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目的 探讨临床骨科中隐匿性血管损伤的临床特点、诊断与治疗,以期提高对此类损伤的认识和临床诊治效率.方法 2003年3月至2010年10月共收治649例血管损伤患者,其中隐匿性血管损伤50例(7.7%),男42例,女8例;年龄13~66岁,平均34.0岁.血管损伤类型:静脉损伤1例,动脉损伤42例,动、静脉同时损伤7例.根据张英泽等提出的肢体动脉编码和损伤分型:A型14例,B型20例,C型16例.初始损伤至诊断时间平均为43.4 d(2~337 d),表现为肢体缺血、骨筋膜室综合征、血肿或假性动脉瘤、出血、神绛受压等征象.辅助检查包括:彩色多普勒超声17例,CT血管造影7例,X线血管造影25例.手术治疗43例,包括血管修补、直接吻合、自体静脉移植、结扎及截肢,其中2例术后行血液滤过治疗;内科治疗3例;介入栓塞治疗4例.结果 4例患者截肢后伤口愈合良好,无并发症发生;其余46例患者出院时患肢皮肤温度、颜色均恢复正常,远端动脉搏动存在,平均随访6.7个月(1~42个月),患肢血运良好.结论临床工作中的隐匿性血管损伤并非少见,其临床表现具有延迟出现、多种多样及不典型的特点.诊断方法应优先选择血管造影.治疗以手术为主,酌情采用血管内介入治疗和血液滤过治疗.Abstract: Objective To investigate clinical characteristics, diagnosis and treatment of insidious vascular injuries in orthopaedic cases. Methods Between March 2003 and October 2010, we treated 649 cases of orthopedic and vascular injuries, 50 (7. 7% ) of which were identified as insidious injuries. They were 42 men and 8 women, aged from 13 to 66 years (average, 34. 0 years). The insidious injury affected the vein in one case, the artery in 42 cases and both in 7 cases. The vascular injuries were categorized as type A (14 cases), type B (20 cases) and type C (16 cases) according to the classification system proposed by Zhang Ying-ze. The diagnoses were made after an average of 43. 4 days from primary injuries, with the assistance of color Doppler ultrasound in 17 cases, CT angiography in 7 and X-ray angiography in 25. Clinical manifestations included limb ischemia, compartment syndrome, hematoma or pseudoaneurysm, hemorrhage and nerve entrapment. Forty-three patients were treated by a variety of surgical options, such as angiorrhaphy, anastomosis, transplantation of autogenous venous graft, ligation and amputation. Among them, hemofiltration was performed in 2 cases as adjuvant therapy. Endovascular embolization was performed in 4 cases and conservative treatment in the other 3. Results Forty-six patients had their limbs salvaged, with normal temperature and color of the skin and existence of distal arterial pulses at discharge from hospital. The other 4 patients had to sustain amputation. An average follow-up of 6. 7 months (from one to 42 months) revealed that all the affected limbs regained normal blood circulation. Conclusions The insidious presentations and atypical clinical manifestations make diagnosis of insidious vascular injury very difficult. We recommend angiography as the first step in diagnosis. Surgical approaches should be considered as the main treatment choice, and hemopurification can be used as adjuvant therapy if necessary. In some cases, endovascular intervention may be faster and safer. 相似文献
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患者,女性,年龄18岁,体重38 kg.主诉:出生后体检即发现心脏杂音,伴口唇、指趾甲床紫绀,平路行走10 min余需蹲踞.查体:体温36.8℃,脉率118次/min,呼吸频率16次/min,BP 94/65 mm Hg(1mm Hg= 0.133 kPa),心前区无隆起,心尖搏动位于左侧第5肋间锁骨中线内0.5 cm,胸骨左缘2~4肋间可闻及Ⅲ~Ⅵ级收缩期杂音,心界不大,HR 118次/min,律齐,肺动脉瓣关闭音稍弱,可见杵状指趾,周围血管征阴性.心脏彩超示:法洛四联症、右室流出道、肺动脉瓣狭窄、室间隔缺损(双向分流)、主动脉骑跨、右室壁增厚、永存左上腔静脉、冠状静脉窦增宽及三尖瓣关闭不全.诊断为法洛四联症.拟在静吸复合全麻下行法洛四联症根治术. 相似文献
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Background Intramedullary nails have been widely used in treating femoral shaft fractures. However, end caps falling into soft tissue intraoperatively may cause trouble to surgeons, prolong operative time and increase radiation exposure. Additionally, difficulties may be encountered when removing nails because of callus formation over the nail tip. We performed a prospective study to compare two types of nails in managing femoral shaft fractures.
Methods Group I consisted of seventy-four patients with unilateral femoral shaft fractures treated with cannulated interlocking anatomical femoral intramedullary nails. Group II consisted of seventy-eight patients treated with cannulated interlocking anatomical femoral intramedullary nails with tail wires. The patients’ ages, fracture severity, duration of operation, fluoroscopy time, blood loss and falls of end caps into soft tissue were recorded. Nails were removed after fracture healing. The duration of operation and blood loss during nail removal were recorded.
Results There were no significant differences between groups with respect to age and fracture severity (P>0.05). End caps fell into soft tissue 17 times in 15 cases in group I and 21 times in 16 cases in group II. An average of seven minutes was spent recovering a lost cap in group I. In group II, all lost caps were recovered immediately. The duration of operation and fluoroscopy time in group II was significantly lower than in group I (P<0.05). Asymptomatic palpable nodules were detected in 4 cases in group II. Nail removals were performed on 58 patients in group I and 69 patients in group II. The duration of operation, blood loss and complications in group II were less than in group I (P<0.05).
Conclusions Intramedullary nails with tail wires facilitate both fracture fixation and nail removal, which can be used to treat femoral shaft fractures with less radiation exposure, shorter surgical time and fewer complications. 相似文献
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本文主要探讨护理部在应对突发卫生事件中的作用,提高护理部应对突发事件的组织管理能力。制定应对突发卫生事件的安全管理条例,参照《突发公共卫生事件应急条例》,建立医院护理应急救助机制,成立专门的护理小组。规范突发公共卫生事件的程序,首先安排相关人员去医院前往营救,然后进行消毒隔离,做好相关的消毒隔离工作。 相似文献
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目的探讨微小动脉瘤血管内治疗手术的观察及护理配合要点。方法分析2010年8月至2012年12月深圳市宝安区人民医院神经外科行动脉瘤血管内治疗的20名患者临床资料。结果 20例病人中总共19例致密栓塞,其中18例术后3~6个月再次入院行DSA检查未发现动脉瘤复发,2例因其他原因死亡;经回顾性分析结果显示瘤体深度及体颈比例与患者结局呈正相关,相关系数分别为0.901(P<0.05)、0.658(P<0.05);动脉瘤形态与手术时间呈现正相关(相关系数为0.68,P<0.05),提示动脉瘤越不规整,则需花的手术时间则越多;随之将影响术后转普通病房还是重症医学科的选择,相关系数分别为0.52(P<0.05)、0.632(P<0.05)。结论微小动脉瘤血管内栓塞是安全的、可靠的,但对护理配合要求高,需配合医师充分评估动脉瘤形态,记录手术角度及路径,配合医师完成术中微导管塑型,配合弹簧圈填塞过程,密切观察,发现术中动脉瘤再破裂情况,同时需重视术后护理。 相似文献