肥胖病人全膝关节表面置换术后疗效观察

[目的]本研究回顾性研究肥胖（根据体重指数）是否是全膝关节表面置换术的危险因素。[方法]由同一组医生使用同一种假体对320例520个膝骨性关节炎患者行全膝关节表面置换手术治疗。[结果]术前肥胖组功能评分较超重组、非肥胖组为低（分别P〈0．05），但关节评分无显著性差异。通过平均28．3个月的随访，无论膝评分和功能评分各组术后均明显提高，各组提高的幅度比较在统计学上无显著性差异（分别P〉0．05）。肥胖组围手术期并发症明显增高。[结论]肥胖病人膝关节置换手术可以取得满意疗效，但围手术期并发症增多，包括伤口愈合、感染、内侧副韧带损伤，注意伤口缝合技术和保护内侧副韧带可减少此类并发症。     

经腹探查改良全腹膜外腹腔镜腹股沟疝修补术

目的探讨经腹探查改良腹腔镜全腹膜外腹股沟疝修补术式（total extraperitoneal repair，TEP）的可行性和优越性。方法从2003年10月至2004年6月，完成了传统TEP术60例。从2004年7月至2007年8月对160例腹股沟疝患者实施了经腹探查改良TEP（即手术开始先行经腹探查）。按术中是否经腹探查分为传统TEP组和改良TEP组。登记患者年龄、性别，记录术中发现对侧隐匿性腹外疝例次、术中漏气与否（是否需要Verres针排放腹腔气体）、术后住院天数、术后恢复日常活动天数以及术后复发情况。结果改良TEP组160例诊断出40例隐匿性腹外疝，包括32例腹股沟疝，8例股疝，而传统TEP组60例中仅发现4例隐匿性腹股沟疝。两组对隐匿性腹外疝的检出比例分别为25％和6．67％，经检验x2=9．167，P〈0．05；比较两组漏气入腹的发生比例19．4％和16．7％，检验x2=0．127，P〉0．05，比较两组患者术后住院天数、恢复日常活动天数，经t检验，P值均〉0．05；改良TEP组回纳经体外不能回纳的大网膜14例，联合行腹腔镜胆囊切除术4例，腹腔镜阑尾切除术3例，与泌尿外科合作同期切除同侧隐睾5例，精索鞘膜积液切除和前列腺电切各1例。传统TEP组有2例复发，腹股沟斜疝和直疝各1例，均位于对侧。结论经腹探查加传统TEP术式是可行的，改良TEP提高了传统TEP术式的效果，扩展了TEP的手术适应症，使TEP联合其它常见腹部外科腹腔镜手术得以实现。     

Development of Mechanical Circulatory Support Devices in China

Myocardial dysfunction leading to low cardiac output syndrome is a common clinical pathophysiological state. Currently, the use of mechanical circulatory support (MCS) is an essential aspect of the treatment of patients with cardiac failure. Several groups in China are engaged in the design and development of MCS devices. These devices can be classified as pulsatile, rotary, and total artificial heart (TAH). There are two types of pulsatile pump, which are driven by air (pneumatic). One of these pumps, the Luo‐Ye pump, has been used clinically for short‐term support since 1998. The other is a push‐plate left ventricular device, which has a variable rate mode. Various rotary devices are classified into axial and centrifugal pumps, depending on the impeller geometry. Most rotary pumps are based on the maglev principle, and some types have been used clinically. Others are still being studied in the laboratory or in animal experiments. Furthermore, certain types of total implantable pump, such as the UJS‐III axial pump and the UJS‐IV aortic valvo‐pump, have been developed. Only one type of TAH has been developed in China. The main constituents of this artificial heart are two axial pumps, two reservoir tanks mimicking the right and left atria, flow meters, two pressure gauges, and a resistance adaptor. Although the development of mechanical assist devices in China is still in a nascent stage, a number of different types of MCS devices are currently being studied.     

瑞芬太尼的靶控输注在自主呼吸短小手术病人中的应用

目的:研究瑞芬太尼作为短小手术异丙酚静脉平衡全麻的临床意义。方法:检验和观察瑞芬太尼在20例行短小手术麻醉病人的呼吸抑制效应。结果:异丙酚的靶控输注浓度为4.5μg·mL-1,瑞芬太尼的靶控输注浓度是变化的,12例病人的自主呼吸能够满意维持,在这些病人当中,瑞芬太尼的靶控输注浓度为1.6 ng·mL-1,输注速度的中位数为0.05μg·kg-1·min-1,保持自主呼吸情况下的瑞芬太尼的浓度范围很宽,范围相差4.7倍,即0.6-2.8 ng·mL-1。结论:瑞芬太尼的半数有效浓度变化大,因此全身麻醉的开始浓度就很难确定,在适当的时候使用控制呼吸还是必要的,尽管加大瑞芬太尼的剂量而减少了异丙酚的用量,但病人同样可以快速苏醒主要得益于瑞芬太尼的超短时间敏感半衰期。     

蒸参水化学成分的研究

本文阐述了蒸参水的化学成分。实验结果表明,蒸参水含有人参总皂甙(1.90g/L),多种氨基酸和多种维生素。     

无血切肝术治疗原发性肝脏恶性肿瘤

目的 探讨无血切肝术在治疗常规手术方法难以切除的肝脏原发性恶性肿瘤中的价值。方法选择有肝切除手术适应证而以常规手术方法不能切除，或外院已作剖腹手术未能切除的肝脏原发性恶性肿瘤，加施无血切肝技术进行治疗６８例资料进行总结分析。结果 ６８例均完成无血切肝术，其中经腹常温下全肝血流阻断切肝术６６例，经胸腹联合切口常温下全肝血流阻断切肝术＋右肺下段转移癌切除术２例。施行右三叶肝切除３例，左三叶肝切除术２例     

各级医疗机构家庭病床常见慢性病的费用及其构成情况调查分析

通过对我市的省、市、区三级医院家庭病床科以及社区卫生服务中心家庭病床６种觉见慢性病的费用及其构成的调查分析得出：不同级别医院家庭病床总费用、日均费用均有显著性差异（Ｐ〈０．０５），医院级别越高，家床费用也越高，且公费病人的日均费用明显高于自费病人。区级及以下医疗机构尤其是社区服务中心的家床是最经济的，其社会效益和经济效益巨大。为此，应完善相关配套政策，理顺社区与上级医院的关系，建立双向转诊制度，以最大限度满足老年人就近服务的保健需要求。     

Nutritional Status and Body Fluid Distribution in Chronic Alcoholics Compared With Controls

BACKGROUND: At present few data are available on the total body water (TBW) content and in particular on the distribution of water in the intra- and extracellular compartments (ICW and ECW) of alcoholics. The aim of this study was to evaluate TBW, ICW, and ECW in chronic alcoholic patients. METHODS: Thirty-six alcoholics meeting DSM-III-R criteria for diagnosis (20 men, 16 women; body mass index [BMI] 22.3+/-2.57 kg/m2) were enrolled. Fifty-four healthy social drinkers (31 men, 23 women; BMI 23.7+/-1.68 kg/m2) matched for age and height were used as controls. Systolic and diastolic blood pressure was measured for all cases. All patients were assessed using specific anthropometric measurements. The waist-to-hip ratio (WHR) was used as an indicator of body fat distribution. TBW was measured by isotopic dilution by giving 100 microCi of tritiated water. ICW and ECW were assessed by multifrequence bioelectric impedance analysis (BIA). Basal metabolic rate (BMR) was measured by indirect calorimetry. RESULTS: Body weight was lower in the alcoholics than in the controls (61.9+/-5.5 kg vs. 65.8+/-5.2 kg;p < 0.01), essentially due to a reduction in fat mass. Significantly higher WHR values were found in both male (p < 0.001) and female (p < 0.001) alcoholics than in healthy subjects. A higher ECW/TBW ratio was found in the alcoholics compared with the controls, both as a whole (0.53+/-0.04 vs. 0.41+/-0.03; p < 0.0001) and separated by gender (p < 0.001). CONCLUSIONS: The increased ECW could derive from an increase in cellular permeability related to endothelial damage linked to the vasoconstriction present in the alcoholics and/or to a direct toxic effect of ethanol on cellular membranes. In addition, because the high ECW volumes correlated positively with WHR in the alcoholics, a potential association of these two factors in determining an increased risk of liver disease, hypertension, and cardiovascular disease may exist. Finally, the lower TBW characteristic of women may be one of the reasons for the observed greater rate of toxic effects of ethanol that occur in women.     

酶法测定血清总胆汁酸在肝病诊断中的应用

通过对英国ＲＡＮＤＯＸ公司生产的酶法测定总胆汁酸试剂盒临床应用应用的可行性进行评价和测定肝病患者血清ＴＢＡ含量，评价酶法测定血清ＴＢＡ在各种肝病诊断中的应用价值。结果；批内ｃｖ为１．２７％和０．８％，批间ｃｖ２．０９％和１．５０％，回收率为１０１．２％，线性范围０－３００μｍｏｌ／Ｌ。