结肠直肠恶性肿瘤手术部位感染危险因素分析

目的评估结肠直肠恶性肿瘤手术部位感染(surgical site infection,SSI)发生率,探讨其危险因素。方法前瞻性调查于2012年9月—2013年9月在重庆医科大学附属第一医院行结肠直肠恶性肿瘤切除术的392例患者,分为SSI组90例和对照组302例,单因素和多因素分析手术部位感染危险因素。结果 SSI组90例,罹患率23.0%。单因素分析显示在手术持续时间>75%分位点、是否结肠造瘘、手术方式、手术切口类型、美国麻醉医师学会(ASA)评分两组差异有统计学意义(P<0.05),二元Logistic回归分析显示污染手术切口(P=0.016,OR=3.311)、手术持续时间>75%分位点(P=0.000,OR=3.017)、结肠造瘘(P=0.008,OR=2.642)、腹腔镜手术(P=0.016,OR=0.523)两组差异有统计学意义。结论手术持续时间>75%分位点、结肠造瘘和污染手术切口是结肠直肠恶性肿瘤切除术发生SSI独立的危险因素,而腹腔镜手术方式是保护性因素。     

第二产程持续时间与分娩结局关系的探讨

目的探讨第二产程(SBC)持续时间与分娩结局的关系。方法根据SBC持续时间将1009例充分试产产妇分为3组,<1h组791例,1～2h组188例,>2h组30例。比较各组羊水性状、新生儿5分钟Apgar评分、新生儿窒息、宫缩、分娩方式、产后出血情况等。结果随着SBC时间的延长,羊水污染程度加重(χ2=59.293,P=0.000),新生儿Apgar评分渐次降低(χ2=141.154,P=0.000)。<1h组、1～2h组和≥2h组窒息发生率分别是1.14%、4.26%和%16.67%(χ2=37.344,P=0.000),继发性宫缩乏力发生率分别是11.25%、20.21%和26.67%(χ2=15.235,P=0.000),剖宫产率分别是13.53%、21.81%和56.67%(χ2=44.325,P=0.000),产后出血发生率分别是2.40%、7.98%和13.33%(χ2=20.843,P=0.000)。结论 SBC持续时间延长可明显降低新生儿Apgar评分,增加羊水污染程度,导致母婴不良预后,针对SBC延长的潜在因素进行早期干预可望获得良好分娩结局。     

腰椎后路融合术术后感染的危险因素分析

目的:探讨腰椎后路融合术男性患者的术后感染的危险因素,分析研究的指标与感染的发生率的相关性。方法:回顾分析2015年1月至2017年12月入院病例,接受腰椎后路融合术的男性患者,发生术后感染的为病例组33例,未发生感染的分为对照组63例。收集年龄、BMI、吸烟、糖尿病、类固醇使用、手术时间、脑脊液漏、输血7个指标作为分析对象,采用单因素Logistic分析和多因素Logistic分析与感染率的相关性。结果:单因素分析结果显示:年龄(P=0.000)、BMI(P=0.019)、吸烟(P=0.033)、糖尿病(P=0.000)、手术时间(P=0.001)、有无脑脊液漏(P=0.030)、术中是否输血(P=0.000)与感染的发生率相关,而"类固醇激素服用"(P=0.052)与感染的发生率并未存在相关,多因素结果分析显示只有手术时间(P=0.008,OR=10.461)、是否输血(P=0.016,OR=7.318)、是否脑脊液漏(P=0.005,OR=8.020)纳入了多元回归方程。这三类因素的纳入,可以影响到感染发生率。结论:腰椎后路融合术应关注患者的手术时间、是否输血和是否脑脊液漏,这三个因素与术后感染相关,减少术后感染的发生率。     

消毒法和保管法

960857乙型肝炎病毒感染者手术的院内感染管理/李静…//中华护理杂志一1995.30(5)一294一295 患者手术前常规作乙肝5项指标检查,阳性者应通知手术室,安排单独手术间。术中输液用物、各种手术单及参加手术人员的衣、物均用一次性。护理人员分两组:一组在手术间内;另一组在手术间外供应临时需要物品,交接在手术室侧门进行。用指定平车,铺一次性被单接送病人。麻醉师及护理人员均戴一次性手套,术者及器械护士戴双层手套,术中接触伤口的敷料放入。.5%过氧乙酸溶液污物桶内,需要计数的敷料置于铺双层一次性敷料的托盘内。术后手术人员脱去衣帽后…     

单、双层手套对骨科手术人员手保护的效果比较

2006年7月～11月,我们对单层及双层手套的穿孔率进行比较,双层手套对骨科手术人员的保护效果满意.现报告如下. 1 资料与方法 1.1 临床资料本组对骨科手术60名(包括急诊和择期手术)、680只手套(包括戴双层的内、外层手套)进行分析.股骨骨折内固定术21名,椎间盘摘除术17名,腰椎骨折内固定术12名,颈椎前后路手术10名.本组21名为乙肝、丙肝及结核等感染性手术,手术人员均戴双层手套,共320只手套,另39名无特殊感染,手术时戴单层手套,共360只.     

围绝经期妇女更年期综合征现状调查及影响因素分析

目的:调查围绝经期妇女更年期综合征现状及影响因素,为制定相应的护理干预措施提供依据。方法:采用自制的调查问卷,选取217名45~55岁妇女为调查对象,进行更年期综合征现状调查及影响因素分析。结果:围绝经期妇女出现更年期综合征者占75.5%,其中骨关节疼痛、头晕、疲倦乏力居于发生率的前三位;围绝经期妇女随着年龄的增加,更年期综合征在一定程度上呈现愈发严重的趋势(P=0.000);围绝经期妇女更年期综合征与年龄(P=0.000)、初潮年龄(P=0.040)、绝经(P=0.000)、流产史(P=0.036)、吸烟史(P=0.012)、生活压力(P=0.004)相关;骨质疏松是最常见的更年期症状之一,不太了解骨质疏松的妇女占71.5%。结论:更年期综合征及相关疾病严重地影响围绝经期妇女的身心健康,同时围绝经期妇女对骨质疏松等症状的了解有待进一步提高,及时采取有效护理干预有重要意义。     

持续质量改进在手术标本缺陷管理中的应用

目的探讨持续质量改进(continuous quality improvement,CQI)在手术标本缺陷管理中的应用效果。方法对我院2013年1~6月73件手术标本缺陷进行调查分析,针对影响原因,CQI护理小组依据PDCA循环进行手术标本质量持续改进。比较改进前后手术标本缺陷发生率及手术患者、手术医护人员对标本管理的满意度。结果改进后手术标本缺陷发生率0.33%(12/3547),明显低于改进前的2.24%(73/3252),差异有统计学意义(χ2=49.947,P=0.000);改进后手术患者满意度(92.2%)高于改进前(75.9%),差异有统计学意义(χ2=16.397,P=0.000);手术医护人员满意度(96.2%)也高于改进前(80.8%),差异有统计学意义(χ2=15.23,P=0.000)。结论应用CQI方法,可有效降低手术标本缺陷发生率,提高手术患者、手术医护人员满意度。     

穿孔性阑尾炎手术切除后是否腹腔引流的近期预后分析的随机对照试验

目的腹腔脓肿是穿孔性阑尾炎(PAP)最常见的并发症,阑尾切除术后是否行腹腔引流取决于阑尾炎症严重程度,但是很大程度上还是取决于术者的专业知识和个人习惯,国际上并未就穿孔性阑尾炎术后是否常规行腹腔引流达成共识。本试验评估阑尾炎伴穿孔患者术后是否腹腔引流的近期预后并比较预后的差异,同时比较腹腔镜阑尾切除术(LA)及开腹阑尾切除术(OA)预后的差异。方法本试验为随机对照试验(RCT),纳入自2012年3月收入我科术中诊断为穿孔性阑尾炎患者540例,采取简单随机分组方法将患者分为试验组(腹腔引流)和对照组(不行腹腔引流),采用χ2检验和t检验对相关资料进行分析。结果 2012年3月2日至2015年4月30日,本试验共纳入540例穿孔性阑尾炎患者并完成阑尾切除术。试验组与对照组术后总并发症发生率分别为11.5%(31/270)和35.2%(95/270),术后腹腔脓肿发生率分别为5.2%和14.8%,术后腹痛发生率分别为0%和13.7%,组间差异有统计学意义(P均<0.05),而切口感染率(5.6%vs.6.3%,P=0.175)以及术后残端瘘(0.7%vs.0.4%,P=0.563)组间差异无统计学意义;两组患者术后再次干预发生率(14.1%vs.32.6%)、经皮/直肠腹腔穿刺引流发生率(0.7%vs.7.8%)以及术后抗生素使用(13.0%vs.23.0%),差异有统计学意义(P均<0.05);术后再次手术和术后住院时间两组患者差异无统计学意义(P=0.102,P=0.094)。LA与OA预后指标比较,两组患者术后并发症发生率分别为35.1%(87/248)和14.6%(34/233),差异有统计学意义(P<0.000 1),术后再次干预发生率分别为19.3%(45/233)和30.2%(75/248),差异有统计学意义(P=0.006),两组患者术后住院时间差异无统计学意义(4.4 d vs.4.2 d,P=0.117)。结论穿孔性阑尾炎术后行腹腔引流可有效降低术后并发症以及术后再次干预发生率,显著提高近期疗效。LA近期疗效优于OA。     

手术护理器具的革新

我们自行设计制作了会阴部手术挂盘、多功能手术头架、绕线机的配套再利用设备,临床使用效果很好,介绍如下。1　会阴部手术挂盘　制作:在器械盘上装配两个垂直挂钩。用法:患者取截石卧位的同时,摇下床尾一部分挂上挂盘,再铺无菌单,最后用无菌中单一端塞于患者臀下,另一端盖好挂盘,用时放下中单即可。优点:(1)器械放置稳固,不会因滑脱造成污染影响手术进行;(2)有利于术者集中精力于手术;(3)缩短了手术时间,术者操作时得心应手,也弥补了万能手术床无适宜放置器械盘地方的不足。2　多功能手术头架　制作:长方形架上置一器械盘。用法:为患者摆放…     

高龄患者心脏瓣膜手术联合冠状动脉旁路移植术发生院内死亡的危险因素分析

目的探讨高龄患者行心脏瓣膜手术联合冠状动脉旁路移植术发生院内死亡的危险因素。方法选择年龄>65岁,在我院行心脏瓣膜手术联合冠状动脉旁路移植术的420例患者。详细统计患者的手术资料,进行多因素Logistic回归分析患者发生院内死亡的独立危险因素。结果 420例患者中发生院内死亡19例,发生率4.52%。多因素Logistic回归分析显示慢性阻塞性肺疾病(COPD)(P=0.030)、体外循环时间(P=0.000)、二次手术(P=0.000)以及恶性心律失常(P=0.014)是院内死亡的独立危险因素。结论 COPD、体外循环时间、二次手术以及恶性心律失常是高龄患者发生院内死亡的独立危险因素。     

Exploring the benefits of double gloving during surgery

Breaches in the glove barrier pose a risk for transmission of bloodborne pathogens during surgical procedures. Double gloving or double gloving with an indicator glove system may provide added protection. For this 24-month study, we used a comparative design to examine the effect of double gloving with inner indicator gloves on the durability of inner gloves and the detection of glove tears or perforations during surgery. The frequency of seeing blood on the hand after surgery was greater with single gloving than with double gloving, and the frequency of changing gloves during surgery was significantly higher among those who double gloved with an indicator glove system versus double gloving alone. The majority of health care providers in our study expressed favorable views about double gloving.     

Anatomy of a defective barrier: sequential glove leak detection in a surgical and dental environment.

OBJECTIVES: a) To determine the frequency of perforations in latex surgical gloves before, during, and after surgical and dental procedures; b) to evaluate the topographical distribution of perforations in latex surgical gloves after surgical and dental procedures; and c) to validate methods of testing for latex surgical glove patency. DESIGN: Multitrial tests under in vitro conditions and a prospective sequential patient study using consecutive testing. SETTING: An outpatient dental clinic at a university dental school, the operating suite in a medical school affiliated with the Veteran's Hospital, and a biomechanics laboratory. PERSONNEL: Surgeons, scrub nurses, and dental technicians participating in 50 surgical and 50 dental procedures. METHODS: We collected 679 latex surgical gloves after surgical procedures and tested them for patency by using a water pressure test. We also employed an electronic glove leak detector before donning, after sequential time intervals, and upon termination of 47 surgical (sequential surgical), 50 dental (sequential dental), and in three orthopedic cases where double gloving was used. The electronic glove leak detector was validated by using electronic point-by-point surface probing, fluorescein dye diffusion, as well as detecting glove punctures made with a 27-gauge needle. RESULTS: The random study indicated a leak rate of 33.0% (224 out of 679) in latex surgical gloves; the sequential surgical study demonstrated patency in 203 out of 347 gloves (58.5%); the sequential dental study showed 34 leaks in the 106 gloves used (32.1%); and with double gloving, the leak rate decreased to 25.0% (13 of 52 gloves tested). While the allowable FDA defect rate for unused latex surgical gloves is 1.5%, we noted defect rates in unused gloves of 5.5% in the sequential surgical, 1.9% in the sequential dental, and 4.0% in our electronic glove leak detector validating study. In the sequential surgical study, 52% of the leaks had occurred by 75 mins, and in the sequential dental study, 75% of the leaks developed by 30 mins. In terms of the anatomical localization, the thumb and forefinger accounted for more than 60% of the defects. There were no differences in the frequency of glove leaks between the left and right hand. Leak rates were highest for the surgeon (52%), followed by the first assistant (29%) and the scrub nurse (25%). No false negatives were noted using the electronic glove leak detector; one false positive was seen out of 225 gloves tested (0.44%), as noted in our validation studies. CONCLUSIONS: Significantly high glove leak rates were noted after surgical and dental procedures, indicating that the present day latex surgical gloves can become an incompetent barrier once they are used. Unused latex surgical gloves demonstrated a higher rate of defects than allowed by the Food and Drug Administration standards, indicating substantial noncompliance of quality control standards by manufacturers as well as inadequate governmental oversight. Double gloving, or the use of thicker latex surgical gloves, would probably reduce the frequency of glove leaks. Latex surgical gloves should be tested for patency before use and during surgical and dental procedures.     

Choosing the right surgical glove: an overview and update

Sterile surgical gloves are routinely worn during all invasive procedures to prevent the two-way transmission of pathogens between the surgical team and the patient. This reduces the risk of surgical-site infections and blood-borne diseases. Since their introduction to the operating room over 100 years ago, surgical gloves, and the materials used to make them, have continued to evolve in line with ever-changing healthcare demands. Following recent developments in surgical glove technologies, including de-proteinized natural rubber latex and newer gloving methods such as triple gloving, it is timely that an overview and update of surgical gloves is given. By providing information on latex-associated allergies, glove materials, gloving methods and glove protection, this article will enable practitioners to choose the most appropriate surgical glove.     

Incidencia de la perforación de los guantes en cirugía y efecto protector del doble guante

ObjectiveTo investigate the incidence of glove perforation in programmed surgery and compare perforation rates between single-gloves and double-gloves. To evaluate the extent to which glove perforations remain undetected during surgery.MethodRandomized and controlled trial. A one year of study period in 2008 consisting of programmed surgeries at the Canary Islands University Hospital. Gloves, randomized into single or double, worn by surgeons, assistants and scrub nurses were analyzed using the Water Leak Test (EN455-1) for 3 min after surgery ended to detect leakage.ResultsA total of 1537 gloves were examined during 113 operations, 7 perforations were noticed during the operation and 104 unnoticed, especially in mayor surgery. Of these, 43 perforations (41.3%) occurred while wearing single gloves and 51 (49%) in the outer of a double glove. Only 10 perforations (9.6%) were found in the inner glove. The perforation rate for surgeons was 9.85%, were slightly greater than nurses at 6,91%, but significantly greater that the rate for assistants, 4,04% (p<0.001).ConclusionsWe conclude that double gloving is effective in surgery, inasmuch as the barrier protection was maintained by the inner glove in four out of five cases when the outer glove was inadvertently perforated. Surgical teams must balance the improved safety of double gloving with the possible discomfort and reduced sensitivity.     

Microbial contamination of procedure gloves after opening the container and during exposure in the environment

The objective of this study was to quantify the colony forming units (cfu) on latex procedure gloves in the beginning, middle, and end of the containers in real (professional) and controlled (researcher) gloving situations; evaluate the microbial load of the gloves, considering the time of exposure in the environment. This comparative prospective study was conducted at an intensive care unit of a teaching hospital. The microbiological data was collected from the gloves using digital-pressure. Microbiological evaluations were performed on 186 pairs of gloves: 93 in the control group and 93 in real gloving situations. In the control group, the average cfu was 4.7 against 6.2 in the real gloving situation. Hence, no statistically significant difference was found (p=.601). In addition, the cfu values of gloves in the beginning, middle and end of the containers also did not show any significant differences (p>.05). The most common strain was Staphylococcus spp. The time of exposure in the environment did not increase the cfu value of the latex gloves.     

Surgical gloves--a comparative study of the incidence and site of punctures.

Five surgical teams in two operating suites were studied for three months with random allocation to receive either A or B operating gloves. The gloves were identified as used by the surgeon, the assistant and the scrub nurse. At the end of each day the gloves were tested by standard air insufflation and immersion under water. Surgeons experienced significantly more punctures 174:884 (19.7%) [17%-23%] than the scrub nurses or assistants 161:1770 (9.4%) [8.6%-10.2%]. Surgeons were particularly prone to experience punctures of the tip of the index or little finger of the left hand whereas nurses were more likely to experience punctures of the index finger and thumb of the left hand. There was a wide variation between the five surgical teams varying between 5.7% [2%-11%] and 37.5% [24%-52%] wearing B and 11.4% and 28.4% wearing A. There were significantly more punctures when wearing A gloves (23.0%) [20%-26%] than when wearing B gloves (15.8%) [13%-19%] for surgeons but no significant difference for surgical assistants or scrub nurses. Contrary to our expectation there were no significant differences between the two types in the tearing of cuffs (1% in each).     

新型约束工具的使用特征及护理现状

[目的]分析重症监护病房(ICU)病人身体约束现状,探讨管理对策。[方法]对2011年1月—2011年6月我院ICU使用新型约束工具(安全背心、约束手的球拍手套、双保险约束带)的案例进行调查分析。[结果]身体约束的人群主要是老年人,病种是神经外科疾病占30.50%,约束的方式是以双上肢双保险约束带约束加穿球拍手套为主,护理人员对约束相关知识掌握不全,告知落实欠到位,主要引发的并发症为非计划性拔管,占27.84%。[结论]ICU身体约束使用规范不明确,约束知识及告知缺乏,应加强约束知识教育,规范操作流程,正确处理约束引起的并发症,能有效减少不良事件的发生。     

Surgical glove perforation among nurses in ophthalmic surgery: A case‐control study

Many of the ophthalmic surgical instruments are extremely fine and sharp. Due to the dim light environment required for ophthalmic surgical procedures, the passing of sharp instruments among surgeons and scrub nurses also poses a risk for glove perforations. A case‐control study was performed to determine the number and site of perforations in the surgical gloves used by a group of scrub nurses during ophthalmic surgery. All six nurses working in an eye and refractive surgery centre in Hong Kong participated in the study. A total of 100 (50 pairs) used surgical gloves were collected following 50 ophthalmic surgeries. Fifty pairs of new surgical gloves were also collected. Every collected surgical glove underwent the water leak test. The surgical procedure perforation rate was 8%, and none of the perforations were detected by the scrub nurses. No perforations were found in any unused gloves. The findings indicate that glove perforations for scrub nurses during ophthalmic surgery do occur and mostly go unnoticed. Future studies should continue to explore factors contributing to surgical glove perforation.     

浦多·丹尼尔洗手液与丹尼尔外科手消毒液联合使用杀菌效果观察

[目的]探讨浦多.丹尼尔洗手液与丹尼尔外科手消毒液联合使用杀菌效果。[方法]将手术室医护人员随机分为两组各100例,实验组使用浦多.丹尼尔洗手液和丹尼尔外科手消毒液进行外科刷手、消毒。对照组使用肥皂液和丹尼尔外科手消毒液进行外科刷手、消毒,并于消毒后采样进行手指细菌培养。[结果]实验组100例均为无菌生长,杀菌率100%,对照组97例为无菌生长,杀菌率97%。[结论]浦多.丹尼尔洗手液与丹尼尔外科手消毒液联合使用杀菌效果优于肥皂液和丹尼尔外科手消毒液联合使用杀菌效果。     

断指再植手术中定时更换外科手套的效果研究

目的探讨断指再植手术中每2.5h更换外科手套的效果,为临床护理提供依据。方法选择2014年4-12月我院收治的断指再植手术110例患者,随机分为对照组58例,观察组52例,其中,观察组采取每2.5h更换手套的干预措施,比较两组手术中手套破损情况。结果对照组55%的手术出现手套破损,观察组26.9%的手术出现手套破损,差异有统计学意义(P0.05);观察组手套破损率为3%,对照组手套破损率为10%,差异有统计学意义(P0.05)。结论断指再植手术中每2.5h更换外科手套能明显降低手术中手套破损。