腹腔灌洗加中药灌肠治疗弥漫性腹膜炎40例

腹腔灌洗加中药灌肠治疗弥漫性腹膜炎４０例柯全太河北省怀来县结石病医院（河北０７５４４１）我院从１９９４年４月至１９９６年８月共治疗弥漫性腹膜炎４０例，报道如下。１资料与方法１．１一般资料本组４０例，男３３例，女７例。年龄１９～８１岁，平均５１岁；其中...     

急性弥漫性腹膜炎340例治疗探讨

<正> 我院自1991年至2002年手术治疗各种原因所致急长弥漫性腹膜炎340例,术后没有发生腹腔残余脓肿或转移脓肿。本文结合文献就其治疗中的几个问题分析讨论。 1 临床资料 本组340例,男248例,女92例,年龄最大者84岁,最小者36岁。致病原因:胃十二指肠穿孔158例,占46.76％;穿孔性阑尾炎68例,占20％;小肠穿孔40例,占11.76％,包括原发性小肠穿孔10例,回肠憩室穿孔4例,外伤性小肠肠穿孔26例;     

急性弥漫性腹膜炎治疗现状与进展

急性弥漫性腹膜炎(acute diffuse peritonitis,ADP)是最常见的腹部外科急重症之一,尽管日前关于ADP的危重症医学、抗生素的应用等得到了长足发展,但病死率仍然较高[1].本文主要探讨ADP的治疗现状及进展.     

高氧液治疗急性脑梗死的效果观察

将 15 6例急性脑梗死病人随机分为观察组 (86例 )及对照组 (70例 )。对照组采用常规方法治疗 ;观察组在常规治疗的基础上 ,对病人输入的液体采用高氧液仪进行氧活化处理 (加入胞二磷胆碱 5 0 0mg)静脉滴注 ,1次 /d。治疗 10d后观察两组临床疗效以及神经功能缺损评分。结果观察组总显效率、总有效率均显著高于对照组 (均P <0 .0 5 ) ;治疗后神经功能缺损评分显著低于对照组 (P <0 .0 1)。提示高氧液配合治疗急性脑梗死 ,可促进神经功能恢复。     

双氧水与甲硝唑冲洗治疗急性继发性腹膜炎的比较

目的对比观察双氧水与甲硝唑冲洗腹腔治疗急性继发性腹膜炎的效果。方法将326例腹腔冲洗治疗急性继发性腹膜炎患者随机分成两组,分别采用双氧水冲洗和甲硝唑冲洗,观察两组患者切口感染、腹腔残余脓肿、门脉感染、脓毒血症、肠鸣音恢复及肛门排气时间、平均住院时间、平均住院费用及两年内肠粘连的发生情况等。结果双氧水冲洗组在切口感染率、腹腔残余脓肿、肠鸣音恢复正常及肛门排气时间、平均住院时间、人均住院费用及两年内发生肠粘连等均低于或少于甲硝唑冲洗组（P〈0.05）,两者比较差别有统计学意义;发生门脉感染及脓毒血症两者比较差别无统计学意义（P〉0.05）。结论双氧水腹腔冲洗治疗急性继发性腹膜炎与甲硝唑腹腔冲洗治疗急性继发性腹膜炎比较,有减少术后并发症、恢复快、缩短住院时间、减少住院费用等优点,值得临床推广应用。     

高氧液治疗老年性及血管性痴呆的疗效观察

目的探讨高氧液治疗老年性痴呆（AD）和血管性痴呆（VD）的效果。方法对38例AD和34例VD患者在治疗液中克高氧后再静脉输入。采用简易精神状态检查量表（MMSE）、韦氏成人智力量表（WAIS-RC）和临床记忆量表（CMS）在高氧液治疗前后对两组患者进行测试。结果行高氧液治疗后，AD组和VD组MMSE、WAIS-RC及CMS评分较治疗前显著提高（P〈0．05。P〈50．01）；VD组较AD组提高更加显著（P〈0.05。P〈0．01）。结论高氧液治疗可提高AD和VD患者的智力和记忆能力，是一种积极有效的治疗方法。     

继发性弥漫性腹膜炎的外科治疗

继发性腹膜炎是指腹腔内脏器发生炎症、缺血坏死、穿孔、破裂或吻合口漏后,大量细菌随消化道内容物或炎性渗液进入腹腔而致的腹腔感染与化脓性炎症。若炎症波及腹部两个以上象限,可称之为弥漫性腹膜炎。此类腹膜炎症在外科临床工作中常见,死亡率也较高。其预后取决于两个方面:一是病人全身和局部的防御机制,另一方面是污染细菌的种类、数量与时间,以及细菌及其产生的内毒素刺激病人的细胞防御机制所激活无数的炎性介质。除细菌之外,这些炎性介质也可阻断三羧酸循环而致细胞缺氧窒息,终致多器官衰竭而死亡。因此,在腹膜炎的治疗过程中对人体…     

急性弥漫性腹膜炎的诊治分析

目的对急性弥漫性腹膜炎的诊断与治疗方法进行探讨分析,旨在提高治疗效果。方法对57例急性弥漫性腹膜炎患者的临床资料进行回顾性分析。结果 57例患者中54例采用手术治疗,3例由于病情较轻采用非手术方式治疗。治疗时间6～23d,平均12.5 d。经过治疗,痊愈出院55例,2例治疗无效死亡,原因为心竭和感染性休克。总有效率为96.5%。结论根据急性弥漫性腹膜炎患者的具体病情合理选择的治疗方式可获得良好治疗效果。     

Potential effects of hyperbaric oxygen therapy in acute pancreatitis

BACKGROUND: To extract from the biomedical published reports, the effects of hyperbaric oxygen (HBO) on inflammatory disease, in particular acute pancreatitis. METHODS: This review will explain these effects and evaluate potential mechanisms of action of HBO in acute pancreatitis. A Medline/PubMed search (January 1966 to July 2004) with manual cross-referencing was conducted, including all relevant articles investigating the molecular and systemic effects of HBO on inflammatory diseases, particularly focusing on the studies of acute pancreatitis. All publication types, languages and subsets were searched. RESULTS: Original and review articles and short communications were extracted. The selected original articles covered the molecular and systemic effects of HBO and the effects in inflammatory disease states. The major findings are that HBO can act as an anti-inflammatory agent and as an antimicrobial agent. Many of the effects of HBO would be beneficial in the treatment of acute severe pancreatitis. Work carried out to date in animal models of acute pancreatitis shows promising improvements in severity but studies are limited to date. CONCLUSION: Acute pancreatitis impairs the pancreatic and systemic microcirculation and causes acute inflammation. These processes are potentially improved by HBO therapy.     

Iatrogenic systemic air embolism treated with hyperbaric oxygen therapy

Air embolism is a rare and potentially severe complication of surgical and invasive procedures. Emboli large enough to produce symptoms require immediate treatment because of the risk of 'gas lock' in the right side of the heart and subsequent circulatory failure. If air is transmitted to the arterial circulation through a shunt, it may cause cerebral emboli with neurological symptoms. We present two cases with venous air emboli and concurrent cerebral arterial emboli. Both patients were successfully treated with hyperbaric oxygen therapy.     

The effect of hyperbaric oxygen therapy on rhabdomyolysis-induced myoglobinuric acute renal failure in rats

Myoglobinuric acute renal failure (MARF) may develop after severe muscle injury. Heme oxygenase-1 (HO-1), a stress-response protein, has been implicated as a protective agent against MARF. We hypothesized that hyperbaric oxygen therapy (HBOT) may alleviate MARF by inducing renal HO-1 expression. Wistar-Albino rats were randomly assigned into three groups: Control (n?=?4), MARF (n?=?8), MARF?+?HBO (n?=?8). MARF was induced by intramuscular glycerol (50%, 8?mL/kg) injection. Saline (8?mL/kg) was injected into the hind limb of the animals in the control group. Animals in the MARF?+?HBO group received two sessions of HBO therapy (90?min at 2.5?atm) 2 and 18?h after glycerol injection. Serum and tissue samples were taken at 24?h. Serum urea and creatinine levels increased in the MARF and MARF?+?HBO groups confirming the development of MARF. But, serum urea and creatinine levels were similar in MARF and MARF?+?HBO groups. Oxidative stress parameters were similar among all groups. Histological renal injury score was similar in MARF and MARF?+?HBO groups. HO-1 level, determined by immunohistochemistry, was significantly higher in MARF and MARF?+?HBO groups, compared to the control group. Although HO-1 level in MARF?+?HBO group was higher than MARF group, it was not statistically significant. We found that HBOT did not reduce renal injury in experimental MARF model. HBOT is used to reduce the muscle damage after crush injury, which may be accompanied by MARF. Therefore, more studies are needed to understand the effects of HBO treatment on renal functions after MARF.     

高压氧治疗SAP大鼠的实验研究

目的　探讨高压氧对SAP大鼠的治疗作用机制。方法　SD大鼠 80只 ,随机等数分成正常对照组、假手术组、SAP对照组、SAP高压氧组。动物模型建立后 2、6、8h分别检测血液中AMS、NO、TXB2、6 K PGF量的变化及胰腺病理组织学评分、CD4、CD8计数。结果　动物模型建立后 2、6、8h ,SAP高压氧组AMS、NO、TXB2 浓度明显低于SAP对照组 (P <0 .0 1) ,而 6 K PGF1α浓度两组无显著性差异。胰腺组织SAP对照组病理组织学评分、CD8计数明显高于SAP高压氧组 ,而CD4计数、CD4 /CD8比值明显低于SAP高压氧组。结论　高压氧通过提高机体各脏器的血氧浓度、改善胰腺组织的微循环、细胞免疫功能而达到治疗SAP作用     

The role of hyperbaric oxygen therapy in treating extensive Fournier's gangrene

BackgroundFournier's gangrene (FG) is a rapidly progressive necrotizing infection of the perineal and genital fascia. The disease is always associated with high morbidity and mortality if diagnosed late and treated improperly.PurposeThis paper analyzed the epidemiology of FG, and clarified the treatment strategy of FG of different origins and prognosis.MethodsFrom January 2007 to December 2015, 60 patients with FG were treated at the Chi Mei Medical Center (Tainan, Taiwan). Their medical records were reviewed and analyzed.ResultsSixty patients were identified: 50 (83.33%) men and 10 (16.66%] women who were aged 29–90 years (mean 59.6 ± 14.5 years). The most frequent systemic illness was diabetes mellitus (73.33%). The location of FG was in the anorectal region in 21 (35.00%) patients, urogenital region in 25 (41.66%) patients, and dermatological region in 14 (23.33%) patients. The patients underwent from zero to nine surgical debridements with an average of 3.1 surgical debridements. Septic shock was observed in 25 patients. All 14 patients who expired died of sepsis. The survival rates were better for patients who underwent an early colostomy than for patients who underwent a delayed colostomy [20/21 (95.2%) patients vs. 2/7 (22.2%) patients, respectively; p < 0.001]. Patients with septic shock who received hyperbaric oxygen therapy (HBO) had better survival rates than patients who did not have HBO [7/7 (100%) vs. 4/18 (22.22%), respectively; p = 0.0007].ConclusionBacteremia and sepsis are major indicators of the mortality rate for FG. The cornerstones of treatment are early diagnosis, aggressive resuscitation, broad-spectrum antibiotic therapy, early colostomy, and prompt and repeated surgical intervention. Adjuvant HBO therapy led to higher survival rates.     

Calcific uremic arteriolopathy ameliorated by hyperbaric oxygen therapy in high-altitude area

Background: Calcific uremic arteriolopathy (CUA), previously called calciphylaxis, is a devastating complication of end-stage kidney disease (ESKD) with an annual incidence of 1–4% in dialysis patients and the mortality is as high as 80%. The rarity of the disease and the multifactorial nature of its causes have compromised good evidences that could determine the best therapy for the condition. For inhabitants in high-altitude area, the content of oxygen in the air is significantly lower than that in sea level area, which leads to the differences in the clinical manifestations and treatments to CUA. Case presentation: We presented a patient with CUA on Tibetan Plateau successfully treated by hyperbaric oxygen (HBO). This 46-year-old uremic Tibetan peasant received hemodialysis for 10 years, and over the last six months, skin necrosis occurred progressively on the distal joint of the middle finger of his right hand and the distal knuckles became paled, hardened, and severely painful. Extensive calcification of the arteries of both hands was revealed and his serum phosphorus elevated and serum calcium decreased. After diagnosis of CUA, patient was treated with HBO therapy for successive three weeks with a session per day, on the basis of secondary infection prevention. Pain of the affected finger was quickly alleviated in one week and the lesions of the affected finger healed in two months. Conclusion: As the dialysis population in high-altitude area increasing rapidly in recent years, this management strategy of improving focal oxygen supply by HBO might act as a reference for the treatment of CUA patients in similar conditions.     

高压氧治疗腰椎间盘突出症不同时机的疗效观察

目的 探讨高压氧治疗腰椎间盘突出症不同时机的临床疗效.方法 100例腰椎间盘突出症急性期患者随机分为两组:治疗组(急性期即予高压氧结合常规治疗)、对照组(急性期后予高压氧结合常规治疗),对照组50例,治疗组50例,2个疗程后进行疗效评价.结果 对照组:治愈22例,显效16例,无效12例,有效率76％;治疗组:治愈34例,显效11例,无效5例,有效率90％.经统计学分析,治疗组优于对照组(P＜0.05);两组治疗前后JOA评分比较有显著差异(P＜0.01),治疗后两组比较,治疗组优于对照组(P＜0.01);治疗前两组神经传导速度无明显差异,治疗前后比较,差异明显(P＜0.01),治疗后治疗组与对照组比较有显著性差异(P＜0.01).结论 高压氧结合常规治疗对腰椎间盘突出症患者疗效理想,并且不同时机给予高压氧治疗对腰椎间盘突出症患者的病情改善也不相同,急性期即予高压氧治疗效果更明显.     

Arterial oxygen tension increase 2-3 h after hyperbaric oxygen therapy: a prospective observational study

BACKGROUND: Inhalation of hyperbaric oxygen (HBO) has been reported to decrease arterial oxygen tension (PaO(2)) in the early period after exposure. The current investigation aimed at evaluating whether and to what extent arterial blood gases were affected in mechanically ventilated intensive care patients within 6 h after HBO treatment. METHODS: Arterial blood gases were measured in 11 ventilated subjects [nine males, two females, synchronized intermittent mandatory ventilation (SIMV) mode] undergoing HBO therapy for necrotizing soft tissue infection (seven patients), burn injury (two patients), crush injury (one patient) and major abdominal surgery (one patient). Blood gases were obtained with the patients in the supine position under continuous analgesia and sedation before the hyperbaric session (baseline), during isopression, after decompression, after each transport, and 1, 2, 3 and 6 h after exposure. Heart rates and blood pressures were recorded. Intensive care unit (ICU) ventilator settings remained unchanged. Transport and chamber ventilator settings were adjusted to baseline with maintenance of tidal volumes and positive end-expiratory pressure (PEEP) levels. The hyperbaric protocol consisted of 222.9 kPa (2.2 absolute atmospheres) and a 50-min isopression phase. The paired Wilcoxon's test was used. RESULTS: Major findings (median values, 25%/75% quartiles) as per cent change of baseline: PaO(2) values decreased by 19.7% (7.0/31.7, P < 0.01) after 1 h and were elevated over baseline by 9.3% (1.5/13.7, P < 0.05) after 3 h. SaO(2), alveolar-arterial oxygen tension difference and PaO(2)/FiO(2) ratio behaved concomitantly. Acid-base status and carbon dioxide tension were unaffected. CONCLUSION: Arterial oxygen tension declines transiently after HBO and subsequently improves over baseline in intensive care patients on volume-controlled mechanical ventilation. The effectiveness of other ventilation modes or a standardized recruitment manoeuvre has yet to be evaluated.     

Air embolism: diagnosis with single-photon emission tomography and successful hyperbaric oxygen therapy

Venous air embolism may occur when the surgical field is abovethe level of the heart. We present a case of venous air embolismin a patient undergoing percutaneous nephrolithotripsy in theprone position and presenting with blindness and neurologicaldeficits 8 h later. The clinical diagnosis of paradoxicalair embolism was confirmed by early single-photon emission tomography(SPET), whereas magnetic resonance imaging including diffusion-weightedimaging (DW-MRI) was diagnostic only 30 h later. Hyperbaricoxygen therapy was successful. In this case, early DW-MRI scanwas inconclusive, but a SPET study of the brain appeared tobe useful in confirming the clinical diagnosis. Early hyperbaricoxygen was demonstrated to be a successful therapy. Br J Anaesth 2002; 89: 775–8     

Does the intraoperative peritoneal lavage cytology add prognostic information in patients with potentially curative gastric resection?

Peritoneal recurrence is the foremost pattern of failure after potentially curative resection for gastric cancer. Our aim was to evaluate the prognostic value of intraperitoneal free cancer cells (IFCCs) in peritoneal lavage of patients who underwent potentially curative resection for gastric carcinoma. Two hundred twenty patients with gastric cancer stage I, II, or III were prospectively evaluated with peritoneal lavage and cytologic examination. Aspirated fluid from the abdominal cavity was centrifuged and subjected to Papanicolaou staining. The mean age was 60.9 years (range, 21–89 years), and 63.6% were men. IFCCs were detected in 6.8% of the patients; suspicious in 2.7%, and negative in 84.5%. No judgment could be given in 5.9% of the cases. Invasion of the gastric serosa (pT3) was observed in all positive cytology patients. Patients with IFCCs had a mean survival time of 10.5 months, while those with negative IFCC had a mean survival time of 61 months (P = 0.00001). There was no correlation between the presence of IFCCs and tumor size, histology, pN, or tumor site. Our conclusions are that (1) positive cytology indicates a poor prognosis in patients who underwent potentially curative gastric resection and (2) peritoneal lavage cytology improves staging in assessing these patients and may alter their therapeutic approach.