Objective:To explore the lung protective effect of nebulized inhalation of lidocaine (NL) on elderly patients undergoing hip fracture surgery.Methods:A prospective study was conducted on 80 elderly patients who underwent hip fracture surgery at the Huizhou Sixth People′s Hospital from September 2020 to December 2021. They were randomly divided into an NL group and a control group with 40 patients in each group. Within 30 minutes before the start of anesthesia, the NL group was given 2% lidocaine 10 ml oxygen driven nebulization inhalation, while the control group was given equal volume sterile injection water nebulization inhalation. All patients underwent general anesthesia with laryngeal mask intubation and iliac fascia space block. A randomized, double-blind, and controlled clinical study was conducted. The average values of intraoperative peak airway pressure (P peak), plateau airway pressure (P plat), and lung dynamic compliance (C dyn) were compared between two groups of patients; We compared the changes in arterial partial pressure of CO 2 (PaCO 2), alveolar arterial oxygen differential pressure (A-aDO 2), respiratory index (RI), and oxygen index (OI) between the two groups of patients and before and after surgery; The clinical pulmonary infection score (CPIS) and lung ultrasound score (LUS) were also compared between two groups of patients on the first day before surgery, the second day after surgery, and the seventh day after surgery. Resultsl:There was no statistically significant difference in the average values of P peak, P plat, and C dyn between the two groups during surgery (all P>0.05). After surgery, A-aDO 2 and RI in both groups increased compared to before surgery, while OI decreased compared to before surgery (all P<0.05); After surgery, A-aDO 2 and RI in the NL group decreased compared to the control group, while OI increased compared to the control group (all P<0.05); There was no statistically significant difference in PaCO 2 between the two groups before and after skin incision (all P>0.05). Compared with the 1st day before surgery, the CPIS and LUS in both groups were significantly increased on the 2nd and 7th day after surgery (all P<0.05); Compared with the second day after surgery, the CPIS and LUS of both groups of patients were significantly reduced on the seventh day after surgery (all P<0.05); On the second day after surgery, the CPIS and LUS in the NL group were significantly lower than those in the control group (all P<0.05); On the 7th day after surgery, the LUS of the NL group was significantly lower than that of the control group ( P<0.05); There was no statistically significant difference in CPIS scores between the two groups ( P>0.05). Conclusions:Nebulized inhalation of lidocaine can reduce lung function damage in elderly patients undergoing hip fracture surgery, and has a certain lung protective effect.

目的 探讨术中持续静脉输注利多卡因对老年髋部骨折手术患者术后疼痛和肺功能的影响.方法 选取某院行髋部骨折手术的老年患者60例,随机分成两组:利多卡因组(L组)和对照组(C组),每组30例.L组麻醉前30 min内静脉注射负荷剂量利多卡因1.5 mg·kg-1,术中持续静脉输注维持剂量利多卡因2 mg·kg-1·h-1至手术结束.C组以同样方式输注生理盐水做对照.所有患者均采用喉罩插管全麻+髂筋膜间隙阻滞.采用随机、双盲、对照方法进行临床研究.对比两组患者之间以及术前和术后PaO2、PaCO2、A-aDO2、RI和OI的变化情况;对比两组患者术后2 h(T1)、6 h(T2)、12 h(T3)、24 h(T4)和48 h(T5)的疼痛评分、48 h内累计自控给药次数和于术后第2天、第7天的临床肺部感染评分.结果 L组患者术后T1、T2、T3、T4和T5时的疼痛评分和48 h内自控给药次数明显低于C组(P＜0.05).两组患者术前A-aDO2、RI、0I和PaCO2差异无统计学意义(P＞0.05).与术前相比较,两组患者术后的A-aDO2和RI明显升高,OI明显降低(P＜0.05).与C组相比,L组术后A-aDO2和 RI明显降低,OI明显升高(P＜0.05).L组患者术后第2天和第7天的临床肺部感染评分明显低于C组(P＜0.05).结论 术中持续静脉输注利多卡因能够明显降低老年髋部骨折手术患者的术后疼痛,减轻肺换气功能损害,具有肺保护作用.

目的:探讨围术期连续腘窝上坐骨神经阻滞镇痛(CSNB)对糖尿病足血流灌注影响.方法:选取美国麻醉医师协会(ASA)分级Ⅰ～Ⅲ级住院需要清创手术治疗的60例糖尿病足溃疡患者作为研究对象,采用随机数字表法分为CSNB组和连续静脉镇痛(PCIA)组,每组30例,麻醉方式均为喉罩插管全麻.两组术后镇痛分别采用CSNB、PCIA,镇痛时间均为4 d.对比两组术后4 d VAS评分及术后镇痛的不良反应;两组术前(T0)、术后第4天(T4)、术后第14天(T14)患侧足背动脉和胫后动脉血管内径(D),血流速度、血流量(FV),足部脉搏灌注指数(PI);两组术前及术后2周足部溃疡面积.结果:两组术后VAS评分比较差异无统计学意义(P>0.05).CSNB组术后镇痛不良反应发生率小于PCIA组(P<0.05).术后各时点CSNB组血管D、血流速度、FV和足趾PI明显大于PCIA组(P<0.05);T14 CSNB组溃疡面积明显小于PCIA组(P<0.05).结论:连续腘窝上坐骨神经阻滞镇痛在围术期应用能显著增加糖尿病足患者足背动脉D、胫后动脉FV,增加足部血流量灌注,改善糖尿病足远端缺血缺氧程度,有利于糖尿病足早期愈合.

目的 观察微创双切口Endobutton带袢钢板内固定治疗RockwoodⅢ型肩锁关节脱位的临床疗效.方法 回顾性分析自2012-01-2018-07采用微创双切口结合双Endobutton钢板内固定术治疗的41例RockwoodⅢ型肩锁关节脱位,术中作2个切口,复位肩锁关节后采用双Endobutton带袢钢板固定重建喙锁韧带并修复肩锁韧带.结果 41例均顺利完成手术,随访时间12～24个月,平均13.4个月.手术时间45～78 min,平均56 min,术中出血量30～150 mL,平均64.1 mL,住院时间5～16 d,平均10d.术后1d疼痛VAS评分1～5分,平均2.1分.术后切口均一期愈合,术后1周内复查X线片肩锁关节复位均良好,带袢钢板位置均良好.2例术后轻度活动疼痛,活动轻度受限,2例肩锁关节间隙为6 mm,未出现切口感染及内置物脱落等相关并发症.末次随访时采用Karlsson标准评价疗效:优37例,良4例.结论 微创双切口Endobutton袢钢板内固定治疗RockwoodⅢ型肩锁关节脱位手术创伤小,手术时间较短,术中出血量少,能解剖重建喙锁韧带,内固定强度足够,无需二次手术取出内置物,值得临床推广.

目的：探讨手指伸肌腱止点撕脱的新鲜损伤应用微型骨锚修复的临床疗效。方法30例新鲜锤状指畸形患者,首先采取将患指远侧的指间关节应用克氏针固定于过伸的位置,然后在受伤的远节指骨基底背侧指伸肌腱止点附着处植入微型骨锚,最后将撕脱的指伸腱与骨锚所带的缝合线缝合固定,形成新的止点,观察治疗效果。结果30例患者均获得有效随访,随访时间为术后3~12个月。按 Dargan 功能评定方法评定疗效：21例为优,7例为良,2例为中。复查 X 线片均无骨锚脱落与松动。结论新鲜锤状指畸形采用微型骨锚修复,是临床上的一种可靠的、有效的、操作简便的治疗方法。

目的 总结真皮下血管网皮瓣修复手指热压伤创面的效果.方法 2005年1月～2010年1月,应用胸腹部真皮下血管网皮瓣修复手指热压伤后皮肤软组织缺损创面50例,其中男37例,女13例.年龄19～45岁.均为急诊手术.对于多指损伤,将皮瓣设计成每个手指一个,形成多叶真皮下血管网皮瓣,手指皮肤缺损区分别置于皮瓣内.结果 术后5例皮瓣远端小部分坏死,经换药后愈合,余45例皮瓣完全成活.术后随访1～3年,受区皮肤平整、外形美观、色泽好、质地软,耐磨性好,断蒂后无须修整,,功能恢复满意.结论 应用胸腹部真皮下血管网皮瓣修复手指热压伤后皮肤软组织缺损具有术后手外形好、功能恢复佳及无须二次手术修复等优点,是比较理想的一种修复方法.

Objective To study the techniques of rhytidectomy by tighting superficial muscular aponeurotic system (SMAS) and platysma. Methods The temporal and faciocervical subcutaneous tissues were seperated in a small region, and the superficial tissue above the deep temporal fascia was sufficiently seperated from the faciocervical tissues under SMAS and platysma with splitting SMAS zygomatic ligament. SMAS faciocervical muscle flap was divided into two parts, front and back. The front part was closely raised: the flap at the distal end of its anterior part was sutured with trans-mattress method with 3-0 terylene thread in order to fix it into the posterior and superior sharp end of SMAS; at the same time the posterior and superior parts were sutured in trans-mattress method to fix it on the periosteum at the root of the zygoma, and then the posterior part was closely lift, and the distal end of its anterior and inferior parts was also sutured in trans-mattress method with 3-0 terylene thread in order to fix it into the posterior and superior sharp end of SMAS. Meanwhile, the posterior part was sutured in the aponeurosis of sternoclavicular mastoid muscle. Temporal branch pedicle flap was closely fixed in the same two-step advanced method, and platysma auricular ligament was reconstructed. The most important operational skill of frontal rhytidectomy was to cut corrugator, procerus and frontal muscle accurately.Results From June 2002, we had performed this operation in 284 cases using the above procedures, in which the majority was satisfied by both patients and surgeons. Only 9 cases had minor or intermediate hematoma, and mastoid flap had bad blood supply at the early stage in 8 cases. With proper treatment, no poor complication occurred in those cases.Conclusions This two-step advanced procedure that raises closely and fix SMAS- faciocervical muscle flap and temporal branch pedicle flap has relative obvious advantages for fixing the droopping of the soft tissue near the nasolabial groove and the anterior part of maxillary edge. But, to the indiridual who has a static face and/or dynamic one, this method is not very effective.