上睑下垂手术治疗的麻醉选择

上睑下垂是临床常见的先天性遗传性疾病.治疗年龄在 4～ 5岁以后为佳.为了达到满意的手术效果,术者希望在术中患者能随时听从睁眼指令,因此对麻醉配合提出了一定的要求.本院在 2000年 6月后对 180例双侧上睑下垂病人进行额肌瓣丝线悬吊术,按患者合作与否选择不同麻醉配合方法,报道如下.     

上睑下垂手术治疗现状

上睑下垂矫正手术的根本目是既要达到扩大视野，防止弱视的生理要求，叉要达到美容。本文从提上睑肌缩短、将眼睑与额肌相连悬吊、肌瓣移植、额肌瓣悬吊术等手术方式进行综述。     

硅胶悬吊术矫正先天性上睑下垂的手术配合

先天性上睑下垂是一种常见的疾病,我院采用硅胶条带作吊物,对126例（158眼,先天性上睑下垂应用硅胶悬吊术进行治疗,结果,116例142眼上睑下垂完全矫正,两眼睑裂高度相差小于等于1cm者118例,占93．65％,余病例也得到不同程度矫正,效果满意,手术中护士全方位配合给手术成功创造了必要的条件。     

探究上睑联合筋膜鞘悬吊术治疗儿童重度上睑下垂的疗效

目的 探究上睑联合筋膜鞘(CFS)悬吊术治疗儿童重度上睑下垂的临床效果.方法 选取2017年10月～2019年3月我院收治的98例儿童重度上睑下垂患者,根据治疗方案不同分为研究组和常规组,每组49例.研究组采用CFS悬吊术治疗,常规组采用上睑提肌缩短术治疗.对比两组治疗效果、并发症发生率、患儿家属对矫正效果满意度、手术...     

儿童重度先天性上睑下垂手术治疗探讨

目的 探讨儿童先天性重度上睑下垂的两种手术治疗方法效果。方法采用提上睑肌缩短术治疗先天性重度上睑下垂53眼,改良额肌瓣悬吊术治疗60眼,并术后随访,效果进行总结分析。结果矫正108眼,其中改良额肌瓣悬吊术50眼,改良提上睑肌缩短术58眼。过矫1眼,低矫4眼。所有病例术后2～6个月的随访,术后效果良好,上睑下垂得到矫正,患眼形态弧度自然。结论 提上睑肌缩短术及改良额肌瓣悬吊术手术操作相对容易,临床效果确切,是治疗儿童先天性重度上睑下垂有效方法。     

改良式额肌腱膜瓣悬吊术治疗先天性上睑下垂

先天性上睑下垂可影响儿童视功能的发育，其弱视发病率高。因此，手术矫正上睑不垂其意义不仅是改善外观，术后配合弱视治疗．有助于患儿最终获得视觉的功能治愈。我们自1997年开始，采用改良式额肌腱膜瓣悬吊术治疗重度先天上睑下垂，共23例（28眼)，疗效满意．现报告如下。     

提上睑肌折叠术治疗先天性上睑下垂疗效观察

34例(44只眼)先天性上睑下垂患者经睑缘皮肤切口,在眼轮匝肌与提上睑肌之间钝性分离,尽可能向上暴露上睑提肌,以1/0丝线将提上睑肌缝合于睑板中上1/3或睑板中部,共三针。结果术后矫正满意37眼(84.09%),较好7眼(15.91%),近期无效1眼(2.27%)。未发生伤口感染、眼眶血肿、泪腺下垂及暴露性角膜溃疡等严重并发症。提上睑肌折叠术治疗先天性上睑下垂,方法简便、安全,效果较好。     

Deep learning-based image analysis for automated measurement of eyelid morphology before and after blepharoptosis surgery

Background and aimEyelid position and contour abnormality could lead to various diseases, such as blepharoptosis, which is a common eyelid disease. Accurate assessment of eyelid morphology is important in the management of blepharoptosis. We aimed to proposed a novel deep learning-based image analysis to automatically measure eyelid morphological properties before and after blepharoptosis surgery.MethodsThis study included 135 ptotic eyes of 103 patients who underwent blepharoptosis surgery. Facial photographs were taken preoperatively and postoperatively. Margin reflex distance (MRD) 1 and 2 of the operated eyes were manually measured by a senior surgeon. Multiple eyelid morphological parameters, such as MRD1, MRD2, upper eyelid length and corneal area, were automatically measured by our deep learning-based image analysis. Agreement between manual and automated measurements, as well as two repeated automated measurements of MRDs were analysed. Preoperative and postoperative eyelid morphological parameters were compared. Postoperative eyelid contour symmetry was evaluated using multiple mid-pupil lid distances (MPLDs).ResultsThe intraclass correlation coefficients (ICCs) between manual and automated measurements of MRDs ranged from 0.934 to 0.971 (p < .001), and the bias ranged from 0.09 mm to 0.15 mm. The ICCs between two repeated automated measurements were up to 0.999 (p < .001), and the bias was no more than 0.002 mm. After surgery, MRD1 increased significantly from 0.31 ± 1.17 mm to 2.89 ± 1.06 mm, upper eyelid length from 19.94 ± 3.61 mm to 21.40 ± 2.40 mm, and corneal area from 52.72 ± 15.97 mm² to 76.31 ± 11.31mm² (all p < .001). Postoperative binocular MPLDs at different angles (from 0° to 180°) showed no significant differences in the patients.ConclusionThis technique had high accuracy and repeatability for automatically measuring eyelid morphology, which allows objective assessment of blepharoptosis surgical outcomes. Using only patients’ photographs, this technique has great potential in diagnosis and management of other eyelid-related diseases.     

小儿前纵隔肿瘤的外科治疗

目的 分析总结小儿前纵隔肿瘤的临床特点及与外科治疗的有关问题。方法 回顾分析外科治疗小儿前纵隔肿瘤36例的临床资料。结果 肿瘤全部切除30例，部分切除4例，未切除2例。肺楔形切除1例，部分心包切除3例，术中损伤血管6例，全部成功修补。结论 小儿前纵隔肿瘤切口的选择应根据肿瘤的大小、位置及类型而定，术中要注意防止大血管的损伤。     

Hyperamylasemia after cardiac surgery in infants and children

Objective This study was conducted to clarify the incidence of hyperamylasemia after cardiac surgery in infants and children.Design and patients 186 infants and children operated on at Children's Hospital, Helsinki, during an 11-month period were enrolled in the study.Serum samples were taken before and on 3 consecutive days after cardiac surgery at the intensive care unit and before discharge from the hospital.Measurements We measured serum total amylase and serum pancreatic amylase with two different assays: (1) reduction of salivary amylase from total amylase activity and (2) measurement of mass concentration with monoclonal antibodies.Results Preoperative values for both total amylase and pancreatic isoenzymes were strongly agerelated. At least one of the three tests showed postoperative hyperamylasemia (>+2 SD above starting values of the age group and maximal value >3 times the individual starting value) in 64/186 (34%) patients. 22/186 (12%) patients had abnormal results in all assays. A more than tenfold rise in pancreatic amylase, suggesting pancreatitis, was found in 14 patients (8%).Mortality was 21% in this subgroup, but 5% in the rest of the patients. Hyperamylasemia was more common after 1 year of age, and after open-heart surgery, especially homograft implantation or cardiac transplantation.Conclusions Hyperamylasemia is a common finding after cardiac surgery in pediatric patients. Amylase isoenzyme measurements are needed for clinical decision making. Age-group-related reference values are mandatory for the right interpretation of amylase values.This work done at Children's Hospital, Helsinki, Finland     

儿童择期手术术前禁食、禁饮方案的对比研究

目的:探讨儿童术前的最佳禁食方案,以减少长时间禁食带来的不良后果。方法:将64例择期手术的患儿随机分成对照组和实验组,对照组术前禁食12 h,禁水4 h,实验组术前禁食8 h,手术前2 h在专业护士指导下饮水100 m。l观察两组患者口渴、饥饿感、焦虑、疲乏无力程度、术中呕吐及误吸的情况,两组胃液和pH值的变化,血糖和胰岛素水平,并进行统计学分析。结果:两组患者口渴、饥饿感、焦虑、疲乏无力程度,实验组发生率低于对照组,两组比较差异有显著性(P<0.05);两组患儿术中呕吐及误吸、胃液和pH值比较,无统计学意义(P>0.05);两组血糖和胰岛素水平,两组比较差异有显著性(P<0.001)。结论:儿童择期手术在术前8 h禁食固体食物,术前2 h口服100 m l清水,能增加患儿舒适感,改善患儿的健康状况,缩短术后恢复时间,安全可行。     

The use of balloon-tipped pulmonary artery catheters in children undergoing cardiac surgery

Percutaneous pulmonary artery (PA) catheterization via the internal jugular vein was studied in 58 children undergoing cardiac surgery. Central venous cannulation, which succeeded in all children, was associated with a 10% incidence of inadvertent carotid artery puncture without untoward effects. Successful placement of the PA catheter was achieved in 47 (92%) of the 51 children in whom it was anatomically possible to enter the pulmonary artery at the time of the catheterization. Four (8%) catheter tip cultures were positive. The PA catheter yielded important information in diagnosing low cardiac output, severe pulmonary hypertension or residual cardiac defects in 27 (47%) children. Twenty (35%) children had critical therapeutic interventions because of the PA catheter information. The high yield of important data and the low incidence of major complications seem to justify the use of percutaneously inserted PA catheters in children with an increased operative risk.     

神经外科患儿全麻插管术后的护理

目的：研究患儿于全麻清醒期间及气管插管拔管前后的护理。方法：在１５６例患儿全麻插管术后护理过程中,观察全麻清醒前后的病情变化,加强呼吸道护理,有预见性地采取护理措施,结果：术后全麻清醒的手术室刷麻醉师拔除气管导管９例,回病刻由护士拔管１４６例,患儿自行拔出１例,平均拔管时间３．３ｈ。结论：应针对患儿的特点,密切观察术后和意识的恢复情况;加强呼吸道护理,保持呼吸道通畅;观察呼吸频率、节律;做好拔管的     

Effectiveness and appropriateness of therapeutic play intervention in preparing children for surgery: a randomized controlled trial study.

PURPOSE: This paper aims to examine the effectiveness and appropriateness of using therapeutic play in preparing children for surgery. DESIGN/METHOD: A randomized controlled trial was employed. Children (7-12 years of age; n = 203) admitted for surgery during a 13-month period were recruited. RESULTS: The results support the effectiveness and appropriateness of using therapeutic play in preparing children for surgery. PRACTICE IMPLICATIONS: The study results promote awareness in nurses and parents that play is a very important part of children's lives, and heighten the importance of integrating therapeutic play as an essential component of holistic and quality nursing care to prepare children for surgery.     

冠状动脉造影致室颤一例的启示

为探讨新生儿剪脐的适当时机,我们观察了１１６ 例新生儿的脐部处理,随机分为潮湿组、干燥组和过干组,分别观察各组剪脐时和剪脐后的出血率、局部分泌物情况和细菌培养以及剪脐前脐带干湿度与出生后时间的关系。结果表明：干燥组剪脐时和剪脐后出血率显著低于其他组,剪脐后局部干燥率高,细菌培养致病菌阳性率低,脐部愈合时间较短。新生儿出生后２８ ～３３ｈ ,脐带处于干燥状态的机会最大（ 占观察例数的７２ ．４１ ％ ） ,显著高于其他时间段。因此我们认为剪脐最合适的时机应以脐带干燥为准,而不能单纯以时间为准。如果从时间安排的角度来看,在新生儿出生后２８ ～３３ｈ ,大部分脐带属于干燥,此时大部分新生儿可以剪脐。     

Serum levels of gastric-acid-stimulating factors in children undergoing open heart surgery

Purpose  Upper gastrointestinal (GI) bleeding is a feared consequence of open heart surgery in children. Increased gastric acid secretion is a known key factor in the pathogenesis of gastritis and upper intestinal ulcerations. The aim of this study is to evaluate the serum kinetics of acid-stimulating factors and associated perioperative parameters after heart surgery in children. Methods  Fifteen pediatric patients after open heart surgery and 15 children with cardiac catheterization were included in this study. Serum levels of gastrin, histidine, alanine, and tryptophan were analyzed before and up to 26 h after surgery. Results  In the postoperative period there was a significant elevation of gastrin with a peak at 4 h after surgery. Serum histidine was increased significantly immediately after surgery only in patients undergoing heart surgery with cardioplegia. No association of gastrin and histidine elevation with ischemia, perfusion time or lactate was observed. Conclusion  Factors that are responsible for postoperative gastrin elevation still have to be determined. Circumstances of extracorporeal circulation (ECC) in low-risk patients most likely do not lead to relevant elevation of amino acids with acid-stimulatory effect in our study population.     

自制降温毯在小儿心脏术后应用的效果

目的观察心脏术后高热患儿使用自制降温毯的临床效果。方法选择心脏术后高热（肛温I〉39．5℃）患儿80例,按照随机数字表法随机分成对照组（n=40）和试验组（n=40）。试验组采用自制降温毯进行物理降温,对照组采用传统冰袋在头部、腋下等部位进行物理降温,比较采取降温措施后1,4,8h两组患儿的体温及心率。结果与降温前比较,试验组患者在1,4,8h后体温分别为（39．03±0．34）、（38．504-0．39）、（37．99±0．45）℃,对照组分别为（39．50±0．37）、（39．13±0．80）、（38．87±0．75）℃,两组比较差异有统计学意义（t分别为5．75,4．42,6．33;P均〈0．05）。试验组患者在1,4,8h心率均有所降低,与对照组比较在1h时差异无统计学意义,在4,8h时差异有统计学意义（t分别为2．58,3．69;P均〈0．05）。试验组患者在降温8h后体温降低幅度大于1h和4h,也大于对照组相应时段。结论应用自制降温毯降温效果优于采用传统冰袋降温,尤其是远期降温效果明显,有利于心脏术后患儿顺利康复。