Pyogenic infections of the central nervous system secondary to dental affections—a report of six cases

Pyogenic infections of the central nervous system of dental origin are quite uncommon in industrialized countries. We report six cases with intracerebral (n=4) and intraspinal (n=2) infections treated in our hospital. The microbial pathogen was successfully isolated in all patients. Fusobacterium nucleatum as well as Streptococcus species were found in three cases. Bacillus species were identified in two patients. Actinomyces was the etiologic agent in one case. All patients suffered from dental pathologies, so that after clinical and radiological exclusion of other sources an oral focus was presumed. Therapeutic management consisted of an operative procedure in order to obtain decompression, as well as evacuation of the pus on the one hand, followed by targeted antibiotics on the other. Clinical improvement was achieved in all patients, with one patient lost to follow-up. On magnetic resonance tomography, the inflammatory changes also disappeared in all cases. We recommend that oral infection with recurrent bacteraemia should always be considered in the pathogenesis of the so-called “cryptic” intracerebral and intraspinal infections.     

颈丛阻滞下行颈动脉内膜剥脱术--附32例分析

目的观察颈丛阻滞下行颈动脉内膜剥脱术的效果.方法 28名ASAⅡ～Ⅲ级患者行32例颈动脉内膜剥脱术,采用深浅丛联合阻滞,观察围术期血液动力学指标变化,分流管放置率和并发症情况.结果 麻醉后血压和心率与麻醉前相比差异有显著性(P＜0.05),其它时点与麻醉前相比差异无显著性(P＞0.05).颈动脉夹闭前后收缩压和心率的波动性的差异无显著性(P＞0.05).围术期高血压的发生率为50.0%,低血压6.25%,心动过速28.1%,心动过缓6.25%,分流管放置率6.25%.患者满意率84.4%.无1例改用全麻,无严重围术期并发症.结论颈丛阻滞是颈动脉内膜剥脱术安全、有效的麻醉方法.     

Comparison of propofol induction with thiopentone or methohexitone in short outpatient general anaesthesia

The per- and post-operative characteristics of three different i.v. anaesthetic induction agents were studied double-blindly in 75 patients admitted for outpatient gynaecological dilatation and curettage. All the patients were premedicated with midazolam 0.1 mg/kg i.m. Induction started with alfentanil 0.015 mg/kg i.v. 60 s before either: propofol 2.2 mg/kg i.v., or thiopentone 4.0 mg/kg i.v., or methohexitone 2.0 mg/kg i.v. All the patients received 66% nitrous oxide in oxygen. The propofol patients were significantly better relaxed and had a higher incidence of hypotension during the procedure. The methohexitone patients had higher pulse rates and a higher frequency of hiccups during the procedure. Propofol induction resulted in a faster awakening of the patients and a better recovery function compared with methohexitone for the first 15 min and compared with thiopentone for the first 240 min after the procedure. Postoperative side-effects were less frequent in the thiopentone group, and minor abdominal pain was significantly more frequent in the propofol group. There was no significant difference between the groups for any variable after 240 min postoperatively.     

Gaseous homeostasis during low-flow anaesthesia

The object of this clinical study was to investigate the circle system gas homeostasis during low-flow anaesthesia using a technique designed to keep a constant inspired oxygen fraction of 0.30. Denitrogenation was adequately accomplished with mask preoxygenation, 10 l/min, for 1 min and an initial fresh gas flow of 5 l/min for 6 min after intubation. There was no need to wash out accumulated nitrogen at intervals, since the already low nitrogen concentration in the system tended to decrease after 1 h. The fresh gas flow of nitrous oxide to oxygen ratio and the inspiratory to end-expiratory oxygen concentration difference both reflected the uptake of nitrous oxide. The calculated rates of uptake of nitrous oxide, a subject of controversy, were in accordance with those found by Severinghaus and Barton & Nunn.     

静脉镇静镇痛技术在隆乳术中的临床应用

目的介绍静脉镇静镇痛技术在局部麻醉隆乳术中的应用效果和体会。方法将606例ASAⅠ、Ⅱ级隆乳术患者分为四组,分别采用负荷剂量后持续输注异丙酚-芬太尼(P-F组,n=56)、咪唑安定-芬太尼(M-F组,n=130)、异丙酚-芬太尼-氯胺酮(P-F-K组,n=68)或咪唑安定-芬太尼-氯胺酮(M-F-K组,n=352)复合液的给药方法,调整注速维持镇静深度在改良的警觉/镇静评分2或3分。结果四组患者术中的镇静镇痛效果均满意,呼吸循环功能基本稳定,均在停药3~10min后清醒,但P-F-K组和M-F-K组患者的术中疼痛发生率及程度显著低于P-F组和M-F组。术后随访所有患者均对麻醉效果满意,仅P-F组和P-F-K组分别有11例和5例患者有模糊术中记忆。结论镇静镇痛技术是适用于隆乳局部麻醉手术简单、安全有效的理想麻醉方法,复合使用小剂量氯胺酮能明显减少术中疼痛的发生率,其中以咪-芬-氯复合镇静镇痛的术中疼痛和记忆发生率最低,程度最轻,是适于该手术的最佳镇静镇痛方法。     

宫腔镜手术的麻醉处理

目的探讨宫腔镜手术麻醉方式的选择及其对患者呼吸循环的影响以及对水中毒预防的体会。方法选取416例妇科宫腔镜手术患者,根据手术种类及难易程度分别采用静脉全麻,腰-硬联合阻滞麻醉及静-吸复合全麻。术中连续监测各项生命体征,观察麻醉前后对患者呼吸循环的影响。同时为防止水中毒的发生,凡是手术时间超过1h,膨宫液超过10000ml以上的宫腔镜手术,预防性地应用呋塞米20~40mg。结果静脉麻醉诱导后,全组病人的RR(呼吸频率),HR(心率),MAP(平均动脉压)均有不同程度降低,与诱导前比较有显著性差异(P<0.01)但仍在正常范围内,无需处理,术毕即恢复正常。在正常吸氧情况下SpO2(血氧饱和度)差异无显著性(P>0.05)。联合阻滞麻醉前后各时点的HR,MAP,RR,SpO2均无明显变化。结论虽然宫腔镜手术是微创手术,但潜在的危险性依然存在,对于麻醉来说,除了选择合适的麻醉方式,为手术提供良好的镇静和肌松条件外,还要进行一系列麻醉监测,密切观察患者的各项生命体征,适当地使用呋塞米可有效预防水中毒。     

53例椎管内肿瘤的临床分析

目的对椎管内肿瘤的诊断和手术治疗进行探讨.方法分析53例不同部位的椎管内肿瘤患者的临床表现、诊断和手术治疗.结果术前所有患者依其不同的临床表现,结合相应的检查明确诊断.53例神经鞘瘤中全切除37例,其余均为次全切除或大部切除,手术全切除率为69.8%.术后有5例肌力较术前略有减退,3例变化不明显,其余患者症状均有不同程度的改善或痊愈;1例为转移瘤患者,因全身衰竭在手术中死亡,手术有效率为83.0%.结论椎管内肿瘤患者术前确诊主要依赖MRI,根据肿瘤的部位,早期采取不同的手术方式治疗能取得满意的效果.     

局部麻醉下经电视胸腔镜和小切口开胸诊治胸膜、肺部疾病

目的探讨局部麻醉下经电视胸腔镜和胸部小切口诊治胸膜、肺部疾病的可行性。方法自2002年2月至2005年3月,对30例胸膜、肺疾病患者施行局部麻醉下开胸手术。按手术方法的不同将患者分为两组,小切口开胸组:16例,在局部麻醉下采用胸部小切口在开放性气胸状态下对增厚的胸膜和弥漫性肺疾病进行活组织检查;电视胸腔镜组:14例,在局部麻醉下经胸腔镜在闭合性气胸状态下诊治恶性胸水、复发性气胸等。结果小切口开胸组中行胸膜活检13例,其中10例为恶性肿瘤胸膜转移、胸膜淀粉样变1例、胸膜纤维增生样改变2例;弥漫性肺疾病活检3例,3例中肺间质性纤维化2例、型肺结核1例。电视胸腔镜组14例中,除1例因发现胸腔内有致密粘连而转行全身麻醉下开胸手术外,其余13例均在局部麻醉下完成胸膜活检,复发性气胸肺大泡切除,顽固性胸水的胸膜固定术;电视胸腔镜组中用胸腔镜辅助诊断为恶性胸水4例,肝性胸水1例;胸腔镜辅助治疗10例,其中顽固性(含肝性胸水)胸水行胸膜固定术8例,复发性气胸行肺大泡切除和胸膜固定术2例。两组患者均无手术并发症和死亡。结论局部麻醉下经胸腔镜及胸部小切口能够完成胸膜、肺疾病活检术及简单的手术。该方法经济、微创、对麻醉要求低,有利于临床普遍开展。     

全麻复合硬膜外阻滞与单纯全麻的比较

比较全麻复合硬膜外阻滞和单纯全麻在围术期对机体应激、炎性、免疫等方面的影响。使用全麻加硬膜外麻醉能有效地抑制手术引起的应激反应，稳定循环状态，减少并发症，使病人在术中更为安全平稳，麻醉效果更为可靠，术毕清醒快，术后镇痛有利于术后病人咳嗽咯痰，并且能减轻围手术期对T细胞亚群的影响。