腰动脉的应用解剖

观察了20具(40例)成人尸体的腰动脉,阐明了腰动脉的数目、起源、走行、口径、长度、起始平面与腹主动脉的夹角及相邻两腰动脉间的距离。为临床上由腰动脉插管进行的选择性脊髓造影术提供了解剖学依据。     

硬膜外麻醉与腰麻联合应用的体会

在临床实践工作中,笔者选择有腰麻(又叫蛛网膜下腔阻滞麻醉SAB)适应症的手术患者,配合以连续硬膜外麻醉(CEA),积累了一些经验,现将体会报道如下。 一、临床资料1.76例患者,(男40例,女36例),年龄12～63岁。这些患者,均能主动配合麻醉操作,无精神、神经系统症     

咽旁间隙肿瘤手术径路及其应用解剖

结合咽旁间隙应用解剖,对咽旁间隙肿瘤手术径路,包括经颈径路、经颈-腮腺径路、下颌骨截骨术、颞下窝径路、经口径路、经鼻径路进行概述。探讨术中保护颈动脉鞘的解剖标志,并详细介绍以上各手术径路的临床应用、手术要点,为临床开展咽旁间隙肿瘤手术提供参考。     

乙状窦后径路的应用解剖（摘要）

乙状窦后径路属小型的颅后凹开颅术,可作为进入桥小脑角的有效途径,在临床已采用。作者在25例正常成人头颅标本上,就与入路有关的形态学进行了观测,以供参考。主要结果如下:一、横窦下缘最高点至枕耳线(枕外隆突与外耳门上     

腰丛神经的数字化解剖及其临床意义

目的:对腰丛及其周围的组织结构进行可视化的研究,为微创手术提供更精确的数据和解剖学资料.方法:利用“虚拟中国人“Ⅰ号女性数据集,重建腰丛及其周围组织结构的三维可视化模型.结果:通过数字人数据集重建的三维图片显示腰丛神经及其主要分支与主要血管和椎体及肾脏之间的关系,又可清楚的显示腰丛神经与腰大肌之间的关系.结论:数字人数据集可提供腰丛和周围组织器官的断层图片,为腰丛的解剖学位置及腰椎前路手术提供了形态依据.     

超声引导甲状旁腺穿刺的应用解剖

目的 :提高甲状旁腺超声引导下介入疗法的成功率和减少穿刺并发症。方法 :在 2 0具成人尸体标本上解剖。观测了甲状旁腺的位置、甲状旁腺与甲状腺上、下动脉吻合支的毗邻关系 ;甲状旁腺的纵径、中部横径和厚度。结果 :2 0例标本共解剖出 65个甲状旁腺、平均每例 3 .2 5个 ,其中上、下甲状旁腺成对出现的为 3 5 % ;成对的上甲状旁腺并单侧下甲状旁腺的为 2 0 % ;成对的下甲状旁腺并单侧上甲状旁腺的为 5 % ,只解剖到上甲状旁腺和下甲状旁腺的分别为 2 0 %。结论 :临床行上甲状旁腺穿刺时 ,穿刺点应距甲状腺侧叶上极下方 16mm和距甲状腺后缘 10mm左右的两点交叉处 ;行下甲状旁腺穿刺时 ,穿刺点应距甲状腺侧叶下极上方 12mm和距甲状腺后缘 10mm左右的两点交叉处进针 ,进针深度约 2 0～ 3 0mm。     

超声引导下细针穿刺甲状腺结节Bethesda I类标本的影响因素

近年来,甲状腺结节检出率显著升高,不同病理类型的甲状腺癌存活率不同,但大多数甲状腺癌预后较好.这使得对恶性结节尽早做出明确诊断至关重要,超声引导下细针穿刺细胞学检查(ultrasound-guided fine needle aspiration biopsy,US-FNAB)是甲状腺结节术前定性诊断的主要方法,但其最...     

天突穴周围的解剖结构与临床应用

天突穴是任脉与阴经脉在咽喉的交会穴道。它位于胸骨上窝正中 ,在胸骨柄颈静脉切迹中点 ,气管颈段下端的前面。在这个部位存在颈静脉弓 (或颈前正中静脉 )、甲状腺下静脉 ,还可能存在甲状腺最下动脉 ;在胸骨柄后面有胸腺、左头臂静脉和主动脉弓上缘三大分支。因此 ,熟悉天突穴位的层次及其周围器官结构的关系 ,对于减少以至杜绝针刺天突穴的意外事故是十分重要的。1　天突穴在胸骨上窝的层次结构在胸骨上窝气管颈段下缘的正中部位 ,由浅入深依次是 :皮肤、皮下浅筋膜 (内有菲薄的皮肌———颈阔肌 )、颈筋膜浅层、颈静脉弓 (或颈前正中静脉 …     

带血管肋间神经与髂腰肌支吻接重建屈髋功能应用解剖

目的：为带血管的肋间神经与髂腰肌支吻接重建屈髋功能提供解剖学基础。方法：在30侧成人标本上对支配髂肌、腰大肌的神经进行解剖和观察。结果：支配腰大肌的神经纤维主要来源于L2，其次是L3肌支纤维在L2神经干的外上部走行，部位较恒定。髂肌肌支则在股神经合于起始处发出，神经纤维主要来源于L4，其次为L3及L2。结论：将肋间神经转位从背侧手术入路与L2神经根前支外上部端侧吻接，或经腹手术入路于股神经起始部与髂肌肌支吻接术式具有可行性。     

超声引导下细针抽吸睾丸组织与粗针活检的比较

目的　探讨超声引导下细针抽吸睾丸组织的诊断价值。 方法　回顾分析2015年1月到2016年12月的睾丸细、粗针穿刺活检病理切片,比较其中生精小管断面数量的差异;除生精小管以外的其他成分（皮肤、血管及纤维软组织）及血肿的差异。 结果　粗针穿刺与细针抽吸睾丸组织病理切片,生精小管断面数量大于20的,粗针穿刺组有8例(8/24,33.3%),细针抽吸组有11例(11/20,55.0%),组间对比（χ2=2.087,P=0.149）,两者差异无统计学意义;存在其他成分例数,粗针穿刺组有19例( 19/24,79.2%);细针抽吸组有1例(1/20,0.9%),组间对比(χ2 =24.203,P=0.000),两者差异有统计学意义;穿刺后出现血肿例数,粗针穿刺组有5例(5/24,20.8%),而细针抽吸组20例均未见血肿,组间对比（χ2=4.70,P=0.032）,两者差异有统计学意义。 结论　细针抽吸睾丸组织标本满意,几乎无其他成分干扰,具有较大的临床应用价值。     

Pythagoras and Cosines: The skin–dural sac distance and optimal angles in paramedian spinal anesthesia

The classical recommendation for paramedian approaches is needle insertion 1–2 cm paramedian and an angle of 10°–15° medial–cephalad to the plane of the back, but contact with vertebrae is frequent. A mathematical approach to individualizing punctures is proposed on the basis of skin–dural sac distance (d): Optimal angle ～ inverse cosine [d/ and the distance covered by the needle ～ for 1 cm paramedian punctures. The inferred angles were compared to optimal angles leading to the central dorsal part of the dural sac from 1 to 2 cm paramedian, measured by Magnetic Resonance Imaging (MRI) in seven cases and in a short stature volunteer (1.58 m, Body Mass Index (BMI) 23.2), to study supine and fetal positions using both closed MR and ultrasound. The average (d) decreased rostrally [6.8 cm (L4–L5)?4.3 cm (T11–T12)] while the mean optimal incidence angles increased [8.3°–16.5° (L4–L5) to 12.7°–24.1° (T11–T12) at 1–2 cm paramedian, respectively] and coincided with the estimated angles with a correlation coefficient = 0.98. In the volunteer, the optimal lateromedial angles increased from 14.4° to 26.7° (L3–L4) to 17.1°–30.3° (T11–T12) for a (d) = 3.7 cm (L3–L4)?3.1 cm (T11–T12) and increased ≤3.7° and ≤5.1° at 1 and 2 cm paramedian, respectively, in fetal positions in MR. Ultrasound yielded comparable figures. The range of possible angles for dural punctures is wider at 1 cm paramedian in lower approaches in lateral decubitus [from 3.6° at T12L1 (12.2°–15.8°) to 9° at L3L4 (8.8°–18.7°)]. The classically recommended angles of 10°–15° differ from the optimal angles, particularly in small patients, suggesting the need for ultrasound guidance or for inferring angles prior to spinal anesthesia. Clin. Anat. 29:1046–1052, 2016. © 2016 Wiley Periodicals, Inc.     

不同浓度、剂量布比卡因用于剖宫产脊麻的效果比较

目的研究比较不同浓度、剂量,等比重布比卡因对产妇的麻醉效果及新生儿的影响,为临床麻醉提供参考依据。方法选择ASAⅠ~Ⅱ级初次足月妊娠拟择期剖宫产手术孕妇80例,随机分为A、B二组,每组各40例。均在左侧卧位下行腰-硬联合穿刺,L2-3进针,见脑脊液外流后,针斜面向下注入等比重布比卡因:A组:8mg(0·5%,1·6ml;配法:0·75%布比卡因2ml+脑脊液1ml);B组:9·6mg(0·6%,1·6ml;配法:0·75%布比卡因2ml+脑脊液0·5ml),20s注药完毕。记录麻醉前(基础值)和脊麻注药后1、3、5、7、10、15min各时间点的平均动脉压(MAP)、心率(HR)、脉搏血氧饱合度(SpO2)。测定并记录麻醉起效时间、平面固定时间、最高麻醉平面点(胸,T)、麻醉完全消退时间、下肢阻滞的最大程度、麻醉并发症等。结果A组感觉阻滞起效时间长于B组(69·27±21·48vs52·43±27·61s,P<0·05);两组最高阻滞平面(T4·50±1·44vsT4·10±0·57)及最高阻滞平面的固定时间(7·69±1·36vs7·35±1·22min)相似(P>0·05)。A组麻醉完全消退时间快于B组(218·40±18·57vs256·22±16·72min,P<0·05);Bromage评分A组明显小于B组(2·03±0·68vs2·93±0·21,P<0·05);麻醉后B组低血压发生率明显高于A组(P<0·05)。两组病人的麻醉效果均优,肌松满意。所有新生儿的Apgar评分均在7分以上,无组间差异。结论两组病人均产生了良好的脊麻效果,权衡利弊剖宫产脊麻时应用8mg(0·5%,1·6ml)布比卡因更为安全合理。     

动脉栓塞术的临床应用

经导管动脉栓塞术 (ｔｒａｎｓｃａｔｈｅｔｅｒａｒｔｅｒｉａｌｅｍ ｂｏｌｉｚａｔｉｏｎ ,ＴＡＥ) ,是指将不同的栓塞物质通过导管选择性有控制地注入到某一病变或器官的供应血管内 ,使之发生闭塞 ,中断血供 ,以达到预定治疗目的的一项技术。近年来 ,随着医学影像诊疗技术的不断发展完善 ,因其操作简便、创伤性相对较少、止血迅速有效 ,而且对脏器肿瘤性病变具有良好的治疗效果 ,而得到临床医生的公认 ,并在临床中得到广泛应用。ＴＡＥ技术中 ,栓塞剂的选择是决定栓塞治疗效果的关键因素。临床上依据栓塞效应的长短将栓塞剂分为短效 (指…     

Crystalloid and colloid preload for maintaining cardiac output in elderly patients undergoing total hip replacement under spinal anesthesia

The aim of the present study was to compare the effects of colloid and crystalloid preload on cardiac output (CO) and incidence of hypotension in elderly patients under spinal anesthesia (SA). A randomized, double-blinded study was conducted including 47 elderly patients undergoing scheduled total hip replacement (THR), who were randomized to three groups: the control group (C group, n = 15), crystalloid (RS group, n =16) and colloid group (HES group, n = 16). An intravenous preload of 8 mL/kg of either lactated Ringer’s solution in the RS group or 6% hydroxyethyl starch in the HES group was infused within 20 min before SA induction, while no intravenous preload was given in the C group. There was a trend of decrease in CO and systolic blood pressure after SA with time in the C group. In the RS and HES groups, CO increased significantly after fluid preloading as compared with baseline (P < 0.01). Thereafter, CO remained higher than baseline until 30 min after SA in the HES group. The change of systolic blood pressure was similar to CO, but no significant difference from baseline was observed in each group. Hypotension occurred in 3 patients in the C group and one each in the RS and HES group, respec-tively (P = 0.362). Intravascular volume preload with colloid is more effective than crystalloid solution in main-taining CO, which may be improved the hemodynamic stability in elderly patients during SA.     

高渗氯化钠羟乙基淀粉40对联合硬膜外-腰麻下子宫全切术中恶心呕吐的防治

目的观察高渗氯化钠羟乙基淀粉40、6%中分子羟乙基淀粉130/04急性高容量血液稀释对联合硬膜外-腰麻下子宫全切术中恶心呕吐的防治效果。方法选择择期行子宫全切术,ASAⅠ~Ⅱ级的病人45例,随机分成三组,每组15例。Ⅰ组为高渗氯化钠羟乙基淀粉40;Ⅱ组万汶;Ⅲ组乳酸格林氏液。三组患者分别于腰麻前20min内静脉输注高渗氯化钠羟乙基淀粉40、万汶、乳酸格林氏液250ml,均采用丁卡因(1%丁卡因1ml 10%GS1ml 3%麻黄素1ml)重比重液2.5ml行腰麻.腰麻后低血压持续超过3min者,静注麻黄素10mg,比较三组腰麻后低血压、恶心、呕吐等的发生率及麻黄素应用率。结果Ⅰ、Ⅱ组低血压、恶心、呕吐的发生率、麻黄素应用率均明显低于Ⅲ组(P<0.05),经快速补液后低血压的自动复升率I,Ⅱ组明显高于Ⅲ组(P<0.01),Ⅰ组低血压、恶心、呕吐的发生率、麻黄素应用率略低于Ⅱ组,但无统计学意义(P(0.05)。结论以高渗氯化钠羟乙基淀粉40、万汶急性高容量血液稀释可有效防治联合硬膜外-腰麻下子宫全切术中恶心呕吐的发生,且高渗氯化钠羟乙基淀粉40的效果略优于万汶。     

载药纳米微粒的临床应用研究进展

载药纳米微粒是纳米技术与现代医药学结合的产物 ,是一种新型的药物输送载体。它缓释药物、延长药物作用时间 ,透过生物屏障靶向输送药物 ,建立新的给药途径等等 ,在药物控释方面显示出其他输送体系无法比拟的优势。近年来载药纳米微粒在临床各个领域的应用基础研究势头强劲 ,并取得了可喜的成绩。本文综述了载药纳米微粒在临床各领域应用的研究成果 ,并对其发展应用前景进行展望     

脊髓性肌萎缩临床表型与SMN2基因拷贝数变化的相关性研究

目的探讨脊髓性肌萎缩（spinal muscular atrophy，SMA）的临床表型与运动神经元生存基因（survival motor neuron，SMN）拷贝数变化之间是否存在相关性。方法应用TaqMan技术的实时荧光定量PCR方法对57例不同临床表型的SMA患者的SMN2基因拷贝数进行检测。结果预测拷贝数为1的SM／Ve基因的平均拷贝数为1．017±0．090，变异系数（coefficient of variation，CV）值8．9％；预测拷贝数为2的SMN2基因的平均拷贝数为2．019±0．080，CV值3．9％；预测拷贝数为3的SMN2基因的平均拷贝数为3．104±0．170，CV值5．4％。Ⅰ型SMA患者SMNe基因平均拷贝数为1．926±0．460，Ⅱ型为2．508±0．460，Ⅲ型为2．876±0．270。Ⅱ型SMA患者SMN2平均拷贝数明显高于Ⅰ型（t=4．24，P〈0．01），Ⅲ型SMA患者SMN2平均拷贝数明显高于Ⅱ型（t=2．44，P〈0．01）。85．72％Ⅰ型SMA患者SMN2以2个拷贝为主；Ⅱ型SMA以2个和3个拷贝为主，分别占40％和60％；82％的Ⅲ型SMA则以3个拷贝为主。结论SMA临床表型的变化与SMN2基因拷贝数明显相关。不同类型SMA患者㈣拷贝数的分布不同：各型SMA患者至少有1个拷贝的Shine，11和Ⅲ型SMA患者的ShiNe拷贝数多于I型患者。提示疾病的严重程度依赖于SMN2拷贝数的变化。     

胎盘免疫调节因子的生物功能及临床应用进展

胎盘免疫调节因子是从人胎盘中提取的活性因子,具有多种生物学功能,近年来引起国内外的广泛关注.本文详细介绍了它的生物学功能和临床应用.     

The influence of various anesthesia techniques on postoperative recovery and discharge criteria among geriatric patients

OBJECTIVE:

We aim to compare selective spinal anesthesia and general anesthesia with regard to postoperative recovery and fast‐track eligibility in day surgeries.

MATERIALS AND METHOD:

Sixty geriatric outpatient cases, with ASA II‐III physical status and requiring short‐duration transurethral intervention, were enrolled in the study. The cases were split into 2 groups: as general anesthesia (Group GA) and selective spinal anesthesia (Group SSA). Group GA (n = 30) received propofol 2 mg kg^‐1 (until loss of eyelash reflex), remifentanil induction 0.5‐1 µg kg^‐1, and laryngeal mask. Maintenance was achieved by 4‐6% desflurane in 60% N₂O and 40% O₂ along with remifentanil infusion at 0.05 µg /kg^‐1 /min^‐1. Drugs were discontinued after the withdrawal of the ureteroscope, and extubation was carried out with 100% O₂. Group SSA (n = 30) received 0.5% spinal anesthesia via L4‐5 space by 0.5% hyperbaric bupivacaine 5 mg. Anesthesia preparation time, time to surgical anesthesia level, postoperative fast‐tracking, and time to White‐Song recovery score of 12, were noted. In the operating room, we evaluated hemodynamics, nausea/vomiting, surgeon and patient satisfaction with anesthesia, perioperative midazolam‐fentanyl administration, postoperative pain, and discharge time.

RESULTS:

Anesthesia preparation time, length of surgery, anesthesia‐related time in the operating room, time to sit, and time to walk were significantly low in Group GA (p<0.05), whereas time to fast‐track eligibility, length of stay in the PACU, discharge time, and other parameters were similar in both of the groups.

CONCLUSION:

While anesthesia preparation time, length of surgery, start time of surgery, time to sit, and time to walk were shorter in the General Anesthesia group, time to fast‐track eligibility, phase 1 recovery time, and discharge time were similar among patients subjected to selective spinal anesthesia.     

The dose-dependent study of verapamil and diltiazem on spinal anesthesia in the rat

The aim of this study evaluated the spinal anesthetic effect of verapamil and diltiazem. After rats were injected intrathecally with verapamil and diltiazem, dose–response curves were constructed. We evaluated the potency and duration of verapamil or diltiazem which compared with mepivacaine, a commonly used local anesthetic, in rats. Verapamil, diltiazem and mepivacaine produced a dose-dependent local anesthetic effect as spinal anesthesia. On a 50% effective dose (ED₅₀) basis, the spinal anesthetic effect of verapamil was more potent than diltiazem or mepivacaine (P < 0.01 for each comparison). On an equipotent basis (ED₂₅, ED₅₀, and ED₇₅), the blockade duration of spinal anesthesia caused by diltiazem was longer than that caused by verapamil or mepivacaine (P < 0.01 for each comparison). In summary, verapamil produced more potent spinal blockades, when compared with diltiazem or mepivacaine. Diltiazem demonstrated longer spinal blockades than did verapamil or mepivacaine.