双腔管插管将胃管带入气管内1例

患者,男,72岁。系食道中上段癌,拟行食道癌切除,食管与胃吻合术。麻醉采用快速诱导,旋转法气管内插入39号长仑(Carlens)氏双腔管,将长仑氏钩踦跨于隆突上。置管顺利。套囊充气后分别闭住左和右分支管,挤压呼吸囊听诊双肺呼吸音均无变化。因考虑该手术对双腔管的隔离要求不很严,故未究其隔离不严的原因,也未更换导管而行手术。当手术进行至断胃需向外牵拉胃管时牵拉不动。术者反复检查没有钳夹,缝扎等情况而引起麻醉者的注意。麻醉者借助喉镜挑起会厌,见胃管呈“∩”形由声门进入气管内。立即将导管套囊的气放尽,用中指食指伸至会厌处,试图从远端和近端将胃管拉出,均牵拉不动。因患者呈右侧卧位,为防止气管导管脱出而未进行任何处理继续手术。手术历经6小时,术毕待病人完全清醒后,缓慢将气管导管拔出,此时胃管也随之而出。     

从左鼻孔留置胃管用于胃部手术的对比研究

胃部手术患者术前在病房常规留置胃管,临床观察发现,护士们一般选择经右鼻孔留置,当患者在全麻气管插管后手术,术中需要切除部分或全胃而需调整胃管长度时,胃管的再插入常常有一定困难;手术中全麻病人不仅不可能吞咽,而且因已经插入气管导管,胃管的再插入更加困难[1]。传统处理方法为:请麻醉医师将充气的卡弗放气,应用气管导管导引插胃管。     

全麻前后胃管置入时机选择

目的：对手术患者全麻前、全麻后胃管置入不良反应及血压、心率比较。方法：选择普通外科择期手术患者60例。随机分为两组，观察组于麻醉后置入胃管，对照组于麻醉前置入胃管，观察记录心率、血压变化；恶心、呕吐发生率；插管成功率。结果：观察组置入胃管成功率高，手术病人不良反应发生率低，心率、血压较对照组变化小，经统计学处理，两组有显著性差异（P〈0．01）。结论：全麻后置入胃管较全麻前置入胃管成功率高，手术病人不良反应小。全麻后置入胃管是胃管置入的最佳时机。     

三腔二囊胃管的改进

<正>三腔二囊胃管压迫止血一直是治疗食道胃底静脉曲张破裂出血的首选方法。临床上通常通过三腔二囊管胃管腔末端注入止血药物,达到止血治疗的目的。但因胃管腔末端管口粗软,而注射器乳头较细,两者连接吻合不紧密,在注入药液时易发生药液外漏,我科将胃管腔末端进行改进,现介绍如下。1方法三腔二囊胃管的胃气囊与食管气囊末端能与注射器连接紧     

食道癌手术胃管及十二指肠营养管的置入时机与方法

目的:探讨食道癌手术胃管及十二指肠营养管的置入时机及方法。方法:术前1天到病房da访视患者,介绍手术室的环境,了解患者的一般情况及潜在问题,在自己的职责范围内给予及时处理,并耐心做好解释工作,以消除其心里压力更好配合手术。术晨由手术室工人到病房接患者到,巡回护士在手术室门口热情接待患者并交接由病房带来的物品,将患者安置于手术床上,注意保暖防止受凉。协助麻醉医师进行深静脉穿刺及实施全身麻醉,麻醉完毕,巡回护士检查患者鼻腔情况,观察鼻腔是否有异物、息肉及鼻中隔是否偏曲等。将患者安置合适的手术体位,常规消毒铺巾实施手术,巡回护士密切关注手术进展情况,在手术医生切除食道病变部分,食道—胃吻合之前就要进行插胃管及营养管的准备工作。结果:通过采取食道癌手术胃管及十二指肠营养管的置入时机及方法,提高了患者的治愈率。结论:胃管的置入是食道癌手术前重要的操作之一,胃管的置入对患者是较难忍受的应激,将舒适护理用于围术期护理工作中,使病人在接受手术时充满信心,在心理上获得满足感和安全感,从而为手术的顺利进行创造了良好的条件,并增加了术后获得最大程度功能恢复的可能性[2]。通过实践得出麻醉后术中插胃管是使患者舒适并确保手术成功的条件之一。     

三腔管胃底囊滑出致病人窒息原因分析及预防

目的:通过对本例病人的资料分析,进一步探讨肝硬化上消化道大出血行三腔二囊管压迫止血时因呕吐使胃管返折脱出胃底囊堵塞咽喉致病人窒息的原因、预防和最佳处理办法.方法:上消化道大出血插三腔二囊管6h后病人呕吐使胃底囊滑出致病人窒息1例的临床资料、处理情况、原因分析和预防对策.结果:本例病人经过及时发现、及时处理、正确治疗和护理,痊愈出院.结论:上消化道大出血病人插三腔二囊胃管后要严密观察病人有否再出血,及时发现,快速减压,防止因呕吐使胃管脱出胃底囊压迫咽喉引起窒息.一旦发生要及时抢救处理,以免危及生命.     

术前基础麻醉下小儿插胃管术的效果分析

目的探讨进行手术小儿术前需插胃管使用基础麻醉下插胃管方法、效果与不良反应。方法随机选择需插胃管手术患儿100例,随机分为实验组与对照组各50例,年龄为3～6岁,体重12～21kg,ASAⅡ～Ⅲ。实验组病例术前采用基麻,使用药品是鲁米那每公斤0.5mg,力月西每公斤0.05mg,氯胺酮每公斤0.7mg,全部药品静脉注入,患儿安静入睡后,使用胃管型号是8号,胃管加管芯,从鼻腔后鼻道贴咽后壁缓慢往下送,当成功插入胃管后,抽出带有黄色液体即可确定胃管是插入胃腔,按一定长度固定胃管接上负压引流瓶。对照组患儿是采用常规护理学上插胃管术清醒状态插胃管,由于患儿恐惧不合作,反复多次插胃管术较多。结果实验组患儿术前插胃管46例均获成功,而对照组是31例。实验组插胃管过程发生恶心7例,呕吐6例。而对照组插胃管过程发生恶心38例,呕吐36例。实验组插胃管过程胃内容物反流2例,误吸无发生,而对照组插胃管过程发生胃内容物反流13例,误吸呼吸道8例,氧饱和度下上波动,呼吸抑制2例。实验组插胃管过程血流动力学平稳,无血压升高和心跳加快现象,而对照组插胃管过程出现心跳加快血压升高现象。所以术前插胃管术实验组患儿与对照组比较具有显著性差异(P<0.01)。结论患儿术前插胃术采用基麻,效果良好,成功率高,安全,并发症及不良反应少,值得临床上推广应用。     

气管插管全麻患者胃管置入法探讨

目的探讨气管插管下全麻患者的胃管置入新方法,提高手术中插入胃管的成功率。方法选择气管插管下全麻需胃管置入的患者73例,随机分为实验组（38例）和对照组（35例）,对照组采用常规胃管置入方法,实验组采用气管导管经口腔插入食道,胃管经气管导管腔直接插入到胃内。观察两组的成功率、操作时间。结果实验组成功率97．368％,平均操作时间7．8min,而对照组成功率74．286％,平均操作时间13．6min,两组比较,差异有统计学意义（P〈0．01）。结论对于气管插管全麻患者插胃管采用气管导管导入胃管的方式,成功率高、操作时间短,是一种非常有效的方法。     

三腔双囊管压迫止血效果观察及护理体会

目的评价用三腔双囊管对食管胃底静脉曲张破裂出血患者止血的护理方法和止血效果。方法对5例用三腔囊管压迫止血患者从置管到拔管护理进行全过程的观察及评估。结果 5例患者中2例36h内有效止血,2例48h内有效止血,1例胃囊破裂止血无效导致再次大出血死亡。结论在药物止血的基础上正确应用三腔双囊管压迫止血仍是一种行之有效的方法。探讨用三腔双囊管对食管胃管胃底静脉曲张破裂出血患者止血的护理方法和止血效果评价。     

氟哌利多和利多卡因用于插胃管的临床观察

腹部手术前留置胃管能有效地减少麻醉中及手术后的并发症。按以往常规的方法插胃管,常给患者带来痛苦。为了减轻病人痛苦,我们应用氟哌利多和利多卡因后插胃管,取得较满意效果,现报道如下。 资料与方法 １．资料：本组选择无心血管病史,术前需准备插胃管的腹部择期手术病人４０例,平均年龄５５．２±３．２岁,最大年龄６２岁,最小４０岁。随机分为观察组和对照组,每组２０例,组间年龄、精神状态、性别无显著差异。 ２．方法：观察组：操作者先将２％利多卡因５ｍｌ倒入患者口内,嘱其含在口咽部约１ｍｉｎ,再把头向后仰,做“啊…     

Colistin as last resort in 2 patients with pulmonary infection with multiresistant nosocomial bacteria

A 57-year-old man requiring ventilation after gastric-tube reconstruction (due to oesophageal carcinoma) and a 16-year-old boy with thoracic trauma developed pneumonia caused by Pseudomonas aeruginosa and other pathogens. Their infections persisted during treatment with antibiotics. The antibiotic colistin was added and the clinical condition improved in both patients after 3-4 weeks. Eventually, they both were transferred to a rehabilitation clinic. The use of colistin was abandoned in the 1970s due to alleged nephro- and neurotoxicity. In recent observational studies, the drug appeared to cause fewer toxic side-effects than previously thought. Colistin is only registered for inhaled use for lung infections and for resistant pulmonary infections in patients with cystic fibrosis, but it may also be effective in the treatment of other patients with multidrug-resistant, Gram-negative bacteria.     

建立一种简易的大鼠肠内营养支持模型

目的:研究和建立一种简易可靠的EN支持大鼠模型。方法:将32只大鼠剖腹建立急性胰腺炎模型,术中经胃放置EN管至Treitz韧带以下5 cm。在导管入口处、胃体、腹膜、颈背部和尾部5处缝合固定导管,用一次性静脉输液管与营养管连接,调节输液管上滑轮,连续匀速输注EN液。结果:所有大鼠均置管成功,平均输液时间为7 d,均耐受良好,无腹泻等症状。TEN支持3～4 d后开始获得正氮平衡。导管无脱出、折曲和泄漏等。结论:该EN支持模型简易、牢固、可靠,所用器材价廉易得,可同时大规模进行,能满足小动物EN支持研究的需求。     

Laparoscopic‐Assisted Percutaneous Endoscopic Gastrostomy

Background/Purpose: Percutaneous endoscopic gastrostomy (PEG) is a simplified catheter placement procedure for alimentation. Although the endoscopic approach to gastrostomy tube placement is a safe and well‐tolerated procedure in most patients, the PEG procedure is difficult in elderly patients disabled since childhood who have severe scoliosis and malpositioning of the stomach. We describe a simple and effective laparoscopic‐assisted PEG (LAPEG) technique that can be used for catheter placement in severely disabled patients. Methods: Thirteen severely disabled patients aged 14–57 years underwent gastrostomy tube placement with the LAPEG technique. After general anesthesia was achieved, an endoscope was placed into the stomach. Then, a 5‐mm camera port was inserted at the umbilicus, and a 3‐mm working port was inserted to identify and lift the optimal site for gastrostomy tube placement. After the 4‐point fixation of the stomach, the 20‐Fr gastrostomy tube was placed under endoscopic and laparoscopic observation. Results: All patients tolerated the procedure well, and there were no major complications. The procedure was successful, and all patients could feed via the tube. Conclusions: Elderly disabled patients who have been bedridden since childhood often have severe scoliosis and malpositioning of the stomach. Our LAPEG procedure is effective, well tolerated, and safe for gastrostomy tube placement in such elderly patients.     

膝关节周围滑囊炎的超声诊断

目的探讨超声检查对膝关节周围滑囊炎的诊断价值。方法对120例患者的膝关节进行扫查,观察膝关节周围各滑液囊是否增大、增宽,测量其大小,观察其形态、边界及内部回声等特征,与周围的毗邻关系及是否与关节腔相连通,并与对侧膝关节对比观察。结果单纯髌上囊积液62例,胴窝囊肿31例,髌前皮下囊积液11例,髌下皮下囊积液5例,髌下深囊积液5例,鹅足囊病变6例。结论超声对膝关节滑液囊肿的检查简便易行,为骨科医生的早期诊断提供了有效依据。     

Probiotic Lactobacillus reuteri alleviates the response to gastric distension in rats

Probiotic lactic acid bacteria have been reported to alleviate symptoms in patients with irritable bowel syndrome. However, they have not been tested for use in functional gastric disease. We therefore investigated if strains previously shown to protect from response to colorectal distension (CRD) in rats also modulate response to gastric distension (GD). Healthy, male Sprague-Dawley rats were treated with viable, heat-killed, gamma-irradiated Lactobacillus reuteri or viable Lactobacillus plantarum wild type (WT), L. plantarum Dltˉmutant, conditioned medium or medium control (9 d), and subjected to GD under anesthesia using an i.g. Teflon catheter. Effects were measured by heart rate (HR) changes during noxious distension (60 mm Hg) compared to baseline HR values. We also investigated the localization of viable, green fluorescent protein-transfected bacteria in the stomach mucosa. Viable L. reuteri decreased the bradycardia induced by noxious GD compared to placebo controls (P < 0.001). Heat-killed or gamma-irradiated L. reuteri and conditioned medium did not have a protective effect in GD. Viable L. plantarum WT and Dltˉmutant, previously shown to be effective antinociceptive agents in CRD, showed no protective effect in GD. All viable bacteria were associated with the pars glandularis of the rat stomach. Thus, we conclude that the antinociceptive mechanisms of action of probiotic bacteria differ between the stomach and the colon. Symptom alleviation cannot be attributed to the localization of the bacteria in the stomach. Information derived from effects of CRD cannot be extrapolated to effects in the stomach, which are likely to be strain and organ specific.     

Testicular Sperm Extraction and ICSI in Patients with Post-Chemotherapy Non-Obstructive Azoospermia

146 MD-TESE procedures were performed in 74 patients presenting with non-obstructive azoospermia (NOA). Five of the 74 patients displayed a history of chemotherapy. Etiology of chemotherapies included testicular cancer, osteosarcoma, Ewing sarcoma, and malignant lymphoma of the stomach. Post-chemotherapy duration was 2.5-18 years. All patients underwent MD-TESE using local anesthesia with spermatic block and sedation. Extracted sperm was cryopreserved for ICSI. Histopathologic examination revealed Sertoli cell-only syndrome in all five patients; however, sperm were retrieved in 3 subjects. Post-chemotherapy MD-TESE and ICSI can be applied successfully in some patients with NOA. However, freezing semen prior to chemotherapy is recommended.     

Occupationally related ultrasonic findings in carpet and floor layers' knees.

Soft-tissue changes in the anterior aspect of the knees were evaluated with ultrasonography among 96 randomly selected carpet and floor layers and 72 painters. The ultrasonography showed thickening of the prepatellar or superficial infrapatellar bursa in 49% of the carpet and floor layers and 7% of the house painters. Fluid collection in the prepatellar or superficial infrapatellar bursa was noted for 10 carpet and floor layers, and this ultrasonographic finding was associated with knee pain in kneeling postures.     

A swollen leg after total hip arthroplasty

Two patients, a 71-year-old and a 59-year old woman who had undergone total hip arthroplasty, presented with pain, difficulty in walking and slow progressive unilateral leg swelling. They did not have any other physical abnormalities. Physical examination and other investigations indicated a cystic enlargement of the iliopectineal bursa causing venous obstruction of the v. femoralis. After exploration and excision of the swelling the patients recovered rapidly. Pathological examination showed a bursa with an extensive foreign body giant cell reaction, double-breaking fibrous polyethylene and a small quantity of granular metal pigment originating from the total hip prosthesis. A unilateral swelling of the leg can also be caused by deep venous thrombosis and primary lymphatic oedema or by other compressing swellings. Venous obstruction due to cystic enlargement of the iliopectineal bursa following total hip arthroplasty is only described incidentally. Treatment consists of decompression of the affected structures and if necessary revision of the polyethylene cup to avoid excessive polyethylene wear.     

The effect of vitamin E on prostaglandin levels in the immune organs of chicks during the course of an E coli infection

The effect of dietary vitamin E supplementation on prostaglandin levels in the bursa and spleen of E.coli infected chicks was studied in two separate but similar experiments. In the first experiment Single Comb White Leghorn chicks were fed either a control diet (adequate in vitamin E) or a supplemented diet (containing an additional 300 IU per kilogram) and sacrificed at 21 days at several time points after infection. Infection had its maximum effect on PGE₂ and PGF_2α at 1 to 4 h post infection in the spleen and 24 to 48 h in the bursa. Vitamin E reduced PGF_2α levels in bursa but not in the spleen. In the second experiment the use of broiler chicks provided enough tissue to also determine thromboxane B₂ and 6-keto PGF_1α levels. Broiler chick bursa levels of PGE₂, PGF_2α, 6-keto PGF_1α and thromboxane B₂ were depressed by vitamin E supplementation whereas only PGF_2α was decreased in the spleen. Infection resulted in increased levels of PGE₂, PGF_2α and thromboxane B₂ in the spleen but not in the bursa.