颅脑外科手术中无菌冲洗盐水给水方式的效果探讨

目的通过对颅脑外科手术中所用开放式与密闭式无菌生理盐水的污染程度的监测,分析原因,进行对比.方法随机将72例颅脑外科择期无菌手术分为开放式给水和密闭式给水各36例.在不同时间点,两种无菌生理盐水同时取样,并进行细菌培养监测.结果密闭组手术中使用的无菌生理盐水未检出细菌.开放组随手术时间和无菌生理盐水开放的时间延长,冲洗水中细菌的检查数量逐渐增加,两组比较有显著差异(P＜0.05).结论使用密闭式无菌生理盐水冲洗可以有效控制细菌污染,降低手术感染率,减少院内感染,减轻患者痛苦和负担.     

颅脑外科手术中无菌冲洗盐水给水方式的效果探讨

目的：通过对颅脑外科手术中所用开放式与密闭式无菌生理盐水的污染程度的监测，分析原因，进行对比。方法：随机将72例颅脑外科择期无菌手术分为开放式给水和密闭式给水各36例。在不同时间点，两种无菌生理盐水同时取样，并进行细菌培养监测。结果：密闭组手术中使用的无菌生理盐水未检出细菌。开放组随手术时间和无菌生理盐水开放的时间延长，冲洗水中细菌的检查数量逐渐增加，两组比较有显著差异（P〈0．05）。结论：使用密闭式无菌生理盐水冲洗可以有效控制细菌污染，降低手术感染率，减少院内感染，减轻患者痛苦和负担。     

新型密闭式冲洗装置的制作与应用

<正>外科手术过程中冲洗多使用普通冲洗球,人工吸取生理盐水给病人进行开放式的冲洗,存在一些缺点,生理盐水均放在开口容器内,容易被空气和器具污染;冲洗过程中用水量大,很不方便;冲洗过程断断续续,不能持续冲洗;术中冲洗需要不断开瓶添加无菌生理盐水,不断吸取生理盐水,操作环节多,稍有不慎便可能造成生理盐水污染,给手术病人造成不必要的感染。为此,笔者设计了一种新型密闭式冲洗装置,能从根本上避免污染的发生,而且简单实用,方便操作,易于控     

新型密闭式冲洗装置的制作与应用

外科手术过程中冲洗多使用普通冲洗球，人工吸取生理盐水给病人进行开放式的冲洗，存在一些缺点，生理盐水均放在开口容器内，容易被空气和器具污染；冲洗过程中用水量大，很不方便；冲洗过程断断续续，不能持续冲洗；术中冲洗需要不断开瓶添加无菌生理盐水，不断吸取生理盐水，操作环节多，稍有不慎便可能造成生理盐水污染，给手术病人造成不必要的感染。     

GSE抗菌洗液在层流手术室上消化道肿瘤手术中应用效果研究

目的:了解外科切口感染及吻合口漏发生相关因素,采取有效措施预防切口感染及吻合口漏的发生。方法:将上消化道肿瘤手术80例患者随机分为GSE抗菌洗液组和无菌生理盐水组各40例,分别应用GSE抗菌洗液及无菌生理盐水冲洗,对食管贲门、胃癌手术吻合切口前后及手术切除结束关腹前后进行冲洗,留取标本送细菌培养,观察有无细菌生长。结果:两组患者断胃后、吻合前有菌例数无统计学差异(P0.05),吻合后、关腹膜后GSE抗菌洗液组有菌例数低于无菌生理盐水组(P0.05。)结论:污染类手术应用GSE抗菌洗液冲洗能有效预防术后切口感染。     

神经外科密闭式冲洗装置的制作与应用

神经外科手术的整个过程需要使用无菌生理盐水不断冲洗手术创面,以保证术野清晰,便于操作和手术的进行.神经外科手术复杂,时间长,冲洗水直接用于颅内冲洗,无菌要求高,尤其是在没有层流洁净设备的手术间,更应避免任何污染的发生.     

产房使用的冲洗茶壶盖内面消毒效果检测

为了解产房洁阴冲洗容器(茶壶)盖内污染情况,并解决消毒方法,于2001～2003年对慈溪市各医院产房使用的茶壶容器污染及其消毒效果进行了监测。1方法本次监测对象是辖区内医院的产房使用的茶壶容器消毒前污染情况和消毒后效果进行评价。对产房病人用的茶壶不定期的用1:5000高锰酸钾消毒液冲洗消毒作用1～3min,再用流水冲洗干净。选择每日使用12h和24h的茶壶盖内面进行采样,用蘸有生理盐水的无菌棉拭在低于茶壶盖内面四周约25cm2面积作涂抹采样,检测细菌总数。判定标准以细菌总数≤5cfu/cm2为合格。2结果对63份茶壶盖内面采样检测结果表明,消毒…     

全程生理盐水密闭式回血法在血液透析患者中的应用

目的:探讨全程生理盐水密闭式回血法在血液透析(HD)患者中的应用效果。方法:将2016年10月～2018年10月300例HD患者按随机数字表法分为对照组和观察组各150例;对照组采取传统单向开放式回血法,观察组采用密闭式回血法;比较两种回血方法的临床效果,评价回血时间、回输生理盐水量、患者凝血状况差异,检测两组开始透析时与透析治疗3个月后C反应蛋白(CRP)水平,记录两组不良事件发生情况。结果:两组回血时间、回输生理盐水量及凝血状况比较差异无统计学意义(P0.05),观察组治疗3个月后CRP水平、感染发生率均显著低于对照组(P0.05)。结论:全程生理盐水密闭式回血法与传统单向开放式回血法比较,能够降低HD患者体内CRP水平和感染发生率,值得在临床广泛应用。     

密闭式与开放式声门下冲洗吸引效果的对比研究

目的比较密闭式串联三通与开放式声门下冲洗吸引装置的效果。方法 2011年1月至2013年8月入住ICU行气管切开并机械通气患者120例,按行声门下冲洗的时间顺序分为A组和B组,A组采用开放式注射器冲洗方法,B组采用密闭式串联三通冲洗吸引装置方法,观察、比较两组2周内呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)发生率、呛咳例数及护理工时、护士操作依从性等。结果 B组2周内VAP发生率、呛咳例数、护理工时少于A组,护士操作依从性高(P<0.05)。结论与开放式方法对比,采用密闭式冲洗吸引装置行气道冲洗,可有效降低VAP及呛咳发生率,能节约护理工时,提高护士操作依从性。     

大量加温生理盐水冲洗液对消化道穿孔患者的影响

目的:探讨大量加温生理盐水冲洗液对消化道穿孔修补术患者的冲洗效果。方法:将60例患者随机等分为试验组和对照组,对照组患者术中使用室温放置的生理盐水进行腹腔冲洗和肠管灌洗,试验组患者术中使用加温生理盐水进行污染腹腔冲洗,比较两组患者冲洗前后体温、心率变化和切口感染、寒战发生率。结果:试验组患者手术过程中体温高于对照组(P0.05),心率与寒战发生率、术后切口感染发生率均低于对照组(P0.05)。结论:采用大量加温生理盐水对严重污染的腹腔进行冲洗,可减轻手术患者低体温的发生,避免由于低体温而引起的各种并发症的发生,减轻患者的痛苦,保证患者舒适。     

额叶p-mTOR异常表达与外伤性癫痫发生的相关研究

目的:探索外伤性癫痫(Posttraumatic epilepsy,PTE)发生与额叶p-mTOR异常表达的相关性。方法:将78只成年雄性SD大鼠分为正常对照组(A组)6只,生理盐水对照组(B组)和癫痫模型组(C组)各36只,C组右侧额叶注射FeCl_2造模。应用免疫组化技术检测造模后1h、24h、1周、2周、4周各组大鼠额叶皮质中p-mTOR(Ser2448)的动态表达。结果:A组额叶p-mTOR(Ser2448)表达的免疫组织化学染色,神经元胞质呈浅棕色,提示弱阳性表达;B组细胞染色程度较A组加深,p-mTOR(Ser2448)表达阳性细胞数增加;C组可见细胞结构紊乱,胞质呈明显的棕黄色,提示该蛋白在细胞质中呈强阳性表达。C组和B组比较,1h表达开始升高(t=-1.435,P=0.182),但差异无统计学意义,1周表达高峰(t=-4.073,P=0.002),2周降低(t=-2.614,P=0.026),4周时再次升高(t=-2.506,P=0.031),差异具有统计学意义(均P0.05)。结论:PTE的发病机制可能与mTOR信号通路上pmTOR(Ser2448)的表达异常增加有关。     

侧卧位闭合或有限切开复位髓内钉内固定治疗股骨转子下粉碎性骨折的临床疗效观察

目的探讨侧卧位闭合或有限切开复位髓内钉内固定治疗股骨转子下粉碎性骨折的临床疗效。方法 41例股骨转子下粉碎性骨折患者,手术方式为闭合或有限切开复位髓内钉固定,根据手术体位不同分为侧卧位组(n=21)和对照组(n=20)。侧卧位组侧卧位于可透视手术床手术,对照组在传统仰卧位牵引床手术。比较两组手术时间、术中出血量、骨折愈合时间、髋关节Harris评分等指标。结果所有患者均获得随访,随访时间12～36月,平均16.8月。侧卧位组及对照组各1例术后出现转子下骨折不愈合内固定失效,予再次手术固定并取髂骨植骨后骨折均愈合。侧卧位组手术时间、术中出血量低于对照组(P<0.05);两组骨折愈合时间、髋关节Harris评分比较差异无统计学意义(P>0.05)。结论侧卧位闭合或有限切开复位髓内钉内固定治疗股骨转子下粉碎性骨折,可缩短手术时间及减少出血,有利于骨折复位及固定,保护断端血运,有望取得满意疗效。     

Minimizing diagnostic blood loss in critically ill patients.

BACKGROUND: Blood loss from diagnostic procedures in critically ill patients needs to be minimized. Traditionally, when drawing blood from arterial lines, the initial sample used to clear the line has been discarded (open method). Use of a temporary reservoir enables this discard sample to be returned to the patient (closed method). METHODS: Critically ill surgical patients were prospectively randomized to the open or closed method of drawing blood from arterial lines. Blood loss to diagnostic sampling was measured in both groups. RESULTS: A comparison study (n = 1657) of these two methods revealed that blood loss to the patient was significantly decreased (P < .01) using the closed method. Mean blood loss per patient per day was 69 mL in the open group (n = 873) vs 35 mL in the closed group (n = 784). CONCLUSIONS: Use of the closed method when drawing blood from arterial lines results in a significant decrease in blood lost to diagnostic procedures.     

Effect of oropharyngeal decontamination by povidone-iodine on ventilator-associated pneumonia in patients with head trauma

OBJECTIVE: To evaluate the effect of a regular oropharyngeal application of povidone-iodine on the prevalence of ventilator-associated pneumonia in patients with severe head trauma. DESIGN: Prospective randomized study. SETTING: A surgical intensive care unit of a university hospital. INTERVENTIONS: Patients with severe head trauma (Glasgow Coma Score of < or =8) expected to need ventilation for > or =2 days were prospectively randomized into three groups: those receiving nasopharynx and oropharynx rinsing with 20 mL of a 10% povidone-iodine aqueous solution, reconstituted in a 60-mL solution with sterile water (povidone-iodine group); those receiving nasopharynx and oropharynx rinsing with 60 mL of saline solution (saline group); or those undergoing a standard regimen without any instillation but with aspiration of oropharyngeal secretions (control group). MEASUREMENTS AND MAIN RESULTS: The prevalence of ventilator-associated pneumonia was compared among the three groups. A total of 98 patients were analyzed (povidone-iodine group, n = 36; saline group, n = 31; and control group, n = 31). A total of 28 cases of ventilator-associated pneumonia were diagnosed. There was a significant decrease in the rate of ventilator-associated pneumonia in the povidone-iodine group when compared with the saline and control groups (3 of 36 patients [8%] vs. 12 of 31 patients [39%] and 13 of 31 patients [42%], respectively; p = .003 and .001, respectively). The length of stay and mortality in the surgical intensive care unit were not statistically different between the three groups. CONCLUSIONS: The regular administration of povidone-iodine may be an effective strategy for decreasing the prevalence of ventilator-associated pneumonia in patients with severe head trauma.     

胸部开放伤后海水浸泡对实验犬血浆渗透压及电解质平衡的影响

探讨胸部开谚伤后海水浸泡对实验犬血浆渗透压和电解质平衡的影响。方法：实验动物致伤后随机分对照组（ｎ＝１０）、海水浸泡组（ｎ＝１０）和生理盐水或生理盐水中,于致伤前及入水１５、３０、４５分钟及１、２、３和４小时取血测定血浆渗透压、血钠、血钾、血氯,同时监测血流动力学变化。结果：海水浸泡组动物有严重的电解质紊乱和血液高渗状态,表现为高渗综合征、高钠血症和高氯血症,而对照组和生理盐水浸泡组致伤前后无明显     

脊髓损伤后孕酮保护作用研究

目的:探讨脊髓损伤后孕酮的保护作用。方法:将54只日本大耳白兔随机均分为假手术组、脊髓损伤组与孕酮治疗组各18只,每组又分为治疗后12 h、24 h、36 h、48 h、72 h和14 d 6个时间点。假手术组只行腹部切开术但不阻断腹主动脉,脊髓损伤组和孕酮治疗组制备缺血再灌注模型,造模后孕酮治疗组注射孕酮治疗,脊髓损伤组在相同时间点注射等量生理盐水。比较各时间点不同组兔神经细胞超微结构变化情况和神经功能(BBB)评分。结果:电镜结果显示,脊髓损伤组可见神经细胞核固缩,异染色质浓染凝集成块,细胞浆中有大量空泡形成。孕酮治疗组可见神经细胞和胶质细胞的核轻度固缩,染色质浓染、细胞浆空泡化均较脊髓损伤组减轻。脊髓损伤组术后12 h BBB评分为0.6分,随后缓慢升高,术后14 d时评分为9.3分。孕酮治疗组BBB评分变化与脊髓损伤组相似,但术后36 h开始,各时间点评分均高于相应脊髓损伤组(P0.05)。结论:脊髓损伤后,采用孕酮治疗可减轻神经细胞变性,发挥神经保护作用。     

基于体感互动的综合平衡训练对脑卒中偏瘫患者平衡功能的影响

目的:探讨基于体感互动的综合平衡训练对脑卒中偏瘫患者平衡能力的影响。方法:35例脑卒中偏瘫患者随机分为体感互动综合平衡训练组(观察组)18例和传统平衡训练组(对照组)17例。对照组进行传统平衡训练,观察组利用体感互动技术,结合任务导向性游戏项目进行平衡训练、躯干控制训练和下肢力量训练的综合平衡训练。治疗期间均配合常规康复治疗。分别在治疗前及治疗4周后进行静动态平衡功能评估。结果:治疗4周后,2组Berg平衡量表(BBS)及Fugl-Meyer运动功能评分(FMA)下肢部分评分均较治疗前明显提高(P0.01),且观察组更高于对照组(P0.01,0.05)。治疗后,观察组在睁眼站立、闭眼站立、脚前后站立时重心摆动速度和稳定时间评分均较治疗前及对照组显著降低(P0.05,0.01),对照组在睁眼站立时重心摆动速度和稳定时间评分与治疗前比较显著降低(P0.05,0.01),脚前后站立和闭眼站立时重心摆动速度与治疗前比较无显著性差异。结论:基于体感互动的综合平衡训练结合常规平衡训练能更有效的改善脑卒中偏瘫患者的静动态平衡能力。     

地塞米松对腹腔海水浸泡伤的保护作用

目的 :观察早期应用地塞米松 (DXM)对腹腔海水浸泡伤大鼠的救治效果。方法 :将 88只腹腔海水浸泡伤 SD大鼠随机均分为模型组和地塞米松治疗组 ,观察术后不同时间 (n=6 )丙氨酸转氨酶 (AL T)、血清淀粉酶 (AMS)、尿素氮 (BUN)、肌酸激酶 (CK)、丙二醛 (MDA )、超氧化物歧化酶 (SOD)及乳酸 (L A )水平变化 ;同时计算两种不同处理情况下实验动物的存活情况。结果 :地塞米松治疗组术后 12、2 4和 36小时存活率分别为6 0 %、35 %和 2 0 % ,而模型组分别为 35 %、2 5 %和 10 %。治疗组 SOD水平显著高于模型组 (P均 <0 .0 5 ) ,而AL T、AMS、BU N、CK、MDA及 L A水平均显著低于对照组 (P<0 .0 5或 P<0 .0 1)。结论 :腹腔海水浸泡后早期应用 DXM能保护机体多器官功能 ,有利于提高存活率     

气管内开放式与密闭式吸痰效果比较

目的 比较密闭式吸痰与开放式吸痰的临床效果。方法 实验组36例气管插管及气管切开的患者应用密闭式吸痰管吸痰,对照组38例用开放式吸痰管吸痰,两组患者年龄、病情、气管插管及气管切开时间经统计学分析P＞0．05具有可比性,两种吸痰方法从肺部感染发生时间、感染率、痰阻、工作量四方面比较。结果 实验组肺部感染发生时间延迟（一周后）,感染率降低,与对照组间差异有显著性意义（P＜0．05）,痰阻发生率两组间差异也有显著性意义（P＜0．05）,工作量实验组（平均16s/次）明显少于对照组（平均28s/次）。结论 密闭式吸痰效果优于开放式吸痰,能降低肺部感染,防止痰阻、减轻护理工作量。     

Vascular permeability increase and plasma volume loss induced by endotoxin was attenuated by hypertonic saline with or without dextran.

Endotoxin given intravenously is known to cause plasma leakage and subsequent loss of circulating plasma volume. Hypertonic saline resuscitation has been successfully applied in hemorrhagic and traumatic shock, but its application for the treatment or prevention of septic or endotoxin shock is less well studied. Our aim was to investigate the effects of endotoxin on plasma leakage in hamsters when administered in two different ways: applied locally to the hamster cheek pouch microcirculation or systemically by i.v. injection. The cheek pouch was studied by intravital microscopy using FITC-labeled dextran as a tracer of plasma leakage. Escherichia coli lipopolysaccharide (LPS) was continuously added into the superfusion buffer of the cheek pouch preparation during 120 min in two control groups (each n = 6) and two further groups (each n = 6) treated with either hypertonic saline (HS) or hypertonic saline and dextran (HSD). Treatment was given as an i.v. injection 0.35 mL NaCl 7.5%/100 g b.w. during 4 min starting 15 min prior to the start of endotoxin application. Endotoxin caused a reversible increase in the number of postcapillary venular leaks with a maximal response at 70 min after start of endotoxin application. The maximal responses were reduced to 36% in the HS-treated and to 37% in the HSD-treated group in comparison to what was seen in the control groups. In the second part of the study endotoxin was given i.v. 0.3 mg/kg to anesthetized hamsters (n = 41) and arterial blood samples were collected at 0, 60, 120, and 180 min after endotoxin injection for measurement of hematocrit and plasma FITC-dextran concentration. Hamsters were divided into seven groups: untreated control group (n = 6); HSC control group given only an i.v. injection of hypertonic saline (n = 6); LPS group given endotoxin 0.3 mg/kg during 1 min (n = 9); HSp group given hypertonic saline (NaCl 7.5%) 10 min prior to i.v. endotoxin (n = 6); HSa group given hypertonic saline 10 min after i.v. endotoxin (n = 6); HSD group given hypertonic saline with dextran 40, 10 min prior to i.v. endotoxin (n = 6); HSD control group given only i.v. hypertonic saline + dextran and no endotoxin (n = 2). Injection of endotoxin caused a significant increase in hematocrit, which was counteracted by hypertonic saline treatment, with or without dextran, probably due to reduced extravasation of plasma in postcapillary venules.