腹部外科手术患者的健康需求与指导

目的探讨腹部外科手术患者在手术前后对健康知识的需求。方法采用问卷方式对100例腹部手术患者进行健康需求调查，然后将患者的需求分类归纳，进行统计。结果100％的患者关心手术的效果、手术及麻醉的安全性、手术前后的注意事项。结论根据患者的健康需求，分别在术前、术后和出院时各阶段实施针对性的健康教育，使患者能积极主动配合治疗和护理，出院时患者对护理满意率达95％以上。     

Abdominal ultrasonography in the diagnostic work-up in children with recurrent abdominal pain

We report on our experience with routine abdominal ultrasonography in 120 children (aged 3–15 years) with recurrent abdominal pain, in order to determine the diagnostic value of this investigation. Eight children (7%) revealed sonographic abnormalities: gallbladder stone (n = 2), splenomegaly (n = 1) and urogenital abnormalities (n = 5). The recurrent abdominal pain could be explained by these findings in only two (may be three) cases. Conclusion The diagnostic value of abdominal ultra‐sonography in unselected children with recurrent abdominal pain is low. However, the direct visualization of the abdominal structures as being normal may be helpful to the parents and the child in their understanding and acceptance of the benign nature of recurrent abdominal pain. Received: 19 March 1996 / Accepted: 29 January 1997     

Impact of Retrograde Cerebral Perfusion on Ascending Aortic and Arch Aneurysm Repair

Purpose. The effect of retrograde cerebral perfusion on the incidence of stroke and death among patients undergoing repair of aneurysms of the ascending aorta and transverse arch was determined.

Material and Methods. Between January 1991 and March 1995, 161 patients were operated on for aneurysms of the ascending aorta and transverse arch. Thirty-three of the patients (20%) had an aneurysm of the ascending aorta only and 128 (80%) had aneurysms of both the ascending aorta and the transverse arch. All the patients underwent cardiopulmonary bypass, profound hypothermia, and circulatory arrest, and 120 (74%) also underwent retrograde cerebral perfusion. Median pump time was 143 minutes (range, 21 to 461 minutes). Median circulatory arrest time was 42 minutes (range, 8 to 111 minutes), and median myocardial ischemic time was 71 minutes (range, 14 to 306 minutes).

Results. The overall 30-day mortality rate was 6% (9 patients) and the incidence of stroke was 4% (7 patients). The use of retrograde cerebral perfusion demonstrated a protective effect against stroke (3 of 120 patients, or 3%) compared with no retrograde cerebral perfusion (4 of 41 patients, or 9%; odds ratio, 0.24; confidence interval, 0.06 to 0.99; p < 0.049). This was most significant in patients more than 70 years of age; none of the 36 elderly patients who received retrograde cerebral perfusion had a stroke, compared with 3 of the 13 (23%) who did not (p < 0.003). Only pump time was associated with an increased risk of stroke (odds ratio, 1.01; 95% confidence interval, 1.00 to 1.02; p < 0.005). Pump time also was associated with increased mortality (odds ratio, 1.01; 95% confidence interval, 1.00 to 1.02; p < 0.008).

Conclusion. Retrograde cerebral perfusion decreased the incidence of stroke in patients undergoing repair of aneurysms of the ascending aorta and transverse arch.     

Laparoscopic repair of a diaphragmatic hernia through the foramen of Morgagni

A 78-year-old woman is described who presented with a diaphragmatic hernia through the foramen of Morgagni. A definitive diagnosis was confirmed by a sagittal view on magnetic resonance imaging prior to surgery. The hernia was repaired laparoscopically under an abdominal wall lifting technique without pneumoperitoneum, and her symptoms completely resolved postoperatively with no evidence of recurrence. The laparoscopic repair was considered a suitable and safe procedure for the treatment of a Morgagni hernia. Received: 3 April 1996/Accepted: 3 May 1996     

Extension of the “Elephant Trunk” Technique in Complex Aortic Pathology: The “Bidirectional” Option

Background. The “elephant trunk” technique, using a free-floating vascular prosthesis, was originally described to facilitate a subsequent operation on the downstream aorta. We developed an additional refinement of this technique, called the “bidirectional elephant trunk.” This option may represent an interesting tool in more complex aortic operations, especially when the descending aorta has to be replaced first in patients with concomitant pathology of the ascending aorta or of the aortic arch.

Methods. The initial operation is performed through a left thoracotomy. The proximal elephant trunk is created by invaginating the future aortic arch graft into the descending aortic graft. The proximal anastomosis between the doubled graft and the proximal descending aorta is performed first. During construction of the distal anastomosis, a distal elephant trunk may be inserted likewise. If the aortic arch and ascending aorta have to be replaced later, this second step is performed through a median sternotomy. The free-floating arch graft is pulled out of the proximal descending aorta with a nerve hook, unfolded, and used for total arch replacement.

Results. This technique was used successfully in 3 patients without mortality. No major complications were observed excepted persistent hoarseness in a patient with preoperative paresis of the recurrent nerve. No perfusion problems due to the unfolding of the free-floating graft occurred during the second operation.

Conclusions. The bidirectional elephant trunk technique is an interesting option that may be suitable for patients presenting with a complex pathology of the whole thoracic aorta when the descending segment has to be replaced first.     

双氢杨梅树皮素对兔胸主动脉条平滑肌收缩反应的影响

用兔胸主动脉条研究双氢杨梅树皮素对去甲肾上腺素（NE）、KCl和CaCl2所致兔胸主动脉条收缩反应量效曲线的影响。双氢杨梅树皮素能显著地抑制NP、KCl和CaCl2所致兔胸主动脉杂的收缩，量效曲线右移，最大反应降低，对高K 所致兔胸主动脉条收缩的抑制作用明显大于NE所致兔胸主动脉条收缩的抑制作用。双氢杨梅树皮素对NE引起的依赖内Ca2 释放的收缩有明显抑制作用，而对NE依赖细胞外Ca2 性收缩区在较高浓度时才显示抑制作用，提示双氢杨梅树皮素可能对电压依赖性钙通道（PDC）有选择性阻滞作用。     

Bilateral subclavian steal associated with severe coarctation of the thoracic aorta and an aberrant right subclavian artery

A 10-year-old girl having bilateral subclavian steal associated with severe coarctation of the thoracic aorta and an aberrant right subclavian artery was found, on admission, to have no difference between upper and lower extremity blood pressure, but echocardiography revealed severe thoracic aorta coarctation and systolic blood pressure in the carotid arteries exceeding 200 mmHg estimated by Doppler ultrasonography. Magnetic resonance imaging and angiography demonstrated bilateral subclavian steal without esophageal compression. We reconstructed the aortic arch using the left subclavian artery and a reversed Blalock-Park procedure, then repaired the coarctation with a 14 mm woven double velor vascular graft. The girl was symptom-free following uncomplicated recovery from surgery. Doppler ultrasonography 2 weeks after surgery showed the pressure gradient across the aortic arch had decreased from 180 mmHg to 60 mmHg. This residual gradient at the anastomosis between the ascending aorta and left subclavian artery may improve as native vessels grow.     

舒芬太尼复合罗哌卡因用于腹部手术后硬膜外自控镇痛

目的:研究舒芬太尼复合罗哌卡因用于腹部手术后硬膜外自控镇痛(patient-controlled analgesia,PCA)的效果和不良反应。方法:选择全身麻醉耐受能力(ASA)Ⅰ~Ⅱ级择期行腹部手术的88例,随机分为舒芬太尼组和芬太尼组。两组术后分别复合0.2%罗哌卡因行硬膜外PCA,观察并记录两组术后16、32小时的静息、咳嗽、活动时的视觉模拟评分(VAS),实际镇痛时间以及术后恶心、呕吐、尿潴留、呼吸抑制、皮肤瘙痒等不良反应。结果:舒芬太尼组术后16、32小时的静息、咳嗽、活动时的VAS评分与芬太尼组比较,差异具有显著统计学意义(P<0.05);在术后镇痛不良反应中,芬太尼组呼吸抑制发生率为17.8%,舒芬太尼组发生率为0,两组比较,差异具有显著统计学意义(P<0.05)。实际镇痛时间:舒芬太尼组为(46.51±1.32)小时,芬太尼组为(36.24±2.28)小时,两组比较,差异具有非常显著统计学意义(P<0.01)。结论:舒芬太尼复合罗哌卡因用于腹部术后硬膜外PCA较芬太尼复合罗哌卡因镇痛效果好,不良反应小,安全性高。     

3,6-(二甲氨基)-二苯骈碘杂六环葡萄糖酸盐对AGEP引起的大鼠主动脉平滑肌细胞增殖及牛主动脉内皮细胞内皮素和一氧化氮改变的影响

目的 :观察 3 ,6 (二甲氨基 ) 二苯骈碘杂六环葡萄糖酸盐对AGEP引起的大鼠主动脉平滑肌细胞增殖及牛主动脉内皮细胞内皮素和一氧化氮改变的影响。方法 :采用牛血清白蛋白 (BSA)与不同浓度葡萄糖 (0 ,2 0 ,5 0 ,80mmol·L-1)体外孵育制备糖基化终产物 (AGEP) ,应用 [3 H] TdR掺入法和MTT比色法观察I-93对重度糖化的AGEP诱导的大鼠主动脉平滑肌细胞 (ASMC)增殖的影响 ;应用放射免疫技术及Greiss法观察I -93对AGEP引起的牛主动脉内皮细胞 (BAEC)释放内皮素 1(ET 1)和一氧化氮 (NO)的影响。结果 :I-93 10 -7～ 10 -5mol·L-1能明显抑制AGEP引起的ASMC增殖 ,其 [3 H] TdR掺入量和MTT比色法的最大抑制率分别为79 .4%和 44 .2 %。随AGEP糖浓度的增加 (2 0～ 80mmol·L-1) ,BAEC培养液中ET 1含量亦逐渐上升 [(4 93± 63 )～ (779± 10 5 )ng·L-1] ,I -93 10 -7～ 10 -5mol·L-1能明显抑制重度糖化的AGEP促进ET 1释放的作用 ;I -93对AGEP灭活NO的作用有剂量依赖性抑制效应。结论 :I -93有抑制ASMC增殖的作用 ;对AGEP诱导的BAEC释放ET 1和NO间平衡失调有调节作用 ,在防治阻塞性血管疾病方面I -93具有潜在的应用价值     

腹部刀刺伤单纯腹壁清创术的临床应用

目的　探讨单纯腹壁清创术在腹部刀刺伤患者中的应用 ,以提高腹部刀刺伤的治疗水平。方法　我科收治腹部刀刺伤患者中 1 6例进行单纯腹壁清创术 ,对病例选择及其注意事项进行了分析总结。结果　 1 6例患者治疗成功 1 4例 (87.50 % ) ,2例 (1 2 .50 % )中转手术。结论　对于腹部刀刺伤的患者 ,选择适合的病人进行腹壁伤口的单纯清创缝合 ,术后严密观察是可行的。