小剂量氯胺酮在断指再植围术期的平衡镇痛作用

目的 观察小剂量氯胺酮在断指再植围术期的平衡镇痛作用。方法 选取ASAⅠ~Ⅱ级断指再植病人120例,随机分为氯胺酮组(K组)和生理盐水组(N组),每组60例。于神经丛刺激仪下行腋路臂丛神经阻滞麻醉,手术开始前5min,K组静注氯胺酮0.15mg/kg,N组静注生理盐水0.15mg/kg。术后两组病人均给予自控静脉镇痛(PCIA),将舒芬太尼150μg加托烷司琼5 mg以生理盐水稀释至120 mL,以2.0 mL/h持续镇痛48h。比较两组臂丛麻醉效果,止血带耐受效果,术后镇痛效果,PCIA需求按压和有效按压次数,术后恶心呕吐、皮肤瘙痒发生率。结果 K组臂丛麻醉效果及止血带耐受效果均优于N组(u=3.154、1.986,P<0.05)。两组术后镇痛效果均满意,视觉模拟评分差异无统计学意义(P>0.05)。K组术后48h内PCIA需求按压和有效按压次数均显著低于对照组(t=5.7、3.7,P<0.05)。两组术后恶心呕吐、皮肤瘙痒发生率差异无统计学意义(P>0.05)。结论小剂量氯胺酮在断指再植围术期中的平衡镇痛作用效果显著,提高了阻滞麻醉的满意率和止血带耐受率,减少了PCIA按压次数,且并未增加病人不良反应。     

甲钴胺对断指再植术后感觉功能恢复的促进作用

目的探讨甲钴胺对断指再植术后感觉功能恢复的促进作用。方法将236例断指再植术后的病人分为5组,A、B、C组分别肌肉注射5001、000、1 500μg甲钴胺,每日1次,共30次,然后改为每日口服1 500μg甲钴胺片剂,累计共4个月;D组每日口服1 500μg甲钴胺片剂,共4个月;E组为阴性对照组。术后不同时间段对手指感觉功能进行评定。结果 A、B、C、D组在术后不同时间段手指感觉功能恢复均明显优于E组(F=11.473~23.388,q=2.533~5.533,P<0.05),感觉功能恢复的效果与应用甲钴胺的剂量呈正相关(r=0.197~0.322,P<0.05),肌肉注射效果优于口服。长期应用甲钴胺不良反应轻微。结论甲钴胺对断指再植术后断指感觉功能的恢复有促进作用,且与药物的剂量呈正相关。     

单环刺缢及同种异体神经制成人工神经修复神经缺损

目的:研究去细胞的单环刺缢体壁和同种异体神经所构成的人工组织神经的组织相容性及其修复神经缺损的效果。方法:取大鼠40只随机分成实验组、自体神经组、硅胶管组、正常组。实验组将去细胞的单环刺缢体壁缝合成神经导管,其内充填去细胞的异体神经,修复大鼠10 mm坐骨神经缺损。术后4月,通过大体观察,组织形态学观察,了解该人工组织神经修复大鼠坐骨神经缺损的疗效。结果:该人工组织神经组织相容性良好,神经功能恢复效果正常组>自体神经组>实验组>硅胶管组,实验组疗效与自体神经组接近,明显优于硅胶管组。结论:将去细胞的单环刺缢体壁和同种异体神经制成人工组织神经修复周围神经缺损是可行的。     

改良型腋窝顶定位穿刺锁骨下位点阻滞麻醉的临床研究

Objective To study the feasibility of subclavicular brachial plexus block with localized puncture at the apex of the axilla.Methods 520 adult patients who underwent upper limb emergency surgery were randomly assigned to receive subclavicular brachial plexus block with localized puncture at the apex of the axilla ( experimental group) and block anesthesia with intraclavicular route ( control group).Patients in both groups received 0.375% ropivacaine, volume (40.0± 2.7)ml.During the 30 minutes after the blockade, the onset and effect of motor and sensory block, the sensory block effect of each nerve branches and integrated effect of nerve block were recorded.The VAS score and acesodyne duration with tourniquet were compared between the two groups at 2, 4, 6 and 8 hours after the drug had been used for 30 minutes.Results Within 30 minutes after the drug was delivered, the onset of motor and sensory block in the experimental group was evidently shorter than that in the control group, while the duration of motor and sensory block was evidently longer ( P ＜ 0.01).There were no statistically significant differences in motor and sensory block score, median nerve block effect and ulnar nerve block effect between the two groups.The musculocutaneous nerve and radial nerve block effects in the experimental group were better than those in the control group ( P ＜ 0.05).After the drug had been used for 30 minutes, VAS score of the experimental group at each point time was significantly lower than that of the oontrol group ( P ＜0.01).The analgesia duration of tourniquet in the experimental group was significantly longer than that of the control group ( P ＜ 0.01 ).Conclusion The modified subclavicular brachial plexus block with localized puncture at the apex of the axilla can provide perfect blockade, satisfactory anesthetic effect and higher safety in upper limb surgery.     

改良型腋窝顶定位穿刺锁骨下位点阻滞麻醉的临床研究

Objective To study the feasibility of subclavicular brachial plexus block with localized puncture at the apex of the axilla.Methods 520 adult patients who underwent upper limb emergency surgery were randomly assigned to receive subclavicular brachial plexus block with localized puncture at the apex of the axilla ( experimental group) and block anesthesia with intraclavicular route ( control group).Patients in both groups received 0.375% ropivacaine, volume (40.0± 2.7)ml.During the 30 minutes after the blockade, the onset and effect of motor and sensory block, the sensory block effect of each nerve branches and integrated effect of nerve block were recorded.The VAS score and acesodyne duration with tourniquet were compared between the two groups at 2, 4, 6 and 8 hours after the drug had been used for 30 minutes.Results Within 30 minutes after the drug was delivered, the onset of motor and sensory block in the experimental group was evidently shorter than that in the control group, while the duration of motor and sensory block was evidently longer ( P ＜ 0.01).There were no statistically significant differences in motor and sensory block score, median nerve block effect and ulnar nerve block effect between the two groups.The musculocutaneous nerve and radial nerve block effects in the experimental group were better than those in the control group ( P ＜ 0.05).After the drug had been used for 30 minutes, VAS score of the experimental group at each point time was significantly lower than that of the oontrol group ( P ＜0.01).The analgesia duration of tourniquet in the experimental group was significantly longer than that of the control group ( P ＜ 0.01 ).Conclusion The modified subclavicular brachial plexus block with localized puncture at the apex of the axilla can provide perfect blockade, satisfactory anesthetic effect and higher safety in upper limb surgery.     

手部严重热压伤20例的临床治疗

目的 探讨手部严重热压伤有效的临床治疗方法。方法 1998年5月～2001年7月对20例(男15例,女5例,年龄19～45岁)手部严重热压伤患者进行手术治疗,观察治疗效果。结果 所有皮瓣与植皮均全部成活,经过3个月～1年(平均半年)的随访,疗效较满意。结论 根据不同的创面选择相应的手术方法,并应充分考虑到患手的二期手术方案及有效的康复治疗,可最大限度地恢复手的外形和功能。     

拇指及手指再造手术血管危象164例临床分析

目的探讨拇、手指再造血管危象的诱因、处理方法与预防措施。方法复习164例拇、手指再造血管危象的病历，分别记录血管危象的类型、发生时间、诱发原因、处理方法与转归，并对结果进行统计、分析。结果本组血管危象发生率为18．4％。其中动脉栓塞85例，动脉痉挛52例，静脉栓塞6例，静脉痉挛14例，动静脉均栓塞7例，经处置后，缓解150例188指，坏死14例14指，处置成功率为93．1％(188／202)。结论拇、手指再造血管危象的及时、恰当处置对提高手术成功率至关重要。为了减少血管危象的发生，应采取适当的预防措施。     

急诊修复拇指指腹缺损三种方法的研究

目的 报道采用不同方法急诊修复拇指指腹缺损的疗效。方法 采用示指背侧岛状皮瓣，拇指桡侧指动脉逆行岛状皮瓣转位有趾腹皮瓣游离移植三种方法，为21例线指指腹缺损进行急诊修复。结果 20例以瓣成活，1例失败。术后随访半年－2年，平均10个月。所有皮瓣血运，弹性，质地均良好。指腹二点分辨觉：示指背侧岛状皮瓣平均为92.mm，拇指桡侧动脉逆行岛状皮瓣平均为8mm，趾腹皮瓣平均为5.6mm。结论 急诊修复拇指指腹缺损首选趾腹皮瓣，其次为拇指桡侧指动脉逆行岛状皮瓣或示指背侧岛状皮瓣。     

地塞米松对大鼠布比卡因毒性的影响

目的：比较不同剂量地塞米松对大鼠经卡因毒性的影响。方法：４０只Ｓｐｒａｇｕｅ－Ｄａｗｌｅｙ）大鼠采用双盲法随机分为四组。对照鼠（Ｉ组）腹腔内注射致死量（０．５％,１００ｍｇ／ｋｇ）的布比卡因;观察鼠（Ⅱ－Ⅳ组）在对照鼠用药的基础上分别加用２０ｍｇ／ｋｇ,１０ｍｇ／ｋｇ、５ｍｇ／ｋｇ的地塞米松。给药后有大鼠均先后死亡,中毒和死亡时间均被记录。结果：含地塞米松的Ⅱ～Ⅳ组大鼠呈死亡时间（Ⅳ组〉Ⅲ组〉Ⅱ组