Protective isolation precautions for the prevention of nosocomial colonisation and infection in burn patients: A systematic review and meta-analysis

ObjectivesTo assess the impact of protective isolation precautions on nosocomial colonisation and infection rates in burn patients.Research methodologyA systematic review and meta-analysis were performed of studies identified through Pubmed and Web of Science. Only articles in English were considered. The Downs and Black tool was used to evaluate their methodological quality. Random-effects meta-analysis obtained pooled risk ratios (RRs) and 95% confidence intervals (CIs) of nosocomial colonisation and infection rates.ResultsFive eligible before-after studies were identified, encompassing a total of 3033 patients (1192 in the experimental group; 1841 in the control group). Varying protective isolation precautions were investigated, resulting in high clinical heterogeneity. Quality assessment revealed overall poor methodological quality. Protective isolation significantly reduces combined colonisation and infection rates compared to baseline care (RR 0.52, 95% CI 0.40–0.69; P < 0.0001). Subgroup analyses indicated significant reductions in both nosocomial colonisation (RR 0.65, 95% CI 0.51–0.83; P = 0.02) and infection rates (RR 0.53, 95% CI 0.49–0.58; P < 0.0001).ConclusionsProtective isolation precautions appear to decrease the risk of colonization and infection in burn patients. Because of the absence of higher quality study designs, clinical heterogeneity and the small number of studies involved, these results must be interpreted cautiously.     

自制手防护具在婴幼儿手部术后早期的保护作用

目的探讨自制手防护具在婴幼儿手部术后早期的保护作用。方法选择2015年1月至2016年4月间在我院行手部手术的80名婴幼儿患者,分为实验组(n=40)和对照组(n=40)。对照组术后给予一般的健康教育和指导,实验组在此基础上应用自制手防护具进行辅助保护。比较患儿术后1周换药时及术后2周拆线时手术部位渗血情况、外敷料滑脱现象、克氏针移位及感染等情况。结果患儿手术部位渗血情况、外敷料滑脱现象、克氏针移位、感染等情况,各时间点观察组均明显优于对照组(P<0.05)。结论应用自制手防护具可对婴幼儿术后早期患肢进行有效保护,有利于术后的早期康复。     

全身麻醉术中肺保护性通气对肥胖患者肺顺应性及氧合指数的影响

目的 观察全身麻醉术中肺保护性通气（LPVS）对肥胖患者肺顺应性及氧合指数（OI）的影响。方法 选择2016年10月~2019年8月于我院择期行全身麻醉下腹腔镜手术的68例肥胖患者,随机分为对照组与观察组,各34例。对照组接受常规模式机械通气,观察组实施LPVS策略。比较气管插管后10 min（T1）、手术开始后60 min（T2）两组肺顺应性（CL）及氧合功能、血压（DBP、SBP）、心率（HR）及术前术后肺功能。结果 T1时两组CL、OI、PaO2比较,差异无统计学意义（P＞0.05）;T2时观察组CL、OI、PaO2分别为（288.49±30.18）ml/cmH2O、（40.53±8.14）、（422.19±57.40）mmHg,均高于对照组的（221.54±28.67）ml/cmH2O、（31.68±6.70）、（331.74±36.59）mmHg,差异有统计学意义（P＜0.05）;T2时两组DBP、SBP、HR比较,差异无统计学意义（P＞0.05）;手术后观察组FEV1、FVC、FEV1/FVC分别为（1.37±0.43）L、（1.68±0.63）L、（81.29±11.76）%,均高于对照组的（1.06±0.32）L、（1.39±0.47）L、（74.83±12.50）%,差异有统计学意义（P＜0.05）。结论 肥胖患者腹腔镜手术全身麻醉时进行肺保护性通气可降低患者肺泡塌陷,改善氧合功能,增加肺顺应性,有助于保护肺功能,且对循环系统影响较小。     

精神科保护性约束评估量表的编制及信效度检验

目的：编制精神科保护性约束评估量表,并评估其信度与效度,为精神科病房保护性约束的使用提供参考依据。方法：通过访谈法,结合文献资料建立保护性约束评估量表的基本框架及发展条目池;经专家咨询及预试验,形成量表。对234名精神疾病患者进行样本测试,评价量表的信度、效度。结果：最终形成了“攻击、自杀、自残、外走、跌倒、坠床”等9个评估指标和27个评估条目。量表总Cronbach’α系数为0.856,各维度的Cronbach’α系数为0.726～0.938;问卷各条目I-CVI的范围为0.80～1.00,S-CVI 为0.98;评定者间信度为0.987。结论：精神科保护性约束评估量表具有较好的信度与效度,作为精神科护士实施保护性约束的测评工具,具有重要的临床应用价值。     

曲美他嗪对糖尿病大鼠心肌损害的保护作用

目的探讨曲美他嗪对糖尿病大鼠心肌损害的保护作用。方法60只健康雄性SD大鼠随机分成对照组、糖尿病组、实验A组、实验B组、实验C组,每组各12只。对照组采用标准颗粒饲料喂养。糖尿病组和实验组采用高糖高脂饲料饲养,第6周一次性腹腔注射链脲佐菌素(FTZ 30mg/kg),注射后72 h,筛选血糖水平连续2次高于11.1mmol/L的大鼠,继续原饲料喂养6周,实验A组、B、C组分别腹腔注射10、30和90mg/kg/d曲美他嗪干预6周后,测定5组大鼠血清CK、LDH、TGF-β1、TNF-ɑ、心肌组织ATP、ADP、AMP、MDA、SOD。结果实验期间糖尿病组大鼠的体重增长显著低于对照组和各实验组（P<0.05）,各实验组和对照组比较差异无统计学意义（P>0.05）;糖尿病血清CK、LDH、TGF-β1、TNF-ɑ、心肌组织MDA、ADP含量均显著高于对照组（P<0.05）,心肌SOD活性、ATP、AMP含量显著低于对照组（P<0.05）;实验A、B、C组血清CK、LDH、心肌ADP含量、实验B、C组血清TGF-β1、TNF-ɑ、心肌MDA含量显著低于糖尿病组（P<0.05）,实验A、B、C组的AMP含量、实验B、C组的SOD活性、ATP含量显著高于糖尿病组（P<0.05）。结论曲美他嗪对糖尿病大鼠心肌损害具有明显的保护作用。     

Role of protective stoma in low anterior resection for rectal cancer: A meta-analysis

AIM: To provide a comprehensive evaluation of the role of a protective stoma in low anterior resection (LAR) for rectal cancer.METHODS: The PubMed, EMBASE, and MEDLINE databases were searched for studies and relevant literature published between 2007 and 2014 regarding the construction of a protective stoma during LAR. A pooled risk ratio (RR) with 95% confidence intervals (CIs) was used to assess the outcomes of the studies, including the rate of postoperative anastomotic leakage and reoperations related to leakage. Funnel plots and Egger’s tests were used to evaluate the publication biases of the studies. P values < 0.05 were considered statistically significant.RESULTS: A total of 11 studies were included in the meta-analysis. In total, 5612 patients were examined, 2868 of whom had a protective stoma and 2744 of whom did not. The sample size of the studies varied from 34 to 1912 patients. All studies reported the number of patients who developed an anastomotic leakage and required a reoperation related to leakage. A random effects model was used to calculate the pooled RR with the corresponding 95%CI because obvious heterogeneity was observed among the 11 studies (I² = 77%). The results indicated that the creation of a protective stoma during LAR significantly reduces the rate of anastomotic leakage and the number of reoperations related to leakage, with pooled RRs of 0.38 (95%CI: 0.30-0.48, P < 0.00001) and 0.37 (95%CI: 0.29-0.48, P < 0.00001), respectively. The shape of the funnel plot did not reveal any evidence of obvious asymmetry.CONCLUSION: The presence of a protective stoma effectively decreased the incidences of anastomotic leakage and reoperation and is recommended in patients undergoing low rectal anterior resections for rectal cancer.     

口腔科门诊医用手套破损情况的对照研究

 目的 研究口腔门诊各专业组间左、右侧手套破损率,为采取更具针对性防护措施、设计专用型防护手套提供依据.方法 将我院口腔科门诊内科、修复、正畸3个专业组使用的各3 000双一次性橡胶医用手套使用后出现破损情况进行对照研究,比较左、右侧手套在各组间破损率的差异.结果 左侧手套破损率在内科组为2.70%,修复组为6.00%,正畸组为4.56%,左侧手套破损率修复组高于正畸组,最低为内科组;右侧手套破损率在内科组为1.33%,修复组为5.33%,正畸组为9.50%,右侧手套破损率正畸组高于修复组,最低为内科组.结论 通用型一次性橡胶医用手套,在预防口腔科门诊医患交叉感染中有安全隐患,有必要设计更为安全、合理的口腔科各专业组专用防护手套.