腹部刀刺伤单纯腹壁清创术的临床应用

目的　探讨单纯腹壁清创术在腹部刀刺伤患者中的应用 ,以提高腹部刀刺伤的治疗水平。方法　我科收治腹部刀刺伤患者中 1 6例进行单纯腹壁清创术 ,对病例选择及其注意事项进行了分析总结。结果　 1 6例患者治疗成功 1 4例 (87.50 % ) ,2例 (1 2 .50 % )中转手术。结论　对于腹部刀刺伤的患者 ,选择适合的病人进行腹壁伤口的单纯清创缝合 ,术后严密观察是可行的。     

心脏创伤35例报告

本文报告心脏创伤３５例。年龄最小７岁，最大６８岁，其中包括心脏刺伤患者１０例，心肌挫伤患者２５例，死亡５例。作者强调快速确定诊断，紧急剖胸心包切开减压和心脏修补止血是心脏刺伤救治成功的关键。同时，对心肌挫伤的临床表现、早期诊断和及时处理等问题进行了讨论。     

Abdominal Stab Wounds in Children: an 18-Year Experience

Objective: Evaluation of the diagnosis, management, and the role of selective treatment in children with abdominal stab wounds. Patients and Methods: 59 children (56 male and three female) were included in the study. The patients' median age was 11.8 years (range, 5–14 years). Time between injury and admission was about 3 h. Laparotomy was performed in 44 patients (74%). Solid organ injury was detected in 32 of these patients (73%) and could not be observed in twelve (27%). 15 patients (26%) were treated conservatively, and only one (6.6%) underwent laparotomy during the follow-up. The stomach was the most frequently injured organ (ten patients), followed by the intestines (nine patients). Types of surgical treatment were as follows: primary suture in 28 patients, resection-anastomosis in three, and osteotomy in two. Results: Some prognostic factors such as presence of abdominal organ evisceration and pneumoperitoneum were not significantly correlated with intraabdominal organ injury, whereas some other risk factors such as acute abdomen on admission (p < 0.002) or abdominal clinical and hemodynamic findings (p < 0.001) showed significant correlation with intraabdominal organ injury. The relative risk (odds ratio) of developing an intraabdominal organ injury was > 2 for patients with signs of an acute abdomen on admission. Postoperative complications were observed in five patients with organ injuries. None of our patients died. Conclusions: Conservative treatment can be safely performed in most children with abdominal stab injuries. Signs of major internal hemorrhage or generalized peritonitis are an absolute indication for emergency operation for abdominal stab wounds. Peritoneal penetrations, free air on the abdominal X-ray, and omental or intestinal evisceration are poor indicators of significant organ injuries, and patients presenting these signs shold be closely followed up for developing acute abdominal symptoms. Received: November 2, 2001; revision accepted: February 15, 2002     

Vaccination rates and adherence in premature infants before and after pneumococcal conjugate vaccine schedule change for term infants – A claims database analysis in Germany

BackgroundIn 2015, the German Standing Committee on Vaccination (STIKO) changed the pneumococcal conjugate vaccination (PCV) schedule for mature infants from a 3+1 scheme (2, 3, 4, and 11–14 months of age) to a 2+1 scheme (2, 4, and 11–14 months of age). For premature infants, the 3+1 scheme remained. The aim of this study was to assess vaccination rates, completeness, and timeliness for PCV in premature infants before and after the modified recommendation.MethodsA retrospective claims data analysis using the “Institut für angewandte Gesundheitsforschung Berlin” Research Database was conducted. Premature infants born in 2013 and 2016 with an individual follow-up of 24 months were included. Hexavalent combination (HEXA) vaccination with a consistent 3+1 recommendation for mature and premature infants was analyzed as reference vaccination.ResultsAfter 24 months, the PCV rate for at least one dose remained stable in premature newborns of 2016 compared to 2013, while the HEXA vaccination rate increased slightly. However, a significant decrease of a completed PCV schedule (4 doses) in premature infants was noted, whereas the completeness of HEXA vaccination did not change. The timeliness of PCV in premature newborns increased for the first and the booster PCV, while the timeliness of HEXA immunization did not change from 2013 to 2016.ConclusionAlthough STIKO still recommends a 3+1 PCV schedule for premature infants in Germany, premature infants were vaccinated according to the changed recommendations for mature born infants. A substantial share of premature infants remained unvaccinated, and their vaccinations were often delayed.     

Review article: Emergency department assessment and management of stab wounds to the neck

A stab wound to neck is an infrequent but highly important presentation to the ED in Australasia. Injuries to the two large neurovascular bundles that are vital to life might occur with associated injuries to midline aerodigestive structures. A literature review was undertaken to discuss the assessment and management of this injury in the emergency medicine setting.     

Is computed tomography tractography reliable in patients with anterior abdominal stab wounds?

Introduction

The current literature and guidelines recommend that determination of peritoneal violation is done first in cases of anterior abdominal stab wounds. The primary endpoint of this study was to determine the reliability of computed tomographic (CT) tractography to assess peritoneal violation in anterior abdominal stab wounds. The secondary endpoint is to compare local wound exploration between conventional CT and CT tractography in the evaluation of peritoneal violation.

PENETRATING TRAUMA IN AUCKLAND: 12 YEARS ON

Background : The current spectrum of penetrating trauma presenting to Auckland Hospital is described and whether this differs from the situation in 1983 is determined. Methods : Prospectively collected trauma registry data were used to describe the characteristics of penetrating trauma cases presenting to Auckland Hospital during the 1995 calendar year. Using data collected from a previous study in 1983, comparisons were made of the incidence, severity, and outcome of penetrating trauma cases between these two cohorts. Results : In 1995, 96 patients, representing 7.3% of total trauma admissions, presented to Auckland Hospital following penetrating trauma. Of these, 32 patients were admitted by the trauma team via the resuscitation room, 13 were admitted to the intensive care unit (ICU) and four died. The median age of these patients was 30 years and median Injury Severity Score, 4. In comparison with the 1983 patients there was no demonstrable change in the numbers of patients or their length of stay. Although injury severity was similar in the 1995 cohort, fewer patients were admitted to the ICU. Mortality of the ‘trauma team’ group was 4/32 in 1995 compared with 7/33 in 1983. Conclusions : Despite public concerns, the frequency of penetrating trauma cases presenting to Auckland Hospital was similar in 1995 and 1983. There is a non-significant decrease in length of stay and mortality in the 1995 cohort.     

黎凯教授浅刺法辨证治疗急性期面瘫经验

从浅刺法及其辨证论治(风寒型、风热型、气虚型、阴虚阳亢型等)对治疗急性期面瘫作了观察,认为初起多为外邪入侵,病位较浅,可用浅刺法。     

临床护理人员针刺伤及相关因素调查分析

目的了解临床护理人员发生针刺伤的状况,分析发生针刺伤的相关因素,并探讨预防对策。方法对某综合性医院全体临床护理人员323位进行问卷调查,了解其针刺伤的发生状况及相关因素,并对调查结果进行分析。结果本次接受调查的323名护理人员在12个月内被针刺伤率为41.80%。针刺时正进行的操作主要是配药、拔针、处理废弃物等;9:00～11:00为针刺伤发生的高发时段;多数护士发生针刺伤时无干扰因素;针刺伤发生与护士视力、工作环境光线的关联不显著;操作中采取防护针刺伤措施的护士的比例为10.07%;刺伤后向护士长报告的仅有16.32%。结论护士发生针刺伤率较高。应提高护理人员重视程度,并减轻临床护士的工作量,督导护士执行操作规程和职业暴露防护措施,以减少针刺伤的发生。     

护理工作中针刺伤的防护

近年来,针刺伤已经成为护理人员面临的主要职业危害之一。它不仅会造成多种血源性疾病的传播,还给护士的心理带来很大的影响,因此针刺伤的防护已经引起了广泛关注。本文综述了护士发生针刺伤的原因以及防护措施,以期对护理人员针刺伤的防护起到一定的指导作用。