【摘要】 目的 探讨经腋静脉穿刺中央静脉置管后上肢深静脉血栓形成情况。 方法 2007年1月-2009年12月共收治60例需行中央静脉置管的患者，所有患者均通过腋静脉穿刺行中央静脉插管，并于拔除导管后行彩色多普勒超声检查了解双侧上肢深静脉血栓形成情况。将腋静脉穿刺侧上肢作为穿刺组，对侧上肢作为对照组，进行前瞻性对照研究，将两组上肢深静脉血栓发生率进行比较。 结果 60例患者中央静脉置管平均时间为（14.7±7.4） d，对照组彩色多普勒超声检查无深静脉血栓形成，穿刺组2例患者出现上肢深静脉血栓形成的症状，无肺栓塞发生，28例患者（47%）拔除的导管周围可见纤维蛋白套形成，经上肢彩色多普勒超声检查，5例患者（8.3%）腋静脉不完全栓塞，2例患者（3.3%）腋静脉完全栓塞。在中央静脉置管时间≤6 d的患者中，无上肢深静脉血栓形成；置管时间在7~14 d的患者中，2例（3.3%）腋静脉血栓形成；5例（8.3%）腋静脉血栓形成发生在置管时间≥15 d（Plt;0.01）。7例腋静脉血栓形成患者，经2~3次穿刺成功，平均穿刺时间（10±2.5） min，与无腋静脉血栓形成患者的平均穿刺所需时间（14±9）min比较，无统计学意义（Pgt;0.05）。 结论 经腋静脉穿刺中央静脉置管后上肢深静脉血栓形成的发生率为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 探讨比较全肠内营养支持和全肠外营养支持对急性重症胰腺炎（severe acute pamcreattis，SAP）预后的影响。 方法 将2003年1月-2008年12月收治的54例SAP患者于入院后第1周内随机分为两组:全肠内营养（A）组27例；全肠外营养（B）组27例。两组患者均静脉给予广谱抗生素预防感染。入院时CT扫描及C反应蛋白水平显示两组患者具有可比性。 结果 B组22例患者发生器官衰竭，明显高于A组（5例）。B组22例患者接受了手术治疗，A组手术患者6例（Plt;0.05）。A组患者胰腺坏死后感染发生率明显低于B组（Plt;0.05）。B组患者死亡率高于A组（Plt;0.05）。 结论 全肠内营养支持，不仅可以促进肠道功能的恢复和营养状况的维持，还可减少肠源性感染的发生率，对减少SAP的感染性并发症和病死率具有积极作用。【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 探讨腹腔镜下行直肠癌根治术（L-Dixon，L-Miles）的应用价值。方法 对我院2009年10月至2011年1月期间收治的68例行腹腔镜直肠癌根治术患者的临床资料进行回顾性分析。结果 68例患者中行L-Dixon术55例，L-Miles术12例，中转开腹行Dixon术1例，手术过程顺利。术后第4天1例并发吻合口漏、盆腔脓肿，行开腹引流、横结肠造瘘术，6个月后关闭瘘口，恢复正常。本组患者随访时间2～12个月，平均随访时间8个月，均恢复良好，无肿瘤复发及转移。结论 腹腔镜下行直肠癌根治术具有手术野清晰、创伤小、恢复快等优点，可取得与开腹手术相当或更好的根治效果，使患者受益。