老年股骨转子间骨折围术期护理体会

目的探讨老年股骨转子间骨折患者围手术期的护理方法。方法对89例老年股骨转子间骨折患者根据其生理和心理特点,实施围手术期护理,使病人增加手术的耐受性,预防或减少术后并发症。结果 89例均顺利通过手术,围手术期发生并发症3例,经治疗均治愈出院。术后功能评定：优60例,良27例,差2例。结论老年股骨转子间骨折由于生理及心理特点,手术风险大易出现多种并发症,护理人员有针对性地进行围手术期护理,可提高手术成功率,减轻和减少并发症。     

肾上腺嗜铬细胞瘤围手术期护理

目的讨论肾上腺嗜铬细胞瘤围手术期的护理方法。方法对32例患者肾上腺嗜铬细胞瘤围手术期护理方法进行回顾性分析总结。结果 28例患者经手术治疗护理无并发症发生,顺利恢复出院。另4例患者术后不同程度出现并发症,经积极治疗护理均顺利出院。结论加强围手术期的观察与护理是提高手术成功率,减少并发症的重要环节。     

急诊手术治疗普外科疾病合并糖尿病55例临床分析

目的：探讨急诊手术治疗普外科疾病合并糖尿病患者的措施。方法：回顾性分析2009-10-2010-10急诊手术治疗普外科疾病合并糖尿病患者55例的临床资料。结果：入院时已明确糖尿病诊断的患者,经围手术期准备,均平稳度过围手术期,肠切除肠吻合术4例与急性化脓性阑尾炎6例术后并发切口感染,经对症处理后均痊愈出院。结论：急诊手术治疗普外科疾病合并糖尿病患者在围手术期应保持血糖稳定。     

老年性急性阑尾炎84例分析

目的：探讨老年急性阑尾炎的诊断与治疗。方法：分析老年性急性阑尾炎84例,其中阑尾切除62例,阑尾切除加腹腔引流17例,单纯腹腔引流2例。非手术治疗3例。结果：本组共发生并发症11例,其中肺炎2例,切口感染2例,心绞痛3例,尿猪溜2例,频发室早2例。痊愈81例,好转3例,无1例死亡。结论：掌握了解老年急性阑尾炎的特点,早期准确诊断,条件容许情况下尽早手术治疗。掌握好手术方式,做好围手术期处理,疗效显著。     

老年急腹症的临床表现与诊治分析

目的：分析老年（≥60岁）急腹症的临床特征及诊治过程,以提高对老年急腹症的诊治水平。方法：将老年急腹症100例与中青年80例（〈60岁）的发病情况、并发症、实验室和辅助检查,以及诊断、手术治疗和结果等临床资料进行分析。结果：老年组入院前有全身慢性疾病93例（93．0%）,术后并发症发生率31．0％;中青年组分别为7例（8．8％）和13例（16．2％）,均根据病情进行相应的手术治疗。老年组治愈出院94例（94．0％）,死亡6例（6．0％）;中青年组均治愈出院,无一例死亡;治愈率与手术时机、具体术式及围手术期处理有关。结论：手术时机、手术方法选择及围手术期处理,是提高老年急腹症治愈率的关键。     

老年急性重症胆管炎的外科处理

目的探讨老年急性重症胆管炎外科治疗方式。方法回顾性分析58例老年急性重症胆管炎患者的外科治疗及预后情况。结果急诊手术44例,治愈40例,死亡4例;择期手术4例,全部治愈;非手术治疗10例,仅2例好转,死亡8例。结论老年急性重症胆管炎的诊断,在应用“急性重症胆管炎诊断标准”的同时,应以全身感染症候群和本病的局部体征为主要依据,结合过去胆道感染病史、B超检查等综合判定,明确诊断后及早手术,积极的围手术处理,是提高治愈率、降低并发症和死亡率的关键。     

老年急性胆囊炎手术治疗76例临床分析

目的 探讨老年急性胆囊炎的临床特点.方法 对我院2004年1月-2010年1月经手术治疗的76例老年急性胆囊炎的临床表现及治疗进行回顾性分析.结果 76例中治愈75例,死亡1例.术后切口感染、电解质紊乱、肺部感染等并发症高达9.0%～10.0%.结论 老年人对急诊胆囊手术一般都能耐受,早期手术及积极防治术后并发症可降老年 急性胆囊炎 右肝萎缩 胆囊异位 手术低死亡率.     

动力髋治疗老年粗隆间骨折围手术期处理及并发症防治

目的:探讨动力髋治疗老年粗隆间骨折围手术期处理及并发症防治.方法:我院自2001年1月～2007年1月应用动力髋(DHS)治疗老年股骨粗隆间骨折138例,所有患者经随访发现其中14例于术后1～6个月均出现不同程度并发症,分析这些并发症,加强围手术期处理,严格掌握手术适应证,提高手术处理技巧,提出防治措施.结果:所有患者经围手术期处理及加强并发症防治后,肺部感染疾病在术前得到控制,褥疮、泌尿系感染均未发生,术后复查X片示骨折均达到或接近解剖对位,发现14例于术后1～6个月均出现不同程度并发症,其中髋内翻畸形6例,下肢外旋畸形2例,内固定失败2例,再骨折2例,股骨头坏死1例,骨延迟愈合1例.结论:对老年骨折患者的全身情况作出评估,正确地制定治疗方案,包括手术方案和麻醉方案,有效地控制伴随症,提高手术技巧,重视支持治疗和术后并发症的防治,是老年股骨粗隆间骨折取得满意疗效的保障.     

急症、重症心瓣膜病9例手术及围手术期处理

目的 探讨临床少见的急症、重症心脏瓣膜病的外科救治体会。方法 对1993年10月至2002年5月，共收治的9例临床少见的急症、重症心脏瓣膜病患进行手术治疗的情况进行总结。结果 无手术死亡，亦无运期死亡，均痊愈出院。经随访2～7年患恢复良好。结论 本组患病情危急，手术、体外循环及麻醉难度极大，围手术期并发症突出，如严重低心排量综合征、恶性心律失常、多脏器功能衰竭、水电解质紊乱等。及时合理地实施手术、力求麻醉平稳、采用良好的心肌保护方法以及强有力的围手术期处理是救治成功的关键。     

高原地区小儿急性阑尾炎54例诊治体会

目的:总结高原地区小儿急性阑尾炎的诊治经验。方法:对高原地区54例经手术确诊的小儿急性阑尾炎进行回顾性分析。结果:单纯性阑尾炎5例,化脓性阑尾炎20例,坏疽性阑尾炎12例,阑尾穿孔17例。术后并发症:切口感染4例,腹腔脓肿3例,不完全性肠梗阻2例,均经治疗痊愈出院。结论:高原地区环境缺氧,小儿急性阑尾炎进展快,为降低并发症及改善预后,早期诊断、尽早手术及正确的围手术期处理非常重要;对诊断不甚明确者应密切观察,随时做好手术准备;对酷似阑尾炎的病例,应注意诊断和鉴别诊断,尽量减少误诊。     

Optimization of the system of medical service of students of Cadet Schools of the Ministry of Defense of the Russian Federation

One of the factors of the successful military career guidance Cadet schools students is preserving and promoting their health. Medical support of children and adolescents aged 10-17 years should include the full range of medical and preventive measures defined for this group. The state of providing outpatient care for pupils at the Cadet School in St. Petersburg was studied. These results show that full medical care in accordance with the standards can be based only on children's health clinics. It is important that the organization of medical support pupils cadet schools should be cooperate with civilian health care.     

带状疱疹83例误诊原因分析

带状疱疹是由水痘—带状疱疾病毒引起的皮肤科常见疾病。其主要的病理损害,一是受累神经的严重炎症性浸润,继而导致受侵犯神经节内神经细胞变性、坏死;二是皮肤的水泡。迅速抑制神经节和相应的感觉神经纤维的充血、水肿和坏死,防止粘连形成,达到迅速镇痛、改善皮损,缩短病程及防止后遗症的发生是治疗的关键。因而,尽早明确诊断,     

Estimation of accumulated dose of radiation by method of ESR-spectrometry of dental enamel of mammals

ESR-spectrometry was used to investigate radiation-induced paramagnetic centers in enamel of mammals: carnivores (polar bear and fox), ungulates (reindeer, European bison, moose), and man. Values at half the microwave power saturation of the radiation signal, P_1/2, evaluated at room temperature, was found to range from 16 to 26 mW for animals and man. A new approach to discrimination of the radiation induced signal from the total ESR spectrum of reindeer enamel is proposed. ‘Dose-response’ dependencies of enamel of different species mammals were measured within the dose range from 0.48 up to 10.08 Gy. Estimations of ‘radiosensitivity’ enamel of carnivores and ungulates showed good agreement with radiosensitivity enamel of man by ESR method.     

Analysis of the results of the international comparison of activity measurements of a solution of Fe

The results of an international comparison of activity measurements of a solution of ⁵⁵Fe organized by the BIPM in 2005 are reported and analysed. This exercise, which follows the procedures of the CIPM mutual recognition arrangement to update older comparisons, is a renewal of the comparison organized by the BIPM that took place in 1978. A EUROMET comparison was organized in 1996 specifically to compare activity measurements of a ⁵⁵Fe solution by means of liquid-scintillation techniques. Results of these three comparisons are presented and discussed in this paper.

The radionuclide solution was provided by the NPL, which also distributed the samples to the participants. The activity of the ampoules was measured by 16 laboratories using 12 methods producing 25 results. Some general considerations on uncertainty assessments pertaining to the different techniques used are drawn. The outcome of four different estimators is compared from which the presence of at least one outlier can be confirmed. Further measurements should be made to try to reduce the discrepancy between the results. To date the outcome of the present comparison does not show an improvement to that of the 1996 comparison.     

Evaluation of the results of various technics of non-surgical therapy of varicocele

A new method of non-surgical treatment of varicocele syndrome is described: it consists in sclerotherapy of spermatic vein by trans-femoral percutaneous catheterization with balloon-catheters. In 8 cases venous thrombosis has been induced by direct electric clotting. The techniques and a 6 months follow-up are discussed. It is pointed out that this procedure should be considered as the method of choice for tubular lesions and sub-fertility prophylaxis in young people and in childhood.     

延迟性脾破裂误漏诊原因分析

目的探讨延迟性脾破裂误漏诊原因和预防措施.方法回顾性分析总结12例延迟性脾破裂中的诊断和误漏诊的经验与教训.结果本组延迟性脾破裂的误漏诊5例(41.66%).对多发伤与脾破裂并存可能认识不足,外伤史轻微或伤员隐瞒外伤史,缺乏腹痛-缓解-突然再腹痛的典型病史,缺乏“对冲性脾破裂”力学分析和整体化诊断思路等为其误漏诊的主要原因.结论详细的外伤史和全面系统检查,重视腹以外多发伤掩盖腹内脏器伤及延迟性脾破裂可能.确立外伤-腹内脏器伤-脾破裂整体化诊断思路.不间断地辅以B超检查脾形态学变化和腹内有无积液,腹腔穿刺确定有无血腹、X线胸腹部检查观察左侧胸肋角和膈肌运动情况、必要时CT检查以尽早发现脾包膜下血肿,降低延迟性脾破裂误漏诊率.