碘酊乙醇棉签擦拭瓶盖的数量及放置时间对消毒效果的影响

目的 探讨2％碘酊、75％乙醇棉签安全消毒瓶盖的数量及消毒后安全放置的时间。方法 将0.9%氯化钠注射液（500ml)180瓶扮为6组，每组30瓶，均用1根碘酊棉签消毒、1根乙醇棉签脱磺，连续消毒6个瓶盖，分别取样行细菌培养。另取同样液体150瓶，分为A、B、C、D、E5组，每组30瓶，1根碘酊、乙醇棉签消毒1个瓶盖，分别于消毒后放置0．5、1、2、4、6min取样行细菌培养。结果 1根碘酊、乙醇棉签连续消毒至第4个瓶盖时污染数明显增加（P＜0．05）。消毒后放置4min时污染数明显增加（P＜0．05）。结论 1根2％碘酊、75％乙醇棉签连续消毒3个瓶盖，消毒后放置2min最为安全。     

胆管电灼伤兔模型的建立

目的:探讨如何建立一种安全、可靠的实验兔胆管电灼伤模型.方法:30只新西兰白兔平均分为5组.麻醉下开腹分离胆总管.使用高频手术器及自制的时间控制装置及改装的电刀,分别用10W、15W、20W、25W、30W功率的电凝各组实验兔的胆总管1s,通过病理观察残余胆管壁厚度.结果:实验中,不高于25W功率的电凝未造成即刻胆漏,...     

手术皮肤消毒剂灭菌效果临床观察

目的 了解手术室常用皮肤、黏膜消毒剂的消毒、灭茼效果，寻找高效、安全的消毒剂。方法 将160例择期手术患者分为8组各20例，分别采用3％碘酊75％乙醇、1．5％碘酊75％乙醇、1％活力碘、0＋5％活力碘、0．1％活力碘、75％乙醇、0．5％氯己定和0，1％氯己定消毒手术部位，观察消毒效果。结果 8种（组）消毒剂的杀菌率分别为100.0％、100．0％、100．0%、89．9％、83．2％、83．9％、89．7％和82．8％；合格率分别为100．0％、100．0％、100．0％、90．0％、90．0％、80．0％、90．0％和75．0％。结论 3％碘酊75％乙醇、1．5％碘酊75％乙醇、1％活力碘消毒效果好，但前2种（组）对皮肤、黏膜刺激性较大。待干时间长，适用于无菌要求高的择期手术；1％活力碘分别对皮肤、黏膜刺激性小，安全性可靠，省时方便，为较理想的消毒剂。     

碘伏联合贝复济预防急诊腹部污染手术后切口感染的疗效观察

目的观察碘伏联合贝复济预防急诊腹部污染手术后切口感染的临床疗效。方法临床纳入急诊腹部切口污染手术患者76例,根据切口消毒剂的不同分为2组,每组38例。对照组给予2%碘酊与75%酒精消毒;观察组给予0.25%碘伏联合贝复济消毒。观察2组患者切口愈合情况与感染情况。结果观察组切口甲级愈合率高于对照组,切口感染率低于对照组;切口愈合时间、换药次数均优于对照组。2组比较,差异均有统计学意义(P0.05)。结论对急诊腹部污染手术切口使用碘伏联合贝复济消毒,能提高切口愈合率并降低感染率,并缩短切口愈合时间,减少换药次数。     

电灼降低剖腹术感染的污染阈

术后感染率为4％～5％，住院日期因之延长，费用也增加，如何降低感染率是值得研究的问题。作者取SD鼠作实验，随机分成3组：冷刀、电刀切割和电刀凝固。共375只鼠，给予细菌污染0、103、105、107和1095个不同等级，原定每组50只鼠，待达到显示显著意义时（P＜0．01）即停止实验，以减少动物用量。常规消毒，麻醉下作正中切口3cm长，分别用刀片、电刀切割（30W，750kHz）或电刀凝固（同上）打开正中线筋膜，5分钟后用3－0人工合成线缝合。皮下层分别注射0．2ml盐水，内含0、103、105、107和109细菌．后者制备自大肠杆菌、绿脓杆菌、化脓性…     

新生儿先天性巨结肠腹腔镜辅助下改良Soave手术的护理配合

目的 为宫颈癌根治术中巡回护士正确调节高频电刀输出功率提供依据,减少对患者组织的损伤及电刀使用的盲目性.方法 将60例宫颈癌行广泛性子宫切除加盆腔淋巴结清扫术的患者随机分为两组各30例.对照组术中维持高频电刀功率在50 W,观察组术中由巡回护士根据手术部位不同的解剖组织结构调节高频电刀输出功率20～50 W.结果 观察组止血效果和组织损伤情况显著优于对照组(P＜0.05,P＜0.01).结论 在广泛性子宫切除术加盆腔淋巴结清扫手术中,巡回护士根据患者组织部位调节高频电刀输出功率,既能止血,又可避免或减轻组织损伤,从而减少电刀使用的盲目性和随意性.     

单极高频电凝对小鼠阴茎、肾脏、睾丸损伤的病理实验研究

目的探索单极高频电凝对小鼠阴茎、肾脏、睾丸损伤的病理实验研究。方法依据电凝方式(W)/电凝持续时间(s)/电凝间隔时间(s)的不同,将100只KM小鼠随机分为7组:组1-20W/0.5s/0.5s;组2-40W/0.5s/0.5s;组3-20W/1.0s/1.0s;组4-30W/0.5s/2.0s;组5-30W/1.0s/1.0s;组6-40W/0.5s/2.0s;组7为空白组。对除组7外的六组进行单极高频电凝对小鼠阴茎、肾脏、睾丸损伤的病理实验研究。空白组不做电凝处理,直接取上述三脏器做病理检查。实验组每组16只,其中电凝后即刻处死4只,3d后处死8只,15d后处死4只。结果组1、组2较组4、组6坏死面积更大,差异有统计学意义(P均<0.01);其中组2和组6相比较差异有统计学意义(P<0.01);组3、组5电凝后坏死面积明显大于实验组其他四组(P<0.01),组5大于组3,差异有统计学意义(P<0.05)。结论在使用高频电刀电凝时,持续时间过长,间隔时间过短,功率过大都是加重肾脏损伤的重要因素;高频电刀对肾脏的损伤重于对阴茎和睾丸的损伤。     

爱洁斯空气净化器消毒效果观察

爱洁斯 KJD- 1 2 0 0静电灭菌型空气净化器 (上海爱洁斯环保设备有限公司生产 ,下称净化器 )是一种新型的空气消毒净化设备。我院于 2 0 0 0年 3～ 1 1月应用于临床 ,并将其与紫外线灯消毒效果进行比较 ,报告如下。1　材料净化器 1台 (输入功率 1 0 0 W,循环风量 40 0 m3 /h,满负荷下可用于 50 m3 /台的空气消毒 ) ,营养琼脂平皿培养基 1 50只 ,紫外线灭菌灯 (功率 30 W) 2台。2　方法选择 2间具有相同条件 (每间病床 2张 ,均有 1例多器官功能衰竭病人 ,2名医护人员 ,进出病室人员数基本相近 ,面积均为 1 8m2 )的 ICU病室 ,第一间使用净…     

宫颈癌根治术中高频电刀输出功率调节方法的改良

目的为宫颈癌根治术中巡回护士正确调节高频电刀输出功率提供依据,减少对患者组织的损伤及电刀使用的盲目性。方法将60例宫颈癌行广泛性子宫切除加盆腔淋巴结清扫术的患者随机分为两组各30例。对照组术中维持高频电刀功率在50W,观察组术中由巡回护士根据手术部位不同的解剖组织结构调节高频电刀输出功率20～50W。结果观察组止血效果和组织损伤情况显著优于对照组（P〈0.05,P〈0.01）。结论在广泛性子宫切除术加盆腔淋巴结清扫手术中,巡回护士根据患者组织部位调节高频电刀输出功率,既能止血,又可避免或减轻组织损伤,从而减少电刀使用的盲目性和随意性。     

手术皮肤消毒剂灭菌效果临床观察

目的 了解手术室常用皮肤、黏膜消毒剂的消毒、灭菌效果,寻找高效、安全的消毒剂.方法 将160例择期手术患者分为8组各20例,分别采用3%碘酊75%乙醇、1.5%碘酊75%乙醇、1%活力碘、0.5%活力碘、0.1%活力碘、75%乙醇、0.5%氯己定和0.1%氯己定消毒手术部位,观察消毒效果.结果 8种(组)消毒剂的杀菌率分别为100.0%、100.0%、100.0%、89.9%、83.2%、83.9%、89.7%和82.8%;合格率分别为100.0%、100.0%、100.0%、90.0%、90.0%、80.0%、90.0%和75.0%.结论 3%碘酊75%乙醇、1.5%碘酊75%乙醇、1%活力碘消毒效果好,但前2种(组)对皮肤、黏膜刺激性较大,待干时间长,适用于无菌要求高的择期手术;1%活力碘分别对皮肤、黏膜刺激性小,安全性可靠,省时方便,为较理想的消毒剂.     

显微镜用于早期牙隐裂的诊断和治疗

目的：判断显微镜诊断早期牙隐裂的效果并对确诊的早期牙隐裂病例进行治疗.方法：应用显微镜结合2.5％的碘酊染色对疑有早期牙隐裂的患牙进行检测,与单独使用2.5％的碘酊染色的诊断效果进行比较,对确诊病例进行治疗.结果：45例患牙（A组）应用显微镜检测出牙隐裂41例,检测准确率91.1％,45例患牙（B组）应用2.5％的碘酊染色检测出牙隐裂31例,检测准确率71.1％.两组经统计学分析有显著性差异（P＜0.01）.结论：显微镜检测诊断牙隐裂的方法有效、快捷,可以避免早期牙隐裂的误诊及漏诊.     

超声消融导管参数对溶栓效果影响的有限元分析

目的探讨不同长度和直径的消融导丝在不同超声频率作用下的远端输出位移,为超声消融导管的设计提供超声频率以及消融导丝的几何外形的选取提供参考。方法利用有限元软件Workbench12．0的谐响应分析功能,分析直径（圣）范围0．5mm≤φ≤2．0mm、长度（L）范围120mm≤L≤310mm的消融导丝在功率10w、频率（P）范围O≤P≤30kHz的超声作用下的谐响应反应,得出不同长度和直径的消融导丝在不同超声频率作用下的远端输出位移。结果对不同长度的消融导丝,超声作用频率为18kHz时的远端输出位移均较其他频率为大,且其位移值几乎不变;对于不同直径的消融导丝,超声作用频率为12kHz时的远端输出位移均较其他频率为大,18kHz次之。结论长度对消融导丝远端输出位移的影响大干直径;对于不同长度的消融导丝,超声频率为18kHz为设计的最佳选择。     

A new method of conduction system staining

Visualization of the conduction bundle is advantageous in the prevention of surgical trauma to the conduction system during open-heart surgery. Because vital staining using an iodine starch complex has been known to result in tissue damage, we have evaluated the effects of iodine gas on the specialized conduction system. The conduction bundle was stained, well enough to be identified, with iodine tincture, with Lugol's solution, and with iodine gas. However, all these agents except for iodine gas caused marked electrophysiological changes. Similar changes occurred with the use of ethanol and of 10% potassium iodine solution, which are the solvents of iodine tincture and Lugol's solution, respectively. Microscopic examination showed that iodine tincture, Lugol's solution, and their solvents caused marked histological changes in the conduction tissue. However, no significant changes in the conduction tissue were noted from iodine gas spraying. Therefore, tissue damage caused by iodine tincture and Lugol's solution was thought to be due not to a reaction to the iodine starch complex itself, but to their solvents. In a long-term experimental study of 10 dogs, we found that iodine gas caused no electrophysiological disturbances or damage of microscopic tissue. Of the agents we tested, only iodine gas is free from harmful effects and can be used clinically.     

Electrovaporization of prostate at power settings below 100 W

BACKGROUND AND PURPOSE: Prostate electrovaporization has usually been performed at high power settings in the pure cut mode, using traditional electrosurgical generators. However, this practice is empirically based on the fact that a vaporization electrode is larger than a cutting wire loop. The role of the electrosurgical unit (ESU) in prostate electrovaporization has not been studied in detail. METHODS: In this Phase II cohort comparison study, we evaluated two different ESUs, coupled to the most clinically efficient vaporization roller electrode available in our opinion, to determine the lowest panel power settings that permit consistent tissue removal despite the desiccation normally produced during electrovaporization. RESULTS: One of these ESUs, the Excalibur Plus, permitted prostate electrovaporization at panel settings below 100 W for the first time, without compromising satisfactory early clinical outcomes. In a small number of cases, the spiked VaporTrode-Force 2 combination permitted effective electrovaporization at a lower power setting (180 W) than has previously been described when this ESU was coupled with the grooved VaporTrode, regardless of prostate size. During bench tests, a comparison of the actual power output curves in the clinically effective panel power setting range for each ESU revealed that the Force 2 overestimated the actual power output as impedance increased, while the Excalibur Plus underestimated it. This difference may explain why tissue could be vaporized at such low panel settings without the use of computer-controlled technology. CONCLUSION: These findings indicate a potential for improving the safety and efficiency of tissue clearance during prostate electrovaporization through future modifications in monopolar electrode design coupled with use of a generator that can either maintain or slowly increase actual power output as impedance increases at low panel settings. A Phase III clinical study would be justified on the basis of our preliminary results.     

宫颈环形电切术与传统冷刀锥切术治疗上皮内瘤变临床对比研究

目的探讨宫颈环形电切术（LEEP）与宫颈冷刀锥切术（CKC）治疗宫颈上皮内瘤病（CIN）的临床效果。方法56例宫颈上皮内瘤变患者,按入院先后分为LEEP组和CKC组各28例,分别采用宫颈环形电切术和宫颈冷刀锥切术治疗,比较2组手术及并发症发生情况。结果LEEP组术后痊愈率96．43％,CKC组92．86％,2组比较差异无统计学意义（P〉0．05）。手术时间、术中出血量、术后切口愈合时间LEEP组明显优于CKC组,2组比较差异有统计学意义（P〈0．05）。结论LEEP术治疗CIN操作简单,并发症少,手术时间和切口愈合时间及术中出血量均优于CKC术,值得推广应用。     

Povidone-iodine: use in hand disinfection, skin preparation and antiseptic irrigation

Iodine and its antibacterial properties have been used for the prevention or management of wound infections for over 150 years. However, the use of solutions (tincture) of iodine has been replaced by the widespread use of povidone-iodine, a water-soluble compound, which is a combination of molecular iodine and polyvinylpyrrolidone. The resultant broad spectrum of antimicrobial activity is well documented and its efficacy, particularly in relation to resistant micro-organisms such as methicillin-resistant Staphylococcus aureus, has been shown. In the clinical environment, there is no general agreement regarding the 'best' antiseptic and the practice varies widely. This article reviews the studies that have assessed the efficacy of povidone-iodine in hand disinfection and skin preparation and its use as an antiseptic irrigant. Although there is a distinct lack of well-designed, randomised controlled trials evaluating antiseptic efficacy, selection should be based on the next best available evidence. This evidence suggests that the use of povidone-iodine as an agent of choice is dependent on the clinical need but is also likely to be influenced by personal preference.     

Pre-operative non-shaving for neurosurgical operations (author's transl)

The authors report their pre-operative technique for scalp attendance according to which they operated on more than 1000 cranial neurosurgical patients in three years without the classical complete hair shave. Major psychological advantages are obvious. Principle technical details are: as complete cleaning of scalp-grease as possible by repeated shampoos; in the operating room: shaving only a thin pathway along the skin incision drawn by the surgeon himself, and disinfection with tincture of iodine exclusively. During the same time, they observed a fall to 0,6% of surgical infections needing bone flap removal because of osteitis. Secondary but always transitory partial alopecia has been observed in three patients.     

中心静脉置管应用不同敷贴局部细菌定植研究

目的 探讨不同敷贴对儿科患者中心静脉置管局部皮肤细菌定植的影响,以寻求一种更有利于降低中心静脉导管相关性感染的敷贴.方法 将61例留置中心静脉置管患儿随机分为透明敷贴组(22例)、含碘敷贴组(20例)和高通透敷贴组(19例),分别采用透明敷贴、含碘敷贴和高通透敷贴覆盖在穿刺点及周围皮肤,在观察期(7 d)内使用同一种敷贴用于中心静脉维护.结果 含碘敷贴组穿刺点细菌培养阳性率显著低于透明敷贴组和高通透敷贴组(均P＜0.017);敷贴内面的细菌培养阳性率显著低于透明敷贴组(P＜0.017);三组患儿未发生全身感染,观察期内各组局部感染率比较,差异无统计学意义(均P＞0.05).结论 含碘敷贴在抑制中心静脉穿刺局部皮肤菌落生长方面的效果优于高通透敷贴及透明敷贴.