腹腔镜下胆道损伤修复术的围手术期护理

目的探讨腹腔镜下胆道损伤修复术的围手术期护理。方法对9例胆道损伤（医源性损伤8例,外伤性损伤1例）患者在腹腔镜下行胆道损伤修复术,做好围手术期护理及术后并发症观察。结果9例患者均获治愈,1例术后出现胆瘘,经保守治疗痊愈。2例出现腹腔渗血,其中1例保守治疗后出血停止,另1例再次腹腔镜下成功止血。2例出现应激性溃疡,经保守治疗痊愈。结论腹腔镜下胆道损伤修复术及精心的围手术期护理是手术成功和患者康复的保障。     

颈椎损伤围手术期呼吸道的护理体会

颈椎的骨折、脱位是临床常见的严重损伤之一，常伴有神经根或脊髓损伤。由于损伤部位靠近生命中枢，症状重、截瘫率高、死亡率高且并发症多。颈椎损伤患者如护理不当，不仅有发生肺部感染和褥疮的可能，而且有增加脊髓损伤的可能，因此颈椎损伤患者围手术期的护理尤为重要。1996年至2002年，我科共收治此类患者18例，根据病人的具体情况，     

自发性气胸的围手术期护理

我科 1 975～ 1 999年共收治自发性气胸 1 56例 ,均采用剖胸探查术闭合患侧肺破裂处 ,彻底解除肺脏压迫 ,使肺复张。术后精心护理 ,效果满意。1　临床资料本组 1 56例 ,男 1 2 0例 ,女 36例 ,年龄 1 8～ 65岁。气胸发生在右侧 72例 ,左侧 80例 ,双侧 4例。原发病气胸多次发作者 1 5例 ,慢性支气管炎 2 8例 ,有肺结核病史 1 2例 ,其余既往无呼吸系统病史。临床表现 :突感疼痛 92例 ,胸闷 98例 ,气短 72例 ,发绀56例 ,刺激性咳嗽 92例 ,心慌 44例。临床体征 :患侧呼吸运动减弱 ,呼吸音减低或消失 ,语颤减弱 ,胸部叩诊鼓音或“上鼓下浊”音。胸…     

乳腺癌围手术期的护理

<正> 乳腺癌是一种常见病和严重的乳房疾病,是威胁广大妇女身心健康的主要疾病之一,并有逐渐年轻化趋势。目前对于乳腺癌仍以手术治疗为主,同时辅以激素、放疗、化疗等综合治疗。手术前后的高质量护理及术后功能锻炼,对于确保手术治疗成功是极其重要的。现将我院自1995年元月～2000年12月共行各类乳癌根治术46例护理体会报告如下。 1 临床资料 本组病例46例,均为女性和住院病人,年龄在30～65岁     

人工全膝置换患者的围手术期护理

人工全膝置换术(TKA)的目的在于缓解疼痛、矫正关节畸形、改善患肢功能状态,从而提高患者的生活质量[1]。而围手术期护理措施是否得当直接影响手术效果的好坏。笔者自2004年12月至2006年5月对27例TKA的病人进行了系统的科学的管理,取得了良好的效果。现将护理体会报告如下。     

胆石症围手术期的护理

<正> 胆石症为我国常见病。近年来发病率有增加趋势,发病率随年龄增长渐增高,多见于女性,肥胖是危险因素之一。 1 临床资料 我院1997年1月～2000年1月做胆石症手术62例,其中男22例,女40例年龄19岁以下者2例,20～29岁者6例,30～39岁者10例,40～49岁者5例,50～59岁者20例,60～69     

重型颅脑损伤254例围手术期治疗体会

自1996年～2 0 0 0年7月,我们充分利用院内急救设备,手术救治了各种损伤所致重型颅脑损伤2 5 4例,占全部救治病人的77.7%。临床资料1.一般资料:本组2 5 4例,男2 3 1例,女2 3例,年龄1～73岁,其中<14岁3 2例,15～40岁164例,41～60岁3 1例,>60岁2 7例。①致伤原因:交通伤14 2例(5     

130例颈椎脊髓损伤围手术期的呼吸管理

目的：探讨颈椎脊髓损伤围手术期的呼吸管理方法。方法：对130例该类病人术前进行气管、食道椎移训练，指导病人做有效咳嗽、咳痰，术后观察颈部伤口渗血，颈部有无增粗，有无呼吸困难，定时翻身、叩背，给予吸氧、吸痰，超声雾化吸入。结果：术后随访半个月-10个月，呼吸功能完全恢复者128例，2例死亡。结论：针对性护理措施能有效提高颈椎脊髓损伤手术的临床疗效。     

17例膀胱癌的围手术期护理

<正>膀胱癌发病率在我国泌尿生殖系肿瘤中占第1位。导致膀胱癌的因素有很多,吸烟是导致膀胱癌的重要因素之一。大多数病人的肿瘤仅限于膀胱,只有<5%的出现转移。治疗以手术为主,放疗和化疗为辅助治疗。一般是以间断肉眼血尿为症状就诊而被发现确诊的,故患者和家属在思想上一下子接受不了,情绪非常低落,患者的心理特征主要有悲观绝望。恐惧愤     

32例眼眶肿瘤围手术期的护理体会

<正> 眼眶与颅腔毗邻且沟通,所以眼眶肿瘤有相当一部分累及颅内,形成眶颅沟通肿瘤(6.9％～75％),其治疗和护理需神经外科参与。我科自1994年2月至2002年2月共收治眼眶肿瘤32例,通过手术治疗和精心护理,均取得满意效果,现将护理体会报告如下。     

围术期病人眼损伤的原因及防治

围术期非眼科病人发生的眼损伤主要原因是:眼睑闭合不全引起角膜干燥导致眼表面损伤,各种原因引起的视神经灌注压降低可造成缺血性视神经病变.对于眼损伤,目前多采用对症治疗的方法.随着纳米技术的发展,药物纳米控释系统在眼科治疗上已成功应用,作为一种新型的药物控释系统,具有广阔的发展前景.     

46例胸腰椎骨折并脊髓损伤患者围手术期护理

目的探讨胸腰骨折并脊髓损伤护理效果。方法对我科在1997年5月～2009年10月收治46例胸腰椎骨折并脊髓损伤患者应用GSS(General Spine System)椎弓根内固定系统治疗,通过术前术后各项护理措施进行回顾性分析。结果所有病例均获随访,时间6～28个月,平均14个月,经X线照片或/和CT检查示固定的椎弓根钉位置良好。神经功能判定(Frankel法):C级1例,D级12例,E级33例。结论 GSS内固定系统能最大限度保留脊柱的活动度固定牢靠,创伤小,并发症少的特点。提高围手术期的各项护理质量对保证手术成功,促进患者全面恢复具有至关重要的意义。     

Occult femoral artery injury in relation to fracture of the femoral shaft

Recognized injury of the femoral artery occurs in two per cent of patients with fracture of the femoral shaft. Delay in detection of these arterial injuries has led to unsatisfactory results in a young group of patients. Therefore, 40 patients who had suffered fracture of the femoral shaft 6-20 months (mean 13 months) prior to examination, were haemodynamically assessed using Doppler ankle/arm pressure indices to determine the incidence of occult femoral artery injury. Six patients (15%) exhibited haemodynamically significant abnormalities all in relation to previously injured limbs.     

Refinement of the rat crush-avulsion femoral artery injury model

A model for studying arterial crush-avulsion injuries in the rat is described. The model uses a standardized crush of ～0.3 joules and a standardized avulsion. The crush is accomplished by gravity acceleration of a 400 g weight over a distance of 7.5 cm. The weight impacts an anvil over the artery distributing the force of the impact over a 10 mm length of the vessel. The avulsion is accomplished by a hemostat attached to a second, 120g weight. Vascular stasis for 90 sec after vessel repair in a 175–225 g rat will consistently result in an 80% anastomotic failure. The model allows evaluation of anticoagulant effects singly or in combination. Agents may be given either systemically by intravenous route or locally by intraarterial route. © 1993 Wiley-Liss Inc.     

股骨上段骨折术中损伤股深动脉分支2例

病例1:患者,男,70 岁,右股骨逆转子间骨折(见图1A),于2018年3月16日在腰硬联合麻醉下行闭合复位股骨近端防旋髓内钉( PFNA)内固定术.术前牵引复位满意后开口置入主钉,主钉进入髓腔后发现骨折近端外展、外旋分离移位.遂取小切口行钢丝捆扎固定,在用手术刀锐性分离股骨外侧软组织时出现涌血,5 min内出血量80...     

Common femoral artery injury secondary to tennis ball strike

Tennis is a popular, safe sport that exposes amateur or professional players to minimal risk of injury. Most of this risk is related to musculoskeletal injuries, and vascular trauma is extremely rare. We present a case of a 68-year-old man in whom intermittent claudication developed after his right groin was struck by a tennis ball. The patient sought medical evaluation 2 months after the accident, and a subtotal occlusion of his right common femoral artery was disclosed by angiography and treated by endarterectomy.     

Common femoral artery injury secondary to bicycle handlebar trauma

Blunt trauma from bicycle handlebars is associated with well-described injuries of the abdominal viscera. These injuries result from the forceful compression of the relatively immobile abdominal organs between the handlebar end and the vertebral bodies. The common femoral artery is also immobile as it passes anterior to the superior pubic ramus, rendering this vessel susceptible to a similar mechanism of injury. We have treated two children who sustained thrombosis of the common femoral artery caused by bicycle handlebar trauma. The lack of familiarity with this uncommon mode of injury may contribute to delayed diagnosis and increased morbidity. We therefore wish to draw attention to this mechanism of injury.     

Plating of femoral shaft fractures. A review of 15 cases

The objective of this study was to define the role, indications and outcome of plating in femur shaft fractures. All femoral shaft fractures admitted and treated by the authors during a 2-year period were analysed. The authors personally treated a total of 135 femur fractures. Of these 135 fractures, 15 (11%) were treated with primary plating. The femoral fractures were classified as grade I (n = 4), grade III (n = 3), grade IV (n = 4), grade V (n = 3), and grade VII (n = 1) (OTA classification). Three patients sustained open fractures (one grade I and two grade II, Gustilo and Anderson classification). Pelvic (6) or ipsilateral lower extremity injuries (4) occurred in 10 of the 15 patients. A total of 23 body areas were injured, most commonly the chest (n = 10), abdomen (n = 5), head (n = 6) and blood vessels (n = 3). There were no infections reported. Two implant failures were noted. Femur plating is a useful technique in polytrauma patients for specific indications where intramedullary nailing (IMN) may be contra-indicated or technically not feasible. Although the postoperative morbidity (ARDS, death) in our study seems to be lower after plating than after intramedullary nailing, the rate of complications of fracture healing (30%) is significantly greater with femur plating than with intramedullary nailing (12%).