气管插管集束Box在急救中的临床研究

目的:为了尽量减轻因气管插管速度慢而对患者预后的影响,探讨气管插管的优化管理方法。方法:使用气管插管集束Box将气管插管所有用物整理成完整的一套或多套用物,放入一个专用气管插管准备箱中。紧急气管插管时可短时间内取用成套用物。分为两个时间段来研究,第1阶段为2010年7～9月,46例气管插管患者采用零散用物整合的管理方法,为对照组;第2阶段为2010年10～12月,46例气管插管患者采用气管插管集束Box管理方法,为实验组。比较两组用物准备平均耗费时间,气管插管后抢救成功率,医护人员体力消耗,医护配合满意度,患者及家属满意度等方面。结果:通过使用气管插管集束Box优化的管理方法,与对照组相比,实验组准备用物耗费时间平均缩短了32 s,气管插管后抢救成功率提升了8.69%,医护人员体力消耗减少,医护合作满意度提高,患者及家属满意度提高。结论:气管插管集束Box的管理方法是紧急气管插管患者安全的一个重要保证。

慢性阻塞性肺疾病经营养支持治疗的临床研究

目的探讨慢性阻塞性肺疾病(COPD)患者营养支持治疗的临床疗效。方法将73例COPD患者随机为对照直组和治疗组,对照组采用常规治疗,治疗组在常规治疗的基础上加用营养支持治疗,比较两组患者治疗前后肺功能指标的变化情况。结果治疗前两组患者第1秒钟用力呼气容积(FEV1)、用力肺活量(FVC)比较差异均无统计学意义;治疗组治疗后FEV1为(1.53±0.38)L,FVC为(3.01±0.53)L,与治疗前[FEV1(1.21±0.47)L,FVC(2.36±0.52)L]比较,差异均有统计学意义(p<0.01)。对照组治疗后,FEV1和FVC虽有改关善,但差异无统计学意义(p>0.05)。治疗组治疗后FEV1、FVC均明显优于对照组治疗后,差异均有统计学意义(p<0.01)。治疗组在治疗期间虽有少数病例出现轻度不良反应,但通过调节输液速度后,症状均能自行消失。结论营养支持治疗有助于改善COPD患者肺功能,提高患者的生活质量。因此,对于存在营养不良的COPD患者给予营养支持治疗有着积极的意义。

Preventive effect of regional radiotherapy with phosphorus-32 glass microspheres in hepatocellular carcinoma recurrence after hepatectomy

AIM: To evaluate the preventive effects of phosph-orus-32 glass microspheres (P32-GMS) in the recurrence of massive hepatocellular carcinomas (HCCs) after tumor resection. METHODS: Twenty-nine patients with massive HCCs received local P32-GMS implantation after liver tumors were removed,while the other 38 patients with massive HCCs were not treated with P32-GMS after hepatectomies. The radioactivity of the blood,urine and liver were examined. The complications,HCC recurrence and overall survival rates in the patients were analyzed. RESULTS: P32-GMS implanted in the liver did not cause systemic absorption of P32. There were no significant differences of postoperative complications between the patients with and without P32-GMS treatment. The short-term (six months and 1 year) and long-term (2,3 and over 3 years) recurrence rates in patients who received P32-GMS radiotherapy were signifi cantly decreased,and the overall survival rates in this group were signifi cantly improved. CONCLUSION: P32-GMS implantation in the liver can significantly decrease the postoperative recurrence and improve the overall survival in HCCs patients after hepatectomy. This therapy may provide an innovative method in prevention of HCC recurrence after operation.

Experimental and clinical study of influence of high-frequency electric surgical knives on healing of abdominal incision

AIM： To study the influence of high-frequency electric surgical knives on healing of abdominal incision. METHODS： Two hundred and forty white rats were divided into 10^0, 10^2, 10^5, and 10^8 groups and rat models of abdominal operation were induced by using electric surgical knives and common lancets respectively. Then they were respectively given hypodermic injections of normal saline and 0.2 mL quantitative mixture of Escherichia coil, Staphylococcus aureus and Pseudornonas aeruginosa at a concentration of 10^2, 10^5 and 10^8. On the basis of the animal experiment, 220 patients undergoing abdominal operations （above type Ⅱ） were randomly allocated into one of following three groups： electric knife （EK, 93 cases）, electro-coagulation （EC, 55 cases） and control （72 cases）. High-frequency electric surgical knives were used to dissect abdominal tissues and electro-coagulation for hemostasis in EK group. Common lancets and electro-coagulation were applied in EC group. Common lancets and tieing silk suture were used in the controls. RESULTS： In all the groups except group 10^0, infection rate of incisional wounds made by electric surgical knives were remarkably higher than that with common lancets. Furthermore, there were significant differences in groups 10^2, 10^5, and 10^8 （P 〈 0.05）, but not in group 10^0 （P 〉 0.05） between EK and EC groups. Clinical studies showed a delayed wound healing in 16 cases （17.20%） in EK, 11 cases （16.36%） in EC and 2 cases （2.86%）in the control groups. A significant difference between EK and the control groups （χ^2= 8.57, P 〈 0.01）, and between EC and the control groups （χ^2 = 5.66, P 〈 0.05） was observed, but not between EK and EC （χ^2= 0.017, P 〉 0.05）. CONCLUSION： High-frequency electric knives may remarkably delay abdominal incision healing. Its application should be minimized so as to reduce the possibility of postoperative complications.

APPLICATION OF ACUPUNCTURE ANESTHESIA TO APPENDECTOMY AND COMMENTS ON THE OPERATION AND ITS POSSIBLE MECHANISMS

Objectives: To observe the analgesic effect and to analyze the related mechanisms of acupuncture anesthesia (AA) for appendectomy. Methods: A total of 41 cases of appendicitis patients (24 males and 17 females) were subjected into this observation. Electroacupuncture (AA, 60-100 Hz, a bearable stimulus strength) of Pishu (BL 20), Weishu (BL 21), Zhangmen (LR 13) and Wushu (GB 27) was performed beginning 30 minutes before operation. Adjuvants used were luminal (100 mg, intra muscular injection), dolantin (1 mg/kg), 0.5% procaine (1-2 mL). Results: Of the 41 cases, the successful rate was 87.80% and the excellent plus good rate was 75.61% respectively. Conclusion: Acupuncture anesthesia is applicable for appendectomy in clinic but is still to be improved further in operation.

SURGICAL TREATMENT OF HALLUX VALGLUS BY RECONSTRUCTION OF METATARSAL ARCH AND MODIFIED MCBRIDE OPERATION（40 CASES REPORT）

feet with hallux valgus among 40 patients treated by reconstruction of metatarsal arch and modified McBride operation are reported in this paper. After an average of 4. 5 years of postoperative follow-up, the results showed an overll 9° and 3° correction of the hallux abductus angle and the intermetatarsal angle, respectively. 95% of the cases of bunions disappeared, 66% calli under the heads of the first and second metatarsal disappeared, and 9l% patients were satisfied with the changes of their feet appearance.

Personal experience with the procurement of 32 liver allografts

AIM: To introduce the American Pittsburgh's method of rapid liver procurement under the condition of brain death and factors influencing the quality of donor liver.METHODS: To analyze 32 cases of allograft liver procurement retrospectively and observe the clinical outcome of orthotopic liver transplantation.RESULTS: Average age of donors was 38.24±12.78 years,with a male:female ratio of 23:9. The causes of brain death included 21 cases of trauma (65.63%) and nine cases of cerebrovascular accident (28.13%). Fourteen grafts (43.75%) had hepatic arterial anomalies, seven cases only right hepatic arterial anomalies (21.88%), five cases only left hepatic arterial anomalies (15.63%) and two cases of both right and left hepatic arterial anomalies (6.25%) among them. Eight cases (57.14%) of hepatic arterial anomalies required arterial reconstruction prior to transplantation. Of the 32 grafts evaluated for early function, 27 (84.38%) functioned well, whereas three (9.38%) functioned poorly and two (6.25%) failed to function at all. Only one recipient died after transplantation and thirty-one recipients recovered. Four recipients needed retransplantation. The variables associated with less than optimal function of the graft consisted of donor age (35.6±12.9 years vs 54.1±4.3 years, P＜0.05), duration of donor's stay in the intensive care unit (ICU) (3.5±2.4 d vs 7.4±2.1 d, P＜0.005), abnormal graft appearance (19.0% vs 100%, P＜0.05), and such recipient problems as vascular thromboses during or immediately following transplantation (89.3% vs 50.0%, P＜0.005).CONCLUSION: During liver procurement, complete heparization, perfusion in situ with localized low temperature and standard technique procedures are the basis ensuring the quality of the graft. The hepatic arterial anomalies should be taken care of to avoid injury. The donor age,duration of donor's staying in ICU, abnormal graft appearance and recipient problem are important factors influencing the quality of the liver graft.

AMPUTATION FOR SEVERELY INJURED LOWER EXTREMITIES

Objective. To investigate the role of amputation in management of severely injured extremities and factors that may influence decision making. Methods. Thirty six patients with amputations following severe injuries of the lower extremities were retrospectively reviewed. Results. There was one death from multiple organ failure. Among the remaining 35 cases, primary and delayed wound healing was achieved in 22 and 13 patients, respectively. Conclusion. Amputation is an important means for management of severely injured lower extremities. When salvage is unlikely to lead to the functional reconstruction of the limb, amputation should be indicated.

Clinical study on radiotherapy combined with surgical treatment of 162 patients with cervical cancer

Objective： To compare the 5-year survival rates and complications of internal and external irradiation therapy combined with operation in patients with Ⅱ-Ⅲ period of cervical cancer. Methods： 162 cervical cancer patients after the whole palace resection pelvic lymphadenectomy were divided into three groups, and then accepted radiotherapy. The first group with 91 cases was accepted internal and external irradiation therapy before operation; the second group with 37 cases was given internal irradiation therapy before operation; the third group with 34 cases was given routine postoperative radiotherapy. External irradiation used ^60Co irradiation or a linear accelerator, to the whole basin, and the irradiation dose of ＂B＂ point in preoperative radiotherapy was 26-30 Gy, in postoperative radiotherapy was 46-50 Gy; intraluminal brachytherapy used ^192lr, the dose of ＂A＂ point was 5-15 Gy. Results： The 5-year survival rate of preoperative combined radiotherapy group was 78.0% （71/91）, preoperative intracavitary radiotherapy group 64.9% （24/37）, and postoperative radiotherapy group 35.3% （12/34）. Comparing the 5-year survival rates of the preoperative combined and postoperative irradiation groups, there was significant difference （P 〈 0.05）. The major complications were radioactive proctitis and cystitis, the complication incidences of three groups were 35.2% （32/91）, 32.4% （12/37）, 38.2% （13/34）, respectively, and the differences were not statistically significant （P 〉 0.05）. Conclusion： The intraluminal brachytherapy plus external irradiation can significantly increase the 5-year survival rate of patients with Ⅱa-Ⅲa stages, and the incidence of complications was not significant difference.

RESECTION OF THE BODY AND TAIL OF THE PANCREAS WITH PRESERVATION OF SPLEEN

A total of 19 cases were performed the resection of the body and tail of the pancreas with preservation of spleen in our department since it was first successfully carried out in the late 1980′s The indications of operation were pancreatic cystadenoma(n=8),pseudocyst(n=2),insulioma(n=3),pancreatic injury(n=6) All but one went well intraoperatively and postoperatively with the normal appearance and function of the spleen The main observation items of postoperation were leukocyte phagocytosis test, splenic CT scan,ultrasonography and Technetium 99m spleen scan The exceptional one showed transient insufficiency of splenic blood supply after the operation Considering the regional conditions in the operations, the procedure could be classified into the resection of the body and tail of pancreas with and without conservation of the splenic artery and vein

REPEATED RECURRENCE OF OSTEOSARCOMA TREATED BY RESECTIONS AND CHEMOTHERAPY

This paper presents 5 patients with repeated recurrence of osteosarcoma (RROS). The primary focus of 3 patients were in the distal portion of femur, and 2 patients were in the proximal Portion of tibia. Three patients, whose chest X ray film were negative, were treated by amputation and chemotherapy. Two patients had isolated metastatic focus l. 5 cm in diameter in lung, were treated by amputation after 1 week of chemotherapy and then treated by lobectomy after 2 weeks of chemotherapy. After operation, the chemotherapy was carried out for 3 courses of treatment. The roentgenogram of chest and affected limb were taken once every two months. There were metastatic focuses found in the lung of 1 patient and in the distal portion of femur of 2 patients. One patient was operated on for 4 times. UP to now, 3 patients have been living for 5 yeara and 2 patients for 6 years after operation.

EXPERIMENTAL STUDY ON THE SEGMENTAL PERFUSION AND PRESERVATION OF SPLEEN

Objective. Spleen transplanlation has developed to be an effective strategy for hemophilia A. But it has not been reported up to date that which kind of established solutions is most suitable for perfusion and preservation of spleen. This study aimed to establish some experiences with the comparison among Hartmann’s solution, Collins’ solution and WMO I solution, in order to instruct the clinical spleen transplantation. Methods. After the splenic artery and vein were dissociated clearly, three kinds of perfusion solutions began to perfuse the corresponding segments of spleen with a randomized sequence. When the efferent fluids from the splenic vein became clear, the perfused spleen segments were preserved for different durations with the same perfusing solution to calculate the survival rate of splencocyte(SRS) and were examined with light and electron microscopy. Results. Among the three solutions, SRS with WMO I solution was significantly higher than those of the other two(P< 0.001). The perfused spleen with WMO I solution showed the slightest morphological changes and a significant longer preservation duration than those with the other two(P<0.05 or P< 0 01). Conclusion. Among the three solutions, WMO I solution was most suitable for perfusion and preservation of spleen.

Clinical impact of selective transarterial chemoembolization on hepatocellular carcinoma:A cohort study

AIM： To prospectively long term clinical impact evaluate the short and of selective transarterial chemoembolization （TACE） on fiver function in patients with hepatocellular carcinoma （HCC）. To assess side effects in relation to treatments. To analyze the overall survival and HCC progression free survival probability. METHODS： One hundred and seventeen cirrhotic patients with HCC were enrolled. Baseline liver function included Child-Pugh score and serum levels of alanine- aminotransferase （ALT）, prothrombin time （PT） and bilirubin. According to Cancer Liver Italian Program （CLIP） and Barcelona Clinic Liver Cancer （BCLC） staging systems, 71 patients were eligible for TACE; 32 had previously received treatment for HCC. No significant differences in liver function were observed between previously treated and not treated patients. TACE was performed by selective catheterization of the arteries nourishing the lesions. While hospitalized, patients underwent clinical, hematologic and ultrasonographic assessments. One month after TACE a CT scan was performed to assess tumor response. A second TACE was performed ＂on demand＂ Liver function tests were checked in all patients every four months. RESULTS： After first TACE, the mean Child-Pugh score increased from a mean baseline 5.62 ±1.12 to 6.11 ±1.57 at discharge time （P 〈 0.0001）, decreasing after four months to 5.81 ± 0.73 （not significant）. ALT, PT and bilirubin significantly （P 〈 0.0001） increased 24 h after TACE and progressively decreased until discharge. After the second TACE, variations in Child-Pugh score, ALT, PT and bilirubin were comparable to that described after the first TACE. No major complications were observed. The mean follow-up was 14.7 ＋ 6.3 mo （median： 16 mo）. Only one patient died. No other patient experienced important long term worsening of clinical status. The overall survival probability at twenty-four months was 98.18% with a correspondent HCC progression free survival probability of 69%. CONCLUSION： Selective TACE may produce significant, but transitory increases in ALT values, with no major impact on liver function and Child-Pugh score. Preservation of liver function is achievable also in patients previously treated with other therapeutic modalities and in patients undergoing multiple TACE cycles. Liver function can remain stable in the long-term, with optimal medium term survival. This result can be achieved through rigorous patient selection on the basis of tumour characteristics and clinical conditions.

Complications induced by decompressive craniectomies after traumatic brain injury

Objective: To find out the optimal approach to decompress externally the severe injured brain and to avoid possible complications caused by external decompression. Methods: 68 patients who underwent external decompression after traumatic brain injury were admitted into Tianjin Medical University General Hospital for cranioplasty from 1995 to 2001. Complications were retrospectively investigated and analyzed in all patients. The findings were compared between the patients who accepted the decompressive craniectomy in our hospital and in local hospitals. χ 2-test was employed for statistical analysis and complication evaluation. Results: Large craniectomy definitely caused some side effects to patients. Among various complications, several of them showed significantly high incidence (P< 0.05) in patients who underwent the decompressive operation in local hospitals such as shunt-dependent hydrocephalous, subdural fluid collection, and CSF leakage from scalp incision. The rest of the complications had no remarkable difference (P> 0.05) between the two groups including dilation or/and migration of lateral ventricle underlying the cranial defect, skin flap concavity, encephalomalacia of the decompressive area, seizure and infection. Conclusions: To reduce the incidence of iatrogenic side effects, surgical craniectomy should be performed according to the strict indication and standard and any abuse should be avoided.