医院保洁员针刺伤情况的调查分析及其防护措施

目的通过对医院保洁员针刺伤情况的调查,分析原因,以提高其自我防护意识。方法采用自行设计的有关医院保洁员针刺伤防护意识调查表,对第二军医大学东方肝胆医院50名保洁员进行问卷调查,并对出现的问题进行分析。结果82％的医院保洁员在工作期间曾发生过针刺伤,68％的医院保洁员被隐藏在敷料里或废弃物里的注射器针头刺伤,78％的保洁员未按正确的程序对针刺伤进行处理,98％的医院保洁员在被针刺伤后未进行血液检测和未上报相关机构。结论医院保洁员对针刺伤防护意识薄弱,对医院感染知识缺乏了解,应重视并加强医院保洁员对医院感染知识、针刺伤防护知识的培训及正确处理针刺伤步骤的学习,以提高其自我防护意识,减少医院保洁员针刺伤的发生。     

负压封闭引流技术在骨科创面修复中的临床应用

目的探讨负压封闭引流术(VSD)治疗严重皮肤损伤的临床疗效;总结VSD技术在骨科损伤中的修复特点。方法对韶关市粤北人民医院骨科收治的45例严重皮肤损伤(复杂创面)患者均使用VSD治疗。结果所有患者创面均得到了完全愈合,其中28例患者行1次VSD引流术后,创面肉芽组织生长良好,肉芽组织红润,颗粒细小,血运丰富,行第2次植皮后植皮成活,创面闭合良好,手术均取得了成功;13例患者行第2次VSD负压引流后,创面肉芽组织生长良好,肉芽组织红润,颗粒细小,血运丰富,行邮票植皮后取得成功;3例骨髓炎患者,经过2次清创VSD引流后,第3次使用皮瓣转移技术最后闭合创面;1例足背肌腱外露的患者因不愿做皮瓣,用VSD负压技术促进肉芽组织生长,经过3次VSD负压引流后,肉芽组织生长良好,配用生肌膏后肌腱全部覆盖肉芽组织,植皮后创面闭合。结论 VSD技术是治疗严重四肢大面积皮肤损伤较好的处理方法。     

珍珠末治疗产后会阴伤口的疗效观察及护理

目的探讨珍珠末治疗产后会阴伤口的疗效及护理。方法将180例产后会阴伤口患者随机分为2组,分别为治疗组和对照组,治疗组95例在常规抗炎的基础上,加用珍珠末外敷会阴伤口;对照组85例给予常规抗炎和常规伤口换药。比较2组会阴切口的愈合情况以及副反应情况。结果治疗组伤口愈合良好率为97．89％,明显优于对照组89．41％（P〈0．05）。治疗结束时2组均未出现过敏等不良反应。结论珍珠末能加速会阴伤口的愈合,疗效显著,价格低廉,值得临床推广。     

Surgical infections surveillance: Results of a sixmonth incidence study in two Italian hospitals

In a six-month incidence study of surgical wound infections (SWI) in two Italian hospitals, 1,019 surgical patients, in three general surgery wards, and 433 surgical patients in one orthopedics ward were studied. For the SWI surveillance, the DANOP-DATA system was used: this microcomputer program was developed by Danish authors and tested in a European multicenter study coordinated by the World Health Organization in 1989. Two Italian hospitals participated in the multicenter study. The overall infection rate was 1.2 per 100 operations in orthopedics and 4.9/100 in general surgery. The risk of infection increased with age (RR = 2.06; 95% CL = 1.20–3.53), wound class (RR = 3.38; 95% CL = 1.97-5.8), length of pre-operative stay (RR = 2.71; 95% CL = 1.54-4.74), and duration of operation (RR = 2.59; 95% CL = 1.48–4.54).The infection rates ranged from 3.7 to 7.3/100 among the three general surgery wards; this variability by ward was only partially explained by differences in the age distribution of in-patients, wound class, duration of operation and length of pre-operative stay. When all these risk factors were simultaneously taken into account using a logistic regression model, the odds ratio, comparing one of the three general surgical wards with the other two, was still 2.29 (95% CL = 1.23–4.26). The observed variability can be attributed to differences, among the participating wards, in the case-mix of patients treated and/or to differences in the quality of infection control programs implemented.Corresponding Author     

重度放烧复合伤大鼠创面处理的实验研究

本文用不同方法对重度放烧复台伤大鼠创面进行了处理。结果显示, 伤后24小时植自体皮、异体皮或伍加输血时, 30天活存率和胸腺及脾细胞功能的恢复程度, 均显著高于对照组, 也高于单给Zn(SD)₂保痴或AgSD及zn(sD)₂保痂植皮组。但伤后7天植皮的动物25天内全部死亡。伤后1天, 痂下和内脏均未捡出细菌, 3～15天, 对照组内脏检出率随痴下增加而升高, 但24小时植皮组仅创面检出2例。这说明伤后24小时切痂植皮时效果最好, 主要因及早消除创面, 使感染减轻、免疫功能改善而有利于提高疗效。但极期应严禁切痂植皮。     

Effect of phenytoin sodium on macrophages in rat wounds

本实验旨在研究苯妥英钠（ＰＳ）对伤口巨噬细胞（Ｍ）的影响．从置入大鼠背部伤口的聚乙烯醇海绵中收集巨噬细胞，分别测定其吞噬功能，肿瘤坏死因子α（ＴＮＦα）和白介素１（ＩＬ－１）的释放以及对成纤维细胞增殖调节作用，通过牵拉伤口组织致其断裂时溢出的水的重量而测定伤口牵张强度．结果表明，伤口Ｍ的功能在伤后ｄ５达到高峰，ＰＳ１，１０，５０ｇ·Ｌ－１浓度依赖性地增加伤后ｄ５的伤口Ｍ的数量，吞噬功能，ＴＮＦα和ＩＬ－１的释放，增强Ｍ对成纤维细胞增殖的刺激作用，增强伤口牵张强度．结果说明ＰＳ加速伤口愈合，与其增强Ｍ的功能有关．     

Morphometric study of endothelial wound-healing following penetrating keratoplasty

Twenty samples of endothelia removed from normal and post penetrating keratoplas-ty (0.5,1,2,3 months after penetrating keratoplasty) were observed by scanning electron mi-croscopy.The photographs of the endothelia in graft-host junction were analyzed by computer-assisted image analysis system,and the morphometric indexes examined were area of the cells,perimeters,density,figure coefficient,long axis,coefficient of variation of the area,and oth-ers.Results showed that the morphology and the density of the endothelial cells changed obvi-ously after operation and improved slowly but progressively with time although at 3 monthspostoperatively some differences still existed.By using the new techniques,the experiment con-firmed and enriched the theories on the corneal endothelial wound-healing,revealing some ofthe new characters of the endothelial wound-healing following penetrating keratoplasty.     

大鼠腹腔海水浸泡时间与死亡率的关系

目的 观察海水浸泡大鼠腹腔对大鼠急性死亡的影响,分析浸泡时间与死亡率的关系。方法:选取SD大鼠40只,随机分为对照组(等渗盐水腹腔浸泡组)及海水腹腔浸泡组,每组20只,观察腹腔浸泡后大鼠急性死亡情况。结果:对照组持续浸泡2小时均无死亡,海水腹腔浸泡组持续浸泡67min50％大鼠急性死亡,浸泡95min全部急性死亡。结论:海水腹腔浸泡可以引起大鼠急性死亡,死亡率随着海水浸泡时间的延长而增高。     

吻合血管尺动脉腕背支为蒂双叶皮瓣的临床应用

目的：探讨尺动脉腕背支为蒂开支与降支分别为营养血管制 双叶游离皮瓣在手指外伤中的应用。方法：9只成人新鲜上肢标本，左4只，右5只，于尺动脉腕背支起始处灌注红色乳胶，手术显微镜下解剖观察尺动脉腕支及其升支与降支起始，行程、分支及吻合情况，临床设计以尺动脉腕背支为蒂，腕背支的升支与降支分别为营养血管的双叶游离皮瓣修复单指皮肤全脱套伤8例，示中指及中环指背或指掌侧皮肤缺损7例。结果：临床应用15例，皮瓣全部成活，术后随访6-15个月，伤指外形及皮肤色质与健指相似，常侧远端指脂两点辨觉为3.2-6.1mm，运动功能按TAM系统标准评价；优6指，良8指，可4指。结论：尺动脉腕背支为蒂升支与降支分别为营养血管的双叶游离皮瓣，是修复单指皮肤全脱套伤及相邻两指背或掌侧皮肤的一种良好方法。