自体血液回收在脊柱外科手术中的应用

探讨自体血液回收在脊柱外科手术中的应用效果。方法:选择脊柱外科行腰椎内固定手术患者40例,对照组红细胞压积(HCT)低于0.30时输库血;血液回收组用自体—3000型血液回收机在术中进行血液回收回输,对患者术前、术后静脉血常规、血液生化检验进行对照比较。结论:血液回收能有效减少术中血液丢失,减少输血后并发症。     

基于诺模图模型预测脊柱术后手术部位感染风险的研究

目的 建立预测脊柱术后手术部位感染(surgical site infection,SSI)发生风险的诺模图模型,以帮助医务人员制定预防策略,降低SSI的发生率.方法 回顾性选择2012年5月至2019年5月在温州市人民医院接受脊柱手术的患者2348例.采用单因素和多因素回归模型确定脊柱手术后SSI的独立预测因素,并根...     

Effects of acute normovolaemic haemodilution and partial exchange transfusion on blood product utilization, haemostasis and haemodynamics in surgery of the thoracoabdominal aorta. A cohort study in consecutive patients

BACKGROUND: This paper outlines the technique of acute normovolaemic haemodilution with partial exchange transfusion (ANHPET) in surgery of the thoracic and thoracoabdominal aorta. Perioperative coagulation parameters and patterns of blood product utilization observed with this technique are described and compared with results for historical controls treated without ANHPET. METHODS: During thoracoabdominal aneurysm repair, acute normovolaemic haemodilution with partial exchange transfusion (ANHPET) was used to withdraw of up to 3 L of blood. This was returned to the patient at the end of the reconstruction. Albumin 5% and stored packed red cells (PRC) were used for replacement. Seven patients underwent surgery with ANHPET, and fifteen without. Univariate and multivariate analysis of variance was used to examine differences between these groups. RESULTS: No differences were observed between the two groups for estimated blood loss, PRC transfused, and postoperative haemoglobin concentration. The ANHPET group received fewer platelets (8 vs 22 units, p = 0.0004), cryoprecipitate (0 vs 13 units, p = 0.02), and desmopressin or epsilon-aminocaproic acid (0 of 7 vs 4 of 15 patients, p = 0.04). FFP use was not significantly different (11 vs 17 units). Postoperatively, PTT values were less prolonged (26 vs 34 sec, p = 0.05) and platelet concentration higher (218 vs 169 x 109/L, p = 0.01) in the ANHPET group. A significant reduction in the total of blood products transfused was observed in the ANHPET group (30 vs 68 units, p = 0.003). Control of hypertension was facilitated by phlebotomy so that nitroglycerine was necessary in low doses only (0.25-1.0 microgram/kg/min). CONCLUSIONS: ANHPET reduced blood product transfusion, improved postoperative haemostatic parameters and simplified the management of cross-clamping hypertension.     

脊柱手术后患者外科手术部位感染及相关危险因素

目的外科手术部位感染（SSI）是脊柱手术后常见的并发症之一，与感染发病率增高，治疗时间延长，医疗费用增加，患者预后效果不良有着密不可分的关系。本研究的目的是探索某教学医院患者进行脊柱手术后发生SSI的现状与其相关危险因素。方法采用前瞻性队列研究方法，对2014年6月26日－11月30日该院所有脊柱手术患者进行目标性监测，以美国疾病控制与预防中心（CDC）颁布的指南作为SSI的诊断依据，通过床旁调查与出院后的检查发现SSI病例,使用标准化的数据收集脊柱手术患者术前，术中及术后资料。结果2014年6月26日-11月30日共监测192例脊柱手术患者，其中7例（3.6%）发生了SSI。通过双变量分析的方法发现切口类型（污染/感染切口）、外科引流、输血与增加SSI风险的密切相关。在192例脊柱手术患者中，120例（62.5%）给予静脉使用预防性抗菌药物，使用周期为2.2 （1～9）d，139例（72.4%）使用中成药。结论该研究有助于了解该教学医院脊柱手术后患者SSI发病率，亦为今后进行脊柱手术后患者发生SSI的研究提供有价值的信息。     

脊柱手术住院患者术后肺部感染危险因素logistic回归分析

目的了解脊柱手术住院患者术后肺部感染的危险因素,以针对性地提出干预措施。方法回顾性分析某院2008年5月—2016年6月脊柱手术住院患者,按术后是否发生肺部感染分为无肺部感染组和肺部感染组,比较两组临床资料。结果共监测脊柱手术住院患者612例,其中术后发生肺部感染43例,术后肺部感染发生率为7.03%。单因素分析显示,患者住院时间≥30 d、长期吸烟、有慢性肺部疾病、有糖尿病、手术节段数≥2、全身麻醉、手术时间≥4 h、出血量≥500 mL、卧床时间≥7 d、使用糖皮质激素、留置导尿管、机械通气、血清清蛋白30 g/L、血糖≥11 mmol/L、血红蛋白90 g/L共14个因素是脊柱手术住院患者术后发生肺部感染的危险因素(P0.05),而雾化吸入是保护因素(P0.05)。多因素logistic回归分析显示,住院时间≥30 d、长期吸烟、有慢性肺部疾病、全身麻醉、卧床时间≥7 d、使用糖皮质激素共6个因素均是脊柱手术住院患者术后肺部感染的独立危险因素(均P0.05),而雾化吸入是脊柱手术住院患者术后肺部感染的独立保护因素(P0.05)。结论脊柱手术住院患者术后肺部感染与多种因素有关,临床应针对术后肺部感染的危险因素,采取综合有效的预防措施,才能降低脊柱手术住院患者术后肺部感染发生率。     

Conserving blood in preparation for elective surgery.

A prospective study was carried out for a period of 6 months (September 1987 to 28 February 1988) to evaluate the possible misuse of blood transfusion service in the department of surgery, Amiri Teaching Hospital, Kuwait. There was a monthly wastage of 45 +/- 13 units of blood. Five hundred and eleven units of blood were crossmatched but never transfused. The time taken by the blood bank technicians in crossmatching blood which was never used amounted to 54.4% of the normal working hours. An annual loss of about US$25000.00 was calculated to have occurred.     

中老年脊柱手术后患者血清维生素D和T细胞亚群水平变化与术后感染的关系

目的 探讨维生素D(VitD)和T细胞亚群水平变化与中老年脊柱手术后患者感染的关系。方法 以2013年1月至2017年12月某院脊柱手术后并发感染的中老年患者41例为观察组并分为感染评分高组和低组,选择同期治疗42例手术后未感染者为对照组;抽取静脉血检测患者血清VitD和T细胞亚群(CD3+数目以及CD4+/CD8+)水平情况。结果 感染评分高、低组VitD水平、CD3+数目及CD4+/CD8+比值均低于对照组(P＜0.05);感染评分高组VitD水平、CD3+数目及CD4+/CD8+比值低于低组(P＜0.05);Spearman相关分析显示老年脊柱手术后患者VitD水平、CD3+数目、CD4+/CD8+比值与感染评分呈负相关(P＜0.001);多重线性回归分析显示,VitD水平与CD3+数目及CD4+/CD8+比值呈正相关(t=6.842和6.9333,P<0.001)。结论 VitD和Ｔ淋巴细胞亚群水平降低的中老年脊柱手术后患者感染风险增加;VitD水平与中老年脊柱手术后患者免疫功能相关。     

A Cost-Effectiveness Analysis of Minimally Invasive versus Open Surgery Techniques for Lumbar Spinal Fusion in Italy and the United Kingdom

ObjectiveEvaluate the cost-effectiveness of minimally invasive surgery (MIS) compared with open surgery (OS) techniques for one- or two-level lumbar spinal fusion in the treatment of degenerative lumbar spinal conditions in the United Kingdom and Italy.MethodsA health economic model was developed on the basis of results from a systematic literature review and meta-analysis to determine the cost-effectiveness of MIS compared with OS for lumbar spinal fusion. The analysis was conducted from a health care payer perspective. Parameters included in the model were surgery, blood loss, duration of hospitalization, postoperative complications, and health-related quality of life (HRQOL). Cost-effectiveness was determined by the incremental cost per quality-adjusted life-year gained.ResultsMIS was the dominant strategy compared with OS (i.e., yielding both cost savings and improved HRQOL). Cost savings were driven mainly by shorter length of hospital stay, reduced blood loss, and fewer complications such as surgical site infection. The total cost saving per procedure was €973 for Italy and €1666 for the United Kingdom, with an improvement of 0.04 quality-adjusted life-year over 2 years in HRQOL. One-way sensitivity analyses and predefined scenario(s) analyses confirmed the robustness of the model.ConclusionsMIS is a less expensive and a more effective treatment compared with OS for spinal lumbar fusion in both Italy and the United Kingdom. Lower downstream costs and increased HRQOL in the MIS group compensate for potential higher upfront costs of MIS implants and surgery equipment.     

经皮脊柱内镜治疗单节段胸椎黄韧带骨化症的效果

目的观察经皮脊柱内镜治疗单节段胸椎黄韧带骨化症(ossification of ligamentum flavum,OLF)的效果。方法回顾性分析2012-01至2018-06福州市第二医院收治的40例单节段OLF患者的临床资料,按手术方法不同分为微创内镜组与开放手术组。开放手术组(25例)采用开放手术摘除骨化黄韧带组织,微创内镜组(15例)采用内镜下手术摘除骨化黄韧带组织。比较两组术前、术后次日、术后3个月、术后1年改良日本骨科协会(Japanese Orthopaedic Association,JOA)下肢运动功能评分;并比较两组手术时间、手术出血量、术后住院时间、术后下地行走时间和术后并发症。结果两组术后次日、术后3个月、术后1年JOA评分均较术前改善,差异有统计学意义(P<0.05);两组术后次日、术后3个月JOA评分对比,差异无统计学意义(P>0.05);微创内镜组患者术后1年JOA评分高于开放手术组,差异有统计学意义(P<0.05);微创内镜组手术时间、术后住院时间、下地行走时间均短于开放手术组,术中出血量少于开放手术组,术后并发症发生率低于开放手术组,差异均有统计学意义(P<0.05)。结论经皮脊柱内镜治疗胸椎OLF是可行的,可降低术中出血量、住院时间和术后并发症发生率,且远期疗效优异。     

The use of allogeneic bone and tendon tissue from a central bone bank

During the period January 1989 to December 1990 the use of bone and related soft tissue allografts from our bone bank was reviewed retrospectively. Data were complete for 278 patients, who received 403 allografts in total. Forty-nine patients were transplanted with a massive deep frozen bone allograft, 41 patients received a deep frozen soft tissue allograft, while 313 units of freeze dried bone allografts were transplanted into 188 patients. Massive deep-frozen bone allografts were used mainly in patients with bone tumours, fibrous dysplasia of the neck of the femur and for revision arthroplasty. Soft tissues were used mainly for reconstruction of ruptured cruciate ligaments. Freeze dried bone allografts such as cancellous chips as well as cortical cancellous chips were used for spinal fusion, arthroplasty, treatment of pseudarthrosis, fractures, tumours and fibrous dysplasia, and in maxillofacial defects. Cancellous blocks were used specifically for spinal fusion. Demineralized cortical dust was used mainly in maxillofacial surgery.     

脊柱内固定术后耐甲氧西林金黄色葡萄球菌感染的研究进展

脊柱内固定术常用于治疗椎管狭窄、脊柱侧弯以及椎体滑脱等各类脊柱疾病。随着脊柱外科手术技术的不断进步以及内固定材料的发展,脊柱内固定术的手术量逐年增加。目前尽管手术无菌条件有了很大进步,但脊柱术后感染仍是脊柱内固定术后影响患者治愈率和生存率的一个不可忽视的问题,尤其是脊柱内固定术后耐甲氧西林金黄色葡萄球菌(MRSA)感染,不仅增加了医疗费用及患者身心负担,而且可能导致内固定术的失败,甚至威胁患者生命。本文对脊柱内固定术后MRSA感染的治疗及预防措施等相关问题进行综述。     

Management of acute lower gastrointestinal haemorrhage in a surgical unit over a 4-year period.

Over a 4-year period 107 patients, 5% of all emergency admissions, were admitted to one surgical unit with significant lower gastrointestinal haemorrhage (requiring more than a 2-unit transfusion of blood). Twenty-three individuals required more than 3 units of blood, and 7 life-saving surgery. All subjects undergoing surgery required more than 3 units of blood in the first 24 hours of admission. Arteriography was diagnostic in 5 of the 9 subjects in whom it was performed. Arteriography was positive if performed in the first 24 hours of admission. A flow chart of the management of patients with lower gastrointestinal haemorrhage is presented.     

丙泊酚持续静脉输注辅助椎管内麻醉镇静的临床观察

目的观察小剂量丙泊酚持续静脉输注辅助椎管内麻醉镇静的临床效果。方法选择腹部手术的病人80例．随机分为两组,每组40例。Ⅰ组为观察组,在椎管内麻醉平面固定且达到符合手术要求的平面后采用静脉推注丙泊酚1mg／kg作为首量,以2～4mg·kg^-1·h^-1。持续静脉泵注维持术中镇静;Ⅱ组为对照组,椎管内麻醉后不予以处理。记录并比较两组病人术前、术中、术后不同时段的心率、血压、SPO2,维持I组的镇静程度,评价两组麻醉效果以及回访病人的满意度。结果观察组泵入丙泊酚5min血压有所下降,HR．平稳,SPO2稍有下降但经加大吸氧浓度后好转（P〉0．05）。Ⅱ组手术开始后HR、血压明显上升（P〈0．05）。结论小剂量丙泊酚持续静脉输注辅助椎管内麻醉镇静效果确切,病人满意度高,可大大提高椎管内麻醉患者的麻醉质量。     

丙泊酚持续静脉输注辅助椎管内麻醉镇静的临床观察

目的观察小剂量丙泊酚持续静脉输注辅助椎管内麻醉镇静的临床效果。方法选择腹部手术的病人80例,随机分为两组,每组40例。Ⅰ组为观察组,在椎管内麻醉平面固定且达到符合手术要求的平面后采用静脉推注丙泊酚1mg∕kg作为首量,以2～4mg.kg-1.h-1持续静脉泵注维持术中镇静;Ⅱ组为对照组,椎管内麻醉后不予以处理。记录并比较两组病人术前、术中、术后不同时段的心率、血压、SPO2,维持Ⅰ组的镇静程度,评价两组麻醉效果以及回访病人的满意度。结果观察组泵入丙泊酚5min血压有所下降,HR平稳,SPO2稍有下降但经加大吸氧浓度后好转(P>0.05)。Ⅱ组手术开始后HR、血压明显上升(P<0.05)。结论小剂量丙泊酚持续静脉输注辅助椎管内麻醉镇静效果确切,病人满意度高,可大大提高椎管内麻醉患者的麻醉质量。     

腰椎管狭窄症术后应用胶原蛋白海绵减少引流量的对比研究

目的观察胶原蛋白海绵在腰椎管狭窄症术后减少引流量的作用。方法因腰椎管狭窄症行腰椎管扩大减压、椎间植骨融合术患者186例,按照随机数字表法将患者分为改进组和对照组。改进组96例患者术后硬膜后放置胶原蛋白海绵;对照组90例患者术后使用传统止血方法止血,未放置胶原蛋白海绵。术后均放置引流管。观察比较两组术后1、12、24h引流量,术前与术后48h血常规的变化,术中及术后48 h输血量及输血率等。结果与对照组比较,改进组术后1、12、24h引流量均明显减少[分别为(106.11±20.02) ml比(127.02±25.09) ml、(236.12±34.06) ml比(327.31±51.21) ml、(355.16±49.03) ml比(506.36±85.29)ml],差异有统计学意义(P＜0.05)。改进组输血量为(176.27±21.37)ml,输血率为10.42％(10/96),均较对照组[(445.94±24.56)ml、32.22％(29/90)]显著减少(P＜0.05)。改进组术后48 h红细胞计数为(2.96±0.45)×1012/L、血红蛋白为(106.75±7.30) g/L,均高于对照组[(2.35±0.57)×1012/L、(90.45±5.10) g/L](P＜ 0.05)。结论胶原蛋白海绵在腰椎管狭窄症术后应用能快速、有效、持久地止血及减少脑脊液渗漏,是减少术后引流量的有效、经济手段。     

Court rejects emotional damages in blood transfusion case

The Texas Court of Appeals dismissed an AIDS phobia claim filed by Jennifer A. Drury, a hospital patient who said she feared contracting HIV because her physician gave her blood during surgery. Drury sued Baptist Memorial Hospital System and Dr. Vernon David Theis, who gave her two units of blood during hysterectomy surgery. Drury had previously signed a consent form without restrictions on the source of blood. Upon learning that a stranger's blood was used in the surgery, Drury panicked that she might have HIV. Despite negative HIV tests on both the donor blood and her own, she remained fearful and sued the hospital. The trial judge and a three-judge appellate panel found no basis for her proposition. The court cited precedents which held that actual or direct exposure to HIV was required in order to recover damages for fear of AIDS.     

双管喉罩在脊柱后路手术中的安全性和有效性

目的 探讨双管喉罩在脊柱后路手术中应用的临床效果及安全性.方法 40例ASA分级Ⅰ～Ⅱ级择期行胸腰椎骨折手术患者按照机械抽样法随机分为双管喉罩组和气管插管组,每组20例.两组患者常规麻醉诱导后,分别置入双管喉罩或气管插管.观察记录操作次数、时间;记录诱导前(T0),置入即刻(T1),置入后1 min(T2)、3 min(T3)、5 min(T4)、10 min(T5)及拔除即刻(T6)的收缩压、舒张压、心率;记录置入、拔除及维持通气过程中的并发症.结果 两组置人双管喉罩和气管插管均一次成功,所需时间比较差异无统计学意义(P＞0.05).气管插管组T1、T2、T3、T6时收缩压、舒张压、心率显著高于T0(P＜0.05),且也显著高于双管喉罩组(P＜0.05).气管插管组置人、拔除、维持通气过程中发生并发症者(5、25、36例次)明显多于双管喉罩组(0、1、6例次)(P＜0.05).结论 双管喉罩用于脊柱后路手术是安全和有效的.

Abstract：

Objective To explore the effect iveness and safety of ProSeal laryngeal mask(PLMA)used in posterior spinal surgery. Methods Forty ASA Ⅰ - Ⅱ patients of thoracic-lumbar fracture were randomly divided into PLMA group and tracheal intubation (TI) group by systematic sampling with 20 cases each. PLMA or TI was inserted after intravenous anesthesia induction. The number of intubation, intubation time and time to surgery were recorded, systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were recorded induction (To), during intubation (T1), at 1 min (T2),3 min(T3), 5 min (T4), 10 min after intubation (T5), during extubation (T6). The intubation, extubation, and the maintain ventilation process of the respiratory and respiratory damage were recorded. Results All patients in PLMA group and TI group achieved satisfactory lung ventilation at the first attempt. There were no significant difference in the number of intubation, intubation time and time to surgery between two groups (P ＞ 0.05 ).SBP,DBP,HR at T1,T2,T3,T6 in TI group were significandy higher than To and those in PLMA group (P＜0.05). The intubation, extubation, and the maintain ventilation process of the respiratory and respiratory damage in TI group (5,25,36 cases) were more than those in PLMA group (0,1,6 cases)(P ＜0.05).Conclusion PLMA for posterior spinal surgery is safe and effective.     

Infection control. Suction waste management in hospitals and nursing homes.

A survey of seven hospitals and 16 nursing homes was conducted to examine the equipment and procedures for handling and disposing of blood and body fluids accumulated by suctioning. In hospitals, it was found that the degree of caution used is greatest in surgery units and declines through OB surgery, recovery, ER, intensive care, cardiac care, nursing and oncology units. The degree of caution when disposing of suction waste is uniformly low in nursing homes. Several recommendations are offered to help prevent contamination from suction waste, and detailed infection control guidelines for safer suction waste disposal are provided.     

A napkin-associated outbreak of Burkholderia cenocepacia bacteraemia in haemodialysis patients

This article reports a catheter-related outbreak of bacteraemia involving 38 patients in two haemodialysis units in Verona. Burkholderia cepacia complex strains were isolated from human blood and from an individually wrapped disinfection napkin that was contained in a commercially available, sterile dressing kit used to handle central venous catheters. Micro-organisms isolated from blood cultures and from the napkin were identified by standard procedures and confirmed as B. cenocepacia (genomovar III) by molecular analysis. Using pulsed-field gel electrophoresis analysis, the clinical isolates were indistinguishable or closely related to the B. cenocepacia isolated from the napkin. In conclusion, this study found that a contaminated commercial napkin soaked in quaternary ammonium, even when quality certified, was the source of infection.     

全脊柱核磁共振在脊柱外科中的应用

目的探讨全脊柱核磁共振在脊柱外科中的应用范围。方法回顾性分析脊柱骨折伴脊髓损伤112例中,39例全脊柱核磁共振的临床资料。结果 39例全脊髓核磁共振中,有2处病灶17例,3处病灶8例。结论对于昏迷截瘫或药物中毒等脊柱外科患者,全脊柱核磁共振检查是早期明确诊断的最佳方法。