围婚期妇女的生育健康现况调查分析

对北京市６个区（县）的２１８７例围婚期妇女的健康状况进行横断面调查。结果发现：围婚期妇女的平均初婚年龄为２５岁,其中９８．５％具有初中及以上文化程度,９３．１％从事各种职业劳动,２２．６％有婚前性行为,９．７％未婚先孕。疾病、住院、被动吸烟、生活紧张度、豆制品及蔬菜等摄入不足是造成月经不规律的高危因素。提示,保护妇女的生育健康应从围婚期作起     

Orbital surgery – perioperative problems and results

Fragestellung: Orbitotomien nehmen innerhalb der Ophthalmochirurgie auf Grund der involvierten anatomischen Strukturen und des daraus resultierenden Spektrums m?glicher perioperativer Probleme eine Sonderstellung ein. Um einen überblick über die Art und H?ufigkeit intra- und postoperativer Probleme bei Orbitotomien zu erhalten, führten wir eine retrospektive Auswertung an unserer Klinik durchgeführter Orbitotomien durch. Patienten und Methode: Es wurden 48 Orbitotomien bei 46 Patienten berücksichtigt, die zwischen 08/1995 und 02/1998 operiert wurden. Ergebnisse: Schwerwiegende intraoperative Komplikationen waren mit zwei transfusionspflichtigen Blutungen und einer Liquorfistel selten. Sie wurden interdisziplin?r behandelt. Postoperativ traten vorübergehende funktionelle St?rungen mit guter Rückbildungstendenz wie Visusminderungen (35 %), Motilit?tsst?rungen mit oder ohne Doppelbildwahrnehmung (20 %) und Lidfehlstellungen auf. Ihnen liegt v. a. die postoperative ?dem- und H?matombildung zugrunde. Persistierende Funktionseinschr?nkungen waren dagegen selten (10 %). Schlu?folgerung: Unsere Untersuchung zeigt, da? perioperativ bei Orbitotomien v. a. vorübergehende funktionelle Einschr?nkungen auftreten, die sich rasch zurückbilden. Schwere Komplikationen sind dagegen selten, treten v. a. intraoperativ auf und k?nnen eine interdisziplin?re Therapie erfordern.      

Programming a predictive rormula for angina and other risk factors in patients with cardiac diseases undergoing noncardiac operations

We programmed a formula which predicts the incidence of either myocardial infarction or cardiac death during the postoperative period. The original formula was proposed by Shah et al, based on their own data and analysis. The program is simple and is written in a language called Quick Basic. The use of this program is also simple. Such a program has improved the use of this analysis substantially. The program has been posted on to a few Computer network services as a free software.(Suwa K, Ogura S: Programming a predictive formula for angina and other risk factors in patients with cardiac diseases undergoing non-cardiac operations. J Anesth 6: 241–242, 1992)     

儿童体外循环围术期内源性一氧化氮浓度的变化

目的 探讨儿童体外循环期间内源性一氧化氮(NO)浓度的变化及意义。方法 将先心病患儿分为非紫绀型与紫绀型组，非紫绀型再分为肺高压与非肺高压组，于转流前、主动脉阻断后、转流结束、术后24h、术后72h和术后7d测定NO浓度。结果 主动脉阻断后略有降低，体外循环结束时显著增高，术后第1d仍处于较高水平，术后第3d恢复正常；在体外循环期间紫绀型与非紫绀型先心病血浆NO浓度的比较有显著意义；非肺高压组NO浓度升高显著，肺高压组则升高较少，两组术后24h及72h的比较有显著意义。结论 本实验显示术后24h、术后72hNO浓度升高显著，可能与体外循环所致的炎性反应有关；肺高压组则升高较少，易发生肺高压危象，这也是术后NO治疗肺高压危象的基础。     

四肢骨折术后镇痛治疗的临床观察

目的通过比较不同的镇痛方案在四肢骨折治疗中的镇痛效果，探讨一种确实有效的符合四肢骨折术后无痛功能锻炼要求的镇痛模式。方法选择2003年8月1日～2003年9月15日50例四肢骨折接受手术治疗的病人，随机分为A、B两组，每组25例，A组接受系统规律的镇痛治疗方案，B组采用传统的疼痛时再给止痛药物的方法治疗，以VAS评分法评判镇痛效果。结果A组患者的VAS评分明显低于B组患者，A组患者开始接受主、被动功能锻炼明显早于B组患者，有利于促进患者术后的康复。结论系统规律的有效镇痛治疗方案，有利于患者的早期功能锻炼，降低术后并发症，促进患者的早期康复。     

Future anesthesiologists will be as much outside as inside operating theaters

During the first decade of the new millennium the intense reorganization of hospitals and of medical care will be replaced by stability and long-term goals. An anesthesiologist is now as active outside as within the operating theater, being a predominant resource in intensive care, pain management, emergency and prehospital care. The anesthesiologist will also have a key part to play in risk analysis of patients scheduled for various kinds of advanced treatment. Anesthesiologists are now also more involved in primary home care where, together with other physicians and categories of health care providers, they offer qualified treatment of various diseases at home – the environment preferred by the patient.     

Prävention perioperativer Myokardischämien – ein Update

Perioperative cardiac morbidity and mortality are a major health care challenge with important individual as well as economic aspects. Up to 30% of all perioperative complications and up to 50% of all postoperative deaths are related to cardiac causes. Perioperative myocardial ischemia, which occurs in more than 40% of patients with or at risk for coronary artery disease and undergoing noncardiac surgery, represents a dynamic predictor of postoperative cardiac complications. Long-duration myocardial ischemia and ischemic episodes associated with myocardial cell damage are particularly of prognostic relevance. In patients suffering from this type of ischemia, the incidence of adverse cardiac outcome is increased up to 20-fold. Reducing the incidence of perioperative myocardial ischemia is associated with a decrease in adverse cardiac outcome. Important issues related to perioperative myocardial ischemia are hematocrit level, body temperature, and hemodynamic variables. In contrast, the choice of anesthetic agents and techniques appears to be less important. Perioperative administration of anti-ischemic drugs in patients at risk, however, leads to a further decrease in the incidence of myocardial ischemia and to an improvement in patient outcome. Recent studies suggest that alpha 2-agonists and particularly beta-adrenoreceptor blocking agents are effective anti-ischemic drugs in the perioperative setting. Perioperative administration of beta-adrenoreceptor blocking agents in coronary risk patients undergoing noncardiac surgery is associated with a reduced rate of postoperative cardiac complications and an improvement in long-term outcome. This is particularly relevant in high risk patients with preoperative stress-induced ischemic episodes. In clinical practice, therefore, chronically administered anti-ischemic drugs should also be administered on the day of surgery and during the postoperative period. In untreated patients with or at risk for coronary artery disease and who have to undergo urgent surgical procedures without the opportunity of preoperative anti-ischemic intervention, perioperative administration of beta-adrenoreceptor blocking agents is mandatory.     

多孔义眼台植入手术围手术期用药的探讨

目的 探讨多孔义眼台植入手术的围手术期用药管理。方法 对116例患者(116眼)围手术期规范用药后，观察1个月。结果 仅1例凝血因子Ⅶ缺乏的患者出现重度出血和水肿，眼台取出；余均未发生术后严重的反应和并发症。结论 围手术期药物的合理使用可以有效地减轻手术的反应，减少手术的并发症。     

选择性冠状动脉内支架置入术围手术期的配合与护理

目的 :探讨合理配合与正确护理在冠状动脉内球囊成形 (PTCA)及支架置入术中的作用。方法 :冠心病病人184例经冠状动脉造影确诊后 ,根据冠状动脉血管狭窄程度行PTCA加内支架置入术 ,术中除配合操作医师完成介入手术及监护外 ,同时对病人进行心理护理 ,术后康复指导。结果 :184例病人置入1个支架者107例 (58 % ) ,2个支架者62例 (33 % ) ,3个支架者12例 (6 % ) ,4个支架者3例 (约占1 6 % ) ,手术成功率达到99 %。结论 :围手术期的合理配合与正确护理对提高PTCA的成功率 ,减少并发症具有重要的意义     

围手术期营养支持在胃肠手术病人中的应用

目的:应用主观全面评价(SGA)法对外科病人进行营养评定,并观察围手术期营养支持对胃肠手术病人的效果.方法:回顾性总结了76例胃肠手术病人,应用SGA法进行营养状况评定,统计各组围手术期营养支持情况,观察围手术期营养支持对病人血红蛋白、清蛋白、前清蛋白、转铁蛋白、纤维连接蛋白等的影响以及手术并发症等情况.结果:应用SGA法评定,34例(44.7%)存在营养不良;与入院时相比,术后血红蛋白明显下降,清蛋白在术后2周内明显下降,前清蛋白在术后2周时明显上升,术后1周转铁蛋白明显下降;各组手术并发症发生率分别为19%、29.6%和14.3%.结论:SGA法可对手术病人进行初步营养评定;围手术期营养支持可改善营养不良的胃肠外科病人的营养状况,但对营养良好的病人效果不明显.