【摘要】 目的 探討經腋靜脈穿刺中央靜脈置管后上肢深靜脈血栓形成情況。 方法 2007年1月-2009年12月共收治60例需行中央靜脈置管的患者，所有患者均通過腋靜脈穿刺行中央靜脈插管，并于拔除導管后行彩色多普勒超聲檢查了解雙側上肢深靜脈血栓形成情況。將腋靜脈穿刺側上肢作為穿刺組，對側上肢作為對照組，進行前瞻性對照研究，將兩組上肢深靜脈血栓發(fā)生率進行比較。 結果 60例患者中央靜脈置管平均時間為（14.7±7.4） d，對照組彩色多普勒超聲檢查無深靜脈血栓形成，穿刺組2例患者出現(xiàn)上肢深靜脈血栓形成的癥狀，無肺栓塞發(fā)生，28例患者（47%）拔除的導管周圍可見纖維蛋白套形成，經上肢彩色多普勒超聲檢查，5例患者（8.3%）腋靜脈不完全栓塞，2例患者（3.3%）腋靜脈完全栓塞。在中央靜脈置管時間≤6 d的患者中，無上肢深靜脈血栓形成；置管時間在7~14 d的患者中，2例（3.3%）腋靜脈血栓形成；5例（8.3%）腋靜脈血栓形成發(fā)生在置管時間≥15 d（Plt;0.01）。7例腋靜脈血栓形成患者，經2~3次穿刺成功，平均穿刺時間（10±2.5） min，與無腋靜脈血栓形成患者的平均穿刺所需時間（14±9）min比較，無統(tǒng)計學意義（Pgt;0.05）。 結論 經腋靜脈穿刺中央靜脈置管后上肢深靜脈血栓形成的發(fā)生率為11.6%。【Abstract】 Objective To determine the frequency of central venous catheter-induced thrombosis of the axillary vein. Methods Sixty patients in a medical-surgical intensive care unit who required central venous catheterization via the axillary vein from January 2007 to December 2009 were selected. On catheter removal, color doppler ultrasonography examination was performed on all the patient. The incidence of deep vein thrombosis in catheterized arms was compared with that in uncatheterized arms. This study was designed by prospective controlled study. Results Catheters were inserted for a mean duration of (14.7±7.4) days. Sixty patients who underwent axillary vein cannulation, one patient had clinical signs of arm vein thrombosis, and no patient had clinical sign of pulmonary embolism. Fibrin sleeves that developed around the catheters were observed in 28 patients (47%). Five patients (8.3%) had phlebographic signs of partial axillary vein thrombosis:nonobstructive clots adherent to the vessel wall and (or) the catheter. Two patients (3.3%) had color doppler ultrasonography signs of complete axillary vein thrombosis. No thrombosis was observed in patients with catheterizations lasting ≤6 days, two cases were observed for duration of 7-14 days, and five cases were observed for duration of ≥15 days (Plt;0.01). In seven patients with axillary vein thrombosis, the vessel was cannulated with fewer than three puncture attempts, and the mean duration for catheter insertion (10±2.5) minutes didn’t differ much from that of patients with no axillary vein thrombosis (14±9) minutes. Conclusion The axillary vein catheterization is associated with 11.6% frequency of upper-extremity deep vein thrombosis.
【摘要】 目的 探討比較全腸內營養(yǎng)支持和全腸外營養(yǎng)支持對急性重癥胰腺炎（severe acute pamcreattis，SAP）預后的影響。 方法 將2003年1月-2008年12月收治的54例SAP患者于入院后第1周內隨機分為兩組:全腸內營養(yǎng)（A）組27例；全腸外營養(yǎng)（B）組27例。兩組患者均靜脈給予廣譜抗生素預防感染。入院時CT掃描及C反應蛋白水平顯示兩組患者具有可比性?！〗Y果 B組22例患者發(fā)生器官衰竭，明顯高于A組（5例）。B組22例患者接受了手術治療，A組手術患者6例（Plt;0.05）。A組患者胰腺壞死后感染發(fā)生率明顯低于B組（Plt;0.05）。B組患者死亡率高于A組（Plt;0.05）?！〗Y論 全腸內營養(yǎng)支持，不僅可以促進腸道功能的恢復和營養(yǎng)狀況的維持，還可減少腸源性感染的發(fā)生率，對減少SAP的感染性并發(fā)癥和病死率具有積極作用。【Abstract】 Objective To evaluate the effects of total enteral nutrition and total parenteral nutrition on the prognosis on severe acute pancreatitis (SAP). Methods A total of 54 patients hospitalized from January 2003 to December 2008 were enrolled. In the first week of hospitalization, the patients were randomly divided into two groups: 27 patients in total parenteral nutrition group (group A) and 27 patients in total enteral nutrition group (group B). All patients were administered with sufficient prophylactic antibiotics. The results of CT scan and C-reactive protein levels were comparable between the two groups. Results Twenty-two patients had organ failure in group B, which was much higher than that in group A (five patieuts). The numbers of the patients undertwent surgical intervention in group A and B were 22 and 6 (Plt;0.05). The incidence of infection after pancreatic septic necroses in group A was obviously lower than that in group B (Plt;0.05). The mortality in group B was apparently higher than that in group A (Plt;0.05). Conclusion Total enteral nutrition support can not only promote the functional recovery of intestinal tract and sustain the nutrition of human body,but also decrease the incidence of enterogenic infection.
目的 探討腹腔鏡下行直腸癌根治術（L-Dixon，L-Miles）的應用價值。方法 對我院2009年10月至2011年1月期間收治的68例行腹腔鏡直腸癌根治術患者的臨床資料進行回顧性分析。結果 68例患者中行L-Dixon術55例，L-Miles術12例，中轉開腹行Dixon術1例，手術過程順利。術后第4天1例并發(fā)吻合口漏、盆腔膿腫，行開腹引流、橫結腸造瘺術，6個月后關閉瘺口，恢復正常。本組患者隨訪時間2～12個月，平均隨訪時間8個月，均恢復良好，無腫瘤復發(fā)及轉移。結論 腹腔鏡下行直腸癌根治術具有手術野清晰、創(chuàng)傷小、恢復快等優(yōu)點，可取得與開腹手術相當或更好的根治效果，使患者受益。