术前综合干预对胃镜下老年上消化道异物取出的影响

目的:探讨术前综合护理对胃镜下老年上消化道异物取出的患者进行干预的临床治疗效果。方法:选取56例老年上消化道异物患者,在胃镜下取出,将患者随机分为对照组和试验组,各28例。对照组采用常规护理,试验组在对照组的基础上采用术前综合护理进行护理干预,比较两组患者生理指标变化,术中的配合程度,完成手术的时间以及患者的焦虑情况。结果:试验组实施干预后,术中心率、收缩压、舒张压明显低于对照组(P0.01),术中的配合程度优于对照组(P0.01),完成手术时间少于对照组(P0.01),患者的焦虑情况改善优于对照组(P0.01)。结论:术前综合干预能够改善患者焦虑状态,利于手术顺利进行。     

神经内镜与显微镜下经鼻蝶入路手术切除垂体腺瘤的临床疗效比较及术中出现脑脊液漏的危险因素分析

摘要 目的：对比垂体腺瘤患者采用显微镜或神经内镜下经鼻蝶入路手术切除后的临床疗效,分析术中出现脑脊液漏的危险因素。方法：回顾性分析2018年3月~2022年2月期间来我院接受手术治疗的178例垂体腺瘤患者的临床资料。根据采用手术器械的不同将178例患者分为A组（显微镜,n=91）和B组（神经内镜,n=87）。比较两组的肿瘤有效切除率、临床指标、术中脑脊液漏发生率及术后并发症发生率。根据术中是否发生脑脊液漏分为脑脊液漏组和无脑脊液漏组。经单因素和多因素Logistic回归分析患者术中发生脑脊液漏的危险因素。结果：B组的手术时间、住院时间短于A组,术中出血量少于A组（P<0.05）。A组、B组的肿瘤有效切除率组间对比,无统计学差异（P>0.05）。B组术中脑脊液漏发生率、术后并发症发生率低于A组（P<0.05）。垂体腺瘤患者术中发生脑脊液漏与再次手术、肿瘤大小、年龄、肿瘤质地、美国麻醉医师协会（ASA）分级有关（P<0.05）。肿瘤大小为巨大腺瘤、再次手术、肿瘤质地为韧是垂体腺瘤患者术中发生脑脊液漏的危险因素（P<0.05）。结论：显微镜与神经内镜下经鼻蝶入路手术切除垂体腺瘤,治疗效果相当,但神经内镜下手术可缩短手术时间、住院时间,减少术中出血量,降低术中脑脊液漏发生率、术后并发症发生率。此外,肿瘤大小为巨大腺瘤、再次手术、肿瘤质地为韧是垂体腺瘤患者术中发生脑脊液漏的危险因素。     

不同手术方式对腰椎间盘突出症治疗的效果比较分析

目的:探讨应用微创技术治疗腰椎间盘突出症的疗效.方法:对我院脊柱骨科自2005年l1月～2010年10月收治的128例腰椎间盘突出症患者应用不同手术方式进行治疗,其中应用APLD( automated percutaneous lumbar discectomy)治疗单纯腰椎间盘突出症48例;应用MED(microendoscopic discectomy)治疗复杂型腰椎间盘突出症42例;应用传统后路椎板开窗技术治疗单纯腰椎间盘突出症38例;比较各组手术时间、术中出血、术后住院时间、疗效及并发症.术后均随访8个月～3年,观察复发情况.结果:三组不同手术方式手术时间及优良率比较差异无统计学意义(P＞0.05),APLD及MED组术中出血量及术后住院时间与传统手术组比较,差异有显著性(P＜0.05);术后随访疼痛全部缓解,无复发.结论:在严格掌握适应症的基础上,采用微创技术和采用传统手术治疗腰椎间盘突出症疗效相当,但微创技术创伤小、术中出血量少,术后住院日短,恢复快,优于传统手术.     

建立犬肺渐次萎陷动物模型的实验研究

目的:术中定位是微小肺癌手术面临的主要难题,而原因则是肺在术中萎陷造成的巨大形变。我们从研究肺的术中萎陷着手,建立肺渐次萎陷动物模型,模拟肺在术中发生的萎陷,用以研究肺萎陷的过程、规律及影响因素,为微小肺癌的术中定位提供理论基础。本文用渐进的人工气胸模拟肺在术中的渐次萎陷过程,探讨简便、有效的肺渐次萎陷动物模型的制作方法。方法:健康成年犬12只机等分入左、右侧手术组麻醉后移至CT扫描床采用切小口置管和胸腔穿刺两种方式制作人工气胸。向胸膜腔内分次、定量地注射气体,使肺逐渐萎陷直至完全萎陷。通过夹闭气管插管协助稳定肺的萎陷状态。将各萎陷状态分别进行CT扫描。结果:所有实验犬均顺利完成实验麻醉良好,无意外情况发生。9只犬给予气管插管,3只未给予气管插管;4只犬采用切小口置管方式制作气胸,8只采用胸腔穿刺方式。气管插管增加了模型制作难度,但有利于稳定肺的萎陷状态;胸腔穿刺方式相对操作更为简便。随着向胸膜腔内注射气体,肺缓慢而均匀地向肺门方向集中,萎陷进程满意。CT扫描记录了肺从膨胀到萎陷的各阶段,经过后期重建再现了肺的萎陷过程。5只犬出现并发症,均通过改变操作得以纠正,未影响实验进程。结论:本研究建立的肺渐次萎陷动物模型,能够很好地模拟肺在术中的萎陷过程,是研究术中肺萎陷的理想动物模型。     

浅谈二尖瓣交界分离术中监护和输液与复苏的关系

本文通过116例二尖瓣决窄分离术中监护和输液,从中体会到术中监护是心脏手术成功必不可少的条件。只有做好术中监护,才能及时了解病情发展,正确指导复苏和输液,提高手术的安全系数。     

戊巴比妥钠联用速眠新Ⅱ对西藏小型猪麻醉效果观察

目的观察联合应用速眠新Ⅱ和戊巴比妥钠对西藏小型猪的麻醉效果。方法采用速眠新Ⅱ（0.1mL/kg）肌内注射和3%戊巴比妥钠生理盐水溶液（0.2 mL/kg）静脉注射联合麻醉方法对15头行胚胎移植术的西藏小型猪进行麻醉,观察动物麻醉维持时间、镇痛效果、呼吸频率和心率变化及术后苏醒情况。结果80%（12头/15头）西藏小型猪初始量麻醉状态维持45 min以上,20%（3头/15头）西藏小型猪手术过程中追加麻醉。麻醉期间肌肉松弛效果好,动物呼吸和心率平稳。手术过程中西藏小型猪呼吸频率为（12-22）次/min,心率为（63-85）次/min,麻醉过程中未出现麻醉死亡,术后苏醒时间为30-60 min。结论速眠新和戊巴比妥钠混合麻醉效果好,且麻醉剂量较以往大幅减少,术后苏醒快。戊巴比妥钠联用速眠新复合麻醉对西藏小型猪是一种较理想的麻醉方法,且动物麻醉安全性高。     

Histopathological evaluation of recurrent goiter

The recurrent goiter is the regrowth of thyroid tissue after thyroidectomy. An inadequate surgical removal of the thyroid gland, lack of substitution therapy and pathological stimulation of the thyroid growth can all promote the recurrence. The aim of this study was to find the connection between the histopathological findings during the first and second operation and the recurrence of goiter. The study group consisted of 29 women and 1 man. The mean time to recurrence was 15 years. The most frequent histopathological finding during the first and second operation was struma nodosa. According to our observations different histopathological findings were found in 63.4% cases after primary and secondary thyroidectomy. Some genetic investigations showed that nodules in recurrent goiters did not derive from nodules left during the first operation but from a group of cells which had high growth potential. Thus, not only the operation technique and substitution after operation are key factors of successful therapy of goiter, but also other factors which stimulate the re-growth of thyroid tissue.     

The value of preoperative Doppler sonography for planning free perforator flaps

The individual perforating vessels have a high degree of anatomical variation, therefore it is desirable to conduct a careful examination of them before undertaking a perforator flap operation. Because locating the vessels beforehand makes performing the operative procedure much easier, the aim of the present study was to assess the value of using simple acoustic Doppler sonography to plan a perforator flap operation. The vessel examinations were carried out before taking 46 free microvascular flaps from either the lower abdominal wall or the buttock for reconstructive breast surgery. The perforating vessels located were marked, and their position relative to the umbilicus or the most cranial point of the rima ani recorded using a coordinate system. In 40 patients, a perforator flap operation (deep inferior epigastric perforator flap, n = 32; superior gluteal artery perforator flap, n = 8) was actually carried out; in six of these patients, a myocutaneous flap was used because of the insufficient availability of perforating vessels. Before the operation, perforating vessels were marked for each patient, with an average of 7.3 for the deep inferior epigastric perforator flap and 6.5 for the superior gluteal artery perforator flap. Out of 286 vessels marked for later perforator flaps, 162 were identified during the operation. A preoperatively marked vessel was used in 37 of 40 patients. In the remaining patients, a vessel was used that had not been previously marked. The vertical and horizontal distance between the perforating vessels identified during the operation and the preoperative marks averaged 0.8 cm. The results show preoperative Doppler sonography to be useful for locating the position of individual perforating vessels, making it much easier to find them during the operation.     

Increased urinary polyamine excretion during liver regeneration

Tumor growth is a process associated with both cell proliferation and cell death. The increase in polyamine excretion observed in cancer patients may be partly due to leakage of polyamines from proliferating cells, which all contain an elevated polyamine level. However, the increased polyamine excretion may also be due to a release of polyamines from dead or damaged cells. To determine if actively proliferating cells release polyamines, the urinary polyamine excretion was measured during a proliferative event associated with minimal cell necrosis. Rats subjected to partial hepatectomy were used as an experimental model. Their 24-hr urines were collected during 6 consecutive days following the operation. Rat liver regeneration is characterized by a proliferation wave with a maximum 24 hr after the operation. The 24-hr urinary putrescine excretion reached a maximum 2 days after the operation and then decreased. The 24-hr urinary spermidine excretion increased during the second day following operation and remained essentially unchanged during the rest of the experimental period. Although there is an apparent correlation between elevated urinary polyamine excretion and the proliferative activity, concurrent permeability changes and necrotic events may contribute to the increase in polyamine excretion.     

Hyperglucagonaemia in the surgical patient.

Twenty-one patients had serial samples of blood taken before, during, and after operation for the measurement of plasma glucagon, plasma insulin, and blood glucose concentrations. A significant rise in plasma glucagon level was noted during the operation. In contrast the plasma insulin concentration fell during the operation and rose in the postoperative period despite hyperglycaemia during and after the operation. These findings show that hyperglucagonaemia is a physiological consequence of a surgical operation and that the relationship of plasms glucagon to plasma insulin is complex.     

胶原膜与羟基磷灰石应用于牙周牙髓联合病变的探讨

目的：初步探索胶原膜与羟基磷灰石在治疗牙周牙髓联合病变中牙槽骨缺损的作用。方法：患牙进行根管治疗,调颌及牙周翻瓣术。其中２１例患牙的牙周骨缺损区植入胶原膜和羟基磷灰石;２０例以传统血充盈法关闭骨腔。二组患牙于治疗后１、３、６、１２、２４个月分别进行随访;结果：提示应用胶原膜和羟基磷灰石组的疗效明显优于对照组,并有统计学上差异。结论：胶原膜加羟基磷灰石治疗牙周牙髓联合病变的方法值得提倡。     

Emotional problems in children; the uses of drugs in therapeutic management

The repair of intracardiac defects under direct vision by opening the heart to expose the operative field, with the aid of hypothermia or a pump-oxygenator, is now a practical clinical method. Twelve patients were operated upon by this method. In eight patients an atrial septal defect was repaired during total circulatory occlusion under hypothermia. The seven patients in this group who had uncomplicated atrial defects survived the operation and are doing well after a short follow-up period. One patient with an unrecognized, associated ventricular defect died at the time of operation. Four patients were operated upon during total cardiac by-pass with the DeWall bubble-oxygenator. The first three patients survived operation and are continuing to do well after a brief follow-up period. In the fourth patient an atrioventricularis communis was repaired by the reconstruction of an atrial and ventricular septum with a plastic prosthesis. This patient died at the end of operation.     

Comparison of surgical and medical management of bleeding peptic ulcers.

During 1975-80, 908 patients admitted to Nottingham hospitals with gastrointestinal bleeding and found to have gastric or duodenal ulcers were analysed retrospectively for short-term outcome of treatment. Overall one-quarter of all patients underwent operation, but when the years 1975-7 were compared with 1978-80 the operation rate fell from one in three to just over one in five. Death rates were much lower in patients treated medically than in those who underwent operation, and the risks of operation were greater for patients with gastric ulcer. Less conventional operations were attended by greater mortality. Almost all patients who died during medical treatment and three-quarters of those who died after operation were over 65. No differences in age or clear variations in haemoglobin concentrations or transfusion requirements were found between the earlier and later periods. Reduction in operation rates had no appreciable effect on mortality, despite the accepted view that early operation is advisable.     

颈部肿瘤患者围术期血清唾液酸、微量元素及CD44v6、CysC、NO、TGF-β、VEGF的变化研究

目的：分析研究颈部肿瘤患者围术期血清唾液酸、微量元素及CD44v6、CysC、NO、TGF—β、VEGF的变化情况。方法：选取2012年1月～2013年2月于本院采用手术治疗的34例颈部肿瘤患者为观察组,将同时期于本院进行体检的34名健康人员选为对照组,然后将观察组术前1d、术后1、3、5、7d和对照组的血清唾液酸、微量元素及CD44v6、CysC、NO、TGF-β、VEGF水平进行检测与比较。结果：观察组术前1d的血清唾液酸、Cu、Cu／Zn及CD44v6、CysC、NO、TGF-β、VEGF均高于对照组,而观察组上述指标术后1、3、5、7d明显低于术前1d,观察组术前1d血清Se、zn低于对照组,术后1、3、5、7d高于对照组,均有显著性差异（P〈0．05）。结论：颈部肿瘤患者围术期血清唾液酸、微量元素及CD44v6、CysC、NO、TGF-β、VEGF的变化较为明显,可有效反应疾病的发展转归。     

布比卡因与左旋布比卡因在剖宫产手术中麻醉效果比较*

摘要目的：探讨蛛网膜下腔注射左旋布比卡因和布比卡因对剖宫产手术中的麻醉效果。方法：选取2012 年3 月到2013 年3 月 期间在我院住院进行剖宫产手术产妇60 例作为研究对象。随机分为左旋布比卡因组与布比卡因组,观察两组患者的麻醉效果以 及术后不良反应的发生情况。结果：剖宫产手术中左旋布比卡因和布比卡因的蛛网膜下腔注射麻醉后的5 min 和7 min 后MAP 值与麻醉前比较差异具有统计学意义（P<0.05）。左旋布比卡因和布比卡因的蛛网膜下腔注射麻醉后的5 min、7 min、10 min 以及 15minHR值比较差异具有统计学意义（P<0.05）。左旋布比卡因和布比卡因的蛛网膜下腔注射麻醉后Bromage 评分0分时间和麻 醉后切口感觉疼痛时间相比差异具有统计学意义（P<0.05）。左旋布比卡因和布比卡因麻醉后的不良反应的发生率比较差异无统 计学意义（P>0.05）。结论：剖宫产手术麻醉中布比卡因的麻醉效果好于左旋布比卡因,临床上剖宫产等腹部手术应该选择布比卡 因进行临床麻醉。     

麻醉诱导期预保温措施对胆道闭锁患儿术中体温的影响

目的:探讨麻醉诱导期预保温措施对胆道闭锁患儿手术中体温的影响。方法:将我院2012年4月~2014年8月收治入院需要行肝门空肠吻合重建肝外胆道术的100例胆道闭锁患儿,按电脑随机法分为对照组和治疗组,每组各50例,对照组患儿麻醉诱导期采用普通盖被覆盖保温0.5 h,试验组患儿麻醉诱导期采用充气保温毯进行预保温0.5h,手术中观察并记录两组患儿的基本情况和术中体温变化。结果:两组患儿入室体温、入室室温、麻醉时室温、手术时间、出血量及输液总量比较差异均无统计学意义(P0.05)。治疗组术中发生低体温的概率为36.2%,明显低于对照组的63.8%。对照组术中患儿体温变化较大,体温下降较明显(P0.05),而治疗组体温变化相对稳定(P0.05)。结论:麻醉诱导期应用充气保温毯预保温有利于胆道闭锁患儿行肝门空肠吻合术时保持相对稳定体温,是预防胆道闭锁患儿术中发生低体温的有效方法。     

布比卡因与左旋布比卡因在剖宫产手术中麻醉效果比较

目的：探讨蛛网膜下腔注射左旋布比卡因和布比卡因对剖宫产手术中的麻醉效果。方法：选取2012年3月到2013年3月期间在我院住院进行剖宫产手术产妇60例作为研究对象。随机分为左旋布比卡因组与布比卡因组,观察两组患者的麻醉效果以及术后不良反应的发生情况。结果：剖宫产手术中左旋布比卡因和布比卡因的蛛网膜下腔注射麻醉后的5min和7min后MAP值与麻醉前比较差异具有统计学意义（P〈0．05）。左旋布比卡因和布比卡因的蛛网膜下腔注射麻醉后的5min、7min、10min以及15minHR值比较差异具有统计学意义（P〈0．05）。左旋布比卡因和布比卡因的蛛网膜下腔注射麻醉后Bromage评分0分时间和麻醉后切口感觉疼痛时间相比差异具有统计学意义（P〈0．05）。左旋布比卡因和布比卡因麻醉后的不良反应的发生率比较差异无统计学意义（P〉0．05）。结论：剖宫产手术麻醉中布比卡因的麻醉效果好于左旋布比卡因,临床上剖宫产等腹部手术应该选择布比卡因进行临床麻醉．．     

剖宫产术中行子宫肌瘤剔除术可行性探讨

目的:观察剖宫产术中行子宫肌瘤剔除术的安全性及可行性。方法:将我院2010年1月-2012年1月入诊的90例子宫肌瘤的妊娠期孕妇,行剖宫产术同时行子宫肌瘤剔除术的患者,与同期83例单纯剖宫产手术患者对比研究,观察两种手术方式的临床疗效及其疾病预后分析。其主要比较的指标是平均手术时间、术中出血量、术后24h出血量、手术前后血红蛋白差值、平均住院时间、产褥病率及并发症等,记录并观察两组患者的上述指标,进行比较分析。结果:两组观察指标比较除剖宫产术中行子宫肌瘤剔除术平均手术时间(77.1±8.5)明显高于单纯剖宫产术(33.7±7.9),(t=34.70,P<0.05)外,其他各项测量术中出血量(t=0.09,P>0.05)、术后24h出血量(t=0.61,P>0.05)、手术前后血红蛋白差值(t=1.57,P>0.05)、住院时间(t=1.05,P>0.05)及产褥病率(x2=0.077,P>0.05),其他并发症发生率(x2=0.246,P>0.05)指标均无明显差异(P>0.05)。结论:对于有手术适应症的妊娠期子宫肌瘤孕妇,可根据患者及其家属医院选择剖宫产术同时行子宫肌瘤剔除术,该手术安全可靠,能避免二次手术或子宫切除等,临床上值得推广应用。     

Neural tube defects and first trimester operations

Swedish health care registries were used to identify women who had surgery during pregnancy and their offspring. Among the 2,252 infants born to women who had first trimester operations during 1973-1981, six had definite diagnoses of neural tube defects (expected number, 2.5). Scrutiny of the records showed that 572 operations occurred during gestational weeks 4-5, the period of neural tube formation, and that the mothers of five of the six infants with neural tube defects had an operation during that period (expected number of neural tube defects, 0.6) although one of the offspring probably had Meckel's syndrome. The relationship between neural tube defects and operation during pregnancy is discussed including the possibility that the association may be random.     

废气处理生物滤器微生物生态学研究进展

废气生物处理是一项新兴的气体污染控制技术,已成为当前环境领域的研究热点.本文概述了生物滤器系统(包括生物过滤器系统和生物滴滤器系统)结构及其去除气体污染物的原理,重点阐述了生物滤器微生物的分离、鉴定及其降解特性,微生物丰度、活性与微生物群落结构多样性之间的相关性,运行条件对微生物群落的影响,微生物群落结构时空变化规律,生物膜形成机理和模型等方面的研究进展,并对今后废气处理生物滤器微生物生态学研究方向进行了展望.