140例硬膜外麻醉术后病人自控镇痛效果观察

目的 评价硬膜外麻醉术后病人自控镇痛的效果、并发症。方法 14 0例硬膜外术后安接止痛泵。观察、记录 48小时循环呼吸功能、镇痛等级、并发证及意外情况。结果 优 88.5 %、良 9%、差 2 %、无效 0 .5 % ,4例出现并发症。结论 自控镇痛管理得当可减少硬膜外麻醉术后病人疼痛 ,若疏于管理 ,则会影响镇痛效果 ,增加并发症。

自控静脉镇痛法在胸科术后患者的临床应用

目的 观察自控静脉镇痛 (PCIA)用于胸科术后患者镇痛的效果。方法 选择胸科手术病人 6 0例 ,随机分成两组 , 组每次哌替啶 1mgkg- 1 肌注镇痛 , 组病人采用 PCIA,术后连接上海博创 BCDB- 10 0一次性使用电子镇痛输注泵静脉给药。配方 :芬太尼 10μg/ kg,咪唑安定 0 .1mg/ kg,地塞米松 5 mg,盐酸格拉斯琼 3mg加生理盐水 10 0 ml,观察术后恶心、呕吐及并发症发生情况。结果 两组患者一般情况无统计学意义 (P>0 .0 5 ) ;术后 VAS评分 组 4 .5± 0 .9,明显高于 组 2 .0± 0 .7(P<0 .0 5 ) ;恶心、呕吐发生率 组 18例 , 组 9例 ,两组相比较差异具有统计学意义 (P<0 .0 5 )。结论 自控静脉镇痛能有效地抑制胸科术后病人的应激反应 ,可维持药物的有效浓度 。

Interventional radiology procedures in adult patients who underwent liver transplantation

Interventional radiology has acquired a key role in every liver transplantation(LT)program by treating the majority of vascular and non-vascular post-transplant complications,improving graft and patient survival and avoiding,in the majority of cases,surgical revision and/or re-transplantation.The aim of this paper is to review indications,technical consideration,results achievable and potential complications of interventional radiology procedures after deceased donor LT and living related adult LT.

Therapeutic effectiveness of echo-guided percutaneous radiofrequency ablation therapy with a LeVeen needle electrode in hepatocellular carcinoma

AIM： To investigate the results of radiofrequency ablation （RFA） in obtaining the necrosis of hepatocellular carcinoma （HCC） in cirrhotic patients and to assess the results of RFA in relation to recurrence of HCC and survival of the treated patients.METHODS： Fifty-six consecutive cirrhotic patients with 63 HCCs were treated with RFA between May 2000 and May 2004. The diameter of the HCCs ranged from 1 cm to 5 cm （mean 2.8 cm）. In all cases RFA was performed with percutaneous approach under ultrasound guidance using expandable needle electrode （LeVeen needle）. Treatment efficacy and recurrence were evaluated with dual-phase spiral computed tomography （CT）.RESULTS： Complete necrosis after single or multiple treatment was achieved in 96.8% （61/63） tumors. We observed recurrence after complete necrosis in 23 patients （41%） during a mean follow-up of 32.3 months. The recurrences were local in 2 patients （8.6%） and in different segments in 21 （91.4%）. Major complications occurred in 3 patients （4%）. During follow-up period, 32 （57.1%） patients died; 15 due to progression of HCC, 11 from liver failure, 3 from esophageal varices bleeding and 3 from the causes not related to liver disease.CONCLUSION： RFA with LeVeen needle is an effective and safe treatment for HCC 〈 5cm in cirrhotic patients. It has yet to be established how far this treatment influences the survival rate of patients. It becomes important to establish treatments to prevent recurrences in different segments, such as interferon therapy.

Minimally invasive video-assisted thyroidectomy for thyroid adenoma

Objective： The aim of the study was to investigate the value of minimally invasive video-assisted thyroidectomy for thyroid benign adenoma. Methods： From June 2003 to June 2007, 128 cases of thyroid tumors, including 123 cases of adenoma and 5 cases of carcinoma, were performed by Miccoli＇s endoscopic thyroidectomy. The surgical techniques and the clinical outcomes with respect to pathologic results, duration of operation, postoperative drainage, pain, cosmetic results and complications of endoscopic thyroid surgery via the neck approach were retrospectively summarized. Results： NI the patients underwent minimally invasive endoscope-assisted thyroidectomy successfully. Five cases of carcinoma revealed by frozen section. In which, 3 papillary carcinoma cases underwent subtotal thyroidectomy of disease-side in video-assisting, whereas the other 2 cases with follicular and medullary carcinoma underwent conventional total thyroidectomy of disease-side combined with subtotal thyroidectomy of the opposite-side. The transient hoarseness occurred in one patient and recovered well one week later, and the other patients recovered successfully without any complications. Conclusion： Minimally invasive video-assisted thyroidectomy for thyroid adenoma is safe and reliable. This procedure offers a shorter incision, less invasion and better cosmetic results as compared with conventional thyroidectomy.

Comparative Analysis of Intractable Postpartum Hemorrhage Intervention Treatments

Abstract： Objective： To explore the clinical efficacy of different treatment methods of intervention for intractable postpartum hemorrhage. Methods： From the accept and treat patients with intractable postpartum hemorrhage in our hospital from June 2013 to March 2014, 86 cases were chosen to be retrospectively analyzed, randomly divided into observation group and control group with 43 cases in each group. The control group was underwent gauze packing while observation group were packing gauze joint with improved uterine suture Cho, the two groups were observed therapeutic effects and complications. Results： The total efficiency of observation group is 93.02%, and the total efficiency of the control group is 62.79%, there is a significant better treatment effect for observed group than the control group （P 〈0.05）, and complication rate of observation group is significantly lower than the control group （P 〈0.05）. Conclusions： In refractory postpartum hemorrhage intervention therapy, the use of gauze packing combined with modified suture uterus Cho has better clinical treatment effect with high security, so it is worthy of clinical application.

Comparative Analysis of Intractable Postpartum Hemorrhage Intervention Treatments

Objective： To explore the clinical efficacy of different treatment methods of intervention for intractable postpartum hemorrhage. Methods： From the accept and treat patients with intractable postpartum hemorrhage in our hospital from June 2013 to March 2014, 86 cases were chosen to be retrospectively analyzed, randomly divided into observation group and control group with 43 cases in each group. The control group was underwent gauze packing while observation group were packing gauze joint with improved uterine suture Cho, the two groups were observed therapeutic effects and complications. Results： The total efficiency of observation group is 93.02%, and the total efficiency of the control group is 62.79%, there is a significant better treatment effect for observed group than the control group （P 〈0.05）, and complication rate of observation group is significantly lower than the control group （P 〈0.05）. Conclusions： In refractory postpartum hemorrhage intervention therapy, the use of gauze packing combined with modified suture uterus Cho has better clinical treatment effect with high security, so it is worthy of clinical application.

Long term surgical treatment outcome of talar body fracture

Objective： Talar body fractures are rare and have poor treatment outcome. The purpose of this study is to report the long term surgical treatment outcome of closed talar dome fractures.Methods： Eight closed talar body fractures, treated by open reduction and internal fixation with small fragment cancellous screws and/or Herbert screws in our level Ⅰ trauma centre were retrospectively analyzed. Preoperative and postoperative radiographs of the foot （antero-posterior, lateral and oblique views） and ankle （antero-posterior, lateral and mortise views） were obtained. The patients were followed up both radiologically and functionally （foot function index, FFI） after 3 weeks, 6 weeks, 3 months, 6 months and then annually.Results： There were five crush fractures and three shear fractures （two sagittal shear and one coronal shear）,with average follow-up of 5 years. No early complications were noticed in these patients. Late complications included osteoarthrosis of subtalar/ankle joints in six patients and osteonecrosis oftalar body in four patients. On functional assessment, mean FFI after 5 years was 104.63 points and worse outcome was noticed in crush injury and coronal shear fractures. Sagittal shear fractures had a good functional and radiological outcome.Conclusions： Late complications subsequent to surgically treated talar body fractures are inevitable, even though exact reduction and rigid fixation are achieved, thus patients are supposed to be counseled about the adverse outcome. Although crush and coronal shear fractures have poor outcome, sagittal injuries have good prognosis on long term evaluation.