纤维支气管镜治疗胸外术后下呼吸道阻塞的效果观察

目的观察纤维支气管镜对胸外科术后下呼吸道阻塞的治疗效果。方法总结83例纤维支气管镜治疗胸外科术后下呼吸道阻塞的临床资料。结果应用纤维支气管镜治疗胸外术后下呼吸道阻塞后,症状改善,血压、脉搏恢复平稳,动脉血氧饱和度达90%以上。结论纤维支气管镜治疗胸外术后下呼吸道阻塞具有明显的效果,应尽早尽快地运用纤支镜对病情进行诊治。     

神经内科患者发生下呼吸道感染的危险因素分析

目的 了解医院神经内科患者下呼吸道感染发生率及引起下呼吸道感染的危险因素,为临床预防和控制医院感染提供参考.方法 对1348例神经内科住院患者临床资料进行逐份查阅,回顾性分析患者医院感染情况及引起感染的危险因素.结果 调查病历1348份,其中发生医院感染132例,医院感染率9.79％,感染部位分布:下呼吸道感染41例、上呼吸道感染35例、泌尿道25例、胃肠道14例、皮肤软组织6例、五官4例、其他7例,分别占26.52％、31.06％、18.94％、10.61％、4.55％、3.03％、5.30％；患者年龄、性别、患病季节、基础疾病、烟酒史、意识状态、住院时间、预防使用抗菌药物、气管切开、气管插管、机械通气及留置导尿均是导致神经内科发生下呼吸道感染的危险因素(P＜0.05)；主要病原菌依次为铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌、鲍氏不动杆菌、肠球菌属及凝固酶阴性葡萄球菌,分别占21.74％、19.57％、17.39％、13.04％、10.87％、8.70％.结论 针对引起的下呼吸道感染的危险因素进行预防与控制,对降低下呼吸道感染具有重要意义.     

New way to raise the V-Y advancement flap for reconstruction of the lower lip: Bipedicled orbicularis oris musculocutaneous flap technique

Abstract

We describe a new way to raise the V-Y advancement flap, which is useful for reconstruction of the lower lip. Various other methods have been reported in the past, but it has been necessary to choose the most suitable method for each particular case. A V-Y advancement flap from the submandibular region is one of the useful techniques to reconstruct the lower lip, and it is suitable for a wide horizontal defect. However, the conventional V-Y flap is insufficiently mobile and the reconstructed vermilion is thin because of the limitation of the pedicle. In such a case, the reconstructed lip may sag or cause an embarrassing defect. We developed a new way to raise the flap to obviate these problems. We use the V-Y advancement flap from the inferior margin of the defect in a conventional way after excision of the tumour, and use a mucosal flap to reconstruct the vermilion border. The skin side of the V-Y flap is undermined, and the orbicularis oris muscles are preserved on both sides as pedicles. The flap is then raised as a bipedicled musculocutaneous flap, which has adequate movement. After the flap has been sutured, the superior margin of the flap is de-epithelialised, and used to create the volume of the vermilion border. Functionally and cosmetically good results were achieved.     

The keystone flap and its simplified version for malignant skin tumor defects of the lower limbs: A review of 25 cases

BackgroundSkin tumors commonly occur on the legs and are treated in first line by surgery. Several techniques are available to repair lower limb defects: secondary-intention healing, partial closure, primary closure with or without an s-plasty, or a skin graft. The lack of tissue laxity of the surrounding skin does not allow several local flaps (advancement, rotation, or transposition). Closing large skin defects at this site may be challenging.Patients and methodsWe retrospectively reviewed a series of consecutive patients undergoing malignant tumor wide excision on lower limbs, with a keystone flap or its simplified technique (releasing incision) for closure of a skin defect.ResultsTwenty-five patients, 17 women and 8 men, ranging from 19 to 95 years old (mean age: 70 years) were included. Keystone flap reconstruction on the lower limbs was performed in 19 cases and the simplified technique in 6. The excised tumors were as follows: squamous cell carcinoma (n = 6), basal cell carcinoma (n = 9), melanoma (n = 9) and Bowen's disease (n = 1). Three local complications were observed. No cases of recurrence were observed.ConclusionKeystone flap is a reliable surgical method for reconstruction of lower limb skin defects. Aesthetic results are better than when a skin graft is used, complications are uncommon, and prolonged operative time is avoided.     

丙泊酚合用氯胺酮在小儿腹部以下手术麻醉中的疗效观察

目的探讨丙泊酚单独使用及与氯胺酮合用在小儿椎管内麻醉中的疗效。方法选取我科40名腹部以下手术的患儿,随机分为两组(Ⅰ组和Ⅱ组),分别以单独使用丙泊酚及联合氯胺酮给药的方式,记录术中生命体征及不良事件情况。术后记录恶心、呕吐等不适及疼痛评分。结果两组术中均无呼吸暂停等严重事件发生,手术开始及手术开始后各时段Ⅰ组的生命体征均有显著差异(P<0.05),Ⅱ组手术开始时的收缩压与手术前有显著差异(P<0.05)。两组术后恢复时间与不适发生无显著差异(P>0.05),Ⅱ组术后镇痛效果优于Ⅰ组(P<0.05)。结论丙泊酚合用氯胺酮能够提供更平稳的镇静效果,减轻不良反应的发生,同时不影响苏醒时间,术后不良反应及疼痛发生率较低,是一种理想的小儿椎管内麻醉方法。     

儿童下呼吸道感染细菌分布及耐药性分析

目地了解本院儿童下呼吸道感染病原茸的分布及耐药情况，以指导临床舍理选用抗生素。方法将住院患儿的痰液、咽拭子进行细菌培养并鉴定，对培养阳性者应用K—B法进行药敏试验。结果送检标本467份，共分离出病原菌247株，阳性率为52．9％，其中以G-菌为主占68．4％，G＋菌占23．9％，真菌占7．7％。感染前5位的病原菌分别是大肠埃希氏菌、肺炎克雷伯氏菌、铜绿假单胞菌、金黄色葡萄球菌、真菌。药敏结果显示，G-菌对氨苄西林耐药率最高，肺炎克雷伯氏菌和大肠埃希氏菌产超广谱B内酰胺酶（ESBk）的比例较高，分别为53．2％和46．1％。G＋菌对大多数抗菌素耐药，对大环内酯类耐药率最高，金黄色葡萄球菌耐甲氧西林的分离率为29．2％。结论儿科下呼吸道感染病原菌主要为G-菌，且呈多重耐药性，G＋菌对大多数抗菌素耐药，临床应根据药敏结果，合理选用抗生素。     

一种骨科患者下肢多功能防护架的研制及应用

目的：研究一种骨科患者下肢多功能防护架的研制及应用。方法：该下肢多功能防护架，包括布朗氏架，在布朗氏架上安装有烧伤架。本试验选取2013年1-10月本院住院的下肢骨折329例和膝关节术后强直患者66例，前者分为试验组169例和对照组160例，后者分为试验组34例和对照组32例。试验组采用新型下肢多功能防护架治疗，对照组则单纯采取常规治疗措施。比较各组的治疗效果。结果：下肢骨折试验组24 h内消肿止痛评分达I、II级130例（77%），对照组仅有39例（24%），试验组显著优于对照组（P〈0.05）；膝关节强直术后试验组达Ⅰ、Ⅱ级28例（82%），对照组仅有12例（37%），试验组显著优于对照组（P〈0.05）。结论：新型下肢多功能防护架的应用效果较好，值得在临床上推广和应用。