快通道胃肠手术后咽部并发症处理方法的比较

目的探讨一种有效防治快通道胃肠道手术后咽部并发症的处理方法,以更好满足临床和患者的要求。 方法采用前瞻性、随机、双盲的研究方法,选择本院拟在全麻下行开腹胃肠道手术者280例,随机分为4组,各70例,A组（对照组）,气管导管用医用石蜡油润滑;B组,气管导管用丁卡因胶浆润滑;C组,气管导管用丁卡因胶浆润滑+插管后静注地塞米松10 mg;D组,C组基础上加静注帕瑞昔布钠40 mg。记录并比较各组麻醉拔管后10 min、30 min、1 h、6 h、12 h、24 h时的术后咽喉痛（POST）发生率及严重程度,观察在PACU期间1 h内的吸痰例数。 结果拔管后10 min观察点同期比较,B、C、D组POST发生率低于A组（P<0.05）;30 min观察点同期比较,B、C、D组POST发生率低于A组（P<0.05）,D组分别低于B、C组（P<0.05）;1 h观察点同期比较,B、C、D组POST发生率低于A组（P<0.05）,D组分别低于B、C组（P<0.05）;6 h观察点同期比较,D组POST发生率低于A组（P<0.05）;12 h、24 h观察点组间POST发生率差异无统计学意义。在PACU观察期间的吸痰人数,C、D组发生率低于A、B组（P<0.05）;A、B组之间,C、D组间发生率差异无统计学意义。 结论气管导管润滑复合静脉用药的多模式处理可有效防止POST,复合静注激素可有效减少拔管后气道分泌物。     

应该正视胃肠手术后并发症的防治

胃肠道肿瘤主要包括胃、小肠和结直肠癌。在中国．大多数医院包括县级医院都在开展胃肠道肿瘤的手术。但是术后并发症的出现给患者及其家属都带来了压力．原因是发生这些并发症会使医疗费用上升．有时还会产生医疗纠纷．故应该引起广泛关注。胃肠道手术后的急性出血、梗阻和吻合口瘘是最常见的并发症。正视胃肠道手术的并发症非常重要。     

腹部外科手术后肺部感染114 例临床分析

目的 探讨腹部外科手术患者术后发生肺部感染的危险因素、临床表现、治疗方法.方法 回顾性分析114 例腹部外科手术后发生肺部感染患者的有关临床资料,并选择同期住院的205 例腹部手术后无肺部并发症作为对照.结果 并发症组患者平均年龄、有吸烟史、合并糖尿病、基础心肺疾病者所占的比例、术中出血量、低蛋白血症比例均显著高于对照组;术后并发肺部感染可表现为:发热、血白细胞升高、呼吸急促、咳嗽、咯痰、肺部口罗音、支气管呼吸音、呼吸音减弱、低氧血症、胸片新出现的浸润、实变、痰培养发现致病菌或真菌;术后并发肺部感染的治疗包括保持呼吸道通畅,清除呼吸道分泌物、抗生素应用、加强支持治疗.结论 高龄、有吸烟史和基础心肺疾病、合并糖尿病、低蛋白血症、术中出血量多、手术时间长的腹部手术患者易发生肺部感染.腹部外科术后并发肺部感染死亡率较高,细菌、真菌是主要的病原体,加强预防和综合治疗,是减少腹部外科术后肺部感染病死率的有效方法.     

肺切除手术后心血管并发症的防治

自１９７３年至１９９４年我们完成肺切除手术５７６例，术后发生心血管并发症５９例，发生率１０．２％。现探讨心血管并发症发生的主要原因及其防治措施如下。临床资料　本组５９例中男４８例，女１１例。年龄３５～７７岁，平均５６岁。年龄大于６０岁者术后心血管并发症发生率２２．６％（２６１１５）。全肺切除者发生率３０．５％（２５８２），局部或肺叶切除者发生率６．９％（３４４９４）。５９例心血管并发症多发生在术后３日内，其中室上性心律失常４７例，窦性心动过速３３例，房扑—房颤１２例（死亡２例），频发结早２…     

胸外科非心脏手术后心血管并发症32例分析

自１９８２年６月至１９９１年１０月连续１１７２例胸外科非心脏手术病例中，术后出现心血管并发症者３２例，其中心律失常２２例（室上性１８例，室性４例），全部治愈。≥６０岁老年组心血管并发症较非老年组明显增高（Ｐ〈０．０１）。食管癌切除弓上食管－胃吻合并发症发生率明显高于弓下吻合者（Ｐ〈０．０１）。全肺切除并发症发生率明显高于肺叶切除者（Ｐ〈０．０１）。３２例发症中，２４例发生于术后３天内。作者强调，改     

外科手术后肺部并发症的防治进展

肺是多器官功能障碍综合征最主要的靶器官。外科手术后肺不张、肺部感染、肺动脉血栓栓塞和急性肺损伤等肺部并发症的发病率,远较心脏异常普遍,亦是导致术后死亡最主要的原因。随着环境危险因素的增多以及诊断技术的提高,其发病率呈稳步上升趋势。因此,术后肺部并发症的及早预防、积极阻断其进一步发展至关重要。     

老年结、直肠癌术后肺部并发症危险因素分析

为探讨老年结、直肠癌患者术后肺部并发症的相关危险因素。 笔者回顾性分析近4年间手术治疗的330例60岁以上结、直肠癌患者术后肺部并发症（PPC）发生的情况。结果示330例中有72例出现PPC，发生率为21.80%，死亡5例，病死率占全组患者的1.51%，占PPC患者的6.94％。PPC发生率如下：年龄﹥80岁者为42.30%；体重指数﹥25者为27.38%；有吸烟史者为37.00%；有慢性阻塞性肺疾病（COPD）史者为33.56%；上腹部手术为37.39%；手术时间﹥2h者为24.60%。提示PPC的发生与高龄、肥胖、吸烟史、COPD史、手术部位、手术时间有明显关系，是相关的危险因素。     

余肺切除治疗肺部疾患临床分析

目的探讨余肺切除的手术适应证、手术方法、并发症防治和远期疗效。方法回顾1985年1月至2006年8月进行的24例余肺切除[占同期全肺切除的2．3％（24／1026）]患者的临床资料。余肺切除距第1次肺切除的时间为5．5个月-30年,平均65个月;肺癌复发患者间隔时间为术后5．5个月～10年,平均32个月。手术历时4-7h,平均5．5h;术中失血300-3000ml,平均1270ml。结果手术切除23例,切除率为95．8％。术后并发症发生率及住院死亡率分别为29．2％（7／24）和4．2％（1／24）。术后病理诊断为支气管扩张症2例、原发性肺癌4例、复发性肺癌18例。术后随访率为91．7％（22／24）。肺癌余肺切除患者的1、3、5年生存率分别为77．3％（17／22）、50．0％（9／18）和29．4％（5／17）;其中复发性肺癌患者余肺切除术后的1、3、5年生存率为72．2％（13／18）、47．1％（8／17）和29．4％（5／17）。结论严格选择患者,术中精细操作,做好围手术期并发症的防治,余肺切除可有效延长患者的生存期。     

25例尿毒症肺部并发症的临床分析

目的探讨尿毒症肺部并发症的临床特点。方法本研究共收集慢性尿毒症患者103例,其中经胸部X线片检查者46例,对其发生机制、诊断及治疗进行分析和探讨。结果死亡病例的Bun和Cr明显高于存活者。结论尿毒症肺的胸部X线表现与病情的轻重、病程有关。     

高龄患者手术后并发心肌梗塞的特殊临床表现

作者从１９９０年至１９９４年共为２６０例６０岁以上高龄患者施行手术，其中１８例并发心肌梗塞，全部为男性，术前多已合并有其他内科疾病，其中１３例合并慢性肺部疾病，占心肌梗塞病例总数的７２％，且此１３例患者均有十年以上吸烟史，吸烟者并发术中后心肌梗塞机率明显高于非吸因者，无痛型心肌梗塞发生率为２２％，不典型症状发生率为７７％，术后常规心电监护有助于早期诊断及提高治愈率，另有６例患者术后出现严重心肌缺氧     

Prediction of the Postoperative Pulmonary Function and Complication Rate in Elderly Patients

We analyzed the risk factors predisposing elderly patients to develop postoperative respiratory complications (PRCs) and investigated the possibility of predicting the postoperative pulmonary function and PRC rate. The postoperative pulmonary functions were predicted according to a simplified system, which we developed using plain chest roentgenograms from patients with primary lung cancer. Both univariate and multivariate analyses of PRCs were performed in 39 elderly patients with lung cancer from July 1982 to March 1991 (the early period). Based on the results obtained, the permissible extent of lung resection to achieve a predicted postoperative % forced expiratory volume in 1 s (ppo%FEV_1.0) and a predicted postoperative % vital capacity (ppo%VC) of more than 55% was selected as the basic criteria for undergoing such an operation after April 1991 (the recent period). A ppo%FEV_1.0 and/or ppo%VC of 55% or less was the most significant risk factor for developing PRCs. The PRC rate decreased from 33.3% to 9.8% (P = 0.0251) and the operative mortality rate decreased from 10.3% to 0%. The survival rates for stage I, II, and III cases were not significantly different between the early and recent periods. Decisions made on the operability and the permissible extent of lung resection based on our system using plain chest roentgenograms therefore appeared to reduce the PRC rate and operative mortality rate in elderly patients. Received: September 20, 2000 / Accepted: May 15, 2001     

Clinical Outcomes in Patients with Pulmonary Hypertension Undergoing Total Hip Arthroplasty

Background

Pulmonary hypertension (PH) is regarded as a risk factor for perioperative complications in patients undergoing noncardiac surgery.

Questions/Purposes

The objective of this retrospective case–control study was to evaluate the adverse outcomes of pulmonary hypertension patients undergoing elective unilateral hip replacements.

Methods

We performed a retrospective case–control study of total hip replacement patients with pulmonary hypertension (cases) and without pulmonary hypertension (control). From the years 2003 to 2008, we identified a total of 132 patients undergoing primary total hip replacements with a diagnosis of pulmonary hypertension (right ventricular systolic pressure >35). The primary outcome assessed was the incidence of adverse events that occurred during the postoperative hospital stay. Secondary outcomes studied included length of hospital stay, mortality, and ability to reach certain physical therapy milestones.

Results

The PH group had significantly more adverse events than the control group. Nonlethal cardiac dysrhythmias comprised the most common adverse outcome among the PH group. Overall, the PH group had a morbidity rate of 34.7% while the control had a rate of 21%. The PH group had longer hospital stay (6.7 days vs. 5.9). Both groups had zero mortality during the hospital stay. The PH group had comparable rehabilitation recovery times than the control group.

Conclusion

This retrospective case–control study demonstrates that pulmonary hypertension patients undergoing total hip arthroplasty are more prone to adverse outcomes, especially cardiac dysrhythmias, and longer hospital stays.     

Effect of Subcutaneous Salbutamol on Postoperative Pulmonary Function in Patients Undergoing Elective Cholecystectomy

In a double-blind study, 14 patients underwent elective cholecystectomy. The patients were randomly allocated to two groups of seven to receive either s.c. salbutamol 0.5 mg or placebo 0.5 mg immediately before extubation and every 6 h for 48 h. In the placebo group there was a significant reduction in mean arterial oxygen tension of seven patients 3, 27 and 51 h after surgery (P = 0.006, P = 0.01 and P = 0.02) compared with the mean value before operation. The reduction in mean arterial oxygen tension in the group receiving salbutamol was not significant 3 h after surgery (P = 0.13), whereas reduction was significant 27 and 51 h later (P = 0.01 and P = 0.02) compared with the mean value before operation. Mean arterial oxygen tension was significantly higher in the salbutamol group than in the placebo group 3 h after operation (P = 0.03), whereas it was not significant 27 and 51 h later (P = 0.48 and P = 0.55). Mean spirometric values showed significant reductions 27 and 51 h after operation in both groups compared with the pre-operative measurements. Smaller insignificant differences were found between the salbutamol and placebo groups 27 and 51 h after operation. However, mean FEV1 in the salbutamol group 51 h after operation was 22% higher in comparison with the placebo group. Our results suggest that salbutamol may reduce postoperative hypoxaemia during the first few hours after the operation, but not later on.     

Lung Complications After Elective Hip Surgery

A total of 350 patients undergoing elective hip surgery were retrospectively studied as regards pulmonary complications. The study is based on the findings of pre-and postoperative chest X-rays and of pulmonary perfusion scintigrams. Twenty-seven per cent of the patients had pulmonary complications of some kind. Twelve per cent had a change in the postoperative as compared to the preoperative X-ray, though most of the changes were minute. In 15.4 per cent there were scintigraphic signs of pulmonary embolism and of these 30 per cent had signs or symptoms of pulmonary embolism; 1.7 per cent of the patients had symptoms of pulmonary infectious disease. Two patients died from pulmonary embolism. The study shows a low frequency of serious pulmonary complications after elective hip surgery.     

Lung Complications After Elective Hip Surgery

A total of 350 patients undergoing elective hip surgery were retrospectively studied as regards pulmonary complications. The study is based on the findings of pre-and postoperative chest X-rays and of pulmonary perfusion scintigrams. Twenty-seven per cent of the patients had pulmonary complications of some kind. Twelve per cent had a change in the postoperative as compared to the preoperative X-ray, though most of the changes were minute. In 15.4 per cent there were scintigraphic signs of pulmonary embolism and of these 30 per cent had signs or symptoms of pulmonary embolism; 1.7 per cent of the patients had symptoms of pulmonary infectious disease. Two patients died from pulmonary embolism. The study shows a low frequency of serious pulmonary complications after elective hip surgery.     

肝切除术后并发症分析

目的总结和探讨肝切除术后常见并发症及其防治经验。方法回顾性分析73例肝切除术后患者的围手术期并发症,其中原发性肝癌28例,肝内胆管结石15例,胆管癌12例,胆囊癌2例,血管瘤5例,肝外伤7例,肝囊肿4例。Ch ild-Pugh肝功能分级A级59例,B级14例。行左半肝切除12例,单纯左肝外叶切除10例,左外叶切除+右肝肿瘤挖除6例,右半肝切除6例,右肝三叶切除2例,其他肝叶肝段不规则切除21例,肝楔形切除或肿块挖除16例。结果术后并发症包括腹腔内出血5例、肝功能衰竭6例、腹腔感染3例、肺部感染与胸腔积液4例、胆汁漏2例及上消化道出血2例。1例死亡,死因为术后肝功能衰竭、上消化道出血。肝脏恶性肿瘤患者术后并发症发生率虽高于肝脏良性疾病患者(38.1%vs.19.4%),但无统计学差异(P>0.05)。结论术前详细评估患者肝功能储备及相应心肺功能情况,提高手术技巧,加强术后管理是防治肝切除术后并发症的关键因素。     

Pulmonary function before and after abdominal surgery in the aged

In patients 70 years or older, pulmonary function tests were performed before and after abdominal surgery to correlated the results with the development of postoperative pulmonary complications which developed in 48% of these patients, compared to 15% in the control group. To predict the development of PPC, preoperative analysis of the flow-volume curve is useful and vital capacity is a valuable parameter for the analysis of the flow-volume curve. Postoperatively, pulmonary function was reduced and there was a delay in the restoration of pulmonary function in cases with postoperative pulmonary complications. The administration of appropriate analgesics may be useful to improve postoperative ventilatory disturbances.     

原发性胃肠道恶性淋巴瘤45例分析

目的 :探讨原发性胃肠道淋巴瘤的诊治。 方法 :回顾性分析 4 5例胃肠道淋巴瘤病例。 结果 :4 5例中胃淋巴瘤32例 ,小肠淋巴瘤 5例 ,结肠淋巴瘤 5例 ,直肠淋巴瘤 3例。粘膜相关淋巴组织淋巴瘤 (MALTlymphomas)占 4 0 %。肿瘤浸润深度、淋巴结转移及是否为MALT淋巴瘤均与恶性程度相关 (P <0 0 5 )。低度、高度恶性者 5年生存率分别为 6 0 %和 36 %。 结论 :MALT淋巴瘤是最常见的病理类型。肿瘤的恶性程度是重要的预后因素。