新型胸骨环抱器结合钢丝固定胸骨的临床效果

目的探讨新型胸骨环抱器结合钢丝固定胸骨在成人心脏正中切口直视手术中的应用效果。 方法回顾性分析2016年1月至2017年12月期间在临沂市人民医院心脏血管外科接受手术治疗的328例心脏大血管疾病患者临床资料，按胸骨固定方法不同分为对照组159例和研究组169例。其中对照组采用传统的钢丝将锯开的胸骨左右两侧缝合，后收紧钢丝、合拢胸骨并拧紧钢丝，予以固定胸骨；研究组采用钢丝对合锯开胸骨的基础上放置新型环抱器固定胸骨。分析2组患者关胸时间(关胸开始到皮肤切口缝合结束的时间)、二次开胸止血(胸骨相关)率、术后24 h引流量、术后切口、胸骨感染或胸骨裂开率、术后胸痛不适发生率以及术后住院时间。患者出院后通过门诊、电话询问进行随访。数据比较采用t检验和χ²检验。 结果关胸术后，对照组1例患者因急性A型主动脉夹层术后急性肾功能衰竭死亡，其余所有患者均痊愈出院。研究组患者关胸时间(32.3±7.3) min，明显少于对照组(51.5±8.4) min，差异有统计学意义(t＝－22.113，P<0.05)。胸骨相关的二次开胸止血，研究组发生1例，而对照组发生6例，2组比较差异有统计学意义(χ²＝3.969，P＝0.046)。研究组术后24 h引流量(372.8±213.1) mL，少于对照组(538.9±202.6) mL，2组比较差异有统计学意义(t＝－7.224，P<0.05)。研究组术后未见切口和胸骨感染和(或)裂开，而对照组感染和(或)裂开共7例，其中胸骨裂开4例，早期予以新型环抱器重新固定胸骨，治愈出院；切口感染2例，予以换药后重新缝合切口后治愈；胸骨感染1例，予以胸骨清创加胸大肌肌瓣转移手术后康复出院，2组比较差异有统计学意义(χ²＝7.599，P<0.05)。研究组术后出现胸痛不适2例，而对照组7例，2组比较差异有统计学意义(χ²＝4.101，P＝0.043)。研究组患者术后住院时间(8.6±4.1) d，少于对照组(10.5±3.4) d，2组比较差异有统计学意义(t＝－4.467，P<0.05)。患者出院后随访(11.3±4.9)个月，所有患者均未见胸骨感染及裂开。 结论新型胸骨环抱器结合钢丝固定胸骨手术切口，与传统手术相比操作简单、固定牢固，在缩短关胸手术时间、减少术后切口并发症、缩短住院时间等方面优势明显，可以广泛使用于成人心脏外科正中手术切口。     

Effectiveness of Hand Hygiene Promotional Program based on the WHO Multimodal Hand Hygiene Improvement Strategy,in Terms of Compliance and Decontamination Efficacy in an Indian Tertiary Level Neonatal Surgical Intensive Care Unit

Background: The WHO Multimodal Hand Hygiene Improvement Strategy (MHHIS) has been proposed to improve the Hand Hygiene (HH) compliance of the WHO recommendations on HH.Therefore, the current study was planned in our neonatal unit with the objective of evaluating the effectiveness of a Hand Hygiene Promotional Program (HHPP) based on the WHO MHHIS, in terms of compliance and decontamination efficacy among the health-care workers (HCWs) in the unit. Objective: The objective of the study was to evaluate the effectiveness of the WHO MHHIS on HH compliance and decontamination efficacy. Methods: The HHPP was carried out in our neonatal surgical intensive care unit from July to August 2013. A pre-intervention phase consisted of assessment of ward infrastructure, HH knowledge and perception, determination of HH compliance and collection of hand rinse samples from the HCWs before and after handwashing. Intervention phase consisted of changing traditional to elbow-operated taps, display of posters and reminders, placement of soaps in water draining trays, autoclaved single-use paper towels for hand drying, availability of hand rubs and training sessions for health-care providers. In the post-intervention phase, all the assessments and observations of pre-intervention phase were repeated. Results: HHPP resulted in a significant increase in overall HH compliance from 26.6% (95% confidence interval [CI] 23.9–29.3) to 65.3% (95% CI 62.4–68.2) (P < 0.001) and reduction in load of microorganisms (P = 0.013). There was a significant improvement in HH knowledge (P < 0.001), and perception surveys revealed high appreciation of each strategy component by the participants. Conclusion: To the best of our knowledge, this is the first study about the effect of implementation of the WHO MHHIS from an Indian hospital. HHPP was found to be effective in terms of HH compliance and decontamination efficacy. Its implementation is highly recommended to promote HH in a developing country like India.     

经椎旁肌间隙入路与微创经皮入路手术治疗胸腰椎骨折的效果比较

目的比较胸腰椎骨折患者接受经椎旁肌间隙入路与微创经皮入路手术治疗的效果及关节功能。方法回顾性分析2014年4月-2015年10月在该院接受内固定手术治疗的胸腰椎骨折患者,根据手术入路不同分为椎旁入路组和经皮微创组,分别接受经椎旁肌间隙入路与微创经皮入路手术治疗。比较两组患者的手术情况、围手术期血清创伤分子含量以及远期功能恢复情况和矫正畸形效果。结果椎旁入路组的手术时间明显短于经皮微创组,差异有统计学意义(P0.05);术中出血量、术后引流量、术后卧床时间、住院总时间与经皮微创组比较,差异均无统计学意义(P0.05);两组患者术后当天的血清肌酸激酶(CK)、肌红蛋白(Myo)和乳酸脱氢酶(LDH)含量比较,差异均无统计学意义(P0.05),术后3、6和12个月时的伤椎前后缘高度比、Cobb角、视觉模拟评分(VAS)比较,差异均无统计学意义(P0.05)。结论椎旁肌间隙入路与微创经皮入路手术治疗胸腰椎骨折的效果和创伤程度相当,椎旁肌间隙入路的手术操作更为简单、手术时间更短。     

Gene-Loaded Nanoparticle-Coated Sutures Provide Effective Gene Delivery to Enhance Tendon Healing

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Short‐term results in infants with multiple left heart obstructive lesions

Objective: Deciding on a surgical pathway for neonates with ≥2 left heart obstructive lesions is complex. Predictors of the successful biventricular (2V) repair in these patients are poorly defined. The goal of our study was to identify patients who underwent the 2V repair and assess anatomic and echocardiographic predictors of success.
Design: Infants born between July 2015 and August 2017 with ≥2 left heart obstructive lesions with no prior interventions were identified (n = 19). Patients with aortic or mitral valve (MV) atresia and critical aortic stenosis were excluded. Initial echocardiograms were reviewed for aortic, MV, tricuspid valve annulus size, and left (LV) and right (RV) ventricle diastolic longitudinal dimensions. The valve morphology and presence of a ventricular septal defect (VSD) and coarctation were assessed. Clinical outcomes included successful 2V repair, complications, and repeat interventions or surgeries. Failed 2V repair was defined as a takedown to single ventricle (1V) physiology, cardiac transplantation, or death.
Results: For 2V repair, 14/19 patients were selected and for 1V, 5/19 patients were selected. Initial surgical procedures of the 2V group were simple coarctation repair (5), complex coarctation/arch reconstruction +/− septal defect closure (6), hybrid stage 1 (2), and none (1). Three of the 2V patients required reintervention in the first 90 days. The LV to RV diastolic longitudinal ratio >0.75 and mitral/tricuspid ratio of <0.8 were observed in 13/14 of the 2V patients. The LV:RV ratio and the aortic valve z score were significantly larger in the 2V group compared to the 1V group. All patients in the 1V group had a nonapex forming LV. There was no mortality with follow‐up to three years of age.
Conclusions: This study showed excellent short‐term and midterm surgical results in the 2V population. The LV:RV diastolic longitudinal ratio may be a useful tool in the risk stratification of a successful 2V repair even in cases with a small MV.