120例唇裂修复术的体会

目的探讨唇裂修复术式的选择及如何避免可能发生的缺陷。方法 120例唇裂应用三角瓣法、矩形瓣法、旋转推进法、前唇全长修复术、Z形修复术。结果基本达到唇裂修复目标的要求者96例,占80%;24例有不同程度的缺陷,有的兼有2种以上缺陷,占20%。结论术前充分的准备,精心设计,术中精心操作,术后精心护理,调动医患双方一切积极因素,才能达到修复的最佳效果。     

145例唇裂手术患儿医院感染调查分析

唇裂修复术是口腔颌面外科的常见手术 ,患儿年龄偏小 ,医院感染率高。我们对我院口腔科 14 5例唇裂患儿医院感染情况进行调查分析 ,以探讨唇裂患儿医院感染的原因及预防措施。一、对象和方法1.调查对象 :1998年 1月～ 2 0 0 0年 12月在我院住院行唇裂修复术的患儿。2 .诊断标准 :按照中华医院感染管理学会审定的《医院感染诊断标准》。3.调查方法 :采用回顾性调查方法。二、结果1.性别、年龄构成及医院感染率 :14 5名唇裂住院患儿中男性 10 4人 ,女性 4 1人 ;年龄 1个月～ 16岁 ,平均 14 11个月。 14 5名患儿共发生医院感染5 0例 ,感染率为…     

改良Tennison术式在单侧Ⅲ°唇裂患者中的临床应用研究

唇裂是口腔颌面部最常见的先天性畸形,常伴发腭裂,由于其可引起除视力以外颌面部多器官的形态和功能障碍而备受人们的关注。根据我国出生缺陷检测中心1996--2000年检测结果显示,在全国31个省市的2218616多万围产儿中检出唇腭裂患儿3603例,其患病率为1．624／万。唇裂患者多采用传统的Tennison术式进行治疗,其优点是定点较明确,初学者易掌握,能够恢复患侧应有的高度;其缺点是在患侧要切除一些正常的唇组织;     

单侧唇裂初期修复术联合鼻畸形矫正对鼻外形效果及美观度的影响

目的观察单侧唇裂初期修复术联合鼻畸形矫正的鼻外形及美观度效果。方法选择2013年5月—2016年3月收治的124例单侧唇裂患儿临床资料,依手术方案不同分2组,各组62例,对照组实施唇裂修复术,观察组实施唇裂修复+鼻畸形矫正术,比较组间鼻外形、美观度。结果观察组治疗优良率93.55%比对照组74.19%高(P<0.05);观察组各指标非对称率均比对照组低,且鼻尖偏移度(1.56±0.49)mm比观察组(3.01±0.73)mm小(P<0.05);观察组鼻外形(71.16±8.93)分、美观度(90.62±6.14)分均比对照组优,且家属满意度96.77%比对照组82.26%高(P<0.05)。结论在初期修复单侧唇裂的同时为患儿采取鼻畸形矫正术治疗,不仅可提高修复效果,还能早期纠正鼻畸形,提高鼻外形对称性,改善鼻部外形及美观度,不影响外鼻发育生长,提高患儿家属满意度。     

唇裂修补术后二期修复鼻畸形19例分析

目的探讨唇裂修补术后二期综合修复的有效治疗方法。方法应用手术的方法延长鼻小柱,重塑鼻尖和两侧鼻翼软骨的形态．矫正遗留的鼻翼基部错位和鼻底凹陷等。结果19例患者经治疗后,形体恢复良好,整形效果满意。结论手术二期修复鼻畸形应首选,切实可行。     

清洁手术预防使用抗菌药物对术后感染的影响研究

目的探讨清洁手术预防使用抗菌药物对术后感染的影响,以期规范抗菌药物应用。方法回顾性分析2011年1月-2013年9月医院的Ⅰ类切口手术、经血管途径介入诊断手术、白内障、腹股沟疝修补术、甲状腺、乳腺手术患者,自2012年起开展了规范性管理,观察以上手术术后感染情况,采用SPSS13.0软件进行统计分析。结果 2011、2012、2013年Ⅰ类切口手术抗菌药物使用率分别为91.0%、35.6%、28.1%,呈逐年下降趋势,差异有统计学意义(P<0.05);2011、2012、2013年Ⅰ类切口手术感染率均为0.6%,差异无统计学意义。结论预防使用抗菌药物要严格掌握适应证,避免滥用,更好地发挥抗菌药物的临床效果。     

双侧唇裂术后修复鼻唇畸形的矫正

唇裂为先天性因素造成的一种颌面畸形。首次行唇裂修复时,患者多在1．5岁以下,大多不做鼻畸形的修复或仅行简单的鼻翼软骨分离复位。故此,术后仍存在明显唇鼻畸形。但2001年9月至2007年2月笔者共完成双侧唇裂术后唇鼻畸形矫正术23例,取得满意效果,现报道如下。     

择期腹股沟疝修补术抗菌药物预防使用对手术部位感染的影响

目的 比较腹股沟疝修补术抗菌药物的使用对手术部位感染影响.方法 选择2011年8月1日-2012年2月29日择期单侧腹股沟疝修补术(补片)病例246例,按照手术日期轮换采用术中预防性应用抗菌物药(A组)、围术期预防性使用抗菌药物24 h(B组)、围术期使用安慰剂(C组),对照研究预防手术部位感染效果.结果 3组均未发生手术部位感染,感染率均为0,仪B组有l例胃肠道感染发生,感染率为1.2％,3组比较,差异无统计学意义;A组与B组抗菌药物使用时间及种类不同(P＜0.01),对预防感染,差异无统计学意义;B组平均住院时间最长,为(2.79±0.65)d,C组最短,为(1.98±0.56)d(P＜0.01);C组抗菌药物费用及总费用最低(P＜0.01).结论 腹股沟疝修补术患者若无易感因素,则不需预防性使用抗菌药物.     

预防性应用抗菌药物对腹股沟无张力疝修补术后切口感染效果的荟萃分析

目的评价预防性应用抗菌药物对腹股沟无张力疝修补术后切口感染的作用,明确对于该类手术患者是否需要预防性使用抗菌药物。方法检索2000年1月-2013年11月所有公开发表的关于预防性使用抗菌药物对腹股沟无张力疝修术切口感染的影响,临床随机对照试验,对符合纳入标准的研究使用Revman5.2软件进行统计分析。结果按照筛选标准,共有14项随机对照试验,5 940例患者纳入研究,预防性使用抗菌药物组与未使用抗菌药物组患者一般情况及病例特征分布均衡,预防性应用抗菌药物组术后切口总体感染率2.82%及切口浅部感染率2.25%,较对照组的3.88%及4.36%明显降低(P<0.05),而切口深部感染率两组比较差异无统计学意义。结论行腹股沟疝无张力修补术术前预防性应用抗菌药物能有效降低切口浅部感染的发生率,而对预防切口深部感染无实质性效果。     

Surgical antibiotic prophylaxis: effect in postoperative infections

Objective: to assess the risk of surgical wound infection and hospital acquired infections among patients with and without adequate antibiotic prophylaxis. Also, to provide models to predict the contributing factors of hospital infection and surgical wound infection. Design: survey study. Prospective cohort study over 14 months, with data collected by a nurse and a epidemiologist through visits to the surgical areas, a review of the medical record and consultation with the medical doctor and nurses attending the patients. Setting: Two hundred and fifty bed, general hospital serving Puertollano (Ciudad Real), population – 50,000. Results: between February 1998 and April 1999, 754 patients underwent surgery, 263 (34.88%) received appropriate peri-operative prophylaxis while 491 (65.12%) received inadequate prophylaxis. For those who received adequate antibiotic prophylaxis, the percentage of nosocomial infection was 10.65% compared with the group who received inadequate prophylaxis in which the percentage of nosocomial infection was 33.40%. The relative risk of nosocomial infection was, therefore, 4.21 times higher in the latter group (confidence intervals 95%: 2.71–6.51). A patient in the inadequate prophylaxis group had a 14.87% chance of wound infection while a patient in the adequate prophylaxis group had a 4.56% chance of wound infection. The relative risk of wound infection was 3.65 times higher in the group that received inadequate prophylaxis (confidence intervals 95%: 1.95–6.86). The final regression logistic model to assess nosocomial infection incorporated seven prognostic factors: age, length of venous periferic route, vesicle catheter, duration of operation, obesity, metabolic or neoplasm diseases and adequate or inadequate prophylaxis. When we incorporated these variables in the multi-factorial analysis we found that the relative risk of developing nosocomial infection was 2.33 times higher in the group which received inadequate prophylaxis. When we applied the second logistic multiple regression model (wound infection), we discovered that the probability of developing surgical wound infection was 2.32 times higher in the group which received inadequate prophylaxis as opposed to the group, which received adequate prophylaxis. The goodness of fit (Hosmer–Lemeshow test) showed a correct significance in all models. Conclusions: a multi-factorial analysis was applied to identify the high-risk patients and the risk factors for postoperative infections. Through the application of these multiple regression logistic models, we conclude that the correct antibiotic prophylaxis is effective and will subsequently reduce postoperative infection rates, especially in high-risk patients. Therefore, the choice of antimicrobial agent should be made on the basis of the criteria of hospital committee.     

改良青霉素皮试液的应用及感染管理

目的 提高对执行“一人一针一管”制度的依从性，保证注射安全。方法 方法1：将1瓶80万u青霉素注射液稀释后配制成40人份含青霉素50U／0．1mL的皮试液，用无菌注射用水反复冲洗该药瓶，将配制的皮试液注入瓶内贴好标签，在4h内使用；方法2：按常规方法配好1mL皮试液后，根据病区皮试人数用数副一次性注射器在配好皮试液的注射器乳嘴处抽吸分为数管使用。同时通过对各科皮试用的一次性注射器、注射针的消耗量及两者比例进行监控“一人一针一管”的执行情况。结果 改良方法的应用大大地提高了工作效率、节约了经费，按40人份计算，改良方法1与原来的常规方法比较，耗时相差20倍，经费相差8．9倍。结论本改良方法简便易行．安全可靠．值得推广。     

北京市男男性行为者HIV新发感染率与高危行为及接受暴露前后预防用药服务情况调查

目的 了解北京市MSM的HIV新发感染率与高危行为及接受暴露前后预防（PrEP/PEP）用药服务情况。方法 采用Epi Info7.0软件计算参加横断面调查和队列调查样本量分别为1 227人和207人年。采用方便抽样法通过手机微信公众号招募MSM参加自填式网络问卷调查,收集其社会人口学、高危行为及接受PrEP/PEP用药服务利用情况,MSM自行采集干血斑样本邮寄到指定实验室进行HIV核酸检测。建立HIV核酸阴性受检者开放式队列,随访观察至研究终点。采用非条件logistic回归分析MSM最近1个月无保护肛交行为、最近1个月同性多性伴的影响因素。结果 共招募MSM 1 147人,其中HIV核酸阴性者956人观察236人年。HIV新发感染率为1.3/100人年（3/236）。最近1个月肛交和口交每次都使用安全套者分别占50.7%（238/469）和4.9%（23/469）。最近1个月与HIV感染者发生性行为的比例为5.9%（43/723）。分别有9.8%（103/1 049）和8.7%（91/1 049）的研究对象曾接受PrEP/PEP用药服务。PrEP/PEP用药期间发生性行为每次使用安全套的比例分别为34.3%（24/70）和72.2%（39/54）。多因素logistic回归分析结果显示,接受PrEP/PEP用药服务者的最近1个月发生无保护肛交行为和有同性多性伴的可能性均较高（aOR=3.16,95%CI：1.45~7.18;aOR=2.64,95%CI：1.19~6.30）;最近1个月使用毒品或Rush Popper者的最近1个月发生无保护肛交行为和有同性多性伴的可能性均较高（aOR=2.34,95%CI：1.67~3.30;aOR=2.42,95%CI：1.76~3.33）。结论 应在MSM中倡导坚持使用安全套及开展常见滥用药物危害的健康教育。在PrEP/PEP用药服务咨询中,需提示MSM坚持使用安全套的重要性。     

青霉素制造过程中发生的职业性皮肤病

本文报告上海某制药厂生产青霉素过程中发生的职业性皮肤病。1964年及1987年分别调查357及193人,发病数分别为242(67.8%)及65(33.7%)人,所见皮损以皮炎湿疹最多,其他有接触性荨麻疹、瘙痒症、手掌角化皲裂、指间浸渍擦烂、甲沟炎及色素异常等。其中皮炎湿疹及手掌角化皲裂,1987年较1964年明显减少(P<0.001)。斑试结果显示甲醛、普鲁卡因、乙醇、青霉素为皮炎的主要致病因素。     

Rabies neutralizing antibody after 2 intradermal doses on days 0 and 21 for pre-exposure prophylaxis

Pre-exposure prophylaxis is recommended for people who will be exposed to rabies virus in the laboratory or who will contact with mammals. World Health Organization recommends 2 doses of a cell-culture rabies vaccine given 1 week apart, and a third booster dose given 2–3 weeks later. Neutralizing antibody response is virtually 100%, and the individual remains sensitized indefinitely. Intradermal pre-exposure regimen for rabies prophylaxis is more economical compared with the conventional intramuscular regimen in terms of vaccine volume. However, both regimens require three clinic visits. In order to reduce non-medical expenses such as transportation to the clinics and to increase compliance, the immunogenicity and safety of two-visit intradermal regimen for pre-exposure prophylaxis were studied. Fifty-five healthy subjects aged between 18 and 24 years were enrolled and divided into two groups. Group A (n = 39) received 0.1 ml of purified Vero cell rabies vaccine (PVRV; Sanofi Pasteur, Lyon, France; Lot no. Z0996 with an antigenic value of 4.8 IU/0.5 ml vial) intradermally each at two sites on days 0 and 21. Group B (n = 16) received 0.5 ml of PVRV intramuscularly on days 0, 7 and 21, as conventional intramuscular regimen for pre-exposure prophylaxis. Rabies neutralizing antibody (Nab) titers were measured on days 0, 35, 365 and 379 (14 days after simulated post-exposure booster vaccination). All subjects from two groups had Nab titers ≥0.5 IU/ml on day 35. In addition, the difference between geometric mean titers for group A (4.51 IU/ml; range of Nab titers 1.69–13.0 IU/ml) and group B (6.74 IU/ml; range of Nab titers 2.20–14.23 IU/ml) on day 35 was not statistically significant (p > 0.05). One year after pre-exposure vaccination, all subjects in both groups received simulated post-exposure booster vaccination with 0.1 ml of PVRV ID on days 0 and 3 (day 365 and day 368 after pre-exposure vaccination). After simulated booster vaccinations with 0.1 ml PVRV ID on days 0 and 3, all subjects in groups A (GMT 14.38 IU/ml; range 2.99–308.44 IU/ml) and in group B (GMT 14.06 IU/ml; range 3.12–62.09 IU/ml) had rabies Nab titers ≥0.5 IU/ml on day 14 post-booster (p > 0.05). Mild local adverse events such as pain at injection site, pruritus and erythema were observed. Our study indicated that 2-site intradermal pre-exposure regimen on days 0 and 21 with 0.1 ml of cell-culture rabies vaccine is safe and immunogenic as the conventional intramuscular regimen.     

Protocol implementation in hospital infection control practice: an Italian experience of preoperative antibiotic prophylaxis

This study evaluates the effectiveness of a protocol implemented to induce behavioural modifications in healthcare workers (HCWs). A preoperative antibiotic prophylaxis protocol for surgical procedures in clean and clean-contaminated wounds was used. The study was conducted in a 300-bed Italian university hospital between 1998 and 1999. The protocol's impact was analysed by retrospective examination of the clinical records for selected common surgical procedures. The study also investigated the reasons for the low compliance with the protocol through a focus group methodology. We examined 723 surgical procedures and the overall compliance was 30.8% (56/182) before the implementation of the protocol and 45.2% (76/168) after 1 year (P< or = 0.01). During the same period compliance with the use of antibiotics increased when antibiotics were recommended by the protocol (5/115 vs. 19/109, P< or = 0.01) and use decreased when they were not (51/67 vs. 57/59, P< or = 0.01). As reported in the focus groups, reasons for low compliance included hospital policy weaknesses in protocol definition and implementation and the cultural behaviour of HCWs. Our results reinforce previous findings that monitoring the effectiveness of protocol implementation in the medical care setting is essential. Critical points that might increase the effectiveness of protocol implementation have also been identified.