碘伏冲洗预防阑尾切除术后切口感染

碘伏冲洗预防阑尾切除术后切口感染柏楠，史争鸣北京积水潭医院（１０００３５）我院自１９９０年６月开始，采用国产碘伏（０．５％碘一聚醇醚ＰＯＮ－Ｉ）冲洗腹膜外切口组织，预防因急性阑尾炎行阑尾切除术后切口感染，显著地降低了术后切口感染率。１临床资料１．１病...     

甲硝唑冲洗预防阑尾切除术后切口感染

甲硝唑冲洗预防阑尾切除术后切口感染吴成光（广西荔浦县人民医院外科荔浦县５４６６００）关键词阑尾切除术;切口感染;预防;甲硝唑自１９９５年１月开始采用本院制剂室配制的甲硝唑溶液（浓度为０．５％）冲洗腹膜外切口,预防因急性阑尾炎行阑尾切除术后切口感染,显...     

预防阑尾炎切口感染的临床分析

目的探讨应用甲硝唑、络合碘及生理盐水冲洗阑尾炎手术切口对切口感染的防治作用。方法对428例急性阑尾炎患者切口感染资料进行临床回顾性分析。结果甲硝唑组、络合碘组的切口感染率均低于生理盐水组，差异有统计学意义：甲硝唑组与络合碘组切口感染率差异无统计学意义。结论手术过程中合理选择冲洗液冲洗切口可明显降低阑尾切除术后切口的感染率。     

络合碘在预防阑尾切除术后切口感染中的应用

我院自１９９２年元月至１９９８年８月采用络合碘（湖南医科大学防疫制品厂生产）、新洁尔灭（国营南昌杨子洲制药厂生产）预防阑尾切除术后切口感染，并进行临床比较，发现络合碘组取得较满意的临床效果，现报道如下。１临床资料１．１病例选择①均为手术证实为化脓性、...     

聚维酮碘预防化脓性阑尾炎术后切口感染的疗效分析

目的：探究聚维酮碘溶液冲洗切口预防化脓性阑尾炎术后切口感染的临床效果及病原学调查。方法：选择2012年4月－2013年10月因化脓性阑尾炎而行阑尾切除手术的患者264例,随机分为实验组和对照组各132例,实验组术中用0．1％聚维酮碘溶液冲洗切口,对照组用生理盐水冲洗切口,观察两组患者术后切口感染发生率及感染细菌类型。结果：实验组切口感染率为6．1％（8例）,明显少于对照组的14．4％（19例）,两组比较有统计学意义（ P＜0．05）。实验组患者切口脂肪液化率为9．1％（12例）,对照组切口脂肪液化率为7．6％（10例）,差异无统计学意义（ P＞0．05）。所有切口感染患者切口分泌物细菌培养共分离出细菌32株,革兰阴性菌25株,占78．1％;革兰阳性菌7株,占21．9％。检出株数居首位的为大肠埃希菌,检出19株,占59．4％。结论：应用聚维酮碘溶液冲洗急性化脓性阑尾炎的手术切口,能降低术后切口感染发生率,感染病原菌多为革兰阴性杆菌。     

阑尾炎术后切口感染相关因素分析及预防

目的探讨引起急性阑尾炎术后切口感染的相关因素及预防。方法回顾性分析430例急性阑尾切除术患者的所有资料,比较发生切口感染与无切口感染患者在一般临床资料及手术指标上的差异。结果430例中急性阑尾切除术患者发生切口感染30例（6．97％,30／430）;感染组较非感染组体质量指数高、阑尾化脓坏疽穿孔比例高、探查切口多、逆行法切除比例高、手术时间长（P〈0．05）,两组性别构成、切口长度无差异（P〉0．05）。结论阑尾炎术后切口感染是多因素综合作用的结果,应针对上述因素预防和控制切口感染的发生。     

阑尾炎术后切口感染的危险因素及预防

目的分析阑尾炎术后切口感染的相关因素,探讨独立危险因素及预防。方法对786例行阑尾切除术的急性阑尾炎患者临床资料进行回顾性分析,将患者分为感染和非感染两组。对相关影响因素采用Kaplan．Meier单因素分析和多因素Logistic回归分析。结果786例中共有34例（4．3％）术后发生切口感染,发生感染的平均时间为术后3．6d。多因素分析显示,病程、切口保护、引流出1：2、病理类型为术后切口感染的独立危险因素（P〈0．05）。结论病程长、阑尾病理改变重、术中未注意切口保护及引流出口不当是引起阑尾炎切除术后切口感染的独立危险因素;而早期手术、加强保护切口,另戳孔引流是降低切口感染的关键。     

阑尾炎术后切口感染的防治

目的探讨阑尾炎患者术后切口感染的预防及治疗方法。方法将2007年6月～2008年12月我院手术治疗的50例阑尾炎患者分为两组,对照组24例采用术后常规甲硝唑液冲洗腹腔预防切口感染,观察组26例术前静滴0．5％甲硝唑注射液100mL、术后采用0．1％新洁尔灭液冲洗腹腔预防切口感染,对两组患者的恢复情况进行观察比较。结果观察组患者的肠道恢复时间及住院时间均明显短于对照组,有统计学意义（均P〈0．01）;且术后切口感染发生率明显低于对照组（P〈0．05）。结论本方法能够有效预防术后切口感染,临床效果满意,值得关注。     

小切口阑尾切除术 126 例临床分析

目的探讨小切口阑尾切除术与传统阑尾切除术的效果。方法回顾性分析该院2009年1月-2013年6月收治的240例阑尾炎患者,随机分为观察组126例和对照组114例,观察组采取小切口阑尾切除术治疗,对照组采取传统切口治疗。比较两组患者切口长度、手术时间、住院时间、进食时间和术后切151感染率。结果两组患者在手术时间上比较差异无统计学意义（P〉0．05）,观察组在切口长度、进食时间及住院时间均低于对照组,各项指标差异有统计学意义（P〈0．05）,患者切口类型对其术后感染的发生率影响较大,观察组患者切口感染发生率为2例（1．59％）,而对照组患者切口感染发生率为8例（7．02％）,两组比较差异有统计学意义（P〈O．05）,观察组护理服务满意度显著优于对照组,两者相比差异有统计学意义（P〈O．05）。结论小切口阑尾切除术治疗阑尾炎的手术效果明显优于传统切口的,其创伤小,恢复快,值得在临床推广。     

聚碘维酮冲洗对腹部肥胖看阑尾切口感染50例临床观察

目的　探讨聚碘维酮预防腹部肥胖者阑尾切口感染的效果。方法　将 10 0例腹部肥胖的急性阑尾炎患者随机分成两组 ,聚碘维酮组予以 1%聚碘维酮冲洗切口并浸湿 2分钟 ,对照组以生理盐水冲洗切口 ,术后观察两组切口的感染情况。结果　聚碘维酮组切口感染率为 6 % (3/5 0 ) ,对照组为 2 8% (14 /5 0 ) ,两组差异有显著性意义 (P <0 .0 0 5 )。结论　聚碘维酮能显著降低腹部肥胖者阑尾切口的感染率。     

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.     

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.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.