气管切开术的并发症(附213例病例分析)

本文报道了气管切开术各种并发症的发病率,并对术中或术后并发症的病的病因、发病机理、治疗和预防进行了讨论。     

距骨骨折的手术治疗

目的探讨距骨骨折的特点、类型、手术方法及影响疗效的相关因素。方法1998年12月至2004年12月,共治疗距骨骨折39例,根据Hawkins分型方法,型骨折5例,型骨折25例,型骨折9例。型骨折采用松质骨拉力螺钉内固定;、型骨折行急诊手术,其中型骨折采用前外侧切口暴露,解剖复位,2枚松质骨拉力螺钉交叉内固定;型骨折采用踝前内侧切口暴露,解剖复位,松质骨拉力螺钉内固定,伴有内踝骨折时同时复位内固定,并以自体髂骨块跨骨折线嵌入植骨。术后短腿管形石膏外固定12~24周,X线片示骨折线模糊后拆石膏行不负重下踝关节活动,骨折线消失后恢复伤前活动。结果除2例失访外,37例获得随访。随访时间1.5~6年,平均3年。根据Hawkins疗效标准判定,优12例(32.4%),良17例(45.9%),可6例(16.2%),差2例(5.4%),优良率为78.4%。结论距骨骨折虽然并发症多且后果严重,但是通过急诊手术、解剖复位、有效内固定、自体髂骨块嵌入植骨、局部封闭、理疗等综合治疗,可降低病残率。     

Inguinal hernia is a common complication in lower midline incision surgery

Inguinal hernia is a known complication after radical retropubic prostatectomy (RRP). We have investigated whether other types of lower midline incision surgery in males increase the risk of inguinal hernia. Male patients operated with open prostatectomy for benign prostate hyperplasia (n = 95), pelvic lymph node dissection for staging of prostate cancer (n = 88), or cystectomy for bladder cancer (n = 76) were identified and were sent questionnaires in which they were asked about postoperative inguinal hernia morbidity. Two-hundred and seventy-one men operated with RRP had previously received a similar questionnaire. The answers were compared with those from a control group of 953 men who had not undergone surgery. Annual attributional hernia morbidity and Kaplan–Meier hernia-free survival were calculated. The cumulative incidence of post-operative inguinal hernia and annual attributional hernia morbidity after the respective surgical procedures were clearly higher during the early years post-operation than for nonoperated patients. Inguinal hernia is a common postoperative complication in males after all the lower midline incision surgery investigated.     

妊高征与眼底视网膜病变的临床探讨

目的 :探讨妊高征患者临床特征与视网膜病变的关系。方法 :观察 2 2 0例妊高征患者的眼底情况。结果 :视网膜病变与水肿关系不密切 ,与平均动脉压、蛋白尿的严重程度、病程及红细胞压积有密切关系 ;有眼底改变者 118例 ,占 5 0 .3%。结论 :眼底镜检查是临床上借以了解视网膜血管的常用方法 ,并可反映妊高征病情的程度 ,为产程处理提供依据     

亚低温治疗患者鼻饲营养并发症的观察及护理

报道48例亚低温治疗患者采用一次性投给、间歇滴注和连续输注营养膳的方式鼻饲营养，其并发症有：腹泻、腹胀、肠蠕动亢进，便秘，食物反流，吸入性肺炎，代谢紊乱，高血糖，水、电解质失衡，鼻胃管堵塞等。护理中体会到亚低温治疗患者鼻饲营养的时机最好在急性期1～2d后，应用鼻饲泵连续输注，适时使用胃肠动力药西沙比利．掌握营养膳的配制和正确的鼻饲方法，严密观察，发现异常及时处理，可大大降低并发症的发生。     

改良开放性手术治疗巨大良性前列腺增生症

目的探讨巨大良性前列腺增生症的开放性手术治疗方法及效果。方法回顾分析16例巨大良性前列腺增生症,年龄61~88岁,平均74岁。作耻骨上经膀胱前列腺切除术。结果手术均成功;手术时间35~65min,出血量100~200mL,术后前列腺重量为200~520g,平均215g;膀胱冲洗2~3d,拔导尿管5~7d;术后3d再出血1例,经DSA同侧髂内血管栓塞止血成功,排尿困难1例,短期尿失禁1例,其余患者术后均排尿通畅,控尿良好。结论开放性手术治疗巨大良性前列腺增生症,其梗阻解除彻底,是一种合理的治疗方法。恰当的手术方法是提高疗效及降低并发症的关键。     

小儿腮腺炎并发中枢神经系统感染52例临床分析

目的:探讨小儿腮腺炎并发中枢神经系统感染的临床特点.方法:对52例小儿腮腺炎并发中枢神经系统感染的临床资料进行回顾性总结分析.结果:3～7月份为小儿腮腺炎并发中枢神经系统感染的发病高峰季节(92.31%).发病年龄以6～12岁为主(82.69%),多发生于腮腺肿痛3天以上伴有持续发热者(78.85%),少数患者同时有其它脏器的损害,一般治疗疗效较好.结论:腮腺炎极易并发中枢神经系统感染,年长儿发生率高,应推广接种流腮活疫苗降低发病率.     

Cardiovascular collapse during anesthesia in a patient with preoperatively discontinued chronic MAO inhibitor therapy

We describe a patient in whom long-term monoamine oxidase (MAO) inhibitor therapy was discontinued 20 days before surgery with general anesthesia. This patient developed severe perioperative hypotension after administration of 10 mg of bupivacaine through an epidural catheter, which was corrected only after potent vasopressor therapy. We attribute this hemodynamic instability to attenuation of this patient's sympathetic tone based on several mechanisms: (1) residual effect of long-term administration of MAO inhibitor that caused a decrease in the number of β-adrenergic receptors (adrenergic subsensitivity due to receptor down-regulation), (2) recovered MAO activity causing effective degradation of sympathetic amines, and (3) combined attenuating effects of general and epidural anesthesia on sympathetic tone.     

大黄(庶虫)虫丸治疗囊肿性痤疮的临床疗效评价

目的　观察大黄虫丸治疗囊肿性痤疮的临床疗效。　方法　选择囊肿性痤疮患者 33 例做为治疗组,给予口服大黄虫丸治疗,观察并记录结果。　结果　治疗的总有效率为 90 9%,对照组(P<0 05)。　结论　大黄虫丸对囊肿性痤疮有较好的临床疗效。     

人工髋关节置换并发假体周围骨折的临床分析

[目的]分析人工髋关节置换术中、术后发生假体周围骨折的原因，探讨其预防措施和治疗方法。[方法]自1995年7月-2006年8月，共640例人工髋关节置换术患者，其中18例发生假体周围骨折，术中骨折11例（股骨距骨折7例，假体柄下端骨折4例），术后骨折7例（假体柄下端、远端骨折），男12例，女6例，年龄51-79岁，平均68岁，按照髋关节假体置换术后骨折的AAOS分型：I型1例，Ⅱ型4例，Ⅲ型4例，IVa型4例，IVb型2例，V型1例，Ⅵ型2例，其中术中假体周围骨折11例有10例予立即内固定，1例（Ⅱ型）股骨距劈裂骨折无明显移位未做内固定，仅延迟下地负重时间；术后假体周围骨折7例有4例在两周内行手术内固定，2例合并假体松动而采用全髋关节翻修术，1例（Ⅵ型）假体远端骨折因身体原因无法手术而采取保守治疗予以骨牵引4周后改石膏外固定。[结果]术后平均随访时间15．2个月（6-38个月），15例患者骨折均达到骨性愈合，2例发生骨折延迟愈合，保守治疗的1例患者术后6个月拍x线片示骨折畸形愈合，术后8个月因内科疾病死亡。Harris评分平均80分（67-92分）。[结论]术中暴力、股骨髓腔发育异常、假体型号过大、骨质疏松是术中假体周围骨折发生的主要原因，骨溶解、假体松动、骨质疏松加外伤是术后发生假体周围骨折的主要原因，根据不同分型采用不同的治疗方法以促进骨折愈合，稳定假体，减少卧床时间和并发症（尤其对高龄患者更为重要），尽早恢复功能。