间断正压冲洗鼻内镜镜头对鼻内镜手术效率的影响

目的 探讨间断正压冲洗鼻内镜镜头对鼻内镜手术效率的影响.方法 选取2019年10月～2020年5月复旦大学附属眼耳鼻喉科医院耳鼻喉科收治的因慢性鼻窦炎伴鼻息肉(CRSwNP)接受鼻内镜手术(FESS)的50例患者,进行前瞻性随机对照研究.所有患者随机分为观察组(n=20)及对照组(n=30).观察组在手术中配合间断正压...     

Implant retention after acute and hematogenous periprosthetic hip and knee infections: Whom,when and how?

Periprosthetic joint infections(PJI) of the hip and the knee are grossly classified as early post-operative, acute hematogenous and late chronic infections. Whereas two-stage exchange arthroplasty is the standard of care in North America for treating chronic infections, irrigation and debridement(I and D) with retention of implants has been used in an attempt to treat the other two types of PJIs. The rationale of this approach is that a PJI may be eradicated without the need of explanting the prostheses, as long as it has not transitioned into a chronic state. With the present paper, we review current evidence regarding the role of I and D with implant retention for treating PJIs of the hip and the knee. While a very wide range of success rates is reported in different studies, a short period of time between initiation of symptoms and intervention seems to play a prominent role with regards to a successful outcome. Moreover, pathogens of higher virulence and resistance to antibiotics are associated with a poorer result. Specific comorbidities have been also correlated with a less favorable outcome. Finally, one should proceed with serial I and Ds only under the condition that a predefined,aggressive protocol is applied. In conclusion,when treating a PJI of the hip or the knee, all the above factors should be considered in order to decide whether the patient is likely to benefit from this approach.     

前列腺摘除术后所致膀胱痉挛与膀胱冲洗液温度的临床研究

目的：探讨不同温度的膀胱冲洗液对前列腺摘除术后膀胱痉挛的影响.方法：将138例患者随机分为A、B、C、D、E和F组,每组23例,冲洗液的温度为11～16℃、17～20℃、21 ～25℃、26～31℃、32 ～37℃、38～40℃,观察各组膀胱痉挛发生率和平均痉挛次数.结果：E组采用等体温（32～37℃）冲洗液温度,患者膀胱痉挛发生率和平均痉挛次数均低于其他组（P＜0.05）.结论：选择32～37℃的膀胱冲洗液温度持续性进行膀胱冲洗,能够有效的减少前列腺摘除术后的膀胱痉挛发生率和平均痉挛次数.     

脊柱畸形后路内固定矫形术后深部感染的治疗

目的:探讨脊柱畸形后路内固定矫形术后深部感染的治疗效果。方法:2012年6月~2014年12月167例脊柱畸形患者行后路内固定矫形术,11例术后并发切口深部感染,男3例,女8例,年龄14.6±4.7岁(11~27岁);其中早发性感染(术后90d内)9例,迟发性(术后90d后)感染2例。9例早发性感染患者中,伤口渗出液或在B超引导下深层穿刺取脓液细菌培养阳性6例,其中2例为耐甲氧西林金黄色葡萄球菌(MRSA)、3例为甲氧西林敏感金黄色葡萄球菌(MSSA),1例为大肠杆菌;另3例培养阴性者,依据伤口脓性渗液、持续胀痛及术中大量脓性积液而诊断为早发性切口深部感染。2例迟发性感染患者分别于矫形术后7个月和10个月时因腰背部持续性疼痛不适,经MRI检查提示切口深部积液形成,以及血沉、C反应蛋白等炎性指标显著高于正常值而确诊,清创术时取内固定旁组织细菌培养均为表皮葡萄球菌感染。均行彻底清创、置管持续冲洗引流,同时联合敏感抗生素治疗。结果:9例早发性感染经一期切口清创、置管持续冲洗引流及联合敏感抗生素治疗后,伤口均愈合,感染获得控制,内置物得以保留;随访13.5±5.8个月(6~36个月),无内置物松动及感染复发迹象。2例迟发性感染经多次清创、置管持续冲洗引流及联合敏感抗生素治疗仍无法控制感染,于矫形术后1年时取出内置物后治愈,取出内置物后分别随访6个月和14个月,无感染复发迹象,但分别有25°和17°的矫形丢失。结论:对脊柱畸形后路内固定矫形术后早发性深部感染,积极采取彻底清创、置管持续冲洗引流联合敏感抗生素治疗,可有效控制感染,避免取出内置物;而迟发性感染则可能需取出内置物才能控制感染,但有矫形丢失风险。     

侧孔式通气管、连通管在膀胱持续冲洗中的临床应用

目的探讨侧孔式通气管、连通管在持续膀胱冲洗中的应用效果。方法210例持续膀胱冲洗患者被随机分为观察组和对照组各105例,两组均以输血器连接冲洗瓶与尿管,对照组采用单瓶500ml冲洗法,观察组采用侧孔式通气管、连通管连接3瓶1500ml冲洗法。比较两组术后凝血堵管例数、膀胱痉挛例数、通气管堵塞例数,尿细菌培养检出率、离心尿沉渣红细胞计数,人均护理时数及24h内人均耗材。结果两组尿细菌培养、48h尿沉渣红细胞计数等差异无统计学意义（P均〉0．05）;观察组24h尿沉渣红细胞计数、凝血堵管例数、膀胱痉挛例数、通气管堵塞例数、人均护理时数及人均耗材明显较对照组少。差异有统计学意义（P均〈0．01）。结论应用侧孔式通气管、连通管进行持续膀胱冲洗方便、经济,减少膀胱冲洗障碍发生,降低护士劳动强度,提高了护理工作效率。     

慢性硬膜下血肿穿刺冲流引流术治疗临床分析

目的研究慢性硬膜下血肿的治疗方法。方法采用床旁骨锥钻孔引流治疗34例慢性硬膜下血肿患者。结果治愈34例,死亡0例,1例复发,同样方法再次处理后治愈。结论床旁骨锥钻孔引流治疗慢性硬膜下血肿是安全、有效的方法,特别适合心肺功能差的老年患者。     

两种不同温度灌洗液在微创经皮肾镜取石术中的应用及效果观察

目的:探讨两种不同温度灌洗液在微创经皮肾镜取石术(MPCNL)中的应用及效果.方法:将164例MPCNL患者随机分为实验组81例和对照组83例.对照组使用室温(22 ℃)生理盐水灌洗液、实验组使用加温后(37 ℃)生理盐水灌洗液进行冲洗,观察两组患者术中体温变化及寒战的发生率.结果:两组手术开始后60 min、90 min、120 min及手术结束时体温比较差异均有统计学意义(P<0.01);两组寒战发生率比较差异有统计学意义(P<0.01).结论:术中使用加温灌洗液,可减少微创经皮肾镜取石术患者术中低体温和寒战的发生.     

关节镜下清理及术后持续灌洗治疗早期化脓性膝关节炎

目的 探讨关节镜下清理及术后持续灌洗对早期化脓性膝关节炎治疗作用。方法采用关节镜行关节灌洗清理术、持续冲洗引流等综合治疗膝关节化脓性膝关节炎38例,同时结合全身抗生素的应用和术后系统的康复训练进行综合治疗。通过体温、皮温、关节活动度来评价该方法的疗效。结果38例均获随访,时间为12～20个月。体温4d内恢复正常,术后7周,无伸膝功能障碍,屈膝活动度超过120°。关节功能按Neer评分：优26例,良9例,可3例,优良率达到88．89％,无复发。结论关节镜下膝关节清理加置管持续冲洗术是治疗早期化脓性膝关节炎的有效方法,具有损伤小,恢复快,膝关节功能恢复好的优点。     

Treatment strategy for infections in patients with permanent pacemakers

Infection after pacemaker implantation can be the most lethal potential complication, although such infections occur infrequently. In this report, we review our experience with patients who were infected after pacemaker implantation and assess their treatment. The infection rate was 1.3% (9 patients) after 712 operations performed in 588 patients. Four men and five women were infected; their mean age was 74.4 years (range, 66 to 86 years). The infection rates after the initial implantation and the second operation were 0.85% and 2.7%, respectively. Two of the nine patients underwent palliative two-stage operations, which included first removing the generator and subsequent irrigation with temporary pacing before a new pacemaker system was implanted during the second stage. Two patients underwent radical two-stage operations (without abandoning old leads); one of these underwent cardiopulmonary bypass after treatment for generalized septicemia. One patient underwent relocation of the pocket 1 month after the onset of pacemaker infection. The remaining four patients underwent palliative one-stage operations, in which new pacemaker units were implanted in the contralateral sides at the same time the first generator was removed. All of the patients were alive and well postoperatively. No recurrent infections were recognized. Therefore, a palliative one-stage operation (“retain old leads” procedure) might be an effective procedure of choice for patients with localized infections over the pocket. Furthermore, irrigation with function water and systemic antibiotic prophylaxis could be effective as measures against infection.     

污灌水对蚕豆根尖细胞及小鼠早期精细胞微核的影响

目的　探讨灌溉用污水的细胞遗传毒性。方法　采集淮南市某蔬菜基地灌溉用污水沟内的水样进行蚕豆根尖细胞微核试验 ,并对水样有机提取物以腹腔注射进行小鼠早期精细胞微核试验。结果　按 1∶ 10、1∶ 2稀释的污灌水样及水样原液的蚕豆根尖细胞微核率均显著高于阴性对照 (P<0 .0 0 1) ,呈剂量 -反应关系 (r=0 .95 1,P<0 .0 5 ) ;污灌水样原液有机提取物小鼠早期精细胞微核率显著高于阴性对照 (P<0 .0 0 1)。结论　该地区灌溉用污水具有一定致突变作用 ,对污灌区居民健康具有潜在危害