骶管麻醉在新生儿外科的应用

根据新生儿椎管的解剖生理特性 ,骶管麻醉具有操作方法简单、麻醉效果确切、安全的特点 ,在新生儿麻醉中有它的独特性 ,经我院多年应用观察取得了良好的麻醉效果 ,现报道如下。资料与方法一般资料　随机选择 12 0例新生儿急诊和择期手术病例 ,分为骶管麻醉组 (Ⅰ组 )和复合麻醉组 (Ⅱ组 )各 6 0例 ;Apgar评分 3～ 8分 ,ASAⅡ～Ⅳ级 ;年龄 :3h～ 82d ;体重 :2 8～ 7kg ;手术种类及例数 :上腹部 2 0例 (Ⅰ组 11例 ,Ⅱ组9例 ) ,中腹部 5 7例 (Ⅰ组 2 8例 ,Ⅱ组 2 9例 ) ,腹股沟、会阴、骶部手术 4 3例 (Ⅰ组 2 1例 ,Ⅱ组 2 2例 )。麻醉方法…     

新生儿呕吐852例分析

目的:探讨新生儿呕吐的原因。方法:对1995年5月～2002年5月收入院的852例新生儿呕吐患儿进行回顾性分析。结果:本组852例,外科疾病528例,占62％,内科疾病324例,占38％。结论:根据呕吐出现的时间、急缓、呕吐物性质及相关检查,可以早期做出诊断。     

36例新生儿呕吐的常见原因X线分析

目的分析新生儿呕吐的常见原因。方法36例呕吐的新生儿均进行消化道钡餐造影检查,检查时以患儿自主口服为主。结果36例中食管闭锁4例,膈疝3例,肠回转不良3例,胃扭转13例,十二指肠闭锁2例,幽门狭窄4例,7例正常。结论新生儿呕吐的原因以先天性消化道病变为多见,病变类型不同,其X线表现亦不相同,消化道钡餐造影是确诊此类疾病的首选方法。     

早期洗胃控制HIE并发呕吐89例护理探讨

早期洗胃控制ＨＩＥ并发呕吐８９例护理探讨山东省青岛市第二人民医院郑青，孔珂，宋纪英，张俊英新生儿缺氧缺血性脑病（ＨＩＥ）是新生儿窒息后的严重并发症之一，患儿常因在宫内大量吸入或吞咽羊水而致出生后频繁呕吐，严重者可因呕吐后误吸或返流窒息而死亡。本文采用...     

口服莫沙必利可减少关节置换术后恶心呕吐发生率

目的 探索口服莫沙必利预防全麻下关节置换术后恶心呕吐(PONV)发生的有效性及安全性.方法 前瞻性纳入全麻下行初次全髋关节置换术及全膝关节置换术且术前存在PONV发生危险因素(Apfel评分≥1分)的患者,排除并存肝肾功能不全、严重肠蠕动障碍及房室传导阻滞及室性心律失常的患者,随机分为莫沙必利组及对照组.莫沙必利组于术...     

2%碳酸氢钠洗胃治疗新生儿呕吐48例疗效分析

目的探讨2%碳酸氢钠洗胃治疗新生儿呕吐的临床疗效。方法选择2008年3月～2011年2月笔者所在医院住院频繁呕吐的足月新生儿共96例作为研究对象。将患者随机分为观察组和对照组各48例。对照组在常规对症补液维持水电解质及酸碱平衡的基础上予以吗丁啉混悬液0.3mg/kg,3次/d,喂奶前15～30min口服;红霉素3～5mg/kg,加入5%～10%葡萄糖注射液20～30mL中,应用输液泵缓慢静脉泵入,1次/d。观察组在对照组治疗药物基础上加用2%碳酸氢钠洗胃治疗。结果观察组采用2%碳酸氢钠洗胃治疗新生儿呕吐总有效率为91.67%,对照组总有效率为77.08%,两组患者临床总有效率比较,差异有统计学意义（P〈0.05）;观察组患儿临床呕吐症状缓解时间和体重减轻重量均明显优于对照组,两组比较差异均有统计学意义（P〈0.01）。结论在综合治疗基础上应用2%碳酸氢钠洗胃是一种切实有效的治疗新生儿呕吐的方法,值得临床推广。     

主动脉缩窄合并弓发育不良新生儿外科治疗的单中心回顾性研究

目的 总结主动脉缩窄合并主动脉弓发育不良新生儿的手术治疗经验。方法 回顾性纳入2013—2020年于广东省人民医院小儿心脏外科接受手术治疗的主动脉缩窄合并弓发育不良新生儿,分析患儿术后并发症、远期生存率、免于主动脉再梗阻等情况。根据手术方式将患者分为3组：扩大端端组（行扩大端端吻合术）,扩大端侧组（行扩大端侧吻合术）,补片扩大组（行肺动脉补片扩大术）。结果 纳入患者44例,其中男37例、女7例,年龄5.00～30.00(19.34±7.61)d,体重2.00～4.50(3.30±0.60)kg。扩大端端吻合术19例,扩大端侧吻合术19例,肺动脉补片扩大术6例。主动脉近弓、远弓、峡部管径Z值的平均值分别为–2.91±1.52、–3.40±1.30、–4.04±1.98。平均随访（45.6±3.7）个月。早期死亡2例,无随访期内死亡。3例进行再手术干预,8例出现主动脉再梗阻,5年免于再梗阻率为78.8%。多因素Cox回归分析显示：远期再梗阻相关因素为术前主动脉近弓管径Z值[HR=0.152,95%CI(0.038,0.601),P=0.007]、术后早期左主支气管受压[HR=15.261,...     

术后恶心和呕吐

手术和麻醉虽有较大进展，但术后恶心和呕吐的发生率没有明显下降。本文就术后恶心和呕吐的生理学，有害后果，发病的危险因素，预防和治疗措施作一综述，同时介绍５－ＨＴ３受体阻滞药呕复宁的应用。     

异丙酚与恶心呕吐

异丙酚用于麻醉诱导和维持能够降低术后恶心呕吐(PONV)的发生率。本文对异丙酚抗吐作用的临床、实验及 其机制研究的进展及如何合理应用异丙酚的抗吐作用予以综述。     

Neonatal surgical emergencies

Improvements in the diagnosis and treatment of congenital disorders have resulted in a change in surgical practice. Many conditions that formerly required corrective surgery immediately after birth are no longer surgical emergencies. Most babies with congenital anomalies that can be corrected by surgery are now stabilized and optimized before the procedure. This article focused on the more common conditions that require semi-elective or urgent surgery in the neonatal period. Salient features of each of these disorders were described. Factors unique to each of these conditions that can affect the anesthetic course of these children were discussed. Methods and techniques that may aid in the anesthetic management of these children were delineated.     

Postoperative nausea and vomiting in paediatric surgical inpatients

A prospective study of postoperative nausea and vomiting (PONV) was conducted in 415 children presenting for inpatient surgery. The overall incidence of PONV was 18.1%. The highest incidence was in children undergoing ENT procedures and increased with age. Avoidance of intraoperative opioids and the use of local anaesthesia and/or non-steroidal anti-inflammatory drugs reduced the incidence of nausea and vomiting postoperatively.     

Neonatal pneumopericardium: a surgical emergency

Transhiatal esophagectomy without thoracotomy has been utilized in 200 patients: 57 with benign disease and 143 with carcinomas at various levels of the esophagus (35 pharyngeal or cervicothoracic, 7 upper third, 47 middle third, and 54 distal third). Stomach has been used to replace the esophagus in 93% of patients undergoing single-stage esophagectomy and reconstruction, and colon has been used in 7%. Among patients with intrathoracic esophageal carcinomas, intraoperative blood loss averaged 1,000 ml, and the hospital mortality was 6%. No patient in the entire series has required a thoracotomy for control of bleeding, either during the esophagectomy or postoperatively. This report reviews the technical maneuvers that my collegues and I have found useful in performing transhiatal esophagectomy without thoracotomy.     

Reduction in postoperative vomiting after surgical correction of prominent ears

There is a high incidence of postoperative nausea and vomitingafter surgical correction of prominent ears. A prospective,randomized study was performed to determine if the method ofdressing the ears influenced the incidence of postoperativevomiting. Avoidance of packing the external auditory meatusand concha produced a significant reduction in postoperativenausea (83% vs 30%; P < 0.005) and vomiting (63% vs 22%;P <0.01). (Br. J. Anaesth. 1994; 72: 592–593     

Neonatal necrotizing enterocolitis: Experience with 100 consecutive surgical patients

One hundred newborns with neonatal necrotizing enterocolitis (NEC) were treated surgically according to a uniform protocol between July, 1980 and June, 1988. The infants (53 females, 47 males) weighed between 600 and 3,800 g, averaging 1,500 g. Twenty-eight weighed less than or equal to 1,000 g, 38 weighed from 1,001 g to 1,500 g, and 34 weighed more than 1,500 g. Median age at the time of surgery was 14 days. Surgery was performed for pneumoperitoneum in 40, a positive paracentesis in 51, and for other reasons in 9 infants. A paracentesis was performed if intestinal gangrene was suspected clinically. Resection of gangrenous bowel with exteriorization was the usual procedure; in only 5 patients was primary closure performed. The hospital survival for the infants was 54% for the group weighing less than or equal to 1,000 g, 74% for the group weighing from 1,001 g to 1,500 g, and 79% for the group weighing more than 1,500 g. Overall hospital survival was 70%; it was 81% for those having a definitive procedure (excluding 14 infants with NEC totalis). There were 3 late deaths from causes unrelated to NEC. Significant long-term complications included failure-to-thrive in 23% and stricture formation in 30% of the survivors. Long-term follow-up showed gastrointestinal status to be normal in 74%; only 8% have persistent major gastrointestinal dysfunction. Mental and motor development was considered grossly normal in only 53% of the patients.

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Resumen Cien neonatos con entercolitis necrotizante neonatal (ENN) fueron tratados quirúrgicamente de acuerdo a un protocolo uniforme entre julio de 1980 y junio de 1988. Los bebés (53 hembras, 47 varones) pesaron entre 600 y 3,800 g, con un promedio de 1,500 g. Veintiocho pesaron menos de o igual a 1,000 g, 38 pesaron entre 1,001 y 1,500 g, y 34 pesaron más de 1,500 g. La edad promedio en el momento de la cirugía fue 14 días. La operación fue realizada por neumoperítoneo en 40 casos, paracentesis positiva en 51, y por otras razones en 9. Se realizó paracentesis ante la sospecha clínica de gangrena intestinal. El procedimiento usual fue la resección del intestino gangrenado con exteriorización; en sólo 5 pacientes se realizó cierre primario. La sobrevida hospitalaria para los bebés de menos de o igual a 1,000 g, entre 1,001 y 1,500 g, y más de 1,500 g fue 54%, 74%, y 79%, respectivamente. La sobrevida hospitalaria global fue de 70%, pero de 81% para aquellos pacientes sometidos a un procedimiento definitivo (excluyendo 14 con ENN totalis). Hubo 3 muertes tardías por causas no relacionadas con ENN. Las complicaciones de significación a largo plazo incluyeron falla en el desarrollo en 23% y formación de estenosis en 30% de los sobrevivientes. El seguimiento a largo plazo demostró un estado gastrointestinal normal en 74%, con sólo 8% con disfunción gastrointestinal persistente. El desarrollo mental y motor fue considerado fundamentalmente normal en sólo 53% de los pacientes.

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Résumé Cent nouveau-nés ayant une entérite nécrosante ont été traités chirurgicalement selon un même protocole entre juillet 1980 et juin 1988. Le poids des enfants (53 de sexe féminin et 47 de sexe masculin) variait de 600 à 3,800 g, la moyenne étant de 1,500 g. Vingt-huit pesaient 1,000 g, 38 entre 1,001–1,500 g, et 34 >1,500 g. L'âge médian au moment de la chirurgie était de 14 jours. L'indication de la chirurgie était un pneumopéritoine chez 40 enfants, une paracentèse positive chez 51, et une autre raison chez 9. La paracentèse a été effectuée quand on suspectait cliniquement une gangrène intestinale. La résection de l'intestin grangréné avec extériorisation des deux extrémités était l'intervention habituelle; une anastomose primaire était effectuée dans 5 cas seulement. La survie à l'hôpital pour les enfants au poids 1,000 g, 1,001–1,500 g, et >1,500 g était respectivement de 54%, 74%, et 79%. La survie hospitalière globale était de 70%; 81% pour ceux qui avaient une chirurgie définitive en excluant les 14 enfants ayant une entérite nécrosante totale. Il y avait 3 morts tardives dues à des causes sans rapport avec l'entérite nécrosante. Les complications à long terme étaient l'absence de développement chez 23% et al sténose chez 30% des survivants. Le suivi à long terme montrait que l'état intestinal était normal chez 74% des patients; 8% seulement des enfants avaient un dysfonctionnement majeur. La croissance psychomotrice était normale chez 53% seulement des patients.

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Presented at the Société Internationale de Chirurgie in Toronto, Ontario, Canada, September, 1989.