两种不同胸腔引流管治疗脓胸的临床研究

目的在改良胸腔套管针引导下，胸腔内置入可冲洗引流管治疗脓胸，并与双腔球囊导尿管相对照，评价其疗效及安全性。方法46例脓胸患者随机分为两组。在引流管侧释放套管针引导下，A组：胸腔内置入双腔球囊导尿管治疗脓胸。B组：胸腔内置入可冲洗胸腔引流管治疗脓胸。结果3周后A组有效15人（65％），B组19人（83％），两组间疗效有统计学差异（P〈0．05）。A组：引流管堵塞5例，包裹性脓胸6例，B组分别1例和2例（P〈0．05）。结论应用引流管侧释放套管针，胸腔内置入可冲洗胸腔引流管治疗脓胸是一种更加安全、有效和同样简单的新方法。     

Role of ciprofloxacin in patients with cholestasis after endoscopic retrograde cholangiopancreatography

AIM To determine the role of ciprofloxacin in reducing cholangitis in cholestatic patients with adequate biliary drainage after endoscopic retrograde cholangiopancreatography (ERCP).METHODS A randomized, controlled trial was performed in 48 cholestatic patients at Rajavithi Hospital (Tertiary Referral Center for ERCP 600 cases per year). All the 48 patients received 200 mg ciprofloxacin intravenous injection for 30 min before starting any procedures, and then were randomly divided in two groups. Twenty-two patients in study group continually received ciprofloxacin until 48 h after ERCP. Causes of biliary obstruction, bacteriology of bile and blood (in cholangitis) and clinical cholangitis were recorded.RESULTS Forty-eight patients were enrolled and divided into continuous ciprofloxacin treatment group (n = 22) and discontinuous ciprofloxacin treatment group (n = 26). During ERCP, stones were found in 22 patients,malignant diseases in 24 patients and other pathologic lesions in 5 patients. One (4.5%) of the 22 patients who received ciprofloxacin and 2 (6.3%) of the 26 patients who discontinued ciprofloxacin after ERCP developed cholangitis (relative risk = 0.71; 95% CI = 0.14-3.65;P = 0.88). Bacterobilia was found in 27 (56.3%) out of 48 patients. E. coli and Streptococcus viridans were the most common organisms.CONCLUSION Continual use of ciprofloxacin in patients with cholestasis after adequate biliary drainage procedures plays no role in reducing cholangitis.     

负压封闭引流治疗糖尿病足疗效分析

【摘要】 目的 探讨负压封闭引流治疗糖尿病足的临床疗效。方法 选取2017年12月至 2019年12月郑州大学附属郑州中心医院收治的74例糖尿病足患者作为研究对象,按照随机数表法将其随机分为观察组(37例)和对照组(37例)?观察组患者局部创面采用负压封闭引流治疗,对照组患者局部创面采用多功能敷料治疗,对比两组患者临床疗效、换药次数以及创面愈合时间。结果 治疗4周后,观察组患者中治愈34例、好转3例,明显优于对照组患者的治愈 25 例、好转12例 (Z = -2.585,P =0.010)。观察组患者换药次数为 (8.16±1.61) 次,明显少于对照组患者的换药次数 (12.67±2.50) 次 (t = 9.226,P < 0.001); 创面愈合时间为(33.06±6.40) d,明显短于对照组患者的创面愈合时间 (47.58±6.72) d (t =9.517,P <0.001)。结论 采用负压封闭引流治疗糖尿病足,可有效减少换药次数,缩短创面愈合时间,疗效显著。     

液体伤口敷料脉冲式脓腔冲洗对化脓性皮脂腺囊肿切开引流的应用效果

 目的 探讨液体伤口敷料脉冲式脓腔冲洗对化脓性皮脂腺囊肿切开引流的应用效果。方法 选择我院江北院区2020-06至2021-12收治的化脓性皮脂腺囊肿行切开引流的患者128例,按照随机数表法分为观察组与对照组,各64例。对照组以常规方法进行冲洗换药,观察组实施普朗特脉冲式冲洗换药。比较两组临床指标[换药次数、换药时间、伤口愈合时间、分泌物消失时间、换药视觉模拟疼痛评分(VAS)]、创面评分(创面面积、创面深度、肉芽情况和渗出情况)、皮肤舒适性(压红、压痛、灼热感、潮湿感)。结果 两组创面面积、创面深度、肉芽情况、渗出情况评分干预前及干预10 d后比较,差异无统计学意义;两组上述指标评分干预3 d后及干预7 d后比较,观察组显著低于对照组,差异有统计学意义(P<0.05)。观察组换药次数、换药时间、伤口愈合时间、分泌物消失时间、换药VAS评分显著低于对照组,差异有统计学意义(P<0.05)。结论 液体伤口敷料脉冲式脓腔冲洗用于化脓性皮脂腺囊肿切开引流患者,可获得明显的感染防治效果,对提高皮肤舒适度及降低炎症水平,促进创面愈合有积极作用。     

Acute bone and joint infections in children: current concepts

Paediatric bone and joint infections can be associated with devastating consequences for the growing child. The diagnosis is challenging, requiring experienced clinical examination with adjunct diagnostic tests to aid the distinction between a multitude of differential diagnoses which includes transient synovitis, fracture, neoplasia, rheumatological conditions, blood disorders and infection. Emergent diagnosis is required to prevent consequences such as sepsis, chronic infection, angular deformity and disruption of longitudinal bone growth. The clinical presentation of bone and joint infections in children is varied and includes pain, erythema and swelling, fever, reduced range of movement and the inability to weight bear. Blood and tissue samples should be obtained, if possible, prior to commencing antimicrobial therapy in order to secure the best chance of identifying a causative organism and guide treatment. However, this should not delay treatment. Various imaging modalities can be helpful. Whilst there is some variation depending on the child's age, Staphylococcus aureus is the commonest causative organism in both septic arthritis and osteomyelitis. Septic arthritis and osteomyelitis in children should be treated jointly by paediatricians and orthopaedic surgeons, with input from the wider multi-disciplinary team. Trends towards reduced rates of surgical intervention and shorter antibiotic courses have been evident over recent decades. In this article we present a review of the continuously evolving concepts for the management of paediatric bone and joint infections.     

半潜式持续冲洗加低负压吸引技术治疗低位直肠癌吻合口瘘

目的评估半潜式持续冲洗加低负压吸引技术对直肠癌术后吻合口瘘的治疗价值。方法按照随机分组的方法将广东医学院第三附属医院茂名石化医院普外科2012年1月至2014年4月收治的直肠癌术后吻合口瘘患者60例分为观察组和对照组,各30例。观察组采用半潜式持续冲洗加低负压吸引装置;对照组行常规普通引流。结果观察组在瘘口愈合时间、换药次数、住院时间及住院总费用均优于对照组,差异有统计学意义(P0.05)。结论半潜式持续冲洗加低负压吸引法能有效地阻止肠内容物对吻合口的污染,是治疗吻合口瘘的有效方法之一。     

Lumbar spinal epidural arteriovenous fistula with perimedullary venous drainage after endoscopic lumbar surgery

Spinal epidural arteriovenous fistulas (AVFs) with perimedullary venous drainage are rare. This report describes a case of lumbar epidural AVF in a patient with a history of endoscopic lumbar discectomy at the same level 8 years prior to presenting with progressive myelopathy secondary to retrograde venous reflux into the perimedullary vein. A 69-year-old man presented with progressive lower extremity weakness and sensory disturbance and loss of sphincter control 8 years after endoscopic lumbar discectomy for a disc herniation at L4–5 level. Magnetic resonance imaging showed spinal cord edema and dilated intradural perimedullary vessels. Spinal angiography revealed an epidural AVF at the site of the previous endoscopic lumbar surgery with intradural perimedullary venous drainage. The fistula was successfully occluded via endovascular transarterial embolization, and the patient had stabilization of his neurological deficits. Lumbar spinal epidural AVFs, especially those associated with iatrogenic trauma, are rare. Endoscopic surgical procedure can occlude the epidural venous plexus and disturb venous drainage, thereby inducing local venous hypertension and leading to epidural AVF with perimedullary venous drainage. This type of pathology should be considered within the differential diagnosis of delayed neurological deterioration after spinal surgery.     

3种固定腹腔引流管方法在肝胆外科护理应用中的效果研究

目的探讨不同的腹腔引流管固定方法在肝胆外科患者护理中的应用效果。方法对250例留置腹腔引流管患者,分别采取3 M医用透气胶布蝶形交叉固定法(A组)、导管固定装置固定法(B组)、3 M弹力胶布高举平台固定法(C组)固定腹腔引流管,分别比较3种固定方法的脱管率、更换间隔时间、费用、皮肤过敏度。结果 A组与B组腹腔引流管脱管率明显多于C组,3组患者脱管率比较差异有显著性(P0.05);A组、B组皮肤过敏率多于C组,3组患者过敏度比较差异有显著性(P0.05);3组平均更换间隔时间中C组更换间隔时间要长于A组和B组(P0.05);3组患者满意度调查,C组的满意度明显高于另2组(P0.05)。结论采用3 M弹力胶布高举平台固定法优于3 M医用透气胶布蝶形交叉固定法及导管固定装置固定,值得临床上推广。     

改良型关节镜排水系统优势研究

目的评价改良的关节镜排水系统能否减轻护理人员的工作量及降低手术间的污染,并将其进行推广。方法对哈尔滨医科大学附属第二医院运动医学科2011年10月至2013年12月的500例关节镜手术进行临床观察研究,分为应用传统关节镜排水系统(A组)150例与应用改良的关节镜排水系统组(B组)350例关节镜手术,与传统关节镜排水系统相比,对其能否降低护理人员工作量及降低手术间的污染方面进行研究。结果在降低护理人员工作量方面,B组中手术护理人员倒液体工作量较A组降低了100%(P<0.05);在降低手术间污染方面,B组中手术间地面污染发生的概率为0.29%,A组为71.33%,差异显著(P<0.05)。结论关节镜手术时采用改良的关节镜排水系统能够明显减轻护理人员的工作量并降低手术间的污染。