51例急性胆源性胰腺炎的治疗体会

目的探讨治疗急性胆源性胰腺炎的方法。方法应用腹腔镜及十二指肠镜(51例急性胆源性胰腺炎病例施行十二指肠镜下乳头括约肌切开取石(EST),并置入鼻胆管引流(ENBD);合并胆囊结石者施行腹腔镜胆囊切除术(LC);同时行胰包膜切开、清除坏死组织及腹腔置管引流术。结果全组51例,其中34例胆管结石经EST取出,所有病例均行ENBD;合并胆囊结石29例,急诊或择期施行LC28例,中转开腹手术1例。术后住院时间(17±8)d,随访6～24个月,无严重手术并发症,无1例死亡。结论腹腔镜及十二指肠镜联合治疗急性胆源性胰腺炎创伤小、腹腔干扰轻,有利于术后快速恢复。     

两镜治疗急性胆源性胰腺炎的体会

目的：探讨急性胰腺炎(acute gallstone pancreatitis．AGP)腹腔镜及十二指肠镜治疗的可行性。安全性和时机性。方法：运用腹腔镜及十二指肠镜对348例急性胆源性胰腺炎首先行十二指肠镜下乳头括约肌切开取石(EST)．同时置入鼻胆管引流(ENBD)；合并胆囊结石着实行腹腔镜胆囊切除术(LC)；同时进行胰腺包膜切开、坏死组织清除及小网膜囊和大腹腔放置大口径胶管引流术。结果：本组266例均行EST ENBD后72h内行LC术及腹腔镜下胰腺包膜切开、小网膜囊和大腹腔冲洗置大口径胶管引流术。取得良好效果。无1例死亡。全部痊愈出院。AGP早期腹腔粘连较轻。腹腔炎性液体未包裹。该手术创伤小、腹腔干扰少、快捷、有效，安全及有利于术后恢复。AGP的中期行EST ENBD对治疗胰腺炎是有效的。AGP后期．在已行EST ENBD治疗后，可在彩超引导下LC术及扩创引流术。结论：AGP的两镜治疗，充分的体现了微创手术的可行性、安全性，只要掌握好手术时机性。是目前比较理想的治疗手段。     

十二指肠镜联合腹腔镜治疗急性胆源性胰腺炎的疗效观察

目的 观察十二指肠镜下行胆总管取石或内支架引流后.再行腹腔镜胆囊切除治疗胆源性胰腺炎的长期疗效.方法 72例合并有胆囊结石的急性胰腺炎患者分成治疗组(40例)和对照组(32例),治疗组患者先行十二指肠镜逆行胰胆管造影(ERCP),根据胆管造影结果 ,采取乳头切开(EST)、胆管取石或胆管内支架引流术.患者在行十二指肠镜手术治疗病情稳定后,再行腹腔镜胆囊切除术(LC),对照组患者行内科保守治疗.结果 治疗组患者行ERCP,诊断为胆总管小结石13例,胆总管末端炎症性狭窄12例,胆总管未见异常15例,12例胆总管末端炎症性狭窄患者行EST或胆管内支架引流术,另28例患者均行乳头切开.LC术36例,4例失败转手术,所有患者在出院后随访2年,治疗组患者治疗后2年内未见再发急性胰腺炎患者,对照组患者内科保守治疗后2年内有40.6%(13/32)患者再发急性胰腺炎.结论 对于合并有胆囊结石的急性胆源性胰腺炎患者,通过十二指肠镜行乳头切开取石或胆管内支架引流治疗急性胰腺炎,再行腹腔镜胆囊切除术,比对照组能够有效的预防急性胰腺炎的发作.     

十二指肠镜治疗高龄急性胆源性胰腺炎的临床应用

目的探讨应用十二指肠镜治疗高龄急性胆源性胰腺炎患者的可行性、有效性和安全性。方法该院2002年5月-2005年10月收治的18例高龄急性胆源性胰腺炎患者首先行内镜下乳头括约肌切开取石，同时置入鼻胆管引流；合并胆囊结石者，待胰腺炎恢复后，施行腹腔胆囊切除术等。结果全组18例病人均行鼻胆管引流（ENBD），11例胆管结石行内镜下乳头括约肌切开取石（EST）取出，胰腺炎顺利治愈17例，治愈率94．4％：6例取石失败。二次内镜治疗行胆道支架引流术、三镜联合胆总管探查术，中转开腹手术治疗，无严重术后并发症发生。结论早期ENBD＋EST，解除胆道梗阻，降低胰管压力，避免急诊手术，为择期手术创造条件，该微创技术尤为适合高龄、合并有多脏器功能不全、难以耐受手术的患者。     

早期十二指肠镜联合腹腔镜胆囊切除治疗急性胆源性胰腺炎47例分析

目的：探讨早期十二指肠镜介入治疗（ERCP＋EST＋ENBD）结合腹腔镜胆囊切除术（LC）治疗急性胆源性胰腺炎的效果。方法：回顾性分析47例早期应用ERCP＋EST＋ENBD联合LC治疗的急性胆源性胰腺炎患者资料。结果：所有患者均治愈,无胰腺炎加重表现,无严重并发症发生。结论：ERCP＋EST＋ENBD结合LC治疗急性胆源性胰腺炎安全可行,效果良好,值得临床推广应用。     

急性胆源性胰腺炎的早期内镜介入治疗

<正>急性胆源性胰腺炎(ABP)是临床常见的急症。十二指肠镜技术在胆总管结石的治疗及腹腔镜在胆囊结石中的应用已取得较好疗效。近年来,随着内镜诊疗技术的提高,两镜联合微创治疗急性胆源性胰腺炎是热门课题。作者总结2005年1月～2006年12月收治的64例胆源性胰腺炎患者,经内镜治疗,即经十二指肠乳头括约肌切开术(EST)、内镜鼻胆引流术(ENBD)、内镜逆行胆管引流术(ERBD)及腹腔镜胆囊切除术(LC),疗效满意。现将结果报告如下。     

急性胆源性胰腺炎的早期内镜介入治疗

急性胆源性胰腺炎（ABP）是临床常见的急症。十二指肠镜技术在胆总管结石的治疗及腹腔镜在胆囊结石中的应用已取得较好疗效。近年来，随着内镜诊疗技术的提高，两镜联合微创治疗急性胆源性胰腺炎是热门课题。作者总结2005年1月-2006年12月收治的64例胆源性胰腺炎患者，经内镜治疗，即经十二指肠乳头括约肌切开术（EST）、内镜鼻胆引流术（ENBD）、内镜逆行胆管引流术（ERBD）及腹腔镜胆囊切除术（LC），疗效满意。现将结果报告如下。[第一段]     

十二指肠镜和腹腔镜治疗重症急性胆源性胰腺炎的护理

我院2001年4月~2005年5月,先急诊行内镜下十二指肠乳头切开(EST)或EST加鼻胆管引流(ENBD)后行腹腔镜胆囊切除术(LC)治疗25例重症急性胆源性胰腺炎,效果满意,现将护理体会报告如下。1临床资料1.1一般资料25例重症胆源性胰腺炎中,男12例,女13例,年龄60.6±15.6岁,所有患者经B超、     

腹腔镜联合十二指肠镜治疗胆囊结石合并胆总管结石

目的:探讨腹腔镜联合十二指肠镜治疗胆囊结石合并胆总管结石的临床疗效.方法:回顾分析2009年1月-2010年12月腹腔镜胆囊切除术(LC)联合十二指肠镜治疗35例胆囊结石合并胆总管结石患者的临床资料.所有患者均采取经十二指肠镜逆行胰胆管造影(ERCP),内镜下十二指肠乳头括约肌切开术(EST),取出胆总管结石,放置胆道塑料支架引流(ERBD).ERCP后3d内行LC,术后4d出院.出院后1～2周内再次行十二指肠镜取出胆道支架并行ERCP了解胆管有无残余结石.结果:35例患者均1次取净胆总管结石,1例EST术中出血,34例成功行LC,1例中转开腹行胆囊切除术.术后并发急性胰腺炎2例,所有患者均无胆漏、十二指肠穿孔、黄疸等并发症.结论:腹腔镜联合十二指肠镜治疗胆囊结石合并胆总管结石具有疗效确切、创伤小、恢复快等优点.     

腹腔镜手术治疗急性胆源性胰腺炎的临床研究

目的 探讨应用腹腔镜技术治疗急性胆源性胰腺炎的可行性、安全性及疗效.方法 回顾性分析 2006年1月～2010年9月收治的急性胆源性胰腺炎42例患者,对26例有急性胆道梗阻者,24例行急诊腹腔镜胆囊切除术、胆总管切开取石T管引流、和(或)胰床清创引流术.术后予以腹腔灌洗.2例急诊鼻胆管引流(ENBD)后择期行腹腔镜胆囊切除术(LC);对16例无胆道梗阻或经36h保守治疗胆道梗阻缓解者,待胰腺炎控制后,在同一住院期间行腹腔镜手术.结果 急诊手术的24例患者中,20例胆总管探查有结石,4例探查阴性.延期手术18例中,6例合并胆总管结石者行腹腔镜胆总管切开取石T管引流术.12例胆囊结石行腹腔镜胆囊切除术(LC).42例均治愈.结论 腹腔镜手术治疗急性胆源性胰腺炎能减少对患者的创伤,减少并发症发 生率,疗效好,是一种合适的治疗方法.     

医生与护士社会地位的调查研究

目的 调查医生、护士对医护社会地位的认知情况及形成医护社会地位差异的影响因素.方法 采用自编的医生护士社会地位问卷对280名医生、290名护士进行调查.结果通过经济待遇、社会权益、职业声望三方面的调查,医生、护士均认为医生的社会地位高于护士的社会地位.医护社会地位差异的影响因素有医生所在医院、对专业技术的要求、工作成就感、工作稳定性;专业化程度、工作压力.结论深入研究医护社会地位问题及其形成的影响因素,有助于我们从对策上研究提高护士社会地位的方法,创建和谐的医护关系促进护理队伍的可持续发展.     

Urban Trauma Transport of Assaulted Patients Using Nonmedical Personnel

Objective: To describe one urban trauma transport system to clarify the impact of transport by nonmedical personnel on patient outcome.
Methods: Retrospective data were assembled over a six–year period through the use of the state trauma registry for an urban county served by seven state–accredited trauma centers. A subset of 4,767 consecutive assaulted patients was analyzed using the TRISS method to estimate survival probability. An unexpected death index (UDI), calculated as the difference between expected (TRISS method) and observed death rates, also was determined. Outcomes for patients transported by fire medics (FMs) vs nonmedical, police personnel (NPs) were compared.
Results: FMs transported 2,108 (44%) and NPs transported 1,356 (29%) of the injured assault victims. The FM–transported patients had a lower expected probability of survival than had the NP–trans–ported patients (p < 0.001). This also was true within the penetrating–injury subgroup (p < 0.001), but not the blunt–injury subgroup. The observed death rate was higher for all the FM–transported patients than it was for the NP–transported patients (15% vs 11%; p < 0.01). The UDIs were not different overall, although the NP–transported patients who had blunt trauma had a significantly lower UDI (p < 0.01).
Conclusions: NP transport of assaulted patients is generally associated with equivalent outcomes in comparison with FM transport in this urban environment. However, these data also provide evidence of an on–scene implicit triage with more severely injured patients generally transported by FMs.     

脊柱骨质增生症的康复治疗

应用离子导入法、超声波、脉冲中频电疗及牵引４种疗法，对４８例脊柱骨质增生患者进行同步、交叉综合治疗，平均治疗时间２５天。结果痊愈８例，显效２８例，好转１２例。作者尚对脊柱骨质增生病因及上述疗法的机理进行了讨论。     

Effect of sevoflurane on P50 and on measurement of oxygen tension

Fresh samples of heparinized human blood from 10 healthy nonsmoking volunteers were used to study the effect of the inhaled anesthetic sevoflurane on the oxygen half-saturation pressure of hemoglobin (P₅₀) and on polarographic measurements of oxygen tension at low values. Control samples had a baseline P₅₀ of 26.9±0.2 mm Hg. When the blood samples were exposed to 1.75% (1 minimum alveolar concentration, MAC), 2.75%, and 3.5% (2 MAC) of sevoflurane, the P₅₀ values were 27.0±0.5 mm Hg, 27.1±0.4 mm Hg, and 26.9±0.5 mm Hg, respectively. Our present data show that 1 to 2 MAC sevoflurane has no significant effect on P₅₀ (P>0.05). Our data also show that sevoflurane did not interfere with polarographic measurements of oxygen tension (P>0.05). Other inhaled agents—halothane, enflurane, and isoflurane—do interfere with these measurements, and we cannot explain the difference.Presented at the annual meeting of the American Society of Anesthesiologists, Atlanta, GA, October 1987.     

患者中心疗法对2型糖尿病患者心理行为的影响

目的 探讨患者中心疗法对糖尿病患者心理状况及行为的影响.方法 将60例糖尿病患者随机分为对照组(30例)和干预组(30例),对干预组进行患者中心疗法干预,干预前后用症状自评量表(SCL-90)和糖尿病患者行为评估表对两组患者心理状况和行为状态进行评定.结果 干预前两组患者在SCL-90量表各因子上得分的差异无统计学意义(P>0.05),干预后两组比较,躯体化、强迫、人际关系敏感、敌对、恐怖、偏执、精神病性等因子均统计学意义(P<0.01);干预后两组患者在不良饮食习惯纠正、戒酒、复查时间的掌握及在血糖控制、坚持运动锻炼、戒烟方面的差异有统计学意义(P<0.01),按时服用降精药物或注射胰岛素无统计学意义(P>0.05).结论 患者中心疗法对提高糖尿病患者的心理健康水平,增加其健康行为有积极的作用.     

逆转录病毒介导Fcy::Fur融合基因联合5-FC治疗胶质瘤的体内试验研究

目的构建含融合自杀基因Fcy::Fur重组逆转录病毒,用自杀基因治疗系统Fcy::Fur/5-氟胞嘧啶(5-FC)对裸鼠胶质瘤进行体内抑瘤作用的实验研究。方法扩增Fcy::Fur基因并构建Fcy::Fur基因重组逆转录病毒载体;载体转染包装细胞获得高滴度病毒并转染鼠胶质瘤细胞C6,筛选并鉴定阳性转基因克隆;构建裸鼠荷胶质瘤动物模型,腹腔注射5-FC,观察裸鼠肿瘤重量变化及电镜、流式细胞仪(FCM)检测肿瘤的凋亡。结果PCR法扩增出全长Fcy::Fur基因,经测序证实序列正确;构建了PLXSN-Fcy::Fur逆转录病毒载体,载体转染包装细胞PT67,获得滴度为3.5×106CFU/mL的逆转录病毒;转染C6获转基因阳性克隆C6-Fcy::Fur,检测C6-Fcy::Fur有Fcy::Fur基因的mRNA表达;裸鼠前肢背部接种转基因细胞,成瘤后腹腔注射5-FC,转基因肿瘤的生长较对照组明显抑制。FCM法检测到凋亡峰,电镜观察到转基因肿瘤细胞有凋亡小体。结论AdE1CMVCD与5-FC联合在体内对胶质瘤有明显的抑制作用,为临床胶质瘤基因治疗提供了可靠的理论及应用依据。     

Comparison of four methods of automated recording of physiologic data at one minute intervals

Introduction. This study aims to evaluate possible differences between the maximum, minimum, and mean value over each epoch, or the instantaneous value at the end of the interval, when recording physiological data at 1-minute intervals.Methods. The mean arterial pressure (MAP), heart rate derived from the radial pulse (PULSE), end-tidal CO₂ (etCO₂), and the arterial O₂ saturation by pulse oximeter (SpO₂) were measured continuously in 10 patients during general anesthesia. Anesthesia was induced and maintained using the same technique for the first 10 minutes. At 1-minute intervals for each parameter, the maximum, minimum, and mean value (over the preceding minute), as well as the instantaneous value at the end of the recording epoch, were automatically downloaded to an electronic spreadsheet. The differences between the maximum and minimum, the maximum and mean, the mean and minimum, and the instantaneous and mean values were calculated for each patient.Results. We found differences between the maximum and minimum values recorded over each interval, between the maximum and mean values, between the mean and minimum values, and between the mean and instantaneous values recorded at the end of each minute interval for all physiological parameters examined.Conclusions. From the data presented, we conclude that during the first 10 minutes of a general anesthetic, including anesthesia induction and endotracheal intubation, the values of physiologic parameters derived from different summary indices, namely the maximum, minimum, and mean values over the 1-minute interval or instantaneous at the end of the interval differ from each other. This source of error must be considered when designing systems for computerized recordkeeping of anesthesia charts and when interpreting the data stored in electronic databases.     

Warning devices for prevention of dental injury during laryngoscopy. Preliminary report

The prototypes of two novel warning devices for protection against dental trauma during direct laryngoscopy are described. Either can be attached to a standard laryngoscope blade (e.g., Macintosh). The basic design is that of as witch that is closed by pressure on the maxillary incisors by the laryngoscope blade. This revised version was published online in July 2006 with corrections to the Cover Date.     

Automated charting of physiological variables in anesthesia: A quantitative comparison of automated versus handwritten anesthesia records

Eight physiological variables—tidal volume, breathing rate, end-tidal carbon dioxide fraction, oxygen fraction in the anesthetic circuit, oxygen saturation by pulse oximetry, systolic and diastolic blood pressure, and heart rate—recorded on-line by a commercially available automated system were compared with the same variables recorded on handwritten anesthesia records. We quantified the differences between the automated and handwritten records generated from the same 30 patients (2,412 minutes of general anesthesia for elective eye surgical procedures). Considering the design of the study, we claim that the differences between both records were caused by the incompleteness or inaccuracy of the handwirtten records, except in two instances. The amounts of missing or erroneous data for these eight physiological variables were expressed as fraction (error fractions) of the time being recorded, designated EF_m and EF_e, respectively. For the first five variables the EF_m on the handwritten records ranged between 0.23 and 0.31, and the EF_c ranged between 0.01 and 0.06. For the last three variables the EF_m range was 0.08 to 0.13, and the EF_e range was 0.05 to 0.11. Most of these missing or erroneous data occurred during the period of induction (first 15 minutes) and at the end of the case (last 10 minutes). The EF_m and EF_e during induction had increased to 0.62 and 0.26, respectively, and to 0.76 and 0.06, respectively, at the end of the case. Erroneous data were observed on the automated records for the tidal volume during induction (EF_e=0.0044) and for the oxygen fraction during maintenance (EF_e=0.0024). The effect of averaging by the recordkeeper is discussed. The results of this study indicate the clinical relevance of automated record keeping.     

脓毒症患者氧利用率的变化与预后关系

目的:探讨脓毒症患者氧利用率(O2UC)的变化与预后关系。方法:60例危重病患者分为脓毒症组30例和非脓毒症组30例;另设30例正常人作为正常对照组。脓毒症组和非脓毒症组患者于急诊入院时及住院后1、2、3、5、7和10 d晨8时抽取股动脉和股静脉或锁骨下静脉血2 m l,查血气并计算O2UC。正常对照组仅查动、静脉血气1次,并计算O2UC(为动静脉血氧饱和度差/动脉血氧饱和度)。结果:患者急诊入院时和住院后1 d,脓毒症组和非脓毒症组O2UC均显著高于正常对照组(P均<0.01),而脓毒症组和非脓毒症组间差异无显著性(P>0.05)。当O2UC持续高于55%达12~24 h,患者预后极差,易于短期内死亡。从住院后2 d起,脓毒症组和非脓毒症组O2UC均很快下降,并低于正常对照组,且脓毒症组较非脓毒症组下降更加明显(P均<0.05)。非脓毒症组于住院后5 d起O2UC逐渐回升,并恢复至正常。而脓毒症组患者于住院后2 d起O2UC始终明显低于正常对照组(P均<0.01)。当O2UC持续低于21%时,提示合并症较多,预后不佳。结论:脓毒症患者常存在较低的O2UC,且病情严重、预后差。O2UC可作为脓毒症患者判断组织缺氧、病情严重程度和评估预后的有效指标。