颅脑手术出血量对凝血功能的影响

为了解颅脑手术出血量对机体凝血功能的影响，将全麻下３０例颅脑手术患者分为３组，每组各１０例，Ａ组为对照组，Ｂ组患者前给予止血２ｋｕ，Ｃ组术前给予立止血２ｋｕ加６－氨基己酸６￣８ｇ，于术前，中终取静脉血，观察凝血酶原时间（ＰＴ）及国际标准化比值（ＰＴＩＮＲ），活化的部分凝血酶时间（ＰＴＴ）、凝血酶时间（ＴＴ）及纤维蛋白原（ＦＩＢ）检测值。结果Ａ组术中，术终的ＰＴ、ＰＴＩＮＲ值增加，ＰＴＴ术终，ＴＴ术     

关于第一位的是技术还是理解接纳

编者按 :为促进和推动我国心里治疗与心里咨询事业的健康发展 ,应广大读者的要求 ,我刊从 2 0 0 1年第 1期开始推出与心理治疗及心里咨询相关问题的讨论专栏。专栏的目的在于讨论和澄清有关心理治疗与心理咨询专业工作中的一些基本问题 ,重点问题和疑难问题 ,以达到“百家争鸣”和普及与提高之目的。本专栏去年讨论的题目主要为 :“第一位的是技术还是理解接纳 ?” ( 2 0 0 1年第一期 )、“谁适合作心理治疗师 ?———对心理咨询与心理治疗专业人员资格的讨论” ( 2 0 0 1年第二、三期 )、“心理治疗与 (精神 )药物治疗之间关系的探讨”( 2 0 0 1年第四、五期 )等。专栏自开设以来得到专业同行的人力支持和关注 ,对此我们深表感谢。本期特选登部分读者的反馈意见 ,以告慰并感谢读者对本专栏的关心和正视。明年本刊将会继续开设此专栏 ,在今年的再期中可能会涉及的讨论题日有 :心理治疗、咨询人员与其来访者的关系问题 (如 :是否可以收礼、一起吃饭 ,有其他在门诊时间以外的接触等 ) :对心理治疗中脱落的来访者应如何处理 (采取何措施 )等问题。希望国内外同行继续支持和关注本专栏的讨论 ,踊跃来稿 ,发表自己的意见和看法 ;也希望大家将自己认为重要的、值得讨论的问题告诉我们。我们将分期、分批整理和     

呼吸道和胃肠道疾病患儿的空腹血清胃泌素含量改变

本文对51例正常儿童、51例常见呼吸道疾患及48例急性胃肠炎患儿进行空腹血清胃泌素(SGa)含量检测,正常儿童SGa含量为98.95±24.39pg/ml。呼吸道疾病和急性胃肠炎患儿明显增高,分别为155.48±32.95pg/ml和216.37±28.62pg/ml(p<0.001)。48例急性胃肠炎患儿治疗后SGa明显下降(p<0.01),本文对上述疾患SGa的变化原因作了初步探讨。     

尿视黄醇结合蛋白检测在糖尿病中的临床应用

尿视黄醇结合蛋白(RBP)是近曲小管损害的一项敏感指标,对肾小管间质性疾病的早期诊断具有重要的价值。我们对59例糖尿病患者及20例正常人进行尿 RBP 检测,现将结果分析如下。1 资料和方法1.1 对象选择糖尿病患者59例,均为非胰岛素依赖型糖尿病(Ⅱ型),其中男40例,女19例,年龄35岁～80岁,平均67岁。59例中尿常规正常48例,11例尿蛋白(+)～(?);正常对照组20例中男10例,女10例,年龄20岁～55岁,平均37岁。均无肾脏疾患史、高血压史及糖尿病史,常规尿蛋     

脑灌注压、颅内压与头位

既往的研究表明,脑灌注压(CPP)的下降可引起颅内压力波。为了控制颅内高压,神经外科患者常规采用20～30度头高位。但该体位常导致颅内压(ICP)增高以及产生压力波。为探索ICP 下降与CPP 下降之间的关系,以及解释高原波发生与头位抬高的有关机制。作者基于以往研究,提出两个假     

胸椎旁神经阻滞对冠脉搭桥术患者麻醉诱导期血流动力学及术后恢复的影响

目的探讨胸椎旁神经阻滞对冠脉搭桥术患者麻醉诱导期血流动力学及术后恢复的影响。方法选择2020年8月—2021年8月于蚌埠医学院第一附属医院择期行冠脉搭桥手术的患者50例。根据随机数字表法将患者分为胸椎旁神经阻滞联合全麻组(P组)和常规全麻组(G组),每组25例。记录2组患者麻醉诱导前(T0)、插管前(T1)、插管即刻(T2)、插管后1 min(T3)及5 min(T4)的平均动脉压(MAP)和心率(HR);术中舒芬太尼用量;术后机械通气时间;拔管后、术后12、24 h的VAS评分;术后24 h补救镇痛例数;留置心脏外科重症监护室时间、术后住院时间;术后不良反应。结果 P组T2～T4时点的MAP分别为(74.84±10.05)mm Hg(1 mm Hg=0.133 kPa)、(74.96±10.03)mm Hg、(74.72±9.18)mm Hg,均低于G组[(85.08±10.57)mm Hg、(89.16±10.00)mm Hg、(81.04±8.92)mm Hg,均P<0.05];P组T2～T4时点的HR均低于G组(均P<0.05)。P组术中舒芬太尼用量、术后机械通气时...     

疑为服用甘草流浸膏而致之幽門阻塞二例

作者在使用甘草流浸膏治疗消化性潰瘍过程中,发現二例在服药期間发生幽門寶部充血水肿而致梗阻,均經胃鏡检查証实,并于停药后經短期之对症治疗痊癒。一例于发病前均每日服用甘草流浸膏三次,每次20毫升,于第五日发現梗阻症状。另一例則每次服用10毫升,持續一个月后发生梗阻现象。     

压缩髓内针对骨折愈合的实验观察

动物实验发现压缩髓内针固定较坚强,使骨折稳定,骨折血肿较小,X线显示外骨痂相应地较小、形状较规则,常呈梭形;普通髓内针内固定不够坚强,骨折仍不稳定,骨折血肿较严重,X线显示外骨痂相应地较大、形状不规则,常呈弥漫状阴影。病理学观察压缩髓内针组的骨折愈合较普通髓内针组为迅速,主要表现在血肿范围较小,炎性反应较轻,肉芽组织生长迅速,骨痂形成较早、较小和较规则,骨断端组织愈合较迅速。     

与其“雷人”，何不“暖人”？

当前的医院公关往往把重点放在“医院”这个抽象的整体上,公关原则和理念并没有体现在医务人员的个体行动中。     

胰管结石的分型和治疗

Objective To explore the classification and surgical management of pancreatic duct stones.Methods The clinical data of 54 patients with pancreatic duct stones who were admitted to the People's Hospital of Hunan Province from June 1994 to November 2009 were retrospectively analyzed. Stones were found in the head of the pancreas (type Ⅰ ) in 31 patients, in the body and tail of the pancreas (type Ⅱ ) in 7 patients, and in all the pancreas (type Ⅲ ) in 16 patients. According to the types of the pancreatic duct stones, ten patients (6 with type Ⅰ , two with type Ⅱ and two with type Ⅲ pancreatic duct stones) received opening of the main pancreatic duct + pancreaticojejunostomy or pancreaticogastrostomy ( group A). Twenty-four patients ( 16 with type Ⅰ and eight with type Ⅲ pancreatic duct stones) received pancreaticoduodenectomy (group B). Fifteen patients (nine with type Ⅰ and six with type Ⅱ pancreatic duct stones) received subtotal resection of pancreatic head preserving duodenum (group C). Five patients with type Ⅱ pancreatic duct stones received resection of the body and tail of the pancreas and the spleen (group D). All data were analyzed using the t test. Results The mean operation time, blood loss, length of postoperative stay and hospital charges of group A were (2.2 ± 1.2)hours,( 127 ±24)ml,( 11.4 ±4.3) days and (3.24 ± 1.15 ) × 104 yuan, respectively. Five out of nine patients who were followed up had stone recurrence. The mean operation time, blood loss, length of postoperative stay and hospital charges of group B were (7.6 ± 1.1 ) hours, (409 ± 37 ) ml, ( 18.9 ± 2.5 ) days and (7.93 ± 1.35 ) × 104 yuan, respectively.No stone recurrence was detected in the 21 patients who were followed up. The mean operation time, blood loss,length of postoperative stay and hospital charges of group C were (4. 1 ± 0.7 ) hours, ( 156 ± 63 ) ml, ( 10.3 ±2.1 )days and (4. 12 ± 1.22) × 104 yuan, respectively. No stone recurrence was detected in the 15 patients who were followed up. The mean operation time, blood loss, length of postoperative stay and hospital charges of group D were (3.3 ± 1.4) hours, ( 185 ± 36 ) ml, ( 9.3 ± 2.0) days and ( 3.22 ± 1.05 ) × 104 yuan, respectively. No complication was detected after the operation, and no stone recurrence was detected in the three patients who were followed up. There were significant differences in the mean operation time, blood loss, length of postoperative stay and hospital charges between patients with type Ⅰ and Ⅲ pancreatic duct stones who received pancreaticoduodenectomy and subtotal resection of pancreatic head preserving duodenum (t = 12. 143, 14. 099, 11. 550, 9. 103,P < 0.05 ). Conclusions Classification of the pancreatic duct stones is important for choosing the proper surgical procedure. Subtotal resection of pancreatic head preserving duodenum is ideal for the treatment of patients with type Ⅰ or Ⅱ pancreatic duct stones.