心源性休克患者应用双泵给药轮流续泵输注大剂量多巴胺的效果

目的探讨心源性休克患者应用双泵给药轮流续泵输注大剂量多巴胺的效果。方法将59例静脉使用多巴胺的心源性休克患者随机分为观察组30例和对照组29例,分别应用双泵给药轮流续泵和单泵给药输完续泵的方式输注多巴胺。结果观察组续泵后15min内血压下降幅度20%、心率波动幅度20%、心律失常发生率显著低于对照组,血压、心率波动幅度显著小于对照组(均P0.01)。结论双泵给药轮流续泵的方式输注多巴胺可以维持心源性休克患者血压心率相对稳定。     

去甲肾上腺素两种换泵方式对感染性休克患者血压的影响

目的评价去甲肾上腺素两种换泵方式对感染性休克患者血压的影响。方法选取60例使用去甲肾上腺素维持血压的感染性休克患者,同一患者均使用两种换泵方式分别换泵1次,其中30例第1次采用双泵双通路(双通路组)换泵法,第2次采用双泵单通路(单通路组)换泵法,另30例换泵顺序反之。两种换泵方式各60例次。结果单通路组换泵后血压波动最大幅度及血压波动时间显著低于双通路组(均P0.01)。结论感染性休克患者应用去甲肾上腺素在换泵时采取双泵单通路换泵法对血压波动的影响较小。     

新型彩头输液管用于多通道微量泵静脉输注的模拟实验研究

目的 探讨新型彩头输液管在多通道微量泵静脉输注时识别的准确性、效率,降低微量泵用药风险及提高抢救效率.方法 模拟微量泵静脉输注试验,设实验组和对照组,各组1个操作站,各有5台微量泵,2个操作站所用药物一致.对照组采用5根传统微量泵输液管连接注射器与三通,实验组采用新型彩头微量泵输液管连接注射器与三通.结果 对照组受试者完成所有药物与三通一一对应所用时间为(45.2±18.4)s,平均每种药物对应所需时间为(9.0±3.7)s,实验组用时分别为(15.7±3.1)s和(3.1±0.7)s;对照组91.95％受试者将药物与三通对应操作完全准确,实验组为99.66％,两组比较,差异有统计学意义(均P＜0.01).结论 新型彩头输液管能提高工作效率,保证微量泵用药的安全性和准确性,有助于降低医疗风险和提高抢救效率;且操作方便快捷.     

首推药物法用于微量泵丙泊酚静脉注射

目的提高微量泵推注药物效果。方法将入住ICU需泵入丙泊酚镇静的50例患者随机分为对照组和观察组各25例,对照组按常规以0.3~5.0 mg/(kg.h)速度泵入丙泊酚;观察组根据患者病情和体质量先静脉推注丙泊酚10~50 mg,再以0.3~5.0mg/(kg.h)速度泵入药物。结果观察组泵入丙泊酚5 min内镇静效果显著优于对照组(P<0.01)。结论应用微量泵泵入丙泊酚,首推一定剂量可有效提高镇静效果。     

微量注射泵持续注射硝普钠泵体移动方式对患者心率及血压的影响

目的了解微量注射泵(下称注射泵)持续注射硝普钠时泵体移动方式对患者心率及血压的影响,以确定更为安全的注射移动方式。方法将术中术后持续注射硝普钠的60例心脏手术患者随机分为对照组和观察组各30例,两组患者术后从手术室返回ICU时,暂不移动注射泵,按护理操作规程安置好患者,然后对照组将注射泵垂直上移至距床面25～35cm输液架固定;观察组将注射泵平行移动至床旁输液架固定。持续监测记录两组注射泵体移动前、后10min的心率、平均动脉压并进行比较。结果对照组移动后10min内患者心率上升8～10次/min、平均动脉压降低4～11mmHg,观察组患者平均动脉压差值和心率平均差值在0值附近窄幅波动;两组移动前、后心率、平均动脉压比较,干预主效应均P0.01。结论使用注射泵持续注入硝普钠垂直上移泵体后使患者心率加快、平均动脉压下降,因此,应尽可能地采用平行移动方式,以保证患者安全。     

双侧髂内动脉结扎及植入化疗药泵对直肠癌患者手术创伤及术后恢复的探讨

目的探讨经双侧髂内动脉结扎及经双侧髂内动脉植入化疗药泵对中晚期直肠癌患者手术创伤术后恢复的影响。方法总结68例双髂内动脉结扎并化疗药泵植入术的手术时间、出血量、术后常见症状和并发症、术后恢复等情况。结果在直肠癌患者接受手术治疗的同时加行双侧髂内动脉结扎化疗药泵植入术，平均增加手术时间35min，增加出血量15ml，术后胃肠恢复时间及拆线时间无明显延长，术后常见的症状为局部不适（36．76％），无双侧髂内动脉结扎及置管相关的严重并发症出现，仅14．71％双侧髂内动脉结扎并植入药泵患者行取泵手术。结论双侧髂内动脉结扎，对直肠癌Mile’s手术可减少输血使会阴部渗出减少，愈合加快，同时双侧髂内动脉化疗药泵的植入，便于中晚期直肠癌患者术后化疗的准备，其术中、术后对患者所致的创伤小，且并发症容易预防，应用安全。     

丙泊酚复合瑞芬太尼与静吸复合麻醉用于腹腔镜胆囊切除术的临床观察

目的:比较微量泵输注丙泊酚复合瑞芬太尼与静吸复合两种麻醉方法用于腹腔镜胆囊切除术(laparoscop ic chol-ecystectomy,LC)的效果。方法:选择胆囊炎或合并胆囊结石的患者30例,观察麻醉诱导及气管插管时的血压、心率变化,术毕停药后患者自主呼吸恢复时间、呼之睁眼时间、拔管时间等。结果:微量泵输注丙泊酚复合瑞芬太尼麻醉术后患者苏醒快、拔管早,定向恢复快,血流动力学无明显改变,更具有效性、安全性、可行性。结论:与常规静吸复合麻醉下行LC比较,微量泵输注丙泊酚复合瑞芬太尼麻醉诱导更加平稳,苏醒迅速,更加有效安全。     

原发性肝癌合并门静脉癌栓的外科治疗方式选择

目的探讨原发性肝癌(HCC)合并门静脉癌栓(TTPV)的外科治疗方式选择。方法对1990年1月至2003年1月期间收治的138例肝癌合并门静脉癌栓患者的临床资料进行分析和总结。结果37例行保守姑息治疗患者1至8个月内死亡,平均生存时间3．9个月。101例患者行手术治疗,其中23例行单纯肝癌切除术,平均生存时问10．9个月;78例采取各种手术方式行肝癌切除加门静脉癌栓取栓术,平均生存时间26．8个月。其中52例术后采用了肝动脉和门静脉双插管微量泵灌注化疗,其1、3、5年生存率为96．2％、51．9％、11．5％,26例未行插管化疗,1、3、5年生存率为76．9％、23．1％、0％。结论手术治疗比保守治疗能相对延长肝癌合并门静脉癌栓患者的生存时间;手术在切除肝癌的同时应尽量使用各种方式取出门静脉癌栓;术后使用肝动脉和门静脉双插管微量泵灌注化疗可有效提高治疗效果。     

微量泵输入硝普钠在高血压病术后救治中的观察与护理

目的探讨微量泵输入硝普钠治疗高血压病术后的护理,以提高抢救成功率。方法对46例微量泵输入硝普钠治疗高血压病进行护理分析。结果血压控制良好,水平较稳定。结论微量泵输入硝普钠是目前治疗高血压病的有效治疗方法,通过严格完善的护理措施有效提高抢救成功率,促进患者康复。     

微量注射泵持续注射硝普钠泵体移动方式对患者心率及血压的影响

目的了解微量注射泵（下称注射泵）持续注射硝普钠时泵体移动方式对患者心率及血压的影响，以确定更为安全的注射移动方式。方法将术中术后持续注射硝普钠的60例心脏手术患者随机分为对照组和观察组各30例，两组患者术后从手术室返回ICU时，暂不移动注射泵，按护理操作规程安置好患者，然后对照组将注射泵垂直上移至距床面25～35cm输液架固定；观察组将注射泵平行移动至床旁输液架固定。持续监测记录两组注射泵体移动前、后10min的心率、平均动脉压并进行比较。结果对照组移动后10min内患者心率上升8～10次／min、平均动脉压降低4～11mmHg，观察组患者平均动脉压差值和心率平均差值在0值附近窄幅波动；两组移动前、后心率、平均动脉压比较，干预主效应均P〈0．01。结论使用注射泵持续注入硝普钠垂直上移泵体后使患者心率加快、平均动脉压下降，因此，应尽可能地采用平行移动方式，以保证患者安全。     

胸腰椎骨折椎弓根内固定断裂与植骨融合方式的相关性分析

[目的]探讨胸腰椎骨折椎弓根螺钉内固定系统内固定术后,椎弓根螺钉断裂与植骨融合方式之间的关系,以探讨胸腰椎骨折植骨融合的最佳方式。[方法]回顾性研究1995年5月~2005年12月本院脊柱外科收治的胸腰椎骨折病人197例,其中A组单纯内固定(不植骨)患者14例,B组“H”形椎板植骨21例,C组横突间植骨67例,D组椎间、椎内联合横突间植骨95例。[结果]术后随访6~32个月,内固定断裂12例,其中A组4例,B组3例,C组5例,D组0例,4组中D组内固定断裂率显著低于其他3组(P<0.05)。[结论]椎间、椎体内联合横突间植骨重建脊柱三柱的稳定性,符合人体生物力学原理,能有效降低内固定断裂的发生。     

On the measurement of the functional properties of the CFTR

A number of methods are currently employed to assess the functional properties of CFTR channels and their response to pharmacological potentiators, correction of the defective CFTR trafficking, and vectorial introduction of new proteins. Here we review the most common methods used to assess CFTR channel function. The suitability of each technique to various experimental conditions is discussed.     

The Measurement of the Inclination Angle of the Hamate and Analysis of the Inclination Angle for the Rotation Deformity of the Little Finger in the Fixation of the Carpometacarpal Joint

ObjectiveComplex base fractures of the fifth metacarpal bone and dislocation of the fifth carpometacarpal joint are more prone to internal rotation deformity of the little finger sequence after fixation with a transarticular plate. In the past, we have neglected that there is actually a certain angle of external rotation in the hamate surface of transarticular fixation. This study measured the inclination angle of the hamate surface relative to the fifth metacarpal surface for clinical reference.MethodsIn a prospective single‐center study, we investigated the tilt angle of 60 normal hamates. The study included thin‐layer computed tomography (CT) data from 60 patients from the orthopaedic clinic and inpatient unit from January 2017 to March 2020, including 34 men and 26 women who were 15~59 years old, average 35 years old. The CT data of 60 cases in Dicom format of the hand was input into Mimics and 3‐Matics software for three‐dimensional (3D) reconstruction and measuring the angle α between hamate surface and the fifth metacarpal surface. According to the possible placement of the transarticular plate on the fifth metacarpal surface, we measured the angle β between the hamate surface 1 and the fifth metacarpal surface and the angle γ between the hamate surface 2 and the fifth metacarpal surface.ResultsThe average angle between the hamate surface and the fifth metacarpal surface was 11.66°. The hamate surfaces 1 and 2 have an external rotation angle of 7.30° and 7.51° on average with respect to the fifth metacarpal surface, respectively. There is no statistically significant difference in the angles between the two groups (P > 0.05).ConclusionsThe horizontal angle of the dorsal side of the hamate is different from the back of the fifth metacarpal surface, and the hamate has a certain external rotation angle with respect to the fifth metacarpal surface. No matter how the transarticular plate is placed, the plate always has a certain external rotation angle relative to the fifth metacarpal surface. When the fixation is across the fifth carpometacarpal joint, if the plate does not twist and shape, it will inevitably cause internal rotation of the fifth metacarpal, resulting in internal rotation deformity of the little finger sequence.     

静脉输注甘露醇开放血脑屏障对抗生素透过血脑屏障的影响

目的　通过快速静脉输注甘露醇可逆性开放血脑屏障 (BBB) ,探知此方法能否增加抗生素透过BBB的量 ,在何时达到最高峰 ,其通透量增加后临床上有无不良反应。方法　采用自身配伍设计 ,共 6个样本组。对照组仅使用抗生素 ;其余 5组分别在使用甘露醇前 60、3 0min ,同时使用甘露醇后 3 0、60min使用抗生素 ,各组皆取使用抗生素后 1h的脑脊液测其抗生素浓度。抗生素选用头孢三嗪。结果　测量值经过q检验 ,经 2 0 %甘露醇处理前后的CSF中的头孢三嗪浓度差异有非常显著性。全组患者经临床观察未出现神经系统的不良反应。结论　经静脉快速输注2 0 %甘露醇后可以使透过BBB的水溶性抗生素的量增加 ,两者使用的顺序是在抗生素使用 3 0min内即给予甘露醇快速滴注。该方法不会增加低神经毒性抗生素在中枢神经系统的不良反应。     

Preservation of the pylorus and resection of the head of the pancreas

The historical evolution of the pylorus-preservation resection of the head of the pancreas is traced from the first resections early in this century to relative standardization of the operation, to a lowering of the operative mortality, and to an interest in improving nutritional status after resection. There are many theoretical advantages for the function of the upper gastrointestinal tract after pylorus and gastric preservation, such as maintenance of gastric capacitance and equilibration of osmotic pressure in gastric digestants, foodstuff digestion and absorption, and bowel motility. After the pylorus-preserving resection, gastric emptying is normal, pyloric function to prevent duodenal reflux is often normal, and gastric acids and serum levels of duodenal hormones are at normal levels, whereas after standard pancreatoduodenectomy, all of these are often abnormal. No prospective blinded studies have been published comparing nutritional values after the two operative procedures, but evidence is presented of a satisfactory result with regard to gastric capacitance, body weight gain, and lack of postgastrectomy symptoms. An undoubted advantage of the pylorus-preserving feature is a simplification of the operation. These gains are achieved without increase in operative mortality, without increase in the incidence of jejunal ulcer, and without theoretical or actual decrease in value of the procedure as a cancer operation, except in patients with duodenal carcinoma proximal to the ampulla of Vater.     

下颌全牙弓后移量及最后界的测量

目的：研究下颌牙弓的有效后移量及找寻下颌牙弓移动的后界。方法：选取涉及拔除下颌第三磨牙或下颌第三磨牙缺失的病例18例（男6例,女12例）。采用种植支抗牵引下牙弓向远中,治疗完成时所有病例均明确到达下颌牙弓后界,即下颌第二磨牙远中到达下颌升支前缘软组织交界处。应用治疗前后的曲断片测量下颌第二磨牙远中到升支前缘的距离。结果：下颌第二磨牙后移量为（3.49±1.21）mm;治疗后磨牙后间隙的长度为（4.43±0.97）mm。结论：下颌牙弓可确定性地实现整体后移;最大后移量由磨牙后间隙的长度决定;其最后界止于下颌第二磨牙远中与下颌升支前缘软组织交界处。     

Preservation of the pylorus in resection of the head of the pancreas

Whipple's pancreatoduodenectomy was the standard operation for diseases of the head of the pancreas for more than 40 years, but the results were vitiated in part by poor gastrointestinal function and malnutrition. Reintroduced in 1978, pylorus-preserving proximal pancreatoduodenectomy (PPPP) has had an increasing impact on pancreatic surgery as its benefits have been recognized: improved nutritional status, decreased incidence of postgastrectomy syndromes, and a technically easier operation. Postoperative mortality rates and 5-year survival rates are comparable with those of the classic Whipple procedure. PPPP is indicated for most patients with chronic pancreatitis of the pancreatic head. It is also appropriate for patients with periampullary cancer and for those with pancreatic cancer arising from the lower part of ‘the head and the uncinate process. More than 650 patients have now undergone PPPP: 31% for chronic pancreatitis and 66% for periampullary and pancreatic cancers. We assess the indications for PPPP, outline the operation, and review the results.