Open Journal of Thoracic Surgery, 2012, 2, 10-12 doi:10.4236/ojts.2012.21003 Published Online March 2012 (/journal/ojts)
Surgeries for the Heart and Abdominal Aorta in a Patient with Heparin-Induced Thrombocytopenia: Manifestations Following Initial Heart Surgery
Shoh Tatebe1, Makoto Taoka2, Imun Tei2, Shuko Nakamura2, Ei-ichi Tei2 1Department of Thoracic and Cardiovascular Surgery, Mito Saiseikai General Hospital, Mito City, Japan; 2Department of Cardio-vascular Surgery, Ayase Heart Hospital, Tokyo, Japan. Received December 4th, 2011; revised January 24th, 2012; accepted February 6th, 2012
ABSTRACT A 72-year-old man with abdominal aortic aneurysm and angina pectoris underwent coronary artery bypass grafting (CABG) prior to abdominal aortic surgery. Perioperatively, he developed thrombocytopenia (29,000 mm3), which was suggested as heparin-induced thrombocytopenia. Cardiac status was also aggravated at the same time, suggestive of bypass graft thrombosis. The results of platelet factor 4 (pf4) antibody test were negative, but platelet aggregation test was positive for heparin. Heparin was immediately discontinued, and replaced by argatroban; the patient’s cardiac status improved. One month later, he underwent abdominal aortic surgery using argatroban without issues related to anticoagulation and hemostasis. Autologous donated fresh blood prepared by the “switch-back method” was also used in this case, and its value was confirmed. Keywords: Heparin-Induced Thrombocytopenia
全膝关节置换术中多模式镇痛的应用效果研究
摘要：目的：探究全膝关节置换术（TKA）过程中采取多模式镇痛的效果。方法：将2016年1月至12月间收纳的56例TKA病人，按镇痛方式分为对照组和观察组各28例，前者采取硬膜外镇痛，后者采取股神经阻滞镇痛，比较两组镇痛效果。结果：在全膝关节置换术后，两组每天静息痛与活动痛均显著下降，观察组VAS疼痛程度比对照组更小（P＜0.05）；两组置换后膝关节活动程度均有一定提高，但观察组膝关节活动度明显大于对照组（P＜0.05）；结论：虽然硬膜外和股神经阻滞均可缓解术后疼痛，但后者的效果更佳，对加快关节功能恢复更显著，而采取多模式结合的镇痛方式可取得更佳效果。
关键词：全膝关节置换术中多模式镇痛的应用效果研究
全膝关节置换术（TKA）作为治疗非感染性膝关节疾病终末期的最佳方式，可有效患者病人膝关节疼痛，改善预后及生活质量。但TKA后可发生持续一段时间难以忍受的疼痛感，给病人带来巨大的痛苦。当前在临床进行TKA治疗时，采取多模式镇痛的方式取得显著成效，其不仅可减轻患者疼痛感，还能促进患者的膝关节功能尽早恢复，有着较高的中远期疗效。对此，本研究对硬膜外镇痛与股神经组织镇痛多模式在全膝关节置换术中所产生的镇痛效果进行分析，以期能为临床施治提供有用依据。
1.资料和方法
1.1一般资料
选择2016年1月至12月间收纳的56例TKA病人中，男32例，女26例，年龄范围46~77岁，均值（58.64±3.81）岁；所有患者均符合全膝关节置换术手术指征，本组研究在医院伦理委员会的批准后进行，所有患者对治疗方案及本组对比试验知情和同意[1]。排除存在精神疾病、心肝肾功能严重不全、腰部脊椎畸形、血液系统疾病及对本组药物过敏者。按镇痛方式分为对照组（硬膜外镇痛）和观察组（股神经阻滞镇痛）各28例，两组在性别、年龄及手术指征对比上差异不具统计意义，P＞0.05具可比性。
帕瑞昔布钠、右美托咪定单纯及联合应用对老年患者术后早期认知功能的效果对比
目的 比较帕瑞昔布钠、右美托咪定单纯及联合应用对老年患者术后早期认知功能的效果。方法 选取2016年7月～2017年6月于我院行全髋关节、股骨头及全膝关节置换术的137例老年患者作为研究对象，按照随机对照法将其分为帕瑞昔布钠组（简称P组，n=42）、右美托咪定组（简称D组，n=47）以及联合组（n=48），在术中分别添加帕瑞昔布钠、右美托咪定以及两者混合液进行治疗。比较三组患者术前1 h（t0）、术后3 h（t1）、24 h（t2）、72 h（t3）的S-100β蛋白、神经元特异性烯醇化酶（NSE）浓度、MoCA量表得分情况以及术后认知障碍发生率。结果 联合组患者t1时的血清S-100β蛋白含量明显低于P组和D组；t2及t3时的血清S-100β蛋白及NSE含量均明显低于P组和D组，差异有统计学意义（P＜0.05）。联合组患者的MoCA得分明显高于P组和D组，差异均有统计学意义（P＜0.05）。联合组患者的POCD发生率（14.5%）明显低于P组（28.5%）和D组（29.7%），差异有统计學意义（P＜0.05）。结论 帕瑞昔布钠联合右美托咪定对老年患者进行维持麻醉，可显著降低患者术后认知障碍的发生率，效果优于单纯使用两者其中一个，值得在临床推广应用。
[Abstract]Objective To study and compare the effect of Parecoxib Sodium and
Dexmedetomidine alone and combined use on postoperative early cognitive function
in elderly patients.Methods From July 2016 to June 2017，137 elderly patients who
underwent total hip replacement，femoral head replacement and total knee joint
病名Name of Disease基本外科General Surgery结节性甲状腺肿nodular goiter甲状腺腺瘤thyroid adenoma甲状腺癌thyroid carcinoma甲亢hyperthyroidism甲旁亢hyperparathyroidism甲状旁腺癌parathyroid carcinoma乳腺结节breast nodules乳腺癌breast cancer乳腺癌breast cancer胃癌gastric cancer十二指肠肿瘤duodenal tumor肝肿物hepatic tumor肝囊肿hepatic cyst肝癌Hepatic cancer肝转移瘤hepatic metastasis 肝血管瘤hepatic hemangioma肝硬化cirrhosis胆管癌Cholangiocarcinoma胆囊炎cholecystitis肝内胆管结石calculus of intrahepatic duct胆石症cholelithiasis胆囊息肉cholecystic polyp胆管囊肿cyst of bile duct胆囊癌cholecystic carcinoma门脉高压portal hypertension胰腺癌/梗黄/胰头/体癌pancreatic carcinoma/obstructivejaundice/pancreatic head/body cancer胰岛素瘤insulinoma胰腺假囊肿pancreatic pseudocyst脾大/脾亢splenomegaly/hypersplenism小肠癌intestinal cancer结/直肠癌colon/rectal cancer结/直肠癌colon/rectal cancer乙状结肠癌sigmoid cancer结肠癌colon cancer腹膜后肿物retroperitoneal tumor腹水ascites切口疝incisional hernia痔hemorrhoid腹股沟疝（斜/直）inguinal hernia, indirect/direct阑尾炎appendicitis
