股骨干粉碎性骨折的治疗

近年来随着交通运输业的发展,由于高能伤所导致创伤骨科中骨折粉碎程度愈来愈重,甚至使骨骼失去完整形态,尤其在股骨干部位,治疗极其困难,开放复位损伤大且达不到满意的固定,疗效不佳。我们最大限度地使用外固定器,很好地解决了这一难题,同样适用于肱骨和胫骨骨折。1临床资料本组12例,均为男性,年龄18~40岁,平均31.3岁。左侧5例,右侧7例。其中交通事故伤8例,高处坠落伤3例,摔伤1例。闭合伤10例,开放伤2例。骨折均为粉碎性,无软组织及血管神经损伤。2治疗方法患者麻醉后仰卧于骨科牵引手术床上,注意使患肢靠外,消毒铺巾后,保持下肢中立位轻度…     

成人阴茎的三维数字化图像分析

目的对成人阴茎进行三维数字化图像分析,为阴茎整形修复获得手术前后形变参数及手术方案的选择,提供精确的形态学数据。方法采用Angel数字快速测量诊断系统,分别测量200例正常成人阴茎安静状态和勃起时的长度、周长、以及勃起时角度与阴茎长度、周径的关系。结果随着年龄和身高增长,阴茎也随之增长;身高与阴茎长度不成正比;阴茎勃起时随着角度的增加硬度增强,但勃起硬度变化时阴茎体积无明显变化。结论从不同径线不同角度对阴茎进行计算机三维测量分析,为阴茎整形修复术前设计、术后效果评价提供重要的量化指标。     

腭裂修复术腭咽肌肉重建与否的鼻咽内窥镜的比较观察

目的通过是否进行腭咽肌肉重建的两组腭裂修复术后患者鼻咽内窥镜的比较观察,了解腭咽部肌肉重建术后腭咽闭合状况的改变。方法将41例腭裂术后患者,按照在腭裂修复时是否进行腭咽肌肉重建分为重建组(22例)和非重建组(19例),以鼻咽纤维内窥镜记录静态和发音时腭咽闭合运动状况,对两组患者腭咽闭合运动类型和状况进行比较。结果重建组静态腭咽腔形态较非重建组明显缩小,各壁光滑丰满,未见软腭鼻腔面V型缺损畸形;动态时以环状闭合为主。非重建组静态腭咽腔形态较大,可见软腭鼻腔面V型缺损畸形;动态时以冠状闭合为主。经比较重建组腭咽闭合良好率(90.91%)明显优于非重建组(37.31%)。结论鼻咽内窥镜观察证实腭咽肌肉重建腭裂修复术后腭咽闭合功能恢复明显优于非重建组。腭裂修复术时重建腭咽肌肉有助于缩小腭咽腔和更易于达到良好的腭咽闭合状态。     

恩度联合特素和卡铂治疗卵巢癌临床分析

目的探讨恩度联合特素和卡铂治疗卵巢癌的疗效及不良反应。方法选择30例卵巢癌患者,采用恩度＋特素＋卡铂联合治疗,至少完成3个疗程,观察疗效及副作用。结果总有效率为80.0%（24/30）,主要副作用为骨髓抑制、脱发、恶心、呕吐,但均属轻微。结论恩度联合特素和卡铂应用于卵巢癌术后化疗,其疗效较佳,且不良反应少,值得推广应用。     

120例产后出血的预防及护理体会

目的:总结120例产后出血的预防及护理体会.方法:通过对120例产后出血患者的一系列适宜护理,得出体会.结果:严密观察产后出血者的生命体征,根据不同原因采取相应的止血措施,抢救体克,纠正酸中毒,并应用大剂量抗生素以预防感染.结论:对产妇加强三期预防保健及产后护理,根据不同的出血原因采取相应的措施,可大大降低其发病率及死亡率.     

不同年龄患者腹腔镜胆囊切除术中肾血流量变化的比较

目的 比较不同年龄患者腹腔镜胆囊切除术中肾血流量的变化.方法 择期行腹腔镜胆囊切除术患者60例,年龄18～75岁,ASA分级Ⅰ或Ⅱ级,性别不限,体重48～78 kg,根据年龄分为2组(n=30):中青年组(18～60岁)和老年组(61 ～ 75岁).经口气管插管后置入食管超声探头,分别于气腹前、气腹1、5、10、15、20、30 min、气腹结束后1和5 min时,采用经食管超声心动图测量左肾动脉主干内径(RAD)和血流速度时间积分(VTI),计算左肾血流量(LRAF),记录最大下降时间点,计算最大下降百分比.结果 与气腹前比较,两组气腹各时点和气腹结束后1 min时RAD、VTI和LRAF降低(P＜0.05).与中青年组比较,老年组气腹前LRAF降低,最大下降时间点延迟(P＜0.05),最大下降百分比差异无统计学意义(P＞0.05).结论 中青年患者和老年患者腹腔镜胆囊手术中肾血流量均发生可逆性下降;老年患者最大下降时间延迟.     

食道静脉曲张套扎结合大剂量聚桂醇治疗体会

目的探讨在密集套扎疗法的基础上进行硬化治疗对于食管静脉曲张复发的防治作用。方法对食管静脉曲张套扎治疗后食管曲张静脉消失或基本消失的患者进行硬化剂治疗。结果套扎加大剂量聚桂醇治疗组与单纯套扎组再出血率有明显差异（P〈0.05）。结论套扎治疗后大剂量硬化剂治疗可显著减少套扎术后残留的食管曲张静脉、延缓静脉曲张的复发。     

全身热疗对全凭静脉麻醉下阿曲库铵肌松效应的影响

目的 观察全身热疗(whole body hyperthhermia,WBH)对晚期癌症患者全凭静脉麻醉(total intravenous anesthesia,TIVA)中阿曲库铵用量和作用时间的影响.方法 晚期癌症TIVA患者,分非高温组(24例),高温组(26例).监测两组患者的体温、心电图(ECG)、中心静脉...     

体外循环下小儿肌部室间隔缺损的镶嵌治疗

目的 探讨镶嵌模式(hybrid procedure)治疗小儿肌部室间隔缺损(Mvsd)的手术方法及临床应用.方法 2006年1月至2010年6月,在体外循环心内直视手术下采用手术及封堵相结合的镶嵌技术矫治小儿Mvsd 45例,其中男20例,女25例;年龄52天～12岁;体重3～32 kg.7例为单个Mvsd,38例为多发性VSD.同时合并大血管错位(D-TGA)1例、法洛四联症(TOF)2例、肺动脉狭窄(PS)3例、动脉导管未闭(PDA)6例、房间隔缺损(ASD)6例、主动脉缩窄1例.均在心脏停跳后直视下将导引钢丝经三尖瓣孔自心脏右室面穿过VSD至左室面,直视下置入导引器,然后送入封堵器,完成Mvsd封堵.多发性VSD 38例,予自体心包片修补膜周部等较大的VSD,心内其他畸形同期完成矫治.结果 42例置入单枚封堵器(直径4～10 mm)、3例置入双枚封堵器(直径4～7 mm).手术经过顺利,术前左室射血分数(EF)均在正常范围,术后1天小于8月龄组EF均值低于正常,大于8月龄组EF正常,两者差异有统计学意义.术后常规每天给予5 mg/kg肠溶阿司匹林3～6个月.术后随访超声检查示封堵器位置无偏移,无残余分流,无二尖瓣、主动脉瓣反流、Ⅲ度传导阻滞及新发心律失常等.术后因重症感染放弃治疗1例,无远期死亡病例.结论 体外循环下镶嵌技术治疗小儿 Mvsd明显降低了围手术期并发症及病死率,简化了手术过程,降低了手术风险,是一种安全、有效的方法.

Abstract：

Objective To summarize the technique and clinical experience of hybrid procedure under cardiopulmonary bypass (CPB) in children with muscular ventricular septal defect (mVSD). Methods From January 2006 to June 2010, 45 cases of mVSD underwent hybrid procedure with CPB. mVSDs were closed with devices under direct vision in 45 cases. Of them, there were 20 males and 25 females. They ranged from 52 days to 12 years [mean (2.05 ±2.48) year] in age and from 3 to 30 kg [(11.93 ±7.70)kg] in body weight. Preoperatively, most of children were highly susceptible to respiratory tract infections. The hybrid approach was used in all patients with CPB under the guidance of transesophageal echocardiography (TEE). The diameter of mVSDs ranged from 2 to 7 mm under TEE. Of 45 cases, 40 patients had increased rates of pulmonary blood flow. 29 patients had left axis deviation and 12 cases had sinus arrhythmia on electrocardiography (ECG). 19 had other congenital heart lesions, including transposition of great arteries in 1 case, tetralogy of Fallot in 2, pulmonary artery stenosis in 3, patent ductus arteriosus in 6, atrial septal defects in 6) and aorta coactation in 1. The quantity of VSDs were from 1 to 7 (single, in 7; two, in 24 case; three, in 8 case; four, in 5 case and seven, in lease. 37 patients were combined with pulmonary hypertension in our cohort. 38 patients with another large VSD and 19 with other congenital heart lesions were required surgical repair at sometime. Results The hybrid procedures were undertaken in all 45 cases of this cohort. All cases were successful and no deaths occurred during operation. A total of 48 devices were implanted in 45 patients, including single devices in 42 cases (device size ranged from 4 to 10 mm) and two devices in 3 cases (device size ranged from 4 -7 mm). The average time on CPB was (58.28 ±20.70) min , while aortic crossclamp time was(34. 94 ± 14.75) min. In addition, the time on mechanical ventilation postoperatively ranged from 2 hours to 6 days. Compared to the older children, 20 infante aged less than 8 monhad a significant difference in cardiac function in the early postoperative period. One infant was given up treatment because of serious infection. Anather cases recovered with the use of supportive treatment, such as using vasoactive agents, digoxin, inhaling nitric oxide, diuresis, and so on. The enteric-coated aspirin was given at dose of 5 mg ? kg -1. day -1 for a period of 3 to 6 months as usual postoperatively. All patients attended follow-up at 1 week, 1 month, 3 months, 6 months, 1 year and 2 years post-procedure. No major complications were encountered during this period. All cases were no instance of migration of any of the devices, residual shunt, aortic regurgitation, atrioventricular valve dysfunction, Ⅲo atrial-ventricular conduction block, new arrhythmia, and so on. There are no death in long-term follow-up. Conclusion Hybrid procedure is safe and effective for the closure of congenital heart defects in children.     

丙泊酚对体外高糖培养的人脐静脉内皮细胞中MDA、SOD和NF-κB的影响

目的 探讨丙泊酚对体外高糖培养的人脐静脉内皮细胞(HUMCEs)中丙二醛(MDA)含量和超氧化物歧化酶(SOD)活性及NF-κBp65表达的影响.方法 按体外培养HUMCEs的条件不同随机分为七组,葡萄糖5.5 mmol/L组(C1组)、甘露醇25 mmol/L组(C2组)、葡萄糖30mmol/L组(HG1组)、葡萄糖30mmol/L+脂肪乳90 μmol/L组(HG2组)、葡萄糖30 mmol/L+吡咯烷二硫代氨基甲酸酯(PDTC)50μmol/L组(HG3组)、葡萄糖30 mmol/L+丙泊酚25μmol/L组(HG4组)、葡萄糖30 mmol/L+丙泊酚100μmol/L组(HG5组).分别检测各组细胞的MDA含量、SOD活性及C1、HG1、HG3、HG4、HG5组中NF-κB p65表达量.结果 与C1、C2组比较,HG1组MDA含量升高,SOD活性降低,NFκB p65表达量增多(P＜0.05).与HG1组比较,HG3组、HG4组及HG5组的MDA含量均下降、SOD活性均升高、NF-κBp65表达量均降低(P＜0.05).与HG2组比较,HG3、HG4及HG5组的MDA含量均下降、SOD活性均升高(P＜0.05).与HG4组比较,HG5组MDA含量下降、SOD活性升高(P＜0.05);HG4、HG5组间NF-κB p65表达量差异无统计学意义.结论 丙泊酚与PDTC一样可抑制高糖对内皮细胞损伤,提示丙泊酚的作用与抑制NF-κB信号通路有关.