剖宫产术后并发下肢静脉栓塞的护理及预防

通过对20例剖宫产术后并发下肢静脉栓塞病人的观察,分析了发生静脉栓塞的原因,提出了相应的护理、观察、预防等一系列措施.     

Wound conditioning by vacuum assisted closure (V.A.C.) in postoperative infections after dorsal spine surgery

The use of vacuum assisted closure (V.A.C.) therapy in postoperative infections after dorsal spinal surgery was studied retrospectively. Successful treatment was defined as a stable healed wound that showed no signs of acute or chronic infection. The treatment of the infected back wounds consisted of repeated debridement, irrigation and open wound treatment with temporary closure by V.A.C. The instrumentation was exchanged or removed if necessary. Fifteen patients with deep subfascial infections after posterior spinal surgery were treated. The implants were exchanged in seven cases, removed completely in five cases and left without changing in one case. In two cases spinal surgery consisted of laminectomy without instrumentation. In two cases only the wound defects were closed by muscle flap, the remaining ones were closed by delayed suturing. Antibiotic treatment was necessary in all cases. Follow up was possible in 14 patients. One patient showed a new infection after treatment. The study illustrates the usefulness of V.A.C. therapy as a new alternative management for wound conditioning of complex back wounds after deep subfascial infection.     

Prevention of Descending Pneumonia in Rats with Perflubron-delivered Tobramycin

OBJECTIVES: Patients undergoing emergent endotracheal intubation are at increased risk for developing pneumonia. Although numerous strategies have been investigated to reduce ventilator-associated pneumonia (VAP), the incidence of VAP and its associated mortality remains high. This investigation tested the hypothesis that LiquiVent (Alliance Pharmaceutical, San Diego, CA-LV) delivered antibiotics (via spray-dried microspheres-SDM) would improve survival in a rat model of descending gram-negative pneumonia. METHODS: Wistar rats (n = 49) were randomized to receive prophylaxis with 1). nothing (controls); 2). intramuscular (IM) tobramycin, 3). intratracheal LV plus SDM shells (vehicle), 4). intratracheal LV plus SDM shells plus IM tobramycin, or 5). intratracheal LV plus SDM containing 1 mg/kg of tobramycin. All interventions were given 24 hours before a bacterial challenge with 10(8) colony-forming units of intratracheal Klebsiella pneumoniae. Mortality at ten days was the sole outcome measure. Survival in individual groups was compared with controls by Fisher's exact test with Bonferroni correction for multiple comparisons. RESULTS: All animals in the control group died of pneumonia within ten days of bacterial inoculation (0% survival). Prophylaxis with either IM tobramycin or SDM vehicle plus IM tobramycin provided no protection (0% survival). This is in sharp contrast to the cohort receiving pretreatment with tobramycin-containing SDM delivered via LV, in which 60% of the animals survived to study completion (p < 0.05). CONCLUSIONS: Prophylaxis with SDM containing antibiotics delivered in low-dose LV provided significant protection in a rat model of descending gram-negative pneumonia. These data support the hypothesis that perfluorocarbon-delivered intratracheal antimicrobials may be useful in the prevention of VAP.     

中老年高尿酸血症预防知识与行为状况的调查研究

[目的]通过对中老年高尿酸血症的预防知识与行为状况的调查，分析预防护理知识缺乏的原因。[方法]2003年1月-2005年2月来我院查体与就诊者年龄在40岁以上的中老年人685例，分为高尿酸组123例，非高尿酸组562例，进行血压（BP）、血尿酸（URIC）、体重指数（BMI）、空腹血糖（GLU）、血清胆固醇（CHOL）、三酰甘油（TG）、血尿素氮（BUN）、肌酐（CREA）等指标对比观察。同时采用问卷调查方法，对123例高尿酸血症者进行预防护理知识与行为状况的调壶分析。[结果]在685例调查者中有123例（17．96％）血尿酸高，在高尿酸血症组中，有半数以上人员对血尿酸高的相关知识认识不足，有近半数人员对高尿酸血症发展预后了解不足，自我护理行为缺乏。另与高尿酸血症同时并存的还有肥胖、高血压、高血脂、高血糖。[结论]中老年高尿酸血症发生率在升高，疾病知识缺乏，自我护理意识不强，应加大对高尿酸血症发生发展的教育力度，以使其建立健康的生活习惯，减少痛风的发生。     

4110例肝炎分型分析

[目的]探讨各型肝炎的感染率。[方法]研究对象为我院住院及门诊患者，共计4110例。采用微粒子酶免分析法（MEIA）及酶联免疫吸附法（ELISA）进行肝炎分型（甲、乙、丙、丁、戊、庚肝）检测。[结果]4110例受检者中，单纯乙肝感染者133例，占3．24％；单纯丙肝感染者134例，占3．26％；单纯戊肝感染者2例，占0．05％；乙肝合并丙肝感染者3例，占0．07％；丙肝合并戊肝感染者1例，占0．02％；HAV、HDV、HGV无一例感染，感染率为0。另外，男性受检者2088人，乙肝感染者88人，占4．21％；丙肝感染者48人，占2．30％；女性受检者2022人，乙肝感染45人，占2．23％；丙肝感染86人，占4．25％。[结论]除丙肝外，各型感染率均低于全国平均感染率，与相关资料报道相差甚远。乙肝及丙肝仍以单纯感染多见。另，本组资料还显示，男性较女性更易感染乙肝病毒，而女性感染丙肝者远远高于男性，对于丙肝感染的性别差异，尚无报道，需进一步探讨。     

广州地区无偿献血人群人类疱疹病毒8型血清流行病学调查

目的：了解广州地区无偿献血者HHV-8的感染情况，为制定预防策略提供依据。方法：采用ELISA法检测3135名无偿献血者血浆HHV-8IgG抗体。结果：3135名献血者中6名血浆标本被检出HHV-8IgG抗体阳性，均为汉族、男性献血员，总阳性率为0．19％。不同年龄和性别组HHV-8感染率差异无统计学意义。结论：广州地区无偿献血人群HHV-8的感染率较低。     

头皮冠状切口的并发症及其防治

目的：对采用头皮冠状切口所引发的并发症进行分析，探讨防治策略。方法：对我科2003-01～2006—07应用头皮冠状切口行颅颌面骨折修复重建、颌面部肿瘤切除与缺损修复、先天性颅颌面畸形矫正的221例中发生并发症的40例进行分析总结。结果：18例出现头皮麻木及感觉异常，9例有较宽切口瘢痕，6例出现脱发，4例发生颞窝凹陷，2例发生头皮下血肿，2例出现单侧面神经颞支损伤，1例发生鼻眶区肥厚。结论：头皮冠状切口具有切口隐蔽、面部疤痕不明显，显露充分的优点，但对其并发症也不容忽视。应根据具体情况选择合适的切口类型，术中精细的解剖、神经血管的良好保护以及正确的缝合方法可减少并发症的发生。     

艾司洛尔预注射对预防颈丛阻滞后心血管副反应的观察

颈丛阻滞常可引起心率增快 ,血压增高 ,被认为是颈动脉窦及迷走神经被阻滞 ,交感神经活性增强所致 [1 ]。我们采用艾司洛尔预注射的方法 ,抑制颈丛阻滞后的心血管副反应 ,取得了良好的效果 ,现介绍如下。1　临床资料和方法1.1　一般资料　选择 ASA I～ 级 ,择期行甲状腺瘤或囊     

白血病病人骨髓抑制期实施防感染措施时机的研究

目的 :研究白血病病人在化疗期间 ,不同时间实施预防感染护理的效果。方法 :对照组在化学疗法结束后给予预防感染的护理措施 ,实验组在化学疗法开始前 3～ 7d实施预防性护理措施。观察两组病人感染发生率。结果 :感染发生率实验组明显低于观察组。结论 :在化学疗法开始前实施预防性护理措施有助于降低感染发生率     

调整给药时间减轻顺铂肾毒性的研究

目的　观察不同给药时间对顺铂肾毒性的影响。　方法　 1 6例癌症患者分为两组各 8例 ,分别在上午 1 0时或下午 8时静滴 6 0mg m2 顺铂 ,3～ 4周后作第 2周期化疗时交换给药时间 ,以尿 β2 微球蛋白浓度作为肾小管功能改变的指标。　结果　治疗前两组的尿 β2 微球蛋白浓度均在 2 0 0 μg L以下。治疗后 ,上午 1 0时给药组的尿β2 微球蛋白浓度在第 1周期为 4 96± 6 6 μg L ,第 2周期为 5 0 4± 74 μg L ,下午 8时给药组分别为 2 77± 4 3μg L(t=3.6 6 ,P <0 .0 1 )和 2 83± 39μg L(t=3.6 3,P <0 .0 1 )。 　结论　不同时间给药对顺铂的肾毒性有显著影响 ,下午 8时给药可明显减轻顺铂的肾毒性。