老年股骨颈骨折围手术期的治疗分析

目的探讨老年人股骨颈骨折的治疗及围手术期的处理。方法回顾性分析2003年1月～2006年12月手术治疗的201例老年股骨颈骨折患者资料，其中男51例，女150例，年龄60～98岁，平均78．2岁。按Garden分型，Ⅱ型20例，Ⅲ型86例，Ⅳ型95例。采用多枚中空螺钉固定、Morre型人工股骨头置换术或双极人工股骨头置换手术进行治疗。结果本组患者平均住院10～14d，5～7d即能早期下床活动，住院期间及术后1年内无一例死亡。85％患者获得8个月～4年（平均2年）的随访，功能恢复按Harris评分，优良率为85％。结论老年人各脏器机能衰退，多同时合并各种内科疾病，手术治疗存在风险，但老年人股骨颈骨折的手术治疗仍能取得满意疗效。     

术中磁共振影像神经导航手术的麻醉管理

目的 探讨术中磁共振(iMR)影像神经导航辅助神经外科手术的麻醉管理.方法 22例神经外科手术患者采用核磁兼容或核磁可用的麻醉材料和设备,在全身麻醉(静吸复合或全凭静脉麻醉)下行iMR影像神经导航辅助颅内肿瘤切除术,术中监测心率、有创血压、脉搏血氧饱和度、呼气末二氧化碳分压、七氟醚浓度、中心静脉压以及动脉血气.结果 22例患者肿瘤的全切率从60.0%提高到86.4%.术中患者iMR扫描次数2～5次,手术时间延长1～3 h,术中未发生与麻醉和iMR相关的并发症和意外事件.结论 在iMR影像神经导航下行颅内肿瘤切除术的围术期麻醉处理中关注iMR影像神经导航外科相关的信息、手术室应用环境、麻醉技术和药物的选择以及围术期管理对患者的安全是重要的.     

原发性肝癌肝移植围手术期辅助治疗

目的探讨原发性肝癌肝移植围手术期治疗的现状及研究进展。方法采用文献回顾的方法对原发性肝癌肝移植围手术期治疗的现状及研究进展进行综述。结果原发性肝癌肝移植围手术期治疗的方法包括：肝动脉栓塞化疗、全身化疗、放疗、瘤内无水乙醇注射以及射频毁损等。结论原发性肝癌肝移植围手术期辅助治疗不仅为肝移植患者赢得了手术时间，而且明显提高术后生存率。     

局部手法按摩用于扩张皮瓣的初步探讨

目的总结局部手法按摩用于扩张皮瓣的初步经验。方法自2006年至2007年，我们将手法按摩用于扩张器置入预扩张皮瓣患者21例（35个扩张器）。采用预定的按摩手法，对置入扩张器的皮瓣进行适当按摩。结果本组21例患者，1例因感染取出扩张器，余20例效果满意。与以往未经手法按摩扩张器置入术比较，注水速度明显增快，扩张周期明显缩短。结论局部手法按摩用于扩张皮瓣，安全可靠，效果明显，值得推广。     

胃肠道恶性肿瘤围手术期肠内免疫营养的临床研究

目的评价肠内免疫营养对胃肠道恶性肿瘤术后免疫功能、炎症反应、营养状态、并发症的影响，探讨I临床推广应用的理论依据。方法将90例胃肠道恶性肿瘤随机分为免疫营养组、普通营养组和对照组，术前5天和术后1、8天分别检测多项指标。结果（1）术后免疫营养组免疫指标明显高于另两组；（2）术后免疫营养组的炎性指标明显低于另两组；（3）术后免疫营养组的前白蛋白明显高于另两组；（4）术后免疫营养组的并发症明显低于另两组。结论围手术期肠内免疫营养可在术后早期提高病人的免疫功能，减轻术后应激反应，降低术后并发症的发生率，并缩短平均住院时间。     

168例甲状腺功能亢进症手术的围手术期护理

目的为了观察甲状腺功能亢进症（甲亢）手术的围手术期的护理与疗效。方法全部患者均采用深入细致的心理护理、术前准备和术前术后病情密切观察以及对术后并发症的防治等方法。结果全组手术治疗168例，治愈163例（97．0％），术后并发甲低3例（1．8％），2例（1．2％）死于术后呼吸道误吸窒息及急性左心衰。结论强高甲亢手术围手术期的护理是保证手术安全、减少病死率及术后并发症的重要环节。     

围手术期患者的心理评估及干预

目的探讨围手术期患者的心理状态及干预措施。方法对2009年1月至2010年1月间在我院接受手术治疗的患者92进行心理评估，分析心理状态及干预措施。结果6项心理测试中得0分者以焦虑最多，恐惧次之，再次为孤独、抑郁、疼痛及依赖等因子。本组0～4分者占9．8％，5～8分者占79．3％，9～11分者占10．9％，无0分及无满分者。结论围手术期患者均存在一定的心理问题，需及时给予心理干预措施。     

手法为主综合治疗腰椎间盘突出手术后复发

腰椎间盘突出症所引起的腰腿痛,目前多主张以保守治疗为主,但经手术治疗的也有一定比率。自2000年10月-2005年12月共收治经手术后复发的腰椎间盘突出症19例,临床应用松肌法、分离神经根粘连法、骨盆旋转整脊法、后伸压腰法、纠正脊柱侧弯法为主,结合骨盆牵引中药熏蒸,药物对症治疗为辅,取得了满意的效果。为探究其疗效机制,现总结如下。1临床资料1.1一般资料19例中,男16例,女3例;年龄26~59岁。有劳损、外伤及受凉诱发者12例。发病部位据CT、MRI检查统计:L3,4椎间盘突出1例,L4,5椎间盘突出9例,L5S1椎间盘突出5例,L4,5和L5S1两节段椎间盘…     

Cytochemical Redistribution of 5'-Nucleotidase in the Developing Cat Visual Cortex

The adenosine-producing ectoenzyme 5'-nucleotidase has recently been shown to undergo a marked redistribution during development of the cat visual cortex and to be involved in the remodelling of ocular dominance columns (Schoen et al., J. Comp. Neurol. , 296 , 379 – 392, 1990). Using an enzyme-cytochemical technique, we now investigate the developmental redistribution of 5'-nucleotidase activity in area 17 of kittens at the ultrastructural level. Between postnatal days 35 and 42, when 5'-nucleotidase is concentrated in layer IV, enzyme reaction product occupies the clefts of asymmetrical synapses within the neuropil. During later development (9th and 13th postnatal weeks), when 5'-nucleotidase spreads over all cortical laminae, the enzyme disappears from its synaptic localization and becomes increasingly associated with astrocytic membranes. The transient appearance of 5'-nucleotidase at synapses parallels the time-course and laminar profile of the synaptic remodelling which takes place during the critical period of visual cortex development. This suggests that synapse-bound 5'-nucleotidase activity plays a role in synaptic malleability, whereas its later association with glial profiles is likely to reflect other functions of the enzyme.     

Corticosterone release in response to repeated, short episodes of neonatal isolation : evidence of sensitization

Repeated isolation of neonatal rats produces persistent changes in physiology and behavior. In Experiment 1, we examined changes in plasma corticosterone (CORT) levels as a possible mechanism for the effects of isolation. Pups that were isolated from their mother and the nest for 1 h per day on postnatal days (PND) 2–9 were compared to control litters of pups that were either nonhandled or handled but not isolated. On PND 2, compared to nonhandled pups, handled pups had elevated CORT levels that returned to baseline levels within 30 to 60 min of return to the home cage. No significant elevation of CORT levels were found in handled pups on PND 9. The CORT levels of isolated pups were over twice those of nonhandled pups on PND 2 and four times those of nonhandled pups on PND 9. In Experiment 2, we investigated whether the increased CORT release in response to isolation on PND 9 was the result of the pups treatment on the previous six days as against an effect of maturation. Plasma CORT levels were measured in rat pups that were either isolated, handled or nonhandled on PNDs 2–8 during the conditions of isolation, handling and nonhandling on PND 9. There were no differences among the groups in basal plasma levels of CORT. Handling on PND 9 did not result in elevated CORT levels in any of the groups. All three groups showed a significant increase in plasma CORT levels after isolation on PND 9. However, the CORT response to isolation of pups previously isolated on PND 2–8 were significantly higher than pups that were either handled or nonhandled on PNDs 2–8. Thus, daily episodes of isolation potentiate the hypothalamic-pituitary-adrenal response to stress.