47例颅脑外伤术后颅内感染的相关危险因素分析

目的：探讨颅脑外伤术后颅内感染的相关危险因素分析,为临床提供参考.方法：采用病例对照研究方法,对我院自2010年6月至2013年6月间收治的47例发生颅脑外伤术后颅内感染患者作为感染组,选取同期47例未发生脑外伤术后颅内感染患者作为对照组,对有统计意义的单因素进行多因素非条件的Logistic回归分析.结果：单因素分析显示脑室外引流、手术时间、脑脊液漏、术后白蛋白、术前GCS评分、血糖水平、手术次数、术后激素、后颅窝手术是颅脑外伤术后颅内感染的危险因素,差异有统计学意义（P〈0.05）.多因素非条件Logistic回归分析显示脑室外引流、手术时间、脑脊液漏、后颅窝手术及血糖等指标是颅脑外伤术后发生颅内感染的独立危险因素,差异具有统计学意义（P〈0.05）.结论：脑室外引流、手术时间、脑脊液漏、后颅窝手术及血糖水平等因素是颅脑外伤术后颅内感染发生的独立危险因素.     

开颅术后颅内感染相关危险因素分析

目的探讨开颅术后颅内感染相关危险因素,为临床预防和控制颅内感染提供依据。方法收集2006-01～2009-12在我院接受了神经外科开颅手术的1 200例患者中30例术后并发颅内感染者与同期50例术后未感染者的临床资料进行回顾性分析,先将导致感染的各项可能危险因素量化后输入SPSS13.0,对各自变量行单因素分析,筛选出与ICI相关的危险因素,再采用多元回归方法进行分析。结果单因素分析显示:手术入路方式、手术持续时间、术后切口脑脊液漏、脑室外引流是影响患者开颅脑术后感染的重要因素(P<0.05)。进一步Logistic回归分析发现,术后置脑室外引流(OR=8.096,P=0.006)、脑脊液漏(OR=4.785,P=0.009)、手术时间(OR=2.798,P=0.021)和后颅窝手术(OR=7.535,P=0.020)是开颅脑手术后发生颅内感染的独立高危险因素。结论形成开颅术后颅内感染的因素可以是单一因素,也可以是多个因素共同作用的结果,而脑脊液漏、脑室外引流、手术入路方式切口和手术时间是手术后发生颅内感染的高危险因素。     

颅脑术后颅内感染的危险因素分析及护理措施探讨

目的:探究颅脑术后颅内感染的危险因素及相关护理措施。方法:选取2013年3月-2015年6月本院收治的208例手术治疗的颅脑损伤患者,对其临床资料进行回顾性分析,分析相关危险因素并提出针对性护理措施。结果:颅脑术后颅内感染发生率为18.3%(38/208),单因素分析结果显示,术前GCS评分、手术类型、手术部位、手术时间、脑脊液漏、脑室外引流、切开气管、术后白蛋白以及使用激素与颅内感染相关(P<0.05);多因素回归分析发现,脑脊液漏、脑室外引流、手术时间≥2 h、后颅凹手术是颅脑术后颅内感染的独立危险因素(P<0.05)。结论:脑脊液漏、手术时间、手术部位和脑室外引流是引发颅脑术后颅内感染的主要危险因素,在手术前后加强护理干预,术中严格执行无菌操作,可有效预防该类并发症的发生。     

开颅术后颅内感染的危险因素及对策

目的探讨开颅术后颅内感染的危险因素以及相关对策。方法对1996年1月至2013年1月的1320例颅脑手术后38例发生颅内感染患者的临床资料进行回顾性分析。结果开颅术后感染38例患者中,31例颅内感染得到控制,7例患者死亡。结论开颅术后感染与多种因素相关,脑脊液漏、开放性颅脑损伤、后颅凹手术、脑室外引流为发生颅内感染的高危因素,对术中术后做出针对性的处理可减少术后颅内感染的发生。     

颅脑手术后颅内感染的危险因素及预防对策

目的探讨颅脑手术后颅内感染的危险因素及预防对策。方法收集2012年1月~2017年1月期间在我院行颅脑手术治疗的986例患者的临床资料,根据术后是否发生颅内感染将患者分为感染组219例和非感染组767例。对两组患者临床资料进行单因素和多因素分析。结果两组在年龄、术前GCS评分、发病至手术前时间、合并疾病为糖尿病、手术类型为Ⅱ、手术入路为幕下、手术时间、切口脑脊液漏、主刀医师等方面比较差异有统计学意义(P0.05),而在性别、术后侵入性置管两方面比较差异无统计学意义(P0.05);通过Logistic回归分析发现,切口脑脊液漏、术前GCS评分、年龄、手术时间、主刀医师是颅脑手术患者术后颅内感染的危险因素,其中切口脑脊液漏的风险比(OR)最高。结论颅脑手术后颅内感染的发生与多种因素有关,其中切口脑脊液漏、术前格拉斯哥昏迷指数(GCS)评分、年龄、手术时间、主刀医师是其独立危险因素,故针对这些危险因素采取预防措施,有利于降低颅内感染风险,改善患者的预后。     

神经外科术后患者颅内感染相关因素分析与预防对策

目的探讨神经外科术后患者颅内感染相关因素,并提出行之有效的预防措施。方法对在该院自2011年12月-2013年1月接受治疗的100例开颅手术治疗患者资料进行回顾性分析,将这些患者根据是否发生感染分为两组,一组为实验组（感染）,另一组为对照组（未感染）,每组有患者50例。比较两组患者手术前GCS评分、手术时间、是否伴有切口脑脊液漏、手术次数、术后白蛋白水平等指标,分析神经外科开颅手术后颅内感染相关因素。结果实验组患者术前GCS评分〈8分、患者切口脑脊液漏、患者手术后白蛋白〈35g/L的例数明显高于对照组患者,且两组差异有统计这意义（P〈0．05）。结论临床上,GCS评分、患者的手术次数、手术时间等都是影响神经外科开颅手术后发生颅内感染的危险因素,医护人员应采取有效办法防止患者颅内发生感染。     

颅脑外伤患者术后颅内感染的风险因素分析

目的 探讨颅脑外伤患者术后颅内感染的风险因素,为其防治提供参考意见.方法 分析394例颅脑外伤手术患者的临床资料,对年龄、性别、术前GCS评分、术区头皮伤口、脑脊液漏、术前抗生素应用、术区人工植入物、多次手术、术中失血量等情况与术后颅内感染之间的关系进行统计学分析,总结出颅内感染发生的风险因素.结果 本研究颅脑外伤术后颅内感染的发生率约为9.39％.脑脊液漏、多次手术及术中大量失血与颅内感染发生之间呈正相关(均P＜0.05),术前抗生素的应用能减少感染发生(P＜0.05).在彻底清创等情况下,术区头皮开放伤及术区植入物与感染发生相关性不大.年龄、性别及术前GCS评分与颅内感染发生之间无明显相关性.结论 术前适当使用抗生素、术区彻底清创、尽量减少手术时间、控制术中出血与输血量、严格把握人工植入物的使用指征,有助于减少颅脑外伤患者术后颅内感染的发生.     

脑外伤术后继发颅内感染的相关因素分析

目的探讨脑外伤术后继发颅内感染的相关因素分析,旨在为临床治疗提供有效依据。方法随机选取我院2014年1月至2016年1月神经外科行颅脑外伤手术的脑外伤患者52例,其中26例发生术后继发颅内感染,分为感染组,其余26例未发生术后继发颅内感染,分为非感染组。回顾性分析两组患者的临床资料及随访资料,探讨脑外伤术后继发颅内感染的相关因素分析。结果两组患者性别比例比较差异无统计学意义(P0.05);感染组中年龄≥60、手术次数≥2次、手术时间≥4h、术前GCS评分8分、术后白蛋白水平25g、术后脑脊液漏、脑室外引流时间≥2天者均明显多于非感染组,差异均具有统计学意义(P0.05)。结论高龄患者的术前GCS评分低、手术次数多、手术时间及脑室外引流时间长,术后发生低蛋白血症以及脑脊液漏等均是脑外伤术后继发颅内感染的相关因素,术前及术后应根据相关因素,及时有效预防感染的发生,改善患者预后。     

重症监护病房开颅术后患者颅内感染的相关因素分析

目的对重症监护病房开颅手术患者出现术后颅内感染的危险因素进行分析与评估。方法2009年1月～2012年1月到我院ICU接受开颅手术的72例患者。按照术后感染发生情况分为两组,其中感染组32例,未感染组40例,对两组患者的临床资料进行回顾性分析,探讨引发感染的危险因素。结果单因素分析显示,术前GCS评分、术后切口脑脊液漏、围手术期用药、术后低蛋白血症、手术时间、手术次数、内置物留置及引流管是导致患者发生开颅术后颅内感染的重要因素（P〈0．05）,通过多因素Logistic回归分析发现,术前GCS评分、围手术期用药、手术次数、手术时间及内置物留置是开颅术后患者发生颅内感染的高危险因素（P〈0．05）。结论导致开颅术后颅内感染的因素可以是单一因素,也可以是多个因素共同作用的结果,其中术前GCS评分、按推荐意见使用围手术期用药、手术时间、手术次数及内置物留置是开颅术后发生颅内感染的高危险因素。     

脑脊液外引流相关颅内感染危险因素分析

目的 分析脑脊液外引流相关颅内感染的危险因素.方法 回顾性分析我科2007-2015年收治并行脑室或腰大池引流患者的临床资料.结果 311例患者26例出现感染,感染率为8.36％.单因素分析结果显示:GCS评分≤8分、脑室外引流(特别是双侧外引流)、外引流留置时间＞5d、脑脊液漏、脑脊液漏持续时间≥1h或＞5h、合并糖尿病、引流期间ICU住院与颅内感染有关(P ＜0.05,P＜0.01);多因素Logistic回归分析结果显示:脑脊液漏及其持续时间、合并糖尿病是发生颅内感染的独立危险因素(P＜0.05).结论 合并糖尿病、脑脊液漏及持续时间是脑脊液外引流相关颅内感染的高危因素,临床应采取相应措施降低感染发生率.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.