地氟醚在循环紧闭麻醉中的药代动力学

目的　了解地氟醚在最低流量循环紧闭麻醉中药代动力学的临床表现。　方法　５０例麻醉分级（ＡＳＡ） Ⅰ～Ⅱ级全麻下的择期手术病人。麻醉诱导采用咪唑安定、芬太尼、琥珀胆碱。气管插管后开始１０ ｍ ｉｎ 氧流量为４ Ｌ／ｍ ｉｎ,行间歇正压控制呼吸,地氟醚挥发罐浓度（ＦＤ）８％ 。此后关闭回路,氧流量０．２０～０．３５Ｌ／ｍ ｉｎ,地氟醚ＦＤ １０％ ～１２％ 。维持地氟醚的肺泡浓度（ＦＡ）在６％ ±０．１％ 。间断给予维库溴胺维持肌肉松弛。　结果　地氟醚ＦＡ 达６％ 和ＦＡ／ＦＩ（吸入浓度）达０．９,分别为４．９±０．８ ｍ ｉｎ 和１２．４±０．２ ｍ ｉｎ,并能维持在０．９０～０．９５。麻醉停止后,５．７±２．４ ｍ ｉｎ 恢复自主呼吸,拔管时间９．７±０．８ ｍ ｉｎ。麻醉中脉搏血氧饱和度均１００％ ,吸入氧浓度≥８０％ 。　结论　地氟醚的低组织溶解特性使其麻醉诱导和麻醉恢复快,麻醉调控性强。地氟醚的药代动力学特性使其能安全、有效地在最低流量循环紧闭麻醉中使用。     

国产房水引流物置入术治疗难治性青光眼远期疗效观察

１９９３年７月～１９９８年１月为１０３例（１０６只眼）难治性青光眼患者施行国产房水引流物（ＨＡＤ）置入术。术后平均随访３２８月。术后１年时平均眼压２２±１．４ｋＰａ。术后１～５年的手术成功率分别为８３８％,８０４％,７７１％,７１０％及６４３％。术中联合应用丝裂霉素Ｃ的病例,其术后１年时的成功率为８９５％。术后常见的并发症有持续性浅前房,局限性脉络膜脱离及眼压升高等。认为ＨＡＤ可用于治疗难治性青光眼。     

Metastatic seeding of bile duct carcinoma in the transhepatic catheter tract: Report of a case

We describe herein the case of a 51-year-old woman in whom metastatic tumor seeding of the percutaneous transhepatic biliary drainage tract occurred following a pancreatoduodenectomy for carcinoma of the distal common bile, duct. An abdominal computed tomography scan done 6 months after the initial operation detected a hepatic lesion located at the site of the previous percutaneous transhepatic biliary drainage tract. Implantation of bile duct carcinoma in the drainage tract was diagnosed, and the recurrent tumor was successfully resected by performing a subsegmentectomy of segment 3 and removal of the adjacent abdominal wall. At present, 5 years and 4 months after the second resection, the patient is in good health without any signs of recurrence. This case report demonstrates that an aggressive surgical approach should be performed for tumor seeding of a transhepatic biliary catheter tract.     

十二指肠腔内置管引流减压在毕-Ⅱ式胃大部切除术中应用疗效的观察

目的探讨防止毕-Ⅱ式胃大部切除术后十二指肠残端破裂发生的方法;方法对毕-Ⅱ式胃大部切除术中出现十二指肠残端水肿或血运差的病例,采取预防性十二指肠腔内置管引流减压的方法,收集临床资料、观察治疗效果;结果采取十二指肠腔内置管引流减压后,十二指肠残端破裂发生率明显下降;结论十二指肠腔内置管引流减压,可以预防十二指肠残端破裂的发生,并可拓宽溃疡穿孔病例采用胃大部切除术的适应证。     

Effect of continuous cisternal drainage on cerebral vasospasm

Summary The effect of continuous cisternal drainage on cerebral vasospasm was studied under strict criteria in 140 patients with ruptured intracranial aneurysms. The degree of subarachnoid haemorrhage (SAH) on the computed tomography scan was graded from I to IV. The patients were classified according to the total amount of cisternal drainage into three groups, regardless of the duration of the drainage and whether or not it was accompanied by irrigation; i.e., those with less than 500 mL (group 157 cases), those with 500–3000 mL (group 2 44 cases), and those with 3000–9500 mL (group 3 39 cases).While correlations could be found between both clinical and SAH grades with the severity of vasospasm, closer correlation could be found in the SAH grades. In analyzing the cases with subarachnoid haemorrhage grades III–IV (severe clots), the angiographic vasospasm was less severe in groups 2 and 3 than in group 1, and the incidences of permanent symptomatic vasospasm and low-density area on computed tomography were lower in groups 2 and 3 than in group 1. Regarding the surgical outcome in cases with SAH grades III–IV, the mortality rate was lower in groups 2 and 3 (22% and 19%) than in group 1 (33%). Further, the rate of good recovery was higher in groups 2 and 3 (61% and 57%) than in group 1 (28%). However, there were no differences between groups 2 and 3 in cerebral vasospasm or in surgical outcome. As a shortcoming of continuous cisternal drainage, the need for shunt operation was higher in groups 2 and 3 than in group 1.     

Inhibition of mixed lymphocyte reaction by thoracic duct lymph: removal of inhibitory effect by thoracic duct drainage in lung cancer.

The inhibitory effect of the thoracic duct lymph of a patient with lung cancer on the "one-way" mixed lymphocyte reaction without cytoxicity is unequivocally demonstrated. The effect seems to be dose related. A moderate inhibition of mixed lymphocyte reaction is still observed, even if the responding cells are preincubated in the thoracic duct lymph for 1 hr only prior to the addition of stimulating cells. The inhibitory effect of thoracic duct lymph on the mixed lymphocyte reaction is no longer evident when the material is added 1-4 days after the beginning of culture. These observations suggest that the mechanism of the inhibitory effect of thoracic duct lymph may be a simple attachment of inhibitory factors to the receptor sites on the responding lymphocytes, causing interference in cell to cell interaction. The inhibitory effect of thoracic duct lymph collected 1 week after the thoracic duct drainage on mixed lymphocyte reaction is significantly lower than that of thoracic duct lymph collected at the beginning of the procedure. This indicates that the blocking effect of thoracic duct lymph can be easily removed by this technique; which is technically feasible in man. The interrelationship of the tumor-specific blocking factor, thoracic duct drainage, and tumor growth pattern are discussed with respect to the potential usefulness of this procedure as adjuvant immunotherapy in the management of patients with neoplastic diseases.     

Crede法排尿与持续导尿对尿路感染和尿道功能影响的研究

目的研究Crede法排尿(间歇人工辅助排尿)与持续导尿对继发尿路感染和远期尿道功能的影响.方法76例神经源性膀胱功能障碍者分别采用Crede法排尿和留置导尿,定期尿液培养进行尿路感染率比较;导尿时间达4～6个月后配合膀胱尿路造影(VCUG)及尿流动力学检查观测尿液返流情况、膀胱颈形态变化和尿道功能指标.结果Crede法排尿组和持续导尿组其尿路感染、尿液返流率分别为16.6%、17.9%和35.1%、40.5%,差异有显著性意义(P＜0.05);VCUG及尿流动力学检查提示持续导尿较C rede法排尿明显损害膀胱颈形态和远期尿道功能.结论对丧失自主排尿功能但无严重意识障碍者宜尽可能减少留置导尿的应用范围和时间,采用Crede法排尿对控制尿路感染、维护和促进排尿功能恢复具有重要意义.     

腰穿置管稳压引流治疗蛛网膜下腔出血后脑积水

目的探讨蛛网膜下腔出血(SAH)后脑积水简便、安全、有效的治疗方法。方法所收治的283例SAH病人中有90例发生了急性脑积水,在内科治疗基础上,其中46例进行了腰穿置管稳压引流治疗结果与无脑积水者对照比较。结果上法治疗后32例(32/46,70%)意识水平均有所改善;所有受治病人12d内再出血和脑缺血的发生率与无脑积水的病人组无显著性差异〔5/46(11%),24/193(12%);16/46(35%)60/193(31%)。P>0.05〕。治疗组未发生脑室炎或脑膜炎。结论腰穿置管稳压引流是一种治疗SAH后脑积水简便、安全、有效的方法。     

超声心动图对儿童完全性肺静脉异位引流诊断价值的探讨

目的　旨在评价超声心动图对完全性肺静脉异位引流 (TAPVD)的诊断价值。方法　对 1987年 9月至2 0 0 2年 11月收治的TAPVD患儿 70例进行分析。均有完整的临床及超声心动图资料 ,其中 35例施行了手术治疗。结果　 70例TAPVD的解剖分型为 :心内型 5 2例、心上型 16例、心下型 2例 ,未发现混合型。 35例施行手术 ,32例与术前超声心动图的诊断一致 ;3例与超声心动图诊断不完全一致 ,其超声心动图诊断分别为 :三房心伴继发孔房缺、左房隔膜伴继发孔房缺、原发孔房缺伴卵圆孔未闭 ,而手术结果均显示为心内型TAPVD伴继发孔房缺。结论　超声心动图检查是诊断TAPVD重要且准确的方法 ,并能确定其分型 ,提供精确的解剖及血流动力学资料。在应用超声心动图诊断TAPVD时 ,应注意与三房心、左房隔膜等疾病进行鉴别。     

复方七叶皂苷钠凝胶治疗急性闭合性软组织损伤临床疗效及安全性评价

目的：观察复方七叶皂苷钠凝胶(商品名：欧菜)对急性闭合性软组织损伤的临床疗效和安全性。方法：采用多中心、随机、双盲、阳性药利百素凝胶平行对照研究，共完成72对(144例)。所有病例均为临床确诊的急性闭合性软组织损伤患者，按损伤面积的大小，采用1g凝胶／1％体表面积涂抹在患处，每日4次，疗程14d。结果：治疗前后试验组和对照组静态时疼痛强度、静态时疼痛强度等级、局部压痛强度、局部压痛等级和局部肿胀评估等指标缓解程度的比较有显著统计学意义(P＜0．01)，两组间各单项指标的缓解程度、疗效、有效率及总有效率的比较均无统计学意义(P＞0．05)。治疗后3，7和14d，试验组总有效率分别达17．14％，70.00％和100．00％。对照组总有效率分别达26.39％，70．83％和100．00％。两组各发生1例不良反应，均表现为皮肤发红并见少量小丘疹，不良反应发生率均为1．39％。结论：复方七叶皂苷钠凝胶能安全有效地缓解和消除急性闭合性软组织损伤引起的静态时疼痛、局部压痛和局部胀肿，与利百素凝胶的疗效相当。