普外手术中应用抗生素预防切口感染的临床分析

目的探讨普外科手术中使用抗生素预防切口感染的应用价值。方法对我院2011年8月—2013年8月间普外科手术中使用抗生素预防切口感染的200例患者进行研究,对其基本资料进行观察,对比不同方式、不同时间、不同抗生素对切口感染情况的影响。结果 200例普外科手术患者中出现切口感染10例,感染率为5%;患者在术前、术后使用抗素比在术中使用的抗生素感染率更高,而在以后的二、三联用药较之一联感染率更高。结论普外科手术在预防切口感染时要严格对抗生素的使用进行掌控,控制其使用时间和指征,从根本上做到合理用药。     

浅谈肝胆外科手术切口发生感染的原因及对感染的防治对策

目的：探讨肝胆外科手术切口发生感染的原因，及对其感染进行防治的方法。方法：对2009年～2011年期间在我院进行手术治疗的652例肝胆疾病患者的临床资料进行回顾性研究。这652例患者均在我院进行了肝胆外科手术治疗。对这652例患者，在手术前的一般身体状况进行评估和并对其进行血液生化检查。对其进行手术的时间、失血量、是否使用碘伏冲洗切口等情况进行对比。术后，对他们使用抗生素的情况进行调查。结果：经研究发现，在这652例患者中，发生术后院内感染的患者有85例。导致这些患者发生切口感染的原因主要有：①患者的手术时间较长，手术时间超过240分钟的患者感染率较高。②患者在术中失血量较大，失血量大于700毫升的患者感染率较高。③未使用碘伏冲洗切口的患者，其感染率明显高于使用碘伏冲洗切口的患者。结论：导致肝胆外科手术切口发生感染的原因主要包括患者的手术时间过长、手术中失血量过多、术后切口未使用碘伏冲洗、未预防性地使用抗生素等。针对这些原因，医护人员应在手术前调整患者的身体状态，在手术过程中尽量缩短施术的时间，减少患者的失血量，并使用碘伏代替生理盐水冲洗切口，在术后，应针对患者的致病菌和基础疾病进行综合分析，合理地预防性地使用抗生素。此防治方法值得在临床上推广使用。     

抗生素在普外科手术中预防切口感染的临床疗效分析

目的:探讨抗生素在普外科手术中预防切口感染的临床疗效。方法:对2001年1月-2015年1月15年来普外科收治的554例普外科手术患者的切口感染率进行统计,分析患者的抗生素使用种类、时间及剂量、切口的感染率及住院时间。结果:554例患者中有34例患者产生切口感染,感染率为6.1%。Ⅲ类切口的感染率最高,其次为Ⅱ切口;术后使用抗生素的患者感染率为6.6%,术前术后半量组使用抗生素的感染患者所占比例为5.6%,前者发生率高于后者,但无统计学差异(P0.05);使用青霉素类、头孢类和喹诺酮类抗生素患者的切口感染率分别为5.2%、7.2%、6.1%。Ⅲ型住院时间最长,其次为Ⅱ型,Ⅰ型切口患者住院时间最短,两两比较具有统计学差异(P0.05)。结论:围手术期合理的使用抗生素能够减少患者术后切口感染率,有利于提高患者的康复速度和缩短住院时间。     

肝硬化患者围手术期抗生素的使用和感染因素分析

目的研究分析肝硬化患者围手术期抗生素的使用和感染因素。方法选取我院收治的50例肝硬化患者为研究对象,两组患者均给予相应的手术治疗,实验组预防性使用抗生素,对照组患者仅在发生感染时给予抗生素。结果经过治疗后,实验组术后3例发生感染。对照组术后8例发生感染。可得,实验组术后感染率为12.0%显著低于对照组术后感染率为32.0%,具有统计学差异(P0.05)。实验组抗生素使用时间为(2.03±0.37)d,对照组抗生素使用时间为(5.55±0.48)d,具有统计学差异(P0.05)。术后,对照组4例患者死亡。实验组中,1例死亡。可得,实验组死亡率为4.0%显著低于对照组死亡率为16.0%,具有统计学差异(P0.05)。结论预防性使用抗生素在肝硬化患者围手术期中的应用临床疗效理想,可显著降低感染发生率。     

耳鼻喉术后感染因素的探讨

目的探讨耳鼻喉疾病患者术后感染的相关因素。方法选取2016年12月~2017年6月我院耳鼻喉科患者96例,治疗方案为手术治疗,统计分析患者术后感染情况,相关因素包括年龄、性别、感染部位、住院时间、手术持续时间、抗生素使用情况等。依据分析情况进行相应临床诊疗操作。结果选取的96例患者发生感染6例,感染率为6.25%。其中男女各3例,感染率为6.52%和6.00%。按年龄分组发现≥45岁和45岁两组均有3例,感染率为5.36%和7.50%。术后发生呼吸系统、消化系统、泌尿系统和其他疾病造成的感染率为6.67%、7.69%、4.76%和5.26%,组间比较差异均无统计学意义(P0.05);按手术时间、住院时间和术后抗生素使用情况对手术感染发生率进行因素间比较发现,三类因素组间差异均有统计学意义(P0.05)。结论分析耳鼻喉科手术患者术后感染因素,针对性进行相关操作,正确合理使用抗生素,可缩短住院时间,提高治疗效果,值得临床推广。     

普外手术应用抗生素预防切口感染的临床分析

目的:探讨普外科抗生素预防切口感染的临床应用方法。方法:选取2012年2月-2013年3月本院普外科收治的528例住院手术患者的临床资料进行回顾性分析,分析其病因、切口分类、使用抗生素种类和时间与感染率的关系。结果:胆囊切除术、阑尾切除术、肠道修补术的感染率较高,其中胆囊切除术、阑尾切除术感染率均高于总感染率,而乳房癌根治术和肝、脾切除术的感染率较低;同种类型切口使用同种抗生素,术后给予全量抗生素的感染率均明显高于术前术后各给予半量抗生素的感染率,比较差异有统计学意义(P0.05),对于使用同一种类型抗生素的切口,Ⅲ类切口的感染率均明显高于Ⅰ类和Ⅱ类切口的感染率,而Ⅱ类切口的感染率均高于Ⅰ类切口的感染率。结论:要预防普外科手术切口术后发生感染,要强调抗生素的种类选择、使用时间和手术切口分类,应在术前和术后分别给予抗生素,手术切口类型与术后手术切口的感染率密切相关,临床手术应根据手术切口类型选择抗生素。     

耳鼻喉外科术后感染影响因素与预防建议

目的:探索耳鼻喉外科手术后感染影响因素,以及研究临床预防措施,为临床实践提供参考.方法:以我院2016年1月至2017年1月间接治的80例耳鼻喉外科术后感染患者作为本文研究对象,对其临床资料进行统计学回顾性分析,探索患者术后感染相关影响因素,以此为基础研究科学的预防措施.结果:经回顾性统计分析发现, 80例耳鼻喉外科术后感染患者中共计25例患者为呼吸道感染,感染率为31.25%;22例患者为泌尿道感染,感染率为27.5%;17例患者为消化道感染,感染率为21.25%;其他感染患者共计16例,感染率共计20%.患者住院时间、抗生素临床使用情况、耳鼻喉外科手术持续时间以及术中消毒化解是耳鼻喉外科术后感染的主要影响因素.结论:耳鼻喉外科术后感染包括呼吸道、泌尿道、消化道以及其他感染.针对术后患者感染病发情况,严格控制手术时间,缩短患者住院时间,并针对不同感染采取科学防治措施,做好临床手术消毒卫生工作,将有助于降低耳鼻喉外科手术后感染,提高临床治疗效果.     

浅谈抗生素在预防普外科手术切口感染中的应用

目的：探讨抗生素在预防普外科手术感染中的应用效果。方法选取我院2012年2月—2013年12月间收治的普外科手术患者620例进行回顾性分析,观察不同的抗生素使用方式、不同时间等对切口感染。结果620例患者中发生感染的例数为15例,感染率为2.42%,术前术后使用抗生素较之术中使用抗生素的感染率更高,采用二三联用药较一联用药的感染率更高。结论采用抗生素预防普外科手术切口感染要选择好用药时机,同时还要针对不同抗生素使用情况做好用药指征控制,切实做到合理用药。     

妇产科术前预防性抗生素的效果观察分析

目的：探讨妇产科术前预防性应用抗生素的临床效果。方法：选择2014年8月至2016年8月期间本院妇产科收治的手术治疗患者220例作为受试者,随机分为对照组（70例）和观察组（150例）。观察组患者均术前预防性使用抗生素,对照组患者常规术后使用抗生素,观察两组患者术后感染情况、退热时间、抗生素总用量情况。结果：观察组术后感染率为4．00％（6／150）,对照组术后感染率为24．29％（17／70）,组间差异P＜0．05。观察组术后退热时间、抗生素、住院时间均显著短于对照组,组间差异P＜0．05。观察组患者的治疗费用明显比对照组少,组间数据存在统计学差异, P＜0．05。结论：术前预防性抗生素应用于妇产科手术中,可有效提高术后抗感染效果,改善患者预后,临床应用价值较高。     

普外科术前、术中、术后应用抗生素预防切口感染的分析

目的：分析普外科术前、术中、术后应用抗生素预防切口感染的临床效果。方法：选取该院普外科2014年6月至2016年4月收治的150例患者为研究对象,对其临床资料进行回顾性分析,统计不同时段内使用抗生素的切口感染率、不同抗生素使用方式的切口感染率与不同种类抗生素的切口感染率。结果：普外科术前、术中、术后使用抗生素的切口感染率分别为6.2％、2.2％、6.9％,其中,术中使用抗生素的切口感染率最低（P＜0.05）。同时,单用抗生素的切口感染率为2.9％,明显低于连用抗生素的切口感染率6.2％（P＜0.05）,但抗生素种类的切口感染率对比差异不显著（P＞0.05）。结论：普外科手术切口感染预防中,在麻醉诱导期用药,单一用药效果良好,不同的手术及手术切口类型下抗生素预防感染的效果存在较大的差异,应当依据实际情况选用适宜的抗生素。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.