一期植骨外固定加灌洗修复下肢火器伤骨缺损

目的：评价一期植骨外固定和灌洗修复下肢火器伤骨缺损的疗效。方法：17例下肢火器伤长骨开放粉碎性骨折伴骨缺损，早期彻底清创，一期自体髂骨瓣植骨，外固定架固定，术后给予持续灌洗、抗生素治疗。结果：16例术后随访7－24个月，6－8周有骨痂形成，植骨与宿主骨愈合时间平均8个月，无骨不愈合发生。结论：外固定架在四肢长骨火器性损伤骨缺损治疗中具有独特的优越性，辅以自体髂骨植骨和术后持续灌洗可以一期修复伤口污染轻、软组织缺损少的火器性损伤。     

Effect of different laser-assisted irrigation activation techniques on apical debris extrusion

Abstract

Objective: The aim of this study was to compare apical debris extrusion when neodymium-doped yttrium aluminium garnet (Nd:YAG) lasers, erbium-doped yttrium aluminium garnet (Er:YAG) or photon-induced photoacoustic streaming (PIPS) are used for irrigation activation.

Materials and methods: A total of 60 extracted human mandibular premolar teeth have similar dimensions were included and the samples were split into four groups according to the irrigation technique (n?=?15): conventional needle irrigation, PIPS, Er:YAG and Nd:YAG. ProTaper Universal system up to F4 was used for root canal instrumentation. Bidistilled water was used as an irrigation solution during instrumentation and irrigation activation. Apically extruded debris was collected into preweighed Eppendorf tubes during instrumentation and irrigation activation procedures. The tubes were then kept in an incubator at 70?°C for 5?days. The initial weight of the tube was subtracted from the final weight and the result was recorded as the weight of dry extruded debris. The data were evaluated statistically using a one-way ANOVA test followed by least significant difference post hoc test (p?<?.05).

Results: Conventional needle irrigation caused significantly less debris extrusion than laser-assisted irrigation activation groups (p?<?.05). Laser-assisted irrigation activation groups caused statistically similar debris extrusion (p?>?.05).

Conclusion: Laser-assisted irrigation activation techniques caused more debris extrusion when compared to conventional needle irrigation.     

The problems associated with pesticide use by irrigation workers in Ghana

The use of pesticides in Ghanaian agriculture, though beneficialin reducing crop loss both before and after harvest, has beenassociated with threats to human health often due to the misapplicationof the chemicals. This study was an initial attempt to explorethe knowledge, attitudes and practices of 123 farm workers onthree irrigation project areas in the Accra Plains, Ghana, regardingthe safe handling and use of pesticides, to assess the prevalenceof symptoms associated with organophosphorus pesticides (OPs)and carbamates and to determine the prevalence of pesticide-relatedsymptoms, and blood cholinesterase. The study design was cross-sectionalin type. Methods used were interviews and observation, and biologicalmonitoring. The results revealed moderate levels of knowledgeof the routes of absorption of pesticides and of potential symptomsfollowing exposure. Knowledge of personal protective measureswas poor to moderate. High risk practices included frequenthandling of the chemicals, home storage of pesticides and shortre-entry intervals. Despite knowledge of some health risks associatedwith pesticides, the use of personal protective equipment (PPE)was minimal due primarily to financial constraints. The prevalenceof symptoms was higher and cholinesterase levels lower thanin a control group of teachers. It is suggested that there isa need for more epidemiologic studies to investigate the problemsassociated with pesticide induced ill health as well as researchinto appropriate and affordable PPE. PPE needs to be subsidized.Training of agriculture and health workers in safety precautions,recognition, and management of pesticide-related ill healthis a matter of urgency.     

液压灌注泵在输尿管镜手术中的应用

本文总结使用液压灌注系统配合输尿管镜术2575例经验体会,提出安全可靠的液压灌注系统在输尿管镜术中的重要性,并介绍一种国产腔内窥镜灌注泵。     

咽喉反流症状或体征评分阳性的慢性鼻窦炎患者鼻内镜术后碱性等渗盐水冲洗的疗效观察

目的 探讨碱性等渗盐水鼻腔冲洗对于伴有咽喉反流症状或体征评分阳性的慢性鼻窦炎患者鼻内镜术后的临床疗效。 方法 80例咽喉反流症状或体征评分阳性的慢性鼻窦炎患者使用随机数字生成器分为2组,其中鼻内镜手术后接受碱性等渗盐水冲洗患者40例为研究组,鼻内镜术后接受生理盐水冲洗患者40例为对照组。根据外周血嗜酸粒细胞占白细胞百分比是否超过4.27%对研究组和对照组分层。在鼻内镜手术后2周、6周进行随访评估。评估包括反流症状指数评分量表、反流体征评分量表、鼻腔鼻窦结局20量表、视觉模拟量表、鼻阻塞症状评估量表、Lund-Kennedy评分以及不良反应记录。 结果 在2周时,研究组视觉模拟量表评分的变化量［3.0(2.0,4.0)分］>对照组［1.5(0.0,3.0)分］(P=0.016<0.05);在6周时,研究组鼻腔鼻窦结局20评分的变化量［(13.4±10.3)分］以及视觉模拟量表评分的变化量［3.0(2.0,4.0)分］>对照组［(8.7±6.1)、1.0(0.0,2.2分)］(P=0.001<0.05)。分层后,使用碱性等渗盐水冲洗的患者中外周血嗜酸粒细胞占白细胞百分比≤4.27%的亚组在鼻内镜手术后2周的鼻腔鼻窦结局20和视觉模拟量表评分变化量［13.0(8.0,19.0)、(3.2±1.9)分］更大(P=0.024<0.05,P=0.030<0.05)且在术后6周的鼻腔鼻窦结局20和视觉模拟量表评分变化量［(15.7±9.5)、2.0(2.0,4.0)分］更大(P=0.002<0.05,P=0.005<0.05)。2组患者均未出现严重不良反应。 结论 对于伴有咽喉反流症状或体征评分阳性的慢性鼻窦炎患者,在鼻内镜手术后早期护理阶段使用碱性等渗盐水进行鼻腔冲洗具有一定的临床疗效,尤其是在外周血嗜酸粒细胞占白细胞百分比低于4.27%的患者中。     

经尿道电切联合丝裂霉素灌注治疗腺性膀胱炎的疗效观察

目的探讨经尿道电切术联合丝裂霉素膀胱灌注治疗腺性膀胱炎的临床疗效。方法 70例腺性膀胱炎患者均经尿道行电切术,术后膀胱灌注丝裂霉素,并定期行膀胱镜检查,治疗结束后将所有患者临床资料进行回顾性分析。结果 70例患者随访2年,58例治愈,9例好转,2例复发,1例癌变行膀胱全切术,所有患者治疗及随访期间均无白细胞、肝肾功能毒性损害发生。结论经尿道电切术联合丝裂霉素膀胱灌注治疗腺性膀胱炎毒副作用少,是一种安全、有效的治疗方法。     

不同膀胱病理状态下庆大霉素膀胱冲洗的安全性考察

目的:考察庆大霉素(GTM)膀胱冲洗在细菌性膀胱炎及出血性膀胱炎下的安全性.方法:收集接受GTM膀胱冲洗患者给药后30 min的血液(80 mg,2次/d),以荧光偏振免疫法(FPIA法)测定血药浓度;12只Wistar大鼠随机等分为对照组和模型组,模型组腹腔注射环磷酰胺140 mg/kg构建出血性膀胱炎模型,并以苏木精-伊红染色法(hematoxylin-eosin staining,HE染色法)观察造模结果.造模24 h后,两组大鼠分别给予GTM 8.4 mg/kg膀胱内注射,FPIA法测定给药30 min后血药浓度.结果:共有8例次患者进入实验,监测GTM平均血药浓度为0.234 μg/mL(0.14 ~ 0.40 μg/mL);模型组大鼠在接受GTM膀胱内注射后平均血药浓度为(7.53±1.32)μg/mL,与对照组(0.63±0.12) μg/mL相比有显著统计学差异(P < 0.01).结论:GTM膀胱冲洗对于细菌性膀胱炎是安全的,但应避免用于出血性膀胱炎患者.     

慢性创面感染的病原学特点及持续灌洗负压封闭引流的治疗效果

目的 分析慢性创面感染的病原学特点及持续灌洗负压封闭引流（VSD）局部治疗的临床疗效。方法 以2015年5月至2017年3月安徽省立医院烧伤整形外科的58例慢性创面感染患者为研究对象,对患者入院时创面分泌物的细菌培养及药敏结果进行回顾性分析,并对经过持续灌洗VSD治疗患者的感染控制情况、治疗次数、创面清洁时间、创面面积、并发症、预后情况进行评价。结果 58例患者共培养出68株病原菌,其中4例患者细菌培养为阴性,创面感染率93.10%。革兰氏阳性菌28株（41.18%）,革兰氏阴性菌40株（58.82%）,主要细菌为金黄色葡萄球菌（25.00%）、铜绿假单胞菌（20.59%）、大肠埃希菌（13.24%）。55例患者接受持续灌洗VSD治疗后,创面感染得到控制,接受1、2、3、4次治疗的例数分别为36、13、4、2例;创面清洁时间6~43 d,平均（14.40±8.93）d;治疗后创面面积缩小平均值为（8.91±3.17）cm²;无明显堵管及严重并发症出现。持续灌洗VSD治疗后,17例患者一期愈合,38例患者经二期植皮或皮瓣修复,仅1例游离皮瓣出现坏死,其余全部存活;无创面进一步恶化或者复发感染患者。治疗优良率达98.18%。结论 慢性创面感染的病原菌主要为金黄色葡萄球菌、铜绿假单胞菌和大肠埃希菌。创面局部持续灌洗VSD治疗可有效控制感染,缩小创面面积,促进肉芽组织生长。     

经皮肾镜碎石取石术中患者体温变化的观察

目的:探讨在经皮肾镜碎石取石术中两种不同温度灌洗液对患者体温变化的影响,减少术后多种并发症的发生。方法:将50例经皮肾镜碎石取石术患者随机分为观察组(25例)和对照组(25例)。对照组使用室温(22℃)生理盐水灌洗液,观察组使用加温后(35℃)生理盐水冲洗,观察两组手术患者术中体温变化及寒战的发生率。结果:两组手术开始后30分钟、90分钟、120分钟及手术结束后体温比较差异均有统计学意义(P0.05);两组寒战发生率比较差异有统计学意义(P0.01)。结论:术中使用加温灌洗液,可减少经皮肾镜碎石取石术患者术中低体温和寒战的发生。     

老年人硬膜外阻滞后腔内氯化钠冲洗对神经功能恢复的影响

目的 观察老年人硬膜外利多卡因和芬太尼麻醉后腔内注入20 ml 0.9%氯化钠对神经功能恢复的影响.方法 拟行泌尿外科手术患者70例,ASA分级Ⅰ～Ⅱ级,按随机数字表法分为冲洗组和对照组,每组各35例.局麻药为1.73%碳酸利多卡因10 ml+芬太尼50μg(1 ml).术毕冲洗组患者接受硬膜外腔注入0.9%氯化钠20ml,对照组不注入0.9%氯化钠;观察10min后,拔出硬膜外导管.结果冲洗组患者术后感觉阻滞消退3个节段、运动阻滞消退到1级时间及术后1 h运动阻滞发生率[(24.6±15.9)min、(32.7±13.4)min、5例(14.3%)]明显小于对照组[(32.8±16.7)min、(47.9±22.6)min、14例(40.0%)](P<0.05或<0.01).两组术后1～6 h使用镇痛药及疼痛视觉模拟评分(VAS)≤3分率比较,差异无统计学意义(P>0.05).两组患者未见其他明显不良反应.结论 老年人硬膜外阻滞后腔内注入0.9%氯化钠冲洗可促进运动和感觉阻滞的恢复,不影响硬膜外芬太尼的镇痛效果,20 ml 0.9%氯化钠已足够且安全有效.