10kg以上婴幼儿室间隔缺损的外科治疗

婴幼儿巨大室间隔缺损 (ＶＳＤ)较早出现肺动脉高压、充血性心力衰竭、反复肺部感染等严重并发症 ,甚至死亡 ,内科治疗常难以奏效 ,而手术治疗是挽救患儿生命的唯一方法 ,但是体重１０ｋｇ以下的婴幼儿外科治疗的死亡率较高［１］。我院１９９７年２月～２０００年１２月共对５５例１０ｋｇ 以下的婴幼儿施行ＶＳＤ修补术 ,取得了良好的疗效 ,现总结如下。１．１一般资料本组男３４例 ,女２１例 ;年龄４～２３个月 ,平均１６．６个月 ,其中小于１２个月２０例 ;体重４～１０ｋｇ,平均８．５ｋｇ。术前均有反复呼吸道感染史 ,２０例有心力衰…     

Effect comparison between sacral blocking and massage combined with traction on protrusion of lumbar intervertebral disc

Background:Epidural injection is an important method in treatment of protrusion of lumbar intervertebral disc.Especially in the recent decade sacral injection is adopted more and more often.Objective:To compare the clinical effects of sacral blocking and massage combined with traction.Unit:Yinhe Hospital of Beijing.Subjects:290 outpatients with grade Ⅱ of ASAI were selected from May,1994 to July,2000.Patients were randomly divided into observation group(n=145)and control group(n=145).Sacral blocking was adopted in observation group and 80 males and 65 females aged 20-78(mean:46.4)years old were included with disease course 3 days to 30 years.Massage combined with treaction was adopted in control group and 74 males and 71 females aged 22-74(mean:44.9)years oled were inmcluded with disease course 2 days to 10 years.Interention:Sacral blocking:Operation was according to sacral blocking and druge(dexamethasone injection,2 mg;0.75% bupivavaine hydrochloride,5 ml;saline,50ml) were injected slowly after success of puncture.Patient rested for 0.5h after injection and left treatment room if no adverse effects occurred.Massage combined with traction:Massage was adopted after traction to every patients.(1)Massage:Patient was seated at square stool and lower limbs separated naturally with same width of shoulders.Doctors sit behind patient.First,thubs of both hands were pressed on projecting part near spinous process(pressing points were selected according to different projecting part).Flexing and extending forward and backward were taken at the same time and extent was ddecided addording to patients‘ maximal endurable degree,5-10 timmes.Upper part of body was turned 45 degrees to left and right.Massage was still taken to affected part,3-t times.(2)Traction:Pelvis was extracted with general physical therapy and massage table.Supine position,chest and treaction bandage were fixed,tractiron wheel was turned slowly until patient felt comfortable with maximal endurance as limit(traction force,20-40kg),After extracting for 5 minutes,massagee switch was turned on to take rolling massage to bck and both lower libmbs.Traction force was increased every5 minutes and limit was still according to patient‘s maximal endurance,30 minutes for every time,once a day and ten times as a therapeutic course.Cohclusion:Effect of sacral blocking on protrusion of lumbar intervertebral disc was positive and fewer therapeutic time were needed.Massage combined with traction was also effective,safe and no adverse effects wer observed,but more therapeutic times were neeeded and inconveinient.