1436例剖宫产手术近期并发症分析

目的 总结我院产科6年剖宫产手术近期并发症的发生情况,探讨剖宫产手术并发症的预防措施.方法 对2003～2008年我院产科行剖宫产手术患者1 436例近期并发症临床资料进行回顾性分析.结果 1 436例剖宫产手术患者中,发生产后出血73例(5.08%),子宫切口裂伤28例(1.49%);产褥感染21例(1.46%);腹胀10例(0.69%);副损伤1例(0.07%),这些病例均治疗成功.结论 严格掌握剖宫产指征,手术前、手术中积极采取相应预防措施,以及手术后精心护理,是提高产科质量,减少剖宫产手术并发症发生的重要环节.     

剖宫产术后镇痛的研究进展

剖宫产是产科最常见的手术之一,剖宫产术后疼痛问题不容忽视。良好的术后镇痛可显著减轻产妇痛苦和减少术后并发症的发生,促进产妇康复。该文就剖宫产术后镇痛的研究进展作一综述,重点阐述剖宫产术后镇痛方式及新型用药研究现状。     

Effect of transcutaneous electrical acupoint stimulation on recovery of gastrointestinal function after cesarean section

<正>Objective To explore the effect on the recovery of gastrointestinal function after cesarean setion treated with transcutaneous electrical acupoint stimulation at Zusanli(ST 36) on the basis of routine treatment. Methods A total of 110 primiparas after cesarean section were randomized into observation group and control group,55 cases in each one. The conventional treatment was applied     

剖宫产术后再次妊娠者阴道分娩与再次剖宫产的对照分析

目的 探讨剖宫产术后再次妊娠分娩方式的选择.方法 随机抽取2008-01～2009-09收治剖宫产术后再次妊娠孕妇156例,对其分娩方式、分娩结局及医疗费用进行回顾性分析评价.结果 156例剖宫产术后再次妊娠者,行再次剖宫产(RCS)125例(其中择期剖宫产112例,阴道试产改行剖宫产13例),占80.13%;阴道试产(TOL)44例,占28.21%,试产成功率为70.45%;阴道分娩(VBAC)31例,占19.87%.RCS组较VBAC组出血量大,分别为(175.7±4.0)ml和(85.5±8.5)ml,平均住院天数RCS组较VBAC组相对较长,分别为(8.20±1.58)d和(3.20±0.42)d,医疗费用RCS组较VBAC组为高.结论 有剖宫产史再次妊娠者,不一定选择剖宫产作为绝对指征,如无试产禁忌者可在严密监护下先行阴道试产.     

Evaluation of postdischarge surveillance of surgical site infections after total hip and knee arthroplasty

BACKGROUND: Artificial joint replacement of hip (HPRO) and knee (KPRO) are 2 of about 20 categories of operative procedures of the surveillance of surgical site infection (SSI) as stated by nosocomial infections surveillance systems in the United States and in Germany. Periprosthetic SSI can manifest itself after a long period. METHODS: Seven hundred fifty-six orthopedic patients from 2 centers were evaluated after HPRO (n = 508) or KPRO (n = 248). SSI was recorded during hospitalization and for 12 month postdischarge. The surveillance regimen was extended by also sending patients a questionnaire after 12 months postdischarge. All complaints were followed up by contacting the patients and any clinicians and general practitioners (GPs) involved. Stratified infection rates and standardized infection ratio (SIR) were calculated and compared with reference data of the national surveillance system. RESULTS: The total response rate to the postal questionnaire survey was 85.2%. SSI was recorded in 16 patients (3.15%) after HPRO; 12 were detected by predischarge surveillance, and the 4 cases found postdischarge were all organ/space SSI. In total, only 1 SSI was detected after KPRO before discharge and none after discharge (SSI rate 0.40%). Time between discharge and detection of SSI cases ranged from 8 days to 8 months. SIR of HPRO was 1.25 and SIR of KPRO was 0.36. CONCLUSION: Because 25% of SSIs after HPRO occurred after discharge and all were organ/space SSI, highlights the importance of postdischarge surveillance of nosocomial infections (NIs). Because all SSIs were reported already by current surveillance, the extended postdischarge surveillance appears to be unnecessary. The pursuit of shorter hospital stay after surgery may challenge the methods of surveillance systems in future.     

Factors influencing infectious complications after pancreatoduodenectomy

Background/purpose

Rates of postoperative morbidity, particularly infectious complications, remain high after pancreatoduodenectomy.

Methods

Subjects comprised 101 patients who had undergone pancreatoduodenectomy, analyzed according to presence or absence of infectious postoperative complications. Nineteen perioperative variables were analyzed to identify risk factors associated with postoperative infectious complications.

Results

Postoperative infectious complications occurred in 56 patients (55%); among them 29 had serious infectious morbidity, including bacteremia (13%), intra-abdominal infection (18%) and pneumonia (12%). One patient (1%) died of multiple organ failure subsequent to a severe septic attack. Only body mass index (BMI) differed significantly between patients with and without serious infection. Logistic regression analysis identified BMI >25 as an independent factor for occurrence of serious postoperative infectious complications. BMI >25 was a common risk factor for individual infection, including bacteremia, intra-abdominal infection, and pneumonia. As for the influence of BMI on perioperative parameters, the high BMI significantly affected the operation time. Meanwhile preoperative biliary drainage had no influence on overall and individual infectious morbidities.

Conclusions

This study demonstrates the need for careful postoperative monitoring in the patient with high BMI.     

Probiotics reduce infectious complications after pancreaticoduodenectomy

BACKGROUND/AIMS: Postoperative morbidity is a significant problem associated with pancreaticoduodenectomy. The clinical value of probiotics in surgical patients remains unclear. This study investigated the effect of probiotics on surgical outcome after pancreaticoduodenectomy. METHODOLOGY: Seventy patients with pancreaticobiliary diseases were randomly allocated to two groups before pancreaticoduodenectomy, one of which received probiotics perioperatively and the other served as controls. Postoperative infectious complications were recorded. RESULTS: Of the 70 patients, 64 completed the trial (30 receiving probiotics and 34 controls). The probiotics used in the study contained Enterococcus faecalis T-110, Clostridium butyricum TO-A, and Bacillus mesentericus TO-A. The probiotics were first administered immediately after admission, 3 to 15 days before the operation, and then reintroduced on the second postoperative day. They were continued until hospital discharge. Infectious complications occurred after pancreaticoduodenectomy in 25 patients (39%). The incidence of infectious complications in the probiotics group (23%, 7/30) was significantly lower than in controls (53%, 18/34) (P = 0.02). Mortality amongst all patients was 1.6% (1 patient in the control group). CONCLUSIONS: The use of perioperative probiotics reduced postoperative infectious complications after pancreaticoduodenectomy, making it a promising potential adjunct therapy for patients undergoing high-risk hepato, biliary, and pancreatic surgery.     

影响剖宫产率及剖宫产指征因素的临床分析

目的 探讨降低剖宫产指征中的社会因素剖宫产率的措施,为制定降低剖宫产率的具体措施提供资料.方法 对2006～2008年间产科住院产妇的足月分娩病例进行回顾性分析.结果　剖宫产率呈逐年上升趋势,胎儿宫内窘迫、臀位、头盆不称、社会因素的比例逐年增加.结论 目前剖宫产手术指征已远远超过单纯医学指征范围,剖宫产率升高主要原因为无医学指征的社会因素增加.胎儿宫内窘迫和头盆不称诊断过度也是剖宫产术增多的重要因素,来自孕妇及医生的主观意愿,影响对分娩方式的合理选择.降低剖宫产率的关键是严格掌握剖宫产指征,尽量减少人为因素的剖宫产.     

Risk factors for postoperative infectious complications after hepatectomy

Background/purpose

This study aimed to clarify the incidence of surgical site infections (SSIs) after hepatectomy.

Methods

The database records of three hundred and eight patients who underwent elective surgical treatment for hepatolithiasis, hepatocellular carcinoma (HCC), and metastatic carcinoma were retrospectively analyzed to determine the occurrence of postoperative infectious complications. The incidences of SSIs, classified as superficial or deep incisional SSIs and organ or space SSIs, and all other infectious complications within 30?days after hepatectomy were evaluated.

Results

The incidences of SSIs after a hepatectomy for hepatolithiasis (23.8%) were higher than those after a hepatectomy for HCC (11.3%) (p?=?0.034) and after a hepatectomy for metastatic carcinoma (2.7%) (p?<?0.001), and the incidence of SSIs after a hepatectomy for HCC was higher than that after a hepatectomy for metastatic carcinoma (p?=?0.028). However, there was no significant difference in the incidence of remote site infections between the three groups. The incidence of superficial or deep incisional SSIs after a hepatectomy for hepatolithiasis (11.9%) was higher than that after a hepatectomy for metastatic carcinoma (1.4%) (p?<?0.001) and the incidence of superficial or deep incisional SSIs after a hepatectomy for HCC (7.8%) was higher than that after a hepatectomy for metastatic carcinoma (1.4%) (p?=?0.050). There was a significant difference in the incidence of space/organ SSIs between the patients with hepatolithiasis (11.9%) and HCC patients (3.6%) (p?=?0.029), and between the patients with hepatolithiasis and metastatic carcinoma patients (1.4%) (p?<?0.001). The rate of positive bile culture was 36.2% in all patients in this study, and the rates were 83.3, 7.8, and 10.0% for patients with hepatolithiasis, HCC, and metastatic carcinoma, respectively. A significantly higher (p?<?0.001) positive bile culture rate was observed in patients with hepatolithiasis as compared with HCC or metastatic carcinoma patients.

Conclusions

Our study suggests the existence of a relationship between postoperative SSIs and bile infection, thus supporting the proposed relationship between post-hepatectomy infection and such variables as liver function, blood sugar control, and nutritional status.     

Successful treatment of life-threatening bleeding after cesarean section with recombinant activated factor VII.

Hemorrhagic shock developed in a 29-year-old nullipara without coagulopathy after emergency caesarean section. Treatment with uterotonic drugs, prostaglandins, and conservative procedures with transfusion of packed red cells and fresh-frozen plasma failed to control the diffuse vaginal and uterine bleeding. Finally an intravenous bolus injection of 90 microg/kg recombinant activated factor VII (rFVIIa, NovoSeven, Novo Nordisk A/S, Bagsvaerd, Denmark), was given and showed success within 20 minutes after administration, without any side effects.     

80后产妇799例剖宫产的原因分析

目的 探讨分析80后剖宫产的原因,正确掌握剖宫产指征,确保母婴安全.方法 回顾性分析2004-01～2008-12在我院分娩及剖宫产原因构成.结果 5年间分娩总数5 232例,剖宫产1 200例(22.9%),自然分娩4 032例(77.1%),剖宫产率呈逐年升高趋势(P<0.01).80后住院分娩产妇1 300例,剖宫产799例(61.5%),自然分娩501例(38.5%),5年间80后和非80后的剖宫产率均呈逐年升高趋势(P均<0.05),80后均维持在较高水平(55.6%～68.5%,平均61.5%),各年度80后剖宫产率显著高于非80后剖宫产率(P均<0.01).80后剖宫产三大原因中,社会因素居首位(436例,54.6%),其次为胎儿因素(264例,33.0%),母亲因素居三(99例,12.4%).结论 剖宫产率升高主要是社会因素所致,降低剖宫产率除了医师严格掌握剖宫产指征外,全社会都应关注剖宫产率逐年升高这一问题.     

Effect of operative duration on infectious complications and mortality following hepatectomy

BackgroundTo study mortality and infectious complications (IC) risk relative to operative duration in a large and contemporary cohort of patients undergoing hepatectomy.MethodsA retrospective cohort study of 21,443 patients from the National Surgical Quality Improvement Program dataset of patients who underwent liver resection from 2012 to 2016.ResultsPatients undergoing hepatectomy during the study period (N = 21,443) had a mean operative duration of 243.5 min of which 16.6% (3533) developed at least one IC. The overall 30-day mortality was 1.6%. A significant increase in mortality and IC was demonstrated from 3 h of operating time (OR: 1.99 and OR: 1.94, respectively), peaking at 8 h (OR: 7.15 and OR: 6.37, respectively). Pneumonia, sepsis/septic shock, and SSI presented high prevalence and were linked to significant mortality. After case-matching, elective hepatectomy was associated with a 4-fold increased risk of infectious complications.ConclusionsOperative duration was associated with a linear increased risk of mortality and IC after hepatectomy. The most critical determinants of IC were ASA class, COPD, CHF, and type of hepatectomy.     

Effects of cesarean section on mean platelet volume

Mean platelet volume (MPV) is a risk factor for cardiovascular complications, cerebrovascular disorders, and low-grade inflammatory conditions prone to arterial and venous thromboses. Cesarean delivery is the most important risk factor for pulmonary embolism, stroke, and intracranial venous thrombosis. The hypothesis is that increase in the prevalence of cesarean section and high MPV may be associated with cardiovascular complications such as stroke along with intracranial complications in addition to known systemic and surgical complications. In this study, platelet counts and MPV for postpartum women who delivered by cesarean section and normal vaginal parturition are compared. The subjects were divided in two groups, one was study group consisting of 118 patients giving birth by cesarean section and the other was the control group consisting 94 patients giving birth by normal vaginal parturition. Peripheral venous blood samples in EDTA tubes were collected from all the subjects 1 week before and after the delivery for their prenatal and postpartum periods, respectively. The values were compared between the groups and also before and after the delivery. In the cesarean group, while the MPV level was 8.60 (1.64) fl in the prenatal period, it increased to 9.10 (2.00) fl in the postnatal period (p?<?0.001). Group effect, time effect (independent from group effect), and group*time interaction effect were statistically significant for MPV variable (p?=?0.032, p?<?0.001, and p?=?0.012, respectively). This study concluded that MPV, along with several other factors, may be used as a prognostic, independent, and therapeutic marker in patients who are inclined to thrombotic events after cesarean section.     

剖宫产后再次妊娠孕妇围产期的管理研究进展

前置胎盘和子宫破裂是剖宫产后再次妊娠孕妇围产期常见严重并发症,规范的产检可及早预知相关风险,为分娩期提供有利信息。逐渐细化的围产期管理,可提高剖宫产术后再次妊娠阴道试产的成功率,减少紧急手术及相关并发症的发生,改善母儿预后。     

Effect of a nurse case manager on postdischarge follow-up

OBJECTIVE: To examine whether use of a nurse case manager to coordinate postdischarge care would improve rates of follow-up, emergency department utilization, and unexpected readmission for general medicine patients. DESIGN: Prospective cohort trial. SETTING: Publicly supported, tertiary-care teaching hospital. PATIENTS: Four hundred seventy-eight patients admitted to the general medicine service. INTERVENTIONS: Use of a nurse case manager to provide discharge planning before hospital discharge and to arrange for postdischarge outpatient follow-up. Patients in the control group had discharge planning in the traditional (“usual care”) manner. MEASUREMENTS AND MAIN RESULTS: The proportion of patients with scheduled outpatient appointments in the medical clinic and the proportion making clinic visits, emergency department visits, or with readmission to the hospital within 30 days following discharge. A significantly greater proportion of patients assigned to the nurse case manager intervention had appointments scheduled at the time of hospital discharge (63% vs 46%,p<.001), and made scheduled visits in the outpatient clinic (32% vs 23%,p<.03). Intervention group patients were especially more likely than control group patients to have definite follow-up appointments if they were discharged on weekends. Intervention and control group patients did not differ, however, in the rates of emergency department utilization (p=.52) or unexpected readmissions within 30 days of discharge (p=.11). CONCLUSIONS: Use of a nurse case manager to coordinate outpatient follow-up prior to discharge improved the continuity of outpatient care for patients on a general medical service. The intervention had no effect on unexpected readmissions or emergency department utilization. Received from the Division of General Internal Medicine, Case Western Reserve University and the MetroHealth Medical Center, Cleveland, Ohio. Presented in part at the 17th annual meeting of the Society of General Internal Medicine, Washington, DC, April 27–29, 1994.