手术后第一天补钾问题的探讨

手术后第一天补钾问题的探讨吴聿洪一般认为，外伤或手术后，钾虽处于负平衡状态，但血钾并不降低，甚至还稍高于正常。因钾离子大量从细胞内进入细胞外液，尚未被肾脏排出。此时如给予大量钾，可使血钾过高而出现中毒现象［１］。因此，临床医师于术后第一天一般不给患者...     

消化道手术后早期补钾的临床意义

笔者在临床观察和实践中，通过对术后３天内补钾与否的比较，发现术后３天不补钾患者胃肠功能恢复较慢，腹胀不易改善，血清钾较术前减低，甚至出现低钾血症。而早期术后补钾者，上述情况有明显改善。１资料与方法１．１一般资料本组７２例，男４７例，女２５例。年龄２２...     

腹部手术后钾代谢的临床研究及早期补钾对胃肠功能的影响

目的　观察腹部手术后早期补钾对胃肠功能恢复的影响。方法　测定 6 7例腹部手术前后血钾、钠、氯的变化和尿、胃肠减压液及引流液中电解质丢失量 ,并观察手术后不同时间补钾者的胃肠功能恢复情况。结果手术日和术后钾丢失平均 72 .6mmol/d ,最多达 2 76 .3mmol/d ,尿钾浓度无明显改变 ,尿钾丢失主要为尿量增加所致。术后平均补钾 49.6mmol/d ,但血钾较术前明显降低 (P <0 .0 5 ) ,5例血钾低于 3 .5mmol/L ,无 1例出现高血钾。术后早期补钾者胃肠功能恢复快。结论　只要肾功能正常 ,术后第 1d可开始见尿即补钾 ,除应常规补钾外 ,应根据尿量随时调整钾的补充量     

胃肠和静脉补钾相结合治疗术后低钾性肠麻痹的体会

1996年7月～2005年7月，我院应用胃肠和静脉补钾相结合的方法，治疗腹部手术后低钾性肠麻痹21例取得了满意的效果，现总结报告如下。     

胃癌根治性手术后合并症及其预防

胃癌根治性手术后合并症及其预防中山医科大学附属第一医院胃肠外科（５１００８０）江建平，王吉甫胃癌手术后的并发症根据术式的不同而有差别，其发生率约在１５％～４０％之间。通常把胃癌术后并发症分为三类。第一类为直接与手术有关的并发症，如感染、出血、吻合口疾...     

食管癌手术后不同镇痛方法对机体应激的影响

腹部手术后硬膜外镇痛对机体应激反应的影响已有报道[1 3] ,本文旨在观察食管癌手术后病人自控硬膜外镇痛(ＰＣＥＡ)和静脉镇痛 (ＰＣＩＡ)的镇痛效果以及对应激激素的影响。表 2　两组病人术后镇痛使用情况组别镇痛时间 (ｈ)用量 (ｍｌ)按压次数有效次数ＰＣＥＡ 5 8 45± 7 662 48 6± 43 0 7 2 3± 1814± 11ＰＣＩＡ 62 85± 7 65 47 45± 14 712 0± 1916± 14表 3　两组病人的ＶＡＳ评分组别ＶＡＳ Ｒ1ＶＡＳ Ｍ 1ＶＡＳ Ｒ2ＶＡＳ Ｍ2ＶＡＳ Ｒ3ＶＡＳ Ｍ 3ＰＣＥＡ 1 2 0± 1 42 3 46± 1 481 95± 2 474 3 7± 2 5 91 0 8±…     

红霉素促进腹部手术后肠蠕动的临床研究

红霉毒作为抗生素应用于临床以来,其胃肠道的副作用从一开始就被注意到,作者利用它的副作用把它作为胃肠道的促动力药进行临床研究。     

胃肠手术后肠蠕动不良的治疗与护理

目的探讨胃肠手术后肠蠕动不良治疗与护理的效果。方法对40例胃肠手术后肠蠕动不良患者的临床资料作回顾性分析。结果40例中,男多于女,中老年人发病多,发生由多方面因素引起,按不同情况治疗后多数在2~3d后好转,无二次手术病例。结论综合治疗中以针灸、复方大承气汤胃管内注入,白萝卜煎汤内服效果较好,适用范围广,病人乐意接受,无不良反应。术后早期下床活动,既能治疗又可预防,是极好的方法,应该是护理中重要的常规工作。     

餐前餐后采血对血钾值的影响

餐前餐后采血对血钾值的影响北京医科大学人民医院内科蔡再同钾是生命必需的矿物质之一，人体中血清钾的高低对机体的影响较大，尤其对心肌收缩运动的协调具有重要的意义，血清钾的浓度过高对心肌有抑制作用。如钾浓度增加三倍时可使心脏停跳在舒张期，血清钾浓度过低则常...     

腹部手术后钾代谢的临床研究

目的 探讨腹部术后是否需立即补钾，血钾与静脉补钾和钾排出的关系，方法 测定４７例腹部手术前后血钾，氯变化和尿，胃肠减压液体及引流液中电解质丢失量。分析酸碱平衡，肌酐清除率对钾代谢的影响。结果 手术日和术后钾丢失平均７２．９ｍｍｏｌ／ｄ，最多达２８９．２ｍｍｏｌ／ｄ尿钾浓度无明显改变，尿钾么失主要为尿量增加所致。术后平均补钾４９．８ｍｍｏｌ／ｄ但血钾较术前明显降低（Ｐ〈０．０１），５例血钾低于３．５     

Effect of bowel preparation on small bowel microflora and postoperative wound infection

A method of wound closure utilizing continuous wound compression and suction decompression of the subcutaneous space is described. This method has reduced the incidence of wound complication in the diverse population of patients in whom it has been utilized.     

尼古丁对腹部术后早期炎性肠梗阻的治疗作用

目的 探讨尼古丁对腹部术后早期炎性肠梗阻的治疗作用.方法 将45例术后早期炎性肠梗阻的病人随机分为两组,对照组(26例)给予常规保守治疗加无尼古丁贴片;研究组(19例)在常规治疗基础上给予尼古丁贴片(21 mg/片),每日更换一次贴片,应用至治愈或最长至7d.结果 研究组与对照组在腹痛缓解时间[(4.3±1.2)d与(5.3±1.4)d]、腹胀缓解时间[(3.7±1.5)d与(4.9±2.2)d]、肠鸣音恢复时间[(3.2±1.3)d与(4.4±1.7)d]、肛门排气时间[(4.5±1.2)d与(6.2±1.8)d]、治疗至出院时间[(7.3±2.6)d与(9.5±3.7)d]等方面相比均较短且差异有统计学意义(P＜0.05);研究组与对照组的治愈率、总有效率相比,差异无统计学意义(P＞0.05).结论 尼古丁用于腹部术后早期炎性肠梗阻的治疗中可促进症状缓解、加快梗阻解除,缩短疗程,但对于治愈率未有显著提高.     

Effect of preoperative colon preparation on serum potassium

Although surgeons and anesthesiologists are constantly warned of the danger of hypokalemia following mechanical bowel preparations during the peri- and intraoperative periods, the amount and significance of this problem have not been quantitated. Therefore, the magnitude of the potassium (K+) depletion resulting from three to four days of mechanical bowel preparation was measured in a randomized, prospective fashion in 53 patients. The 27 patients in Group I received intravenous and/or oral potassium chloride supplementation during the preoperative bowel preparation, while the 26 patients in Group II received no supplementation. In an additional five patients, renal and colonic excretory potassium losses were measured to determine if they correlated with preoperative serum potassium levels. All patients had a standard preparation consisting of clear liquid diet (15 mmol K+/day), magnesium citrate orally, enemas, and oral antibiotics. Serum K+ levels in patients in Group I decreased from control levels of 4.01 + 0.41 mmol/1 to 3.71 +/- 0.58 (P less than 0.01) despite an average of 60 mmol potassium chloride supplementation during the preparation. The serum potassium levels in patients in Group II decreased from 4.13 + 0.69 mmol/1 to 3.43 +/- 0.53 (P less than 0.001) during the preparation. Measurement of stool K+ content revealed values that varied considerably between patients and that did not correlate with immediate preoperative serum levels. Urinary K+ measurement showed little renal compensation during the preparation and it did not significantly correlate with preoperative serum levels either.     

Effect of postoperative chemotherapy on the serum alpha-fetoprotein level in hepatoblastoma

Purpose

It is generally accepted that postoperative chemotherapy does not affect the serum alpha-fetoprotein (AFP) level. The authors report on 3 patients who supposedly showed chemotherapy-related changes in their AFP levels after operation.

Methods

This study included 3 patients with hepatoblastoma (1 case of PRETEXT III and 2 cases of PRETEXT IV).

Results

One patient with PRETEXT III underwent a complete tumor resection, and the postoperative AFP level decreased until it reached the normal range. However, he consistently exhibited a transient, 2- to 3-fold increase in the AFP after each course of chemotherapy for 3 courses. The chemotherapy regimen had to be stopped because of drug-induced encephalopathy, but he has been followed up for 5 years without any evidence of recurrence, and his AFP level has also remained stable and in the normal range. Two patients with PRETEXT IV, who underwent a curative tumor resection, also showed similar chemotherapy-related changes in AFP levels. Both of these cases were observed only after the administration of routine postoperative chemotherapy instead of administering further high-dose chemotherapy. The AFP level remained stable for 17 months and 7 months after the cessation of chemotherapy in 2 cases, respectively.

Conclusions

Regarding the postoperative chemotherapy of hepatoblastoma, we have to pay close attention to both the AFP status during chemotherapy as well as the absolute AFP level.