优化保留灌肠方法在标准化病人中的临床研究

目的观察优化保留灌肠方法在标准化病人中的临床效果。方法招募30名护士作为标准化病人,将其随机编号为1至30号,单号先实施传统保留灌肠方法,5 d后实施优化保留灌肠方法,双号先实施优化保留灌肠方法,5 d后实施传统保留灌肠方法。比较两种保留灌肠方法插肛管时的疼痛程度、便意感、黏膜出血情况及灌肠后药液保留时间。结果优化保留灌肠组插肛管时无痛14例、轻度疼痛16例,传统保留灌肠组无痛4例、轻度疼痛9例、中度疼痛17例,两组疼痛程度比较,差异有统计学意义(P<0.05)。优化保留灌肠组插管时便意感评分为(2.76±0.71)分,传统保留灌肠组为(3.46±0.90)分,两组便意感比较,差异有统计学意义(P<0.05)。优化保留灌肠组药液保留时间为(70.43±19.34)min,传统保留灌肠组为(37.34±16.53)min,两组药液保留时间比较,差异有统计学意义(P<0.05)。优化保留灌肠组肠黏膜出血2例次,传统保留灌肠组肠黏膜出血8例次,两组肠黏膜出血比较,差异无统计学意义(P>0.05)。结论优化保留灌肠方法可减轻患者插肛管时的疼痛程度和便意感,延长药液保留时间。     

改良清创术在肢体开放性创伤伤口患者中的应用

目的：探讨改良清创术在肢体开放性创伤伤口的患者中的应用效果.方法：将我院2010年1月～2012年12月开放性外伤患者3513例随机分为对照组1688例和观察组1825例,对照组采用传统清创术,观察组伤后8h以内清创,采用改良清创术.比较两组患者Ⅰ期伤口愈合率和感染率.结果：观察组患者Ⅰ期伤口愈合率高于对照组（P＜0.05）,感染率低于对照组（P＜0.05）.结论：早期正确应用清创术,有利于创伤性伤口的Ⅰ期愈合,降低感染率,值得临床推广应用.     

改进抽吸中药针剂产生泡沫和药液流洒的对比研究

目的探讨改进抽吸中药针剂产生泡沫和药液流洒的临床效果。方法教材中抽吸药液方法为传统法,临床实用抽吸药液方法为改进法。由技术相当的专业护理人员进行抽取中药针剂,抽吸2 mL醒脑静注射液500次,抽吸10 mL清开灵注射液500次。比较两种方法抽吸中药针剂产生泡沫和药液流洒情况。结果改进法抽吸醒脑静注射液产生泡沫次数和药液流洒总量明显小于传统法,差异均有高度统计学意义（均P〈0.01）。改进法抽吸清开灵注射液产生泡沫次数和药液流洒总量明显小于传统法,差异均有高度统计学意义（均P〈0.01）。结论改进法不仅可以明显减少泡沫产生,还可以减少药液流洒,减少药液浪费,是一种安全有效的抽吸方法,值得临床推广使用。     

Mucosal colonic tube fistula with antireflux wrap for antegrade colonic enema

Antegrade enemas can provide children with excellent faecal continence in situations where adequate control has been compromised because of underlying congential anomaly or poor surgical outcome in their treatment. The enema is often delivered through an appendicostomy. If the appendix is absent or utilized for another purpose, then placement of a chait tube or caecostomy button can provide access to the colon for the enema. However, these devices may be associated with breakages, accidental removal and leakage and replacement may require another operative procedure under a general anaesthetic. Full thickness colonic tubes can also be constructed at any point along the colon but in the author’s experience, they can be associated with significant leakage of both gas and faecal material. The construction of a mucosal colonic tube with anti-reflux wrap is a technique that avoids the above problems and offers a distinctive advantage in selected situations. The technique relies on tabularising mucosa alone to create a continent fistula. Six children with severe soiling underwent the technique. The outcomes were evaluated using a modified quality of life score (QOLI) [1, 2]. The score included assessment of soiling, staining, odour, self-esteem and socialization measure. Technical evaluation included analysis of the ease of catheterization and continence of the mucosal fistula site. All six patients had dramatic improvement in their faecal continence with complete resolution of soiling in all six. Follow up median is 42 months and the range is 6–48 months. QOLI scores improved from a total of 4.75 to 18.5. Possible range is 0–21. All the six fistula sites catheterize easily and no stenosis or faecal leakage has occurred. Two patients required treatment of minor granulations at the entry site of the fistula during the early healing phase.     

中药灌肠并针灸佐治小儿病毒性肠炎60例疗效观察

目的：观察中药灌肠并针灸对小儿病毒性肠炎的疗效。方法：临床上将110例病儿随机分为治疗组和对照组,对照组不用抗生素,纠正水电解质及酸碱平衡紊乱,并常规口服思密达12包-1包;治疗组：在对照组相同治疗的基础上加用中药30m l-50m l灌肠2次/d,针灸1次/d,观察患儿治疗后症状缓解情况。结果：治疗后,治疗组总有效率96.7%,对照组总有效率68.0%,疗效明显优于对照组,且减少了不良反应。结论：中药灌肠并针灸治疗小儿病毒性肠炎操作简单,使用方便,不良反应少的优点,可明显提高治愈率。     

改良横行小切口治疗小儿斜疝手术的精细技巧(附154例报告)

目的探讨小儿腹股沟斜疝治疗的手术技巧。方法 154例斜疝患儿均采用改良横行小切口手术治疗,即经横纹切口显露外环或内环区域,不将精索提出切口外而在原位进行剥离、横断疝囊行疝囊高位结扎的手术方法治疗。结果除1例阴囊血肿、30例轻度阴囊水肿外,术后随访无复发及其他并发症。结论改良的疝手术方法符合微创特点,操作安全、简捷,恢复快,美容效果好,适合各年龄组患儿的手术治疗,适合基层医院推广使用。     

改良封管液在血液透析中的应用效果

目的 探讨改良封管液在长期性双腔透析导管血透患者中的应用效果.方法 将180例使用长期性双腔透析导管行血液透析的患者随机分为实验组和对照组,每组各90例.实验组于透析结束后采用尿激酶10000U＋氨苄西林钠1g ＋肝素50mg＋NS,进行封管,对照组于每次透析结束后采用纯肝素50mg＋NS进行封管.3个月后观察2组患者导管相关性感染和血栓的发生率.结果 3个月后,实验组患者导管相关性感染发生率为0 00%.对照组为8.89%（χ2=6.41,P〈0.05）;实验组患者血栓的发生率0 00%,对照组为6.67%（χ2=4.31,P〈0.05）,实验组患者导管相关性感染和血栓发生率均低于对照组.结论 改良封管液不仅可以较好地预防导管相关性感染,同时还可以降低血栓的发生率.     

The Correlation of Symptoms,Occult Blood Tests,and Neoplasms in Patients Referred for Double-Contrast Barium Enema

One hundred and forty-nine patients (86 women) with a mean age of 64 years (52-74 years), referred for double-contrast barium enema (DCE), were invited to have fecal occult blood test and recto-sigmoidoscopy (60 cm) (RSS) before the DCE. Carbon dioxide was used for inflation at RSS to enable the two examinations to be done at the same time. Eight adenomas < 1.0 cm in diameter, 11 adenomas = 1.0 cm in diameter, and 5 carcinomas were diagnosed in altogether 23 patients. There was no correlation between symptoms, diverticula, or neoplasm, but a positive rehydrated Hemoccult II test was correlated to the presence of neoplasms (cancer and adenoma 1.0 cm in diameter), but Hemoccult is not suitable as selection basis for work-up of symptomatic subjects. To diagnose colorectal neoplasms, we have to accept a certain number of negative work-ups of the large bowel. If DCE is chosen for work-up of the large bowel, it has to be combined with rectosigmoidoscopy (60 cm).     

中药保留灌肠联合吡喹酮治疗血吸虫性结肠病

采用中药保留灌肠联合吡喹酮治疗血吸虫性结肠病并观察其临床疗效，结果显示，经过1～2个疗程治疗后总有效率可达95％。