm组中硬膜下出血的显示MRI略优于CT;10mm以上组硬膜下出血的显示MRI与CT一致。结论 MRI对颅骨内板下硬膜下出血的显示率极高,尤其是对等密度的、厚度越小的硬膜下出血的显示MRI优势越明显,可作为颅骨内板下硬膜下出血诊断的重要标准。     

硬脑膜下积脓

报道17例经手术证实的硬脑膜下积脓病人,最常见的感染途径是中耳炎。有效的诊断方法为脑血管造影术,诊断明确应即行开颅手术,行硬脑膜下引流。对局部病灶、原发病灶及全身抗生素的治疗亦很重要。     

微创闭式冲洗引流术治疗慢性及亚急性硬膜下血肿68例分析

目的观察微创闭式冲洗引流术治疗慢性及亚急性硬膜下血肿的疗效。方法回顾我院68例采用一次性YL-1型针行颅内血肿穿刺及闭式冲洗引流血肿术治疗的硬膜下血肿患者情况,分析微创闭式冲洗引流术的安全性和实用性。结果68例均一次行成功（其中1例为复发型）,均无颅内出血、颅内感染、急性脑膨胀、张力性气颅及癫痫等并发症。结论微创闭式冲洗引流术治疗慢性及亚急性硬膜下血肿安全可靠,方法简便易行。     

Subdural haematoma presenting with transient neurological deficits.

OBJECTIVE: To stress that transient neurological deficits do not always imply transient cerebral ischaemia, and may be produced by subdural haematoma. CLINICAL FEATURES: An 80-year-old man was seen for intermittent gait disturbance, with normal findings on initial examination. He was then admitted after the onset of a fixed neurological deficit which worsened. Subdural haematoma was diagnosed by computed tomography (CT). An 80-year-old woman was seen after she had experienced left hemisphere transient neurological deficits. A CT scan showed a left-sided subdural haematoma. INTERVENTION AND OUTCOME: Both patients underwent successful surgery with complete resolution of their symptoms and signs. CONCLUSION: Subdural haematoma is relatively common and must be considered in those with unexplained transient neurological deficits. Magnetic resonance imaging or CT are the diagnostic procedures of choice. Antiplatelet or anticoagulant therapy must not be instituted until subdural haematoma is excluded.     

Case of the month. Symptomatic chronic calcified subdural hematoma in a 5-year-old child

Head trauma is a frequent cause of morbidity and mortality in the pediatric population. The pathophysiology and clinical outcomes of head trauma differ between children and adults. Traumatic mass lesions such as subdural and epidural hematomas occur less frequently in children and, when present, are associated with lower mortality. Subdural hematoma is the collection of blood on the cortical surface beneath the dura with bleeding from bridging veins or cortical arteries. These hematomas are usually associated with trauma. Chronic subdural hematomas are much more common in infants and frequently exist as a single entity; it is rare for chronic subdural fluid accumulations to occur after one year of age. Specific traumatic events are usually unrecognized or unreported. In rare instances, subdural hematoma may indicate an underlying bleeding disorder, hematological malignancy or benign expansion of subarachnoid space. We report the dramatic presentation of a strikingly large calcified chronic subdural hematoma in a 5-year-old with increased intracranial pressure and subfalcine herniation.     

Large calcified subdural empyema

Subdural empyema is a known disease entity; however, calcified subdural empyema is uncommon. The authors present a case of an 11-year-old boy in whom there was diagnosed a chronic calcified subdural empyema 10 years after an attack of meningitis. The patient had suffered from generalized tonic clonic seizures occurring 2-6 times in a month. A large fronto-temporo-parietal craniotomy was carried out and the subdural empyema filled with numerous uncharacteristic tissue fragments with thick pus together with the partially calcified and ossified capsule was removed. The empyema mass was found to be sterile for bacteria. After the operation, no epileptic seizure occurred and the boy is on sodium valporate. We must emphasize the unusual occurrence of the chronic subdural empyema presenting with calcification-ossification and large size as observed in our case.     

硬膜转移瘤合并硬膜下血肿(附2例报告及文献复习)

目的：探讨硬膜转移瘤合并硬膜下血肿的临床特点。方法：报告1993年3月至1997年11月收治的硬膜转移瘤合并硬膜下血肿2例,结合文献进行回顾性分析。结果：2例“硬膜转移瘤合并硬膜下血肿”患者均无外伤史,1例有“胃癌”手术史,1例无肿瘤史。均以“慢性硬膜下血肿”行钻孔引流术,术后均出现复发性颅内血肿而作开颅血肿清除,开颅术中发现颅骨、硬膜转移瘤病灶并经病理证实。结论：硬膜转移瘤合并硬膜下血肿具有易于漏诊及术后血肿复发倾向明显的特点。     

Subdural and epidural empyema: diagnostic and therapeutic problems.

OBJECTIVE: A clinical and microbiological review of cases of subdural and epidural empyema. DESIGN, SETTING, PATIENTS: A 10-year retrospective review of patients with subdural and epidural empyema in all Brisbane hospitals with neurosurgical units. In this period there were 14 cases. RESULTS: The paranasal sinuses were the primary focus in 8 of the 14 cases, the middle ear in 3 and a surgical or traumatic wound in 2. One case occurred as a complication of Haemophilus influenzae meningitis. Streptococci, particularly Streptococcus milleri, were the causative organisms in all cases of sinus origin, most of which occurred in the second decade of life. An intracranial collection was considered in the differential diagnosis within 24 hours of admission in all 3 cases of otic origin but in only 2 of the 10 sinus or post-traumatic cases. The most common initial diagnosis was viral or partially-treated bacterial meningitis (8 of 13 cases). The initial computed tomographic (CT) scan was not diagnostic in 3 of 11 patients. No patient was successfully treated without surgery, and all 3 deaths in the series were associated with delayed surgery. CONCLUSIONS: Subdural and epidural empyema is an uncommon condition. The majority of the cases in this series were associated with sinusitis, and Streptococcus milleri was the commonest organism identified. The condition remains a diagnostic challenge; CT scanning cannot be relied upon although the use of intravenous contrast and more modern scanners has improved the diagnostic yield. Surgical drainage and early aggressive antimicrobial therapy are essential to avoid significant morbidity and mortality.