力百傲用于手术创口冲洗消毒的临床观察

目的 比较临床上使用消毒剂的抗菌效果。方法 用力百傲进行普外科、泌尿外科、骨科、心胸外科及妇产科的200例手术患者创口消毒。结果 手术切口均为甲级愈合，力百傲对创口及手臂部皮肤细菌的即时杀灭率均为100％，在术后24h换药时切口部位亦未检出细菌。结论 手术伤口采用具有持效杀菌作用的力百傲进行消毒后再缝合，对控制医院感染有积极意义。     

乳腺癌手术中应用温热蒸馏水冲洗创面的效果分析

目的观察探讨乳腺癌手术中应用温热蒸馏水冲洗创面的适宜水温及其临床效果,总结其临床应用价值。方法选取本院2007年10月～2009年10月收治的乳腺癌手术患者57例,分别采用1000ml温热蒸馏水进行手术创面冲洗,其中采用水温为35℃～36．9℃13例,37℃10例,37．1℃～41．9oC8例,42℃12例,43℃14例,观察对比5组水温下的冲洗效果,记录相关数据进行统计学分析。结果所有患者经温热蒸馏水冲洗创面后术后情况良好,无术后感染案例,创口I／甲愈合,无水中毒及吸收热的现象出现,5组水温下的冲洗效果存在一定的差异,以43℃的水温下冲洗手术创面的引流液量最少,具有统计学意义（P〈0．05）。结论：乳腺癌手术中应用温热蒸馏水冲洗创面的适宜水温为43℃,有利于创口愈合,降低术后并发症发生率,安全有效,无副作用,值得在临床上合理推广使用。     

负压封闭引流技术对骨科内固定术后切口感染患者的改善情况分析

目的探讨负压封闭引流技术对骨科内固定术后切口感染患者的改善情况,为临床治疗提供依据。方法选取2014年10月-2016年12月于医院骨科行骨科内固定手术后发生切口感染的68例患者为研究对象,将患者分为试验组和对照组,每组34例;对照组患者彻底清创,反复多次冲洗创口,引流条引流创面内分泌物,采用无菌敷料覆盖于创口表面,试验组患者采用负压封闭引流处理,彻底清创,反复多次冲洗创口,进行负压封闭引流,同时两组患者均静脉应用抗菌药物,治疗7天。观察两组患者处理后3、7、12、24天的愈合情况,分析两组患者的临床疗效、平均换药次数、创面愈合组织病理学评分、创口愈合时间、抗菌药物使用时间、住院时间。结果在治疗3、7、12、14天后,试验组患者愈合面积均优于对照组患者(P0.05);试验组患者总有效率为94.12%,高于对照组患者的总有效率73.53%(χ~2=5.314,P=0.021);试验组患者平均换药次数少于对照组患者,创面愈合组织病理学评分高于对照组患者,创口愈合时间、抗菌药物使用时间、住院时间均短于对照组患者(P0.05)。结论负压封闭引流技术可改善骨科内固定术后切口感染患者的局部感染情况,促进创面愈合,缩短患者使用抗菌药物及住院时间。     

左氧氟沙星和碘伏冲洗防治急性阑尾炎术后切口感染的疗效观察

目的:探讨左氧氟沙星联合碘伏冲洗防治急性阑尾炎术后切口感染的临床效果。方法:抽选2014年1月-2015年2月在我院接受手术治疗的急性阑尾炎患者96例为研究对象,随机数字表法分为两组。对照组(48例)患者创口使用头孢噻肟钠静脉滴注以及生理盐水冲洗处理,观察组(48例)患者创口则使用左氧氟沙星静脉滴注联合碘伏冲洗处理,对比两组患者术后伤口感染率以及切口愈合率。结果:观察组患者切口感染发生率(4.2%)明显低于对照组(20.8%),差异显著(P0.05)。观察组患者切口愈合优良率(97.9%)高于对照组(83.3%),差异显著(P0.05)。结论:左氧氟沙星联合碘伏冲洗能有效降低急性阑尾炎患者术后切口感染的发生率,提升患者切口愈合优良率,值得临床推广。     

吸收性止血绫在肛周疾病手术中的应用观察

目的：观察吸收性止血绫在肛周疾病手术中的止血效果。方法：筛选280例在我科接受肛周疾病手术治疗的病人，分为治疗组和对照组2组。其中150例术中均使用吸收性止血绫于切口创面，对照组130例仅术后常规换药。比较术后平均住院时间，术后创面频繁渗血，创面过敏，切口愈合时间等指标。结果：术后比较以上指标，治疗组在平均住院日，创面愈合时间及频繁渗血情况方面均明显优于对照组，两组差异均有统计学意义，P〈0．01。结论：吸收性止血绫用于肛周疾病手术中止血效果确切，使用安全。可以在临床中广泛应用。     

白糖换药法治疗产科术后创口裂开

我院产科自1985～1989年应用白糖换药治疗削宫产创口裂开者10例,会阴侧切口裂开60例,取得显著疗效,现报道如下: 换药方法:常规碘酒、酒精消毒创口周缘,用生理盐水清洗创口。①创口轻度或局部裂开,可将食用白糖填满创口,再用无菌纱布覆盖创口封闲,2～3天换药一次;②创面附有脓苔者可先用0.5％雷佛奴尔冲洗创而后再填充白糖;③创口浓汁多,创口深者可先用0.5％雷佛奴尔纱条引流数天后,再用白糖换药,对分泌物多者可每天换药一次。治疗结果:剖宫产术及会阴侧切口裂开主要因局部感染、组织水肿或皮下脂肪肥     

急性骨与软组织感染脉冲冲洗术清除创面病原菌的临床研究

目的探究脉冲冲洗术对于急性骨与软组织感染创面病原菌清除率的影响,为临床合理选择创面清除措施提供依据。方法选取2012年1月-2014年1月外科急性骨与软组织感染116例住院患者,随机分为两组,各58例,对照组患者采用常规方法清除创面,试验组患者采用脉冲冲洗术清除创面病原菌,采用不同清洗措施后,分别观察两组患者的细菌数、肿瘤坏死因子(TNF-α)、白介素-6(IL-6)水平和伤口愈合等效果,并进行统计分析。结果对照组患者术后创口表面铜绿假单胞菌(2.01±0.57)×108 CFU/g、金黄色葡萄球菌(1.49±1.14)×108 CFU/g、大肠埃希菌(1.08±0.62)×108 CFU/g、TNF-α为(69.47±11.32)pg/L、IL-6为(80.35±13.18)pg/L,创口愈合甲级占37.9%、乙级占46.6%、丙级占15.5%;试验组患者术后创口表面铜绿假单胞菌(1.47±0.35)×108 CFU/g、金黄色葡萄球菌(0.76±0.18)×108 CFU/g、大肠埃希菌(0.61±0.22)×108 CFU/g,TNF-α为(42.13±7.44)pg/L、IL-6为(52.41±8.27)pg/L,创口愈合甲级占58.6%、乙级占36.2%、丙级5.2%;试验组患者创面铜绿假单胞菌和金黄色葡萄球菌的数目明显少于对照组,对照组TNF-α、IL-6水平明显高于试验组,试验组治疗后创口甲级愈合率明显高于对照组,差异均有统计学意义(P<0.05)。结论急性骨与软组织感染时,脉冲冲洗术可有效减少创口病原菌,降低感染率,增加伤口愈合效果,在临床治疗中具有重要价值。     

手部创面皮瓣修复术后医院切口感染患者的临床特点及影响因素分析

目的探讨手部创面皮瓣修复术后医院切口感染临床特点及相关影响因素,为临床治疗和预防提供参考。方法选取于2012年1月-2017年9月医院收治的手部皮瓣移植术患者236例,以无菌注射针对深部切口抽取脓液,以拭子采取浅部切口脓性分泌物,分离鉴定病原菌及药敏试验。分析患者一般资料,包括性别、年龄、受伤原因、皮瓣的手术方式、受伤时手部创面受污染情况、手术时间、住院时间、预防性使用抗菌药物。结果 236例手部创面各类皮瓣修复术患者中有20例发生术后切口感染,感染发生率为8.47%;术后切口感染20例中共分离培养出病原菌34株,其中革兰阳性菌22株占64.71%、革兰阴性菌12株占35.29%;主要革兰阳性菌对青霉素G和红霉素耐药率均为100.00%,主要革兰阳性菌对头孢曲松和头孢呋辛耐药率较高,均60%;Logistic多元回归分析结果显示,受伤时手部创面受污染严重、手术时间≥1h、住院时间≥7d及预防性使用抗菌药物为术后切口感染的影响因素。结论手部创面皮瓣修复术后医院切口感染病原菌以金黄色葡萄球菌、溶血性链球菌及大肠埃希菌为主,术后切口感染受多种因素影响,临床应规范操作,预防性合理使用抗菌药物,缩短手术和住院时间,以预防切口感染。     

手术切口感染炎症介质水平及护理干预效果

目的了解医院手术切口感染患者创口分泌物炎症介质水平,并探讨护理干预对减低手术切口感染的效果。方法对2 498例手术患者进行调查,选取其中180例患者随机分为干预组和对照组,每组90例,检测创口分泌物白细胞介素(IL-6)、超敏C-反应蛋白(hs-CRP)、肿瘤坏死因子α(TNF-α)、前列腺素E2(PGE2)、P物质(SP)等炎症介质水平;干预组采取综合护理干预措施,对照组采取常规护理措施,观察两组感染发生及切口愈合情况。结果 2 498例手术患者中发生术后切口感染197例,感染率7.89%。干预组患者创口分泌物IL-6为(8.94±1.25)pg/mL、hs-CRP为(1.22±0.24)mg/L、TNF-α为(2.01±0.30)ng/mL、PGE2为(117.82±21.53)pg/mL、SP为(6.50±0.53)μg/mL,均低于对照组,差异均有统计学意义(P值均0.05)。干预组手术切口感染率(5.56%)低于对照组(14.44%),干预组甲级愈合率(77.78%)明显高于常规组(60.00%),乙级、丙级愈合率明显低于常规组,差异均有统计学意义(P值均0.05)。结论术后切口感染患者创口分泌物炎症介质明显表达,感染严重程度与护理措施密切关联,护理干预能够降低术后切口感染率,提升术后切口愈合等级。     

骶前引流冲洗在腹会阴联合直肠癌根治术后的应用及护理体会

行经腹会阴联合切口根治术是低位直肠癌主要的手术方式,手术后会阴部切口缝合后骶骨前间隙及直肠残腔创面较大、渗液多,且该手术并非无菌手术,如术后处理不当,易发生上述部位感染,导致会阴部切口裂开,影响切口Ⅰ期愈合(1).本院于2008年至2010年采用骶前双管引流加冲洗的方法来处理会阴部切口,取得了良好效果,现报告如下.     

手术室消毒灭菌管理与医院感染控制

目的 通过加强手术室消毒灭菌管理,控制医院感染的发生.方法 按照《消毒技术规范》规定的操作对消毒灭菌效果进行监测;采用回顾性和现场临床观察方法,观察患者术后伤口情况.结果 2010年医院手术室空气灭菌合格率为98.9％,灭菌物品与消毒物品灭菌合格率均为100.0％,医护人员手卫生合格率为100.0％,与2009年相比,手术室消毒灭菌合格率明显提高;2010年我院Ⅰ类切口术后感染率为0.4％,Ⅱ类切口感染率为2.0％,Ⅲ类切口感染率为5.6％,与2009年相比,医院术后感染率明显降低.结论 加强手术室消毒灭菌管理是有效控制医院感染的关键.     

667例骨科手术切口目标监测与干预效果评价 FREE

目的 了解引起骨科手术切口感染的因素,采取有效措施预防与控制骨科手术切口感染。方法 分2个阶段对在洁净手术室进行的骨科手术切口进行监测,第1阶段即2008年3月1日-12月31日（调查阶段）,主要调查感染情况及相关因素;第2阶段即2009年1月1日-5月31日（干预阶段）,根据前阶段的调查结果对可干预的相关因素进行干预。比较两阶段的感染率。结果 调查阶段的手术切口感染率为5.07%（23/454）,干预阶段的手术切口感染率为1.41%（3/213）,干预阶段切口感染率显著降低（χ2=4.25,P＜0.05 ）。结论 加强洁净手术室的管理、保证手术器械及用物灭菌质量、围手术期合理使用抗菌药物、正确进行外科手消毒、严格执行换药操作规程、提高医护人员感染控制意识等干预措施可有效预防与控制骨科手术切口感染。     

Postoperative infections in colonic surgery after enteral bacitracin-neomycin-clindamycin or parenteral mezlocillin-oxacillin prophylaxis

In a prospective randomized, blind trial, three groups of patients undergoing elective colonic surgery were compared for frequency of surgical wound infection, intra-operative wound contamination and other postoperative infections. All patients allotted to the three groups received whole gut irrigation (101 balanced salt solution) by gastric tube on the evening before surgery and were treated as follows. Group A: no antibiotics; Group B: neomycin (1 g/l) + bacitracin (50,000 IU/l) + clindamycin (900 mg/l), contained in the last 31 of irrigation fluid; Group C: mezlocillin (4 g) + oxacillin (2 g) intravenously (iv) at induction of anaesthesia, followed by two identical doses at 8 and 16 h. The rate of postoperative wound infection was highest in A (38 per cent) and much lower in B (3.3 per cent, P less than 0.002) and C (6.9 per cent, P less than 0.004). The difference between B and C was statistically not significant. In A a correlation was established between the degree of wound contamination and the occurrence of wound infection. Intra-operative wound contamination was lowest in B (30 per cent), equal in A (58.1 per cent) and B (55.2 per cent). Other infections were least frequent in group C (four of 29 patients), but were not significantly different to groups B (six of 30) and A (nine of 31). It is concluded that antibiotics together with an effective mechanical preparation considerably reduce the rate of wound infection in colonic surgery.     

PFNA在老年股骨转子间骨折的运用效果分析

目的：探讨及分析股骨近端防旋髓内钉治疗老年股骨转子间骨折的运用效果。方法：本院2009年4月-2013年5月住院的48例老年股骨转子间骨折患者应用近端防旋髓内钉的方法进行治疗,分析记录手术时间以及出血量,术后随访6～8个月,观察记录全部患者有无内固定物松动、手术切口感染、深静脉血栓形成、股骨头坏死等情况出现。通过Harris疗效评价标准对所有患者术后的疗效进行评价。结果：全部患者的手术均进行顺利,术后影像学资料证实骨折复位情况良好,手术时间平均（55.7±7.6）min,手术出血量平均为（53.8±9.3）mL,随访期间未出现内固定松动、手术切口感染、深静脉血栓形成、股骨头坏死等情况出现,所有患者骨折均完全愈合。Harris评分优良率为93.75%。结论：股骨近端防旋髓内钉治疗老年股骨转子间骨折疗效确切、手术创伤小、固定牢固、易操作、并发症较少,值得临床进一步推广。     

Surgery, sterilization and sterility

The history of sterilization was not linked from the first with surgery. Surgery came first, fully 600 years before the principles of asepsis and anesthesia were even introduced in the middle of the 1800s. Also in the 1800s, the beginnings of thermal sterilization were being developed in the food industry. The basic principles of antisepsis and prevention of wound suppuration, including the destruction of germs on instruments, dressings, the hands of the surgeon and his assistants, and everything else in contact with the wound were clearly elucidated by Lister in the 1870s and remain the inviolate principles of surgical asepsis today. In general, the marriage between the surgeons and the sterilizers was a successful one; the major handicap to eternal bliss and harmony, however, was an incompatibility between the partners. As in many marriages, the partners made unwarranted demands upon each other, and became frustrated when these demands were unfulfilled. The field of surgical sterilization and surgical safety is less confused by technical inconsistencies than it is by semantic nightmares, such that we will never reach a universal definition of sterility. However, we do not really need a universal definition of sterility. Rather we should learn how to translate sterility tests in terms of the real world infections hazards.     

爱护佳手部皮肤消毒效果监测及评价

目的探讨4%爱护佳皮肤消毒剂消毒效果。方法将参加手术的医护人员按8个时段随机分成涂抹、未涂抹两组,每组50例;均采用4%爱护佳外科洗手液进行皮肤消毒;在消毒后,需再次涂抹0.5%爱护佳快速无水消毒洗手液于手部和前臂,为涂抹组;无需涂抹0.5%爱护佳快速无水消毒洗手液,为未涂抹组;两组均在消毒后即刻及术中1、2、3、4、5、6 h及6 h后分别进行手指采样培养,检测消毒效果。结果两组人员在各时段进行细菌学检测,菌落数均<5 CFU/cm2,手消毒效果均达到国家卫生部《消毒技术规范》标准,涂抹组与未涂抹组在各时段及总时段的培养结果差异无统计学意义(P>0.05)。结论4%爱护佳皮肤消毒剂消毒效果可靠,无需再次涂抹0.5%爱护佳快速无水消毒洗手液,其抗菌作用可持续≥6 h,使用流程简便,并能降低手术成本,提高工作效率。     

Significance of the hemostatic effect of lasers in oral surgery

The authors summarize the operative experiences performed with CO2 laser in 352 cases of oral surgery with special regard to the hemostatic effect. One of the patients suffered from hemophilia, 5 from thrombocytopenia and 5 from hypoprothrombinemia. Of the alterations to be eliminated 128 were especially inclined to hemorrhage (hemangioma, epulis, granuloma fissuratum). The operations were carried out with out-patients in local anesthesia. Due to the hemostatic effect of the laser the surgery could be performed in dry operative areas, the laser knife coagulates in the course of cutting the small vessels. Both in the group of patients with hemorrhagic diathesis and in the group of operation of alterations inclined to bleeding the experiences were highly favourable. No significant differences were found between the group of patients with hemorrhagic diathesis and other patients in the respect of the duration of operation, degree of bleeding, healing of the wound and complication. CO2 laser of high energy was found to be well applicable in the field of oral surgery owing to its excellent hemostatic effect, especially in operations where the patient or the alteration to be removed (possibly both) are disposed to bleeding.     

老年人梗阻性结肠癌的临床特点和围手术期处理

目的 探讨老年人梗阻性结肠癌的临床特点和治疗方法.方法 回顾性分析2000年1月至2010年11月老年人梗阻性结肠癌30例的临床特点和围手术期处理情况.急诊手术11例,限期手术19例.一期切除吻合术26例(86.7％),短路性肠吻合术或单纯造瘘术4例(13.3％).结果 30例患者住院22～56d.术后出现切口感染5例,切口液化3例,切口裂开2例,吻合口瘘2例,肺部感染3例.围手术期死亡2例.结论 对于老年人梗阻性结肠癌,除尽早作出诊断外,还要根据病情作适当的围手术期处理.选择合适的手术时机和合理的手术方式是提高临床疗效的关键.     

An observer blind trial of co-amoxiclav versus cefuroxime plus metronidazole in the prevention of postoperative wound infection after general surgery

A consecutive series of 509 patients undergoing abdominal surgery were entered into a randomized, observer and patient blind, controlled, prospective, study to evaluate the efficiency of co-amoxiclav (‘Augmentin’, SmithKline Beecham, UK) compared with cefuroxime (‘Zinacef’ Glaxo, UK) plus metronidazole (Flagyl, M&B, UK) for the prevention of postoperative wound infections. One or three doses of antibiotics were given depending on the type of surgery and operative factors. Co-amoxiclav was given to 230 patients with a total wound infection rate of 5·6% and cefuroxime plus metronidazole were given to 225 patients with a total wound infection rate of 3%. The difference between infection rates was not significant. Both groups were comparable in terms of demographic details, type and duration of surgery, risk factors associated with surgical procedures and postoperative management. Although not statistically significant, a difference in the wound infection rate for those patients undergoing colorectal surgery was seen: for the co-amoxiclav group and for the cefuroxime/ metronidazole group. The estimated cost to our hospital (October 1993) of one dose of co-amoxiclav was less that half the cost of cefuroxime and metronidazole. This study demonstrates that co-amoxiclav is an effective prophylactic antibiotic for abdominal surgery.     

木糖葡萄球菌引发术后医院感染的鉴定与分析

目的 调查分析深圳市某医院常规手术术后感染的原因。以加强术后感染的控制。方法 对深圳市某医院术后感染病例进行病原学分析及常规监测分析。结果 引发术后感染的病原菌是木糖葡萄球菌，结论 手术室消毒措施不得力，手术用具灭菌不严格，是造成术后并发院内感染的重要因素。因此应采取相应的监控措施。