驱血供血按摩疗法在断指再植和手指再造术中的应用(附57例静脉危象的原因分析)

目的探讨驱血供血按摩疗法在指再造和再植术后防止静脉危象的应用.方法将1989年～1998年间行指再造和再植术者1086指按时间分为两组.第一组:1989年～1992年共487指,第二组:1993年～1998年采用按摩疗法后共599指,比较两组的手指成活率和发生静脉危象发生率.结果第二组的手指成活率高于第一组;而发生静脉危象后的手术探查率却低于第一组.结论驱血和供血按摩疗法对解除再造和再植手指术后静脉危象有显著效果.     

重度闭合性腹部交通伤急诊一站式诊治体会

目的探讨重度闭合性腹部交通伤急诊一站式诊治流程及效果。方法回顾性分析65例经急诊一站式诊治重度闭合性腹部交通伤患者的临床资料,强调急诊基础生命支持治疗、病史采集、快速查体、诊断性腹腔穿刺术及急诊一站式辅助检查对诊断重度闭合性腹部交通伤患者的重要性。诊断明确或部分诊断不清而又高度怀疑有腹内脏器损伤者应及时手术治疗;对损伤严重无手术指征者,仅行非手术治疗。结果术前确诊51例,术中确诊14例;手术治疗64例(其中确定性手术治疗31例、损伤控制外科治疗33例)、非手术治疗1例;治愈62例,死亡3例(其中术后死亡2例,1例合并脑疝患者未手术即死亡)。结论急诊一站式辅助检查及优化的诊断、救治流程,有助于重度闭合性腹部交通伤患者早期诊断及早期手术治疗;一站式诊治模式是提高重度闭合性腹部交通伤救治成功率的关键。     

钝性闭合性手损伤致动脉危象17例护理体会

<正> 手指血管细小,断指再植或血管修复术后发生血管危象较为常见。1995～1999年,笔者收治钝性闭合性手指损伤368例414指,其中17例19指发生血管危象,现将体会介绍如下。1 临床资料1.1 一般资料 本组男12例13指,女5例6指,年龄13～67岁,平均28.9岁。致伤原因:重物砸伤6例7指、挤压伤4例5     

CTA在诊断闭合性隐匿性动脉损伤中的应用

目的:探讨CT血管成像技术(CTA)在诊断闭合性隐匿性动脉损伤中的应用价值.方法:对9例CTA检查确诊有闭合性动脉损伤患者的临床资料进行回顾分析.结果:CTA检查均成功,9例患者诊断明确后均行手术治疗.术后损伤动脉血流通畅,血运正常.结论:CTA是诊断闭合性动脉损伤的方法之一;怀疑有闭合性动脉损伤者应行CTA检查;CT...     

驱血供血按摩疗法在断指再植和手指再造术中的应用

目的 探讨驱血供血按摩疗法在指再造和再植术后防止静脉危象的应用。方法 将１９８９年￣１９９８年间行指再造和再植术者１０８６指按时间分为两组。第一组：１９８９年￣１９９件共４８７指，第二组：１９９３年￣１９９８年采用按摩疗法后共５９９指，比较两组的手指成活率和发生静脉危象发生率。结果 第二组的手指成活率高于第一组；而发生静脉危象后的手术探查率却低于第一组结论 驱血和供血按摩疗法对解除再造和再植手术     

低分子肝素钙联合非洛地平预防穿支皮瓣术后动脉危象疗效研究

目的探讨低分子肝素钙联合非洛地平预防穿支皮瓣术后动脉危象的疗效。方法采用随机及单盲的原则将412例行游离穿支皮瓣移植患者分为研究组及对照组,研究组(198例)行穿支皮瓣移植患者术后应用低分子肝素钙联合非洛地平预防术后动脉危象,对照组(214例)行穿支皮瓣移植患者术后应用罂粟碱、肝素钠预防术后动脉危象。观察两组动脉危象发生情况、动脉危象救治疗效及药物不良反应情况。结果研究组术后发生穿支皮瓣动脉危象例数及动脉危象救治疗效均要好于对照组,差异均有统计学意义(均<0.05)。研究组药物不良反应发生率要低于对照组,差异有统计学意义(<0.05)。结论低分子肝素钙联合非洛地平应用于穿支皮瓣移植术后,能够降低术后动脉危象发生率,且药物不良反应少,患者对药物的依从性及耐受性好。     

脐动脉舒张期血流消失时胎儿生长发育及出生情况分析

目的：分析晚孕期脐动脉舒张期血流信号消失时胎儿生长发育和出生时情况。方法采用彩色超声诊断仪检测脐动脉血流信号,对比分析脐动脉血流正常与脐动脉舒张期血流消失时胎儿的生长发育指标和出生时Apgar评分。结果脐动脉舒张期血流消失的胎儿生长发育小于孕龄的发生率明显高于正常组,出生时宫内窘迫的发生率也明显高于正常组。结论晚孕期脐动脉舒张期血流消失提示胎儿宫内缺氧,胎儿生长发育相对缓慢。     

血管斜形端端吻合法在断指再植中的应用

目的研究采用血管斜形端端吻合进行断指再植的临床效果。方法收治断指患者380例共断指575指,离断时间20-720 min,平均180 min。随机分为观察组和对照组,观察组采用斜形端端吻合血管方法再植,对照组采用传统垂直端端吻合血管方法再植。术后给予抗感染、抗凝及抗血管痉挛药物治疗。发生动脉或静脉危象后给予抗血管痉挛或溶栓药物治疗,未见明显改善行手术探查。结果观察组术后出现动脉危象10例,静脉危象13例,动脉危象发生率5.2%,静脉危象发生率6.7%;对照组术后出现动脉危象18例,静脉危象22例,动脉危象发生率9.5%,静脉危象发生率11.7%。观察组再植后指体坏死6例12指,成活率95.9%;对照组植后指体坏死14例21指,成活率92.6%。统计学分析观察组与对照组动脉危象发生率、静脉危象发生率及再植成活率有显著差异,P0.05。结论采用血管斜形端端吻合进行断指再植可明显提高血管通畅率及再植成活率。     

断指再植术后血管危象的观察护理

血管危象是断指再植手术常见的严重的并发症之一,尤其是撕脱、碾压伤的患者,一旦发生可引起血管危象,血管危象可分动脉危象和静脉危象。24h内易出现动脉危象,1～3d出现静脉危象。我科1999年1月～2004年12月共收治断指再植患者205例。发生危象37例,发生率为5.5%。经及时观察和护理并采取有效措施,提高了断指再植的成活率。现将有关观察和护理体会报告如下:1临床资料本组205例患者208指中,男152例155指,女53例53指,年龄15～45岁。其中撕脱、碾压伤25指,切割伤183指,出现静脉危象28指,动脉危象14指。有33指经观察并采取有效治疗而成活,成活率89…     

断指再植术后血管危象的发生原因与护理对策

目的探讨断指再植术后血管危象发生因素与处理.方法回顾性分析2005年1月至12月断指再植病例198例212指临床资料.结果本组病例198例212指中发生血管危象23指,其中动脉危象13指,静脉危象10指,经及时发现、对症处理,18指成活,救治成活率78.26%.结论血管危象的发生与疼痛、吸烟、体位及神经体液等多因素有关.正确处理血管危象的发生因素,可提高断指再植成功率.     

自残性断指再植术后应用枣仁逍遥汤的疗效及预后影响因素

目的 探究自残性断指再植术后应用枣仁逍遥汤的疗效,分析影响术后断指存活的相关因素.方法 选取2017年3月—2020年3月期间在河北省沧州市中西医结合医院手显微外科就诊的行自残性断指再植术的住院患者118例.按照随机数字表法分为治疗组59例,对照组59例.对照组予以断肢再植术后常规治疗.治疗组在对照组基础上,予以枣仁逍...     

吸烟对不同病变支数冠心病患者下肢动脉硬化闭塞的影响

目的 探讨吸烟对不同病变支数冠心病患者下肢动脉硬化闭塞的影响.方法 选择行冠状动脉造影检查的患者200例,按结果分为无冠心病的对照组和冠心病组,其中冠心病组患者又分为单支病变、两支病变、三支病变,每组各50例.分析患者吸烟与下肢动脉硬化闭塞情况及下肢动脉踝肱动脉压力指数(AAI)的关系.结果 吸烟者中,冠心病患者的下肢动脉闭塞情况较非冠心病者的严重(P<0.05);非吸烟者中,冠心病患者的下肢动脉闭塞情况与非冠心病者无差异(P>0.05);随着冠状动脉病变支数增多,吸烟者AAI的降低幅度要大于未吸烟者(P<0.05).结论 吸烟对不同冠状动脉病变患者下肢动脉硬化闭塞较高,吸烟冠心病患者病变分支越多,其AAI值越低.     

Lipid patterns and fibrinogen levels of smokers and non-smokers

Hypercholesterolaemia, smoking and elevated levels of fibrinogen are independent risk factors for cardiovascular disease (CVD). The aim of this study was to determine whether smoking indirectly affects the other risk factors, namely cholesterol and fibrinogen levels. Serum lipid patterns and fibrinogen levels were determined in 67 cigarette or beedi smokers and 51 non-smokers in the age group 18 to 50 years. Serum thiocyanate levels were measured as an indirect indicator or smoking exposure. Smokers had significantly higher serum thiocyanate levels than non-smokers. The serum total cholesterol levels in smokers was significantly higher than in non-smokers, but there was no association with the degree of smoking. In contrast, smokers had significantly elevated fibrinogen levels which were positively related to thiocyanate levels, indicating that plasma fibrinogen levels increase in smoking exposure. These results suggest that smoking may increase the risk of CVD by elevating plasma fibrinogen levels.     

重建感觉的指动脉背侧支逆行岛状皮瓣与指动脉逆行岛状皮瓣修复手指指端缺损效果比较

目的：比较重建感觉的指动脉背侧支岛状皮瓣与指动脉逆行岛状皮瓣两种手术方法修复指端缺损的效果,为临床选择提供参考。方法自2012年8月～2013年9月,选择本科2～4指甲弧以远的复合组织缺损,指腹单纯软组织缺损者,采用重建感觉的指动脉背侧支逆行岛状皮瓣修复17例（20指）或指动脉逆行岛状皮瓣修复14例（16指）,比较手术时间,术后皮瓣情况,随访两组皮瓣两点感觉,受区、供区外观及患指活动度等。结果①指动脉背侧支皮瓣组手术时间平均为78．6min,指动脉皮瓣组45min,两者比较有显著差异（P＜0．01）;②指动脉背侧支皮瓣中有3例（3指）发生血管危象,指动脉皮瓣组中1例（1指）发生静脉回流障碍;③术后12个月时测量两组皮瓣静态两点辨别觉,指动脉背侧支皮瓣组6．2～10．4mm,平均8．3mm,指动脉皮瓣组8．5～12．4mm,平均10．45mm;④指动脉皮瓣组中术后患指怕冷、严寒疼痛现象发生率高于指动脉背侧支组。结论与指动脉岛状皮瓣相比,指动脉背侧支皮瓣可较好地重建指端感觉,应用效果较为满意。     

Abstention from cigarette smoking improves cerebral perfusion among elderly chronic smokers

A cross-sectional study of cerebral blood flow (CBF) levels in 268 neurologically normal volunteers contrasting nonsmokers, smokers who quit, and current cigarette smokers indicated that subjects who quit smoking had significantly higher cerebral perfusion levels than subjects who had continued to smoke but remained lower than subjects without a history of cigarette smoking. All subjects were matched for age and sex, and smoking groups were matched for duration and amount of smoking. A prospective study of 11 subjects who were able to stop smoking in which CBF levels were available both antecedent to and following cessation of the habit indicated that significant gains occurred in cerebral perfusion levels within one year following cessation of smoking. A control group of 22 subjects who continued to smoke (matched for age, sex, duration of smoking, and duration of time between baseline and follow-up) showed no change in CBF values. A correlation between magnitude of CBF change and duration of cessation of cigarette smoking demonstrated a significant linear increase in CBF during the one-year period. These results suggest that elderly individuals who have smoked for three to four decades can benefit substantially by abstaining from cigarette smoking and that significant improvement in cerebral circulation occurs within a relatively short period.     

改良小切口放血护理在末节断指再植动静脉危象中的应用研究简

目的探讨改良小切口放血护理在末节断指再植动静脉危象中的应用价值。方法回顾性分析台州恩泽医疗中心集团路桥医院手足外科病房末节断指再植动静脉危象患者102例,分为对照组（n=51）和观察组（n=51）。对照组给予“挑拨”方式,观察组采用改良小切121放血。观察两组住院天数、并发症及再次手术发生率。结果对照组住院天数为（18．23±6．14）d,再次手术发生率为33．3％（17／51）,感染和坏死并发症发生率分别为23．5％（12／51）和17．6％（9／51）;观察组住院时间为（12．76±4．59）d,再次手术发生率为17．6％（9／51）,感染和坏死并发症发生率分别为9．8％（5／51）和7．8％（4／51）。两组比较差异有统计学意义（均P〈0．05）。两组术后情况比较,对照组血管危象发生11例,发生率为21．6％;再植指成活数35例,发生率为68．6％;患者满意度76．5％（39／51）;观察组血管危象发生3例,发生率为5．9％;再植指成活数49例,发生率为96．1％;患者满意度94．1％（48／51）,两组比较差异均有统计学意义（均P〈0．05）。结论改良小切口放血护理能够减少末节断指再植动静脉危象,缩短患者住院时间,减少并发症,减少再次手术发生率,提高断指再植成活率,提高患者满意度。     

吸烟对HDL-C正常者的胆固醇外流功能影响的研究

目的:通过对比吸烟和不吸烟者外周血中高密度脂蛋白(high-density lipoprotein,HDL)相关的巨噬细胞胆固醇外流功能,以明确吸烟对于胆固醇逆向转运过程的影响。方法:分别纳入42名高密度脂蛋白胆固醇正常的吸烟者和不吸烟者为研究对象,使用胆固醇外流荧光分析法,测量研究对象外周血血浆中的HDL对J774A.1巨噬细胞外流率的影响。结果:两组研究对象在一般情况、血脂谱和高敏C反应蛋白基本一致情况下,吸烟组巨噬细胞胆固醇外流率显著低于不吸烟组,差异具有统计学意义[(25.72±7.36)%vs.(29.53±7.97)%,P<0.05],提示吸烟可影响HDL相关的胆固醇外流功能。结论:吸烟者HDL相关的胆固醇外流率显著低于不吸烟者,表明吸烟者体内HDL的抗动脉粥样硬化功能受到明显削弱,提示戒烟在心血管疾病一级预防中的重要性。     

血清抵抗素与吸烟者动脉弹性的相关性研究

目的测定吸烟者血清抵抗素水平,并行颈动脉ET技术（血管回声跟踪技术）检测,探讨血清抵抗素水平与动脉弹性的关系。方法选择非吸烟者38例,吸烟者45例,检测血压、身高、体重、体重指数（BMI）、生化指标、血清抵抗素水平,并应用ET技术检测颈动脉压力应变弹性系数（Ep）、僵硬度（β）、顺应性（AC）、增大指数（AI）及脉搏波传导速度（PWVβ）。结果（1）吸烟组Ep、β、AI及PWVβ均高于非吸烟组,差异有统计学意义（P〈0．05）;AC低于非吸烟组,差异有统计学意义（P〈0．05）。（2）血清抵抗素水平与β、P、PWVβ呈正相关关系（r=0．346,P=0．003;r=0．305,P=-0．009）。结论吸烟者血清抵抗素水平与β、PWVβ有相关性,三者均是早期发现动脉弹性病变的敏感指标。     

Effect of cigarette smoking on serum hydrocodone levels in chronic pain patients

Nicotine is reported to have analgesic properties. Patients with chronic pain who smoke could therefore, be expected to require less analgesia than non-smokers because of the possible synergism of the two substances. One hundred healthy patients were studied who had non-radicular low back pain for greater than three months. Each patient failed conservative therapies, which consisted of muscle relaxants, physical therapy and/or NSAIDS. Our study population consisted of two groups of 50 patients. Each group included: I, cigarette smokers; and II, non-smokers. Each patient received 0-40 mg/24hrs of hydrocodone as needed for pain relief for the duration of this four week study. Numeric pain intensity scores (0-10), mean total hydrocodone dosing, and quantitative blood nicotine and hydrocodone levels were assessed at the beginning and end of this study. Patients kept daily diaries and recorded pain scores and self hydrocodone dosing upon awakening, in the afternoon, and at bed time. Parametric and nonparametric statistical analysis was performed using the appropriate test with p < or = 0.05 necessary to reject the null hypothesis There were no differences in demographics between the two groups. Smokers had higher end of study pain scores and required more hydrocodone than non-smokers but had significantly lower serum levels of hydrocodone than non-smokers. The results of this study suggest that cigarette smoking adversely affects serum hydrocodone levels. Prescribing physicians should be aware that in some cigarette smokers, serum hydrocodone levels might not be detectible.     

Cigarette Smoking and Platelet Aggregation

The influence of cigarette smoking on platelet aggregation was studied in habitual and non-habitual smokers. The results indicate that habitual smokers have a greater tendency to platelet aggregation than do non-habitual smokers. Acute effects of cigarette smoking were, however, not significant. The nucleotide content and the serotonin content of the platelets were analyzed. The adenosine nucleotide and serotonin contents were similar in smokers and non-smokers in the control state and neither showed significant changes on cigarette smoking. There were significant correlations between the control concentrations of the various nucleotides in both groups and there were even higher correlations after smoking. Platelet aggregation bore no demonstrable relationship to the nucleotide or serotonin contents of the platelet. We conclude that the long-term effect of smoking is probably more important than the acute effect.