目的探讨术后早期肠梗阻的临床特点、诊断及治疗。方法对10例术后早期肠梗阻患者进行回顾性分析。结果10例均为机械性肠梗阻。保守治疗6例，其中治愈5例，死亡1例； 手术治疗4例，其中3例术中有绞窄性肠梗阻征象，均治愈。1例术中发现为广泛癌性粘连，行部分粘连松解术，术后第8天再发肠梗阻，保守治疗1天无效，患者自动出院。结论术后早期肠梗阻诊断并不困难； 保守治疗多数有效，故宜先行保守治疗； 可疑肠绞窄时应及时中转手术。
Tricuspid valve, also known as "forgotten valve" because of the high natural and surgical mortality. Transcatheter tricuspid valve replacement is an innovative surgical method to treat tricuspid regurgitation, which improves the prognosis of patients and is gradually being popularized in clinics. However, postoperative pulmonary complications are still the main causes affecting the rapid recovery and death. More and more medical experts begin to use preoperative inspiratory muscle training to reduce postoperative pulmonary complications and improve the quality of life of patients after cardiac surgery. However, there was no report on the effect of preoperative inspiratory muscle training on pulmonary complications after transcatheter tricuspid valve replacement. Therefore, for the first time, we boldly speculate that inspiratory muscle training can reduce pulmonary complications after transcatheter tricuspid valve replacement, and put forward suggestions for its treatment mechanism and strategy. But this rehabilitation intervention lacks practical clinical research. Unknown challenges may also be encountered, which may be a new research direction.
Objective To evaluate the risk factors affecting the prognosis in patients with myasthenia gravis after thymeetomy. Methods Therapeutic effects were evaluated with Relative Counting Method in 136 cases with myasthenia gravis who receivingthymectomy. Six clinical factors including sex, age, preoperative course, et al. were converted into quantitative parameters and used for analysis. Cumulative logit model for ordinal response was employed to investigate the therapeutic effects of various factors. Results Sex, age and preoperative course exerted significant effects on postoperative prognosis in patients with myasthenia gravis, while clinical subtype, pathological changes and preoperative administration of cholinesterase inhibitors had no significant impact on therapeutic effects. Conclusion Some factors may lead to the remission and improvement in postoperative patients with myasthenia gravis, therefore, they should be included for the evaluation of prognosis. Early diagnosis and early thymeetomy may improve the therapeutic effects and shorten the duration of amelioration.
Objective To explore the cause of haematoma after the cemented total hip arthroplasty (THA) and find out the way to decrease the incidence of haematoma perioperatively. Methods From March 2000 to October 2006, 103 patientswere treated with the cemented THA. Among the patients, 44 were males and 59 were females with their ages ranging from 36 to 89 years, averaged 55.3 years.The femoral neck fracture (Garden 4) was found in 49 patients, avascular necrosis of the femoral head (Ficat 4) in 26, and osteoarthritis of the hip joint (Tonnis 3) in 28. Their illness course ranged from 1 day to 8 years. The average Harris score preoperatively was 36 (range, 1948). The patients were divided into Group A (n=43) and Group B (n=60). The patients in Group A underwent the conventional surgical operations from March 2000 to December 2003; the patients in Group Bunderwent the same surgical procedures combined with additional procedures (e.g., ligation of the external rotators before incision, use of plastic bandage after the drainage tube was pulled out, prolonged stay period in bed postoperatively) from January 2004 to October 2006. Results In Group A, postoperative haematoma occurred in 9 patients and the averaged 317.8±75.3 ml(range,110-410 ml) of the accumulated blood was drained with a syringe. An average amount for the firstdrainage of the accumulated blood was 86.7±30.7 ml(range, 50-125 ml)， and an average drainage time was 4.2(range, 2-7). In Group B, postoperative haematoma occurred in 2 patients, with an amount of 110 ml and 160 ml of the accumulated blood and an amount of 40 ml and 60 ml of the drained blood at thefirst drainage. There was statistical difference in the amount of heamotoma between two groups(P＜0.05). The followup of 91 patients (39 in Group A, 52 in Group B) for 1.2-5.5 years (average, 3.7 years) revealed that the Harris scores were 78 in Group A and 85 in Group B on average.The Harris score for pain was 44 (Grade A) in 16 patients, 40 (Grade B) in 24 patients, and 30 (Grade C) in 3 patients in Group A; Grade A in 48 patients,Grade B in 12 patients, and Grade C in none of the patients in Group B. There was no statistical difference in Harris score between the two groups (P＞0.05). Conclusion Additional surgical procedures for the cemented THA, such as ligation of the external rotators before incision, use of plastic bandage afterthe drainage tube is pulled out, and prolonged stay in bed postoperatively, can greatly help to reduce the incidence of postoperative haematoma and the amount of the accumulated blood.
【摘要】目的探讨喉癌手术后患者对两种不同雾化方式的耐受性,为选择最佳雾化方式提供参考。方法将49例喉癌手术后患者随机分为观察组(25例)和对照组(24例),观察组采用氧气雾化吸入,对照组采用空气压缩泵雾化吸入。分别记录两组患者雾化吸入前及吸入15 min时脉搏血氧饱和度(SpO2)及心率;雾化过程中患者有无心慌、气紧等不适以及雾化后痰液的性质及量。采用SPSS 13.0软件进行统计分析。结果两组患者雾化吸入15 min时的SpO2差异有统计学意义(Plt;001),观察组高于对照组;而两组患者雾化吸入前SpO2、心率、不适主诉及雾化后痰液的性质差异均无统计学意义(Pgt;005)。结论氧气雾化吸入可以提高喉癌手术后患者雾化过程中的SpO2,使患者感觉更加舒适。【Abstract】Objective To investigate postoperative patients with laryngeal carcinoma atomization of two different forms of tolerance, in order to choose the best means of atomization. Methods Fifty postoperative patients with laryngeal carcinoma were divided into observation group using oxygen inhalation and control group using the air compression pump inhalation. Two groups of patients were recorded the value of SpO2 and heart rate before 15 minutes after the inhalation,as well as the discomforts such as flustered,gas tight during the atomization process and the nature and olume of sputum. Results The results of two groups of patients at the time of 15 minutes inhalation SpO2 statistically significant difference (Plt;001), the observation group than in the control group average SpO2 high; and two groups of patients with preinhalation SpO2 average, average heart rate, Discomfort chief complaint and the nature of sputum after aerosol compared no significant difference (Pgt;005). Conclusion Oxygen inhalation in patients with laryngeal cancer can improve the atomization process SpO2 value, so that patients feel more comfortable.
目的 讨论甲状腺患者围手术期护理措施及经验。 方法 对2004年6月－2012年12月收治的171例甲状腺手术患者的围手术期护理方法进行回顾性分析，并就护理要点进行经验总结。 结果 171例甲状腺手术患者均获治愈。术后并发症发生率1.8%～9.9%，包括切口内出血16例（9.9%），甲状腺机能减退11例（6.4%），单侧喉返神经损伤5例（2.9%），术后呼吸困难和窒息4例（2.3%），甲状腺危象4例（2.3%），喉上神经损伤3例（1.8%）。经及时对症处理，并发症得到有效控制，预后良好。 结论 术前细致的准备、术中积极的配合、术后密切观察并及早发现并发症、恰当处置，同时强化对患者的健康教育，对提高甲状腺围手术期护理质量与改善患者预后具有重要意义。
目的 探讨术后早期炎性肠梗阻的病因、临床特点及诊断与治疗。方法 对我院40例腹部手术后早期炎性肠梗阻患者的诊断和治疗情况进行回顾性分析。结果 全部患者症状缓解的时间为3～7 d（平均5 d）、住院时间为7～20 d（平均13 d）。随访时间为6～12个月（平均9个月），随访中有2例再次出现肠梗阻, 经保守治疗治愈。结论 术后早期炎性肠梗阻好发于腹腔污染重或创伤大的腹部手术，多发生于术后1～3周，肠梗阻症状和体征典型，很少发生肠绞窄坏死，保守治疗效果好。
【摘要】 目的 探讨腰部放置衬垫物对经皮冠状动脉介入手术后卧床患者的作用。 方法 选取2008年7〖CD3/5〗12月于我科行经皮冠状动脉介入手术后50例患者,随机分为试验组25例和对照组 25 例。试验组在常规护理基础上予腰部放置衬垫物,对照组25例予常规护理,手术次日对患者进行视觉模拟量表测试方法(VAS)评分。 结果 试验组VAS评分秩和检验低于对照组,差异有统计学意义(Plt;0001);两组除烦躁外其他并发症无显著差异。 结论 冠状动脉介入手术后患者在平卧位制动时予腰椎弯曲处放置衬垫物可降低患者腰部疼痛程度。【Abstract】 Objective To investigate the effects of lumbar pad on bed patients who uhderwent percutaneous coronary intervention operation. Methods The 50 patients who uhderwent percutaneous coronary intervention operation in our deparment from July to December 2008，then randomly divided into experimental group(25 patients)and control group(25 patients). Control group were received conventional care，the experimental group were received lumbar pad based on the conventional care. The second day after operation，the patients were scored by visual analog scale test method (VAS). Results The VAS scores of experimental group was lower than control group，the difference was statistically significant (Plt;0001). The differences of other complications between two groups except fidgety were not statistically significant. Conclusions Coronary intervention after surgery，the patients in peripharyngeal braking to bend lumbar pad material can reduce the waist ache degree.