心脏瓣膜置换术后循环呼吸骤停的复苏

心脏瓣膜置换术后发生循环呼吸骤停复苏成功的病例,国内外很少报道。近年来,我院加强医院病房(ICU)遇到2例心脏瓣膜置换术后循环骤停、心肺脑复苏(CPCR)成功的病例,报告讨论如下。     

356例隆乳术和麻醉问题的探讨

隆乳术是应用在美容外科中最常见的一项体形塑型术，针对３５６例患者的手术切口、假体使用、放置部位以及出血、感染、硬化变形等并发症作了分析，尤其对隆乳术的麻醉方法的改进和探讨文中进行阐述。过去单纯局麻手术，因麻醉不全和时间不足可导致病人止痛不全，紧张不安，追加剂量少数引起毒性反应，近５年改用不同浓度局麻药应用，控制总量在４００ｍｇ以内，配合静脉强化麻醉，必要时静注或静滴氟胺酮，效果好，无并发症。     

咽后壁脓肿致气道梗阻强化治疗一例报告

病例报告患儿女性,80天,体重4.5公斤,因感冒鼻塞,咳嗽,呼吸困难症状加重入院。经查,左侧咽后壁肿胀明显,张口困难,但不发热。摄片报告:咽后壁软组织明显肿胀,呼吸道变狭。诊断为咽后壁脓肿。患儿发育营养较差,张口呼吸困难,两肺呼吸音较粗,律齐。患儿入院后即行咽后壁脓肿切开引流术,术中见左侧咽后壁肿胀明显,用穿刺针接吸引器抽吸,     

急性呼吸窘迫综合征的急救处理

报告3例重症呼吸窘迫综合征急救成功的体会。认为对长时间休克,短时间大量输血输液,循环呼吸停止复苏的病例,术后24小时内应高度警惕,及时防治;机械通气宜早使用麻醉机或呼吸器施行通气治疗;休克纠正后应根据血压、CvP 和尿量控制入量,要使肺动脉压     

嗜铬细胞瘤摘除术对葡萄糖代谢的影响

嗜铬细胞瘤为分泌肾上腺素和(或)去甲肾上腺素的良性或恶性肿瘤。由于肾上腺素能受体阻滞剂的应用,促使术中、术后循环稳定,从而提高了麻醉手术的安全性。近七年来在国外文献虽已有嗜铬细胞瘤摘除术后发生严重低血糖的零星报道但至今关于该肿瘤对糖代谢的影响仍未受到足够的重视。为此,我们观察了嗜铬细胞瘤摘除术对糖代谢的影啊,并就术后低血糖问题进行讨论。     

EFFECTS OF HIGH DOSE NARCOTICS AND CONTROLLED HYPOTENSORS ON THE HEART CONDUCTION SYSTEM

The effects of narcotics on the heart conduction system were studied in 51 rabbits. It was found that at equal efficacy dosages, the effects of high dose morphine, pethidine and fentanyl on the heart con duction system differ. Morphine 3 mg/kg injected iv did not influence the heart conduction system; fentanyl 30 ug/kg might improve both sinus node automaticity and sino-atrial conduction and pethidine 30 Vg/kg might seriously harm the heart conduction system. So fentanyl may be an ideal narcotic in patients with sick sinus syndrome. But when the dosage of fentanyl was increased t0 75 yg/kg, the sinus node was inhibited. The degree of pethidine effect upon the heart conduction system depends upon the dosage and rate of injection. The effects of controlled hypotensors on the heart conduction system were studied in 48 dogs. Trimethaphan (TMTP), sodium nitroprusside (SNP) nitro-glycerine (NG) and phentolamine (PA) were dripped iv respectively to lower the blood pressure by 30-40%. Five and 60 minutes after TMTP ad- ministration the atrio-ventricular junction was in inhibited and at 60 minutes the sino-atrial conduction was also inhibited. NG had no influence on the heart conduction system but SNP might inhibit the sinus node automaticity PA may also inhibit the sino atrial conduction, so this agent contraindicated in patients with sick sinus syndrome or sino-atrial block.     

嗜铬细胞瘤切除术病人围手术期的血压变化及处理(23例临床分析)

嗜铬细胞瘤切除时围手术期血压的急剧波动是影响这类病人手术安危的关键。现就我院近几年中23例嗜铬细胞瘤切除术病人围手术期的血压、心率变化及其处理作一临床分析。一般资料全组23例,男16,女7,年龄12～58岁(平均33.56岁)。肿瘤位于肾上腺19例(其中1例为双侧),腹主动脉旁1例,膀胱2例,后腹膜1例。均经病理诊断为嗜铬细胞瘤,其中良性22例,恶变1例。所有     

嗜铬细胞瘤病人的麻醉处理

嗜铬细胞瘤是较罕见的疾病,其发病率占高血压病人的0.4～2％。Grahan(1951)报道了术前已明确诊断的病人在手术切除时死亡率为25％,术前未确诊的病人手术的死亡率上升到50％。目前随着外科和麻醉技术的改进以及对这种疾病治疗的进展(最好的诊断方法,控制高血压发作的最有效药物及对此病和低血容量问题的更一步的认识),使死亡率降至1～5％。     

溴化二甲基轮环藤宁对心内传导系统的影响(摘要)

20只家兔静注溴化二甲基轮环藤宁(以下简称环轮宁,系中草药千金藤的生物碱)1mg/kg,窦房传导时间(SACT)明显缩短(P>0.01),表明环轮宁可以改善窦房传导功能,窦房结恢复时间(SNRT)明显延长(P>0.01),但校正窦房结恢复时间(CSNRT)及窦房结恢复时间指数(SNR-TI)无改变,表明此剂量环轮宁不抑制窦房结自律性,SNRT延长系由于心率减慢所致。P-R间期无延长,提示环轮宁不抑制房室交界区的传导。     

老年患者心肺脑复苏

心跳骤停发病突然,发病时情况往往千差万别,本文报告一例79岁高龄患者心跳骤停后抢救复苏成功的经过。患者衡某,男,79岁。腹部胀痛伴恶心呕吐6天,诊断为肠梗阻、中毒性休克。既往有冠心病、房颤及老慢枝肺气肿病史多年。急诊入院后,在全麻下行剖腹探查术,术中见阑尾坏疸穿孔,束带形成至机械性肠梗阻。术前,术中心电监护均示快速房颤。术后送入监护病房加强医疗。入室时患者麻醉尚未清醒,保