256例小切口胆囊切除术临床分析

目的结小切口胆囊切除术治疗胆囊病变的临床效果及应用。方法顾分析256例胆囊病变运用小切口切除术治疗的病例资料。结果采用小切1：2胆囊切除术治疗,手术时间最短35min,最长80min,平均61min;术中出血28-65ml,平均45ml;切1：2长度2-7cm,平均4．2cm;术中术后并发症4例,其中胆道损伤1例,术中大出血1例,胆漏1例,切口感染1例。结论切口治疗胆囊病变与常规手术比较具有创伤小、手术时间较短、出血较少、患者恢复快等优点,符合低创要求,值得,临床推广。     

小切口胆囊切除术23临床分析

目的 探讨小切口胆囊切除术的有关问题.方法 回顾性分析2 3例胆囊结石或胆囊息内样变患者行小切口胆囊切除术的病例资料.结果 采用小切口胆囊切除术治疗,切口长4-6cm.顺行切除12例,逆行8例,顺行和逆行结合切除3例,手术成功20例(占84.3%),中转传统胆囊切除术3.术中出现出血、灼伤邻近脏器、肝床撕裂饬等并发症5例,术后置管引流管2例;无胆瘘及胆道损伤.结论 小切口胆囊切除术应有选择地进行,切口的选择应遵循个体化的原则,特殊器械的应用有助于手术的完成.熟练正确的操作和及肘果断改行传统胆囊切除是预防并发症的关键.     

腹腔镜与小切口胆囊切除术治疗胆囊结石合并胆囊炎临床观察

目的探究腹腔镜胆囊切除术与小切口胆囊切除术治疗胆囊结石合并胆囊炎患者的临床疗效。方法选取2015年3月至2016年4月就诊于我院胆囊结石合并胆囊炎患者92例,随机分为两组,各46例。对照组给予小切口胆囊切除术治疗,观察组给予腹腔镜胆囊切除术治疗。比较两组患者并发症发生率、手术情况及术后情况。结果观察组各项手术指标均优于对照组,差异显著(P0.05);观察组术后各项指标较对照组均明显下降,差异显著(P0.05);观察组患者并发症发生率明显低于对照组,差异显著(P0.05)。结论采用腹腔镜胆囊切除术治疗胆囊结石合并胆囊炎患者效果显著,与小切口胆囊切除术相比,具有能优化各项手术指标、缩短治疗时间、降低术后并发症发生率等优势,在临床应用中具有较高的推广价值。     

不同麻醉方式对老年腹部肿瘤手术患者术后免疫功能及血清IL-6、TNF-α水平的影响

为探讨不同麻醉方式对老年腹部肿瘤手术患者术后免疫功能及血清IL-6、TNF-α水平的影响,选择老年腹部肿瘤患者94例,按照随机数字表法分为观察组(47例)、对照组(47例)。对照组采用全身麻醉,观察组采用腰硬联合麻醉复合全身麻醉,比较两组患者术前、手术15 min和术毕血流动力学指标,手术时间、拔管时间和苏醒时间,术前和术后3 d免疫功能及血清IL-6和TNF-α水平变化。观察组手术15 min和术毕心率(heart rate,HR)、平均动脉压(mean arterial pressure,MAP)低于同期对照组(P0.05)。两组手术时间比较,差异无统计学意义(P 0.05)。观察组拔管时间和苏醒时间快于对照组(P0.01)。观察组术后3 d CD3~+、CD4~+和CD4~+/CD8~+高于对照组(P0.01)。观察组术后3 d血清IL-6和TNF-α水平低于对照组(P0.001)。腰硬联合麻醉复合全身麻醉对老年腹部肿瘤手术患者效果明显,对血流动力学、免疫功能及炎症反应影响小。     

小切口与腹腔镜胆囊切除术比较初探(附19例报告)

目的为探讨小切口胆囊切除术与腹腔镜胆囊切除术两术式的利弊.方法随机分小切口胆囊切除术组(MC)8例和腹腔镜胆囊切除术组(LC)11例.以术中所需时间(min)、术后肛门排气时间(h)、术后起床活动天数(d)、术后住院天数(d)、术后出现并发症和住院费用等指标比较.结果手术时间和术后住院日两组无明显差别.术后肛门排气LC(12～48h)先于MC(25～60h).术后起床活动MC当天7/8例先于LC第1天7/11例.平均住院费用MC(3900元)低于腹腔镜组(5200元).结论MC无需昂贵器械,对Calot三角区的操作比腹腔镜操作更具安全;手术误伤胆道等脏器,MC比LC更易于避免或及时发现处理;对机体的微创程度可与腹腔镜媲美,且费用低廉.故MC在基层医院更具扩大应用价值.     

腰麻联合硬膜外持续泵注在妇科手术中的应用观察

目的 观察腰麻联合硬膜外持续泵注在妇科手术中的的应用效果,探讨其在临床麻醉的可行性.方法 将ASAⅠ-Ⅱ级60例病人随机等分为腰麻联合硬膜外持续泵注组(A组)和联合腰麻硬膜外分次注药组(B组).观察并记录术前、术中MAP、HR、R、SpO2,ECG的变化;术中局麻药物剂量及辅助用药情况;术中麻醉效果;术后麻醉并发症及恶心,呕吐,头痛等不良反应.结果 两组病人手术过程中呼吸频率(R)、血氧饱和度(SpO2)、心电图(ECG)无明显变化(P >0.05); A组血压和心率在麻醉后10min、15min、30min、50min、60min与麻醉前比较无明显差异(P >0.05);B组血压和心率在麻醉后50min与麻醉前比较明显升高(P <0.05),在麻醉后60 min又明显下降,且均与A组比较有显著差异性(P <0.05);两组麻醉药物剂量和麻醉效果无明显差异(P >0.05);两组均无明显不良反应.结论 腰麻联合硬膜外持续泵注可以安全有效的应用于妇科手术,是一种值得推广的麻醉方式.     

胆囊切除三种术式的治疗体会

胆囊切除三种术式为 :传统胆囊切除术 (ＣＣ)、小切口胆囊切除术 (ＭＣ)、腹腔镜胆囊切除术 (ＬＣ) .首例胆囊切除术获得成功至今已有一百多年的历史 ,为安全、成功的经典手术 .1982年法国Ｄｕｂｏｉｓ为了减少手术创伤首先施行了小切口胆囊切除术 .随着医疗技术的发展出现了腹腔镜胆囊切除术 .为探讨三种术式的优劣点 ,1998年 1月～ 2 0 0 1年 8月共 15 0例胆囊切除术者分析如下 .1　临床资料1 1　一般资料　 15 0例Ｂ超检查 :胆囊结石 12 8例 ,胆囊憩肉 2 2例 .15 0例中择期胆囊切除 138例 ,急诊胆囊切除 12例 .术前常规血、尿、肝肾功能…     

小切口胆囊切除术的麻醉探讨

我院从96年起共施行小切口胆囊切除术150例,现将麻醉情况报告如下。 一、临床资料:本组150例,男性68例,女性82例,年龄27至70岁,连续硬外麻醉120例,全麻30例,老年、肥胖、冠心病者选择全麻、硬外麻醉不全改全身麻醉1例,手术时间45分钟至2小时,单纯胆囊切除基本     

腰-硬联合麻醉在经尿道前列腺切除术中的优势

目的:比较腰-硬联合麻醉(CSEA)和硬膜外麻醉(EA)在经尿道前列腺切除术(TURP)中的麻醉效果。方法:收集我院2011年3月～12月行TURP术的患者100例,按其麻醉方式分为两组,每组50例。EA组于L_3/4间隙穿刺、CSEA组于L_3/4间隙穿刺,注药后向头置管。观察患者的BP、HR、SPO₂和ECG变化及患者的术中不适反应。并记录两组从麻醉到手术结束的时间。结果:EA组手术开始后,HR较术前明显减慢(P＜0.05);两组患者麻醉后SPB、DBP均有所下降,CSEA组麻醉后5 min较术前下降更明显(P＜0.05),同时低于EA组(P＜0.05);EA组在手术开始后15 min明显下降(P＜0.05)。EA组出现的不适反应明显高于CSEA组(P＜0.05)。从麻醉到手术结束时间EA组约60 min,CSEA组约40 min。结论:CSEA用于TURP麻醉效果好,起效快,不适反应少,患者满意度高。     

老年人胆囊炎胆石症58例手术治疗体会

目的 探讨外科治疗老年人胆囊炎、胆石症的临床特点及经验.方法 择期手术41例,急诊手术17例均采用全身麻醉,行单纯胆囊切除术37例,胆囊造漏术2例,胆囊切除术、胆总管切开取石术加"T"管引流术17例.胆总管空肠Koux-en-v吻合2例.手术时间(54±26)min,术中出血量(101±27)ml.结果 全所有患者均能完成手术,治愈56例,术后自动出院1例,死亡1例.发生并发症15例(25.86%),主要并发症包括肺部感染、切口裂开、切口感染、泌尿系感染、腹腔脓肿、应激性溃疡、急性肺水肿、心衰、肾衰等.结论 对老年人急性腹痛要注意询问病史,详细体格检查,尽早做B型超声波检壹以早期诊断;应该早期手术治疗,手术时机选择要得当,术前准备要充分,根据结石的分布情况选择适合的术式,注意并发症.     

胸腔镜下肺癌手术时单肺通气的临床麻醉分析

目的 分析胸腔镜下肺癌手术时单肺通气的临床麻醉效果。方法 回顾分析2018年9月~2019年8月在我院治疗的60例肺癌患者临床资料,患者均在胸腔镜下手术,采用静脉快速诱导插入双腔支气管导管,在麻醉诱导后进行间歇性正压通气（IPPV）,在单肺通气过程中采用间歇性IPPV或萎缩肺持续正压通气,并相应的调整呼吸参数。比较不同时间（麻醉前、双肺IPPV、单肺的IPPV 30 min、IPPV 60 min、IPPV 90 min、双肺IPPV 15 min）血压（MAP）、心率（HR）以及动脉血气指标。结果 麻醉前、双肺IPPV、单肺的IPPV 30 min、IPPV 60 min、IPPV 90 min、双肺IPPV 15 min时间段MAP、HR比较,差异无统计学意义（P＞0.05）,而在动脉血氧分压（PaO2）、二氧化碳分压（PaCO2）、呼末二氧化碳分压（PETCO2）比较,差异有统计学意义（P＜0.05）;双肺IPPV与单肺IPPV在鼻导管吸氧（FiO2）、TV比较,差异有统计学意义（P＜0.05）。结论 单肺通气可使胸腔镜下肺癌手术患侧肺萎缩满意,在PaO2下降的情况下可有效维持呼吸正常,促进手术的顺利进行。     

Influence of intensive cycling training on heart rate variability during rest and exercise.

The current study examined whether changes in heart rate variability (HRV) following intensive cycling training contribute to the mechanism of training-induced bradycardia. Thirteen healthy untrained subjects, ages 18-27 years, underwent recordings of heart rate (HR) and VO2max before and after 8 weeks of cycling, 25-60 min/day, 5 days/week at > 80% maximum HR (HRmax). Heart rate recordings were obtained during supine rest and submaximal exercise and were analysed for the following components of HRV: low frequency (LF, 0.041-0.15 Hz); high frequency (HF, 0.15-0.40 Hz); LF/HF ratio and total power (TP, 0-0.40 Hz). At posttraining, VO2max was significantly increased while HR was significantly reduced at rest and all absolute exercise work rates. Training-induced lower HR was accompanied by significantly greater HF and TP during rest as well as LF, HF, and TP during all absolute exercise work rates. Posttraining HR and the majority of HRV measures were similar to pretraining values at the same relative exercise intensity (% HRmax). These results indicated that 8 weeks of intensive cycling training increased HRV and cardiac vagal modulation during rest and absolute exercise work rates but had little effect during relative exercise work rates. Increased vagal modulation resulting from intensive exercise training may contribute to the mechanism of training-induced bradycardia.     

Non-autonomic component in bradycardia of endurance trained men at rest and during exercise

Autonomic nervous alterations have generally been held responsible for the bradycardia of the endurance athlete. In order to determine whether there is also a non-autonomic component in the bradycardia of long-term training, we compared the intrinsic heart rate (HR) of highly trained bicyclists (heart volume: 995±155 ml) with that of untrained men (heart volume: 805±195 ml) at rest and during bicycle ergometer exercise at 50, 75 and 100% of maximal oxygen uptake (V_O2 max.) Intrinsic HR was achieved by combined vagal and beta-adrenergic blockade with atropine and propranolol or metoprolol (cardioselective) injected intravenously. Intrinsic HR was significantly lower in trained (T) than in untrained (UT) at rest and at all levels of exercise. The chronotropic reserve from resting HR to maximal HR was identical in the two groups. Nearly identical intrinsic HRs were achieved with atropine and either beta-adrenergic antagonist. HR differences between T and UT were very similar in magnitude—approximately 13 beats/min—at rest and during exercise at a given percentage of V_O2 max, with and without autonomic blockade. Evidence is thus provided for a non-autonomic component in the bradycardia of well-trained men which may be responsible for a parallel downward shift in the relationship between HR and percentage of V_O2 max. The lower intrinsic HR in well-trained men might be explained by, i.a. the cardiac enlargement.     

Effect of a 24-h continuous walking race on cardiac autonomic control

This study investigated the relationships between walking speed and heart rate (HR) variability (HRV) in eleven subjects during a 24-h race. It was hypothesized that the nycthemeral rhythm on HR is preserved during the race. RR intervals and walking speed were measured. Fast Fourier transform was applied to samples of 1,024 successive RR intervals collected every hour from a HR monitor. Walking speed was averaged every hour and decreased (first lap: 8.8 ± 0.3 vs. last lap: 7.3 ± 0.8 km h⁻¹, P < 0.001) with HR also decreasing (max at 19:00 h: 143 ± 9 vs. min at 7:00 h: 117 ± 14 beats min⁻¹, P < 0.001) following a third order polynomial shape. HRV power spectral components followed distribution patterns similar to the mean RR during the race with a minimum in the early evening (19:00–20:00 h) and a maximum in the morning (5:00–8:00 h). Thus, as for mean RR, spectral components over time are also fitted to a third order polynomial regression. LF/HF ratio increased linearly (min = 0.5 ± 0.3, max = 2.8 ± 5.3, P = 0.02). Although mean HF peak did not decrease significantly over time, it was positively correlated with walking speed. In conclusion, this study showed that despite a constant decrease in walking speed, HR circadian rhythm is preserved during a continuous 24-h walking race. The short-term HRV components remain linked to HR whereas the LF/HF ratio increases linearly until the end of the race whatever HR is.     

Pharmacological evidence that central alpha 2-adrenoceptors are involved in cardiovascular responses to intravenously injected enkephalins in anesthetized dogs

In anesthetized dogs, intravenous infections of 30 micrograms/kg of leucine- and methionine-enkephalin (L- and M-enk respectively) produced a significant reduction of mean blood pressure (MPB) and heart rate (HR). The peak decreases in MBP and HR occurred within 1 min after injection and recoveries to pre-injection levels within 3 min. The depressor responses to both L-enk and M-enk were abolished by intracisternal pretreatment with yohimbine (0.5 mg/kg) but not with prazosin (0.1 mg/kg). Pretreatment with either drug did not alter the bradycardia. All cardiovascular effects of both L-enk and M-enk were prevented by intravenous pretreatment with naloxone (2 mg/kg). These results suggest that central alpha 2-adrenoceptors may participate in the central actions of enkephalins on blood pressure regulation. HR responses to enkephalins may be elicited by a different mechanism.     

The reflex bradycardia during brain ischemia in the rabbit.

We examined the responses of whole aortic nerve activity, aortic baroreceptor activity, heart rate (HR), and arterial pressure (AP) to brain ischemia sustained for approximately 30 s in anesthetized spontaneously breathing rabbits. The minimum values of HR observed during brain ischemia were 76 +/- 11 beats/min (mean +/- S.E., n = 14) before sectioning the bilateral aortic nerve (BAN), and 161 +/- 12 beats/min after sectioning the left aortic nerve (LAN), and 225 +/- 11 beats/min after sectioning the LAN and right aortic nerve (RAN). Averages for reflex fall in HR during BAN, LAN, and RAN activation were 140 +/- 9, 78 +/- 7, and 62 +/- 7 beats/min, respectively, by subtracting the HR fall responses to brain ischemia in the absence of aortic baroreceptor afferents from their control values. The heights of the integrated whole left and right aortic nerve activities in systole slightly increased during brain ischemia, whereas the brain ischemia remarkably increased those activities during the diastolic phases. The brain ischemia induced a hysteresis in the mean AP-aortic barorecept or activity relationship. These results suggest that the total activity of aortic nerve fibers would determine the bradycardia evoked by brain ischemia and that the difference between the relative contributions of LAN and RAN on the brain ischemia-induced reflex bradycardia would reflect the total impulse frequency of aortic myelinated and non-myelinated fibers.     

Physiological aspects of freezing behaviour in willow ptarmigan hens

When threatened, wild willow ptarmigan (Lagopus lagopus lagopus) hens displayed freezing behaviour, i.e. motionless, crouched with head down and eyes open. But while non-incubating hens showed increased heart (HR) (from 229 +/- 18 to 254 +/- 33 beats min-1) and ventilation rates (VR) (from 25 +/- 2 to 31 +/- 4 breaths min-1), incubating hens showed bradycardia (from 208 +/- 40 to 102 +/- 13 beats min-1) and reduced VR (from 25 +/- 2 to 10 +/- 2 breaths min-1), which could be maintained for as long as 20 min. The bradycardia response became stronger as hatching approached. The bradycardia period was interspersed by short bursts of tachycardia and hyperventilation which presumably supplied oxygen to blood and muscles. The bradycardia period was typically followed by a period of increased HR (276 +/- 104 beats min-1) and VR (32 +/- 3 breaths min-1). Atropine abolished the bradycardia response, which was thus apparently due to parasympathetic stimulation. The bradycardia response observed in incubating ptarmigan hens, during forced diving of birds and mammals and during death feigning in other animals are all examples of how emotional stimuli trigger a basic bradycardia reflex.     

Role of the medial prefrontal cortex in the development of conditioned bradycardia in rabbits with lesions of the cerebellar vermis

The effects on the expression of conditioned bradycardia of pairing an early (fourth postnatal day) cerebellar vermal lesion with a lesion of the medial prefrontal cortex (mPFC) were studied in adult New Zealand rabbits. In the conditioning procedure, an auditory stimulus (5 s, 1000 Hz) served as a conditioning stimulus (CS) and a train of electrical impulses applied to the ear (500 ms, 100 Hz, 1.5 mA) was used as the unconditioned stimulus (US). Heart rate (HR) responses exhibited by rabbits with the early double lesion (PFCBs) during orientation (CS-alone) and conditioning (CS–US paired) were analyzed and compared with those shown by unoperated controls as well as by a group of animals in which a cerebellar lesion alone had been performed on the fourth postnatal day (CBs). In all the experimental groups vermal lesions were localized in the cortex of lobules V–VII and the underlying white matter. As for mPFC ablation, the lesioned area involved the agranular precentral region (Brodmann’s area 8), the anterior cingulate cortex (Brodmann’s area 24) and the prelimbic area (Brodmann’s area 32). All the experimental animals had a normal baseline HR as well as a marked orientation response, both comparable with those exhibited by controls. In contrast, while CB rabbits showed an increase in the amplitude of the conditioned bradycardic response when compared with controls, the HR conditioned response of PFCB animals was comparable to that exhibited by controls. These results suggest that, since the double lesion produces a conditioned bradycardia similar to that of the controls, the increase in the amplitude of this response observed after early cerebellar removal may depend on the mPFC which, in the absence of specific cerebellar circuits, is unable to produce a properly calibrated HR conditioned response. Received: 9 September 1998 / Accepted: 29 May 1999     

Median Effective Dose of Dexmedetomidine Inducing Bradycardia in Elderly Patients Determined by Up-and-Down Sequential Allocation Method

Purpose: When dexmedetomidine is used in elderly patients, high incidence of bradycardia is reported. Given age-related physiological changes in this population, it is necessary to know the safety margin between the loading dose of dexmedetomidine and bradycardia. Therefore, we conducted this study to investigate the median effective dose (ED50) of dexmedetomidine causing bradycardia in elderly patients.Methods: Thirty patients with ages over 65 years undergoing elective general surgery were enrolled. The Dixon and Massay sequential method were applied to determine the loading dose of dexmedetomidine, starting from 1.0 µg/kg. The dose for the follow-up subjects increased or decreased according to the geometric sequence with the common ratio 1.2, based on the ''negative'' or ''positive'' response of the previous subject. Positive mean that the subject developed bradycardia during the test. Hemodynamic data including heart rate and systolic blood pressure were recorded. The level of sedation was assessed with the Observer Assessment of Alertness and Sedation Scale (OAA/S).Results: Bradycardia occurred in 13 patients (43.3%). The ED50 of dexmedetomidine causing bradycardia was 1.97 µg/kg (95% CI, 1.53-2.53 µg/kg). OAA/S scores at 10 min after the beginning of the dexmedetomidine infusion and 10 min after the termination of dexmedetomidine administration showed no significant differences between the positive and negative groups (P > 0.05).Conclusion: The ED50 of dexmedetomidine causing bradycardia in our cohort was higher than clinical recommended dose. A higher loading dose appears acceptable for a faster onset of sedation under careful hemodynamic monitoring.Trial registration: ChiCTR 15006368.     

盆底补片用于骶棘韧带固定术的临床疗效

目的探讨盆底补片用于骶棘韧带固定术(SSLF)对盆底支持结构的有效性和安全性。方法选取64例中盆腔缺陷患者,采用双盲法随机分为观察组(31例)和对照组(33例)。观察组采用“Y”形补片实施SSLF,对照组采用传统SSLF。比较2组患者围术期相关指标、并发症、手术前后阴道轴向变化、POP-Q分期以及Aa、Ap、Ba、Bp、C指示点位置变化。采用盆底障碍影响简易问卷7(PFIQ-7)、盆底功能障碍问卷简短版20(PFDI-20)、视觉模拟量表(VAS)及POP-Q分期评价疗效。结果所有患者均顺利完成手术。观察组手术时间、术中出血量均短/少于对照组(P<0.05),2组患者并发症、肛门排气时间、尿管留置时间、住院时间比较,差异无统计学意义(P>0.05)。术后6、12个月POP-Q分期以及Aa、Ba、Ap、Bp、C指示点位置组间比较差异均无统计学意义(P>0.05);观察组阴道轴向右侧偏离角度小于对照组,差异有统计学意义(P<0.05);2组患者PFIQ-7和PFDI-20评分较术前均下降(P<0.05),但组间比较差异无统计学意义(P>0.05)。结论SSLF采用补片重建阴道顶端的盆底支持结构,可克服坐骨棘深藏、术野狭窄、操作困难等问题,且具有快捷、微创、治愈率高的特点,对于全身状况欠佳的中盆腔缺陷患者安全、有效。