共查询到20条相似文献,搜索用时 31 毫秒
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
Shander A 《Vascular》2008,16(Z1):S37-S47
The prospect of surgery without blood loss is an emerging reality. Use of a blood conservation strategy is gaining increasing recognition as a sound and practical approach, especially for the majority of large blood loss surgeries. However, critical situations still occur in which transfusions are necessary or unavoidable for the short-term survival of the patient. The decision-making processes for determining when to transfuse, which blood products to give, and how much are presented here with an evaluation of the risks of transfusion and a discussion on blood conservation strategies. Modalities that may be used in such strategies include restricted phlebotomy, the implementation of restrictive transfusion triggers, acute normovolemic hemodilution, intraoperative and postoperative blood salvage, and refined operative techniques to achieve meticulous hemostasis. In addition, the proper use of erythropoiesis-stimulating agents well before surgery can reduce the number of units transfused. The risks and costs of allogeneic blood transfusions underscore the need for and value of blood conservation techniques. Increasingly, hospitals are adopting blood conservation strategies as part of their routine practice. Blood conservation is a rapidly evolving field in which active research is expanding our understanding of the molecular, physiologic, and clinical aspects of hematopoiesis, circulatory response, coagulation enigmas, artificial oxygen carriers, and the impact of anemia on organ function. Ongoing research offers the possibility of replacement or elimination of allogeneic blood transfusions in a variety of clinical settings. 相似文献
14.
Zühlke H 《Zentralblatt für Chirurgie》1999,124(Z3):55-63
Intuition, even at the end of the 20th century, has decisive significance in the field of medicine. Intuition within the medical field is understood to be a type of thinking based on experience, but without conscious recourse to its situations and thought processes; rather, it represents an act without reflection and one determining our medical actions to some extent. It is a cognitive process, an intuitive gain in recognition on the basis of experiential values called up from memory. Intuition is a combination of knowledge, ability, endurance, intellectual abilities, and discoursive methods of recognition, in short, the abilities of an expert. To become an expert, one must go through the stations of surgical training. In these the knowledge is imparted, which leads via decision-making to diagnosis and therapy. Intuition in the sense of the definition as experiential thinking cannot be learnt, but it can be schooled. The prerequisites for this are analytic thinking, expert knowledge, and metacognitive knowledge. 相似文献
15.
16.
Reconstruction of cutaneous defects of the hand has dramatically progressed. It should also benefit from the development of robot-assisted surgery. The aim of the present study was to consider the feasibility of a kite flap in robotic surgery. Two cadaver hands were used in this study, one for a conventional procedure, and one for a robotic surgical procedure using a da Vinci Si robot. The operative duration was measured, and all difficulties encountered during the procedures were reported. The total duration of the intervention was 19 minutes with the conventional procedure and 30 minutes with the robotic technique. Some difficulties were encountered, related both to lack of specific instrumentation and haptic feedback. Robotic surgery presents interesting advantages such as the suppression of physiological tremor, increased degrees of freedom, and enhanced precision and accuracy of hand maneuvers. In this study, it allowed the realization of a pedicled flap without any external help. 相似文献
17.
18.
19.
20.
Vasco Senna-Fernandes 《Indian Journal of Plastic Surgery》2008,41(2):116-127