会阴缝合中两种缝合方法的效果比较

目的:对比研究会阴切开缝合术中两种缝合方法的效果比较.将同时期内行会阴切开缝合术的400例初产妇随机分试验组和对照组,每组200例,均采用可吸收合成缝线缝合会阴伤口；试验组在缝合皮肤过程中采用连续皮内缝合,简称内缝法.对照组皮肤层采用传统的丝线间断缝合法,简称外缝法.产后的治疗和护理均相同.对两组产妇的产后会阴伤口疼痛程度和伤口愈合情况以及首次起床活动时间和出院时间进行比较.结果:试验组产妇产后的伤口疼痛程度明显轻于对照组,经统计学处理差异有统计学意义(P＜0.01).伤口愈合完好以及首次起床活动时间平等明显优于对照组.可见不同的缝合方法对切口的愈合影响较大[1].结论:会阴皮肤连续皮内缝合方法临床效果优于传统丝线外缝,值得在临床推广.     

External application of potato slices to lateral episiotomy cut

目的 观察新鲜马铃薯片外敷促进会阴切口愈合的临床效果.方法 将住院行会阴侧切术的产妇196例随机分为对照组与观察组各98例.观察组每天采用0.1％碘伏擦洗切口后用新鲜马铃薯片外敷切口,每日2次；对照组每天采用0.1％碘伏擦洗切口2次.结果 观察组会阴切口愈合情况显著优于对照组,会阴切口处肿胀及疼痛消退时间显著短于对照组(均P＜0.01).结论 使用自制马铃薯薄片贴敷会阴切口能有效加速肿胀及疼痛消退,促进会阴切口愈合.     

30°会阴切开及皮内缝合术对产妇切口愈合的影响

目的 探讨不同会阴切开方式及缝合术对产妇会阴切口愈合的影响.方法 将252例足月妊娠拟经阴道分娩的初产妇随机分为两组,观察组(130例)行会阴30°切开及薇荞线皮内包埋缝合术,对照组(122例)行会阴45°侧切开及羊肠线、丝线缝合术.观察两组切口撕裂伤率、出血量,术后伤口肿胀、疼痛、愈合情况及住院时间.结果 观察组阴道裂伤率32.31%,对照组为57.38%,两组比较,差异有显著性意义(P＜0.01);观察组会阴切口出血量少、疼痛程度轻、住院时间短、切口愈合良好(均P＜0.01).结论 30°会阴切开及皮内缝合术对产妇会阴损伤小、切口疼痛反应轻,切口愈合良好,住院时间短,有利于产妇早期下床活动,提高母乳喂养率,对提高产科医疗护理质量有重要意义.     

生理盐水用于会阴切开缝合术后擦洗效果观察

目的观察生理盐水用于会阴切开缝合术后伤口擦洗的效果。方法按时间顺序将790例会阴切开缝合术后产妇分为对照组371例，观察组419例。分别采用5％活力碘与生理盐水擦洗外阴及伤口，比较两组伤口愈合情况。结果两组伤口愈合情况比较，差异无显著性意义（P〉0．05）。结论采用生理盐水擦洗会阴及伤口对伤口愈合亦可起到与活力碘同样的作用，且成本低，对皮肤无刺激。     

生理盐水用于会阴切开缝合术后擦洗效果观察

目的 观察生理盐水用于会阴切开缝合术后伤口擦洗的效果.方法 按时问顺序将790例会阴切开缝合术后产妇分为对照组371例,观察组419例.分别采用5%活力碘与生理盐水擦洗外阴及伤口,比较两组伤口愈合情况.结果 两组伤口愈合情况比较,差异无显著性意义(P＞0.05).结论 采用生理盐水擦洗会阴及伤口对伤口愈合亦可起到与活力碘同样的作用,且成本低,对皮肤无刺激.     

会阴体长度及弹性评估在初产妇分娩中的应用

目的 探讨会阴体长度及弹性评估在初产妇分娩中的应用效果,为减少分娩损伤、降低会阴侧切的盲目性提供依据.方法 将320例足月初产妇随机分为观察组与对照组各160例,观察组分娩期测量会阴体长度及弹性,根据测量结果予以15°～40°、2～4 cm长的左斜侧切或手法扩张产道.对照组以会阴后连线中点作为切口起点,采取角度≥45°、4～5 cm长的左斜侧切法.结果 两组产妇会阴侧切率、会阴裂伤程度比较,差异有显著性意义(均P＜0.01).会阴侧切切口出血量、产后不同时间会阴切口疼痛程度、会阴切口愈合情况、住院时间比较,观察组显著优于对照组(均P＜0.01).结论 分娩期评估会阴体长度和弹性,可避免盲目行会阴切开术,有效维护初产妇分娩安全.有利于提高产妇产后生活质量.     

计血量型中药产妇垫预防难治性产后出血及会阴侧切伤口感染的效果观察

目的探讨计血量型中药产妇垫是否能及时准确估计难治性产后出血以及对会阴侧切伤口感染的临床应用效果。方法将北京同仁医院产科2013年6月至2014年6月间单胎孕足月、阴道分娩行会阴侧切术的1 100例初产妇,随机分为试验组和对照组,试验组术后使用计血量型中药产妇垫护理会阴伤口,对照组术后使用普通产妇垫,比较两组产妇产后2h、24h出血量,难治性产后出血率,子宫复旧、伤口愈合及会阴舒适满意度等情况。结果试验组产后2h、24h出血量、产后出血发生率高于对照组,难治性产后出血发生率(0.73%)低于对照组(1.27%),差异均有统计学意义(P0.05)。会阴伤口甲级愈合率试验组(92.36%)高于对照组(80.73%),伤口感染率试验组(1.82%)明显低于对照组(3.82%),差异均有统计学意义(P0.05)。试验组子宫复旧较快,使用舒适满意度(92.36%)明显高于对照组(73.09%),差异有统计学意义(P0.05)。结论计血量型中药产妇垫能较准确计量产后出血量,有助于及时处理治疗;可有效加强子宫收缩,减少难治性产后出血,促进伤口愈合,使用方便舒适,值得临床推广。     

Nursing care of open perineal incision of Mile's operation: an improved method

目的 探讨Mile's术后会阴开放切口护理的改进方法及效果.方法 将123例Mile's术后患者按随机数字表法分为观察组(62例)和对照组(61例).观察组用小喷雾器装入高锰酸钾液对Mile's术后会阴开放切口进行冲洗,对照组用高锰酸钾液坐浴.结果 两组切口愈合时间、窦道发生率及操作时间比较,差异有统计学意义(均P＜0.01).结论 用小喷雾器进行会阴部切口冲洗可以促进切口愈合,预防窦道的发生.     

无保护会阴接生技术降低初产妇会阴侧切率及疼痛的临床分析

目的探讨无保护会阴接生技术降低初产妇会阴侧切率及疼痛的临床分析。方法随机将正常分娩的120例初产妇分为2组,对照组采用传统保护会阴法接生,观察组采用无保护会阴法接生。比较2组产妇会阴裂伤率、侧切率及产后疼痛程度。结果观察组产妇会阴裂伤率、侧切率及产后疼痛程度均低于对照组,差异有统计学意义(P0.05)。结论采用无保护会阴法接生,可明显减少产妇的会阴侧切率缓解其产后疼痛,促进产妇产后顺利康复。     

经腹会阴联合直肠切除术后会阴切口处理的随机对照研究

目的 对比研究经腹会阴联合直肠切除术(Miles术)后骶前腔隙的自然引流或持续灌洗对会阴切口愈合的影响.方法 对2004年10月至2009年8月实施Miles术的74例患者进行前瞻性研究,术后3 d将患者随机分为骶前持续灌洗组和骶前自然引流组,观察比较两组患者会阴部切口感染、积液、延迟愈合等情况.将会阴切口愈合情况分为甲级、乙级和丙级愈合三种.结果 共74例患者纳入本研究.随机入组持续灌洗组37例(含术前放疗12例),入组自然引流组37例(含术前放疗10例).持续灌洗组会阴切口出现丙级愈合2例,乙级愈合3例,甲级愈合32例;自然引流组则分别为8例,3例,26例;两组间丙级愈合率差异有统计学意义(5.4%比21.6%,P=0.042).本研究中行术前放疗者22例,3例会阴切口丙级愈合,4例乙级愈合,15例甲级愈合;直接手术患者52例,7例会阴切口丙级愈合,2例乙级愈合,43例甲级愈合,两组间乙级愈合率差异有统计学意义(18.2%比3.9%,P=0.039).结论 持续骶前灌洗明显改善经腹会阴联合直肠切除术后会阴切口的愈合情况,术前50 Gy的长程放疗可明显提高会阴切口乙级愈合的比例.     

负压封闭引流联合银黄洗剂冲洗治疗下肢静脉性溃疡的效果观察

目的:观察负压封闭引流联合银黄洗剂冲洗治疗下肢静脉性溃疡的临床疗效。方法:将52例下肢静脉性溃疡患者随机分为对照组和治疗组各26例,对照组给予负压封闭引流联合生理盐水冲洗治疗,治疗组给予负压封闭引流联合银黄洗剂冲洗治疗,疗程均为28 d。比较两组患者创面的面积及状态评分(气味、肉芽形态及疼痛的评分)、相关炎性指标(白细胞计数及超敏C反应蛋白值)的变化情况及总有效率。结果:治疗组的总有效率为88.46%,高于对照组的61.54%,差异有统计学意义(P<0.05)。与治疗前比较,两组治疗后创面的面积及状态评分明显改善,白细胞计数及超敏C反应蛋白值明显降低(P<0.05),且治疗组较对照组改善更明显,差异均有统计学意义(P<0.05)。结论:负压封闭引流联合银黄洗剂冲洗治疗下肢静脉性溃疡可有效促进肉芽组织生长、改善创面状态并降低炎性反应,明显提高创面愈合率。     

多学组分层管理模式在会阴伤口护理中的实施

目的 探讨多学组分层管理模式在会阴伤口护理中的实施效果.方法 采用历史对照设计,将2018年6月至2019年8月就诊的33例纳入对照组,2019年9月至2021年1月就诊的31例纳入观察组.对照组给予会阴伤口常规处理方法,观察组采用多学组分层管理模式进行会阴伤口的护理跟踪和管理.比较两组治疗效果.结果 观察组伤口愈合时...     

Outcomes of immediate vertical rectus abdominis myocutaneous flap reconstruction for irradiated abdominoperineal resection defects

BACKGROUND: Perineal wound complications after chemoradiotherapy and abdominoperineal resection (APR) for anorectal cancer occur in up to 60% of patients, including perineal abscess and wound dehiscence. Vertical rectus abdominis myocutaneous (VRAM) flaps have been used in an attempt to reduce these complications by obliterating the noncollapsible dead space with vascularized tissue and closing the perineal skin defect with nonirradiated flap skin. Many surgeons are reluctant to use VRAM flaps unless primary closure is not possible. STUDY DESIGN: All patients who underwent chemoradiotherapy and APR during a 12-year period at the University of Texas MD Anderson Cancer Center were retrospectively reviewed. Patient, tumor, and treatment characteristics and surgical complications and outcomes were compared between patients who underwent VRAM flap reconstruction of wounds that could have been closed primarily (flap group, n = 35) and those who had primary closure of the perineal wound (control group, n = 76). RESULTS: Overall, there were no significant differences in the incidence of perineal wound complications between the groups; the flap group had a significantly lower incidence of perineal abscess (9% versus 37%, p = 0.002), major perineal wound dehiscence (9% versus 30%, p = 0.014), and drainage procedures required for perineal/pelvic fluid collections (3% versus 25%, p = 0.003) than the control group had. Despite flap harvest and the need for donor site closure in the flap group, there was no significant difference in abdominal wall complications between groups during the study's mean patient followup of 3.8 years. CONCLUSIONS: VRAM flap reconstruction of irradiated APR defects reduces major perineal wound complications without increasing early abdominal wall complications. Strong consideration should be given to immediate VRAM flap reconstruction after chemoradiation and APR.     

大鼠自体异体表皮细胞悬液混合移植的实验研究

目的　探讨自、异体表皮细胞悬液混合移植技术在创面修复中的应用。　方法　 30只大鼠随机配成 15对后 ,分成细胞悬液移植组 (A组 ,10对 )和细胞膜片移植组 (B组 ,5对 )。取每只大鼠全厚皮 ,分离表皮细胞 ,并根据配对情况按 1∶1的细胞比例混合 ,体外常规培养。 4d后收获A组混合细胞悬液 ,14d后收获B组混合细胞膜片。将此细胞悬液和膜片分别转移至A、B组相应供体大鼠的去全厚皮创面。随后A组每对大鼠的创面交叉覆盖配对方的异体全厚皮 ;B组创面覆盖胶原膜及“优妥”敷料。比较移植后 2～ 3周两组的创面修复情况。　结果　术后 2～ 3周 ,A组创面大多愈合 ,表面光滑 ,与皮下连接紧密。术后第 5天 ,B组创面部分细胞膜片脱落 ,部分成活 ,膜片成活的创面后期再次出现小创面 ,经久不愈。　结论　自、异体表皮细胞悬液混合移植是一种可行的、体内构建皮肤、修复创面的方法。     

超选择性动脉溶栓治疗急性脑梗死患者的护理

对16例脑梗死患者术前行充分的评估和术前准备，术后密切观察病情变化，重点做好留置溶栓导管的护理。结果闭塞血管完全或部分再通，临床症状较治疗前均有不同程度的改善。患者均治愈出院，未发生护理并发症。提示动脉溶栓具有创伤小、溶栓效果显著、并发症少的优点。手术前后认真、细致的护理时手术的成功至关重要。     

Primary myocutaneous flap closure following resection of locally advanced pelvic malignancies

BACKGROUND: Perineal wounds, created at the time of extended resection for locally advanced malignancy and following chemoradiation, are at risk of serious complications. METHODS: To determine whether immediate myocutaneous flap closure prevents complications, 57 patients treated with multimodality therapy and proctectomy (35 perineal wounds) or sacrectomy (22 posterior wounds) were studied. Patients were categorized according to whether they underwent primary skin and pelvic closure (group 1; ,n = 20); primary skin and omental pelvic closure (group 2; n = 24); or immediate myocutaneous flap closure (group 3; n = 13). RESULTS: Groups were similar with respect to age and sex; however, group 1 had more primary tumours and required less radical surgery and chemoirradiation than groups 2 and 3. Groups 1 and 2 experienced more complications overall (eight of 20, nine of 24 and three of 13 patients in groups 1, 2 and 3 respectively), more acute wound complications (seven of 20, nine of 24 and two of 13), delayed wound healing (three of 20, six of 24 and one of 13) and more reoperations for perineal wound problems (five of 20, seven of 24 and zero of 13). Patients in group 2 had a significantly longer hospital stay than those in group 1. Flap closure (group 3) did not increase the length of stay. The routine use of primary flap closure reduced overall wound complications (eight of 31 versus ten of 26 patients) and length of hospitalization (13 versus 17 days). CONCLUSION: Complete wound healing was achieved in all patients; however, immediate myocutaneous flap closure reduced the need for readmission and reoperation.     

会阴清洗用于无感染留置尿管护理的效果评价

目的针对留置尿管患者探索出一种简单、有效、无不良反应的会阴护理方法。方法将200例无感染留置尿管的患者随机分为观察组与对照组各100例,观察组采用小毛巾蘸温开水行会阴部清洗,对照组常规采用0.5%碘伏棉球行会阴部消毒。结果两组患者留置尿管后尿道口不良症状(红肿热痛、脓性分泌物)发生率及出现时间,留置尿管第3、7、10天中段尿培养阳性率比较,差异无统计学意义(均P>0.05);观察组患者对会阴部护理舒适度的评价显著高于对照组(P<0.01)。结论采用小毛巾蘸温开水清洗会阴部,不增加尿道口不良症状及尿路感染率,可提高患者舒适度。     

牛羊膜在烧伤创面的临床应用研究

目的 观察牛羊膜应用于烧伤创面的临床效果，并筛选最佳制备和储存方法。方法 2004年1月～2005年11月，随机选取58例浅Ⅰ度、深Ⅱ度、Ⅲ度切削痂植皮创面、供皮区及残余创面的患者，采用同体对照，将每例患者相同性质的创面等分为3分，分别贴附经0．1％洗必泰处理（A）、0．4％戊二醛处理（B）的牛羊膜和作为对照的凡士林油纱敷料（C），比较各组的临床效果，并对制备和储存牛羊膜的方法作出评价。结果 材料A较材料B质地柔软，随意性好，应用不需预处理。临床应用见：A、B组材料换药时患者疼痛轻微，C组较明显；A、B组创面愈合时间在各类创面中均低于C组，差异有统计学意义（P〈0．01），A、B组间比较，差异无统计学意义（P〉0．05）。A、B组创面感染率在深Ⅰ度和残余创面明显低于C组，差异有统计学意义（P〈0．05）；在浅Ⅰ度、Ⅲ度切削痂植皮创面和供皮区创面与C组比较，差异无统计学意义（P〉0．05），A、B组间比较，差异无统计学意义（P〉0．05）。结论 牛羊膜可以促进烧伤创面愈合，降低创面感染率，应用于常见的烧伤创面，戊二醛处理和洗必泰处理的牛羊膜疗效相似，但后者更易推广。     

Vacuum-assisted abdominal closure: its role in the treatment of complex abdominal and perineal wounds. Experience in 48 patients

INTRODUCTION: Vacuum-assisted closure (VAC) is a promising approach for the management of complex abdominal and perineal wounds. This paper summarizes our experience with this therapeutic modality and demonstrates its efficacity in difficult situations. PATIENTS AND METHODS: From January 2003 until December 2005, 48 patients (age 30-89) were treated with VAC therapy for open abdomen, infected laparotomy wounds, or tissue loss due to debridement of Fournier's gangrene. Wound dressings were changed every 2-3 days. RESULTS: Thirty-eight patients (79%) had major co-morbid conditions liable to impact negatively on wound healing. The treatment duration with VAC varied from 20-30 days with an average of eleven dressing changes (minimum 3-maximum 18). Treatment was effective in all patients. Spontaneous closure was achieved in 36 cases (75%); nine patients (19%) required a split-thickness skin graft, and three (6%) underwent delayed secondary closure. CONCLUSION: In our institution, VAC has become the treatment of choice for complex abdominal and perineal wounds. It is a safe, simple, and effective technique to speed wound healing and it has reduced the duration of hospital treatment in difficult clinical situations and in patients whose general condition is often severely compromised.     

康复新液治疗乳腺癌根治术后皮瓣坏死创面不愈的效果

目的 探究康复新液治疗乳腺癌根治术后皮瓣坏死创面不愈的效果。方法 选取2021年10月-2022年 10月于本院实施乳腺癌根治术且术后存在皮瓣坏死创面不愈的80例患者为研究对象,采用随机数字表 法分为观察组和对照组,每组40例。对照组给予碘伏换药治疗,观察组给予康复新液治疗,比较两组 临床疗效及临床指标。结果 观察组治疗总有效率为95.00%,高于对照组的85.00%,差异有统计学意义 （P＜0.05）;观察组新生上皮出现时间、创面愈合时间、上肢康复活动时间均短于对照组,创面面积小于 对照组,VAS评分低于对照组,差异有统计学意义（P＜0.05）。结论 康复新液治疗乳腺癌根治术后皮瓣 坏死创面不愈的效果良好,能够有效抑制创面处的炎症反应,减轻患者疼痛感,有利于提高愈合速度,缩 小创面面积,提升愈合效果。