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1.
目的 探讨重型颅脑损伤开颅术中急性脑膨出的原因、防治措施与预后关系. 方法 回顾性分析本院近年来收治的112例重型颅脑损伤开颅术中急性脑膨出病例的临床资料,总结其原因和防治经验. 结果 迟发性颅内血肿、弥漫性脑肿胀是颅脑损伤术中急性脑膨出的主要原因.术后6个月根据格拉斯哥预后评分(GOS)评定:恢复良好20例,中残14例,重残16例,植物生存14例,死亡48例,死亡率42.9%. 结论 正确认识重型颅脑手术中急性脑膨出的原因,采取各种措施积极降低颅内压,提高生存率,改善预后.  相似文献   

2.
目的探讨特重型颅脑损伤患者术中急性脑膨出的原因及防治方法。方法回顾性分析2l例特雨型颅脑损伤标准外伤大骨瓣开颅术中急性脑膨出患者的临床资料,18例患者术后寸即复查头部CT,发现迟发性颅内血肿7例,远隔部位原有血肿扩大4例,弥漫性脑肿胀6例,人而积脑梗塞1例。单侧开颅7例,双侧开颅14例;其中6例行内减压术。结果疗效评定采用GOS评分:4分(中度病残)4例,3分(重度病残)5例,2分(植物生存)3例,1分(死亡)9例。结论术中急性脑膨出的主要原因是对侧迟发性颅内血肿和弥漫性脑肿胀,积极寻找脑膨出的原因并及时止确的处理直接关系到患者的预后。  相似文献   

3.
脑膨出是重型颅脑损伤后急性弥漫性脑肿胀开颅术中常见的问题,处理困难,预后差.2000年6月至2004年2月,本院共收治76例外伤性急性弥漫性脑肿胀开颅减压术中出现脑膨出的重型颅脑损伤患者,现报告如下.  相似文献   

4.
重型颅脑损伤术中急性脑膨出原因及防治   总被引:8,自引:1,他引:7  
目的探讨重型颅脑损伤术中急性脑膨出的形成原因及有效的防治措施。方法回顾性分析76例重型颅脑损伤患者术中出现急性脑膨出的原因及防治措施的疗效。结果迟发性颅内血肿、弥漫性脑肿胀、侧裂区脑挫裂伤、脑疝后脑梗塞、呼吸道梗阻等是颅脑损伤术中急性脑膨出的主要原因。结论术中出现急性脑膨出的原因有多种,应及时复查头部CT,明确病因,准确处理,提高疗效。  相似文献   

5.
重型颅脑损伤开颅术中急性膨出的重要原因是急性弥漫性脑肿胀,往往在血肿清除后,脑组织开始疝出手术窗口,造成手术极大的困难。笔者根据术前临床表现及影像学,探讨急性弥漫性脑肿胀的发生原因及防治措施,现报告如下。  相似文献   

6.
目的 探讨重度颅脑损伤急性脑膨出的原因及最佳治疗方案.方法 回顾性分析26例采用双侧开颅治疗重度颅脑损伤术中急性脑膨出患者的临床资料.结果 恢复良好4例,中残5例,重残2例,植物生存3例,死亡12例.结论 迟发性颅内血肿和急性弥漫性脑肿胀是颅脑损伤开颅术中急性脑膨出的主要原因,而采用双侧开颅可明显提高抢救成功率和患者的生存质量.  相似文献   

7.
目的探讨重型颅脑损伤术中急性脑膨出的病因及其预后。方法对28例开颅术中出现急性脑膨出的重型颅脑损伤患者的临床资料进行回顾性分析。结果术中出现急性脑膨出的主要因素为迟发型颅内血肿及急性弥漫性脑肿胀。6例恶性脑膨出患者,术中表现为急性弥漫性脑肿胀,全部死亡。余22例良性脑膨出患者,术中表现为迟发型颅内血肿。根据GOS评定标准,于伤后6个月随访,恢复良好6例,中残3例,重残5例,植物生存4例,死亡4例。结论手术前综合头部着力点、头颅CT检查结果,评估手术过程中可能发生急性脑膨出的病因,根据手术过程中出现的急性脑膨出的特点,预测预后转归,再确定进一步治疗方案。  相似文献   

8.
重型颅脑损伤开颅术中急性脑膨出防治策略   总被引:1,自引:0,他引:1  
重型颅脑损伤开颅术中发生急性脑膨出,病情危重,病因复杂,处理棘手。过去一般认为,颅脑外伤术中发生脑膨出是急性脑肿胀引起的,死亡率几乎达100%。近15年来笔者加强了对颅脑外伤开颅术中急性脑膨出原因的观察研究,发现这种急性脑膨出,除急性脑肿胀外尚有很大一部分是由颅内迟发性异位血肿等其他原因引起。针对病因,结合综合治疗,疗效较好。现报告如下。  相似文献   

9.
目的探讨重型颅脑损伤术中急性脑膨出的原因及处理方法。方法回顾性分析21例重型颅脑损伤术中急性脑膨出患者的临床资料。结果术中急性脑膨出主要原因为迟发性颅内血肿13例,急性弥漫性脑肿胀4例,外伤性大面积脑梗死2例,广泛性脑挫裂伤1例,严重脑组织缺血缺氧1例;经对脑膨出原因综合处理后均关颅成功。术后给予综合治疗,格拉斯哥预后(GOS)标准评定,患者存活11例(52.4%),其中良好4例,轻残3例,中、重残3例,植物生存1例;死亡10例(47.6%)。结论术前准确评估、术中准确判断并及时处理,为重度颅脑损伤术中急性脑膨出有效防治措施,可减低致残及死亡率,改善患者预后。  相似文献   

10.
目的结合颅脑外伤相关临床资料,探讨分析颅脑外伤开颅术中急性脑膨出的原因和处理对策分析。方法回顾性分析2002年1月至2012年1月,收治的颅脑外伤开颅术中急性脑膨出的128例患者,总结分析相关的临床资料,探讨颅脑外伤引发急性脑膨出的具体原因和应对策略。结果本研究中发现颅脑外伤中引发急性脑膨出主要的原因有迟发性颅内血肿(50%),急性弥漫性脑水肿(21.88%),充血性脑肿胀(27.3%),其他原因(0.82%)。本组患者中迟发性脑血肿引发的急性脑膨出与外伤带来的解剖结构的异常和大脑受压迫情况有一定的关系。通过资料研究显示Ⅱ型脑膨出在颅脑外伤手术中比较多见。结论颅脑外伤开颅术中急性脑膨出比较常见,且病因多样化,根据不同患者的具体临床表现和CT检查以及病情变化适时调整治疗方案,进行有效有针对性的治疗,进而减轻患者疼痛,降低死亡率。  相似文献   

11.
Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI2) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI2), TXB2 (stabile metabolite of thromboxane A2) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI2 release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB2 (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI2 release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A2, presumably contributing to hemodynamic stability within 30 min after MT.  相似文献   

12.
Don Dame 《Artificial organs》1996,20(5):613-617
Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.  相似文献   

13.
Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.  相似文献   

14.
Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H2O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg−1 followed by 0.15 mg · kg−1 · h−1, n=8) or verapamil (0.1 mg · kg−1 followed by 0.3 mg · kg−1 · h−1, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.  相似文献   

15.
Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.  相似文献   

16.
Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.  相似文献   

17.
Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg?1 i. v. or midazolam 0.05 mg · kg?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg?1 i. v. and 32 μg · kg?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg?1. The mean ED50s, calculated from dose-response curves, were 5.4 mg · kg?1, 3.9 μg · kg?1 and 0.4 mg · kg?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg?1 i. v. or midazolam 0.05 mg · kg?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg?1 and 8 μg · kg?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.  相似文献   

18.
Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg?1 · min?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min?1 · m?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO2I) and oxygen consumption index (VO2I) were also significantly increased in the dopexamine group (DO2I: from 416±91 to 717±110 ml/m2 · m2; VO2I: from 98±25 to 157±22 ml/m2 · m2), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.  相似文献   

19.
A concept of balanced analgesia using nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol (acetaminophen), opioids, and corticosteroids can also be used in patients with pre-existing illnesses. NSAIDs are the most effective treatment for acute pain of moderate intensity in children; however, these drugs should be avoided in patients at increased risk for serious side effects, e.g. patients with renal impairment, bleeding tendency, or extreme prematurity. NSAIDs can be given with minimal risks to the younger child with mild to moderate asthma, and, in these patients, the use of steroids can be encouraged; in addition to their antiemetic and analgesic action, a beneficial effect on asthma symptoms can be expected. In the non-intubated child with cerebral trauma, exaggerated sedation caused by opioids and increased bleeding tendency caused by NSAIDs must be avoided. In neonates and small infants, the oral administration of sucrose or glucose is helpful to minimize pain reaction during short uncomfortable interventions.  相似文献   

20.
Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.  相似文献   

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