解剖型钢板治疗锁骨骨折

锁骨呈＂S＂型弯曲,位置表浅,肩关节外伤后易发生骨折,是临床上常见的骨折之一,约占全身骨折的6%,且骨折后容易旋转和错位。而其中又以中1/3骨折最为多见[2]。锁骨骨折以往多采用非手术治疗,随着科技的发展,新材料、方法的不断涌现,对于不稳定的锁骨骨折,钢板内固定已经成为首选治疗方法[3]。本科近来采用解剖钢板治疗锁骨骨折,获得了满意的疗效。     

葡萄糖酸钙对佳乐施扩容性血液稀释性凝血功能降低的影响

为对比观察不同剂量的葡萄糖酸钙对佳乐施扩容性血液稀释性凝血功能抑制的预防作用 ,将 30例颅脑手术病人分为 3组 ,Ⅰ组单独用佳乐施 ,Ⅱ组、Ⅲ组佳乐施中葡萄酸钙的加入量分别为 1g/L和 2 g/L。麻醉诱导后 ,分别用相应液体以 2 5mL/min的速度扩容 ,分别于麻醉诱导后、输液 5 0 0、1 0 0 0、1 5 0 0mL及完成扩容后 30min时测定红细胞比容 (HCT)、活化部分凝血活酶时间 (APTT)、血浆凝血酶原时间 (PT)、血清钙离子浓度 (Ca2 + )等参数。结果 :3组病人扩容期间PT和APTT均逐渐延长 ,但Ⅱ组和Ⅲ组病人延长程度明显低于Ⅰ组 ,而Ⅱ组和Ⅲ组病人之间基本相同。输入 1 5 0 0mL后 ,Ⅰ组病人PT和APTT分别延长 1 3.9%和 2 1 .8% ,Ⅱ组分别延长 1 0 .6 %和 1 2 .4 % ,Ⅲ组分别延长 9.8%和 8.2 %扩容期间。Ⅰ组病人血清Ca2 + 逐渐降低 ,Ⅱ组无明显变化 ,Ⅲ组明显增高 ,输入 1 5 0 0mL后 ,Ⅰ组病人Ca2 + 降低 1 3.8% ,Ⅱ组无明显变化 ,Ⅲ组增高 6 .4 %。提示佳乐施可较好地应用于扩容性血液稀释 ,但可造成凝血功能下降 ,Ca2 + 较低是其主要原因之一 ,输入 5 0 0mL佳乐施的同时补充 0 .5 g葡萄糖酸钙可起到一定的预防作用。     

急诊闭合复位小切口空心螺钉治疗股骨颈骨折

作者自2003-2006年采用伤后12h内闭合复位小切口空心加压螺纹钉内固定治疗新鲜股骨颈骨折22例，失访3例，现报告如下。1临床资料本组22例，均为新鲜骨折，男13例，女9例。年龄27-73岁，其中27-70岁17例，71岁以上5例。按骨折部位分：头下型8例，经颈型4例，基底型10例。按Garden分型：1—2型骨折14例，3—4型8例。伤后6小时内手术者16例，6h～12h者6例。     

七氟烷用于癫痫手术麻醉及其对脑电图的影响

Objective To assess the effects of concentration of sevoflurane on the electrocorticogram (ECoG) of intractable epileptic patients or non-epileptic patients undergoing surgery and investigate the suitable concentration of sevoflurane for epilepsy surgery. Methods Of 24 patients with intractable epilepsy and 15 patients with non-epilepsy but brain diseases, ECoG were recorded under sevoflurane anesthesia with 0.7 minimum alveolar anesthetic concentration (MAC), 1.0 MAC, 1.3 MAC, and 1.5 MAC, respectively, under similar ventilatory conditions. Spike activity and other frequency brain waves were evaluated. Results The frequencies and leads of spike waves (or spike-form waves) were similar with 0.7-1.3 MAC sevoflurane anesthesia in epileptic patients, whereas the spike waves were significantly increased at 1.5 MAC in epileptic patients and 5 of 15 non-epileptic patients (P<0.05). The change of other frequencies brain waves was similar in both group: the frequency of α and β waves decreased, δ waves increased and θ waves changed a little. Conclusion The maintenance of anesthesia with 0.7-1.3 MAC sevoflurane is safe and suitable for the craniotomy surgery of epileptic patients with ECoG monitoring. Careful attention should be paid to the higher concentration of sevoflurane (>1.5 MAC) used when intraperative ECoG is used in both epileptic patients and non-epilepsy patients.     

牛磺酸对大鼠心肌肌浆网钙转运功能的影响

目的；观察牛磺酸大鼠心肌肌浆网（ＳＲ）钙转运动的影响。方法；动物分为假手术、休克和牛磺酸组；盲肠结扎穿地复制休克模型；蔗糖密度梯度离心法制备心肌ＳＲ，分别测定ＳＲ钙摄取、「＾３Ｈ」ｒｙａｎｏｄｉｎｅ受体结合。结果；与休克组比较，牛磺酸组的ＳＲ摄钙率和最大摄钙量分别提高９１．５％（Ｐ〈０．０１０和３２．２％（Ｐ〈０．０１），「＾３Ｈ」ｒｙａｎｏｄｉｎｅ受体结合Ｂｍａｘ值增加５４．２％（Ｐ〈０．０１）     

七氟烷对癫痫和非癫痫病人脑电图的影响

目的对比观察不同呼气末七氟烷含量时癫痫及非癫痫病人脑电图及棘波的变化,以探讨癫痫手术中七氟烷维持麻醉的合适含量。方法20例癫痫需行手术治疗及15例非癫痫开颅手术病人,以1·0MAC七氟烷维持麻醉,术中置入硬膜外电极后,调整蒸发器刻度,分别控制呼气末七氟烷含量于0·7、1·0、1·3、1·5MAC,并各稳定15min后描记脑电图。结果癫痫病人1·0、1·3MAC七氟烷时棘波的频数与0·7MAC时相比无明显变化,而1·5MAC时棘波的频数明显高于0·7MAC时(P<0·05)。非癫痫病人在0·7、1·0及1·3MAC七氟烷时均无棘波出现,于1·5MAC时有5例出现棘波。随着呼气末七氟烷含量的升高所有病人的α和β波均逐渐减少,而δ波增多。结论癫痫手术用七氟烷维持麻醉,术中需行皮质脑电图监测时,将七氟烷含量维持于0·7~1·3MAC较为适宜,以保证癫痫源灶准确的定位及手术切除范围。     

七氟烷用于癫痫手术麻醉及其对脑电图的影响

Objective To assess the effects of concentration of sevoflurane on the electrocorticogram (ECoG) of intractable epileptic patients or non-epileptic patients undergoing surgery and investigate the suitable concentration of sevoflurane for epilepsy surgery. Methods Of 24 patients with intractable epilepsy and 15 patients with non-epilepsy but brain diseases, ECoG were recorded under sevoflurane anesthesia with 0.7 minimum alveolar anesthetic concentration (MAC), 1.0 MAC, 1.3 MAC, and 1.5 MAC, respectively, under similar ventilatory conditions. Spike activity and other frequency brain waves were evaluated. Results The frequencies and leads of spike waves (or spike-form waves) were similar with 0.7-1.3 MAC sevoflurane anesthesia in epileptic patients, whereas the spike waves were significantly increased at 1.5 MAC in epileptic patients and 5 of 15 non-epileptic patients (P<0.05). The change of other frequencies brain waves was similar in both group: the frequency of α and β waves decreased, δ waves increased and θ waves changed a little. Conclusion The maintenance of anesthesia with 0.7-1.3 MAC sevoflurane is safe and suitable for the craniotomy surgery of epileptic patients with ECoG monitoring. Careful attention should be paid to the higher concentration of sevoflurane (>1.5 MAC) used when intraperative ECoG is used in both epileptic patients and non-epilepsy patients.     

术前晶体液和胶体液急性扩容稀释期间血流动力学变化的对比研究

目的：比较乳酸钠林格液与海脉素用于术前急性扩容稀释期间血流动力学的变化。方法：26例颅脑手术病人，随机等分为乳酸钠林格液组(LR组)和海脉素组(H组)。麻醉诱导后，分别用相应的液体以25ml／min的速度进行扩容稀释；用UNION CACH-2001无创阻抗法监测仪连续监测扩容期的血流动力变化。结果：LR组SVI、CI、TPR、MAP和HR无明显变化。H组MAP和HR无明显变化，SVI和CI逐渐增高，输入海脉素1000ml后，二者分别增加27．5％和17．3％，TPR下降22．3％。结论：麻醉诱导后用海脉素扩容稀释优于乳酸钠林格液。     

精-甘-天冬-丝氨酸对脓毒性休克大鼠心肌肌浆网钙转运的影响(英文)

目的:探讨一种人工合成的纤维蛋白原降解肽片段RGDS对脓毒性休克大鼠心肌肌浆网钙转运功能的影响。方法:大鼠盲肠结扎穿孔术后4h和14h分两次尾静脉注射RGDS 5μmol·kg~(-1)。制备大鼠心肌肌浆网(SR)膜;测定SR Ca~(2 )摄取和[~3H]ryanodine受体结合功能。结果:RGDS组大鼠心肌SR摄Ca~(2 )率及摄Ca~(2 )量分别较休克组提高104％(P<0.01)和12％(P<0.05),而心肌SR钙释放通道-[~3H]ryanodine受体结合B_(max)和K_d值没有明显变化。同时RGDS还可以减轻休克大鼠心肌组织钙聚积。结论:RGDS提高休克大鼠心肌SR Ca~(2 )摄取功能,维持心肌细胞钙稳态,具有心肌保护作用。