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完全离断指断指再植术后观察及护理 总被引:1,自引:0,他引:1
目的总结完全离断指再植患者术后护理经验,提高断指再植的成活率。方法对100例(127指)断指再植患者进行术后的护理和观察。结果手术100例(127指),直接成活93例(118指),另外7例9指因受伤严重、疼痛、情绪悲观焦虑,术后发生血管危象,经抢救成活5例(6指),坏死清创2例(3指)。结论合理、有效的断指再植术后护理和观察对提高断指再植手术成功率是一个重要保障。 相似文献
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目的探讨断指再植患者的心理特点及护理对策。方法对20例断指再植围手术期患者心理特点进行总结、分析,并采取行之有效的护理措施。结果通过围手术期的心理护理,减轻了患者的紧张、恐惧心理,提高了手术的成功率及恢复效果。结论在做好基础护理的同时进行有效的心理护理对患者的康复有促进作用,而高度的责任心和深切的同情心是做好心理护理的关键。 相似文献
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目的:探讨精神分裂患者断指再植的急救措施和护理方法。方法:对5例断指再植合并精神分裂的患者进行急救,密切观察再植指体的血运情况,给予患者人性化护理。结果:5例断指再植合并精神分裂的患者术后再植指体基本存活,精神分裂症状得到控制。结论:及时准确全面的整体护理,是患者获得康复的必要条件。 相似文献
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目的 探讨铡草机所致不同类型断指的手术方法 和疗效.方法 单手指再植,应用传统方法 再植;多指、多节段再植应根据伤情、人员组成、再植的顺序等方面进行合理的规划后有序的进行再植;无再植条件的指体则进行残修、皮瓣修复或足趾再造.结果 36例患者离断79指、再植69指、成活63指,成活率91.3%.术后随访3月~2年,按中华医学会手外科分会断指再植功能评定试用标准评定:优44,良10,可6,差3,优良率85.7%.结论 铡草机所致的不同断指经严格掌握再植适应症、周密的手术计划与术中精细操作、术后精心护理和早期功能锻炼,再植指体存活率高,外观及功能良好. 相似文献
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The replantation of large limb segments presents two major problems: first, a general danger to survival because of major accompanying injuries and additional ischemia-reperfusion injury; second, local soft-tissue damage at the amputation site. Successful replantation can be compromised by infection, vessel thrombosis, and disturbed bone healing. Possible risk reduction may be accomplished by the concept of a two-staged replantation. A brief primary emergency procedure involving bone resection, osteosynthesis, and revascularization (with the goal of limb survival) is followed by a second procedure within 72 hr after trauma, for final debridement, completing the osteosynthesis, nerve and tendon suturing, and soft-tissue coverage by free flaps. The advantages of the double procedure are demonstrated in 27 patients by comparison of two treatment groups. Group I comprised 15 patients with definitive primary care. In Group 2 (n = 12), the two-stage operation was performed. The second group showed a shorter duration of overall treatment, reduction of blood loss, and fewer infections. 相似文献
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目的:探讨显微外科技术治疗断掌再植的方法及临床疗效。方法:自2009年1月至2012年12月,采用显微外科技术急诊行断掌再植术治疗断掌患者45例,其中男37例,女8例;年龄13~45岁,平均25岁。术后采用存活率、中华医学会手外科学会上肢断肢再植功能评定试用标准对断掌再植功能恢复以及临床疗效进行评价。结果:通过再植手术治疗断掌患者45例,共成活39例共121指,成活率为87%;45例患者均获随访,时间3~15.5个月,平均11.5个月。中华医学会手外科学会上肢断肢再植功能评定试用标准总分80.27±1.93,其中优27例,良8例,差4例。结论:严谨把握断掌再植手术的适应证,掌握断掌复杂性的特点以及局部解剖关系,术中做到清创彻底,残存组织利用充分,并结合显微外科技术尽快、最大程度地吻合动静脉,重建血液循环并使损伤的神经得到合理的修复是断掌再植成功的关键。 相似文献
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An experimental study to define the usefulness of heparin in microvascular surgery was undertaken. Fifty-four rabbits underwent replantation of an amputated ear. The animals were randomly divided into two groups--"heparin" and "no heparin," with 27 animals in each group. Arterial patency was recorded based on direct microscopic observation of the anastomosed vessels prior to wound closure and on subsequent viability or necrosis of the ear during the surgical procedure was markedly enhanced by the use of intraoperative heparinization. The overall patency rate for the heparin group was 74%, whereas that of the no-heparin group was 44%--a statistically significant difference. This study confirms the value of intraoperative heparin in experimental replantation surgery using a rabbit ear model. 相似文献
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能量设备的持续性发展,为普通外科微创手术的实施提供了强大的技术保障,各种能量设备应用于临床,使手术步骤简化、手术范围增大、精细度增高,给手术医生带来了前所未有的机会和挑战。使用能量设备可以减少术中出血、降低周围组织副损伤并缩短手术时间。为保证患者的手术安全,防止手术过程中因能量设备发生故障而延长手术时间,减少医疗纠纷,必须保证能量设备的正常使用,因此必须在归档管理、人员管理、安全管理、维护管理四个方面规范能量设备的维护与管理至关重要。 相似文献
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Y Clouatre P Cartier R Charbonneau C Déziel M Allard F Madore 《Nephrology, dialysis, transplantation》2000,15(2):231-234
BACKGROUND: Partial replantation (i.e. replacement of the extraperitoneal portion of the catheter with creation of a new subcutaneous tunnel) has been suggested to avoid catheter removal in patients with persistent exit-site/tunnel infection (ESTI). However, published experience with this technique is limited. METHODS: Partial replantation was performed on an outpatient basis under local anesthesia for seven patients with persistent ESTI of >3 months duration. All patients resumed CAPD immediately following surgery. RESULTS: One patient had dialysate leakage less than 1 week after surgery that required catheter removal. The other patients had no complications and mean catheter survival following surgery was 7. 7 months (range 3.5-13 months). There was no recurrence of ESTI after surgery, although two patients presented with exit-site infection unrelated to the initial episode (i.e. different organism, long latency). Three other patients presented with episodes of peritonitis unrelated to surgery (i.e. delay >1 month) or ESTI (i.e. different organism). CONCLUSIONS: Partial replantation allows significant prolongation of catheter survival without major complications or interruption of CAPD. This novel procedure appears to be an appropriate alternative to catheter removal for the management of persistent ESTI. However, further studies are needed to prospectively compare partial replantation with catheter removal. 相似文献
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断指再植术发生血管危象的原因分析及防治措施 总被引:4,自引:1,他引:3
目的 探讨断指再植术发生血管危象的原因及预防和处理方法,提高再植的成活率.方法 观察不同时间、不同环境条件下进行再植98例132指发生血管危象情况,回顾分析其原因并针对性提出有效的预防措施和处理方法.结果 2006年3月至2007年6月再植49例65指,术中及术后发生血管危象分别为35指和19指,经用温生理盐水、局部注射罂粟碱等保守处理,对不缓解的再植指手术探查,成活58指,成功率89.2%.2007年7月至2009年3月再植49例67指,术中及术后发生血管危象分别为10指和5指,先经保守处理,对不缓解的再植指手术探查,血运恢复后经屈指肌腱鞘植入PCA泵给药防止术后血管危象的发生,成活66指,成功率98.5%.术后9例失访,89例随访时间为6~8个月.手指功能恢复良好.结论 良好充分的麻醉和保持适宜的术中环境温度是预防断指再植术发生血管危象的有效手段,重视血管危象的预防和处理可有效提高再植成活率. 相似文献
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为观察保肛手术治疗低位直肠癌的疗效及患者术后生活质量,回顾性分析行保肛手术与传统Miles术治疗的低位直肠癌患者的临床资料,其中行保肛手术46例(保肛组),行传统Miles术14例(Miles组),观察两组患者平均手术时间、术中出血量等指标;术后随访36个月,观察患者术后生存率、复发率和生活质量评分。结果显示,两组患者在平均手术时间、术中出血量、术后复发率和生存率等方面差异无统计学意义(P〉0.05),但保肛组在生活质量方面显著高于Miles组(P〈0.05)。结果表明,在严格掌握手术适应症的前提下,治疗低位直肠癌行保肛手术可行。 相似文献
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目的探讨仅掌侧皮肤相连的多指离断伤的再植方法和疗效。方法对2006年5月-2012年6月收治的10例40指仅掌侧皮肤相连的多指不完全性离断伤患者采用变更再植操作次序的方法进行断指再植术。结果术后40指均成活,成活率100%。随访1-5年,手指优良40指,优良率100%。结论采用变更再植操作次序的再植方法治疗仅掌侧皮肤相连的多指不完全性离断伤,保留了相连的掌侧皮肤,促进断指静脉回流,缩短了手术时间,提高了断指成活率,疗效满意,是治疗仅掌侧皮肤相连的多指不完全性离断伤的好方法。 相似文献