坏疽或穿孔型阑尾炎手术患者腹腔引流预防切口感染的效果观察

目的 观察坏疽或穿孔型阑尾炎手术患者腹腔引流预防切口感染的效果,探讨腹腔引流在坏疽或穿孔型阑尾炎手术治疗中的应用价值.方法 将100例坏疽或穿孔型阑尾炎患者随机分为观察组和对照组各50例,均行阑尾切除治疗,观察组行腹腔引流,对照组不予腹腔引流,对比观察术后两组并发症发生情况.结果两组均手术顺利,成功切除阑尾;观察组手术时间为(37.1±10.2)min、术中出血量为(50.2±11.2)ml,对照组为(37.4±11.3)min、(49.2±10.9)ml,两组手术时间、术中出血量比较,差异无统计学意义;观察组术后住院时间为(10.2±2.2)d、对照组为(14.2±3.4)d,两组比较差异有统计学意义(P＜0.05);观察组出现切口感染1例、对照组4例,两组比较差异有统计学意义(P＜0.05);观察组出现肠瘘1例、对照组0例,两组比较差异无统计学意义;两组均未发生盆腔脓肿、腹腔内出血、阑尾残株炎、盲肠壁脓肿、肠梗阻、门静脉炎、肝脓肿等严重并发症.结论 坏疽或穿孔型阑尾炎手术患者实施腹腔引流,可显著减少切口感染的发生率.     

微创PFNA内固定与人工股骨头置换术治疗高龄股骨转子间骨折的临床对比研究

目的 探讨比较微创PFNA内固定与人工股骨头置换术治疗高龄股骨转子间骨折的临床疗效.方法 选择100例高龄股骨转子间骨折患者,按就诊时间先后顺序随机分为微创PFNA内固定治疗组(观察组)和人工股骨头置换术治疗组(对照组),每组50例.比较两组手术时间、术中出血量、术后下地负重行走时间、功能评分和术后并发症发生情况.结果 观察组感染1例,髋内翻2例,内固定松动2例;对照组感染1例,髋内翻3例,内固定松动1例,两组并发症比较差异无统计学意义(P＞0.05).观察组手术时间、术中出血量、术后下地负重行走时间分别为(32.79±5.48) min、(140±46) ml、(3.56±0.78)d,显著低于对照组的(54.05±9.71) min、(325±74) ml、(6.31±1.48)d,差异有统计学意义(P＜0.05).观察组术前Harris评分为(92.51±6.78)分,对照组为(92.38±6.59)分,两组比较差异无统计学意义(P＞0.05);观察组术后Harris评分为(70.63±5.31)分,对照组为(83.29±5.62)分,两组比较差异有统计学意义(t=12.369,P＜ 0.05).观察组和对照组术后Harris评分与术前比较差异均有统计学意义(t=11.276、12.902,P＜ 0.05).结论 对于高龄股骨转子间骨折患者,两种手术方式均可获得满意的临床疗效,微创PFNA内固定在缩短手术时间、减少术中出血量、改善功能和早期负重方面优于人工股骨头置换术.     

股骨近端抗旋转髓内钉治疗老年股骨转子间骨折疗效分析

目的 探讨股骨近端抗旋转髓内钉(PFNA)治疗老年股骨转子间骨折(ITF)的临床疗效.方法 106例老年ITF患者按随机数字表法分为观察组和对照组,每组53例.对照组采用动力髋螺钉内固定治疗,观察组采用PFNA内固定治疗.观察两组髋关节功能恢复情况,术中出血量、手术时间、骨折愈合时间、切口愈合时间、并发症发生情况.结果 观察组术后髋关节功能Kuderna 评分优31例,良20例,可2例,优良率为96.2％(51/53);对照组优28例,良14例,可11例,优良率为79.2％(42/53),两组优良率比较差异有统计学意义(P＜0.05).观察组术中出血量、手术时间、骨折愈合时间均少于对照组[(318.29±74.26)ml比(425.16±82.52)ml、(47.45±12.57) min比(61.99±13.62) min、(6.77±1.16)周比(8.28±1.27)周],差异有统计学意义(P＜0.05);两组患者切口愈合时间比较差异无统计学意义(P＞0.05).对照组11例患者术后发生不同程度的髋关节功能障碍,观察组仅2例,两组比较差异有统计学意义(P＜0.05).结论 采用PFNA治疗老年ITF,可以明显提高术后髋关节功能恢复情况,减少术中出血量、手术时间和骨折愈合时间,值得在临床中推广使用.     

普通吸引器刮吸法在肝切除术中的应用

目的 探讨普通吸引器刮吸法切肝在临床应用中的可行性.方法 回顾性分析80例肝切除术患者的临床资料,普通吸引器刮吸法切肝45例(刮吸法组),指捏法切肝35例(指捏法组),比较两组术中出血量、手术时间及肝门阻断时间、术后并发症和住院时间.结果 刮吸法组术中出血量(282±160)ml,住院时间(7±5)d;指捏法组术中出血量(410±220)ml,住院时间(14±12)d,两组比较差异有统计学意义(P＜0.05或＜0.01).指捏法组术后并发出血3例,胸腹水4例,肝功能衰竭4例,感染7例;而刮吸法组仅1例发生感染.手术时间及肝门阻断时间差异无统计学意义.结论 吸引器刮吸法切肝优于常用的指捏法切肝,是临床值得推广的一种切肝方法.     

腹腔镜下行胃十二指肠穿孔修补术的临床疗效分析

目的 探讨腹腔镜下行胃十二指肠穿孔修补术的临床疗效.方法 回顾性分析2009年1月至2010年12月行胃十二指肠穿孔修补术300例患者的临床资料,采用随机机械抽样法分为腹腔镜组和开腹组,每组150例,比较两组手术时间、术中出血量、术后排气时间、切口感染情况及住院时间.结果 腹腔镜组手术时间[(51.5±7.9)min]、术中出血量[(10.0±3.1)ml]、术后排气时间[(30.3±8.4)h]及住院时间[(5.4±2.0)d]均明显优于开腹组[分别为(79.6±16.4)min、(50.3±16.5)ml、(57.8±20.1)h、(10.5±3.2)d],差异有统计学意义(P＜0.05).腹腔镜组术后未出现切口感染的病例,开腹组有19例患者出现切口感染,差异有统计学意义(P＜0.05).结论 腹腔镜下修补胃十二指肠穿孔的疗效优于开腹术,可在临床中推广应用.     

肝癌患者术后肺部感染的危险因素分析

目的 分析肝癌手术患者术后肺部感染的危险因素,探讨防治该类感染发生的措施.方法 选取210例行手术治疗的肝癌患者为观察对象,根据是否并发肺部感染进行分组比较相关指标,探讨肝癌患者术后并发肺部感染的相关危险因素.结果 并发肺部感染组患者既往吸烟患者占42.55％,既往慢性呼吸道疾病史患者占53.19％,术前低蛋白血症患者占23.40％,术前进行深静脉穿刺患者占36.17％,均高于未并发肺部感染组,比较差异有统计学意义(P＜0.05);并发肺部感染组术后使用镇痛泵患者占21.28％,低于未并发肺部感染组,比较差异有统计学意义(P＜0.05);并发肺部感染组患者术前住院时间为(7.2±1.4)d,手术时间为(186.4±32.5)min,术中气管插管时间(162.1±17.8)min,术中出血量为(1264.8±150.7)ml,术后留置鼻胃管时间为(12.5±4.5)d,术后呼吸机使用时间为(4.5±2.4)d,均大于未并发肺部感染组,差异有统计学意义(P＜0.05).结论 既往吸烟史、慢性肺部疾病史、术前低蛋白血症、术前住院时间较长、术前进行深静脉穿刺、手术时间较长、术中气管插管时间较长、术中出血量较大、术后不使用镇痛泵、术后长时间留置鼻胃管时间和使用呼吸机均是肝癌患者术后并发肺部感染的相关危险因素,针对相关危险因素采取相应防治措施有利于减少术后肺部感染的发生.     

电视胸腔镜手术治疗纵隔肿瘤32例临床分析

目的 研究完全电视胸腔镜下手术治疗纵隔肿瘤的围手术期临床效果.方法 回顾性分析完全电视胸腔镜下手术治疗的纵隔肿瘤患者32例(观察组),选取传统开胸手术治疗的纵隔肿瘤患者53例(对照组),比较两组患者在手术时间、术中出血量、引流管留置时间、术后住院天数、术后并发症的发生情况及术后辅助镇痛药物应用情况.结果 两组患者均未发生围手术期死亡.观察组手术时间为(121.9±41.2) min,对照组手术时间为(141.7±35.2)min,两组比较差异无统计学意义(P＞0.05);而观察组在术中出血量[(116.0±53.2)ml]、引流管留置时间[(5.2±1.2)d]、术后住院天数[(8.5±1.3)d]、术后辅助应用镇痛药物的数量[(0.8±0.7)次]、术后并发症发生情况(3例)等方面明显优于对照组[分别为(147.2±45.2) ml、(6.8±2.2)d、(11.2±2.4)d、(2.1±0.9)次、15例],两组比较差异有统计学意义(P＜ 0.05).结论 胸腔镜手术治疗纵隔肿瘤创伤小、术后恢复快、并发症少,在纵隔肿瘤患者的治疗中具有较高的应用价值.     

颈前路椎间盘切除减压融合术与椎体次全切除减压融合术治疗多节段脊髓型颈椎病疗效比较

目的 比较多节段脊髓型颈椎病(病变节段≥3个)采用两种颈前路减压植骨融合术治疗的疗效.方法 选择23例多节段脊髓型颈椎病患者,其中采用颈前路椎间盘切除减压融合术(ACDF)治疗10例(ACDF组),颈前路椎体次全切除减压融合术(ACCF)治疗13例(ACCF组).比较两组患者手术时间、术中出血量、JOA评分、神经功能改善率以及手术前后颈椎曲线深度D值变化量.结果 ACDF组手术时间和术中出血量分别为(130.0±31.5) min、(150.0±120.8) ml,均低于ACCF组的(150.0±42.5) min、(310.0±320.8) ml,差异均有统计学意义(P＜0.05);ACDF组术后颈椎曲线深度D值变化量为(3.1±1.4) mm,高于ACCF组的(2.3±0.9) mm,差异有统计学意义(P＜0.05);ACDF组JOA评分差值和神经功能改善率分别为(4.5±1.6)分、79.3％,ACCF组分别为(4.6±1.2)分、80.2％,两组比较差异无统计学意义(P＞0.05).ACDF组出现脑脊液漏2例,经压迫及引流等治疗后恢复.ACCF组术后14d出现食管瘘并发症1例,经修补后痊愈;出现钛网移位2例,经随访获得融合.结论 ACDF与ACCF治疗多节段脊髓型颈椎病均能取得良好的减压效果,术后疗效良好.ACDF与ACCF比较手术时间短、术中出血量小、保持颈椎生理曲度的效果更优.     

益气活血生肌方配合耳穴压豆法对剖宫产术后感染的预防效果

目的 研究益气活血生肌方配合耳穴压豆法对降低剖宫产术后感染的预防效果,以益气活血生肌方配合耳穴压豆法降低术后感染率.方法 选择2010年3月-2012年3月160例行剖官产术的住院产妇进行研究;按照随机表法分为试验组和对照组,每组各80例;对照组采用传统西药头孢唑林对孕妇进行预防感染,试验组在对照组的基础上,采用益气活血生肌方配合耳穴压豆法对剖宫产术后进行预防感染;术后,对两组患者治疗的临床疗效进行比较分析,记录两组患者治疗的手术时间和术中出血量,并对两组患者术后感染发生进行比较分析.结果 试验组患者治疗的手术时间(37.2±1.3)min与对照组(38.1±1.1)min差异无统计学意义,试验组患者的术中出血量(143.1±1.1)ml与对照组(144.2±1.0)ml差异无统计学意义;术后,对两组患者术后官颈、盆腔、泌尿系感染以及腹部切口愈合不良、发热发生率进行比较分析,试验组患者感染2例,感染率2.50％,对照组感染8例,感染率10.00％,两组比较差异有统计学意义(P＜0.05).结论 益气活血生肌方配合耳穴压豆法对剖宫产术后感染的预防效果良好,明显优于传统西医用药.     

子宫肌瘤剥离器在腹腔镜下阔韧带肌瘤剥除中的应用

目的 探讨子宫肌瘤剥离器在腹腔镜下阔韧带肌瘤剥除中的应用价值.方法 选取住院手术的阔韧带肌瘤患者164例,按随机数字表法分为腹腔镜下应用子宫肌瘤剥离器组(A组)、普通腹腔镜组(B组)、开腹手术组(C组).比较三组患者的手术时间、术中出血量及术后住院时间.结果 A组手术时间为(54 ±9)min,显著少于B、C组的(58±12)、(65±10) min,差异有统计学意义(P＜0.05).A组术中出血量为(36±8)ml,显著少于B、C组的(41±17)、(97±21) ml,差异有统计学意义(P＜0.05).A、B、C组术后住院时间分别为(3.7±1.1)、(3.4±1.4)、(5.6±2.3)d,A组虽稍高于B组,但差异无统计学意义(P＞0.05),A组显著少于C组,差异有统计学意义(P＜0.05).结论 应用子宫肌瘤剥除器在腹腔镜下剥除阔韧带肌瘤,手术时间短,术中出血量少,恢复快,值得推广.     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.