小儿手术前后智能情况观察

对11例播散性组织胞浆菌病患者采用二性霉素B抗真菌及支持治疗和护理。结果住院15～60d,均临床治 愈出院。提出主要针对发热,肝脾肿大,血细胞减少,口腔、消化道症状进行对症护理,预防及处理二性霉素B等药 物不良反应,防止交叉感染,同时做好营养指导、健康教育及心理护理。     

小儿心内直视手术前后肺表面活性物质的变化及临床意义

体外循环心内直视手术后肺部并发症的发生率较高,尤其是左向右分流伴有肺动脉高压的病儿,心内畸形纠治后肺不张、肺水肿甚至呼吸窘迫综合症临床常见,已经肯定肺表面活性物质(PS)在维持正常的呼吸功能方面有极其重要的作用。为了解先天性心脏病小儿心内直视手术前后肺表面活性物质的变化及其与肺泡死腔的关系,本文研究测定围体外循环期PS的变化并探讨其与动脉一呼气末二氧化碳分压差(Pa—ETCO_2)的关系。资料与方法全组46例,男26例,女20例。根据疾病种     

小儿心脏手术中脑监测

本文分析经颅多谱勒超声（ＴＣＤ）在小儿心脏手术中监测意义，ＴＣＤ结合前囱压力测定来判断脑血流、脑血流速度和脑灌注压，能对心脏手术后脑损伤程度进行评估和预测术后神经精神状态。但深低温低流量或停循环期ＴＣＤ重复性较差。ＴＣＤ还可探测脑血管内栓子。     

小儿肠套叠手术的麻醉处理

我院从1977年以来共施行急性小儿肠套叠手术45例。临床资料本组45例,男32例,女13例,年龄3个月至6岁,其中2岁以下40例,占88.8％。45例均有不同程度的脱水酸中毒,其中18例伴有不同程度的感染性休克(40％),休克病例中均伴有不同程度的呼吸困难。28例行肠套叠单纯复位,17例因伴肠坏死而行肠切除术。     

部位麻醉辅以氯胺酮用于小儿四肢手术的麻醉观察

我们对 12 0例小儿四肢手术采用部位麻醉辅以氯胺酮麻醉取得了满意效果 ,现报告如下。临床资料一、一般资料　 12 0例 ASA ～ 级四肢手术的患儿 ,男 70例 ,女 5 0例 ,年龄 5～ 10岁 ,体重 16～ 30 kg。本组患儿均无镇静药服用 ,无循环系病史 ,无肝肾功能损害 ,无精神病 ,癫痫病史。手术时间 30～ 15 0 min。二、方法　本组患儿术前 6 h禁食 ,4 h禁水 ,术前 30 min常规肌肉注射安定 0 .2 m g/ kg,阿托品 0 .0 1m g/ kg。入手术室开放静脉通道 ,对于上肢手术采用臂丛麻醉 ,下肢手术视术程长短用连续硬膜外或腰麻等部位麻醉 ,麻醉生效后以…     

小儿肝胆手术麻醉处理65例

小儿肝胆手术麻醉处理６５例周淑文小儿肝胆疾病中先天性胆道系统发育异常较多见，新生儿或婴幼儿期表现为阻塞性黄疸。胆道不完全性梗阻或炎症所致的黄疸则多见于较大儿童。肝脏肿瘤或肝与脐膨出部紧连需行肝部分或肝叶切除者亦不少见。我院自１９８７年７月至１９９４年...     

微型腹腔镜小儿疝手术8例

20 0 1年 10月至 2 0 0 2年 5月 ,我们用 5ｍｍ微型腹腔镜治疗小儿斜疝 8例。患儿均为男性 ,2 2个月～ 13岁 ,其中嵌顿疝急诊手术 1例 ,术中发现对侧隐性疝 1例 ,均痊愈 ,3～ 4ｄ出院 ,平均手术时间 2 0ｍｉｎ。本组患儿均为氯胺酮全麻 ,术中头低位 ,先在脐孔上缘切开 5ｍｍ切口 ,建立气腹 ,设定压力为1 33ｋＰａ ,置入 5ｍｍ腹腔镜找到斜疝内环口 ,再于脐左旁 3～4ｃｍ处切一 5ｍｍ切口置入分离钳 ,于内环口体表投影处切开一长 2 0ｍｍ戳孔 ,术者左手持带 8号线似雪橇样钝头针刺入戳孔处 ,缝合内环口内半周侧 ,右手用分离钳夹住 8号线留于…     

Body Composition Before and After Heart or Lung Transplantation: Preliminary Results

Little is known about the importance of changes in body composition of patients before and after heart or lung transplantation. Reduced muscle mass may be a poor prognostic factor for death and morbidity in patients after orthotopic heart transplantation. Only a few studies have shown data on changes in the amount of adipose tissue and muscle tissue and their impact on patient prognosis. Therefore, more data is needed concerning this issue.The aim of this study was to assess the body composition of patients before and after heart or lung transplantation using bioimpedance.Forty-two patients have been recruited to the study, including 20 patients before organ transplant, 11 patients after heart transplant, and 11 patients after lung transplant (up to 24 months after organ transplantation). The mean age of patients enrolled in the study before and after organ transplantation was 52.05 ± 16.24 years and 50.77 ± 13.38 years, respectively. Body composition measurements were performed by bioimpedance using the SECA mBCA 515 - medical Body Composition Analyzer.In summary, we have shown that body composition was significantly changed after heart and lung transplantation, such as in muscle mass value and fat-free mass value. Adequate intervention at these points might reduce the risk of short and long-term mortality and morbidity.     

漏斗胸患儿手术前后心功能测定及其意义

目的　探讨漏斗胸患儿手术前后心脏功能的变化。　方法　用超声心动图测定４１ 例漏斗胸患儿术前、术后的心脏功能,并选择年龄、性别、身高、体重相同的正常儿童４１ 例作对照。　结果　病例组患儿术前射血分数与平均左心室周径向心缩短率与对照组相比有所降低（ Ｐ＜ ０－０１） ;术后３ 个月复查时其每搏输出量增加;长期随访（ 平均４－７年） 发现患儿术后射血分数、平均左心室周径向心缩短率与每搏输出量较术前有所上升（ Ｐ＜ ０－０１） ,而且这些指标与对照组相比差异无显著性（ Ｐ＞ ０－０５） 。　结论　漏斗胸患儿术前心脏功能有损害,术后心功能可逐步恢复正常。     

普外科患者手术前后焦虑抑郁症状及其相关性研究

目的探讨手术与焦虑、抑郁之间的联系,以及焦虑和抑郁的关联状况。方法手术前后1d及术后3d应用焦虑自评量表(SAS)和抑郁自评量表(SDS)对患者进行评估。结果手术前后患者的焦虑和抑郁水平均高于常模,手术前后焦虑和抑郁发生率及其程度比较,差异无显著性意义(均P>0.05),而焦虑和抑郁呈中等相关(r=0.66,P<0.01)。结论焦虑和抑郁症状不因手术结束而减弱或消失,应及时提供心理干预,尤其注重焦虑和抑郁两者并存患者的干预。     

Eating Patterns in Morbidly Obese Patients Before and After a Gastric Restrictive Operation

Background: The present study was set up to analyze the relationships between eating patterns in morbidly obese patients who had undergone an adjustable silicone gastric banding (ASGB) followed for at least 2 years and morbidly obese patients without a gastric restrictive procedure. Methods: Eating pattern was monitored by using the Dutch Eating Behavior Questionnaire in 99 morbidly obese patients (BMI ≥ 35 kg/m²) preoperatively and in 31 patients who had undergone a stomach reduction by the Lap-Band? followed at least 2 years. Both groups were compared to the Dutch normative scores. Results: In the preoperative group, the scores on emotional eating and external eating were significantly higher than the Dutch normative scores. The scores on restrained eating were preoperatively equal to the Dutch normative scores. Although not significant, the scores in the postoperative group on external eating were lower than the Dutch normative scores and equal on emotional eating. The variable restrained eating postoperatively was significantly higher compared with the preoperative group. On emotional and external eating, the scores postoperatively were significantly lower compared with the preoperative group. Conclusions: According to the results, surgical treatment using an ASGB or another gastric restrictive operation could be the right solution in patients with an emotional and external eating behavior. Placement of the ASGB has a negative effect on restrained eating behavior.     

男性甲亢患者治疗前后血清性激素水平观察

目的:探讨男性甲亢患者治疗前后血清性激素水平的变化及其临床意义。方法:采用化学发光免疫法测定68例男性甲亢患者治疗前后血清卵泡刺激素(FSH)、黄体生成素(LH)、睾酮(T)和雌二醇(E2)的水平,并与对照组比较,进行统计学分析。结果:男性甲亢患者治疗前血清T和E2的水平明显高于对照组,差异有显著性(P<0.05);FSH、LH的水平与对照组相比差异无显著性(P>0.05)。男性甲亢患者治疗后血清FSH、LH、T和E2的水平与对照组相比差异无显著性(P>0.05)。结论:男性甲亢患者存在性激素代谢紊乱;患者血清T和E2水平的增高是机体为了适应高代谢环境,下丘脑-垂体-性腺轴所产生的适应性变化;随着甲亢得到控制,其水平恢复正常。     

妇科手术病人麻醉前后留置导尿对比观察

将硬膜外麻醉下妇科手术病人100例随机分为对照组和观察组,各50例.对照组在入手术室后麻醉前留置导尿,观察组在麻醉平面出现后留置导尿,监测两组病人留置导尿前后心率、血压,观察导尿时病人反应.结果观察组留置导尿前后心率、血压比较,差异无显著性意义(均P＞0.05);对照组留置导尿前后心率、血压比较,差异有显著性意义(均P＜0.01).对照组不适反应明显高于观察组(P＜0.05).提示麻醉后留置导尿可明显减轻妇科手术病人的应激反应.     

食管癌病人手术前后焦虑状态调查及护理对策

探讨食管癌手术病人焦虑状态的严重程度和特点,为心理评估和心理护理提供依据。用Zung氏焦虑自评量表（SAS）对90例食管癌手术病人焦虑状态进行测评,结果焦虑是食管癌手术病人主要的心理反应,且手术前、后焦虑检出率亦不同,术前显著高于术后（P＜0．05）;不同年龄、文化程度的病人焦虑状态不同,＜50岁中年人、文化程度高者其焦虑严重。提示食管癌手术病人心理健康状态较差,手术前、后的心理咨询和心理治疗必不可少;建立良好的护患关系、争取家属的配合及手术前、后的护理教育、音乐治疗对缓解病人焦虑症状有积极作用。     

Women Demonstrate More Pain and Worse Function Before THA but Comparable Results 12 Months After Surgery

Background

Many studies report differences in patient-reported outcome measures (PROMs) for men and women undergoing total hip arthroplasty (THA). Few studies have evaluated whether these are explained by corresponding differences in important preoperative factors.

Questions/purposes

(1) Are there differences between men and women in PROM scores preoperatively and 12 months after THA? (2) Do baseline differences in comorbidity, age, body mass index (BMI), and mental health status explain these differences in PROM scores?

Methods

Preoperatively, 300 patients completed the Oxford Hip Score (OHS), WOMAC, and SF-12; 261 (86%) of them (129 women, 64 ± 11 years; 132 men, 66 ± 10 years) completed the same questionnaires 12 months postoperatively and also rated the acceptability of their current symptoms and change in general health.

Results

Preoperatively, women showed worse scores than men in the OHS (−1.9; 95% confidence interval, −3.6 to −0.3) and WOMAC (−6.3; −10.9 to −1.7). At 12 months postoperatively, the absolute scores for all PROMs were not significantly different. After controlling for BMI, age, comorbidity, SF-12 mental health scores, and sociodemographic characteristics, the baseline differences remained.

Conclusions

Surgeons may be more reluctant to operate on women than men because they perceive that, because of their worse baseline status, women are likely to have worse outcomes; however, given that we found no evidence for differences in patient-reported outcomes at 12 months, these suspicions would appear to be unfounded. Women and men can be expected to benefit to a similar extent from THA.

Level of Evidence

Level III, therapeutic study.     

Functional Capacity Before and After Liver Transplantation

The maximal oxygen uptake (VO₂ max) is a standard tool for preoperative counseling of candidates for lung and heart transplantations, as well as an optional measurement to assess liver or renal transplant patients. Also, it provides an objective tool of the functional capacity of posttransplant patients. Exercise limitation and loss of aerobic capacity are common among patients with end-stage liver disease. The functional capacity of these subjects is decreased, as estimated by measuring the VO₂ max in a cardiopulmonary exercise test (CPET). After transplantation improvement is expected in physical capacity. We sought to describe the influence of orthotopic liver transplantation (OLT) on the physical fitness of the recipient at 3 and 12 months after transplantation. Since CPET is an objective test, it is an important tool for clinicians to evaluate patients' functional capacity before and after OLT.