自体大隐静脉移植治疗四肢主要动静脉缺损21例

目的:探讨自体大隐静脉移植修复四肢主要动静脉损伤的治方法。方法:采用大隐静脉移植术修复四肢外周主干动脉及部分深静脉缺损21例。结果:本组21例中1例动脉静脉缺损均用大隐静脉移植,用血管床覆盖移植血管后,创面用VSD覆盖,1周后皮瓣移植,动脉外形及搏动均良好。1例长段移植术后1月复查多普勒血管超声移植动脉通血及血流量恢复正常。1例血管瘤病人肿瘤切除血管移植肢体无功能障碍。本组21例病人恢复良好,肢体活动感觉均正常。结论:自体大隐静脉口径与外周主干动脉相当,组织相容性好,长度足够,取材方便,适宜作为外周主干动脉缺损的移植材料。     

甲磺酸罗哌卡因、左旋布比卡因与布比卡因低位硬膜外麻醉90例效能比较

目的:评价国产的3种不同长效酰胺类局麻药在低位硬膜外麻醉中的临床效能和不良反应。方法:择期下肢手术病人90例,ASAI～II级,年龄20～65岁,体重42～65kg,随机分成3组(n=30):0.5%甲磺酸罗哌卡因组(A组)、0.5%左旋布比卡因组(B组)和0.5%布比卡因(C组)。行连续低位硬膜外麻醉,观察感觉阻滞起效时间、感觉阻滞平面上界、运动阻滞起效时间、运动阻滞程度及麻醉质量。结果:A组运动阻滞起效时间,最大运动阻滞时间明显长于C组(P<0.05),与B组相比无显著性差异(P>0.05),A组最大Bromage评分为0级、I级的例数和与B、C组相比有显著性差异(P<0.05),B组的运动阻滞持续时间明显短于A、C组(P<0.05)。3组患者均未发生局麻药相关不良反应。结论:0.5%甲磺酸的罗哌卡因、0.5%左旋布比卡因和0.5%布比卡因低位连续硬膜外麻醉能满足下肢手术的要求,均有良好的感觉和运动阻滞效果,3种药物麻醉效能相似。     

舒芬太尼与丁丙诺啡在口腔外科术后镇痛的比较

目的 比较等效剂量丁丙诺啡与舒芬太尼在口腔外科术后镇痛的效果.方法 60例ASAⅠ或Ⅱ级口腔外科术病人依病历号奇偶数分为舒芬太尼组(S)与丁丙诺啡组(B),每组30例.两组均采用静脉自控镇痛(PCIA)给药,S组舒芬太尼50μg,B组丁丙诺啡0.6 mg,总量100 ml,首次负荷剂量4 ml.术后5、10、20及40 h行VAS疼痛与Ramsay运动评分,记录PCA有效按压次数及不良反应发生率.结果 两组VAS疼痛评分、Ramsay运动评分及PCA有效按压次数差异均无统计学意义,而不良反应发生率B组显著高于S组(P<0.05或P<0.01).结论 等效剂量舒芬太尼与丁丙诺啡用于口腔外科术后镇痛效果相当,但舒芬太尼不良反应发生率较低,更适合口腔外科术后镇痛使用.     

双氯芬酸钠栓剂用于腹腔镜胆囊切除术后镇痛

非甾体类消炎镇痛药（NSAIDs）氯芬酸钠临床上以往主要用于缓解类湿关节炎、神经炎、癌症等疾病引起的疼痛,现已逐步用于术后镇痛。本研究观察双氯芬酸钠栓剂用于腹腔镜胆囊切除术（LC）的镇痛效果。     

360例腹腔镜胆囊切除术体会

目的总结腹腔镜胆囊切除术的经验与体会。方法回顾性分析了本院360例腹腔镜胆囊切除术临床资料。结果本组360例拟行腹腔镜手术病例中,357例成功实施,3例中转开腹。结论探明和确认胆囊壶腹与胆囊管的交界部解剖关系,是防止胆管损伤的关键。     

老年下肢关节置换及植入物内固定治疗中应用罗哌卡因腰椎及硬膜外联合麻醉的优势

BACKGROUND: In the elderly patients with a variety of diseases, poor physical and compensatory ability results in a high demand for anesthesia during hip replacement and internal fixation. Lumbar epidural anesthesia with ropivacaine is the commonly used method of narcotic analgesics, but this method of anesthesia has been less studied in elderly hip replacement and internal fixation.  OBJECTIVE: To investigate the effects of lumbar epidural anesthesia with ropivacaine in elderly hip replacement and internal fixation. METHODS: Data of fifty elderly patients with hip replacement implants and internal fixation, who were treated in the Department of Orthopedics, Affiliated Hospital of Xizang Minzu University from February 2014 to August 2015, were analyzed. 50 patients were randomly divided into continuous epidural anesthesia group and ropivacaine lumbar epidural anesthesia group, with 25 patients in each group. Anesthetic effect was compared. Self questionnaire on risk factors was used for non-conditional Logistic multivariate analysis between the two groups. RESULTS AND CONCLUSION: (1) Anesthetics onset time, the amount of local anesthesia, the use of trimetaphan camsilate agent number, complete block time, heart rate after anesthesia and complication rate were significantly less in the ropivacaine lumbar epidural anesthesia group than in the continuous epidural anesthesia group (P < 0.05). (2) The highest block level, Bromage score, mean arterial pressure after anesthesia and anesthesia satisfaction rate were significantly higher in the ropivacaine lumbar epidural anesthesia group than in the continuous epidural anesthesia group (P < 0.05). (3) Logistic multivariate analysis on postoperative cognitive dysfunction showed that postoperative cognitive dysfunction was strongly associated with age, education, complications, and hip arthroplasty (P < 0.05). (4) Results verified that lumbar epidural anesthesia with ropivacaine showed ideal effects in hip arthroplasty and internal fixation. Postoperative recovery was rapid, and it is safe and reliable.       

带蒂腓肠神经营养血管皮瓣修复足踝部软组织缺损26例报告

目的:观察腓肠神经营养血管蒂逆行皮瓣修复足踝部软组织缺损的手术方法及临床效果。方法:应用带筋膜蒂的腓肠神经营养血管逆行皮瓣修复足踝部软组织缺损26例。急诊Ⅰ期修复11例,Ⅱ期修复15例。逆行切取皮瓣,皮瓣面积5cm×6cm～10cm×16cm。皮瓣蒂最长7cm,最短4cm,平均6cm。对于足底足背软组织缺损,同侧皮瓣不能修复,外固定架固定交腿腓肠神经营养血管皮瓣修复。结果:26例皮瓣全部成活,其中4例皮瓣远端皮缘部分坏死,经换药后愈合。经3～32个月随访,皮瓣外形满意,功能良好。结论:腓肠神经营养血管皮瓣切取简单,血管恒定动脉供血和静脉回流可靠,成活率高,是修复足踝部软组织缺损的有效方法。     

高龄患者围术期三种麻醉管理方法及体会

目的探讨硬膜外麻醉、单纯全麻和硬膜外加全麻对老年患者麻醉安全性,为临床提供更为适宜的麻醉方法。方法选择年龄65～80岁,ASAⅠ～Ⅱ级,择期手术老年患者60例,随机分为硬膜外组（麻药未稀释组和麻药稀释组）、单纯全麻组（Ⅰ组）和硬膜外加全麻组（Ⅱ组）,每组20例,术前、切皮后和手术结束时测定平均压（MAP）和心率（HR）,记录术中知晓,术后躁动及药物用量,并行术后镇痛。结果Ⅱ组插管、切皮时MAP、HR上升幅度少于Ⅰ组（P〈0.05）,Ⅱ组术后躁动发生率及丙泊酚和异氟醚等药物用量显著降低（P〈0.05）。结论硬膜外阻滞复合全麻用于老年患者手术血流动力学稳定,应激反应小,全麻用药量和术后躁动少,而硬膜外麻醉用于老年患者施行下腹部及其以下部位手术效果好。     

无痛胃镜诊疗患者2600例麻醉效果分析

目的:探讨无痛胃镜检查治疗的临床效果。方法:选择拟行无痛胃镜检查患者2600例,分别采用芬太尼与异丙酚或咪唑安定配伍的麻醉方法行胃镜检查,记录并观察检查前后血氧饱和度和心血管系统等生理指标变化,并与常规胃镜检查600例作对照观察。结果:全部病例检查结束后,观察组5~15 min内均完全清醒,均未遗留痛苦回忆,280例有舒适感或轻度欣快感。结论:镇静状态下胃镜检查术可减少病人的紧张、焦虑和恐惧情绪,并能减少诱发心血管系统并发症。     

手指末节离断指动脉静脉化再植15例分析

手指离断伤是手部较常见的创伤之一，我院于2005年6月至2008年11月共实施完全性断指再植手术113例168指，其中末节离断采用离体指一侧指动脉静脉化与近端静脉吻合再植15例15指，取得较好效果，现分析报告如下。