快通道麻醉在加速康复外科中的作用

<正>Fast-Track Surgerly一词最早出现在上世纪90年代,中文直译为"快通道外科"。它提倡采用多模式的围手术期恢复方案,加快患者的康复,缩短住院日,因此,Fast-Frack Surgery解释为"加速康复外科"可能更为贴切。"加速康复"意味着患者围手术期时间表的重大变革,并已涉及到外科治疗的各个领域。与此相适应的快通道麻醉(Fast-Track Anes- thesia),使得麻醉医生从仅提供最佳的手术条件和术后镇痛的内科医生,转变为围手术期医生。     

Fetal Surgery

As prenatal diagnosis has become increasingly sophisticated and as technological advances have enhanced the range of diagnostic capabilities, invasive therapies have developed from our expanded understanding of the natural history and pathophysiology of structural anomalies. This article presents a comprehensive review of the treatment options currently available for the entire spectrum of fetal diagnoses that are potentially surgically correctable. The current indications, contraindications, and outcomes for shunting procedures, open fetal surgery, and fetoscopic surgeries are reviewed.     

Out-Patient Surgery

This study was done at the Linköping University Hospital, Sweden, to assess the quality of care given to patients undergoing outpatient anaesthesia. A questionnaire was given to all adult patients (> 15 years old) immediately on admission to the outpatients' surgical ward and the patients were asked to answer all the questions, if necessary with the help of an attending nurse. Another questionnaire was given to the patients in the post-operative ward immediately prior to their being discharged home. Analyses of results indicate that although most patients were satisfied with the care offered at the outpatient surgical unit, 50% requested, but were not given, anxiolytic premedication before the operation. A majority of these were women undergoing gynaecological operations. Twenty per cent of the patients complained of post-operative pain that was poorly managed. Drowsiness (12%), headache (10%), and sore throat (8%) were common complications following general anaesthesia. In contrast, patients who had regional or local anaesthesia had an extremely low incidence of complications. Almost one-third of the patients were discharged without a responsible person accompanying them home and 25% were alone at home during the first 24 hours. Of the patients who went home alone, most either walked, cycled or took the bus, but 4% actually drove home after the operation. In our opinion more stress should be laid on patient information before the operation and better methods to relieve preoperative anxiety should be used whenever indicated. If possible, local or regional anaesthesia should be used to reduce the incidence of post-operative complications and, finally, patients should not be encouraged to go home alone without a responsible adult.     

胃肠外科围手术期处理中的加速康复外科的新理念

<正>胃肠外科手术是普通外科临床工作中最常见的一大类常规手术,其围手术期处理如术前肠道准备、术中麻醉方法选择、预防性抗生素的使用、术前及术中各种引流管的放置、术后补液、营养支持及患者康复等围手术处理问题在经典的外科学教科书有了详细地描述,广大外科医生根据教科书和文献上的处理原则、治疗规范及以往经验,进行着大量胃肠外科围术期处理的日常工作,形成了胃肠外科围手术期处理原则及方法。然而,近年来国外学者提出的旨在促进患者术后康复的加速康复外科的新理念极大地挑战我们业已形成的胃肠外科处理原则和措施,迫使我们重新审视这些已被广泛接受的并已作为常规的处理原则和措施。     

Cosmetic Surgery

The self-image fundamentally influences motivation and behavior. Thus, cosmetic surgery to improve appearance, if only to satisfy normal vanity, may greatly benefit a patient. Proper selection of the candidate for a face-lift procedure demands both medical and psychologic evaluation. Preoperative counseling is necessary to acquaint the patient with the procedure, its limitations, and probable temporary and permanent results. Good technic creates a younger-looking face without residual deformities or objectional scars.     

Cosmetic Surgery

The goal of rhinoplasty is to create a nose harmonious with the other features. Pathologic factors are more important in rhinoplasty than in any other form of cosmetic correction. Skillful modeling of bones and cartilage can correct the nose that is humped, oversized, small, wide or distorted. Nasal packing and an external splint fix the structures to the desired shape and reduce swelling.