骨科手术后脑血管意外的预防

老年人是脑血管意外的高危人群，笔者自2001年1月-2004年1月施行2235例骨科手术，其中5例出现脑血管意外。     

普胸手术后脑血管意外的防治

目的总结普胸手术后脑血管意外的防治经验。方法回顾性分析安阳肿瘤医院2006年1月至2014年1月普胸手术后并发脑血管意外28例患者的临床资料。其中男16例、女12例,年龄56~79岁。结果普胸手术后脑血管意外发生率为0.20%（28/14 645）,均为缺血性脑血管病。其中麻醉苏醒期发现者7例,术后1~20d发现者21例。死亡9例,病死率为32.15%,其中6例死于脑疝,3例死于多器官功能障碍。结论普胸手术后脑血管并发症以缺血性脑血管病为主。发生率较低,病死率较高,预防是关键。     

脑血管意外所致偏瘫的康复护理

脑血管意外是一类严重威胁中老年人牛命的疾病,尤其在老龄人中发病率相当高。随着医学科学的进步,脑卒中病人抢救成活率在不断提高。对于生存下来的病人,住院期间护理措施是否合理和正确,会对日后康复程度产生相当影响,需要引起重视。以下就综合医院中偏瘫康复护理问题谈谈个人体会。一、影响偏瘫病人康复的因素: 在制订偏瘫病人护理计划时要考虑到一些会影响康复的因素,采取相应的措施。首先,脑卒中发病后肢体突然瘫痪对病人是沉     

高血压病人保健活动中脑血管意外分析及预防

随着人们生活水平的提高 ,越来越多的人关注健康 ,尤其是一些病愈者和病人 ,为增进健康而热衷于保健活动。然而 ,保健不当也可能发生各种意外 ,甚至死亡 ,尤其是高血压病人。为了预防高血压病人意外事件的发生 ,笔者对我院 1991年 1月至 2 0 0 1年 12月收治的 8例高血压病人因保健不当致急性脑血管意外而死亡的原因进行分析 ,并提出预防对策。介绍如下。1　临床资料本组 8例 ,男 5例、女 3例 ,年龄 6 5～ 73岁。高血压病史 10年以上。其中大学教授 1例、高级会计师 2例、小学教师 1例、农妇 1例、退休人员 3例。因保健行为 (晨练、服药、自…     

肾移植术后脑血管意外的治疗和预防

自1986年1月～1995年12月行同种异体肾移植606例（611次），其中发生脑血管意外6例（7次），平均发病时间为2年8个月。对2例脑出血而血压增高明显者停用环孢素A（CSA），减少泼尼松（Pred）用量，加用硫唑嘌呤（Aza），1例脑出血症状较轻的患者维持Pred＋Aza用量，3例脑血栓患者加用氨茶碱，同时服用复方丹参和潘生丁，适当加大Aza用量。结果5例治愈，1例死亡。认为对脑血管意外者除常规治疗外，免疫抑制剂的调整是很重要的治疗措施之一。术前充分透析，严格选择受者，切实做好组织配型，加强术后严格管理是预防肾移植术后脑血管意外的重要措施。     

脊柱手术后深静脉血栓预防的研究进展

深静脉血栓(deep venous thrombosis,DVT)形成是骨科术后严重并发症之一.下肢血栓部分或全部脱落后随血液循环进入肺动脉,可继发肺栓塞(pulmonary embolism,PE),引起血流动力学不稳定及右心功能不全,致残、致死率高[1].预防和治疗血栓栓塞病在骨科围手术期至关重要.目前针对骨科术后DVT预防的研究较多,我国也出版了相应的指南[2],但关于脊柱手术后DVT预防的经验却鲜有报道.笔者对脊柱术后DVT的流行病学、危险因素以及预防措施的研究进展综述如下.     

脊柱侧凸手术后的失败因素分析

断棒、脱钩、假关节形成可导致脊柱侧凸手术后矫形失败，对脊柱侧凸畸形的矫正及防止脊柱畸形的发展是明显不利的，对其原因的分析及提出预防措施是非常重要的。我们对25例脊柱侧凸中断棒、脱钩及假关节患者进行全面检查后再手术，现报告如下。     

脊柱损伤及脊柱手术后深静脉血栓的预防与护理进展

脊柱损伤或者脊柱手术后因为护理不当很容易产生深静脉血栓（DVT），影响了疾病的治疗效果。近年来许多医学专家学者对脊柱损伤及脊柱手术后DVT的预防 和护理开展了大量的理论和临床研究工作，本文对近些年来的研究进展进行综述，主要包括脊柱损伤及脊柱手术后DVT形成的风险因素、DVT预防和护理措施 等，从而在临床工作中更好的对脊柱损伤及脊柱手术后DVT进行预防，降低DVT的发生概率。     

56例脑血管意外患者康复期的护理体会

我院2002～2005年对56例脑血管意外后遗症患者实施康复护理,取得一定经验,现总结如下。1临床资料56例患者均为住院治疗者,其中男性42例,女性14例,年龄38～83岁。经过精心治疗和护理,8例痊愈,34例好转出院。2护理要点2.1心理护理:脑血管后遗症患者有自弃心理,尤其是后遗症重、生活无法自理者,更易产生焦虑、恐惧、自厌情绪,表现为急躁易怒、悲伤啼哭或冷漠,甚至拒绝治疗或自杀。这些负面情绪对康复治疗非常不利,因此要建立良好的护患关系,做患者的知心朋友,深入了解患者的思想状况,尊重理解他们,帮助他们解决困难,告知患者所有症状通过顽强锻…     

Prevention of venous thromboembolism in spinal surgery

Deep vein thrombosis (DVT), and its most feared complication, pulmonary embolism (PE), still have a high incidence with high risk for patients health. Proven prophylactic measures are available but are generally underused, and DVT is still considered the most common cause of preventable death among hospitalized patients. The rationale for prophylaxis of venous thromboembolism is based on the clinically silent nature of the disease, the relatively high prevalence among hospitalized patients and the potentially tragic consequences of a missed diagnosis. During the last 15–20 years, spine surgery has changed radically, developing into a well-defined area of specialist surgery, and some attention is now being given to DVT events in spine surgery. The incidence of DVT during spine surgery is not documented in the literature, because only case reports or retrospective studies are reported. It would therefore be very helpful to initiate a multicenter study in order to understand this problem better and to develop, if possible, some guidelines on prophylactic measures in spine surgery. In doing so, we need to consider each patients pattern, any risk factors and every kind of surgical technique related to DVT, in order to improve the outcome of the patient and to reduce any medicolegal problems that could arise from a thrombotic complication or an epidural hematoma, with its high potential for irreversible consequences.     

Haematological effects of postoperative autotransfusion in spinal surgery

A prospective, randomized, controlled study was performed to determine the haematological and biochemical changes and clinical safety of postoperative autotransfusion (Solcotrans Orthopedic Plus® system) in patients undergoing spinal surgery. Fifty patients were studied and were randomly allocated to Control (n = 25) and Solcotrans (n = 25) groups. Both groups had their postoperatively drained blood collected into the Solcotrans reservoir but only the Solcotrans group had this salvaged blood considered for reinfusion. After a 5–h postoperative collection period, analysis of the shed blood showed a haematocrit of 0.26± 0.11, few platelets (80 ± 63 10^g1^-1), a fibronogen level of less than 0.1 gl^-1 and a high level of D-dimers. The salvaged blood did not clot and aerobic and anaerobic culture produced no growth. The volume of blood collected was greater than 200 ml in 21 patients in the Solcotrans group who were autotransfused (384 ± 101 ml, range 200–600 ml), and in 16 patients in the Control group. Within 15 min following completion of reinfusion of the salvaged blood there was a significant, but moderate decrease in platelet count (181 ± 74 vs 223 ± 90 108 1^-1, P <0.001) and fibrinogen concentrations (2.1 ± 0.8 vs 2.3 ± 0.9 g 1^-1, P < 0.02), and an increase in circulating D–dimers (P < 0.001) and plasma free haemoglobin concentrations (236 ± 155 vs 82 ± 79 mg l^-1, P < 0.001). Prothrombin time (PT) and activated partial thromboplastin time (APTT) did not increase, and potassium concentrations were not significantly affected. Because the haematocrit of shed blood was lower than that in the patients' systemic blood, there was no significant increase in haematocrit following reinfusion. Cultures of systemic blood following reinfusion yielded no bacterial growth. No side–effects were observed. There were no significant differences in the haematological parameters (haematocrit, platelet count, free haemoglobin, APTT, PT, fibrinogen, D–dimers) between the two groups at the eighth (3 h after reinfusion) and the 24th postoperative h. No predictive factor of the volume of blood collected during the postoperative period could be identified. Postoperative autotransfusion induced no clinically relevant haematological effects after spinal surgery. However, since important haematological modification were found in the shed blood, further studies are required to determine the maximum amount of shed blood that can be safely transfused during the postoperative period.     

Prevention of postoperative paraplegia during thoracoabdominal aortic surgery

BACKGROUND: We present data showing the impact of sequential multisegmental aortic clamping accompanied by reimplantation of as many segmental arteries as possible on the prevention of postoperative paraplegia or paraparesis during thoracoabdominal aortic graft replacement. METHODS: Since 1987 we have performed graft replacements in 51 individuals undergoing thoracoabdominal aortic surgery using the technique of normothermic partial bypass with sequential multisegmental aortic clamping. The procedure was performed emergently in 10 patients and electively in 41 patients. The patients ranged in age from 22 to 82 years (mean, 57.6 +/- 13.8 years). Indications for surgery included dissecting thoracoabdominal aortic aneurysm (n = 19) and nondissecting thoracoabdominal aortic aneurysm (n = 32). The extent of aneurysm was Crawford type I in 19 patients, type II in 7 patients, type III in 12 patients, and type IV in 13 patients. Along the entire extent of aneurysm to be replaced, we reimplanted as many of the patent segmental arteries as feasible. RESULTS: Five patients died during hospitalization, for an in-hospital mortality rate of 9.8%. The number of aortic clampings per patient ranged from one to five (median, three). A total of 124 segmental arteries were reimplanted in 44 (86.3%) of 51 patients. Of the 124 arteries, 90 (72.6%) were distributed between T9 and L2. Postoperative paraplegia or paraparesis did not develop in any of the patients. CONCLUSIONS: Our results demonstrate that extensive reimplantation of segmental arteries using sequential multisegmental aortic clamping, accompanied by adequate intraoperative distal aortic perfusion, is effective in preventing spinal cord ischemia.     

Quantifying postoperative deficits of physical function following spinal surgery

This study evaluates the degree of objectively quantified physical deconditioning of spinal surgery patients. The object is to evaluate the data in terms of the pain and disability claimed by 35 male and 11 female patients three months after spinal surgery. Among the males, two subgroups (i.e., disc excision or spinal fusion) were evaluated. All patients reported subjective indices of pain/disability and completed quantified tests of lumbar motion, sagittal trunk strength, lifting capacity, and bicycle ergometry. In general, true lumbar motion was markedly restricted to 50%-60% and trunk strength means were below 50% of gender-specific normative values. There were similar deficits for lifting capacity. Those who had spinal fusions tended to perform poorly, with a relatively high incidence of pain/disability. There were no differences found between the male group and subgroups who were gainfully employed or had a brief period of disability prior to surgery or had low subjective pain/disability. These results indicate that a patient's subjective pain/disability were not a reliable measure of functional capacity by three months postoperatively. Regardless of working status, pain level, or brevity of disability, there was a significant loss of performance ability and risk of persistent dysfunction after surgical treatment.     

脊柱术后手术部位感染的危险因素分析

目的 :分析脊柱术后手术部位感染的危险因素,总结降低脊柱术后手术部位感染发生率的经验。方法 :收集我科自1995年1月~2015年12月实施脊柱开放手术患者的资料,对文献中常见脊柱术后感染高危因素高龄、糖尿病、肥胖、长手术时间、内固定置入、输血、长期吸烟史、类固醇激素服用史、全身其他部位感染、脑脊液漏、二次手术、后路手术等进行统计并行单因素卡方检验,筛选出阳性危险因素,对阳性危险因素进行多因素Logistic回归分析。结果:共有3964例患者实施脊柱开放手术,术后36例发生手术部位感染,其中男9例,女27例;年龄16~76岁(61.2±3.6岁)。其中合并糖尿病者12例,全身其他部位感染(包括慢性感染)3例,类固醇激素服用史(自身免疫性、代谢性疾病)1例。单因素卡方检验提示高龄、糖尿病、肥胖、长手术时间、内固定置入、输血是脊柱术后感染相关阳性危险因素。长期吸烟史、类固醇激素服用史、全身其他部分感染、脑脊液漏、二次手术、后路手术与脊柱术后感染无相关性。多因素Logistic回归分析提示:高龄、糖尿病、输血、内固定置入及长手术时间会增加脊柱术后手术部位感染的风险,其中长时间手术、肥胖、输血导致脊柱术后手术部位感染的风险最高,其次是糖尿病和内固定置入,而高龄在所有阳性危险因素中导致脊柱术后手术部位感染的风险最小。结论:肥胖、高龄、糖尿病、输血、内固定置入及长手术时间会增加脊柱术后手术部位感染的发生风险。对于有相关危险因素的患者,应尽早控制相关危险因素,加强围手术期预防以降低脊柱术后手术部位感染的风险。