眶隔脂肪异位游离移植矫正眶鼻沟凹陷的睑袋美容手术

目的 探讨一种用切除的眶隔脂肪异位游离移植以矫正眶鼻沟凹陷的睑袋美容方法 .方法 在眼轮匝肌与眶隔间分离,于眶下缘打开眶隔,去除多余的眶隔脂肪,折叠加强眶隔后,将去除的眶隔内脂肪重新回填于眶隔外,用于修复眶鼻沟的凹陷畸形.自2007年3月至2009年2月,用此术式共诊治睑袋患者135例.结果 本组患者共135例,获随访1～12个月,术后异位游离移植的脂肪存活率高,下睑外形饱满,眶鼻沟存在的凹陷有明显改善.结论 本方法 是一种矫治睑袋的有效方法 ,适用范围较广,尤其适用于伴有下眶缘眶鼻沟凹陷的睑袋患者.     

自制简易盐袋、冰块固定装置在膝关节置换术后应用简

人工全膝关节置换术的应用极大改善了患者生活质量,对于骨性关节炎、类风湿性关节炎等患者现已成为一种重要的治疗手段;但术后大量渗血,增加了围手术期风险,影响其预后。国内学者应用石膏托固定、冰敷、弹力绷带等综合措施,在减少术后出血方面取得了一定疗效。在临床使用冰敷过程中由于多种原因致冰块移位,达不到有效的冰敷止血。为此,我科自制简易盐袋、冰块固定装置在全膝关节置换术后应用起到良好效果。     

改良早期更换气囊漏气的气管切开套管对患者的影响

目的:研究采用改良方法早期更换气囊漏气的气管切开套管对患者的影响。方法:随机将72例早期气囊漏气的气管切开患者分为常规换管组(A组)和改良早期换管组(B组),B组采用无气囊气管导管作为支架在发现气管切开套管漏气时即予更换,观察一次性换管成功率、换管时间、漏气期间与换管后3d内平均每天发生气促次数、发现气囊漏气时及发现漏气后5d取痰行细菌培养并行床边胸部X线拍片以了解肺部感染情况、漏气期间及换管后均抽取动脉血气分析、气囊漏后的机械通气时间及发现气囊漏气后ICU停留时间等指标。结果:改良早期更换组一次性换管成功率高于常规组(P<0.05),换管时间亦短于常规组、换管期间SpO2下降发生率低于常规组、局部出血少于常规组(均P<0.05)。换管后肺部细菌感染发生率、漏气后机械通气时间与ICU停留时间,B组均明显少于A组(均P<0.05)。结论:采用无气囊气管导管为支架更换早期气囊漏气的气管切开套管安全、可靠、有效,有利于改善氧合,可减少人机对抗,可更有效地控制肺部感染、缩短机械通气时间及ICU停留时间,值得临床推广。     

瘢痕子宫妊娠不同引产方法的结局分析

目的 探讨瘢痕子宫妊娠安全有效的引产方法.方法 回顾性分析75例瘢痕子宫妊娠引产患者的临床资料,采用药物（n=22）、乳酸依沙丫啶羊膜腔注射（n=30）、水囊（n=23）引产,观察三组的宫缩发动时间、排胎时间、引产成功率、阴道出血量、胎盘胎膜残留率、引产并发症及用药不良反应.结果 三组引产方法的引产成功率、阴道出血量、子宫破裂差异无统计学意义（P＞0.05）;乳酸依沙丫啶羊膜腔注射组宫缩发动时间、胎盘胎膜残留率、宫颈会阴裂伤与药物组、水囊组相比,差异有统计学意义（P＜0.05）;水囊组排胎时间与药物组、乳酸依沙丫啶羊膜腔注射组相比,差异有统计学意义（P＜0.05）;药物组不良反应与乳酸依沙丫啶羊膜腔注射组、水囊组差异有统计学意义（P＜0.05）.结论 瘢痕子宫妊娠采用以上引产方法均可行.     

可吸收隔囊预防硬膜外粘连的初期疗效观察

目的：探讨可吸收隔囊预防全椎板减压术后硬膜外粘连的初期疗效。方法：选用11只新西兰纯种考力代羊,根据椎板切除术后硬膜外局部处理方法不同分为可吸收隔囊组（隔囊组）、聚己内酯／聚乳酸膜组（隔膜组）、对照组（局部仅应用生理盐水）。将11只羊进行编号,选取腰椎第1、3、5节为实验椎体。术后12周将羊处死,对各椎板缺损区进行MR扫描,计算瘢痕面积,并肉眼及放大镜观察瘢痕量及其与硬膜囊粘连情况。结果：隔囊组硬膜外瘢痕组织较疏松,瘢痕范围较小且量少,瘢痕与硬膜囊易于分离。隔膜组的硬膜外瘢痕组织多为疏松状,但瘢痕量较多,且范围较大,瘢痕与硬膜囊可行钝性分离。对照组的硬膜外瘢痕较致密,瘢痕范围较广泛,瘢痕量最多,瘢痕组织与硬膜囊粘连明显,分离困难,部分出现硬膜撕裂。结论：可吸收隔囊依赖其三维立体的空间效应及其内容物玻璃酸钠可以有效地预防硬膜外瘢痕的形成。     

Vinyl bag cover method to avoid droplet-containing aerosol escape from endoscopic forceps channel caps during COVID-19 pandemic (with Video 1 and Video 2)

Endoscopists are at high risk of allowing transmission of coronavirus disease 2019 (COVID-19) during gastrointestinal endoscopy (GIE) procedures under pandemic conditions. The main avenues of droplet-containing aerosol generated during GIE are the mouth, anus, and endoscopic forceps channel. Although the usefulness of personal protective equipment for preventing COVID-19 dissemination has been well reported, measures to address infected aerosol escaping during endoscopic forceps use have been neglected. Pathogen-contaminated aerosol from the endoscopic forceps channel, leading into the gastrointestinal lumen, has been confirmed and is a highly problematic source of infection. We developed a technique that entails covering the forceps entry/exit hole with a vinyl bag, thereby preventing contamination of the endoscopy room by the infected aerosol that escapes from this hole. The technique can be used in daily clinical endoscopic practice. Furthermore, this shielding technique is useful for all patients who undergo GIE, regardless of the purpose of the procedure such as for making a diagnosis, administering therapy, or in an urgent situation. In this letter, we introduce our novel, easily performed, inexpensive method of infection prevention by disallowing infected aerosol to escape from a COVID-19-infected patient into the air during a procedure that requires the use of endoscopic forceps.     

直立式聚丙烯输液袋壁厚度对输液性能影响的数值研究

目的研究直立式聚丙烯输液袋（简称直立式输液袋）壁厚度对袋体输液性能的影响,寻求输液袋各参数随壁厚度改变的变化规律。方法针对标示容量为100、250、500mL3种直立式输液袋,分别设置4种不同壁厚度（n2、n3、0．4、0．5mm）,采用有限元方法模拟排液过程．研究直立式输液袋应力分布、实际加药空间及排空率等参数的变化规律。结果在标示容量一定的条件下．100mL的直立式输液袋应力随壁厚度变化不显著;250mL直立式输液袋随壁厚度的增加应力逐渐减小．最大应力降幅为65％：500mL直立式输液袋壁厚度为0-2～0．3mm时,应力变化不明显,而壁厚度由0．3mm到0．5mm,最大应力下降28％。3种直立式输液袋的实际加药空间、排空率和袋壁接触面积均随壁厚度的上升而降低,100mL直立式输液袋为27％、11％和67％,250mL直立式输液袋为54％、11％和38％,500mL直立式输液袋为49％、11％和43％。结论综合考虑应力分布、实际加药空间、排空率和袋壁接触面积等参数的变化规律,直立式输液袋壁厚度不宜过大。在所考虑的壁厚度参数中．最佳壁厚度为0．2mm,但最终的壁厚度确定还需要综合考虑直立式输液袋的透气、透湿性和抗穿刺能力等因素。     

手助腹腔镜改良网袋肾捆绑术结合独一味治疗肾破裂

目的：探讨手助腹腔镜下改良网袋肾捆绑术结合独一味胶囊内服在肾破裂保肾手术中的应用价值。方法：将50例肾破裂患者分为3组,A组采取非手术治疗结合独一味内服;B组采用手助腹腔镜下改良丝线网袋肾捆绑术治疗结合独一味内服;C组采用单纯手助腹腔镜下改良丝线网袋肾捆绑术治疗。结果：A组有11例非手术治疗成功,成功率39.3%,延期肾切除率40%,近、远期并发症46.4%,远期肾功能损害14.3%;B组11例手术成功,成功率91.7%;C组手术均成功。B组在术后症状减轻时间、术后血尿消失时间、腰部引流量等方面明显优于A、C两组。结论：手助腹腔镜下改良网袋肾捆绑术结合独一味胶囊内服治疗肾破裂,不失为一种较好的保肾方法。     

Foley尿管水囊联合缩宫素用于足月妊娠促宫颈成熟的有效性、安全性和对产程的影响#br#

Objective?To explore the application effectiveness and safety of Foley catheter water bag combined with oxytocin in promoting cervical ripening and its influences on stages of labor in full-term pregnancy. Methods?A total of 102 full-term pregnant women with induced labor indications in Obstetrics Department of our hospital were enrolled between June 2017 and January 2021. According to different treatment methods by their willingness, they were divided into control group (51 cases, oxytocin) and combination group (51 cases, Foley balloon combined with oxytocin). Before induced labor and after intervention, cervical ripening effects in both groups were observed. The effect of cervical ripening before labor induction and after intervention in the two groups was observed, and the labor process and maternal and infant outcomes were compared between the two groups. Results?After intervention, Bishop scores were significantly higher than those before induced labor in both groups, which were significantly higher in combination group than control group (P<0.05). The first stage of labor and total stage of labor in combination group were significantly shorter than those in control group (P<0.05). The successful rate of labor induction and vaginal delivery in the combined group were higher than those in the control group, and the rates of postpartum hemorrhage and soft birth canal tearing were lower than those in the control group (P<0.05). The neonatal Apgar score in combination group was higher than that in control group (P<0.05). Conclusion?Foley catheter water bag combined with oxytocin can effectively and safely promote cervical ripening and shorten stages of labor in full-term pregnant women.     

自制可调式冰袋对髋膝关节置换术后患者疼痛及引流量的影响

目的探究髋膝关节置换术后患者应用自制可调式冰袋对其疼痛及引流量的影响。方法选取海安市中医院2018年4月至2020年4月收治的髋膝关节置换术患者126例为研究对象,按随机数字表法分为对照组和观察组各63例。对照组采用常规冰袋冰敷,观察组采用自制可调式冰袋冰敷。对比两组患者手术后关节引流量、肿胀度及疼痛情况。结果观察组患者干预1 d、2 d、3 d后,关节引流量均少于对照组,关节肿胀度和疼痛程度均轻于对照组,差异有统计学意义（均P＜0.05）。结论自制可调式冰袋应用于髋膝关节置换术后患者可有效减少其关节引流量,减轻其关节肿胀及疼痛程度,值得临床推广。