自动加温多功能手术清创车的研制

目的：研制一种冲洗液可自动加温、避免伤员清创时长时间受低温刺激以及防止患者在术中或术后发生低体温的一种多功能手术清创车.方法：储液桶底部设置加热板,根据需要对液体加温.水槽中间安装过滤网,可将污水和污物分离,避免因冲洗时污水的飞溅而污染手术环境.在储液桶内安装潜水泵,潜水泵管道并联连接于冲洗液管上,管道上均设置有对应的电磁阀连接脚踏控制开关,通过脚踏选择冲洗液的种类.结果：冲洗液可加温;能自主选择冲洗液;冲洗压力可控制;方便操作者独立完成清创手术.结论：自动加温多功能手术清创车实现了自动化和人性化,具有实用性和便捷性,适用于各级医疗机构,尤其适用于严重创伤需要大量冲洗伤口的患者.     

鼻窦口大小与鼻腔冲洗疗效临床研究

目的 探讨鼻腔冲洗需要多大窦口才能保证冲洗液进入窦腔从而达到鼻腔冲洗治疗的可靠疗效。方法50例鼻病患者术前及FESS手术治疗后分别给予鼻腔冲洗液（5ml美兰＋200m1生理盐水）,通过鼻内镜观察冲洗液进入鼻窦的情况以及测量各鼻窦口的大小。结果t检验结果表明窦腔内有美兰着色的鼻窦口大于无着色的窦口,两者之间差异有统计学意义;多因素回归分析表明,当鼻安口大小为4．05mm时,进行鼻腔冲洗时冲洗液进入窦腔的可能性为95％。结论未经手术处理的鼻寓在鼻腔冲洗时,美兰不易进入窦腔,不能达到冲洗冶疗效果;最小窦口大小为4．05mm时才能保证冲洗液进入窦腔并达到冲洗疗效。     

加味五昧消毒饮冲洗液鼻腔冲洗对鼻窦炎术后的疗效观察

目的观察加味五味消毒饮冲洗液鼻腔冲洗对慢性鼻窦炎鼻内镜手术（FESS）术后的临床疗效及黏膜修复的影响。方法对60例Ⅱ型慢性鼻窦炎患者,在鼻内镜手术后,治疗组用自拟加味五味消毒饮冲洗液冲洗术腔,对照组以常规的西药冲洗液冲洗术腔,随访6个月,比较两组的疗效。结果治疗组的治愈率、总有效率分别与对照组比较,差异均有统计学意义（P〈0．05）。且治疗组鼻腔修复时间明显短于对照组,提前结束治疗病例数有明显差异（P〈0．05）。结论中药配方加味五味消毒饮冲洗液鼻腔冲洗液,进行鼻腔冲洗能缩短鼻黏膜修复时间,提高临床疗效。     

术中结肠冲洗器的应用分析

我院自 1997年 1月至 2 0 0 0年 3月对 2 4例急症结肠手术病人行术中结肠冲洗。同时 ,一期进行肠修补 /肠切除吻合术。观察冲洗前后结肠三项指标变化 ,并与同期 18例行常规术前肠道准备的结肠手术病人进行对比观察 ,现将情况分析如下。1　材料与方法1·1　结构与使用方法　冲洗器由插头、进液管、吊瓶、出液管、污桶、负压源六部分组成。使用时将插头插入肛门 ,进液管经插头的侧孔插入直肠 ,在术者的引导下进液管插到回盲部。进液管的体外端接通大吊瓶 ,吊瓶以依次灌入冲洗液 (肥皂水 /生理盐水 /消毒液 )。冲洗液经进液管注入结肠 ,待结肠…     

3种结膜囊冲洗液效果比较

目的通过3种结膜囊冲洗液冲洗结膜囊的效果比较,探索一种安全、高效的结膜囊冲洗液。方法选择行内眼手术患者的201只眼,随机分为3组,分别用3种不同的结膜囊冲洗液冲洗结膜囊,A组为生理盐水组;B组为庆大霉素稀释液组;C组为聚维酮碘稀释液组,冲洗前、后分别采集结膜囊标本进行细菌学检查。结果 3组冲洗液冲洗结膜囊前后的细菌培养阳性率分别为A组35.9%、14.1%;B组30.9%、8.8%;C组36.4%、0;3组冲洗液均有显著效果,C组优于其他两组。结论 0.025%聚维酮碘稀释液是一种理想的结膜囊冲洗液,值得临床推广应用。     

腔镜乳腺癌腋窝淋巴结清扫手术脱落细胞检查的初步研究

目的分析腔镜乳腺癌淋巴结清扫手术腋窝冲洗液细胞学检查结果,并为其安全性提供可靠的依据。方法对66例淋巴结阳性的乳腺癌手术患者腋窝冲洗液进行细胞学检查,其中腔镜组32例、常规组34例,并将其结果与临床参数进行对比分析。结果脱落癌细胞阳性率,腔镜组与常规组分别为37.5%、29.6%(P>0.05);经过局部热低渗化疗后,其阳性率下降为6.25%(腔镜组)、2.94%(常规组)(P>0.05);在淋巴结转移>3枚患者中,腔镜组脱落癌细胞阳性率(56.2%)明显高于<3枚组(18.7%)(P<0.05)。结论腔镜腋窝淋巴结清扫手术微创、美观、安全性大,但随着淋巴结转移数量增多,脱落癌细胞检出率亦增加,腋窝创面采用杀灭脱落癌细胞的措施是必要的。     

鼻腔疾病手术术后鱼腥草冲洗术腔的疗效观察

目的 探讨鼻鼻腔疾病后术腔使用不同冲洗液对疗效的影响.方法 对行鼻腔手术60例(96侧)慢性鼻窦炎,鼻息肉患者,随机分为2组:术后分别用生理盐水+庆大霉素+地塞米松(A组),生理盐水+鱼腥草注射液(B组),冲洗术腔.结果 B组疗效优于A组.结论 术后坚持冲洗治疗有重要意义;鱼腥草注射液冲洗治疗疗效更显著.     

冲洗液预防泌尿科患者术后引流管逆行感染的临床分析

目的 观察冲洗液对泌尿科室患者术后引流管逆行感染的预防作用.方法 选择医院2011年8月-2012年1月泌尿科收治的68例泌尿系疾病手术后留置引流管患者,随机分为冲洗液组和对照组,每组各34例；对照组患者采用常规护理措施,冲洗液组在常规护理的基础上,在留置导管部位推注0.9％氯化钠冲洗液,收集两组患者术后24、48、72h的引流液进行细菌培养,观察细菌阳性率,评价冲洗液的预防效果.结果 冲洗液组与对照组引流液细菌培养阳性分别为4、18例,阳性率为11.76％、52.94％,两组比较差异有统计学意义(x2=13.42,P＜0.05)；冲洗液组有2例大肠埃希菌感染,对照组有13例大肠埃希菌感染.结论 采用0.9％氯化钠冲洗液对术后留置引流管进行冲洗,明显降低了逆行感染细菌的发生率,且操作简便,值得临床推广.     

膀胱冲洗液温度对前列腺电切术后并发症的影响

目的探讨膀胱冲洗液温度对前列腺电切术后并发症的影响。方法将80例行前列腺电切术的患者随机分为两组,术后分别用室温(24~25 e)冲洗液(室温组)及体温(36~37 e)冲洗液(体温组)进行膀胱持续冲洗,观察术后两组患者前列腺电切术后并发症的发生率。结果用体温冲洗液的患者发生术后并发症的几率明显低于用室温冲洗液的患者。结论前列腺电切术后用体温(36~37 e)冲洗液持续冲洗膀胱,能最大限度降低术后出血及发生膀胱痉挛的几率,明显有利于术后患者恢复。     

腔镜乳腺癌腋窝淋巴结清扫手术脱落细胞检查的初步研究

目的分析腔镜乳腺癌淋巴结清扫手术腋窝冲洗液细胞学检查结果，并为其安全性提供可靠的依据。方法对66例淋巴结阳性的乳腺癌手术患者腋窝冲洗液进行细胞学检查，其中腔镜组32例、常规组34例，并将其结果与临床参数进行对比分析。结果脱落癌细胞阳性率，腔镜组与常规组分别为37．5％、29．6％（P〉0．05）；经过局部热低渗化疗后，其阳性率下降为6．25％（腔镜组）、2．94％（常规组）（P〉0．05）；在淋巴结转移〉3枚患者中，腔镜组脱落癌细胞阳性率（56．2％）明显高于〈3枚组（18．7％）（P〈0．05）。结论腔镜腋窝淋巴结清扫手术微创、美观、安全性大，但随着淋巴结转移数量增多，脱落癌细胞检出率亦增加，腋窝创面采用杀灭脱落癌细胞的措施是必要的。     

慢性鼻炎鼻窦炎鼻内镜术后行鼻窦灌注液冲洗的临床效果分析

目的：探讨鼻窦灌注液冲洗术腔对慢性鼻炎鼻窦炎鼻内镜术后治疗的效果。方法：将45例经鼻内镜手术治疗的慢性鼻炎鼻窦炎患者随机分为治疗组和对照组,对照组给予鼻窦灌注液冲洗术腔治疗,治疗组在鼻窦灌注液中加用布地奈德,两组患者均持续治疗3个月,记录比较所有患者糖精试验检测结果,SCT改变及两组患者接受治疗总有效率。结果：两组患者接受治疗后SCT均显著小于治疗前（P〈0.01）,治疗组SCT显著小于对照组（P〈0.05）,治疗组治疗总有效率显著高于对照组（P〈0.05）。结论：鼻窦灌注液冲洗鼻腔对于慢性鼻炎鼻窦炎鼻内镜术后治疗效果显著,且在鼻窦灌注液中加用布地奈德效果更加明显,临床上可以推广应用。     

新型侧俯卧体位垫的研制与手术中应用研究

目的:研制一款新型侧俯卧体位垫,用于胆胰疾病患者内镜下逆行胰胆管造影(ERCP)侧俯卧位手术,以解决术中体位安置困难问题.方法:采用高密度加硬海绵、优质聚氨酯(PU)皮革等材料,用魔术贴组合;体垫由头垫模块、胸腹垫模块和下肢辅助垫模块构成,组合各模块研制成新型侧俯卧体位垫.选取在医院行侧俯卧位手术的54例胆胰疾病患者,...     

Endoscopic harvesting of saphenous vein during coronary artery bypass operations

The great saphenous vein is the most commonly applied conduit in coronary bypass surgery during the treatment of ischaemic heart disease. Regarding the increasing age of patients, multiple comorbid factors and poor patient's general state, the minimally invasive approach is of basic significance during these operations. OBJECTIVES: The aim of study was to evaluate the possibilities of endoscopic saphenous vein harvesting and the quality of saphenous veins harvested endoscopically. METHODS: The authors applied the endoscopic approach for saphena harvesting in 24 patients undergoing coronary bypass surgery or combined bypass surgery with valve reconstruction. Ten of the harvested veins were sent for histological examination to evaluate the structure of the endothel layer. RESULTS: No wound complications were noted with the endoscopic approach. The harvested veins were used as conduits during surgery except for 2 cases, where the calibre of the vein was too small to apply. The histological examination revealed normal endothel layer structure in all of the 10 cases. CONCLUSION: The endoscopic approach can be used in the harvesting of saphenous vein during coronary bypass surgery. For the time being, the apply of this approach is restricted by the longer operation time, which hopefully would be reduced in the future.     

A randomized trial of endoscopic and fluoroscopic placement of postpyloric feeding tubes in critically ill patients

BACKGROUND: Early postpyloric feeding is considered the accepted method of nutrition support in critically ill patients. Endoscopic and fluoroscopic techniques are associated with the highest percentage of successful placement. The purpose of this study was to compare endoscopic vs fluoroscopic placement of postpyloric feeding tubes in critically ill patients. METHODS: This is a randomized prospective clinical trial. Forty-three patients were randomized to receive feeding tubes by endoscopic or fluoroscopic technique. All procedures were performed at the bedside in the critical care unit. A soft small-bore nonweighted feeding tube was used in all cases. Successful placement was confirmed by either an abdominal x-ray for endoscopic technique or a fluoroscopic radiograph for fluoroscopic technique. RESULTS: Postpyloric feeding tubes were successfully placed in 41 of 43 patients (95%). The success rate using endoscopic technique was 96% (25 of 26), whereas the rate using fluoroscopy was 94% (16 of 17). The average time of successful placement was 15.2 +/- 2.9 (mean +/- SEM) minutes for endoscopic placement and 16.2 +/- 3.2 minutes for fluoroscopic placement, which was not statistically significant (p > .05). CONCLUSIONS: Endoscopic and fluoroscopic placement of postpyloric feeding tubes can safely and accurately be performed at the bedside in critically ill patients. Our results showed no significant difference in the success rate or time of placement between endoscopic vs fluoroscopic placement of postpyloric feeding tubes.     

Percutaneous endoscopic gastrostomy complication rates and compliance with the American Society for Gastrointestinal Endoscopy guidelines for the management of antithrombotic therapy

Background: The American Society for Gastrointestinal Endoscopy (ASGE) has published recommendations in regards to anticoagulant (AC) and antiplatelet (AP) therapy management during endoscopic procedures. So far, no study has assessed either ASGE recommendation compliance during percutaneous endoscopic gastrostomy (PEG) placement or procedure‐associated complication rates as related to the observance of these recommendations. The aims of this study were to compare the incidence and type of complications during PEG placement in patients receiving or not receiving AC and/or AP therapy and to determine the compliance with ASGE's AC and AP management guidelines. Methods: Medical files of patients who underwent PEG placement from January 2004 to December 2008 were reviewed. Clinical and procedure‐related data were recorded. Patients were separated into 1 of 2 groups: patients under AP and/or AC therapy prior to PEG placement (n = 51) and a control group of patients (n = 40) not receiving any AP and/or AC treatment at least 6 months prior to the procedure. Results: A total of 91 patients (51 cases) were included. Groups were comparable in demographics and clinical characteristics. No differences in the frequency and type of complications were found between groups. ASGE's recommendations were not followed in any of these patients. Conclusions: Overall PEG placement complication rate was 13.7%. AP therapy may be safely discontinued closer to the time of endoscopic procedure than the time currently recommended by the ASGE guidelines.     

A method for measuring the cleaning effect of flushing disinfectors.

A method is presented with which the mechanical cleaning effect of flushing disinfectors can be estimated independently of the thermal disinfecting effect of the hot flushing water. This makes it possible to specify the demands to be placed on the disinfecting effect of flushing with water of 85 degrees C or more. Bacillus stearothermophilus spores suspended in faeces were used as indicators because of their non-sensitivity to the hot-water temperature. Their elimination by flushing could thus be attributed to the mechanical effect of the water and not to the disinfecting effect of the temperature. A simple bacteriological technique was used, and the elimination factor (EF) was calculated as the ratio of the number of micro-organisms in the contamination before and after flushing. By using flushing water below 50 degrees C for 130 s the EF on a bedpan was about 10(4)-10(6). The effect of flushing with water of the same temperature for only half that time was somewhat weaker and when the temperature was raised to 85 degrees C after half the flushing time the effect was somewhat stronger. It can be presumed that the conventional disinfecting phase with hot (85 degrees C) water for about 45 s in the commonly used flushing units could be substantially shortened and the costs of their use thereby reduced.     

A method for measuring the cleaning effect of flushing disinfectors

A method is presented with which the mechanical cleaning effect of flushing disinfectors can be estimated independently of the thermal disinfecting effect of the hot flushing water. This makes it possible to specify the demands to be placed on the disinfecting effect of flushing with water of 85 degrees C or more. Bacillus stearothermophilus spores suspended in faeces were used as indicators because of their non-sensitivity to the hot-water temperature. Their elimination by flushing could thus be attributed to the mechanical effect of the water and not to the disinfecting effect of the temperature. A simple bacteriological technique was used, and the elimination factor (EF) was calculated as the ratio of the number of micro-organisms in the contamination before and after flushing. By using flushing water below 50 degrees C for 130 s the EF on a bedpan was about 10(4)-10(6). The effect of flushing with water of the same temperature for only half that time was somewhat weaker and when the temperature was raised to 85 degrees C after half the flushing time the effect was somewhat stronger. It can be presumed that the conventional disinfecting phase with hot (85 degrees C) water for about 45 s in the commonly used flushing units could be substantially shortened and the costs of their use thereby reduced.     

多层螺旋CT在鼻科的应用价值

目的：回顾性分析行鼻内镜手术病例的多层螺旋CT资料，探讨多层螺旋CT对鼻内镜手术的指导意义。方法：对临床入院行鼻内镜手术的232例患者术前常规行多层螺旋CT扫描，并行冠状位、矢状位、斜位重建。结果：多层螺旋CT能够很好地显示和诊断鼻腔鼻窦疾病，尤其对窦口鼻窦复合体、额窦引流通道等复杂精细结构能够清晰显示，所有病例多层螺旋CT表现与鼻内镜检查及术中所见一致。结论：多层螺旋CT具有扫描时间短、患者接受射线剂量少、可任意多平面多角度成像、显示复杂结构清晰精细．对鼻内镜手术有积极的指导意义．可作为鼻内镜手术前的常规检查。     

医学检验标本收集运送车的研制

目的为规范医学检验科收集和运送标本，研制一款实用性小推车。方法根据医学检验科目标本数量、标本类型、检验目的、运送条件及实验室生物安全防护要求等因素设计和研制出一款多功能标本收集运送车，分析其性能特点及使用效果。结果该款标本收集运送车设计轻巧、时尚，长×宽×高：65cm×45cm×8512cm。分3层共6个独立收集单元，可同时满足血液、尿液、粪便等不同的检验标本的规范化运送需要，各收集单元温度外部显示。密封性、保温性、防震性能好，且易于消毒。结论该收集运送车的使用能规范医院检验科的标本收集和运送，降低标本收集运送差错率，缩短运送时间从而提高工作效率；能减少分析前的误差因素，提高检验结果的准确性；能降低生物气溶胶污染环境和感染工作人员的机率，值得在各级医院推广使用。