新型仿生学尿袋在老年患者关节置换术后的临床应用

目的探讨新型仿生学尿袋在关节置换术后老年患者中的应用而减少因导尿引起并发症的效果。方法选择64例留置尿管老年手术患者,随机分为试验组和对照组各32例,试验组采用新型仿生学尿袋,对照组采用抗反流尿袋,分别比较导尿至拔出尿管自行排尿时间、2次以上溢尿发生率、经诱导排尿后需要2次导尿比例、尿路感染发生率。结果试验组和对照组导尿至拔出尿管自行排尿时间分别为(64.49±4.98)h和(82.64±1.47)h,2次以上溢尿率分别为6.25%和25.00%,2次导尿比分别为15.63%和40.63%,尿路感染发生率分别为6.25%和18.75%。结论新型仿生学尿袋能缩短尿管拔出时间,促进患者自行排尿,同时减少溢尿的发生和2次导尿,明显减少尿路感染的发生,保证了老年关节置换患者的术后康复,也减少了护理工作时间。     

止痒袋泡洗剂联合止痒散外用治疗肛周湿疹的临床疗效

为探讨痒袋泡洗剂联合止痒散外用治疗肛周湿疹的临床疗效．将200例肛门湿疹患行随机分为对照组和治疗组,各100例。对照组单纯使用丁酸氧化可的松乳膏局部外涂治疗,治疗组在以止痒袋泡洗剂局部外洗治疗后,外涂止痒散,两组均以2同为一疗程。结果显示,治疗组痊愈72例（72．0%）,有效24例,无效4例．总在效率96．0％;对照组痊愈44例（44．0％）．有效47例,无效9例,总有效率91．0%。两组总在效率差异无统计学意义．P〉0．05;但治疗组治愈率明显高于对照组．P〈0．05。停约8周后,治疗组痊愈者复发32例（44．4%,32／72）．对照组复发33例（75．0%．33/14）．对照组复发率明显高于治疗组．P〈0．05。治疗组未出现不良反应,对照组有1例出现肛周局部烧灼感,未予处理,停药后症状消失。结果表明,止痒袋泡洗剂联合止痒散外用治疗肛周湿疹治愈率高,无不良反应。复发率低,值得临床推广应用。     

GC法测定一次性肠外营养输液袋中乙酸乙烯酯迁移量

目的:建立GC法测定一次性肠外营养输液袋中乙酸乙烯酯的迁移量.方法:以DB-624毛细管色谱柱为固定液;程序升温:起始温度90℃,维持5 min,以每分钟50℃的速率升温至250℃,维持5 min;进样口温度为220℃;检测器温度为250℃;流速为1.0 mL·min-1;分流比为10:1.结果:本法可将溶剂、空白溶液与乙酸乙烯酯单体较好分离,乙酸乙烯酯在4.47~10.44μg·mL-1(r=0.9993)浓度范围内线性关系良好,回收率为100.4%,RSD为1.25%.结论:本法灵敏度高,操作简单、快速、准确,适合输液袋中乙酸乙烯酯单体迁移量的监测.     

儿童扁桃体切除术后疼痛的非药物性护理干预

目的探讨儿童扁桃体切除术后疼痛的非药物性护理干预效果。方法将行双侧扁桃体切除术的108例患儿,按时间段分为对照组56例和观察组52例。对照组实施常规口腔护理、饮食指导和冰袋颌下冷敷;观察组在对照组的基础上改进颌下冷敷装置,并结合知识讲授、注意力转移等措施。应用视觉模拟评分表(VAS)分别在术后6h、术后1~3d对患儿进行疼痛评估。结果观察组术后6h、1d、2d及3d疼痛程度显著轻于对照组(均P0.01)。结论对扁桃体切除术后患儿采用改进颌下冷敷装置联合其他非药物性干预可有效缓解疼痛。     

自制双层盐袋固定袋应用于永久起搏器植入术后压迫的效果分析

摘要 目的：探讨自制双层盐袋固定袋在永久起搏器植入术后患者切口压迫中的效果。方法： 2015年1月～2016年6月间在心内科行永久起搏器植入术的患者,随机进行分组。对照组患者术后使用两个500g普通盐袋压迫12～24 h,观察组患者术后采用自制的双层盐袋固定袋压迫切口6～12 h。观察患者术后并发症、心理、睡眠状况、舒适度,患者和护士对压迫工具的满意度。结果：观察组与对照组相比,观察组患者术后并发症少、患者心理、睡眠状况及术后舒适度更好,患者和护士的满意度高（P＜0.05）。结论：使用自制的双层盐袋固定袋压迫切口处,临床使用效果满意,有效降低术后并发症,提高患者的睡眠质量。 关键词 盐袋;永久起搏器;切口压迫;并发症;舒适度     

Methods for siting emergency stomas in the absence of a stoma therapist

Introduction

Stomas often have to be sited in emergencies by trainees who may have had little training in this. Emergency stomas and stomas where the site has not been marked preoperatively by a stoma therapist are more prone to complications. These complications may severely affect a patient’s quality of life. Advice in the literature on how to best site stomas is conflicting. We compared two easy anatomical methods of siting stomas to sites chosen by a stoma therapist and looked at how this site was affected by the patients’ body mass index (BMI).

Methods

Patients undergoing elective colorectal surgery were seen either pre or postoperatively. Each patient’s BMI was recorded and the positions of three different potential stoma positions (site G: the gold standard, marked by a stoma therapist; site S: marked using a pair of scissors against the umbilicus; site H: halfway between the umbilicus and anterior superior iliac spine) were compared.

Results

The two fixed anatomical methods described (method S and method H) both gave poor results. The most common reason for poor siting was the proximity of a skin crease. There was a statistically significant correlation between the patient’s BMI and the laterality of the gold standard site.

Conclusions

The two simple anatomical methods described here do not provide a shortcut to effective siting. A more effective method may be calculating the laterality of the site using the patient’s BMI, and then moving up/down to avoid a skin crease and improve the patient’s view for changing the bag. This deserves further study.     

肠造瘘术后一次性造口袋拆除方法的改进

介绍一种肠造瘘术后一次性造口袋拆除的方法。将2000—2008年的108例肠造瘘术后使用一次性造口袋患者按时间顺序分为对照组和观察组,每组各54例。对照组采用传统方法拆除一次性造口袋,观察组采用改进方法拆除。对照组发生局部皮肤破损14例（25.93%）,观察组1例（1.85%）,2组比较有显著性差异（P＜0.01）。观察组患者主观感受及局部皮肤破损具体情况优于对照组。改进后的拆除一次性造口袋的方法安全、科学,可减轻患者痛苦。     

Vinyl bag cover method to avoid droplet-containing aerosol escape from endoscopic forceps channel caps during COVID-19 pandemic (with Video 1 and Video 2)

Endoscopists are at high risk of allowing transmission of coronavirus disease 2019 (COVID-19) during gastrointestinal endoscopy (GIE) procedures under pandemic conditions. The main avenues of droplet-containing aerosol generated during GIE are the mouth, anus, and endoscopic forceps channel. Although the usefulness of personal protective equipment for preventing COVID-19 dissemination has been well reported, measures to address infected aerosol escaping during endoscopic forceps use have been neglected. Pathogen-contaminated aerosol from the endoscopic forceps channel, leading into the gastrointestinal lumen, has been confirmed and is a highly problematic source of infection. We developed a technique that entails covering the forceps entry/exit hole with a vinyl bag, thereby preventing contamination of the endoscopy room by the infected aerosol that escapes from this hole. The technique can be used in daily clinical endoscopic practice. Furthermore, this shielding technique is useful for all patients who undergo GIE, regardless of the purpose of the procedure such as for making a diagnosis, administering therapy, or in an urgent situation. In this letter, we introduce our novel, easily performed, inexpensive method of infection prevention by disallowing infected aerosol to escape from a COVID-19-infected patient into the air during a procedure that requires the use of endoscopic forceps.     

Review of stoma site and midline incisional hernias after stoma reversal

Background

The incidence of incisional hernias after stoma reversal is not well reported. The aim of this study was to systematically review the literature reporting data on incisional hernias after stoma reversal. We evaluated both the incidence of stoma site and midline incisional hernias.

Methods

A systematic review identified studies published between January 1, 1980, and December 31, 2012, reporting the incidence of incisional hernia after stoma reversal at either the stoma site or at the midline incision (in cases requiring laparotomy). Pediatric studies were excluded. Assessment of risk of bias, detection method, and essential study-specific characteristics (follow-up duration, stoma type, age, body mass index, and so forth) was done.

Results

Sixteen studies were included in the analysis; 1613 patients had 1613 stomas formed. Fifteen studies assessed stoma site hernias and five studies assessed midline incisional hernias. The median (range) incidence of stoma site incisional hernias was 8.3% (range 0%–33.9%) and for midline incisional hernias was 44.1% (range 8.7%–58.1%). When evaluating only studies with a low risk of bias, the incidence for stoma site incisional hernias is closer to one in three and for midline incisional hernias is closer to one in two.

Conclusion

Stoma site and midline incisional hernias are significant clinical complications of stoma reversals. The quality of studies available is poor and heterogeneous. Future prospective randomized controlled trials or observational studies with standardized follow-up and outcome definitions/measurements are needed.