External application of potato slices to lateral episiotomy cut

目的 观察新鲜马铃薯片外敷促进会阴切口愈合的临床效果.方法 将住院行会阴侧切术的产妇196例随机分为对照组与观察组各98例.观察组每天采用0.1％碘伏擦洗切口后用新鲜马铃薯片外敷切口,每日2次；对照组每天采用0.1％碘伏擦洗切口2次.结果 观察组会阴切口愈合情况显著优于对照组,会阴切口处肿胀及疼痛消退时间显著短于对照组(均P＜0.01).结论 使用自制马铃薯薄片贴敷会阴切口能有效加速肿胀及疼痛消退,促进会阴切口愈合.     

马铃薯片外敷促进会阴切口愈合的效果观察

目的观察新鲜马铃薯片外敷促进会阴切口愈合的临床效果。方法将住院行会阴侧切术的产妇196例随机分为对照组与观察组各98例。观察组每天采用0.1%碘伏擦洗切口后用新鲜马铃薯片外敷切口,每日2次;对照组每天采用0.1%碘伏擦洗切口2次。结果观察组会阴切口愈合情况显著优于对照组,会阴切口处肿胀及疼痛消退时间显著短于对照组(均P<0.01)。结论使用自制马铃薯薄片贴敷会阴切口能有效加速肿胀及疼痛消退,促进会阴切口愈合。     

甲硝唑与庆大霉素预防宫颈癌根治术后尿路感染的临床观察

目的探讨0.5%甲硝唑、庆大霉素加入0.9%氯化钠溶液膀胱冲洗预防宫颈癌术后留置尿管感染的临床效果.方法宫颈癌(Ⅰ b～Ⅱa期)根治术后留置尿管患者97例,随机分为观察组(49例)和对照组(48例),观察组术后用0.5%碘伏棉球会阴擦洗,2次/d,并于第5天开始每天上午予0.5%甲硝唑0.5g、下午予庆大霉素16万U膀胱冲洗;对照组术后用0.1%苯扎溴铵棉球会阴擦洗,2次/d,并于第5天开始予0.02%呋喃西林250 ml膀胱冲洗,2次/d.观察两组患者置尿管后3、7、10 d中段尿培养细菌阳性率.结果观察组置尿管后3、7、10 d尿路感染率显著低于对照组(P＜0.05,P＜0.01).结论甲硝唑与庆大霉素膀胱冲洗可以有效预防或减少宫颈癌根治术后留置尿管患者尿路感染的发生.     

高渗盐水湿敷联合红外线照射治疗产后会阴水肿疗效观察

目的 提高产后会阴水肿治疗效果.方法 将120例侧切会阴水肿的产妇随机分为对照组和观察组各60例,对照组采用0.5%碘伏消毒后用0.5%碘伏纱布湿敷.观察组采用0.5%碘伏消毒后用高渗盐水纱布湿敷,湿敷第2天均辅以红外线照射.结果 两组均100%痊愈,观察组治愈时间显著短于对照组(P<0.01).结论 用高渗盐水纱布湿敷治疗会阴水肿可显著缩短疗程.     

碘伏联合过氧化氢溶液口腔护理预防重型颅脑损伤患者并发肺部感染

目的探讨应用碘伏联合过氧化氢溶液进行口腔护理预防重型颅脑损伤患者并发肺部感染的效果。方法将158例重型颅脑损伤患者按Glasgow昏迷评分相同分为两组各79例。观察组采用0.05%碘伏进行口腔擦洗,2次/d,当评估口腔内有血痂或痰痂时,先用0.5%过氧化氢溶液湿润血痂或痰痂,再使用碘伏进行口腔擦洗;对照组采用0.02%醋酸氯己定溶液口腔擦洗,2次/d。结果口腔干预后第8天观察组咽拭子和痰标本细菌培养阳性率以及肺部感染发生率显著低于对照组(均P<0.05)。结论应用0.05%碘伏必要时加用0.5%过氧化氢溶液为重型颅脑损伤患者进行口腔护理能有效消除口咽部致病菌,降低肺部感染发生率。     

社区皮肤擦伤患者创面处理方法探讨

目的探讨效果好、经济、简单、方便的社区皮肤擦伤处理方法.方法将148例(180处创面)皮肤擦伤患者随机分为A、B、C三组各60处.经常规清创处理后,A组采用0.25%碘伏外涂,4～5次/d;B组采用0.25%碘伏涂搽后,用"优拓"覆盖创面,再加盖无菌敷料,胶布固定,每日更换1次;C组采用0.25%碘伏涂搽后,用无菌干纱块覆盖,胶布固定,每日换药1次.结果A组、B组创面愈合时间显著短于C组(均P＜0.01).A组胶布过敏、创面感染率为0,且费用显著低于B组和C组(均P＜0.01).结论社区皮肤擦伤患者创面采用0.25%碘伏涂搽疗效好,且经济、简单、方便.     

高渗盐水湿敷联合红外线照射治疗产后会阴水肿疗效观察

目的提高产后会阴水肿治疗效果。方法将120例侧切会阴水肿的产妇随机分为对照组和观察组各60例,对照组采用0.5%碘伏消毒后用0.5%碘伏纱布湿敷,观察组采用0.5%碘伏消毒后用高渗盐水纱布湿敷,湿敷第2天均辅以红外线照射。结果两组均100%痊愈,观察组治愈时间显著短于对照组（P〈0.01）。结论用高渗盐水纱布湿敷治疗会阴水肿可显著缩短疗程。     

活力碘喷雾消毒产妇会阴切口的观察

产妇会阴侧切后常规采用5％活力碘棉球擦洗法消毒会阴切口。我科1997年8—9月采用5％活力碘喷雾法消毒会阴切口，效果与常规法无差异，并具有操作简便、节省用物等优点，现报告如下。1临床资料及方法在我院分娩且有会阴切口的产妇100例，缝合方法一致，产程时间、产后出血量等均在正常范围内，产前均无感染。随机分观察组与对照组各50例。自产后第1d开始，观察组用活力碘喷雾法，对照组用活力碘棉球擦洗法消毒会阴切口，消毒前均用温水洗净外阴，每日早晚各1次，连续sdo第2、5d早上擦洗后取样作细菌培养。观察组病人取仰卧位，两腿曲膝略外…     

三种冲洗液用于产妇会阴冲洗效果的研究

目的 探讨0.2％碘伏、肤疾洗剂、温开水三种洗液用于产妇会阴冲洗的效果.方法 将150例有会阴伤口的产妇随机分为三组各50例.分别用0.2％碘伏、肤疾洗剂、温开水每日冲洗会阴2次,比较三组伤口甲级愈合率、皮肤采样的结果、患者疼痛程度.结果 三组疼痛程度比较,差异有统计学意义(P＜0.01);伤口甲级愈合、冲洗后即刻皮肤细菌及霉菌检出率无统计学差异(均P＞0.05);冲洗后3h,伤口皮肤细菌检出率差异有统计学意义(P＜0.01).结论 碘伏、肤疾洗剂或温开水均有较好的抑菌作用,温开水取材方便、患者舒适度高,可作为产妇会阴冲洗的首选.     

社区皮肤擦伤患者创面处理方法探讨

目的 探讨效果好、经济、简单、方便的社区皮肤擦伤处理方法。方法 将148例（180处创面）皮肤擦伤患者随机分为A、B、C三组各60处。经常规清创处理后，A组采用0．25％碘伏外涂，4～5次／d；B组采用0．25％碘伏涂搽后，用“优拓”覆盖创面，再加盖无菌敷料，胶布固定，每日更换1次；C组采用0．25％碘伏涂搽后，用无菌干纱块覆盖，胶布固定，每日换药1次。结果 A组、B组创面愈合时间显著短于C组（均P〈O．01）。A组胶布过敏、创面感染率为0，且费用显著低于B组和C组（均P〈O．01）。结论 社区皮肤擦伤患者创面采用0．25％碘伏涂搽疗效好，且经济、简单、方便。     

Different episiotomy techniques, postpartum perineal pain, and blood loss: an observational study

Introduction and hypothesis

The lateral episiotomy technique has been postulated to cause more postpartum perineal pain and blood loss compared to the midline and mediolateral episiotomy technique. The aim of the study was to explore the association with postpartum perineal pain and blood loss between different episiotomy techniques.

Methods

Clinical evaluation of episiotomy was performed 0–3 days after delivery on 300 participating women. Episiotomy technique was classified by millimeter distance from the incision point to the posterior fourchette and by angle from the sagittal plane in degrees. Postpartum perineal pain was scored on a visual analogue scale (VAS) the first day after delivery. Blood loss data were collected from medical charts. Different episiotomy techniques and different episiotomy incision point groups were compared in relation to perineal pain perception and blood loss.

Results

We found no difference between midline, mediolateral, and lateral episiotomy techniques in perineal pain perception the first postpartum day (p?=?0.74) or in estimated blood loss (p?=?0.38). No differences were found in perineal pain or blood loss between midline and lateral incision points. Mediolateral angles were significantly narrower than lateral angles (p?<?0.005). Physicians performed longer episiotomies than midwives (p?<?0.005), but episiotomy angle did not vary between professions (p?=?0.075).

Conclusions

No differences in perineal pain perception the first postpartum day and no differences in estimated blood loss were found when comparing different episiotomy techniques or when comparing midline and lateral incision points.     

Effect of different episiotomy techniques on perineal pain and sexual activity 3 months after delivery

Introduction and hypothesis

The effect of different episiotomy techniques on pain perception 3 months after delivery is unknown. Study aims were to explore the association between different episiotomy techniques and perineal pain 3 months after delivery and to assess female sexual activity in relation to episiotomy technique.

Methods

This is a prospective observational study, designed to investigate short- and long-term complications of different episiotomy techniques. All 300 participants were recruited and clinically examined during their postpartum hospital stay in order to evaluate episiotomy performance. A 3-month follow-up questionnaire addressing pain, sexual activity, and puerperal wound infection was distributed to 208 women who had scored perineal pain in a personal interview the first day after delivery.

Results

A response rate of 87.7 % was obtained. We found no difference in pain score distribution by Visual Analogue Scale (VAS) when comparing midline, mediolateral, and lateral episiotomy techniques (p?=?0.32) or between midline and lateral incision points (p?=?0.58). Dyspareunia was reported by 33 out of 179 women, but no difference between episiotomy techniques (p?=?0.90), or between episiotomy incision points (p?=?0.14), was found. Perineal wound infection was reported by 9.5 %, but there was no significant difference between episiotomy techniques (p?=?0.73).

Conclusions

No difference was found in perineal pain perception 3 months postpartum between different episiotomy techniques or when comparing midline and lateral incision points. Dyspareunia was not associated with any particular episiotomy technique or incision point.     

产妇会阴侧切术后切口感染病原菌分布及相关因素

目的探讨产妇会阴侧切术后切口感染病原菌的分布特征,分析影响产妇会阴侧切切口感染的危险因素,为会阴侧切切口感染的防治提供依据。 方法选择2014年3月至2018年10月重庆市开州区人民医院产科收治的461例会阴侧切产妇为研究对象进行回顾性分析,依据细菌培养结果分为感染组（46例）和未感染组（415例）。统计会阴侧切后切口感染病原菌种类和构成比,采用Logistic非条件回归分析产妇会阴侧切切口感染的危险因素。 结果入组产妇会阴侧切切口感染率为9.98%（46/461）;共检出菌株43株,其中革兰阴性菌占53.49%（23/43）,革兰阳性菌占39.53%（17/43）。大肠埃希菌和表皮葡萄球菌为会阴侧切切口感染主要致病菌,检出率分别为25.58%和23.26%。54.35%（25/46）产妇存在两种或两种以上病原菌感染。单因素分析结果显示,产妇会阴侧切术后切口感染与产妇BMI、阴道产检次数、胎膜早破、产程、切口长度、助产士工作年限、术后住院时间、妊娠期合并糖尿病、生殖道感染有关（P均< 0.05）,而与产妇年龄、是否为初产妇、是否急诊分娩无关（P均> 0.05）。Logistic回归分析结果显示,产妇BMI （OR = 2.282、95%CI：1.958～8.265、P < 0.001）、阴道产检次数（OR = 1.855、95%CI：1.065～4.682、P = 0.002）、胎膜早破（OR = 2.085、95%CI：1.730～7.165、P < 0.001）、生殖道感染（OR = 2.732、95%CI：2.015～10.562、P = 0.015）、妊娠期合并糖尿病（OR = 3.337、95%CI：2.356～12.526、P < 0.001）、产程（OR = 1.714、95%CI：1.305～4.928、P < 0.001）均为产妇会阴侧切切口感染的独立危险因素。 结论受多种因素影响,产妇会阴侧切切口感染发生率较高,大肠埃希菌和表皮葡萄球菌为主要致病菌。临床应对增加切口感染发生率的危险因素采取针对性措施进行干预,以降低会阴侧切术后切口感染的发生。     

皮下美容缝合法在会阴侧切中的应用

目的 探讨皮下美容缝合法在会阴侧切中的效果。方法 选取2023年3月-2024年2月句容市人民医 院分娩产妇368例,利用随机数字表法将产妇分为对照组（184例）与观察组（184例）。对照组予以会阴 侧切缝合术,观察组予以皮下美容缝合法,比较两组缝合时间及缝合后肿胀评分、疼痛评分、线结情况 和切口愈合情况。结果 观察组缝合时间短于对照组,术后第1、2、3天肿胀评分及疼痛评分均低于对照 组（P＜0.05）;两组均无3度情况,观察组0度占比高于对照组,1度及2度占比低于对照组（P＜0.05）;观 察组切口愈合程度高于对照组（P＜0.05）。结论 皮下美容缝合法不仅可以缩短会阴侧切后的缝合时间, 还可缓解患者疼痛,促进切口的愈合,具有较高的临床意义。     

PDCA模式对初产妇会阴侧切率及会阴切口美观性影响

分析PDCA模式护理对初产妇会阴侧切率及切口美观性的影响。方法 选取2022年4月-2023年 1月南京医科大学附属妇产医院/南京市妇幼保健院收治的正常分娩产妇86例为研究对象，依据随机数字表 法分为对照组和观察组，每组43例。对照组予以常规护理，观察予以PDCA模式护理，比较两组会阴侧切 率、会阴切口美观性、生活能力评分（ADL）。结果 观察组会阴侧切率为13.95%，低于对照组的23.26%， 差异有统计学意义（P ＜0.05）；观察组会阴切口美观率为95.35%，高于对照组的81.40%，差异有统计学意 义（P ＜0.05）；观察组干预后ADL评分为（94.31±4.22）分，高于对照组的（83.13±4.60）分，差异有统 计学意义（P＜0.05）。结论 PDCA模式护理能够有效地降低初产妇分娩过程中的会阴侧切率，提升会阴切 口的美观性和生活能力，值得临床应用。     

会阴侧切皮下美容缝合术联合综合护理干预对产后切口愈合的影响

目的 探讨会阴侧切皮下美容缝合术联合综合护理干预对产后切口愈合影响。方法 选取2022年 10月-2023年3月我院收治的74例会阴侧切初产妇作为研究对象，以随机数字表法分为观察组和对照组，对 照组应用会阴侧切皮下美容缝合术联合常规护理，观察组应用会阴侧切皮下美容缝合术联合综合护理干 预，比较两组切口美观度、总产程时间、切口愈合时间及线结反应情况。结果 观察组VSS各项评分均低于 对照组（P＜0.05）；观察组总产程时间、切口愈合时间、疼痛程度均优于对照组（P＜0.05）；观察组线 结反应程度优于对照组（P＜0.05）。结论 会阴侧切皮下美容缝合术联合综合护理干预可有效改善切口美 观度，减轻线结反应，有利于缩短总产程时间及切口愈合时间，促进产后恢复。     

皮下美容缝合法在会阴侧切中的应用效果

目的 探究美容缝合法对会阴侧切愈合以及切口的影响。方法 选取2022年4月-2023年3月于我 院行会阴侧切术的60例产妇作为研究对象，随机分为对照组（n=30，会阴外缝合技术）及观察组（n=30， 皮下美容缝合法），比较两组产妇切口愈合情况、手术指标、切口肿胀程度、线结反应、疼痛程度、美 观满意度及切口感染情况。结果 观察组切口甲级愈合占比多于对照组（P＜0.05）；观察组平均出血 量、手术缝合时间少于对照组（P＜0.05）；观察组切口肿胀程度低于对照组（P＜0.05）；术后第3天， 观察组0度线结反应占比高于对照组，2度线结反应占比低于对照组（P＜0.05）；观察组VAS评分低于 对照组（P＜0.05）；观察组美观满意度评分高于对照组（P＜0.05）；观察组切口感染发生率低于对照组 （P＜0.05）。结论 行会阴侧切术时采用皮下美容缝合法，可获得较理想的切口愈合效果，具备舒适、操 作简单与美观等优势，值得临床应用。     

会阴侧切术中不同侧切角度及缝合方法的比较分析

目的：比较会阴侧切术中不同侧切角度及缝合方法的优劣。方法选取2009年2月～2012年1月于我院妇产科实施会阴侧切术的初产妇300例,按照随机分配原则,将患者分为观察组（158例）与对照组（142例）：观察组行30°会阴切开,切口内可吸收缝合线皮内连续缝合方法;对照组行45°会阴切开,采用传统皮外缝合方法。比较两组患者切口愈合、住院时间、切口疼痛等情况。结果观察组与对照组切口愈合率分别为94.94%（150/158）、83.09%（118/142）,两组比较差异显著（P＜0.05）;观察组住院时间、切口疼痛程度与对照组比较均具有统计学差异性（P＜0.05）。结论30°会阴侧切内可吸收缝合线皮内连续缝合方法用于手术缝合中,与传统45°会阴切开皮外缝合方法比较,其切口愈合率高、住院时间短、疼痛程度较轻,值得广泛应用于临床。     

自制手套与常规腹腔镜器械行单孔腹腔镜阑尾切除术的学习曲线分析

目的:评估单孔腹腔镜阑尾切除术(SILA)的学习曲线.方法:纳入2016年9月至2018年9月确诊为急性阑尾炎的79例急腹症患者,由同一位外科医生行SILA,按时间顺序,患者共分为A组(n=24)、B组(n=26)、C组(n=29).比较每组手术时间、术后进食时间、住院时间、术后并发症等指标.结果:79例患者均无中转开...     

Activity of the descending noradrenergic pathway after surgery in rats

Background: Previous studies have shown that activation of the descending noradrenergic inhibition pathway results in analgesia after surgery. However, the time course of activity of the descending noradrenergic pathway after surgery has not been examined previously. Here, we investigated the spinal release of noradrenaline (NA) in the post‐operative period in a freely moving rat model of incisional pain. Methods: Loop microdialysis catheters were implanted subarachnoidally via the atlanto‐occipital membrane in Sprague–Dawley rats. Twelve healthy rats without neural deficits were divided into two groups, Group A and Group B, following 5 days of recovery. A plantar incision in the right hind paws of rats in Group A was performed under 1.2% isoflurane. All rats in Group B were only anesthetized by 1.2% isoflurane for the same duration. The microdialysate samples for NA determination were collected before anesthesia, 3 h and 1, 2 and 3 days after incision (or isoflurane anesthesia in Group B) in both groups. The cumulative pain scores were assessed at the above time points. Results: The spinal release of NA increased gradually, peaked at 2 days after the incision and remained at the peak level up to the third day after the incision. The cumulative pain scores peaked 3 h after the incision, and gradually decreased afterwards and returned to the baseline values 3 days after the incision. Conclusions: The descending NA tone might be apparently more active in the post‐operative period. The descending noradrenergic inhibitory pathway plays an important role in post‐operative neuroplasticity.