手术室医疗耗材管理方法及效果评价

医疗市场竞争日益加剧 ,使许多医院感受到了生存危机。我院为了主动适应市场的变化 ,探索新的管理体制和运行机制 ,实行了以全成本核算为核心的企业化管理体制[1,2 ] 。手术室于 1998年 8月至 2 0 0 1年3月实施全成本核算的管理 ,同时对医疗耗材的管理方法进行了改进 ,杜绝了资源浪费和漏收费现象 ,减少了医疗费用纠纷 ,取得满意效果 ,现报告如下。1　资料与方法1.1　一般资料手术室工作人员 72人 ,其中副主任护师 1人 ,主管护师 15人 ,护师 19人 ,护士 2 0人 ,工人 17人。手术间 2 9个 ,手术台 31张 ;日均手术量 5 5台左右 ,最多可达 86台 …     

手术室冷冻病理标本管理方法的改进

活体组织病理诊断是外科疾病的第一诊断,是金指标[1].特别是肿瘤患者,手术标本对其诊断、治疗及病情预后有着重大意义.我院属三级甲等综合性医院,手术室平均每天需送检20～30个冷冻病理标本.为减少医疗护理安全隐患,我科于2005年1月起,将冷冻病理标本送检登记本(下称登记本)及传真机应用于冷冻病理标本管理中,收效甚好,介绍如下.     

手术病理标本管理及质量控制措施

为防止手术后病理标本的混淆与丢失，杜绝差错事故发生，我科从2003年1月起，对手术病理标本进行管理，取得满意的效果，现介绍如下：     

手术室冷冻病理标本管理方法的改进

活体组织病理诊断是外科疾病的第一诊断，是金指标。特别是肿瘤患者，手术标本对其诊断、治疗及病情预后有着重大意义。我院属三级甲等综合性医院，手术室平均每天需送检20～30个冷冻病理标本。为减少医疗护理安全隐患，我科于2005年1月起，将冷冻病理标本送检登记本（下称登记本）及传真机应用于冷冻病理标本管理中，收效甚好，介绍如下。[第一段]     

肝硬化病人的健康教育及其效果评价

正确有效的健康教育对预防疾病、防止疾病的复发和减少并发症具有重要意义。 1 997年 1月至1 999年 1月 ,我科对 1 53例肝硬化住院病人进行健康教育和常规护理的对比观察 ,结果报告如下。1　资料与方法资料 :1 53例肝硬化病人 ,男 1 2 7例 ,女 2 6例 ,年龄 1 6～ 74岁。其中代偿期 84例 ,失代偿期 69例。并发各种感染 65例 ,上消化道出血 49例 ,肝性脑病32例 ,电解质紊乱 34例 ,功能性肾衰竭 3例 ,原发性肝癌 4例。小学及以下文化程度 2 1例 ,中学 96例 ,大专及以上 36例。按入院顺序分成两组 ,观察组76例 ,对照组 77例。两组病人一般情况、…     

手术室病理标本处理流程的优化效果

目的改进手术室病理标本处理流程,确保病理标本在各处理流程中的安全、准确、及时。方法组建品质圈活动(QC)小组,通过对相关人员的调查与访谈,发现原标本处理流程存在的问题,对手术室护士及护工进行专业培训,制定病理标本处理流程图,应用信息系统代替手工书写,改进病理标本固定液取液装置,设计并使用病理标本车,安装监控摄像装置等。结果改进前后标本袋字迹不清、病检单字迹不清、病检单有污迹和名称不一致发生率比较,差异有统计学意义(均P0.01)。改进后病理标本的处理时间与核对时间显著短于改进前,标本固定液外漏发生率显著低于改进前(均P0.01)。结论通过各项措施的落实,减少了病理标本处理流程中的安全隐患发生率,缩短了标本处理与核对时间,减少了固定液外漏率,在确保临床护理工作安全的同时,也有效地增强了对护理人员的职业安全防护。     

洁净手术室感染管理环节控制与效果

目的探讨洁净手术室的感染管理方法与效果。方法将400例手术患者根据加强手术室感染控制管理措施时间分为2组,各200例。将2010-12—2013-02间实施常规管理模式的作为对照组,将2013-03—2016-01间实施加强管理模式的作为观察组。比较2组患者的感染发生率与患者对手术管理的满意度。结果观察组3例(1.50%)对照组有17例患者(8.50%)发生感染,差异有统计学意义(P0.05)。发放手术管理满意调查表显示,观察组199例患者(99.50%)满意,对照组178例患者(89.00%满意),2组手术管理满意比较差异有统计学意义(P0.05)。结论加强对洁净手术室的感染管理,能有效降低术后感染率,提高患者对手术室管理的满意率。     

术中微小标本管理新方法

标本管理是手术室护理工作中一项非常重要的内容，对患者疾病的诊断、治疗、预后有重大意义。器械护士必须妥善保管和正确处理手术切除的病理标本，尤其对于那些体积非常小又疑似肿瘤的标本，若保存方法不当，易造成病理标本受压、变性、丢失，影响病理检验结果。鉴此，2007年3月始笔者将使用后的一次性无菌注射器制作成标本容器盛装微小病理标本，解决以上问题，效果较好，介绍如下。     

鼻综合整形的方法探讨及效果评价

目的：探讨鼻综合整形的手术方法并评价其临床效果。方法：根据外鼻形态的具体缺陷情况,同时采用假体隆鼻、鼻头缩小、鼻翼缩小、耳软骨鼻尖延长、鼻小柱延长等多项技术中的二项以上进行鼻整形手术。结果：2007年3月～2010年4月对307例患者采用上述方法行鼻整形术,术后均获明显改善效果。随访6个月～2年,其中1例于半年后发生感染而取出鼻假体,其余就医者对效果均感满意,形态自然,切口瘢痕不明显。结论：鼻综合整形能从全方位改善外鼻不良形态从而增加鼻部整体美感。术中均衡考虑不同部位手术之间的相互影响关系,是把握手术整体成形效果的关键。     

自制标本袋在手术室的应用

病理诊断是外科疾病诊断、治疗的重要依据,手术中切下的标本对患者疾病的诊断、治疗、病情预后有重大意义,尤其是疑似肿瘤的标本、活体组织,因此,手术标本安全管理及有效的固定可为病理诊断提供保障.鉴此,笔者采用自制标本袋用于手术标本管理,效果较好,介绍如下.     

Operative Techniques in the Fetal Rabbit

The development of fetal surgical techniques has made the antenatal correction of congenital defects possible. These techniques have evolved from trials with animal models, permitting increasingly sophisticated operations with low morbidity and mortality. Experimental models range from large animals offering longer gestations but with single pregnancies and high cost, to smaller animals offering multiple pregnancies at reduced cost but with shorter gestations. This paper describes operative techniques in the fetal rabbit and its advantages as a fetal surgical model. Experience with the pregnant rabbit has shown it to be a suitable surgical model for several reasons. Pregnancies are multiple, increasing cost effectiveness and permitting operation on up to eight fetuses per litter without fetal loss. Techniques that promote fetal survival include local housing of does several days prior to operation and preoperative sedation. Spontaneous mask ventilation provides ease of anesthetic administration and titration. Overall surgery is well tolerated with a low incidence of intraoperative complications. Rabbit models have been used in the study of transamniotic fetal feeding, abdominal wall defects, and wound healing. These techniques have resulted in postoperative fetal viability approaching 90%, with negligible maternal mortality in over 4000 fetal operations, thereby making the rabbit a manageable cost-effective model of fetal surgery.     

Effect of the Raga Ananda Bhairavi in Post Operative Pain Relief Management

Music is considered as an universal language and has influences the human existence at various levels.In recent years music therapy has evolved as a challenge of research with a clinical approach involving science and art. Music therapy has been used for various therapeutic reasons like Alzheimer’s disease,Hypertension and mental disorders to name a few. We conducted a study to establish the effect of the classical ragam Anandhabhairavi on post operative pain relief. A randomized controlled study involving 60 patients who were to undergo surgery was conducted at PSG Institute of Medical Sciences and Research,Coimbatore.30 patients selected at random and were exposed to the ragam Anandhabhairavi which was played in their room pre operatively (from the day they got admitted for surgery) and 3 days post operatively. The control group did not listen to the music during their stay in the hospital. An observation chart was attached in which the requirement of analgesics by the patient was recorded. On completion of the study and on analysis,the ragam Anandhabhairavi had a significant effect in post operative pain management which was evidenced by the reduction in analgesic requirement by 50 % in those who listened to the ragam.A significant p value of <0.001 was obtained.     

Posterior Fusion of the Lumbosacral Spine: Evaluation of the Operative Results and the Factors Influencing Them

The operative results of 79 patients subjected to posterior fusion of the lumbosacral spine were evaluated on the basis of a follow-up examination performed on average 5.4 years after operation. A method of evaluation was developed which measured the patients' subjective improvement and working capacity. The method proved appropriate for clinical use and gave a more correct picture of the operative result than methods relying on the patient's own opinion or the radiographic assessment as the only criterion. Sixty per cent of the patients were subjectively improved, 40 per cent had returned to their previous or a corresponding occupation and 24 per cent had a good operative result, assessed by the method applied.

A statistical analysis was performed in order to find the factors influencing the operative results. Age over 40 years, heavy or moderately heavy preoperative work and over 6 months' preoperative disability had a statistically significant, unfavourable effect on the results. In the case of labourers in heavy occupations, working capacity was seldom restored to a degree sufficient for return to their previous work.

The operative technique proved reliable with 91 per cent successful fusions, assessed from functional radiographs. Successful fusion did not imply a good operative result, although it did so more often than non-fusion.

On the basis of this study, operative fusion of the lumbosacral spine seems to be of relatively little value in the treatment of patients suffering from low back pain, and factors other than purely medical or surgical have a considerable influence on the operative results.     

CT影像评价无或轻微神经症状胸腰椎爆裂骨折的手术治疗

报告采用CT影像评价对无或轻微神经症状的脊柱爆裂骨折的手术治疗17例满意结果。采用CT的椎管横截面积与突入椎管的横截面积比和骨片对神经根和脊髓的压迫影像,来判断这类损伤手术治疗适应证。证明CT影像仍不失为最廉宜的首选手段。     

Long-Term Results of Cemented Total Hip Arthroplasty in Developmental Dysplasia With Acetabular Bulk Bone Grafts After Improving Operative Techniques

We present the long-term results (mean follow-up, 11.8 years; range, 6.3-15.4 years) of cemented total hip arthroplasty with acetabular bulk bone grafting in 147 dysplastic hips using improved surgical techniques. Operations were performed through a direct lateral approach with partial trochanteric osteotomy to avoid nonunion of the greater trochanter. Bioresorbable poly(l-lactide) screws were used for fixation of the acetabular bone grafts to prevent any possible delayed remodeling. Preoperative planning using computer simulation was performed to estimate the optimal size and position of the acetabular component. Analysis predicted rates of survival of the acetabular component of 96% and 91% at 15 years, with revision for aseptic loosening and radiologic loosening as the end points, respectively. Our results indicate excellent long-term clinical and radiographic survivorship of a cemented acetabular component with bulk autograft for acetabular dysplasia.     

Occipitocervical Fusion Surgery: Review of Operative Techniques and Results

Objective Varying types of clinicoradiologic presentations at the craniovertebral junction (CVJ) influence the decision process for occipitocervical fusion (OCF) surgery. We discuss the operative techniques and decision-making process in OCF surgery based on our clinical experience and a literature review. Material and Methods A total of 49 consecutive patients who underwent OCF participated in the study. Sagittal computed tomography images were used to illustrate and measure radiologic parameters. We measured Wackenheim clivus baseline (WCB), clivus-canal angle (CCA), atlantodental distance (ADD), and Powers ratio (PR) in all the patients. Results Clinical improvement on Nurick grading was recorded in 36 patients. Patients with better preoperative status (Nurick grades 1–3) had better functional outcomes after the surgery (p = 0.077). Restoration of WCB, CCA, ADD, and PR parameters following the surgery was noted in 39.2%, 34.6%, 77.4%, and 63.3% of the patients, respectively. Complications included deep wound infections (n = 2), pseudoarthrosis (n = 2), and deaths (n = 4). Conclusion Conventional wire-based constructs are superseded by more rigid screw-based designs. Odontoidectomy is associated with a high incidence of perioperative complications. The advent of newer implants and reduction techniques around the CVJ has obviated the need for this procedure in most patients.     

移位髋臼骨折的手术治疗

髋臼骨折是一种暴力强，机制复杂，移位多样，常伴有股骨头骨折脱位，且治疗困难的关节内骨折。往往因处理不当而并发创伤性关节炎。我院自1996年以来收治移位髋臼骨折61例。经手术治疗获得明显的治疗效果。     

欧洲心脏手术风险评估系统预测中国人心瓣膜手术后并发症的发生及预后

目的评估欧洲心脏手术风险评估系统(EuroSCORE)能否有效预测中国人心瓣膜手术后重症监护(ICU)时间延长、死亡以及主要并发症的发生。方法将2004年1月至2006年1月北京阜外心血管病医院连续收治的后天性心瓣膜病患者2 218例纳入研究,其中男1 047例,女1 171例;年龄49.26±11.10岁。所有患者均行心瓣膜手术。将EuroSCORE的logistic模型和additive模型应用于所有患者,评估两种方法预测心瓣膜手术后患者死亡I、CU时间延长以及重要并发症的发生。模型的区分能力采用受试者工作特征曲线(ROC曲线)评价,校正能力采用Hosmer-Lemeshow拟合优度检验评价。结果 EuroSCORE的logistic模型和additive模型预测术后死亡的ROC曲线面积分别为0.710和0.690,ICU时间延长为0.670和0.660,心力衰竭为0.650和0.640,呼吸功能衰竭为0.720和0.710,肾功能衰竭为0.700和0.740,二次开胸止血为0.540和0.550;其中肾功能衰竭和心力衰竭两种模型的ROC曲线下面积差异有统计学意义(P0.05)。EuroSCORE预测术后死亡、心力衰竭、肾功能衰竭、二次开胸止血以及ICU时间延长的Hosmer-Lemeshow拟合优度欠佳,但logistic模型预测术后呼吸功能衰竭的拟合优度良好(P=0.120)。结论 EuroSCORE预测中国人心瓣膜手术后死亡I、CU时间延长以及重要并发症发生的预测效果较差,但logistic模型可用来预测术后呼吸功能衰竭。     

评估髋臼骨折的手术疗效及相关因素

目的评估髋臼骨折的手术疗效及影响手术疗效的相关因素。方法回顾整理1999年3月至2004年10月期间63例因髋臼骨折在我院行手术治疗患者的流行病学及并发症资料。结果52例患者（82．54％）至少合并1个其他部位的损伤。14例患者（22．22％）有坐骨神经损伤表现。29例患者（46．03％）有术后并发症但大多数没有影响手术效果。再手术率4％。59例患者（93．65％）有门诊随访和X线片复查结果，平均随访时间为2年4个月。44例患者（69．84％）的疗效为优／好。结论疗效优／好的与早期手术和解剖复位等因素相关。疗效差的与手术延迟、复位失败或内固定不牢靠以及受伤时合并股骨头骨折等因素相关。     

跟骨骨折的钢板内固定治疗

目的探讨手术治疗跟骨骨折的效果及相关问题。方法自2001至2004年共手术治疗各型跟骨骨折32例（34足）,男28例,女4例。伤因：坠落伤21例,车祸伤8例,其他伤3例。年龄19～50岁,平均27.2岁。合并全身其他骨折13例。按E ssex-Lopresti分型,Ⅰ型：舌形骨折4足;Ⅱ型：压缩骨折24足;Ⅲ型：严重粉碎骨折6足。均采用切开复位支持钢板（AO跟骨钢板,国产仿AO跟骨钢板）内固定治疗,手术入路均为外侧“L”形扩大入路,术后不用石膏固定,2～3 d后即行不负重功能锻炼,6～8周后逐渐负重锻炼。随访12～34个月,平均16个月。结果按M ary land足部评分系统评价,并以每足为基数,全组优良率91%,其中Ⅰ型骨折优良率为100%,Ⅱ型骨折优良率为96%,Ⅲ型骨折优良率为67%。有各种并发症包括：跟部增宽、距下关节炎2例,跟骨骨刺影响行走1例,手术切口皮缘坏死愈合不良1例（后经换药而愈）,螺钉后退刺激皮肤不适1例等。结论恢复距下关节面及跟骰关节面平整,维持正常足弓形态和跟骨宽度是治疗的重点,恰当地选择手术指征、手术入路,正确地骨折复位和术后处理是治疗的关键,钢板内固定治疗跟骨骨折是一种较理想的方法。