肠造口黏膜大部分断裂的原因分析及预防

对1例患者发生肠造口黏膜大部分断裂的原因进行分析,认为造口袋底板裁剪方法及粘贴方法不当均可引起肠造口黏膜损伤,患者未定期复诊是出现肠造口黏膜损伤后逐渐加重、导致断裂的重要原因.造口扩理中应指导患者掌握正确裁剪追口底板及粘贴技巧,出院时告诉患者就诊指征和就诊途径,每次复诊时根据造口并发症的发生状况,对造口惠者的复诊时间作相应安排,以便及时发现肠追口黏膜损伤等并发症.     

病耻感对肠造口患者生活质量影响的研究进展

随着人们生活方式的改变和生活水平的提高,结直肠癌的发病率在呈上升趋势.肠造口手术的开展给结直肠癌患者带来了生机,挽救了患者的生命,延长其平均寿命.然而,手术后永久性人工肛门为患者带来了不同程度的病耻感,生活质量明显下降.本文就肠造口术后患者的病耻感对生活质量的影响进行回顾分析,为提高患者生活质量提供参考.     

早产儿坏死性小肠结肠炎的临床分析

目的：了解早产儿坏死性小肠结肠炎（NEC）的临床特点，探讨及时诊断和防治早产儿NEC的方法。方法：分析32例早产儿NEC的临床表现、影像学特点、病程发展、预后，并与27例足月儿NEC进行比较。结果：早产儿NEC更多表现为反应差（46．9％）、胃纳差（34．4％），肠穿孔率（21．9％），明显高于足月儿组；病死率（28．1％）也高于足月儿组（3．7％）。结论：与足月儿比较，早产儿NEC临床表现中以反应低下和纳差比较突出，穿孔发生率高，病死率也比较高。     

足月新生儿坏死性小肠结肠炎的临床特点

１８例足月新生儿坏死性小肠结肠炎（ＮＥＣ）的临床分析表明，ＮＥＣ的发生虽与各种危险因素有关，但亦可发生于完全正常的足月新生儿；发病时间早和病变以结肠受累为主是足月新生儿ＮＥＣ的特点；足月新生儿ＮＥＣ的预后明显优于早产儿ＮＥＣ。     

腹会阴联合直肠癌根治术后造口旁瘘的护理

介绍了1例腹会阴联合直肠癌根治术后造口皮肤黏膜分离、造口旁瘘患者的护理。通过造口插入肛管持续低负压引流粪水,避免粪水通过瘘口刺激周围组织;及时开放创面,彻底清洗,清除坏死组织,充分引流粪水和脓液;瘘口闭合后拔除肛管,根据创面渗液情况应用相应的湿性愈合敷料进行换药处理。创面愈合后尽早行造口指检,及时发现造口狭窄情况,并指导患者自行扩肛,防止造口狭窄进一步加重。     

自制帽式引流袋在预防小儿肠造口周围皮肤并发症中的应用

目的 探讨自制帽式引流袋在预防小儿肠造口周围皮肤并发症中的应用。 方法 根据肠造口患儿造口周围皮肤护理的需求,研制了积存瘘口粪汁、减少臭气、防范浸渍皮肤的帽式引流袋。以问卷方式调查 65 名医护人员及56 名患儿家属,以评价应用效果。结果 医护人员认为自制的帽式引流袋不仅能弥补造口袋和开放式造口护理中存在的过敏、滑脱、损伤、造价高等缺陷,而且能减少造口周围皮炎的发生率,提高患儿家属的满意度。 超过 95% 的家属认为自制帽式引流袋取材方便、操作容易,能减轻家庭经济负担。 结论 帽式引流袋具备制作简单、操作方便、安全有效且经济实惠的优点,能有效防范小儿肠造口周围皮肤并发症的发生。     

腹部超声与X线平片预测新生儿坏死性小肠结肠炎临床转归的应用价值比较研究

目的：比较腹部超声与X线平片在新生儿坏死性小肠结肠炎（NEC）协助诊断及预测临床转归的应用价值。方法：回顾性选择2014年2月至2019年2月我院儿科收治的80例NEC患儿,根据修正Bell-NEC分级诊断标准将患儿分为疑似组（39例）、确诊组（41例）,根据临床转归分为转归良好组（内科保守治疗,50例）和转归不良组（手术治疗或死亡,30例）。均行床旁腹部超声和X线平片,收集疑似组和确诊组两种影像检查结果,比较不同临床转归患者两种检查结果的差异,分析其预测NEC患儿临床转归的价值。结果：确诊组腹部超声对肠管扩张、门静脉积气检出率分别为58.54%（24/41）、36.59% （15/41）,高于腹部X线平片的36.59%（15/41）、17.07%（7/41）（P＜0.05）。转归不良组腹部X线平片腹腔游离气体、肠壁积气、门静脉积气、肠管扩张检出率分别为13.33%（4/30）、16.67%（5/30）、20.00%（6/30）、50.00%（15/30）,高于转归良好组的2.00%（1/50）、2.00%（1/50）、2.00%（1/50）、24.00%（12/50）（P＜0.05）,腹部超声腹腔游离气体、腹腔积液、肠壁增厚、肠管扩张检出率分别为16.67%（5/30）、50.00%（15/30）、40.00%（12/30）、50.00%（15/30）,高于转归良好组的2.00%（1/50）、24.00%（12/50）、14.00%（7/50）、32.00%（16/50）（P＜0.05）。Logistic回归分析结果显示腹部超声检出腹腔游离气体、腹腔积液、肠壁增厚,腹部X线平片检出肠管扩张、腹腔游离气体是NEC患儿临床转归不良的危险因素（P＜0.05）。研究结果还显示腹部超声、腹部X线平片检查预测NEC转归不良的灵敏度分别为83.33%、63.33%,特异度分别为78.00%、72.00%。结论：与腹部X线平片比较,腹部超声对NEC患儿肠管扩张、门静脉积气有更高的检出率,可探察到NEC患儿肠道的细微变化,腹部超声在协助NEC诊断和临床转归预测中更具价值。     

Necrotizing Enterocolitis: Past Trends and Current Concerns

Necrotizing enterocolitis is the most common gastrointestinal emergency in the preterm infant. It is unpredictable, and the etiology is complex and not well understood. Yet, the care of these infants requires astute assessment and management for the outcome to be favorable. No one can predict to whom or when this life-threatening emergency will occur. The purpose of this article is to explore the physiology of the gastrointestinal tract, the pathophysiology associated with necrotizing enterocolitis, the contributing factors needed to confirm the diagnosis, and the plan of care required for these infants. In addition, a discussion of new management strategies is included.     

Pneumatosis intestinalis in a patient with polyarteritis nodosa

Necrotizing enterocolitis of the small bowel in polyarteritis nodosa is rare. In the proper clinical setting, pneumatosis intestinalis and mesenteric air are characteristic of this entity.     

自制造口评分表对造口人生活质量的影响

目的 探讨造口评分表对减少非住院肠造口患者(造口人)并发症的影响.方法 将186例肠造口患者随机分为A组和B组各93例.A组在住院期间即与护士共同使用造口评分表直至延续出院后患者独立使用,而B组常规护理,未使用造口评分表.2组在出院后1,3,6个月电话随访及上门随访,了解2组患者的生活质量.结果 对照2组并发症,A组并发症发生率仅为14.0％,丽B组造口并发症发生率为36.6％,且2组患者对自我的满意率相比差异有统计学意义.结论 通过使用造口评分表能明显减少肠造口并发症的发生,大大提高肠造口患者的生活质量.     

Intrahepatic and portal venous gas detected by ultrasonography

During a 3-year period, sonographic evidence of portal venous gas (PVG) was found in 11 patients. Of these, 10 patients were examined for clinically suspected necrotizing enterocolitis (NEC). In the 11th patient, suffering from nephroblastoma, PVG was detected by routine sonography. Radiographic examination, performed in nine of 11 patients did not show any PVG. Intestinal pneumatosis was radiographically identifiable in only four of these children, whereas eight of 11 patients with sonographically detectable PVG also had sonographic evidence of intramural gas. Follow-up examinations in five patients showed cessation of PVG soon after onset of adequate therapy, indicating that ultrasonography is also a reliable method for monitoring NEC. Sonographic evidence of PVG, however, may be limited to the time before onset of therapy.     

54例肠造口刺激性皮炎患儿的护理

肠造口刺激性皮炎不仅引起患儿疼痛不适、周围皮肤感染,影响二期手术的进行,还会增加患儿或照顾者的心理压力。通过对54例患儿肠造口刺激性皮炎的原因进行分析,找出引起儿童肠造口周围皮炎的主要原因,根据具体原因选用适合的造口护理用品和粘贴方法,并根据皮炎的程度采取不同的处理方法,详细指导患儿家属造口护理知识与技能,定时门诊复查及追踪指导。所有患儿肠造口刺激性皮炎均在2～8d内愈合,未再发生刺激性皮炎。     

Mesenchymal stem cell transplantation in a premature infant with octreotide induced fulminant necrotizing enterocolitis

Necrotizing enterocolitis (NEC) continues to cause significant morbidity and mortality in the newborn period. The mortality rate among severe NEC patients requiring surgery is over 50 %. The capacity of mesenchymal stem cells (MSC) for self-replication, differentiation, preventing apoptosis, and reducing inflammation has caused an interest for their use in NEC therapy. Here we present an infant treated with human umbilical cord-derived MSC transplantation 30 days after undergoing surgery for extensive fulminant NEC.     

Changing patterns of neonatal necrotizing enterocolitis

In a 4 year and 4 month period 80 patients with necrotizing enterocolitis were treated. Review of the mode of clinical presentation, radiological features, management, mortality, and complications showed that there have been considerable changes over this period. The disease is now frequently diagnosed clinically prior to the development of paralytic ileus. Scalloping of the bowel wall and separation of the bowel loops are probably the earliest radiological signs. The management has become a more aggressive medical approach with more limited and welldefined surgical indications. These changes have been associated with a marked decrease in mortality and a concomitant increase in the number of late complications.     

Using probiotics to prevent necrotizing enterocolitis: Why have we not changed practice?

Very low birth weight preterm infants are at risk to develop multiple health co-morbities; one of the most devastating of which is necrotizing enterocolitis (NEC). NEC is a life altering infection with increased morbidity and mortality. While the exact etiology of NEC remains unknown, several factors related to gut proliferation seems to be linked to this infection. A thorough review of the literature revealed that evidence does support the use of probiotics to prevent NEC. Although clinical research implies the use of probiotics, practice guidelines have yet to adopt this change. This article presents the evidence behind the justification for probiotics, and suggestions for future practice.     

Complications of muscle injuries

Muscle injuries can be classified into strain injuries and contusions. Depending on the type of injury, different complications may occur, which in turn can be divided into early, intermediate and delayed complications. A prompt diagnosis of complications allows early treatment and permits to avoid harmful sequelae. Imaging studies, ultrasonography in particular, allow (recognizing) the assessment of complications whenever clinically suspected. In this article the most frequent complications of muscle injuries are presented.     

白内障超声乳化术后并发症的分析

目的 分析白内障患者超声乳化术后并发症的原因,探讨其处理方法并为术者提供参考.方法 回顾性分析658例（755眼）接受超声乳化手术白内障患者术中、后并发症.结果 术中前房出血9眼（1.19%）,后囊膜破裂26眼（3.44%）.7眼未能植入人工晶体;术后角膜水肿及角膜内皮失代偿139眼（18.41%）,人工晶体无法植入7眼（0.93%）,虹膜嵌顿2眼（0.26%）,后发障22眼（2.91%）,黄斑囊样水肿5眼（0.66%）.结论 超声乳化手术中、后并发症较少,最主要的是后囊膜破裂和角膜水肿,对出现并发症者应采取积极有效的措施,仍可获得满意的手术效果.     

Ischemic jejunitis and pneumatosis intestinalis secondary to anastomotic obstruction following jejunal atresia repair

An infant with jejunal atresia developed ischemic jejunitis with intramural and portal venous gas postoperatively following prolonged anastomotic obstruction. The importance of differentiating ischemic bowel disease secondary to obstruction from classic necrotizing enterocolitis is illustrated by this case report.Authors alone are responsible for the opinions expressed in the contribution.     

超声导向穿刺并发症附15例报告

本文报告Ｂ超导向穿刺１６９１例发生的并发症。本研究包括细针穿刺１３５４例，粗针穿刺３３７例，穿刺部位主要为腹部。发生严重并发症３例（肿瘤细胞种植２例，过敏性休克１例），发生率为０．１８％，其他并发症１２例，发生率为０．７１％，总并发症发生率为０．８９％。本文结果，治疗性穿刺并发症发生率高于诊断性穿刺并发症发生率，粗针穿刺并发症发生率高于细针穿刺并发症发生率。