100例妊娠高血压综合征剖宫产麻醉处理

目的:探讨妊娠高血压综合征(妊高征)行剖宫产术的麻醉处理方法。方法:100例妊高征患者行剖宫产术,腰麻-硬膜外联合麻醉98例,气管内全身麻醉2例。结果:98例腰麻-硬膜外联合麻醉者收缩压下降至110 mmHg以下12例,应用麻黄素5 mg,使收缩压上升至120 mmHg以上;2例全麻术毕清醒拔管,无烦躁不安和抽搐。全组病例手术过程顺利,术后经综合治疗,母婴平安,均无任何并发症发生。结论:术前全面了解病情,充分完善术前准备,选择合理的麻醉方法,围术期对患者的合并症进行积极治疗,采取止惊、降压、强心、利尿、扩容等综合措施,是提高妊高征患者麻醉成功的重要因素。     

急性高容量血液稀释对全髋关节置换术患者血浆杀菌/通透性增加蛋白表达的影响

Objective To study the effect of acute hypervolemic hemodilution on expression of plasma bac-tericidaL/permeability-increasing protein (BPI) in patients undergoing total hip replacement. Methods Twenty ASA Ⅰ-Ⅱ patients undergoing elective total hip replacement were randomly divided into two groups (n=10 for thesia. The blood loss,blood transfusion and the time of operation were recorded. Venous blood samples were taken before anesthesia (T0) ,at the begining of operation (T1) ,30 min after operation (T2) ,and at the end of operation (T3) for determination of plasma bactericidal/permeability-increasing protein. Results The blood loss and the blood transfusion in HES group were significantly lower than that of LR group[blood loss: (560±90)ml vs (810±110) ml and blood transfusion: (200±100) ml vs (600±200) ml,t=5.562 and 5.657,P<0.001]. The plasma BPI concentrations in HES group were significantly increased at T2～T3 as compared to baseline value at T0 [(8.9±1.6)μg/L,(13.4±1.2)μg/L and (4.9±1.2)μg/L,P<0.05]. The plasma BPI concentrations in LR group were significantly increased at T2～T3 as compared to baseline value at T0 [(7.3±1.2)μg/L,(9.9±0.8) μg/L and (5.0±1.1)μg/L,P<0.05],but were lower than those in HES group (t=2.530 and 7.674,P=0.021 and 0.001 ). Conclusion Acute hypervolemic hemodilution with 200/0.5 hydroxyethyl starch can reduce blood transfusion during total hip replacement operation and also can increase the BPI level which would beneficial for the immunological function.     

不同剂量氯胺酮对芬太尼诱发呛咳反应的影响

目的对比观察静脉注射氯胺酮对芬太尼诱导的呛咳反应的影响。方法60例患者随机分为3组,A组力月西0.1~0.2 mg/kg,丙泊酚2~3 mg/kg,芬太尼3μg/kg,氯化琥珀胆碱1.5~2 mg/kg;B组力月西0.1~0.2mg/kg,氯胺酮20 mg,丙泊酚2~3 mg/kg,芬太尼3μg/kg,氯化琥珀胆碱1.5~2 mg/kg,C组力月西0.1~0.2 mg/kg,氯胺酮40 mg,丙泊酚2~3 mg/kg,芬太尼3μg/kg,氯化琥珀胆碱1.5~2 mg/kg。观察呛咳反应的发生率。结果呛咳反应发生数A组8例,B组3例,C组2例;B组、C组与A组比较差异有显著意义,B、C两组比较差异无显著性。结论静脉注射20 mg或者40 mg氯胺酮可以有效减轻芬太尼诱导的呛咳反应。     

光索与喉镜插管对血流动力学的影响

目的:探讨光索与喉镜插管对学流动力学的影响.方法:40例病人随机分为两组每组20例,分别用光索和喉镜插管,观察插管前后血压、心率的变化.结果:光索插管对血压、心率的变化要弱于喉镜插管.结论:光索插管安全可行,有利于插管时学流动力学的稳定,值得临床推广.     

急性高容量血液稀释对全髋关节置换术患者血浆杀菌/通透性增加蛋白表达的影响

Objective To study the effect of acute hypervolemic hemodilution on expression of plasma bac-tericidaL/permeability-increasing protein (BPI) in patients undergoing total hip replacement. Methods Twenty ASA Ⅰ-Ⅱ patients undergoing elective total hip replacement were randomly divided into two groups (n=10 for thesia. The blood loss,blood transfusion and the time of operation were recorded. Venous blood samples were taken before anesthesia (T0) ,at the begining of operation (T1) ,30 min after operation (T2) ,and at the end of operation (T3) for determination of plasma bactericidal/permeability-increasing protein. Results The blood loss and the blood transfusion in HES group were significantly lower than that of LR group[blood loss: (560±90)ml vs (810±110) ml and blood transfusion: (200±100) ml vs (600±200) ml,t=5.562 and 5.657,P<0.001]. The plasma BPI concentrations in HES group were significantly increased at T2～T3 as compared to baseline value at T0 [(8.9±1.6)μg/L,(13.4±1.2)μg/L and (4.9±1.2)μg/L,P<0.05]. The plasma BPI concentrations in LR group were significantly increased at T2～T3 as compared to baseline value at T0 [(7.3±1.2)μg/L,(9.9±0.8) μg/L and (5.0±1.1)μg/L,P<0.05],but were lower than those in HES group (t=2.530 and 7.674,P=0.021 and 0.001 ). Conclusion Acute hypervolemic hemodilution with 200/0.5 hydroxyethyl starch can reduce blood transfusion during total hip replacement operation and also can increase the BPI level which would beneficial for the immunological function.     

无张力修补术在治疗腹股沟疝中的临床应用分析

目的：探讨无张力修补术在治疗腹股沟疝中的临床应用效果。方法选取我院收治确诊腹股沟疝患者60例,随机分为对照组与观察组各30例。对照组给予传统的疝修补术进行治疗,观察组采取充填式无张力修补术进行治疗,比较2组患者的各项指标及并发症发生情况。结果观察组手术所用时间、住院时间、术后下床活动时间均低于对照组（P〈0.05）;术后切口感染、尿潴留、切口出血、阴囊水肿等并发症发生情况优于对照组（P〈0.05）。结论采用充填式无张力修补术治疗腹股沟疝手术操作简单、所用时间短、术后恢复快,且对患者损伤小,安全可靠,临床效果显著。     

辨证治疗重症水肿一例

患者张××,男,55岁,社员。于1982年7月4日住院。该患自诉,浮肿十五天。半月前因感冒而出现发热、恶寒,眼睑浮肿、伴尿少黄赤,眩晕,腰痛。四诊所见:精神不振,面色萎黄,眼睑如卧蚕状,腹水+,阴囊部肿大积水,双下肢按之凹陷。舌体胖,两脉弦滑有力。血压180/120mmg,体温:37.7℃,脉搏80次/分,血常规。血红蛋白11.5g,红细胞:400万、白细胞:14200、中性:64％、淋巴36％,尿     

急性高容量血液稀释对全髋关节置换术患者血浆杀菌/通透性增加蛋白表达的影响

Objective To study the effect of acute hypervolemic hemodilution on expression of plasma bac-tericidaL/permeability-increasing protein (BPI) in patients undergoing total hip replacement. Methods Twenty ASA Ⅰ-Ⅱ patients undergoing elective total hip replacement were randomly divided into two groups (n=10 for thesia. The blood loss,blood transfusion and the time of operation were recorded. Venous blood samples were taken before anesthesia (T0) ,at the begining of operation (T1) ,30 min after operation (T2) ,and at the end of operation (T3) for determination of plasma bactericidal/permeability-increasing protein. Results The blood loss and the blood transfusion in HES group were significantly lower than that of LR group[blood loss: (560±90)ml vs (810±110) ml and blood transfusion: (200±100) ml vs (600±200) ml,t=5.562 and 5.657,P<0.001]. The plasma BPI concentrations in HES group were significantly increased at T2～T3 as compared to baseline value at T0 [(8.9±1.6)μg/L,(13.4±1.2)μg/L and (4.9±1.2)μg/L,P<0.05]. The plasma BPI concentrations in LR group were significantly increased at T2～T3 as compared to baseline value at T0 [(7.3±1.2)μg/L,(9.9±0.8) μg/L and (5.0±1.1)μg/L,P<0.05],but were lower than those in HES group (t=2.530 and 7.674,P=0.021 and 0.001 ). Conclusion Acute hypervolemic hemodilution with 200/0.5 hydroxyethyl starch can reduce blood transfusion during total hip replacement operation and also can increase the BPI level which would beneficial for the immunological function.     

老年胆道疾病外科治疗的探讨

我院与附属医院外科1984年～1997年共收治经手术治疗的胆道疾病患325例，其中60岁以上老年人66例，占20．31%，现将有关资料分析如下。     

重症急性胰腺炎74例诊治探讨

重症急性胰腺炎起病急四,病情发展迅速并发症多,病死率高,是腹部外科的严重疾病之～。1982年8月～1997年8月,我院收治需经手术治疗的重症急性胰腺炎74例,占同期胰腺炎的33．48％,报道如下：1临床资料1．l一股资料本组74例,男28例,女46例：年龄28岁～66岁,发病距入院时间为：6h～4d,平均ZI3d。距手术时间最短8h,最长4d,平均2．13d。丑．2病史诱［k经手术证实有胆源性疾病（结石感染）30例;l‘,4054％;暴饮暴食和酗酒后发病41例,占55．4％;光明显诱因3例,占4．16％。1．3化验检杏血淀粉酶（温氏）升高＞128U58例;尿淀粉…