The Value of Pulmonary Function Studies in the Assessment of Patients for Cardiac Surgery

Preoperative pulmonary function, intracardiac pressures and degree of dyspnea were related to the incidence of postoperative respiratory insufficiency in 102 adult patients who underwent cardiac surgery. The purpose was to seek a reliable method of prognosticating the risk of postoperative respiratory insufficiency, especially after the use of cardiopulmonary bypass. When the heart-lung pump was used, 24 of 30 patients with a vital capacity less than 80% of the predicted normal developed respiratory insufficiency, whereas only eight of 41 patients with a normal vital capacity had this complication. In 26 patients where the vital capacity and gas diffusion were both normal, only three developed postoperative respiratory insufficiency. Other single or combined pulmonary function abnormalities, including tests of the mechanics of breathing, were of no greater value in predicting the postoperative course. The degree of dyspnea and the level of intracardiac pressures, although sometimes helpful, were often misleading.     

人体坐下站起过程中平衡功能评估及训练系统软件的设计与实现

本研究针对脑卒中偏瘫患者的平衡功能定量评估的需求,设计一种针对坐下站起过程中各阶段平衡功能评估及训练的系统软件,该软件配合坐位站起平衡功能训练仪使用。软件采用面向对象编程技术,应用VS2010(Microsoft Visual Studio2010)开发平台编写,可实时获得人体在坐下站起过程中的各评估参数,包括左右臀前后最大压力、左右足底平均压力、伸展期时间、伸展前期时间、左右侧最大和平均压力及站起时的最大加速度等。结合图形和数字实时显示及虚拟现实技术,对人体坐下站起的各阶段进行平衡功能评估和训练,通过视觉、听觉反馈,使训练更具趣味性。经过测试应用,结果表明,该系统软件运行稳定可靠,具有针对性的评估并结合实时可观测的压力曲线及大量的评估参数,可使评估结果更快速更有效。     

Evaluation of the findings of computed tomography of the lungs in patients with nonspecific pneumothorax in late periods after surgical treatment

By using the results of examination of 54 patients operated on for nonspecific spontaneous pneumothorax (NSP), the authors conclude that X-ray computed tomography (CT) is of high value. In addition to external respiratory function that identifies pulmonary functional changes, it is recommended that a comprehensive examination should include X-ray CT with parenchymal densitometry of the upper, middle and lower lung to reveal lung tissue structural changes. The examination of patients should be performed as soon as possible when the disease is detected and in the late postoperative period for early surgical correction of an emphysematous process in the lung.     

Myasthenia Gravis: Anesthetic and Surgical Management of the Patient Undergoing Thymectomy

Experience in the anesthetic and surgical management of 25 patients with myasthenia gravis is recorded. These are subdivided into two groups: those operated on during the period 1950-1958 and those operated on during the period 1959-1964. The purpose of this paper is to indicate improvement in mortality and morbidity due to three major advances: (1) use of the decamethonium diagnostic test in a myasthenia gravis clinic; (2) improvements in assessment and management of respiratory insufficiency; and (3) avoidance of anticholinesterase treatment in the immediate and early postoperative recovery period.Fourteen patients with myasthenia gravis, including five with thymoma and two who were refractory to medication, were in the second (1959-1964) group. There were no deaths and no myasthenic or cholinergic crises. Three prophylactic tracheostomies were performed. No emergency bronchoscopies or tracheostomies were required.     

Incidence of early post-operative iliofemoral thrombosis.

The doppler ultrasound probe was used to study 138 patients after major surgery to assess the incidence of iliofemoral thrombosis in the early postoperative period. The patients were simultaneously studied with the 125-I-fibrinogen uptake test. The accuracy of the ultrasonic technique was assessed concurrently by comparing its results with those of ascending phlebography in a separate group of patients. The ultrasound probe detected thrombus proximal to the calf but was inaccurate in locating its exact site. Of the 138 patients studied postoperatively 28 developed calf vein thrombosis detected istopically, but there was no evidence of iliofemoral thrombosis in any patient. Thus, spontaneous iliofemoral thrombosis in the early postoperative period is rare.     

Respiratory activity during germination of seeds of Cicer arietinum L. II. Effect of some metabolic inhibitors and mitochondrial activities

Changes in respiration rate during the early period of germination of Cicer arietinum L. seeds were studied. Three phases were distinguished. During phases I and II the RQ was higher than unity. Sodium fluoride showed no effect on gaseous exchange during phase I while in phases II and III a progressive increase in the inhibition of the respiratory activity was obtained. Iodoacetate inhibited oxygen uptake and carbon dioxide evolution from the beginning of germination. The activities of mitochondrial enzymes increased during the germination period, especially after the first 24 hours. The respiratory control and ADP/O ratio of the isolated mitochondria increased gradually during germination, reaching maximum values at 48 hours, lower, however than the expected theoretical ones.     

Early neurological complications of coronary artery bypass surgery.

A prospective study of 312 patients undergoing elective coronary artery bypass surgery was undertaken to determine the incidence, severity, and functional impact of postoperative neurological complications. Detailed evaluation of the patients showed that neurological complications after surgery were common, occurring in 191 of the 312 patients (61%). Although such a high proportion of the total developed detectable changes, serious neurological morbidity was rare. Neurological disorders resulted in death in only one patient (0.3%) and severe disability in only four (1.3%). Forty eight patients were mildly disabled during the early postoperative period, and the remaining 138 with neurological signs had no serious functional disability. The postoperative neurological disorders detected included one death from cerebral hypoxic damage. Prolonged depression of conscious level was observed in 10 patients (3%) and definite stroke in 15 (5%); 78 (25%) developed ophthalmological abnormalities and 123 (39%) primitive reflexes; postoperative psychosis was observed in four (1%); and 37 (12%) developed disorders of the peripheral nervous system. The incidence of serious neurological problems such as fatal cerebral damage, stroke, and brachial plexopathy is in accordance with experience elsewhere. Lesser abnormalities, whose detection required detailed neurological examination, were much commoner than expected from previous reports.     

Criteria of fitness for anaesthesia in patients with chronic obstructive lung disease.

Twelve patients with severe chronic obstructive lung disease undergoing 15 operations were assessed with preoperative lung function tests and blood gas estimations. Their operative and postoperative course was followed. There were no deaths or serious complications. Patients fell into three groups: those with low respiratory capacity but normal blood gases, who required no special respiratory treatment apart from physiotherapy and antibiotics; those with hypoxaemia but normal arterial carbon dioxide pressure, who needed more prolonged oxygen treatment after operation; and those with hypoxaemia and hypercapnia, who needed postoperative ventilatory support. While forced expiratory volume in one second (FEV) is a good screening test in preoperative assessment it should be supplemented by arterial blood gas estimations in patients with an FEV of less than 1 litre.     

Postoperative Pulmonary Atelectasis and Collapse,and its Prophylaxis with Intravenous Bicarbonate

Of 181 patients undergoing major abdominal surgery 116 developed chest complications associated with a metabolic acidosis, low Pco2, depressed tidal volume, increased respiratory rate, but no increase in minute volume. In a matched group of 116 patients given intravenous bicarbonate postoperatively only 15 developed chest complications. This suggests that respiratory physiological dead space decreases in patients with pulmonary collapse and atelectasis following surgery. Acidotic respiration proved inefficient in the postoperative period, and intravenous bicarbonate had a very pronounced effect on the tidal and minute volumes of acidotic patients with pulmonary collapse and atelectasis.     

术前呼吸功能训练联合术后快速康复操对胸腔镜肺叶切除术肺癌患者呼吸功能、生活质量和康复效果的影响

摘要 目的：观察术前呼吸功能训练联合术后快速康复操对胸腔镜肺叶切除术肺癌患者呼吸功能、生活质量和康复效果的影响。方法：97例研究病例选取自2019年4月~2021年5月期间我院收治的行胸腔镜肺叶切除术肺癌患者。将97例患者根据信封抽签法分为对照组（48例）和观察组（49例）,对照组患者予以术前呼吸功能训练和手术常规康复训练,观察组患者在对照组基础上联合术后快速康复操。对比两组术前、术后1周的呼吸功能、生活质量和康复效果,对比两组术后并发症发生率。结果：观察组术后1周用力肺活量（FVC）、第1秒用力呼气容积（FEV₁）、动脉血氧分压（PaO₂）高于对照组（P<0.05）。观察组术后1周动脉二氧化碳分压（PaCO₂）低于对照组（P<0.05）。观察组术后1周症状领域评分低于对照组（P<0.05）。观察组术后1周功能领域、总体健康状况评分高于对照组（P<0.05）。观察组患者的术后肛门排气时间、保留尿管时间、保留胸管时间、住院时间短于对照组（P<0.05）。观察组的术后并发症发生率低于对照组（P<0.05）。结论：术前呼吸功能训练联合术后快速康复操应用于胸腔镜肺叶切除术肺癌患者,可促进术后康复,改善其呼吸功能,提高生活质量,减少并发症发生风险。     

不同预防性抗生素用于肿瘤患者围手术期的成本-效果分析

目的:探究不同抗生素用于肿瘤患者围手术期的成本-效果。方法:选择于我院接受手术治疗的93例肺癌患者,所有患者按照随机数字表法均分为三组,每组31例,三组患者实施不同的抗生素预防方案,对比三组患者的一般手术情况(手术时间、术中出血量、术后7 d最高体温、术后住院时间)、抗生素应用效果(术后呼吸道感染率、术后7 d平均体温、术后7 d平均白细胞计数)以及不同抗生素预防方案成本-效果。结果:(1)三组患者手术时间、术中出血量、术后7 d最高体温、住院时间对比差异均无统计学意义(P0.05);(2)三组患者术后呼吸道感染率、术后7 d平均体温、术后7 d平均白细胞计数对比差异均无统计学意义(P0.05);(3)A组患者具有最高的成本-效果比值,单位效果所花费的成本显著低于B、C两组(P0.05)。结论:术前预防及术后短疗程应用头孢唑林钠能够显著降低肺癌患者术后感染率,减少抗生素用量及花费,提高患者围手术期成本-效果。     

Delayed results after implantation of bifurcated prosthesis in aorto-iliac incompetence]

Early results and those seen after a 5-year follow up are discussed. Three hundred fifty one patients with aortoiliac incompetence were treated with the implantation of bifurcated aortoiliac prosthesis. Very favourable early result was achieved in 284 (81%) patients. Very favourable delayed effect was noted in 133 patients, i.e. in 75% of patients who reported for the control examination. In the follow up period, amputation of the limb was performed in 30 (8.5%) patients because of progressing ischemia. Hundred thirty seven (39%) followed up patients died during 5 years. Causes of so high mortality rate are discussed in view of risk factors and postoperative complications.     

Postoperative hypoparathyroidism: Direct para-operative period]

Surgical hypoparathyroidism is a severe complication of the operations on thyroid gland. Hundred thirty patients aged between 17 and 77 years have been analysed clinically. Group I involved 45 patients with surgical hypoparathyroidism of transient or partial character, group II involved 85 patients with severe irreversible surgical hypoparathyroidism. Hypocalcemia in postoperative period was significantly higher in group II than that in group I (p < 0.02), and negatively correlated with the maximal dose of vitamin D3 necessary to compensate calcemia (r = -0.42). Follow-up results indicate that the age and sex of patients, preoperative diagnosis, radiotherapy, and type of surgery have no effect on the degree of damage to parathyroid glands, tetany development rate, degree of hypocalcemia and hyperphosphatemia. High degree hypocalcemia diagnosed in the early postoperative period suggests irreversible injury to parathyroid glands. Management of patients with postoperative tetany requires a close cooperation of surgeon and endocrinologist.     

添加丙氨酰谷氨酰胺的胃肠外营养对存在营养风险的胃癌根治术患者免 疫功能、营养状态及术后恢复的临床意义*

目的:本研究旨在探讨NRS评分大于5分的胃癌根治术患者围手术期应用丙氨酰谷氨酰胺(Ala-Gln)强化的肠外营养对免疫功能、营养状况及术后恢复情况的临价值。方法:NRS-2002评分大于5分的胃癌患者60例,随机分为两组,每组30例。术前开始给予肠外营养支持,5日后手术,手术方式为根治性胃切除,包括远端胃大部切除术和全胃切除术。术后继续给予常规肠外营养。只有实验组给予谷氨酰胺双肽每日20克。于入院时和手术后第6日测量CD4、CD8、CD4/CD8、IgG、IgA、IgM淋巴细胞计数等免疫指标,血清总蛋白、白蛋白、谷丙转氨酶、总胆红素、血肌酐等肝肾功能指标,观察手术恢复过程及术后并发症发生情况。结果:采用谷氨酰胺强化的试验组CD4、CD8等免疫指标恢复情况显著优于对照组。二者一过性肝功能损伤发生率无明显差异。但试验组白蛋白较对照组恢复迅速。试验组术后肠蠕动恢复较对照组快,术后腹泻发生率较低。两组在术后抗生素应用时间、术后感染等发病率方面未显示统计学差异。结论:对存在营养风险的胃癌患者进行围手术期静脉营养支持时添加谷氨酰胺制剂可明显改善患者的免疫状况,促进术后恢复减少手术并发症。     

Evaluation of surgical results in lower limb atherosclerotic ischemia comparing men and women]

Multicenter studies involved 1449 male and 131 female patients operated for the atherosclerotic ischemia of the lower limbs. About 50% of all limbs were in the III or IV stage of ischemia (according to Fontaine's classification) before surgery. Atherosclerotic lesions involved mainly aortoiliac segment in the majority of patients. Early results of surgery were similar in both men and women. An improvement during a 5-year follow up period was noted more frequently in women than in men--86% and 68.5% of limbs respectively. Late result of lumbar sympathectomy was similar in both groups. Limb amputation and mortality rates were similar in both groups in the early postoperative period and during a 5-year follow up as well.     

术中局部化疗对大肠癌患者预后影响的临床观察

目的：观察术中局部化疗对大肠癌患者的预后影响,探讨提高大肠癌患者临床疗效的辅助治疗方法。方法：选择DuckB期和DuckC期患者76例,根据自愿的原则均分为常规手术组和术中化疗组,常规手术组采取常规手术治疗,术中化疗组在常规手术过程中给予局部化疗治疗,比较两组患者术后第7d血常规、肝肾功能及两组患者术后并发症,并随访两组患者术后12个月和24个月局部复发情况。结果：两组患者在术后血常规、肝肾功能及术后并发症方面比较,差异无统计学意义（P〉0．05）;术后12个月和24个月局部复发病例比较,差异具有统计学意义①〈0．05）,术中化疗组显著少于常规手术组。结论：在DuckB期和DuckC期大肠癌患者外科手术治疗过程中．应积极采取术中化疗的治疗措施。     

Autoantibodies to light myosin chains as an early marker of damage to the myocardium

The concentration of autoantibodies to myosin light chains in the blood serum of patients who have undergone operation on heart under conditions of artificial hypothermal circulation was measured after 3, 6, 9, 18, 24, 36 h following the reperfusion of myocardium. According to the postoperative data, the patients were divided into three groups: patients with stable hemodynamics in the postoperative period (group 1); patients with myocardial stunning following reperfusion of myocardium (group 2); and patients with severe heart failure that developed in early postoperative period (group 3). Significant differences in the concentration of autoantibodies to myosin light chains have been found between the groups. A high correlation was established between the duration of cross-clamping of aorta and the concentration of autoantibodies. By means of multivariant regression analysis, factors characterizing the initial severity of disease that can influence the concentration of autoantibodies to myosin light chains in blood have been revealed.     

经皮骶髂关节空心螺钉内固定联合支架外固定与切开复位重建钢板内固定治疗Tile B、C型骨盆骨折的比较研究

摘要 目的：对比经皮骶髂关节空心螺钉内固定联合支架外固定与切开复位重建钢板内固定治疗Tile B、C型骨盆骨折的临床效果。方法：选取本院2018年3月至2021年10月收治的Tile B、C型骨盆骨折患者共68例进行前瞻性研究。将纳入患者按随机数字表法分为经皮骶髂关节空心螺钉内固定联合支架外固定治疗（观察组）与切开复位重建钢板内固定治疗（对照组），每组各34例。比较两组患者手术时间、术中出血量、术后早期疼痛视觉模拟评分（VAS）、住院时间及术后早期并发症发生率；此外随访6个月，观察患者术后Matta影像学评分标准优良率（Matta优良率）、Majeed骨盆骨折功能评分（Majeed评分）和术后骨折愈合时间，另记录术后6个月时两组术后并发症发生情况。结果：两组手术时间、术后3天VAS评分、术后7天VAS评分、住院时间及术后骨折愈合时间比较均未见明显差异（P>0.05）；观察组术中出血量明显少于对照组，差异具有统计学意义（P<0.05）。观察组术后3个月时Matta优良率和Majeed评分均优于对照组，差异具有统计学意义（P<0.05），但两组术后6个月比较差异无统计学意义（P>0.05）；观察组的术后早期并发症发生率低于对照组，差异具有统计学意义（P<0.05）；术后6个月时两组并发症情况无统计学意义（P>0.05）。结论：两种方法治疗Tile B、C型骨盆骨折均可取得良好疗效，但切开复位重建钢板内固定方法仍保功能恢复良好的优点，而经皮骶髂关节空心螺钉内固定联合支架外固定具有低并发症发生率，更利于提升术后早期恢复效果。     

Thoracic Surgery in the Elderly

With careful attention to details of preoperative, operative and postoperative care, intrathoracic procedures can be carried out safely in the elderly patient. The authors describe such procedures in 111 patients over 60 years of age who presented with a wide variety of primary diseases. Bronchogenic carcinoma, present in 48 patients, was the commonest. One-third of the total group had significant associated disease, usually in the form of coronary artery or chronic respiratory disease. The overall mortality rate was 6.3%.Before surgery, all patients were prophylactically digitalized regardless of their cardiac status. Blood volume estimations were determined in those with excessive weight loss. At operation, measurement of central venous pressure was found to be the best guide to blood replacement.Retention of bronchial secretions was the commonest postoperative complication. This problem can be minimized with intensive chest physiotherapy, adequate hydration, minimal doses of analgesic agents and, when indicated, early tracheostomy.     

Regional Lung Function in Patients with Obstructive Lung Diseases

Regional lung function was measured, using radioactive xenon-133, in a group of normal subjects and in three carefully defined groups of patients with obstructive lung disease. When compared with the normal subjects, patients in the emphysematous group showed a relative reduction of ventilation and perfusion to the upper zones, while patients having chronic bronchitis without cardiac or respiratory failure showed a predominantly lower zone defect. In the group of patients with chronic bronchitis with cardiac and respiratory failure no consistent pattern was found.