高血压脑出血无创定位穿刺引流治疗的临床研究

目的：探讨无创立体定位穿刺引流治疗高血压脑出血的准确性和安全性。方法：高血压脑出血患者127例,经CT定位,采用青岛嘉隆科技发展有限公司生产的立体定位器在血肿内置管,对血肿采取无创立体定位穿刺进行液化、引流治疗.结果：血肿内置管准确,误差小于0.3 cm;48 h内71.7%的患者血肿被有效清除,死亡13例,总死亡率占10.2%。结论：无创立体定位穿刺血肿引流术操作简单,定位客观,精确度高,能迅速有效的引流清除血肿,对治疗高血压性脑出血效果显著。     

A MODIFIED SUCTION DRAINAGE DEVICE

A simple modified suction drainage device made from Gibbon catheter and intravenous fluid glass bottle is described. It is cheaper than the suction drains available in the market and useful to general surgeons in peripheral hospitals.KEY WORDS: Drainage, Suction     

Comparison of four-day and ten-day post-mastectomy passive drainage in Accra, Ghana

OBJECTIVES: To determine the optimum period for passive post-mastectomy drainage in Accra, Ghana, comparing early (day 4) to late (day 10) drain removal. DESIGN: Randomised prospective clinical study. SETTING: Surgical Department, Korle Bu Teaching Hospital, Accra, Ghana SUBJECTS: Patients with breast cancer scheduled for total mastectomy and level 11 axillary clearance. INTERVENTIONS: Patients were randomised to one of the two groups: early (day 4) and late (day 10) passive drainage. MAIN OUTCOME MEASURES: Duration of hospital stay, seroma formation and postoperative wound infection. RESULTS: Forty five patients had 4-day drainage and 42 had 10-day drainage. Late removal of drains (Day 10) was associated with a significantly higher drainage (1123ml) than those with early (4-day) drain removal (571 ml); p=0.0019. Late removal, however, had fewer seromas (28.6% vs. 46.7%; p=0.2), smaller aspirate volumes (435ml vs. 563ml) and fewer number of aspirations (2.1 vs. 3.2). Early removal had a shorter hospital stay of 6.2 (+/-1.52) days compared to 11.07 (+/- 0.76) days for late removal, and a lower wound infection rate (2.2% vs. 9.5%). There was a low incidence of seromas when drainage was <30 ml/day at the time of drain removal. CONCLUSIONS: Post-mastectomy passive drains may be removed when drainage is <30 ml in 24 hours. When there is a persistent large volume of axillary drainage, patients should be counselled about the relative risks of early and late drain removal. For patients who do not find seroma aspiration unacceptable, early (day 4) removal appears preferable to late (day 10) removal of drains.     

慢性硬膜下棚中术后使用引流管有效吗

慢性硬膜下血肿会导致很高的致残率和死亡率。目前，慢性硬膜下血肿术后引流管的使用取决于医师的个人习惯。术后使用引流管对慢性硬膜下血肿患者预后的影响还没有明确的结论。针对这个问题，剑桥大学的一个研究小组进行了长达三年的研究。他们的研究结果提示，慢性硬膜下血肿术后使用引流管可以显著地降低复发率和六个月内的病死率。     

A regional survey of chest drains: evidence-based practice?

Although the use of chest drains is common in medicine, there appear to be wide variations in practice. A survey was therefore conducted to establish the current status of chest drain management in the Northwest region. A questionnaire targeted consultants practising in the specialties of chest medicine, general surgery, accident & emergency and cardiothoracic surgery. The questionnaire consisted of five sections encompassing aspects of the insertion, day-to-day care and removal of chest drains. With an overall response rate of 75.3% (110/146), important variations in every major aspect of the practice of chest drains were found between the specialties and to a large extent within each specialty. We have made a number of recommendations which aim to encourage good practice and reduce unnecessary complications, including the adoption of standardised protocols for inserting and managing chest drains.     

多槽硅胶引流导管在微创胸外科的临床应用

目的 探讨多槽硅胶引流导管在微创胸外科手术中的可行性,评价术后应用该引流系统的优越性。 方法 选取2016 年1 月-2017 年9 月该院行胸腔镜手术的患者160 例,根据术后应用引流管不同,将其分为 负压组（应用多槽硅胶引流导管+ 自带负压硅胶球囊）和对照组（传统胸管+ 水封瓶）,每组各80 例。比较 两组术后24 h 胸腔引流量、总引流量、拔管时间、术后胸穿次数、术后住院时间、术后第1 天与第3 天疼痛 程度（NRS 数字分级法）及术后胸腔出现活动性出血引流效果。结果 两组总引流量比较,差异无统计学意 义（P >0.05）;负压组术后24 h 胸腔引流量升高、拔管时间缩短、胸穿次数减少、术后住院时间缩短及疼痛评 分降低,负压组优于对照组（P <0.05）。负压组2 例48 h 时、对照组2 例24 h 时因活动性出血而再次手术止血。 结论 多槽硅胶引流导管临床应用有一定优势,但因引流槽较细、有活动性出血时易堵塞而形成凝固性血胸, 故需把握不同引流装置的指征。     

肝移植术后不常规放置腹腔引流管安全性及可行性探讨

目的:探讨肝移植术后不放置腹腔引流管的安全性及可行性?方法:回顾2010年1月~2013年8月在南京医科大学第一附属医院肝移植中心行肝移植术的患者资料,根据术中是否放置腹腔引流管分成引流组(n = 63)和非引流组(n = 112)?分析比较患者术前因素?术中因素以及围手术期并发症和住院时间?结果:患者在术前因素及术中腔静脉阻断时间?门静脉阻断时间及术中出血?输血情况均未见显著差异?两组患者术后并发症分级(P = 0.78)以及腹腔引流管相关并发症(出血?胆漏?大量腹水?切口渗液等)均未见明显差异?而两组在ICU住院天数及术后住院天数有显著差异(P < 0.01)?结论:肝移植术后不放置腹腔引流管是安全的?     

肝切除术后胆漏的处理

目的探讨肝切除术后胆漏的发生及处理。方法回顾性分析441例无胆道重建肝切除术后胆漏的发生情况和处理方式。结果441例肝切除后出现胆漏21例,发生率为4．8％,其中原发性肝癌11例,转移性肝癌1例,肝脓肿2例,肝血管瘤2例,肝胆管结石5例。经腹腔充分引流治愈12例,行内镜下胆管支架引流或鼻胆管引流治愈6例,再手术2例,1例死于术后肺部感染和腹腔感染。结论经腹腔充分引流或鼻胆管引流和胆管支架置入可有效治疗胆漏,尽量避免早期再次手术。     

The urine bag used in pneumothorax

Pneumothorax is the presence of air in the pleural cavity. It can be classified into spontaneous, traumatic or iatrogenic. The majority of pneumothorax cases are spontaneous, which can be further classified into primary spontaneous pneumothorax (PSP) or secondary spontaneous pneumothorax (SSP), defined by the absence or presence of obvious underlying lung disease respectively. The treatment of spontaneous pneumothorax includes simple aspiration, intercostal tube drainage or surgical intervention. When intercostal tube drainage is used, it is usually attached to an underwater-seal system. Mobile chest drains, such as the Heimlich valve, replace the underwater-seal and allow outpatient management of spontaneous pneumothoraces. The Heimlich valve however, is costly and not readily available in many local hospitals. Cheaper and easily obtainable alternatives which are also safe are being sought. This is a case report describing the use of the urine bag in the management of a patient with spontaneous pneumothrax.     

经皮肝穿刺胆道内引流的临床应用

本文报道了24例经皮肝穿刺胆道内引流,对黄疸病人效果显著。内引流使大部分胆汁通过多侧孔引流导管顺行进入十二指肠,避免外引流丢失大量胆酸、纳和水分,有利病人恢复。内引流可对胆道晚期肿瘤患者行姑息性治疗;对高度危险的深度黄疸病人作术前准备;并对急性梗阻性化脓性胆管炎病人行有效的胆道减压和引流作用。并对内引流的适应证、禁忌证、操作方法,结果和并发症作了详细的讨论。     

Spontaneous pneumothorax: use of aspiration and outcomes of management by respiratory and general physicians

Background: Spontaneous pneumothorax is a common problem in hospital practice. Despite the publication of guidelines controversy over its initial management still exists, particularly over the use of simple aspiration. Methods: The management of spontaneous pneumothorax by respiratory and general physicians at our hospital was analysed by retrospective case note review. Eighty five patients were identified over the study period (36 managed by respiratory and 49 by general physicians). Results: There was a significantly greater use of simple aspiration by respiratory (81%) than general physicians (47%, p<0.001) and a higher rate of success in this group. As a result those patients managed by respiratory physicians had fewer intercostal drains inserted and significantly shorter length of stays (mean 5.6 (3.8) days respiratory group and 9.5 (6.8) days in general physicians group, p<0.05). Conclusions: The greater and more successful use of simple aspiration by respiratory physicians as an initial treatment for spontaneous pneumothorax resulted in improved outcomes and reduced length of hospital stays.     

重症急性胰腺炎非手术治疗方法的探讨

为探讨重症急性胰腺炎 (SAP)的非手术治疗措施及中转手术的时机。对 2 2 3例SAP患者均先行包括重要脏器功能的支持、防治感染及促进胃肠功能恢复等非手术综合治疗 ,以后根据有无胰腺感染等并发症决定是否中转手术。结果 :前期组 ( 1 990～ 1 994年 ) 97例 ,患者一经诊断胰腺感染即手术治疗 ,病死率为 1 1 .3% ;近期组 ( 1 995～1 999年 ) 1 2 6例 ,选择性延期手术 ,将胰腺感染局限作为手术时机 ,病死率为 5.6%。全部患者非手术治疗过程中因胰腺感染中转手术 2 3例 ,其中胰腺感染局限者的手术病死率 ( 7.7% )显著低于感染未局限者 ( 50 % ) (P <0 .0 5)。结果提示 ,SAP应以积极、有效、综合的非手术治疗为主 ,胰腺感染局限者中转手术的效果优于感染未局限者     

腹腔引流管在普外手术中的应用观察

目的探讨腹腔镜引流管在普外科患者手术中的应用价值,以提高普外科患者临床治疗效果。方法选取某院普外科2012年5月—2014年7月收治的120例患者为研究对象,按照收治时间分为对照组与研究组各60例,对照组实施普外科手术进行治疗;研究组在普外科手术基础上运用腹腔引流管进行治疗,对比两组患者临床治疗效果（术后并发症、临床治愈率、出血例数）。结果研究组普外科患者通过采用腹腔引流管,并发症发生4例（6.7%）、临床治愈54例（90%）、出血2例（3.3%）,明显优于对照组8例（13.3%）、48例（80%）、4例（6.7%）,取得了比较理想的临床治疗效果,差异有统计学意义（P〈0.05）。结论通过对实施普外手术患者运用腹腔引流管,能够显著降低患者术后并发症、出血几率,提高临床治愈效果,具有较高的临床应用价值,值得在普外科手术中推广使用。     

呼吸科和全科医生采用抽气法治疗自发性气胸的对比

背景自发性气胸是一种常见病,对它的初始治疗方法目前仍有争议,尤其是单纯抽气法.目的对比呼吸科和全科医生采用抽气法治疗自发性气胸的使用率及疗效的区别.方法回顾由我院呼吸科医生及全科医生处理的共85例患者的临床资料,其中36例由呼吸科医生处理,49例由全科医生处理.结果呼吸科医生明显倾向于使用单纯抽气(81%),显著高于全科医生(47%,P＜0.01),并且成功率较高.呼吸科医生处理的患者最终需要闭式引流的比例也较低,而且住院天数(平均5.6天)较全科医生处理的(平均9.5天)明显减少(P＜0.05).结论由呼吸专科医生采用单纯抽气作为自发性气胸的初始治疗方法成功率更高,能缩短住院天数.     

普外科术后两种引流方式效果的比较及护理

目的:评价普外科术后引流管道采用负压吸引引流方式与虹吸引流方式的临床效果。方法:抽取500例普外科术后患者,随机分为试验组和对照组,试验组采用虹吸方式引流,对照组采用负压方式引流,观察总引流量,持续引流时间,引流管堵塞情况等指标。结果:试验组术后总引流量与对照组比较,差异无统计学意义(P>0.05),持续引流时间与对照组比较,差异无统计学意义(P>0.05),术后并发症与对照组比较,差异无统计学意义(P>0.05),但引流管堵塞情况明显少于对照组(P<0.01),相关治疗费用明显低于对照组(P<0.01)。结论:普外科术后采用负压引流方式与虹吸引流方式效果相同,但虹吸引流方式操作简单、费用低廉、便于观察及护理,更适合于临床工作。     

脓胸76例分析

本文报道76例脓胸分析。认为脓胸多来自肺源性感染,防治肺部感染为降低脓胸发生率的重要措施。急性脓胸转为慢性主要由于治疗上的疏忽或潜在有肺部病理。对急性脓胸治疗应尽早采用闭式引流;晚期脓胸主张采用大敞开皮瓣引流。     

全膝关节置换术后自体引流血经过滤抗凝后回输的安全有效性分析

①目的探讨全膝关节置换术后自体引流血经过滤抗凝后回输的安全性和有效性。②方法使用回顾性评估设计,将42例全膝关节置换患者分为A、B两组。 A组15例,未进行自体血回输;B组27例,进行了自体血回输。分析自体血经过滤后回输的影响、出血倾向、出血量、异体输血比例和术后血红蛋白水平的变化等因素。③结果术后48小时内异体输血比例A组为26．7％（4/15）,B组为0;术后14天异体输血比例A组为46．7％（7/15）,B组为7．4％（2/27）;平均出血量A组为（600＆#177;150）mL,B组为（590＆#177;160）mL;术后第1、7和14天血红蛋白水平平均下降值：A组分别为（2．9＆#177;1．5）、（2．9＆#177;1．6）和（2．3＆#177;1．5）g/dL ,B组分别为（2．7＆#177;0．8）、（4．0＆#177;1．0）和（2．9＆#177;1．3） g/dL。④结论自体血回输降低了异体输血的比例,而血液抗凝并没有增加出血量。全膝关节置换术后抗凝血的自体回输在节约用血方面是安全有效的。     

腹腔引流管内置管持续冲洗引流治疗吻合口瘘

目的:探讨腹腔硅胶引流管内置管持续冲洗引流治疗吻合口瘘的效果,促进其临床推广应用。方法:普外科复杂手术中预先放置32#硅胶引流管,当术后发现吻合口瘘后,及时在硅胶引流管中置入冲洗管、引流管和进气管来进行持续冲洗引流,观察冲洗引流液的性质和进出平衡等,观察患者临床症状如腹痛、发热等,记录瘘的愈合时间。结果:腹腔引流管内置管持续冲洗引流后,所有7例患者可在自然住院日内出院,明显缩短吻合口瘘愈合时间,保证重大外科手术患者顺利痊愈。结论:引流管内置管持续冲洗引流是治疗吻合口瘘的一种有效方法,简单经济,值得临床推广应用。     

妇科腹腔镜术后改良的引流管固定方法与传统固定方法对引流口的影响

目的 比较妇科腹腔镜术后改良的引流管固定方法与传统固定方法对引流口的影响。方法 将2019年1—12月我科采用传统方法固定腹腔镜引流管患者50例(对照组)与2020年1—11月采用改良方法固定腹腔镜引流管患者50例(实验组)资料进行回顾性分析,比较两组的一般资料及术后切口并发症情况:引流口不闭合(拔管当日)、渗血渗液、延期愈合(术后4 d引流口仍未达甲级愈合)、感染、引流管脱落及拔管困难或断裂。结果一般资料比较:实验组和对照组的年龄、体重指数(BMI)、术前血红蛋白比较,差异无统计学意义(P0.05);术后指标的比较:实验组患者术后引流口不闭合、渗血渗液、延期愈合比例低于对照组,差异有统计学意义(P0.05);两组引流口均无感染,两组引流管均无脱落及拔管困难或断裂。结论 腹腔镜术后改良的引流管固定方法可减少引流口的并发症,对于腹腔镜手术需腹腔引流的患者可借鉴。     

胸腔镜肺癌根治术后胸腔引流管应用的研究进展

肺癌(lung cancer)是我国发病率和死亡率最高的恶性肿瘤之一.如今肺癌根治术进入腔镜时代,同时快速康复外科学的倡导及患者对微创手术的青睐,胸腔镜手术更加成为普胸重要的手术方式,其可缩短患者住院时间,减小患者肢体创伤及术后瘢痕,然而患者术后所留置的胸腔闭式引流管却成为快速康复外科学的又一大难题,因术后引流液的量,...