电视胸腔镜解剖学肺叶切除20例

目的 探讨电视胸腔镜（ＶＡＴＳ）辅助小切口解剖学肺叶切除术的手术式和手术指征,尤其对肺癌的手术。方法 应用ＶＡＴＸＳ辅助小切口中小学肺叶切除手术２０例,手术通过胸前外侧７ｃｍ左右辅助小切口,ＶＡＴＳ专用器械和常规开胸器械联合使用。２０例肺叶切除共用缝合切割器（ＥＮＤＯＰＡＴＨ）钉仑４４只,肺癌病人通过小切口均作了肺门及纵隔淋巴结摘除。３例术中因胸膜腔粘连肺裂不完整和门血管粘连出血处理困难,将辅助小     

下颈椎后路固定方法的力学比较

目的：评价不同于颈椎后路内固定器的生物力学性能。方法：应用５具新鲜尸体颈椎标本（Ｃ２￣Ｃ７）建立脱位模型后,依次用棘突钢丝、侧块螺钉、自制螺钉、椎弓根螺钉固定,用材料试验机测算其垂直压缩刚度,前后水平剪切刚度和左右水平剪切刚度。结果：棘突钢丝的垂直压缩刚度和前后剪切刚度虽较完整颈椎增大,但无显著性差异（Ｐ〉０．０５）,而左右剪切刚度尚较完整颈椎减小（Ｐ〈０．０５）。侧块螺钉、自制螺钉和椎弓根螺钉的     

胸导管结扎预防食管癌术后乳糜胸的临床研究

目的　寻找减少或消除食管癌切除术后乳糜胸发生率的有效方法。方法　随机选取 45例 (A组 )食管癌患者 ,在食管癌切除加胃 食管残端吻合时 ,一期行预防性低位胸导管结扎术 (第 8胸椎水平以下 ) ;另 92例 (B组 )作对照组 ,仅做食管癌切除加胃 -食管残端吻合术。结果　两组患者在术后乳糜胸发生率 (A :1/ 45 ;B :9/ 92 ,P =0 0 3)、术后 48h胸腔引流量〔第 1个 2 4h :A :(2 5 4 33± 45 15 )ml,B :(4 93 6 1± 76 6 7)ml;第 2个 2 4h :A :(141 11± 2 5 5 3)ml,B :(32 3 39± 5 8 17)ml;P <0 0 5 )〕、3天内拨管率 (A :94 78% ;B :6 2 2 1% ,P =0 0 0 1)、并发症 (A :3/ 45 ,B :0 / 92 ,P =0 0 34)以及随访锁骨上淋巴结转移 (A :0 / 45 ,B :9/ 92 ,P =0 0 3)等方面有统计学意义。结论　术中行预防性低位胸导管结扎术可明显减少甚至消除食管癌患者术后乳糜胸的发生。     

非感染性肺底积液的X线诊断分析

目的 :探讨肺底积液X线诊断的准确性。方法 :回顾性分析 42例非感染性肺底积液的X线征象。结果 :肺底积液的主要X线表现是假膈征、心淹征、双膈影征和变换体位液体弥散征象。结论 :熟悉肺底积液的X线诊断和鉴别诊断 ,对肿瘤患者胸膜转移的早期诊断、及时治疗有重要意义。     

沈氏装置稳定性的生物力学评价

评价沈氏经椎弓根内固定装置的生物力学稳定性。方法采用５具新鲜尸体脊柱标本,制造Ｌ１损伤模型,测量并比较标本在完整状态,损伤状态、沈氏装置固定、沈氏装置疲劳及ＣＤ装置固定下的Ｔ１２和Ｌ２之间的三维运动范围,并将沈装置与ＣＤ装置固定下的运动范围进行,经统计学处理,评价沈氏装置的稳定性。     

Characterization of α1-adrenoceptor subtypes mediating contractions to phenylephrine in rat thoracic aorta,mesenteric artery and pulmonary artery

1. The subtype of α₁-adrenoceptor mediating contractions to phenylephrine of the rat thoracic aorta, mesenteric artery and pulmonary artery were investigated by use of antagonists which show selectivity between the cloned α₁-adrenoceptor subtypes in binding studies.
2. Cumulative concentration-contraction curves for phenylephrine were competitively antagonized in the rat thoracic aorta by prazosin (pA₂ 9.9), WB4101 (pA₂ 9.6), 5-methylurapidil (pA₂ 8.1), benoxathian (pA₂ 9.2) and indoramin (pA₂ 7.4). These compounds were also competitive antagonists in the mesenteric and pulmonary arteries (except for 5-methylurapidil in the pulmonary artery), (prazosin pA₂ 9.9 and 9.7; WB4101 pA₂ 9.8 and 9.6; 5-methylurapidil pA₂ 7.9 and pK_B estimate 8.0; benoxathian pA₂ 8.8 and 9.3; indoramin pA₂ 7.2 and 7.5, respectively).
3. RS 17053 was not a competitive antagonist in any blood vessel as Schild plot slopes were greater than unity. The pK_B estimates for RS 17053 were 7.1 in aorta, 7.0 in the mesenteric artery and 7.7 in the pulmonary artery.
4. The α_1D-subtype selective antagonist BMY 7378 appeared to be non-competitive with shallow Schild plot slopes. The data were better fitted with two lines in all tissues, with Schild plot slopes that were no longer different from unity, except in the pulmonary artery. The higher affinity site for BMY 7378 in the aorta had a pA₂ of 9.0, while it was 8.8 and 8.9 in the mesenteric and pulmonary arteries, respectively.
5. MDL73005EF acted in a non-competitive manner in all three blood vessels, with shallow Schild plot slopes. The pK_B estimates for MDL73005EF were 8.4 in aorta, 7.5 in the mesenteric artery and 8.0 in the pulmonary artery.
6. In all three blood vessels the functionally determined antagonist affinity estimates correlated best with published pK_i values for their displacement of [³H]-prazosin binding on membranes expressing cloned α_1d-adrenoceptors compared with α_1a- or α_1b-adrenoceptors. The antagonist affinity estimates in the aorta, mesenteric and pulmonary arteries correlated highly with their previously published pA₂ values in rat aorta (α_1D) and less well with those for α_1A- and α_1B-adrenoceptors mediating contraction of the rat epididymal vas deferens and rat spleen, respectively.
7. The results of this study suggest that the contraction to phenylephrine of the rat thoracic aorta, mesenteric artery and pulmonary artery are mediated in part via the α_1D-subtype of adrenoceptor. The data for both BMY 7378 and MDL73005EF in all three blood vessels are consistent with receptor heterogeneity. However, the identity of the second site is unclear.

     

The effect of accident mechanisms and initial findings on the long-term course of whiplash injury

The aim of this study was to assess the relationships between accident mechanisms as well as initial findings and the long-term course of whiplash injury. A representative sample of 117 consecutive patients referred by primary care physicians was followed-up over 12 months. Fractures or dislocations of the cervical spine, head trauma and pre-existing neurological disorders were exclusion criteria. The interval between the accident and the baseline examination was 7.4 days (SD 4.2 days). Assessment included accident features (e.g. passenger position in the car, head restraint, head position, type of collision), initial symptoms (e.g. intensity and onset of pain, symptoms of neurological dysfunction, multiple symptom score), and signs (restricted neck movement, neurological deficits). At the 1-year examination, patients were divided into an asymptomatic and a symptomatic group and were compared with respect to accident features and baseline findings. Twenty-four percent of patients were still symptomatic after 1 year. Analysing accident mechanisms separately, rotated or inclined head position was the primary feature related to symptom persistence (P=0.005). The symptomatic group scored higher at baseline on the multiple symptom rating (P=0.004) and had a higher incidence of initial headache (P=0.004) and neurological symptoms (P=0.008) together with a higher intensity of headache (P=0.0002) and neck pain (P=0.0009). The following set of initial variables predicted persistence of symptoms at 1 year (logistic regression): intensity of neck pain (P=0.001) and headache (P=0.009), rotated or inclined head position (P=0.02), unpreparedness at the time of impact (P=0.01) and car stationary when hit (P=0.01). In conclusion, accident mechanisms and initial findings suggestive of more severe injury were significantly related to long-term persistence of symptoms after whiplash injury.This study was supported by the Swiss National Science Foundation (project number: 3.883-0.88) and the Swiss Accident Insurance Company (Schweizerische Unfallversicherungsanstalt), Berne     

Anaesthetic management of a patient with a descending thoracic aortic aneurysm and severe bilateral bullous pulmonary parenchymal disease

The anaesthetic management of the surgical repair of a descending aortic aneurysm in a patient with large, bilateral, pulmonary bullae is described. Anaesthesia for descending aortic surgery normally involves unilateral, positive-pressure ventilation, an option which poses some risk of barotrauma in the presence of bilateral bullae. Patients with bullous disease commonly have severe lung disease and thorough preoperative assessment and preparation are necessary. Intraoperatively, bilateral rupture of the bullae could be catastrophic and preparations should be made for this possibility. In order to diminish this risk, a surgical technique including preemptive collapse of the bulla by minithoracotomy and tube drainage, with use of a bronchial blocker to the affected part of the lung may be used. If rupture occurs, then high frequency jet ventilation may be effective. Use of a double lumen endobronchial tube may be advantageous for patients with either unilateral and bilateral bullae. Anaesthesia for patients with bullae should avoid positive-pressure ventilation and nitrous oxide in order to limit the risk of barotrauma from a ball valve mechanism. In this case, the risk of barotrauma was reduced by performing an inhalational induction of anaesthesia and limiting peak inflation pressures during thoracotomy. It was elected to use positivepressure ventilation through a double lumen endobronchial tube following chest incision. A high frequency jet ventilator was available but not employed. Anaesthetic management was complicated by the presence of pleural adhesions, surgical approach directly through a bulla, and the requirement for one lung ventilation. The de i’aone descendante aecouverte cnez un pattent porde grosses bulles bilatérales d’emphysème est discutée, esthésie habituelle pour une chirurgie de l’aorte descendante site une ventilation mécanique unilatérale et constitue ainsi sque additionnel pour le porteur de bulles emphysémas bilatérales. Ces patients ont ordinairement des affections onaires graves et l’évaluation et la préparation préopéraprennent une importance spéciale. Pendant l’intervention, pture de bulles bilatérales peut être catastrophique et il se préparer à cette éventualité. Pour minimiser ce risque, technique chirurgicale qui inclut le collapsus préventif de lle par minithoracotomie et drainage, avec installation d’un ieur bronchique sur la partie atteinte du poumon. Si une re survient, le passage à la ventilation par jet à haute tence peut être salutaire. Le tube endobronchique à double ère peut présenter des avantages aussi bien dans les cas ulles unilatérales que bilatérales. Chez ces patients, il vaut x s’abstenir de ventiler avec une pression positive et du xyde d’azote afin de limiter le risque de barotraumisme soupape. Dans ce cas-ci, on a réussi à limiter le risque arotraumatisme en réalisant une induction par inhalation réduisant la pression d’inflation de pointe pendant la cotomie. Après l’incision thoracique, on a choisi d’utiliser tilation mécanique avec un tube endobronchique à double ère. Un ventilateur à jet à haute fréquence était prêt mais as été utilisé. La gestion de l’anesthésie a été compliquée par dhérences pleurales, par la rencontre d’une bulle d’emphysà l’incision et par l’obligation de ventiler un seul poumon.     

44例脓胸的外科治疗

目的：探讨脓胸的治疗方法。方法：根据已出院的44例脓胸患者的治疗资料进行分析。结果：胸腔闭式引流、胸腔灌洗是治疗中不可缺少的手段。结论：在全身治疗的基础上,配合胸腔闭式引流、胸腔灌洗、必要的外科手术可望取得较为理想的治疗结果。     

胸段硬膜外麻醉对神经肽Y的影响

为探讨胸段硬膜外麻醉对患者血浆ＮＰＹ的影响,本文采用放射免疫分析法测定了３１ 例择期上腹部手术病人胸段硬膜外麻醉前后血浆ＮＰＹ的含量。结果显示：麻醉后平均动脉压较麻醉前显著下降（ Ｐ＜０－０１） ,血浆ＮＰＹ则无显著变化（ Ｐ＞ ０－０５）。提示患者处于硬膜外麻醉状态下体内ＮＰＹ 含量的变化与交感神经系统调节具有一定的关系。