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find Keyword "自发性" 66 results
  • 老年慢性阻塞性肺疾病患者并发自发性气胸的护理

    摘要:目的:探讨老年人慢性阻塞性肺疾病(COPD)并发自发性气胸的临床特点和护理方法。方法:回顾性分析我院2005年8月至2009年1月47例老年COPD患者并发自发性气胸的临床资料。结果:采用以肋间闭式引流的内科治疗为主。其中35例肺完全复张,6例肺复张80%~90%,2次或2次以上复发5例,除1例死于呼吸衰竭外,其余患者经过一般护理和专科护理都得到康复。结论:老年COPD并发自发性气胸临床表现多不典型,易误诊,正确诊断和全面护理是治疗的关键。

    Release date:2016-08-26 03:57 Export PDF Favorites Scan
  • 老年自发性气胸合并肺大泡患者术后并发症的预防及治疗

    目的 总结预防和治疗老年自发性气胸合并肺大泡患者术后并发症的临床经验、治疗难点,探讨治疗对策,以降低术后并发症的发生率。 方法 回顾性分析117例老年自发性气胸合并肺大泡患者外科治疗的临床资料,117例患者中55例行胸腔镜手术,62例行开胸手术。 结果 住院死亡4例(3.4%),均死于呼吸衰竭、多器官功能衰竭。术后发生并发症45例(38.5%,45/117),主要并发症为心律失常、心功能不全、呼吸衰竭、肺部感染等。术后胸腔引流管漏气72例,其中16例漏气时间gt;7d,5例漏气时间gt;14d,再次开胸修补1例。术后留置胸腔引流管1~60d(5.2±8.2d)。随访113例,随访时间3~18个月,无气胸复发。 结论 老年自发性气胸合并肺大泡患者由于术前合并症多、肺组织质地和弹性差以及愈合能力差,导致围手术期并发症发生率增高。严格掌握手术指征、术中采取有效的肺修补方法减少漏气、减少手术时间和创伤是患者术后顺利康复的重要条件。同时应强化呼吸道祛痰、营养支持,尽早拔除胸腔引流管,早期活动。

    Release date:2016-08-30 06:09 Export PDF Favorites Scan
  • 结肠自发性穿孔的诊断和治疗

    【摘要】 目的 总结结肠自发性穿孔的病因、诊断和治疗方法。 方法 回顾性分析2000年-2010年收治的9例因自发性结肠穿孔接受急诊剖腹探查手术患者的临床资料。 结果 平均发病年龄67.6岁(55~84岁),5例有慢性便秘病史;患者均以突发性腹痛起病,2例得到术前确诊。1例行穿孔修补术,6例行穿孔修补或穿孔肠段切除加近端结肠造瘘术,2例行Hartmann手术。治愈出院6例,2例切口感染,1例严重感染。 结论 自发性结肠穿孔好发于老年长期便秘史者,通常预后不良,且术后病死率较高。早期发现和手术治疗、彻底的腹腔内冲洗和严密的术后管理是改善预后的重要因素。

    Release date:2016-09-08 09:26 Export PDF Favorites Scan
  • Advanced Research of Association of HBV with Spontaneous Rupture of Hepatocellular Carcinoma

    Objective To study the relationship of hepatitis B virus (HBV) to spontaneous rupture of hepatocellular carcinoma (HCC-SR) and its mechanism. Method The related literatures about theory of HCC-SR were consulted and reviewed. Results The injury of small arteries was usually followed in patients with HCC-SR, which was related to vascular autoimmune injury caused by the HBV infection. The small arteries in which immune complex deposited were readily injured, as a result HCC-SR happened while vascular load increased. Conclusion The HBV infection resulted in vascular autoimmune injury maybe a important factor in the pathogenesis of HCC-SR.

    Release date:2016-09-08 10:23 Export PDF Favorites Scan
  • 自发性气胸两种手术方式的对比观察

    【摘要】 目的 比较腋下小切口与常规后外侧切口手术治疗自发性气胸的临床疗效。 方法 将2006年5月-2010年1月收治的64例自发性气胸患者,按手术时间和患者自身对手术的选择性随机分为腋下小切口手术组(A组,34例)和常规后外侧切口手术组(B组,30例)。两组患者性别、年龄、单双侧、病程等一般资料比较差异无统计学意义(Pgt;0.05),具有可比性。两组均采用肺大疱切除修补术及壁层胸膜机械性摩擦。 结果 两组术后切口均Ⅰ期愈合,无切口感染等并发症发生。两组随访时间均为3~24个月,平均12.6个月;术后6个月时均无复发。A组手术时间、术中出血量、术后引流量、术后住院时间、住院费用方面均明显优于B组,差异有统计学意义(Plt;0.05)。 结论 两种手术方法均安全,但与常规后外侧切口比较,腋下小切口具有手术时间短、创伤小、恢复快、住院费用低等优点。

    Release date:2016-09-08 09:27 Export PDF Favorites Scan
  • Treatment of Spontaneous Pneumothorax

    ①在自发性气胸的治疗方面:目前尚无足够高质量的临床证据确定任何干预或非干预措施对自发性气胸的治疗更有效.现有2个小样本的随机对照试验(RCT)显示,胸腔闭式引流比穿刺抽气治疗气体消散更快,但穿刺抽气治疗更能减少患者痛苦和住院时间;1个小样本的随机对照试验显示,采用标准的胸腔闭式引流管或细管,两者的置管时间无差异,但对大量积气的患者,标准管的气体吸收率高于细管;另1个小样本的随机对照试验显示,在使用瓣膜单向阀或水封引流瓶方面,两者对患者的气胸吸收率无影响,但使用瓣膜单向阀更能减少患者痛苦和住院时间;在胸腔闭式引流管连接负压吸引方面,1个小样本的随机对照试验显示,是否连接负压吸引对疗效无影响.②在自发性气胸复发的预防方面:2个随机对照试验和1个非随机对照试验显示,化学性胸腔粘连术比非化学性胸腔粘连术更能减少自发性气胸的复发率,但胸腔粘连术同时也引起患者疼痛和住院时间的延长;无足够临床证据证明需在首次或自发性气胸复发时采用胸腔粘连术;无足够临床证据进行外科和化学性胸腔粘连术疗效的比较,仅有1个小样本的随机对照试验提示进行电视胸腔镜手术比直接开胸术的住院时间短,但在降低复发率方面,两者无显著性统计学差异,但由于样本量的问题,尚不排除两者问有临床意义差异.

    Release date:2016-09-07 02:27 Export PDF Favorites Scan
  • Clinical Diagnosis and Treatment of Spontaneous Esophageal Rupture:A Report of 14 Patients

    Objective?To summarize our experience of surgical treatment of Boerhaave’s Syndrome. Methods We retrospectively analyzed clinical records of 14 patients with Boerhaave’s syndrome in West China Hospital between January 1998 and December 2011. There were 11 male patients and 3 female patients with a mean age of 55.2±14.4 years and mean time interval between onset and admission of 49.6±21.2 h. Primary repair was performed in 11 patients.Esophagectomy and reconstruction of digestive track was performed in 1 patient and intra-luminal stent implantation was applied in 1 patient. Intercostal catheter insertion was performed in 1 patient.?Results?Thirteen patients underwent surgical therapy, and their survival rate was 84.6% (11/13). Among the eleven patients who underwent primary repair, 8 patients (72.7%)were cured and 3 patients experienced postoperative leakage resulting 2 deaths. The other one patient was cured with in-hospital time of 22.3±7.0 d. Two patients underwent digestive track reconstruction and intra-luminal stent implantation respectively and all survived with in-hospital time 39.0±5.7 d. Another patient underwent bedside chest drainage and died 10 d after admission.?Conclusion?Aggressive surgical management is an effective way to treat Boerhaave’s syndrome, and primary repair can lead to ideal prognosis in delayed patients whose time interval between onset and admission is beyond 24 h. Digestive track reconstruction and intra-luminal stent implantation are alternative methods on condition that primary repair can not be accomplished.

    Release date:2016-08-30 05:50 Export PDF Favorites Scan
  • Diagnosis and Treatment for Spontaneous Rhexis Hemorrhage of Liver Cancer

    Objective To explore the diagnosis and treatment for spontaneous rhexis hemorrhage of liver cancer. Methods Clinical data of thirty patients who suffered from spontaneous rhexis hemorrhage of liver cancer from January 1995 to March 2009 were collected and analyzed retrospectively. Results Twenty-six cases were stanched by surgical therapy, in which 14 cases underwent liver cancer resection, 10 cases underwent bleeding transfixion and hepatic artery ligation (or intubation), and 2 cases underwent omentum stuff transfixion. Four cases died one week after surgery, one died after 15 d, 9 cases died 1 to 3 months after operation, 5 cases survived after 4 to 6 months, 3 cases survived after 7 to 12 months, and in 4 cases survival time was longer than 12 months (in which one patient’s survival time was 16 months, one was 5 years and two patients were still alive with survival time of 3 and 13 years respectively). Four patiens went through the non-surgical therapy and survival time was 3 to 14 d. Conclusion The spontaneous rhexis hemorrhage of the liver cancer is not the telephase of the liver cancer. Early diagnosis and operation can stanch bleeding effectively. The surgical therapy is better than the non-surgical therapy. Resection of liver neoplasms in time can raise long-term survival time.

    Release date:2016-09-08 10:56 Export PDF Favorites Scan
  • Comparison of Autofluorescence Bronchoscope and White Light Bronchoscope in Airway Examination for Patients with Central Type Lung Cancer

    Abstract: Objective To compare the sensitivity and accuracy of autofluorescence bronchoscope (AFB) and white light bronchoscope (WLB) in airway examination for patients with central type lung cancer. Methods From September 2009 to May 2010, 46 patients including 36 males and 10 females with an average age of 62.1 years underwent both AFB and WLB procedures in People’s Hospital of Peking University. Among them, 35 were preliminary diagnostic cases and 11 were postoperative surveillance cases. Local anaesthesia of glottis and airway, and general anaesthesia with continuous intravenous drugs were given before electric bronchoscope was adopted. All patients underwent WLB examination followed by AFB procedure. All suspicious abnormal visual findings were recorded for biopsy and pathological examination. Results All procedures were carried out safely without death or severe complications. We performed bronchoscopy 48 times for all 46 patients and 159 tissues of various sites were taken out for biopsy and pathologic examination which showed 64 malignancies and 95 none malignancies. In 64 malignancies, AFB found all but WLB missed 15 with a missed diagnosis rate of 23.4%. Thirtysix times of examination were performed for the 35 preliminary diagnostic cases and 56 sites of malignancy were found. AFB found all, while WLB missed 12, and 6 sites of malignancy found by AFB were larger in size than those found by WLB. AFB detected 3 cases of multisite malignancy, but WLB missed these diagnoses. The results of AFB and WLB were the same for 26 patients. Twelve times of bronchoscopy were performed for the 11 postoperative surveillance cases and 8 sites of malignancy were found. AFB found them all while WLB missed 3 which were two recurrent cases during the early period after lung cancer surgery. The sensitivity of AFB and WLB was 100.0 % and 76.6%(Plt;0.05) respectively, and the negative predictive value of AFB and WLB was 100.0% and 84.5%(P=0.002) respectively. Conclusion AFB has a better sensitivity and negative predictive value than WLB in detecting mucous canceration lesions in central type lung cancer, and is more accurate in assessment of tumor margins, more sensitive in finding multiple lesions in airway and detecting early cancer recurrence in postoperative surveillance patients.

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  • 剑突下入路单孔胸腔镜手术治疗自发性气胸 30 例Subxiphoid approach single-incision video-assisted thoracoscopic surgery for 30 patients with spontaneous pneumothorax

    目的 探讨剑突下入路单孔胸腔镜手术治疗自发性气胸的安全性和可行性。 方法 回顾性分析 2014 年 8 月至 2016 年 1 月间剑突下入路单孔胸腔镜手术治疗自发性气胸 30 例患者的临床资料,其中男 19 例、女 11 例,年龄 16~28(20.5±5.2)岁。 结果 手术均顺利完成,无中转开胸,无术后出血、漏气等并发症。手术时间(30.5±12.4)min,术中出血量(20.0±10.0)ml,术后胸腔引流管留置时间(1.5±0.8)d,术后住院时间(3.5±0.5)d。术后随访 1 个月,无复发、感染等其他并发症。 结论 剑突下入路单孔胸腔镜手术治疗自发性气胸安全、可行。

    Release date:2017-01-22 10:15 Export PDF Favorites Scan
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