Application of artificial pneumothorax in thoracoscopic and laparoscopic resection of esophageal carcinoma

目的 初步探讨胸腹腔食管癌切除术中,建立人工气胸对呼吸、循环的影响,评价其安全性及可行性.方法 2010年5月至2011年6月本院在人工气胸条件下采用胸腔镜联合腹腔镜食管癌切除术治疗食管癌患者80例,其中双腔气管插管60例、单腔气管插管20例.在充气流速3 L/min、维持胸内压6～8 mmHg的条件下,监测心率、有创动脉压(ABP)、脉搏血氧饱和度(SpO2)、气道压及呼气末CO2分压(PetCO2)等呼吸、循环指标和血气分析结果,观察其在CO2充气前、后的变化趋势.结果 手术开始建立人工气胸后,患者的心率、有创动脉压(ABP)、脉搏血氧饱和度(SpO2)基本没有变化,气道压、PetCO2及CO2分压(PCO2)均有不同程度升高,血气pH值下降,停止充气后,检测指标均恢复至基础值水平.所有病例均顺利完成胸腹腔食管癌切除腔镜食管癌切除术,术后仅1例患者由于误吸出现肺部并发症,其余患者均无肺部并发症发生,所有患者均顺利出院.结论 在胸腹腔镜下行食管癌切除术中,在充气流速3 L/min、胸内压维持6～8 mmHg,采用二氧化碳建立人工气胸条件下,其增加显露且安全、有效.与双腔插管相比,单腔插管建立人工气胸对患者的呼吸影响更小,更为安全.     

双重抗血小板治疗急性冠状动脉综合征胃肠道症状60例临床分析

本文回顾性分析我院2009～2011年度诊治的60例心内科急性冠状动脉综合征(acutecoronary syndrone,ACS)住院患者,经双重抗血小板治疗的胃肠道并发症患者的临床资料,比较内镜下治疗联合静脉注射奥美拉唑、口服奥美拉唑联合雷尼替丁和单纯口服奥美拉唑的治疗效果,探讨内镜下治疗联合静脉注射奥美拉唑治疗ACS住院患者经双重抗     

Botulinum injection for the treatment of acute esotropia resulting from complete acute abducens nerve palsy

PurposeThe objective of this study was to investigate the effectiveness of botulinum toxin A (BTX-A) injections in the treatment of acute esotropia resulting from complete acute abducens nerve palsy.MethodsFifteen patients treated for complete acute abducens nerve palsy in our clinic were retrospectively reviewed. All patients who experienced an onset within 3 months and who were treated with early subtenon BTX-A injections at the ipsilateral medial rectus muscle without electromyography (EMG) guidance were included in this study. Responses and complications were recorded during a follow-up of at least 6 months.ResultsThirteen patients who had trauma and two patients who had brain tumor that caused their abducens nerve palsy were enrolled. Overall, six patients (40%) had full recovery and two patients (13%) had partial recovery, but the residual esotropia could be tolerated with prism correction in an average of 14.6 weeks. Seven patients (47%) received strabismus surgery afterward. Patients who did not respond well to early BTX-A injections at the 1-week interval were prone to subsequent surgical intervention (p = 0.026). Three eyes (20%) had transient subconjunctival hemorrhage following the subtenon space injection; no other complications were found after the treatment.ConclusionBTX-A offers patients with complete abducens palsy a possible better chance to regain binocular vision and indicates whether additional surgical interventions are needed for these patients. We also discovered that the subtenon space injection of BTX-A without EMG guidance was a safe, time-saving, and simple technique.     

结直肠非急诊手术患者术前机械性肠道准备的临床研究

目的评估术前机械性肠道准备(mechanical bowel preparation,MBP)在结直肠非急诊手术中的作用,探讨术前不行机械性肠道准备的安全性和可行性。方法 200例因结直肠腺瘤或腺癌拟行结直肠手术的患者按1.5∶1的比例随机分为两组:MBP组(120例)和非MBP组(80例)。比较两组患者术后30d内的心血管并发症、全身感染性并发症和手术部位相关并发症。结果 135例患者完成试验,MBP组81例,非MBP组54例。两组患者性别、年龄、肿瘤良恶性、吻合部位及方法、术中失血量、手术时间均无显著性差异。两组患者术后30d内心血管相关并发症发生率分别为1.2%和1.9%,全身感染性并发症发生率分别为7.4%和13.0%,手术部位相关并发症发生率分别为8.6%和13.0%,差异均无统计学意义(P<0.05)。其中MBP组1例、非MBP组2例发生吻合口瘘,两组各有1例围手术期死亡,差异均无统计学意义。结论结直肠非急诊手术术前机械性肠道准备并不能降低患者术后并发症发生率,常规术前机械性肠道准备并非必要。     

女性初潮前后骨代谢生化因子与雌激素、瘦体重相关分析

目的:探讨女性骨代谢生化因子骨钙素(OC)、骨碱性磷酸酶(BAP)和抗酒石酸酸性磷酸酶(TRAP)在初潮前后的变化特征及其相关影响因素。方法:以平均年龄(11.4±0.6)岁的115名小学女生为对象,测量其身高(H)、体重(W)、脂肪含量(FM)、瘦体重含量(LM),血清雌二醇(E2)、睾酮(T)、性激素结合蛋白(SHBG)及血清OC、BAP和TRAP。随访获得实验对象的初潮时间,以测量时相距初潮的时间作为自变量,拟合骨代谢生化因子及相关指标的回归曲线方程。采用偏相关方法检测骨代谢生化标志物与其影响因素之间的相关性。结果:初潮前呈上升趋势的OC、BAP在初潮时显著下降,而TRAP从初潮前至初潮一直下降。从初潮前至初潮,H与BAP(r=0.22,P=0.001)、OC(r=0.21,P=0.002)和TRAP(r=0.14,P=0.04)显著相关,E2、LM与BAP(E2:r=0.2,P=0.003;LM:r=0.15,P=0.029)、OC(E2:r=0.34,P<0.0001;LM:r=0.30,P<0.0001)也显著相关,与TRAP无明显相关。结果表明:女性初潮时骨代谢速度明显减慢,身高增长与骨代谢密切相关,雌激素和瘦体重含量是骨组织代谢的相关影响因素。