腰麻硬膜外联合麻醉在全产程中的镇痛效果及对母婴的影响

①目的　探讨腰麻硬膜外联合麻醉在全产程中的镇痛效果以及对母婴的影响。②方法　选择ASAⅠ～Ⅱ级、无禁忌证的单胎头位临产初产妇 30 0例 ,随机分为腰硬组 (腰麻硬膜外联合麻醉 )、硬外组 (硬膜外麻醉 )和对照组 (未用任何麻醉方法 )各 10 0例。行L2～ 3 椎间隙一点穿刺并一次成功。分别观察镇痛效果、起效时间、用药量、副作用、产程、分娩方式及母婴情况。③结果　腰硬组镇痛效果、起效时间以及用药量明显优于硬外组(uc=5 .34,t=16 .92～ 2 9.6 9,P <0 .0 1) ;与对照组比较 ,宫颈扩张加速 ,第一产程明显缩短 ,而第二产程延长 (t =3.34～ 4 8.4 9,P <0 .0 1) ,剖宫产率明显下降 ,而阴道助产率增高 ,胎儿宫内窘迫的发生率下降 (χ2 =6 .82～ 2 0 .35 ,P <0 .0 1)。④结论　腰麻硬膜外联合麻醉用于分娩镇痛优于硬膜外麻醉 ,是一种安全有效、更适合全产程镇痛的麻醉方法。     

胸椎骨折合并胸外伤的外科治疗

目的　总结 17例胸椎骨折患者的特点与诊疗情况 ,为提高此类合并胸外伤患者的疗效提供有效的治疗方案。方法　分析了 17例胸椎骨折患者的临床特点、诊疗经过、近远期随访结果。结果　 14例 (82 .4 % )合并肋骨骨折 ,11例 (6 4 .7% )合并血气胸 ,10例 (5 8.8% )合并严重脊髓伤 ,3例 (30 % )远期脊髓伤为有用恢复。结论　胸椎骨折常合并肋骨骨折、血气胸、严重脊髓损伤 ,预后较差 ,为此应重视合并胸外伤的胸椎骨折的围手术期处理     

The Application of Topical Anesthesia Combined with Subconjunctival Anesthesia for Glaucoma Surgery

Purpose: To evaluate the feasibility, reliability and analgesia effect of topical anesthesia combined with subconjunctival anesthesia in anti-glaucomatous surgery.Methods: Two hundred and four cases (357 eyes) underwent anti-glaucomatous surgeries under topical anesthesia with 0.5％ Alcaine eye drops combined with subconjunctival anesthesia with 2％ Lidocaine. The analgesic effect was analysed with visual analogue pain scale.Results: Among all of 357 eyes, 62 eyes underwent peripheral iridectomy, 67 eyes underwent simple trabeculectomy, 167 eyes underwent compound brabeculectomy and 12 eyes nonpenetrating trabecular surgery. The effects of anesthesia were as follows: 304 eyes (85.2％) were painless (Grade Ⅰ), 50 eyes (14.0％) were slight painful (Grade Ⅱ), and 3 eyes (0.8％) were more painful (Grade Ⅲ) during surgery. And no severe complications were observed in all the cases during surgery and postoperatively. Amaurosis fugax was not observed in the glaucoma patients at the late stage with narrow vi     

臂丛加强化麻醉后并发颈部抽动9例分析

目的探讨臂丛加强化麻醉后颈部抽动的原因及防治。方法对近年来在麻醉方法、用药相同,术后颈部抽动患者的观察治疗过程进行分析。结果臂丛麻醉并发颈部抽动给予充分镇静后可完全治愈。结论麻醉后并发颈部抽动为药物副作用及颈局部刺激的综合作用。     

Double congenital bronchoesophageal fistulae in an adult

We report adult congenital bronchoesophageal fistula with both symptomatic fistula and asymptomatic one. A 56-year-old woman with a history of cough after drinking fluids was diagnosed as bronchoesophageal fistula by upper gastrointestinal series that showed a diverticulum in the middle portion of the esophagus with a fistula between the esophagus and right lower lung. Esophagoscopy revealed an orifice of the fistula located 27 cm from the incisors. Computed tomography showed chronic inflammatory change with bronchiectasis in the S6 segment of the right lung. The patient underwent video assisted thoracic surgery that identified two fistulae without missing a symptomatic one, and both were successfully resected. The fistulae were lined by squamous epithelium and smooth muscle without evidence of malignancy, infection or chronic inflammation that were histologically compatible with congenital fistulae.     

上胸椎骨折手术治疗方法的探讨

目的 探讨上胸椎骨折的特点及治疗。方法 15例病人按AO分型，A型2例、B型10例、C型3例。均经后路切开复位、脊髓减压、长节段内固定、取髂骨植骨融合术治疗。结果 随访18-24个月，后路长节段固定随访时无一例失败，完全瘫的患者9例中有1例神经功能改善I级．不完全瘫的5例均有Ⅲ级改善，1例无神经损伤。结论 上胸椎骨折损伤严重，后路长节段固定技术是一种合理的有效治疗方法。     

长托宁用于全麻术前用药的效果观察

目的:观察长托宁作为全麻病人麻醉前用药对心血管系统和呼吸道分泌物的影响.方法:随机选择20例需全麻手术病人,在麻醉诱导前静注长托宁0.015 mg/kg,观察注药前、后5、10、20分钟各时点的血压、心率、脉搏氧饱和度及口干程度以及术中术毕口腔和呼吸道分泌物情况.结果:病人使用长托宁后5、10、20分钟的血压、心率与使用前相比有下降趋势,但无统计学意义(P＞0.05),脉搏氧饱和度未见明显改变,用药10分钟病人有轻度口干,术毕拔除气管导管时口腔及呼吸道分泌物较少.结论:长托宁用于全麻病人麻醉前给药效果满意.     

Percutaneous nephrolithotomy of a staghorn stone in thoracic ectopic kidney

Congenital thoracic ectopic kidney is a very rare developmental anomaly and the rarest form of all ectopic kidneys. It is usually asymptomatic and discovered incidentally on routine chest radiography. Herein we reported the first case of staghorn stone in a thoracic kidney managed successfully by percutaneous nephrolithotomy.     

胸部类癌

本文报道了３１例胸部类癌，其中胸腺类癌１４例，支气管类癌１７例，伴有异位ＡＣＴＨ综合征者１７例。１２例患者发生转移（３９％），２４例行原发肿瘤全部或部分切除，术后放疗或化疗或两者均有者１７例，４例仅行探查并取活检，２８例经手术及病理证实。     

Unusual course of an epidural rhabdomyosarcoma of the upper thoracic spine

Summary This report deals with a case of rhabdomyosarcoma in the upper thoracic spine. It is of particular interest, not only for the rarity of type and location of this tumour, but for its clinical course, which presented fluctuations of neurological status, included an acute demonstration of complete paraplegia followed by full recovery after conservative treatment, and gradual relapsing of neurological deficit, one year later.