白内障手术感染性眼内炎相关因素分析

目的 研究与白内障术后感染性眼内炎的相关因素。方法 对我中心1992～2001年10年间白内障手术进行回顾性分析。结果 共计施行54822例(眼)白内障手术，其中感染性眼内炎25例(眼)，感染率为0．046％，24例标本送检，17例培养阳性，病菌检出率70．83％，革兰阳性球菌占82．35％，＞60岁患者占72％，8例术中晶状体后囊膜破裂，经治疗后92％的患者感染均得到控制且恢复部分视力。结论 我中心白内障手术感染性眼内炎发生率为0．046％，致病菌以革兰阳性球菌为主要菌属，条件致病菌是感染性眼内炎的主要菌群。早期发现及时处理是控制感染性眼内炎的最有效的方法。     

预防性应用抗生素对分流手术术后感染率影响的回顾性分析

目的分析预防性应用抗生素是否降低分流手术术后感染率,探讨影响分流手术术后感染率的危险因素。方法采用回顾性队列研究,分析天津市环湖医院神经外科2010年10月-2015年10月5年间分流手术病例,按照术前是否预防性应用抗生素分为预防性应用抗生素组(antibiotic prophylaxis,AP)和未预防性应用抗生素组(non-antibiotic prophylaxis,n-AP),观察两组病例术后感染率有无差别;应用Logistic回归分析分流术后感染率的影响因素。结果 101例分流手术病例纳入研究,AP组54例感染2例,n-AP组47例感染3例,两组间感染率差异无统计学意义(χ~2=0.383,P=0.576);术后感染率与既往颅内感染病史有关(OR=34.50,P=0.000),5例术后感染病例中脑脊液细菌培养阳性3例,其中2例为表皮葡萄球菌,1例为粪肠球菌。AP组与n-AP组平均住院天数差异无统计学意义,但感染组与非感染组住院天数差异有统计学意义。结论预防性应用抗生素并不能降低分流手术术后感染率;颅内感染史为分流术后感染的危险因素;表皮葡萄球菌为分流术后颅内感染常见致病菌,感染显著延长住院时间。     

The prevention of wound infection in patients undergoing colorectal surgery

Colorectal operations are, at best, clean-contaminated procedures, and at times there is gross contamination of both the peritoneal cavity and the surfaces of the surgical wound. In addition, the diseases of the large bowel that require surgery tend to afflict elderly patients. Collectively, the combination of an unclean environment, major surgery and debilitated patients creates a situation that is associated with a very high incidence of wound infection. This review documents the considerable support from clinical trials and meta-analyses that exists for the prophylactic use of a single dose of a suitable parenteral antimicrobial agent. In addition, although the evidence is less clear cut, it does not appear that the use of mechanical bowel preparations reduces the incidence of wound infections after colorectal surgery.     

球后麻醉致青光眼术中一过性视力丧失2例分析及文献回顾

目的探讨球后麻醉导致青光眼术中一过性视力丧失的临床特征及治疗。方法分析舟山市妇幼保健院2例青光眼患者手术前球后麻醉中出现一过性视力丧失的临床资料,回顾相关文献。结果球后麻醉并发一过性视力丧失较少见,与局麻药物对神经的视觉传导影响及循环障碍引起局部缺血等因素有关。经过处理患者已恢复术前视力。主要治疗措施是:术前含服硝苯地平、尼莫地平等血管扩张剂,选择麻醉方式及局麻药等可减少一过性视力丧失时的发生。结论球后麻醉导致青光眼术中一过性视力丧失应早期发现,积极吸氧扩血管等处理可及时恢复视力。     

不同时机应用抗生素对剖宫产患者术后感染的影响

目的：探讨不同时机应用抗生素对剖宫产患者术后感染的影响,为临床诊治提供参考。方法将600例接受剖宫产患者按照随机数字表法分为A、B、C组,每组各200人。 A组采用术前0．5h预防性使用抗生素头孢曲松钠,术后不使用任何抗生素;B组术前0．5h预防性使用抗生素头孢曲松钠,术后继续使用抗生素头孢曲松钠;C组只在术后使用抗生素头孢曲松钠。比较3组患者剖宫产手术一般情况及术后感染情况。结果各组产妇平均手术时间、手术出血量比较均无显著性差异（F值分别为0．913、0．495,均P＞0．05）。 A组和B组术后体温恢复正常时间、术后平均住院时间均显著低于C组（ t值分别为7．753、14．674、8．766、16．797,均P＜0．05）,A组和B组术后体温恢复正常时间、术后平均住院时间无显著性差异（t值分别为1．021、0．729,均P＞0．05）。 A组和B组术后体温连续2d≥38℃、腹部切口感染、产褥感染、泌尿系统感染发生率均显著低于C组（χ2值分别为18．581、22．826、14．414、4．737、24．738、25．201、18．587、8．591,均P＜0．05）,A组和B组术后体温连续2d≥38℃、腹部切口感染、产褥感染、泌尿系统感染发生率无统计学差异（χ2值分别为0．957、0．562、0．510、0．438,均P＞0．05）。结论剖宫产手术术前预防性使用抗生素可显著降低患者术后感染率。     

Changes in the appearance and treatment of deep sternal infections

The Department of Thoracic Surgery at the University Hospital, Link?ping, Sweden, has actively followed up infectious complications of cardiac surgery since 1989. The aim of this study was to investigate whether changes occurred during the 1990s in the appearance and the management of deep infections. This was done by studying patients undergoing surgical revision of infected wounds. We studied 42 patients during 1990-94 and 49 during 1997-98 (total number of operations in these periods, 3075 and 1646, respectively). Pre-operative and intra-operative variables were recorded for the two patient populations. The proportion of cardiac surgery procedures followed by a surgical revision for an infection in the sternal wound increased between the two periods (1.4% vs. 3.0%). Variables associated with the surgical procedures preceding the infection remained unchanged. In the later period, treatment was started earlier (64 vs. 24 days), and the length of antibiotic treatment was decreased (115 vs. 72 days). The incidence of osteomyelitis of the sternal bone was lower (61% vs. 27%). It appears that as the proportion of patients undergoing surgical revision increased, management of the infections became more effective, with aggressive surgical and antibiotic treatment policies and shorter treatment periods. This indicates that in order to evaluate the overall impact of measures designed to reduce infections after cardiac surgery, not only the incidence of infection needs to be followed up but other factors also need to be taken into account.     

Endotoxins isolated from the air of a Danish paper mill and the relation to change in lung function: an 11-year follow-up

BACKGROUND: A decline in lung function has been associated with farming, cotton spinning, and work in the animal feed industry. The aim of the study was to reveal if loss of lung function was associated to work at a paper mill. METHODS: Ninety-seven male paper workers (PW), and 55 control workers were examined. Hygiene samples included total dust, endotoxins, and microorganisms. Interview, pulmonary function testing, and skin prick test (SPT) were performed and yearly decline in lung function was calculated. RESULTS: The exposure for endotoxin (LPS) ranged from Median (Max-Min) 69 (370-6) EU/m3, in the wet-end of the paper machines to 6 (19-16) in the pulping area. The lung function decline among the controls was comparable to the decrements among the maintenance and repair workers at the paper factory, around 51-54 and 37-38 ml/year among smokers' and non-smokers, respectively. After adjustment for baseline FEV1, the variables associated to an increased loss of FEV1 were age smoking and cough. For FVC we found an inverse relation between exposure and yearly decline. CONCLUSION: No increase in loss of lung function is seen among workers exposed to up to 200 EU/m3 of LPS.     

A 12-year review of Staphylococcus aureus bloodstream infections in haemodialysis patients: more work to be done

Staphylococcus aureus bloodstream infections (BSI) are a significant cause of morbidity and mortality in haemodialysis patients. This study describes a 12-year retrospective review of S. aureus BSI in a large haemodialysis centre in a tertiary referral hospital. The overall rate of S. aureus BSI was 17.9 per 100 patient-years (range 9.7–36.8). The rate of meticillin-resistant S. aureus (MRSA) BSI was 5.6 per 100 patient-years (range 0.9–13.8). Infective complications occurred in 11% of episodes, the most common being infective endocarditis (7.6%). Ten percent of patients died within 30 days of S. aureus being isolated from blood. Most cases of S. aureus BSI (83%) were related to vascular catheters. The provision of lower-risk vascular access, such as arteriovenous fistulae, and reduced use of intravascular catheters should be priorities in all haemodialysis units. Where alternative vascular access cannot be established, interventions to reduce the risk of catheter-related infections should be implemented to reduce morbidity and mortality in this vulnerable patient group.     

Selective decontamination of the gastrointestinal tract as an infection control measure

An outbreak caused by a Klebsiella aerogenes resistant to ceftazidime, cefuroxime, cefotaxime, ampicillin and piperacillin and sensitive to aminoglycosides, imipenem and temocillin occurred in a teaching hospital's busy multi-disciplinary Intensive Care Unit over a 3-month period. Four patients had bacteraemia and a further four were colonized. Traditional infection control measures failed to eradicate the outbreak. The introduction of a selective gastrointestinal decontamination regimen consisting of tobramycin, amphotericin and colistin as a gel to the oropharynx, nose and rectum and a suspension via a nasogastric tube resulted in rapid disappearance of the outbreak strain with no new isolates being detected clinically or in surveillance specimens over an 8-week period.     

Hospital care at home: an evaluation of a scheme for orthopaedic patients

We report on an evaluation of the practicality and acceptability of the 'Going Home Service', an early discharge intensive patient support scheme for orthopaedic patients in their own homes. Patient outcomes were assessed in terms of health and functional status and the impact on patient's carers was assessed. Eight-seven patients who were successfully discharged from the service were compared with 17 patients readmitted to hospital prior to their discharge from the service, 44 patients suitable for the service who did not take it up and 15 patients discharged from hospital traditionally immediately prior to the service becoming operational. Data were collected via face to face semistructured interviews and note searching. Twenty-six of the patients' informal carers were also interviewed. The majority of patients in all four groups were elderly women, readmitted patients being significantly older than those successfully discharged. The readmitted patients were also more likely to have been admitted originally for traumatic surgery and less likely to have been independently mobile prior to the initial admission. Hospital length of stay was shorter amongst Going Home Service patients than those cared for traditionally, but the total episode of care was greater. Patients and carers were well satisfied with the service. Although there was no evidence that quality of life or functionality were affected by their early discharge, at three months post operation, there was some evidence that Going Home Service patients were experiencing less pain than those discharged traditionally. This early discharge service provided a good quality of health and social care for the majority of patients. However, it did not suit all patients and a minority were re-admitted. The findings reported here add to those obtained in other settings and highlight new aspects for consideration in the planning and delivery of high quality hospital at home schemes.     

应用ISO标准对口腔外科医院感染控制的研究

目的避免口腔外科医院感染的发生。方法采用国际ISO质量标准实施医院感染控制。结果通过规范口腔外科医院感染的质量控制和质量保证,使各项监控指标控制在医院感染法律、法规允许范围;至今未发生医院感染病例。结论实施ISO标准是口腔外科医院感染管理工作的切实保证和必然趋势。