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41.
目的探讨多模式联合镇痛应用于人工关节置换术后的效果。方法选取2011年1月~2013年12月行单侧全髋(THA)、全膝关节置换(TKA)病例138例,年龄53~79岁,平均68.4岁。手术及麻醉均由同一组医生完成。根据镇痛方式分为3组:术后自控静脉镇痛泵组(PCIA,对照组);术后自控静脉镇痛泵+塞来昔布口服组(塞来昔布组);术后自控静脉镇痛泵+塞来昔布口服+罗哌卡因局麻组(罗哌卡因组)。比较术后各组6小时(T1)、12小时(T2)、24小时(T3)、48小时(T4)疼痛视觉模拟评分(VSA)、药物不良反应、病人满意程度、自控追加剂量(Bolus)次数、自控静脉镇痛药用量。结果术后各组T1、T2、T3、T4时间节段点的疼痛VSA评分均无统计学意义。与对照组比较,塞来昔布组和罗哌卡因组药物不良反应减少,镇痛满意度显著升高见(值均<0.05),Bolus次数、舒芬太尼用量显著减少(值均<0.05)。与塞来昔布组比较,罗哌卡因组恶心呕吐、尿潴留的发生率显著降低,镇痛满意度显著升高(值均<0.05),不同时间节段点Bolus次数、舒芬太尼用量显著减少(值均<0.05)。结论自控静脉镇痛泵+塞来昔布口服+罗哌卡因局麻组成的多模式联合镇痛方法有助于降低阿片类镇痛药物用量,减少副作用,提高患者满意度,在人工关节置换术后镇痛疗效确切。 相似文献
42.
M. Konermann J. Grötz B. Sorge-Hädicke B. Sanner 《Journal of molecular medicine (Berlin, Germany)》1990,68(21):1059-1065
Resümee Schwerwiegende gastroduodenale Erkrankungen sind bei fast der Hälfte aller Patienten, die sich einer Operation am offenen Herzen unterziehen müssen, auch bei Fehlen von Symptomen nachweisbar. Das erhebliche Überwiegen von Magenläsionen spricht dafür, daß die arteriosklerotisch bedingte Perfusionsminderung der Schleimhaut die entscheidende Ursache hierfür ist. Routinemäßige präoperative Ösophago-Gastro-Duodenoskopien können die nicht unerhebliche durch gastrointestinale Komplikationen bedingte postoperative Mortalität senken helfen.
Abkürzungen ASS Azetylsalizylsäure - J. Jahre - GI-Trakt Gastrointestinaltrakt 相似文献
Pathological changes in the upper gastrointestinal tract in patients awaiting open heart surgery
Summary While waiting for open heart surgery, in 153 patients (104 male, 49 female, 22–76 years of age) without gastrointestinal symptoms and/or history esophago-gastro-duodenoscopy was performed. 124 patients suffered from coronary heart disease, 29 from valvular defect, aneurysm of the sinus of Valsalva or tumor of the heart.In 47.1% endoscopy revealed serious abnormal findings: in 16.3% gastric ulcer, in 20.9% erosive gastritis, duodenal ulcer and erosive duodenitis in 5.2%, respectively, 1 case of gastric carcinoma, 2 of large polyps and 3 of reflux esophagitis of higher degree (totally 3.9%).In patients with coronary artery disease, the relation of erosive and ulcerous gastric lesions as compared with those of duodenal origin was 41, in patients with other cardiac diseases it was 21, respectively (p<0,001).Compared with a normal population, the incidence of pathological gastric findings was 54-fold higher in our patients, and 1.7-fold concerning duodenal lesions, respectively (p<0.001).51 patients on acethylsalicylic acid (160 mg/ die) showed pathologic findings in 41.2%, and 96 patients without ulcer-inducing therapy in 51%. Thus, low-dose Aspirin does not seem to have serious gastric side effects.The results of the study stress the necessity of routinely performed endoscopy of the upper gastrointestinal tract in patients awaiting open heart surgery. This will lead to a lower incidence of serious gastrointestinal complications postoperatively, which are known to have a high mortality.
Abkürzungen ASS Azetylsalizylsäure - J. Jahre - GI-Trakt Gastrointestinaltrakt 相似文献
43.
44.
45.
Sulimma F Lieb WE 《Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft》1999,96(11):724-727
Fragestellung: Orbitotomien nehmen innerhalb der Ophthalmochirurgie auf Grund der involvierten anatomischen Strukturen und des daraus resultierenden
Spektrums m?glicher perioperativer Probleme eine Sonderstellung ein. Um einen überblick über die Art und H?ufigkeit intra-
und postoperativer Probleme bei Orbitotomien zu erhalten, führten wir eine retrospektive Auswertung an unserer Klinik durchgeführter
Orbitotomien durch.
Patienten und Methode: Es wurden 48 Orbitotomien bei 46 Patienten berücksichtigt, die zwischen 08/1995 und 02/1998 operiert wurden.
Ergebnisse: Schwerwiegende intraoperative Komplikationen waren mit zwei transfusionspflichtigen Blutungen und einer Liquorfistel selten.
Sie wurden interdisziplin?r behandelt. Postoperativ traten vorübergehende funktionelle St?rungen mit guter Rückbildungstendenz
wie Visusminderungen (35 %), Motilit?tsst?rungen mit oder ohne Doppelbildwahrnehmung (20 %) und Lidfehlstellungen auf. Ihnen
liegt v. a. die postoperative ?dem- und H?matombildung zugrunde. Persistierende Funktionseinschr?nkungen waren dagegen selten
(10 %).
Schlu?folgerung: Unsere Untersuchung zeigt, da? perioperativ bei Orbitotomien v. a. vorübergehende funktionelle Einschr?nkungen auftreten,
die sich rasch zurückbilden. Schwere Komplikationen sind dagegen selten, treten v. a. intraoperativ auf und k?nnen eine interdisziplin?re
Therapie erfordern.
相似文献
46.
We programmed a formula which predicts the incidence of either myocardial infarction or cardiac death during the postoperative period. The original formula was proposed by Shah et al, based on their own data and analysis. The program is simple and is written in a language called Quick Basic. The use of this program is also simple. Such a program has improved the use of this analysis substantially. The program has been posted on to a few Computer network services as a free software.(Suwa K, Ogura S: Programming a predictive formula for angina and other risk factors in patients with cardiac diseases undergoing non-cardiac operations. J Anesth 6: 241–242, 1992) 相似文献
47.
四肢骨折术后镇痛治疗的临床观察 总被引:1,自引:0,他引:1
目的通过比较不同的镇痛方案在四肢骨折治疗中的镇痛效果,探讨一种确实有效的符合四肢骨折术后无痛功能锻炼要求的镇痛模式。方法选择2003年8月1日~2003年9月15日50例四肢骨折接受手术治疗的病人,随机分为A、B两组,每组25例,A组接受系统规律的镇痛治疗方案,B组采用传统的疼痛时再给止痛药物的方法治疗,以VAS评分法评判镇痛效果。结果A组患者的VAS评分明显低于B组患者,A组患者开始接受主、被动功能锻炼明显早于B组患者,有利于促进患者术后的康复。结论系统规律的有效镇痛治疗方案,有利于患者的早期功能锻炼,降低术后并发症,促进患者的早期康复。 相似文献
48.
Lindahl SG 《Acta anaesthesiologica Scandinavica》2000,44(8):906-909
During the first decade of the new millennium the intense reorganization of hospitals and of medical care will be replaced by stability and long-term goals. An anesthesiologist is now as active outside as within the operating theater, being a predominant resource in intensive care, pain management, emergency and prehospital care. The anesthesiologist will also have a key part to play in risk analysis of patients scheduled for various kinds of advanced treatment. Anesthesiologists are now also more involved in primary home care where, together with other physicians and categories of health care providers, they offer qualified treatment of various diseases at home – the environment preferred by the patient. 相似文献
49.
Prävention perioperativer Myokardischämien – ein Update 总被引:2,自引:0,他引:2
Perioperative cardiac morbidity and mortality are a major health care challenge with important individual as well as economic aspects. Up to 30% of all perioperative complications and up to 50% of all postoperative deaths are related to cardiac causes. Perioperative myocardial ischemia, which occurs in more than 40% of patients with or at risk for coronary artery disease and undergoing noncardiac surgery, represents a dynamic predictor of postoperative cardiac complications. Long-duration myocardial ischemia and ischemic episodes associated with myocardial cell damage are particularly of prognostic relevance. In patients suffering from this type of ischemia, the incidence of adverse cardiac outcome is increased up to 20-fold. Reducing the incidence of perioperative myocardial ischemia is associated with a decrease in adverse cardiac outcome. Important issues related to perioperative myocardial ischemia are hematocrit level, body temperature, and hemodynamic variables. In contrast, the choice of anesthetic agents and techniques appears to be less important. Perioperative administration of anti-ischemic drugs in patients at risk, however, leads to a further decrease in the incidence of myocardial ischemia and to an improvement in patient outcome. Recent studies suggest that alpha 2-agonists and particularly beta-adrenoreceptor blocking agents are effective anti-ischemic drugs in the perioperative setting. Perioperative administration of beta-adrenoreceptor blocking agents in coronary risk patients undergoing noncardiac surgery is associated with a reduced rate of postoperative cardiac complications and an improvement in long-term outcome. This is particularly relevant in high risk patients with preoperative stress-induced ischemic episodes. In clinical practice, therefore, chronically administered anti-ischemic drugs should also be administered on the day of surgery and during the postoperative period. In untreated patients with or at risk for coronary artery disease and who have to undergo urgent surgical procedures without the opportunity of preoperative anti-ischemic intervention, perioperative administration of beta-adrenoreceptor blocking agents is mandatory. 相似文献
50.