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11.
12.
左双腔支气管导管管端位置与吸气峰压变化的关系 总被引:13,自引:3,他引:10
目的 观测无隆突钩双腔支气管导管(DLT)管端位置与吸气峰压(Ppeak)以及肺顺应性环形状改变的关系,探讨用Ppeak和顺应性环的变化评估DLT管端位置的可行性。方法 拟行右侧剖胸手术的成年患者32例,静脉诱导后插入左Mallinckrodt DLT,吸入氧化亚氮和地氟醚维持麻醉。按纤维支气管镜(FOB)确认DLT管端位置和通气方式将观测过程分为四个阶段:第一阶段(S1),管端位置正确的双肺通气;第二阶段(S2),管端位置正确的左侧单肺通气;第三阶段(S3),管端插入左下支气管(置管过深)的左侧单肺通气;第四阶段(S。),管端处在左支气管开口(置管偏浅)的左侧单肺通气。每阶段均机械通气15min。结果 回归方程预计插管深度与FOB检查符合者占71.9%。S2时Ppeak值比S1时增加50.8%,肺顺应性(Cdyn)值减少36.2%;S3时Ppeak值比S1时增加87.4%,Cdyn值减少56.8%。PV环曲线斜率向右明显移位,环体显著延长。结论 用无隆突钩DLT行肺隔离,在无FOB定位的条件时,联合应用听诊法、回归方程预计插管深度、动态监测气道峰压和P-V环的变化综合评估,可提高DLT管端的正确到位率。单肺通气的气道峰压超过双肺通气时的1.65倍,且气道峰压超过25cm H2O.应高度怀疑DLT管端发生过深移位。 相似文献
13.
The measurement of amniotic fluid (AF) acetylcholinesterase isoenzyme (AChEI) is a relatively new method for early diagnosis of open neural tube defects (NTDs). As quantitative methods are of unproven reliability at present, the authors used a high resolving power qualitative method-vertical slab polyaerylamide gel electrophoresis. The benefits of this technique are: simplicity of operation, accuracy, unsophisticated equipment, and easily available reagents. Combined results of 9 NTDs studies revealed that samples from early pregnancy gave more accurate results than those from late pregnancy. 相似文献
14.
Anesthesia safety for endoscopic laryngeal laser surgery has been a major limiting factor for laser applications in the larynx and the hypopharynx. Several anesthesia techniques have been proposed and each technique appears to have its own limitations. This paper will deal with the distinct advantages offered by the malleable copper tube which is used for delivery of the open Venturi system anesthesia for endoscopic laser surgery. A retrospective study of 100 patients who have undergone this modality of anesthesia at our institution will be presented. Our conclusion from this study shows clearly the superiority of the copper tube over the conventional aluminium-foil-wrapped endotracheal tube in safety and the exposure of the larynx during surgery. 相似文献
15.
Johanna Albert Leif Kindlund Barbro Nilvér Waldemar Gożdzik 《Central European Journal of Medicine》2006,1(2):162-171
Abstract: Background: The laryngeal mask airway (LMA) can be used in general anaesthesia without neuromuscular block. The
laryngeal tube (LT) is a new airway device with similar airway features as LMA. LT is provided with a distal cuff to prevent
regurgitation. In this study we compared the LMA and LT concerning patient and user aspects.
Methods: Sixty patients with ASA (American Society of Anestesiologists) score 1–2 scheduled for minor surgery were randomized
to be ventilated either through LMA or LT. After insertion, the number of insertion attempts, and “positioning” and “airway-assessment”
was evaluated. The patients reported on “sore throat” after 30 and 60 minutes and the day after anaesthesia.
Results: Gender and mean age were equal in both groups. The first insertion attempt was successful in 25 of 28 patients randomised
to LMA and in 23 of 27 patients randomised to LT. LMA was evaluated to be easier in “positioning” whereas no difference in
“sore throat” was reported.
Conclusion: We found no difference between the LMA and the LT in terms user and patient friendliness and safety. 相似文献
16.
17.
E. Croce M. Golia M. Azzola R. Russo L. Crozzoli S. Olmi C. Pompa M. Borzio 《Surgical endoscopy》1996,10(11):1064-1068
Background: Thirty-three patients were candidates for laparoscopic choledochotomy. The indications for this operation are described.
Methods: The procedure was completed 32 times (97%). We had 29 successful common bile duct (CBD) clearances, three negative explorations,
and one failed clearance which needed to be converted to laparotomy. All the completed procedures ended with primary closure
of the main duct. Median duration of surgery was 180 min (range 100–300), including three associated laparoscopic procedures.
Results: There were three postoperative complications (9.4%), none major. Average postoperative hospital stay was 7.1 days (range
4–14). In May–June 1995 we controlled 31 out of the 32 consecutive patients (one patient was lost to follow-up) who had a
successful laparoscopic choledochotomy from October 1991 to December 1994. Median follow-up was 22 months (range 5–44). Besides
clinical control, 23 patients also had ultrasound (US) controls and 24 had blood tests. Eleven had intravenous cholangiotomography.
Two patients died 11 and 22 months after the operation for unrelated causes and without biliary symptoms. Two patients had
umbilical hernias. One had a small residual asymptomatic stone, which was removed endoscopically. None had signs of postoperative
CBD stricture. At US, CBD was ≤7 mm in 15 patients, 8–10 mm in four patients, and 10–12 mm in three patients. The last group
had preoperative CBD dilation, too. We could compare preoperative and postoperative CBD diameters in 22 patients: 11 had no
change; in nine it decreased; and two had a slight increase (8–10 mm).
Conclusions: We conclude that laparoscopic choledochotomy with primary closure is a very good operation: It has a high success rate and
low morbidity. Mortality is nil so far. Medium-term results are very positive: We had no CBD stricture and only one case of
asymptomatic residual stone, which could have been avoided. Our results suggest that intraductal biliary drainage is useless,
and its specific complications are well known.
Received: 20 October 1995/Accepted: 28 February 1996 相似文献
18.
Hitoshi Taguchi Koh Yamada Hideo Matsumoto Akira Kato Toshihiro Imanishi Koh Shingu 《Journal of anesthesia》1997,11(3):173-178
Purpose Several case reports indicate critical respiratory complications in relation to the double-lumen endobronchial tube (DLT).
A prospective survey for the airway problems in using the DLT is presented.
Methods One hundred adult patients undergoing thoracotomy for lung cancer were investigated. Tube malposition and airway obstruction
were searched using a fiber-optic scope. The endobronchial cuff was positioned just below the trachcal carina while the trachea
was intubated with a DLT (Rüsch). The distances of displacement, from the tracheal carina to the bronchial cuff, were measured
during anesthesia using an epidural catheter, which had marks every 5 mm. The distances for correcting the tube position were
measured at both the bronchial cuff and the level of the teethPaO2,PaCO2 andSPO2 were also measured.
Results Malposition (displacement over 5 mm from the correct position) was found in 42 patients, and 40 of them were in a withdrawal
direction, occurring at the postural change and during one-lung ventilation, especially during manipulation of the lung hilum.
Correcting distances at the level of the teeth were 15.3–3-times longer than those at the bronchial cuff. Airway deformities
and gradual withdrawal of the bronchial cuff were found in association with surgical manipulation. Obstruction occurred at
the tips of the tracheal tube in four patients and the bronchial tube in six patients, and at the tip of both in two patients.
Hypoxemia (PaO2<60 mmHg) occurred in four patients and hypercapnea (PaCO2>60 mm Hg) in two patients.
Conclusion Most of the DLT obstructions were associated with withdrawal malposition. Great attention to DLT displacement and airway deformity
is advised. 相似文献
19.
以往以乳头为圆心的同心圆剥离法常形成假体的移位,使假体的体表轮廓与前方的自然乳房分离,产生“双重乳房”现象。在研究了女性不同体位下不同的乳房形态及总结了以前的经验后,提出了偏心圆剥离的概念。偏心圆手术设计方法:以乳头为圆心,按其内侧、下侧为直径3/5的比例,以外侧、上侧为直径2/5的比例,形成一偏心圆的剥离范围。偏心圆的直径因考虑到假体的不同形态、大小及底面直径,以经中心假体纵截面的周长的1/2再放大2cm,作为剥离范围的直径。自1991年10月以来已应用了176例,无一术后移位现象,也没有固较多地剥离胸大肌内、下侧止点纤维而影响上肢活动。自然乳房并不是静态的圆锥形或半球形,它具有伸缩的组织学特点,又有随体位变动而变化的特点。用偏心圆法剥离,可使置入的假体与前方的自然乳房融为一体,消除“双重乳房”现象,而成为“真实”的乳房。同时也应积极寻找一种与身体组织相容性好的,弹性、比重与女性乳腺较为一致的,假体容量相对恒定的生物性材料。这样隆乳术才可以更广泛地开展。 相似文献
20.
Central nervous system (CNS) progenitor cells transiently proliferate in the embryonic neural tube and give rise to neurons and glial cells. A characteristic feature of the CNS progenitor cells is expression of the intermediate filament nestin and it was previously shown that the rat nestin second intron functions as an enhancer, directing gene expression to CNS progenitor cells. In this report we characterize the nestin enhancer in further detail. Cloning and sequence analysis of the rat and human nestin second introns revealed local domains of high sequence similarity in the 3' portion of the introns. Transgenic mice were generated with the most conserved 714 bp in the 3' portion of the intron, or with the complete, 1852 bp, human second intron, coupled to the reporter gene lacZ. The two constructs gave a very similar nestin-like expression pattern, indicating that the important control elements reside in the 714 bp element. Expression was observed starting in embryonic day (E)7.5 neural plate, and at E10.5 CNS progenitor cells throughout the neural tube expressed lacZ. At E12.5, lacZ expression was more restricted and confined to proliferating regions in the neural tube. An interesting difference, compared to the rat nestin second intron, was that the human intron at E10.5 mediated lacZ expression also in early migrating neural crest cells, which is a site of endogenous nestin expression. In conclusion, these data show that a relatively short, evolutionarily conserved region is sufficient to control gene expression in CNS progenitor cells, but that the same region differs between rodents and primates in its capacity to control expression in neural crest cells. 相似文献