神经导航在胶质瘤手术中的应用

对于胶质瘤手术切除是最基本的治疗手段。但由于胶质瘤呈浸润性生长 ,仅凭手术医生的经验决定切除范围 ,不但难以全切病灶 ,肿瘤复发率较高 ;且易损伤正常脑组织 ,造成手术并发症。由于在MRI图像上 ,胶质瘤与周边脑组织存在界限。这种特点为神经导航辅助胶质瘤手术提供了可能。一、资料与方法1.病例资料 :1997年 9月～ 2 0 0 1年9月 ,我们通过神经导航行胶质瘤手术80例 ,男性 48例 ,女性 32例 ;平均年龄40岁。病灶位于大脑半球 70例 ,深部(丘脑、基底节、侧脑室、胼胝体 ) 9例 ,脑干 1例 ;低级别 (WHOⅠ、Ⅱ级 ) 6 2例 ,高级别 (WHOⅢ、…     

肛门病手术应用低浓度小剂量利多卡因局麻的效果

目的观察低浓度小剂量利多卡因在肛门病手术中的应用效果。方法选择接受肛门病手术者100例,手术时用0．25％盐酸利多卡因5-20ml,根据病情和手术需要作局部浸润麻醉。结果通过100例的肛门手术观察,结果显示麻醉满意顺利83例,麻醉良好17例,无1例麻醉无效失败。总有效率100％。此法麻醉效果确切,未发现严重不良反应。结论此法具有易于掌握,效果好而安全的优越性,适于临床应用和推广。     

颌面毁损伤的围麻醉期处理

颌面部血液循环丰富，损伤后骨折、软组织撕裂可导致大量出血，使大部分病人伴有休克及呼吸道不同程度的梗阻，常常危及生命。其麻醉处理有其特殊性。自2000年1月～2006年11月，作者先后对41例颌面毁损伤患者实施麻醉。为总结经验，现做回顾性报告如下。     

0.5%布比卡因脊麻用于老年人下肢手术的麻醉效果分析

老年人生理功能降低对麻醉与手术的耐受力差 ,容易引起血流动力学紊乱及呼吸抑制。对于老年人下肢手术的麻醉选择 ,作者采用 0 5 %布比卡因蛛网膜下腔麻醉 ,现报告如下。1　资料与方法1 1　一般资料　ＡＳＡⅠ -Ⅱ级择期老年手术病人4 0例 ,男 12例 ,女 2 8例 ,年龄 6 5～ 82岁 ,其中股骨颈骨折切复内固定术 2 6例 ,髌骨骨折 10例 ,全髋关节置换术 2例 ,胫排骨骨折切复内固定术 2例。随机分为两组 ,Ⅰ组为脊麻组 ,Ⅱ组为连硬组。两组在年龄 ,性别 ,ＡＳＡ分级方面经统计学处理无明显差异 (Ｐ >0 0 5 )。1 2　麻醉方法　术前半小时均肌注鲁…     

浅谈临床困难插管气道的处理方法

困难插管气道简称困难气道，是指可能对气管插管及麻醉后维护气道畅通造成困难的各种临床情况。这类情况在临床麻醉中并非少见，约占5％，如处理不当，轻者麻醉失败，手术延期，气道损伤等，重者则可能因为严重通气障碍而缺氧，甚至窒息死亡。[第一段]     

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.     

蝮蛇咬伤的处理体会

我市属于丘陵地带，到了春末夏秋，气温在18～30℃时，毒蛇由冬眠渐渐开始复苏，卅没在山林、田野等地，以蝮蛇为主。我院每年都要收治一批蝮蛇咬伤的病人，在处理方面积累了丰富的经验。笔者统计了我院2005年5月～9月，共收治蝮蛇咬伤31例，由于蝮蛇咬伤具有神经毒和血液毒两种蛇毒的特征，并有复视的特点，局部症状明显，病情发展快，但只要被咬伤后及时到院，正确处理，病情都能得到控制，现将处理体会报告如下。[第一段]     

1例神经白塞氏病的护理

白塞氏病(Behcet’s disease,BD)是一种以反复发作的口腔及外阴部溃疡、眼炎及皮肤损害为临床特征的,累及多个系统的慢性疾病。当中枢或周围神经系统受累时,则成为神经白塞氏病(Neuro-Behcet’s disease,NBD)[1]。NBD是BD的严重并发症之一[2],由于病变累及多个系统,存在诸多护理问题,因此,护理在本病的治疗恢复中有重要作用。目前,国内对神经白塞氏病的护理偶见报道。我科于2005年12月20日收治了1例该病患者,现将护理体会介绍如下。1病例介绍患者,女性,51岁,主因左侧肢体麻木、无力4d入院。入院后查体:神志清楚,双瞳孔等大等圆,对光反…