改良气囊导尿管内固定方法的临床探讨

目的探讨改良气囊导尿管的内固定方法，减轻患者的不适感，增加尿管留置成功率。方法将150例需留置导尿管的患者随机分为A、B、C3组，常规导尿成功后，A组向气囊内注入生理盐水12ml；B组向气囊内注入空气12ml；C组向气囊内注入生理盐水和空气各6ml，于24h后采用自制问卷调查患者不舒适的程度，并在1周后统计置管的成功率。结果A组Ⅱ度以上不舒适38例，留置失败1例，失败率为2．0％；B组Ⅱ度以上不舒适5例，留置失败12例，失败率为24．0％；C组Ⅱ度以上不舒适5例，留置失败2例，失败率为3．9％。满意度B组与C组比较差异无统计学意义，A组与B组和C组比较差并均有统计学意义（P〈0．01）。失败率A组与C组比较差异无统计学意义（P=0．3864），B组与A组和C组比较差异有统计学意义（P〈0．01）。结论3组从舒适的角度和留置成功率全面比较C组的方法优于A、B两组，留置气囊导尿管时向气囊内注入生理盐水和空气各6ml是内固定最佳的方法，在临床上是可行的。     

腰大池持续外引流的临床观察与护理

笔者报道72例腰大池持续外引流病人的观察与护理。认为对于腰穿持续外引流的病人，观察脑脊液的性质、量，严密观察病情变化，加强引流管的护理及基础护理，增强营养，是提高治愈率，减少并发症的重要措施。     

Chest wall implantation of lung cancer at the drainage tube site: Report of a case

We report herein the case of a 70-year-old man in whom a chest wall implantation of adenocarcinoma of the lung at the drainage tube site was found 4 months after a right lower lobectomy with mediastinal lymph node dissection had been performed for adenocarcinoma of the right lower lobe. The lesion was successfully treated by tumor extirpation. We believe that tumor seeding to the chest wall occurred at the time of thoracotomy. To prevent such tumor seeding, the pleural cavity should be washed out routinely with a massive volume of physiological saline solution prior to closure of the chest wall.     

A study of infant feeding practices in an urban Indian community

Thirty mothers, attending either a paediatric clinic at a Government hospital or a private paediatrician's surgery, both in Tirupati, Andhra Pradesh, South East India, were questioned about their infant feeding practices. A sample of milk from their child's bottle was requested and subsequently analysed for the presence of dilution. Over-dilution, defined as less than 75% of the standard concentration, was found to be common (P<.05). No significant correlations were found between the incidence of over-dilution and either family income or educational status of the mothers due to the small sample size. The study suggests the need for practical education on the reconstitution of milk feeds.     

恶性梗阻性黄疸的外科姑息治疗

不能切除肿瘤的恶性梗阻性黄疸的外科姑息治疗方法繁多，本文介绍自1989年以来，采取开腹经不同途径的带支撑导管胆肠内引流的方法治疗30例，减黄确切，尚对7例高位胆管癌在解除胆道梗阻的基础上行术后(192)Ir和(60)Co联合放疗，提高了病人生存质量及延长了生命。     

Management of abdominal sepsis

Introduction: Today the management of the different forms of peritonitis is generally standardised. The classification of primary and secondary peritonitis is well accepted. From a pathophysiological point of view, postoperative and post-traumatic peritonitis should be considered as independent entities. The bacteriological isolates from the inflamed peritoneal cavity do not correlate with the clinical course, and the occurrence of enterococci and bacteroides may be slightly related to ongoing infectious complications. Classification: Valuable scoring systems mainly rely on systemic signs of the septic disease and seem to better differentiate the prognosis of the disease than more surgically oriented scores do. Although the scoring systems did not allow any clinical decision, they should be used to help better compare patients treated in different institutions. The observation of the minor relevance of bacteriology and the superiority of general sepsis scores agrees with the fact that pre-existing septic organ dysfunction and pre-existing comorbidity are the main determinants of mortality. Treatment: Surgical therapy focuses on the control of the source of infection because it has been clearly shown that, without resolving the source of infection, the prognosis remains poor. Adjuvant surgical measures aim at the further reduction of the bacterial load in the peritoneal cavity. Planned relaparotomy, relaparotomy on demand, and continuous closed peritoneal lavage are used. Results: Clinical results proved these methods to be equally effective although pathophysiological considerations favour closed peritoneal lavage. Conclusion: Summarising the available data, we need a more sophisticated understanding of the pathophysiology of the peritonitis, and well-designed clinical studies are necessary to define the optimal surgical treatment modalities. Received: 27 November 1997     

肝尾状叶的外科解剖及其临床应用

在42例成人肝脏标本上，研究了肝尾状叶的形态，动脉、静脉和肝管的分布特征；尾状叶常有3个突起，即尾状突、乳头突和下腔静脉后突，且变异较大；尾状叶有两个恒定的蒂，其结构排列由浅入深分别是门静脉支、肝动脉支和肝管。尾状叶静脉有2～5支，其中以3支居多，主要汇入下腔静脉肝后段的中、下1／3部的左前壁。中结合解剖学研究总结了施行肝尾状叶肿瘤切除术的方法和经验。     

机械通气气管插管吸痰方法探讨

目的探讨不同的吸痰方法,从而有效地清除气管插管患者的呼吸道分泌物。方法对47例气管插管病人均采用常规法和呛咳法两种方法吸痰,呛咳法要求:吸痰管带负压进入气管插管,随吸痰管插入深度调节负压,适时安全吸痰,适度气道湿化。常规法按临床一般方法进行吸痰。将两种方法吸出的痰量,痰液性状及吸痰前后20min血氧饱和度(SpO2)进行比较。结果两种方法在吸出的痰量,痰液性状和SpO2方面存在着显著差异(P<0.05,P<0.01),呛咳法吸出的痰多且粘稠。吸痰后SpO2明显高于吸痰前和常规法。结论呛咳法吸痰能充分吸出气道深部的痰液,可以有效防止气道阻塞,改善通气功能。     

伴和不伴类风湿性关节炎患者腰椎管狭窄后路减压融合过程中隐性失血的对比

背景:腰椎管狭窄症后路手术除术中出血和术后引流外,还存在大量的"隐性失血"。合并类风湿性关节炎患者可能会影响围术期出血尤其是隐性失血,此前并无报道。目的:针对合并类风湿性关节炎的腰椎管狭窄患者与非类风湿性关节炎行腰椎后路手术时术中出血量、术后引流量以及隐性失血情况进行对比,并探讨类风湿性关节炎患者隐性失血的危险因素。方法:回顾性纳入了65例合并类风湿性关节炎的腰椎管狭窄患者(类风湿性关节炎组),筛选87例未合并类风湿性关节炎的腰椎管狭窄患者(非类风湿性关节炎组),所有患者均采取椎弓根螺钉+钛棒+椎间融合器内固定系统进行腰椎后路减压融合和后外侧融合治疗,术中行自体骨后外侧植骨。提取信息包括人口统计学信息、类风湿性关节炎信息(如类风湿性关节炎病史、Steinbrocker分级、抗类风湿性关节炎药物)、手术信息以及出血量相关指标。以术中出血量、术后引流量和隐性失血作为主要指标;以手术时间、术前术后红细胞压积和血红蛋白及其变化值、手术前后贫血数量、术后新发贫血数量、自体血和异体血输注量等作为次要指标。结果与结论:①类风湿性关节炎组腰椎管狭窄患者平均年龄为(65.97±8.02)岁,平均体质量指数为(25.76±3.68)kg/m^2,非类风湿性关节炎组中患者在性别比例、年龄和手术节段数上均与之匹配;②类风湿性关节炎组中患者平均病程为(16.78±12.73)年,其中单药或联合口服改变病情抗风湿药者最常见,2组在椎弓根螺钉数和椎间融合器置入数量上差异均无显著性意义,围术期并发症发生率2组差异亦无显著性意义;③主要结果对比显示2组在总失血量、术中出血量和术后引流量方面差异无显著性意义,而隐性失血以及隐性失血所占总失血量比例在非类风湿性关节炎组中更低(P<0.001,0.012);根据手术节段数进行分层分析,长节段(≥3节段)手术中非类风湿性关节炎组中隐性失血和隐性失血所占总失血量比例均优于类风湿性关节炎组;④次要指标对比红细胞压积改变值(P=0.021)在非类风湿性关节炎组小于类风湿性关节炎组但血红蛋白减小值2组差异无显著性意义;术后2组新发贫血以及贫血加重情况相比差异无显著性意义,异体血输注和手术时间相比差异也无显著性意义;⑤对类风湿性关节炎组患者隐性失血进行多元线性回归分析显示,类风湿性关节炎的Steinbrocker级别高、未服用改变病情抗风湿药、血红蛋白变化和输注异体血为隐性失血的独立危险因素;⑥提示类风湿性关节炎组和非类风湿性关节炎组在总失血量、术中出血、术后引流和手术时间上无差异,而隐性失血以及隐性失血所占总失血量比例类风湿性关节炎组高于非类风湿性关节炎组,尤其是长节段手术;类风湿性关节炎组的Steinbrocker分级高、未服用改变病情抗风湿药、血红蛋白改变较多以及输注异体血为隐性失血的独立危险因素。