术中压力性损伤与受压部位微环境关系的研究

目的探究受压部位微环境与俯卧位手术患者发生术中压力性损伤的关系,为临床实施预防措施提供参考。方法选取择期手术患者99例,获取患者人口学及手术相关资料,以及受压部位皮肤温度和皮肤湿度情况。结果俯卧位手术患者术中压力性损伤发生率为10.10%,多发生在手术结束后24 h内,颧骨及髂前上棘为好发部位。皮肤温度、核心温度升高是俯卧位手术患者压力性损伤的危险因素(OR值为8.215、7.186,均P<0.05)。结论受压部位微环境对俯卧位手术患者术中压力性损伤有影响,应采取针对性干预措施,降低术中压力性损伤发生率。     

手术患者术中获得性压力性损伤发生特征及危险因素的多中心研究

目的 探讨手术患者术中获得性压力性损伤的发生特征并分析其影响因素,为防治手术患者术中获得性压力性损伤提供参考.方法 调查全国7所三级甲等医院的8 622例手术患者,收集相关人口学资料、手术类别、术中获得性压力性损伤发生特征等,并对危险因素进行统计分析.结果 手术患者术中获得性压力性损伤发生率为2.28％,1期最多见(91.24％),骶尾部发生率最高(46.08％),坐位是发生率最高的手术体位(13.64％),胸外科是发生率最高的手术专科(4.33％),≥75岁老龄患者发生率最高(3.53％);麻醉分级、受压部位皮肤状态、术前肢体活动、计划手术时间、高危疾病(糖尿病)、体温丢失因素、实际手术时间是手术患者压力性损伤的预测因素(P＜0.05,P＜0.01).结论 术中获得性压力性损伤高危因素较多,应早期识别患者的高危因素,采取个性化防治措施,降低术中获得性压力性损伤的发生率.     

多学科团队合作预防脊柱后入路手术患者术中压力性损伤

目的探讨多学科团队合作预防脊柱后入路手术患者术中压力性损伤的效果。方法选取2016年1～6月行脊柱后入路手术患者655例作为对照组,2017年1～6月656例作为观察组。对照组采用常规术中压力性损伤防护管理方法,观察组实施多学科团队合作的术中压力性损伤预防管理干预。结果对照组发生术中压力性损伤9例(15处,发生率为1.37%),观察组发生2例(3处,发生率为0.30%),两组比较,差异有统计学意义(P0.05)。结论实施多学科团队合作的术中压力性损伤预防管理,能有效降低脊柱后入路手术患者术中压力性损伤的发生。     

围手术期手术患者发生压力性损伤现状及危险因素分析

目的 针对围手术期手术患者压力性损伤发生的现状及危险因素进行总结分析,旨在为压力性 损伤护理管理工作提供参考依据。方法 运用统计学工具采用单因素和多因素分析2021年8月-2022年8月在 我院进行手术的450例患者压力性损伤的发生情况及危险因素。结果 本研究共纳入450例患者,其中16例 发生压力性损伤,发生率为3.55%;单因素分析显示不同性别、术中低血压压力性损伤发生率比较,差 异无统计学意义（P＞0.05）;不同年龄、BMI、手术体位、麻醉时间、手术时间、术前压力性损伤风 险评分（waterlow）、术中出血量、手术体位固定装置、合并症、手术分类压力性损伤发生率比较, 差异有统计学意义（P＜0.05）;经变量赋值后多因素分析结果显示有9个独立性危险因素：①年龄＞ 70岁;②BMI≥27 kg/m2 ;③术中失血量＞80 ml;④术前压力性损伤评分（waterlow）＞14分;⑤麻醉时 间＞3 h;⑥手术时间＞3 h;⑦合并营养不良;⑧合并水肿;⑨手术体位固定装置。结论 受患者自身、手 术、麻醉等多方因素导致围手术期手术患者压力性损伤发生率高,应针对性开展有效的护理措施,以降低 手术室压力性损伤的发生风险。     

医源性肝外胆管横断性损伤的防治

我院外科 2 4年间共发生横断性胆管损伤 1 0例 ,经过及时有效的处理 ,均取得了满意的效果。1 .临床资料 :1 978年～ 2 0 0 1年共施行胆囊切除术 3 594例 ,其中横断性胆管损伤 1 0例 (0 2 8% )。 1 0例中 ,男 6例 ,女 4例。平均年龄 52岁 (37～ 67岁 )。1 0例均为胆囊炎胆石症行手术治疗的患者 ,术中误伤胆管。胆管损伤发现时间 :7例术中发现 ;1例术后 1d发现 ,另2例分别在术后 1 4d和 1 8d明确诊断。1 0例中 ,胆管周围严重粘连 3例 ;胆管畸形 2例。损伤部位 :左右肝管汇合部 3例 ;总肝管 5例 ;总胆管 2例。所有胆囊切除患者均行常规术中胆…     

骨科患者术中压力性损伤发生情况及危险因素研究

目的了解骨科患者术中压力性损伤发生情况,并分析其危险因素,为骨科术中压力性损伤的预防提供依据。方法选择骨科手术患者1 516例,记录患者术中压力性损伤发生情况,采用自设的骨科手术患者压力性损伤危险因素调查表收集资料。结果骨科患者术中压力性损伤发生率为9.56%。Logistic回归分析显示,术前感知能力(OR=3.970)、术前活动能力(OR=2.315)、压力性损伤病史(OR=41.230)、手术时长(OR=62.846)、使用骨科医疗器具(OR=28.586)、手术体位(俯卧/牵引位/半坐卧位/半截石位)(OR=6.059)、术中体温降低(OR=5.973)、敲击(OR=2.128)、牵引(OR=1.777)是压力性损伤发生的危险因素。结论骨科患者术中压力性损伤涉及自身和手术多种危险因素,应通过全面的危险因素评估,及早采取预防措施,降低术中压力性损伤的发生。     

腹腔镜胆囊切除术中右肝动脉损伤5例处理体会

目的探讨腹腔镜胆囊切除术(LC)中引起右肝动脉损伤的原因及诊断和处理方法。方法对我院2000年1月至2013年12月行腹腔镜胆囊切除术6 000余例中5例发生右肝动脉损伤的患者资料进行回顾性分析。结果本组5例,均为术中发现并及时进行处理。术后2例感觉肝区轻微胀痛不适;1例发生低热,但数天后就很快消失。术后2~3 d抽血行肝脏功能检查,均示有不同程度的肝功能损害的发生,但术后1个月内复查均全部恢复正常。1例胆道支撑的T管于术后6个月后拔除。所有病例术后均获随访6~24个月以上(平均20.4个月),均恢复良好,无并发症的发生。结论在LC术中发生右肝动脉的损伤,往往是多种因素共同导致的结果。术中发现、诊断并及时处理是最为常见的方式。对于具体的处理方式,应根据损伤的部位、类型、设备及技术条件、局部组织条件、术前肝脏功能状况、有无合并胆管损伤及胆管损伤的部位等来进行个体化的选择。     

1期压力性损伤预后影响因素分析

目的分析1期压力性损伤预后的现状及影响因素,为压力性损伤干预提供参考。方法对91例医院获得1期压力性损伤患者的人口学资料和压力性损伤情况(资料收集终点为痊愈或患者出院/死亡)进行归类分析。结果痊愈51例(56.04%)、持续1期状态29例(31.87%)、进展至2期或3期11例(12.09%)。不同预后患者的年龄、Braden评分、跌倒/坠床评分、发生部位比较,差异有统计学意义(P0.05,P0.01)。结论 1期压力性损伤的预后受上述4项因素影响,应采取针对性防治措施,控制危害性因素,避免压力性损伤的发生。     

术中压力性损伤患者围手术期特征的回顾性分析

目的 分析发生术中压力性损伤患者的围手术期特征。 方法 回顾性调查48 398例手术患者,发生术中压力性损伤的219例患者作为病例组,匹配438例未发生压力性损伤的患者为对照组,比较两组患者的围手术期特征。 结果 回归分析结果显示,体质量较高（OR=1.086）、术前Braden评分＜23分（OR=4.600）、术前白蛋白异常（OR=3.896）、麻醉时长延长（OR=1.009）是手术患者术中压力性损伤的危险因素。术中压力性损伤患者术后住院天数、总住院天数及术后并发症显著高于对照组（P＜0.05,P＜0.01）。 结论 护理人员应评估围手术期患者体质量、术前Braden评分、术前白蛋白及麻醉时长,积极预防术中压力性损伤,同时关注术中压力性损伤患者的术后并发症风险。     

重症脑卒中患者压力性损伤发生特征及影响因素分析

目的了解重症脑卒中患者压力性损伤发生特征并分析影响因素,为临床防治提供依据。方法回顾性选择上报的院内获得性压力性损伤重症脑卒中患者308例为病例组,以性别进行1∶1匹配,选取同期住院的308例未发生压力性损伤患者为对照组,进行多因素Logistic回归分析探讨影响因素。结果 3 573例重症脑卒中患者发生压力性损伤308例,压力性损伤发生率为8.62%;压力性损伤发生部位骶尾部最多(占33.97%),分期以1期为主(占55.49%)。住院时间、空腹血糖6.1 mmol/L、留置导管、机械通气、发热、贫血、瘫痪、大小便失禁是重症脑卒中患者压力性损伤的独立危险因素,而营养支持、使用气垫床、使用预防性敷料是保护因素(P0.05,P0.01)。结论应针对重症脑卒中患者压力性损伤危险因素采取针对性预防措施,并加强营养,预防性使用保护器具,以降低压力性损伤的发生。     

颈椎挥鞭样损伤的致伤机制研究进展

随着人们生活水平的提高,汽车等交通工具已成为日常生活中不可或缺的代步工具。随之而来的交通伤不断增加,挥鞭样损伤的发生率也呈不断增长的趋势。在追尾事故中,颈椎挥鞭样损伤的发生率可达38％。英国因挥鞭样损伤造成的经济损失每年多达36．4亿英镑,     

Breathlessness in spinal cord injury depends on injury level

Little is known about the prevalence and predictors of breathlessness in individuals with neurologically complete chronic spinal cord injury (SCI). Between December 1992 and September 1993, we mailed a respiratory questionnaire to 1,147 community-based individuals with chronic SCI. The questionnaire included four questions about the presence of breathlessness during activities related to moving about. Of the 485 who replied (42 percent response rate), analysis was limited to adult males with neurologically complete motor injuries who reported using a hand-propelled wheelchair more than 50 percent of the time to get around. Of 130 subjects (33 tetraplegics, 53 high thoracic SCI, 44 lower injury levels), the patients with tetraplegia reported breathlessness more frequently (range for the four questions, 21-33%) than those with high thoracic (range, 9-15%) or lower injury levels (range, 2-11%). For each of the four questions there was a significant trend (p < 0.05) for subjects with higher levels of injury to report the greatest prevalence of breathlessness (tetraplegia > high thoracic > lower). The frequency of breathlessness was greatest in those with neurologically complete cervical injuries, an effect that was independent of obesity, smoking, age, and years since SCI. The mechanisms of breathlessness in SCI are unclear but elucidation might lead to strategies for providing relief.     

Mild traumatic brain injury and diffuse axonal injury in swine

Until recently, mild traumatic brain injury (mTBI) or "concussion" was generally ignored as a major health issue. However, emerging evidence suggests that this injury is by no means mild, considering it induces persisting neurocognitive dysfunction in many individuals. Although little is known about the pathophysiological aspects of mTBI, there is growing opinion that diffuse axonal injury (DAI) may play a key role. To explore this possibility, we adapted a model of head rotational acceleration in swine to produce mTBI by scaling the mechanical loading conditions based on available biomechanical data on concussion thresholds in humans. Using these input parameters, head rotational acceleration was induced in either the axial plane (transverse to the brainstem; n=3), causing a 10- to 35-min loss of consciousness, or coronal plane (circumferential to the brainstem; n=2), which did not produce a sustained loss of consciousness. Seven days following injury, immunohistochemical analyses of the brains revealed that both planes of head rotation induced extensive axonal pathology throughout the white matter, characterized as swollen axonal bulbs or varicosities that were immunoreactive for accumulating neurofilament protein. However, the distribution of the axonal pathology was different between planes of head rotation. In particular, more swollen axonal profiles were observed in the brainstems of animals injured in the axial plane, suggesting an anatomic substrate for prolonged loss of consciousness in mTBI. Overall, these data support DAI as an important pathological feature of mTBI, and demonstrate that surprisingly overt axonal pathology may be present, even in cases without a sustained loss of consciousness.     

Secondary injury in traumatic brain injury patients--a prospective study.

OBJECTIVE: Secondary insults of hypotension and hypoxia significantly impact on outcome in patients with traumatic brain injury (TBI). More than 4 hours' delay in evacuation of intracranial haematomas has been demonstrated to have an additional impact on outcome. The objective of this study was to document the incidence of these preventable secondary insults in patients admitted with moderate or severe brain injury. METHODOLOGY: All moderate and severe head injury patients admitted to Groote Schuur Hospital over a 3-month period were studied prospectively. Data were obtained from ambulance dockets, referral letters, patient charts and attending medical staff. Preventable secondary insults (hypotension, hypoxia) and time delay to assessment and surgery were documented. Outcome was assessed using the Glasgow outcome scale (GOS) at discharge or outpatient follow-up. RESULTS: Ninety-six patients were studied. Forty-nine patients experienced at least one recorded preventable event of hypoxia or hypotension. Seventeen had an intracranial haematoma requiring evacuation. The mean time interval between injury and surgery was 455 minutes. No haematoma was evacuated within 4 hours of injury. Patients referred via a primary or secondary care facility experienced a mean additional delay of 70 minutes. These results demonstrated a significant incidence of secondary injury and delay to assessment and surgery. We believe that education and a raised awareness of the impact of secondary insults may have a positive impact on TBI outcome in our referral area.     

急性脊髓损伤中继发性损伤的治疗进展

急性脊髓损伤（ａｃｕｔｅｓｐｉｎａｌｃｏｒｄｉｎｊｕｒｙ,ＡＳＣＩ）是致残率很高的疾病。如何采取更有效的措施降低脊髓损伤患者的致残率,提高治愈率,减轻患者痛苦,提高其生活质量,成为骨科界面临的主要课题之一。随着ＣＴ和ＭＲＩ等现代影像技术及电生理技术的应用,以及近２０年来大量针对ＡＳＣＩ病理生理机制的研究,使得ＡＳＣＩ损伤机制的理论及治疗方法不断丰富和发展。作者就ＡＳＣＩ中继发性损伤的治疗及进展作一综述。１　继发性损伤的机制Ａｌｌｅｎ早在１９１１年就首次提出了二期损伤理论,将急性脊髓损伤分为原发性…