摘要:目的: 評價機械通氣對胸腔內脈搏氧飽和度的影響。 方法 :以食道、氣管和降主動脈作為胸腔內脈搏氧飽和度的監測位點,將改制后的氧飽和度探頭分別固定于上述部位,并連接于同一監護儀上。純氧通氣,待上述氧飽和度容積波波形和讀數穩定,停止機械通氣30s。以錄像的方式記錄機械通氣停止前后30 s內食道、氣管和降主動脈SpO2容積波和讀數的變化。同時記錄舌SpO2。 結果 :機械通氣時,食道、氣管和降主動脈三個監測位點均可獲得異常高大的SpO2容積波;停止通氣時,異常高大的氧飽和度波形消失。食道、氣管和降主動脈脈搏容積波變異率分別為112%,74%,302%。降主動脈脈搏容積波的變異率明顯高于食道和氣管( 〖WTBX〗P ＜005)。機械通氣停止前后30s內食道、氣管和降主動脈的SpO2讀數變化無顯著差異(〖WTBX〗P ＞005)。 結論 :機械通氣對胸腔內食道、氣管和降主動脈氧飽和度讀數無影響,主要影響是脈搏容積波。且各位點間脈搏氧容積波受呼吸的影響不同。Abstract: Objective: To investigate the impact of mechanical ventilation on pulse oximetry in thoracic cavity. Methods : After dogs anesthesia induction and thoracotomy, pulse oximeters were simultaneously placed at esophagus, trachea, and descending aorta, and connected with the same monitor for SpO2 monitoring. During ventilation with 100% oxygen, the mechanical ventilator was temporarily switched off for 30 seconds after high quality PPG waveforms and SpO2 readings were obtained. SpO2 signals and readings from esophagus (SeO2), trachea (StraO2), descending aorta (SDAO2) shown on the monitoring screen were recorded by the SONY video before and after stopventilation. And StonO2 were also recorded. Results : Abnormally largeamplitude PPG waves were found in normal waves at monitoring sites of esophagus, trachea, and descending aorta in all animals during ventilation; however, they disappeared without ventilator. The variation rate in ventilationinduced PPG amplitude were 112%, 74%, 302% at esophagus, trachea and descending aorta respectively. The PPG amplitude variation rate from SDAO2 was higher than that from SeO2 and StraO2 (〖WTBX〗P ＜005). However, the SpO2 readings obtained from pulse oximetries in all sites were no significantly statistical difference within 30s before and after temporarily stopventilation (〖WTBX〗P ＞005). Conclusion : Abnormally amplitude PPG waveforms from oximetry probe placed at esophagus, trachea, and descending aorta were induced by ventilation. The Variation rate in ventilationinduced PPG amplitude was various at different monitoring sites. The SpO2 readings from esophagus, trachea, and descending aorta were not significantly contaminated by ventilation.
Surgerical treatment has been used for portal hypertension over a hundred years, and has evolved from various portosystemic shunts to devascularizations and selective shunts. Selective shunting, which has the advantages of long-term prevention from recurrent variceal bleeding and maintenance of hepatic portal vein perfusion, has developed from single distal splenorenal shunt to various procedures including distal splenocaval shunt, coronary caval shunt, coronary renal shunt, etc. Selective shunting can also be achieved after reconstruction of spontaneous portosystemic shunt. Preoperative portal venous system CT angiography, intraoperative ultrasound Doppler and portal vein pressure measurements may provide patients with a more reasonable treatment of choice.
目的:觀察經鼻內鏡檢查引導下通過改良三腔二囊管加沙氏導絲引導支撐,結合內鏡下硬化劑治療肝硬化食管靜脈曲張破裂出血的療效。方法:14例肝硬化食道靜脈曲張破裂出血患者經過經鼻內鏡檢查后通過改良的三腔二囊管加沙氏導絲支撐下,結合內鏡下硬化劑治療食管靜脈曲張破裂出血,觀察止血效果以及并發癥。結果:14例患者均1次止血成功,1例患者治療后8h再次出血,行急診TIPSS手術治療。主要反應為胸骨后疼痛,持續時間為2～7d,對癥處理后消失,3、6個月后再次復查食道胃底曲張靜脈明顯改善,3例10d左右行內鏡下再次硬化治療(因第1次硬化劑量少或治療不完全)。結論:經鼻內鏡檢查行改良三腔二囊管加沙氏導絲引導支撐下,結合內鏡下硬化劑治療肝硬化食管靜脈曲張破裂出血是一種有效的治療方法。
The pectoralis major myocutaneous flap was used to repair laryngopharyngeal and esophageal defect following radical excision of pharyngeal and inferior laryngeal carcinomas in 3 cases. The results were susscessful. The patients were follwedup for 6 months to 3 years. The deglutition functions were all reestablished, the general nutritional conditions were improved, and no recurrence or distant metastasis was observed. The advantages of this operative procedure were discussed.
ObjectiveTo observe the efficacy of dense ligation and non-dense ligation in treating severe esophageal varices. MethodsSixty cirrhotic patients with severe esophageal varices treated in our hospital between January 2009 and October 2011 were divided into two groups based on their operative ways.Group A was the dense ligation group including 32 patients,and group B was non-dense ligation group in which there were 28 patients.Six-shooter multi-band ligators were used for endoscopy.If the number of loop ligature collar was larger than six,it was regarded as dense ligation and the rest was regarded as non-dense ligation. ResultsIn group A,one month after first ligature,six patients were basically cured,24 were greatly improved,and two did not respond to the treatment,with a total effective rate of 93.8% and an average ligation of 1.94 times.In group B,one month after first ligature,one patient was basically cured,24 were greatly improved,and three did not respond to the treatment,with a total effective rate of 89.3% and an average ligation of 2.75 times. ConclusionDense ligation is a safe,reliable and effective approach for esophageal varices,which brings about a high disappearance rate of esophageal varices and reduced ligation frequency.