经皮扩张性气管切开术的临床应用

目的：探讨经皮扩张性气管切开术行气管切开及气道套管插入的方法与效果。方法：在内科ICU病房内，采用一步性扩张气管切开术，对35例患者进行气管切开，同时采用纤维支气管镜对其中l0例患者进行气道内检查。结果：按照操作规程，均完成了气管切开及气管套管的插入，平均操作时间为5．4min．所有患者在带管过程中及拔管后，未发现有气道狭窄的发生，无瘘管或瘘道形成，且创口愈合良好。结论：经皮扩张性气管切开术操作简便易行，值得临床推广使用。     

左双腔支气管导管管端位置与吸气峰压变化的关系

目的 观测无隆突钩双腔支气管导管(DLT)管端位置与吸气峰压(Ppeak)以及肺顺应性环形状改变的关系，探讨用Ppeak和顺应性环的变化评估DLT管端位置的可行性。方法 拟行右侧剖胸手术的成年患者32例，静脉诱导后插入左Mallinckrodt DLT，吸入氧化亚氮和地氟醚维持麻醉。按纤维支气管镜(FOB)确认DLT管端位置和通气方式将观测过程分为四个阶段：第一阶段(S1)，管端位置正确的双肺通气；第二阶段(S2)，管端位置正确的左侧单肺通气；第三阶段(S3)，管端插入左下支气管(置管过深)的左侧单肺通气；第四阶段(S。)，管端处在左支气管开口(置管偏浅)的左侧单肺通气。每阶段均机械通气15min。结果 回归方程预计插管深度与FOB检查符合者占71．9％。S2时Ppeak值比S1时增加50．8％，肺顺应性(Cdyn)值减少36．2％；S3时Ppeak值比S1时增加87．4％，Cdyn值减少56．8％。PV环曲线斜率向右明显移位，环体显著延长。结论 用无隆突钩DLT行肺隔离，在无FOB定位的条件时，联合应用听诊法、回归方程预计插管深度、动态监测气道峰压和P-V环的变化综合评估，可提高DLT管端的正确到位率。单肺通气的气道峰压超过双肺通气时的1．65倍，且气道峰压超过25cm H2O．应高度怀疑DLT管端发生过深移位。     

PRENATAL DIAGNOSIS Ⅰ. EARLY DIAGNOSIS OF OPEN NEURAL TUBE DEFECTS BY QUALITATIVE ACETYLCHOLINESTERASE ISOENZYME IN AMNIOTIC FLUID

The measurement of amniotic fluid (AF) acetylcholinesterase isoenzyme (AChEI) is a relatively new method for early diagnosis of open neural tube defects (NTDs). As quantitative methods are of unproven reliability at present, the authors used a high resolving power qualitative method-vertical slab polyaerylamide gel electrophoresis. The benefits of this technique are: simplicity of operation, accuracy, unsophisticated equipment, and easily available reagents. Combined results of 9 NTDs studies revealed that samples from early pregnancy gave more accurate results than those from late pregnancy.     

Safe anesthesia for endoscopic laryngeal laser surgery

Anesthesia safety for endoscopic laryngeal laser surgery has been a major limiting factor for laser applications in the larynx and the hypopharynx. Several anesthesia techniques have been proposed and each technique appears to have its own limitations. This paper will deal with the distinct advantages offered by the malleable copper tube which is used for delivery of the open Venturi system anesthesia for endoscopic laser surgery. A retrospective study of 100 patients who have undergone this modality of anesthesia at our institution will be presented. Our conclusion from this study shows clearly the superiority of the copper tube over the conventional aluminium-foil-wrapped endotracheal tube in safety and the exposure of the larynx during surgery.     

小肠内固定术治疗粘连性肠梗阻

目的评价小肠内固定术治疗粘连性肠梗阻的疗效。方法回顾性分析28例粘连性肠梗阻行小肠内固定术患者的临床资料。结果28例患者中有5例发生切口感染,无手术死亡和小肠瘘发生。其中25例患者平均随访23.6个月,1例肠梗阻复发,保守治疗后好转。结论小肠内固定术是治疗预防粘连性肠梗阻可行、有效的方法,但需要注意手术操作细节。     

A clinical comparison of the Laryngeal Tube™ and the Laryngeal Mask™ in spontaneously breathing anesthetized patients

Abstract: Background: The laryngeal mask airway (LMA) can be used in general anaesthesia without neuromuscular block. The laryngeal tube (LT) is a new airway device with similar airway features as LMA. LT is provided with a distal cuff to prevent regurgitation. In this study we compared the LMA and LT concerning patient and user aspects. Methods: Sixty patients with ASA (American Society of Anestesiologists) score 1–2 scheduled for minor surgery were randomized to be ventilated either through LMA or LT. After insertion, the number of insertion attempts, and “positioning” and “airway-assessment” was evaluated. The patients reported on “sore throat” after 30 and 60 minutes and the day after anaesthesia. Results: Gender and mean age were equal in both groups. The first insertion attempt was successful in 25 of 28 patients randomised to LMA and in 23 of 27 patients randomised to LT. LMA was evaluated to be easier in “positioning” whereas no difference in “sore throat” was reported. Conclusion: We found no difference between the LMA and the LT in terms user and patient friendliness and safety.     

肝动脉结扎在重度肝外伤中的临床应用

目的探讨严重肝外伤的治疗和疗效。方法总结分析10年间收治的81例严重肝外伤,按AAST分级法。Ⅲ级30例,Ⅳ级36例,Ⅴ级15例,分别以不同的方法治疗对比。结果治愈71例,10例死于术后胆瘘并发感染及多器官衰竭,为能忽视Ⅲ级肝外的肝动脉结扎及T管引流术。结论肝动脉结扎加网膜及纱布带填塞、不规则的肝叶切除、T管引流、肝血回输,是提高严重肝外伤抢救成功率的重要措施。     

直肠Ca男性患者手术病人麻醉后插尿管的临床观察

目的观察直肠Ca男性患者手术麻醉后插尿管对患者的好处。方法对92例直肠Ca手术男性患者随机分成实验组及对照组进行麻醉后插尿管及常规术前1小时插尿管做法对比。结果直肠Ca手术男性患者选择麻醉后插尿管更优于术前1小时常规插尿管,成功率更高。结论直肠Ca男性患者手术采用麻醉后插尿管值得推广采用。     

高性能战斗机改装体检飞行员的耳功能分析

目的 分析高性能战斗机改装体检飞行员的咽鼓管功能、前庭功能和听功能状况。方法 对改装体检的196名飞行员的耳功能资料进行分析。结果 ①声导抗示196例392耳中193例368耳为A型曲线，6例7耳为AD型曲线，15例17耳为C型曲线。196例392耳均无声反射衰减；②眼震电图示196例前庭功能均正常：③纯音测听以气导在500、1000、2000、3000Hz的平均听阈表示，196例的结果为左耳12．58dB HL；右耳12．48dB HL，但37例47耳有高频区噪声性听损伤的表现。结论 参与高性能战斗机改装体检的飞行员，其耳功能状况总体良好，但部分有噪声性听损伤的应随访观察。     

Laparoscopic choledochotomy with primary closure

Background: Thirty-three patients were candidates for laparoscopic choledochotomy. The indications for this operation are described. Methods: The procedure was completed 32 times (97%). We had 29 successful common bile duct (CBD) clearances, three negative explorations, and one failed clearance which needed to be converted to laparotomy. All the completed procedures ended with primary closure of the main duct. Median duration of surgery was 180 min (range 100–300), including three associated laparoscopic procedures. Results: There were three postoperative complications (9.4%), none major. Average postoperative hospital stay was 7.1 days (range 4–14). In May–June 1995 we controlled 31 out of the 32 consecutive patients (one patient was lost to follow-up) who had a successful laparoscopic choledochotomy from October 1991 to December 1994. Median follow-up was 22 months (range 5–44). Besides clinical control, 23 patients also had ultrasound (US) controls and 24 had blood tests. Eleven had intravenous cholangiotomography. Two patients died 11 and 22 months after the operation for unrelated causes and without biliary symptoms. Two patients had umbilical hernias. One had a small residual asymptomatic stone, which was removed endoscopically. None had signs of postoperative CBD stricture. At US, CBD was ≤7 mm in 15 patients, 8–10 mm in four patients, and 10–12 mm in three patients. The last group had preoperative CBD dilation, too. We could compare preoperative and postoperative CBD diameters in 22 patients: 11 had no change; in nine it decreased; and two had a slight increase (8–10 mm). Conclusions: We conclude that laparoscopic choledochotomy with primary closure is a very good operation: It has a high success rate and low morbidity. Mortality is nil so far. Medium-term results are very positive: We had no CBD stricture and only one case of asymptomatic residual stone, which could have been avoided. Our results suggest that intraductal biliary drainage is useless, and its specific complications are well known. Received: 20 October 1995/Accepted: 28 February 1996