硬膜外阻滞复合全身麻醉用于慢性阻塞性肺病病人的临床效果

目的比较硬膜外阻滞复合全身麻醉或单纯全身麻醉对上腹部和胸腔内手术病人术后肺功能和肺部并发症的影响。方法24名伴有中度术后肺部并发症危险的慢阻肺病人,接受上腹部或胸腔内手术,随机分成单纯全身麻醉(GA组)和硬膜外阻滞复合全身麻醉(Epi-Ga组)两组。术后采用VRS法评定镇痛效果。根据临床症状和体征、X线胸片、血气分析和床旁肺功能测定评估是否发生肺部并发症。术前1d和术后3d内评估和记录上述指标。结果术毕,GA组病人平均(34±16)min苏醒,(67±22)min拔除气管导管;Epi-Ga组苏醒时间和拔管时间分别为(12±4)和(32±12)min。术后第1天和第2天,Epi-Ga组病人术后镇痛效果明显优于GA组(P<0.01)。术后第1天,Epi-Ga组病人的FVC、FEV1/FVC%和FEF25%-75%下降不如GA组显著(P<0.05)。GA组有4例需要纤维支气管镜协助吸痰,而Epi-Ga组则无一例需要。两组病人术后肺炎、肺不张、支气管痉挛和呼吸衰竭的发生率无显著差异。结论局麻药加阿片类药物硬膜外自控镇痛使病人术后更加舒适,且能够改善病人术后肺功能。尽管两组病人术后肺部并发症无明显差异,但硬膜外阻滞复合全身麻醉以及术后硬膜外自控镇痛确实能够方便慢阻肺病人的术后管理。     

肿瘤坏死因子α与妊娠高血压综合征发病关系的研究

探讨肿瘤坏死因子α在妊娠高血压综合征发病中的作用。方法对４１例妊高征患者（妊高征组）和１７例正常妊娠妇女（正常妊娠组）进行了下列研究：（１）测定血浆中ＴＮＦα水平,观察胎盘血管内皮细胞的形态学变化;（２）利用其血清对离体培养的脐血管内皮细胞作用,观察其损情表现;（３）利用４００Ｕ／ｍｌ的人重组ＴＮＦα对离体培养的脐血管内皮细胞作用,比较ＴＮＦα和妊娠高征孕妇血清对内皮细胞的损伤作用。结果（１）妊娠     

正常妊娠、妊高征血浆C型利钠肽水平的变化

目的：比较不孕龄妇女血浆Ｃ型利钠肽（ＣＮＰ）水平的变化,探讨ＣＮＰ在妊高征发病机制中的可能作用。方法：采用放射免疫分析法,对门诊及住院的１９３例正常妊娠妇女、８９例妊高征患者和４６例正常非孕妇女血浆中ＣＮＰ浓度检测。结果：早、中和晚期妊娠三组比较,血浆ＣＮＰ差值有极显著性意义（Ｆ＝１０．８４,Ｐ〈０．０１）,早孕组的血浆ＣＮＰ值显著升高,中晚期无变化。不同程度妊高征组之间血浆ＣＮＰ水平有极显著差别（Ｆ＝６６．１７,Ｐ〈０．０１）。与正常妊娠对照组相比,轻度妊高征者血浆ＣＮＰ水平降低,中度者接近妊娠对照,重度者显著高升。正常妇女、正常妊娠、妊高征血浆ＣＮＰ水平有显著性差别（Ｆ＝１３．６１,Ｐ〈０．０１）,主要表现在妊高征血浆ＣＮＰ值明显高升,正常妇女与正常妊娠组间无显著性差别。结论：在生理状态下,ＣＮＰ以自分泌和     

477例患者血液透析中留置中心静脉导管的临床分析

目的：总结留置中心静脉导管的经验,探讨如何防治中心静脉留置导管的并发症。方法：分析１９９２年７月！￣１９９８年７月我院血液净化中心对４７７例肾功能不全患,留置中心静脉导管共５６６例次。     

Percutaneous retrieval of an impacted ureteric T-tube

An impacted ureteric T-tube was removed percutaneously, using an Amplatz goose-neck snare. This new snare has advantages over conventional snares, particularly in situation where atraumatic manipulation is essential. Correspondence to: R. D. Edwards     

Marlex Mesh Gastric Banding: A 7-12 Year Follow-Up

This paper presents a 7-12 year (mean 9.8 years) follow-up of 92 extremely obese patients treated with Marlextrade mark mesh gastric banding (GB). The follow-up rate was 92% (85 patients). Weight loss was initially good (an average reduction in BMI of 13 during the first year), but late weight gain has been a common complaint and a reason for reoperation. Other complications that necessitated reoperation were severe vomiting and esophagus not amenable to medical treatment. Four patients have developed signs of Barrett's esophagus at late follow-up. Forty-six patients (50%) were reoperated 70 times for correction of the band or conversion to vertical banded gastroplasty (VBG). The most common reoperative procedure was conversion to VBG (38 patients). Only 25 (31%) of the 80 patients with long-term follow-up have an intact band. Our results show the need of long follow-up and that this GB cannot be recommended for the treatment of morbid obesity.     

Gastric Banding: Advantages and Complications. A 5- and 10-Year Follow-up

Background: Gastric banding is one of the simplest surgical procedures for the treatment of morbid obesity. We performed more than 150 ‘laparotomy’ (open) gastric bandings and more than 50 ‘laparoscopic’ bandings in the last 10 years. Methods: In most procedures we used non-adjustable bands, but since the beginning of 1995 we have used adjustable silicone banding. Results: The 5- and 10-year follow-up weight loss results are encouraging. The average long-term weight loss was 35.5 kg. Since 1993, we performed all the procedures laparoscopically, and the postoperative complications decreased from 18.5% in the ‘laparotomy’ group to 9.5% in the ‘laparoscopic’ group, with the majority being esophagitis and outlet area irritation. Conclusion: Gastric banding itself and especially the minimally invasive laparoscopic approach is an easy technical procedure. The long-term weight loss results and the reoperation rate are acceptable for bariatric surgery criteria.     

头颈部恶性肿瘤累及颈动脉的治疗(附3例报告)

报告３例头颈部恶性肿瘤颈部转移累及颈动脉,术中保留预动脉,术后４～６ｄ颈动脉破裂大出血。分析原因为伤口感染和颈动脉已被肿瘤浸润所致,提示受肿瘤侵犯的颈动脉不宜保留。     

Hyperacute spinal subdural haematoma as a complication of lumbar spinal anaesthesia: MRI

We report two cases of hyperacute spinal subdural haematoma secondary to lumbar spinal anaesthesia, identified with MRI. Prompt diagnosis of this infrequent, potentially serious complication of spinal anaesthesia is essential, as early surgical evacuation may be needed. Suggestive MRI findings in this early phase include diffuse occupation filling of the spinal canal with poor delineation of the spinal cord on T1-weighted images, and a poorly-defined high-signal lesion with a low-signal rim on T2-weighted images. Received: 10 November 1998 Accepted: 6 April 1999     

Comparison of transarterial and multiple nerve stimulation techniques for axillary block using a high dose of mepivacaine with adrenaline

BACKGROUND: High-dose transarterial (TA) technique results in high effectiveness of the axillary block. The technique is fast and simple, but does not produce a satisfactory success rate when using the manufacturer's recommended dose of mepivacaine. The multiple nerve stimulation (MNS) technique requires more time and experience. This double-blind study compared effectiveness, safety and the time used to obtain an effective analgesia in 101 patients, having an axillary block by either TA or MNS techniques. METHODS: Mepivacaine with adrenaline (MEPA), 850 mg, was used for the initial block. Five millilitres of 1% solution was injected subcutaneously. In the TA group, 20 mL of 2% solution was injected deep to, and 20 mL superficial to the axillary artery. In the MNS group, four terminal motor nerves were electrolocated in the axilla, and injected with 10 mL each. Analgesia was assessed every 10 min and, when needed, supplemented after 30 min. The block was effective when analgesia was present in all sensory nerve areas distal to the elbow. RESULTS: The MNS group required median 11 min for block performance compared with 8 min for the TA group (P < 0.001). Latency of the initial block was shorter and the frequency of supplemental analgesia lower in the MNS group (median 10 min and 6%) than in the TA group (30 min and 36%, respectively), P < 0.001. All incomplete blocks were successfully supplemented. However, the total time to obtain an effective block was shorter in the MNS group (23 min) than in the TA group (37 min), P < 0.001. Two patients in each group had signs and symptoms of systemic toxicity, the most serious being atrial fibrillation and temporary loss of consciousness in a cardiovascularly medicated patient. The local adverse effects (intravascular injections and haematomas) were fewer in the MNS group, P < 0.001. CONCLUSION: The MNS technique of axillary block by four injections of 10 mL of 2% MEPA produces faster and more extensive block than the TA technique by two injections of 20 mL. Therefore, the MNS technique requires fewer supplementary blocks and results in faster patient readiness for surgery. However, high doses of MEPA may result in dangerous systemic toxic reactions.