Closed suction drainage for deep neck infections

PurposeThere have been various incision and drainage methods for deep neck infection (DNI). Closed-suction drainage (CSD) has been used to decrease hematoma or to drain pus in other forms of medical surgery. The purpose of this investigation was to evaluate the usefulness of CSD for DNI.Patients and methodsThis study consisted of 30 patients who underwent CSD after incision and drainage for DNI between January 2006 and December 2011. The patients' demographics, systemic diseases, methods of airway control, involved spaces, incision, CSD results, duration of hospitalization, and complications were investigated.ResultsCSD was used to treat 30 DNI patients. Eleven patients (37%) had underlying systemic diseases like diabetes mellitus, hypertension, hepatitis, asthma, etc. Twenty four patients (80%) had odontogenic infections in the mandibular molar region. Tracheostomy was performed in 5 patients (17%). The involved spaces were various from parapharyngeal space to mediastinum (mean: 4.8 spaces), and CSD was applied with drainage lines (mean: 3; 2–7 drains) over the course of 4–37 days (mean 14.6 days). The total amount of drained pus was 8–1344 cc (mean: 406 cc) and the daily amount was 1–61 cc (mean: 28 cc) from each patient. The mean length of hospital stay was 26 days, with a range of 9–83 days. Wound rupture happened in 7% of 56 total incision sites and spontaneous removal of the drain tube occurred in 3% of 91 total tubes. Four patients died because of cardiac arrest, pulmonary edema, and hypoxia. A statistical significance was accepted about total and daily amount of drainage at Pearson's correlation test (p < 0.001).ConclusionAccurate diagnosis, safe airway management, and early surgical drainage were important in DNI treatment. Compared to other drainage systems, CSD is clinically useful for treating DNI due to minimal incision, convenience of post-operative management, and less postoperative complications.     

Gastric Biopsy in Peptic Ulcer: A Follow-up Study

Fundal biopsy was performed in 155 peptic ulcer patients (GU 65, DU 90) and antral in 43 (GU 17, DU 26) of the 155 patients. In GU fundal gastritis was found in 74 and antral in 94 % of the cases. In DU the percentages were 16 and 65 respectively. In a short-term follow-up of 30 patients (GU 15, DU 15) the state of the fundal macosa remained essentially unchanged in 19, became worse in 6, and possibly showed an improvement in 5. In a 1–6 year follow-up of 58 patients (GU 28, DU 30) the same type of mucosal structure was preserved in 40, worsening of the changes in 13, and some improvement in 5.     

输尿管负压吸引鞘在输尿管软镜碎石术中的价值探讨

目的探讨输尿管负压吸引鞘在输尿管软镜碎石术治疗肾结石中的安全性及有效性。方法回顾性分析96例行输尿管软镜碎石术治疗肾结石患者的临床资料,应用输尿管负压吸引鞘46例(治疗组),未应用50例(对照组),比较两组患者的结石清除率、手术时间、肾盂内压、术后肾绞痛、石街形成情况、术后全身炎症反应综合征(SIRS)、降钙素原(PCT)浓度、白细胞计数、住院时间、住院费用和治疗有效率。结果治疗组肾盂内压在最小值、最大值和平均值方面均明显小于对照组(P0.05);在1个月后检查发现,对照组患者治疗有效率为70.0%,清除率为82.0%,而治疗组患者治疗有效率为84.7%,清除率95.6%,治疗组患者结石治疗有效率和清除率明显优于对照组(P0.05);治疗组和对照组手术时间分别为(86.3±5.2)和(108.6±3.5)min,治疗组明显短于对照组(P0.05);对照组和治疗组术后肾绞痛例数分别为13和2例(P0.05);对照组和治疗组术后石街形成例数分别为11和2例(P0.05);对照组和治疗组术后SIRS分别为10和2例,治疗组术后肾绞痛和石街形成、SIRS例数均明显低于对照组(P0.05);对照组和治疗组住院时间分别为(8.8±1.1)和(7.7±1.2)d,住院费用分别为(23 067.5±392.8)和(21 957.3±378.6)元,治疗组住院时间和住院费用与对照组比较差异无统计学意义(P0.05);对照组和治疗组术后PCT分别为(1.5±0.3)和(0.3±0.1)ng/ml,白细胞计数分别为(14.6±0.5)×109/L和(6.4±0.6)×109/L,术后治疗组患者PCT和白细胞计数明显低于对照组(P0.05)。结论输尿管负压吸引鞘在输尿管软镜碎石术治疗肾结石中安全、有效,缩短手术时长,同时提高结石清除率,减少不良反应发生,应当推广。     

可重复使用硬吸引瓶在临床中的应用

可重复使用硬吸引瓶是一种新型、实用性强、安全性能好的引流瓶,全封闭性,在直视条件下观察引流液的量及颜色不需每日更换,只要内袋满了以后更换内袋。患者出院即可更换硬吸引瓶,使用后须按照医院制度进行清洗、消毒。含有大量致病菌及毒素的痰液、引流液全部收集在液体收集袋内,减少对环境的污染,创造了一个清洁卫生的工作环境,保护了医护人员的身心健康,有利于控制院内感染,符合控制医院感染的要求,也符合国家的环保产业政策。     

Randomized Trial of Clitoral Vacuum Suction Versus Vibratory Stimulation in Neurogenic Female Orgasmic Dysfunction

Objective

To examine the safety and efficacy of using a clitoral vacuum suction device (CVSD) versus vibratory stimulation (V) to treat orgasmic dysfunction in women with multiple sclerosis (MS) or spinal cord injury (SCI).

2种方法治疗良性前列腺增生并电切镜进镜困难患者的比较

比较2种方法在治疗良性前列腺增生（BPH）行经尿道前列腺等离子电切术中电切镜置入困难患者的临床疗效。选择2007年9月至2014年1月曲靖市第二人民医院泌尿外科收治的BPH患者行经尿道前列腺等离子电切术中发现电切镜进镜困难患者90例,随机分成观察组和对照组,每组45例。观察组采用去除外鞘电切术联合耻骨上膀胱微穿刺负压引流治疗,对照组采用扩张尿道和（或）尿道外口剖开,再置入电切镜行电切术治疗。2组手术均取得成功,平均手术时间、出血量无显著性差异（P＞0。05）,观察组术后平均住院时间、继发尿道狭窄的发生率均小于对照组（分别为P＜0.05、P＜0.01）。去除外鞘电切术联合耻骨上膀胱微穿刺负压引流在治疗BPH并电切镜进镜困难患者可降低术后继发尿道狭窄发生率,减少术后住院时间,临床疗效较好。     

改良深部吸痰法在重型颅脑损伤气管切开患者中的应用

目的探讨改良深部吸痰法在重型颅脑损伤后气管切开患者中的应用效果。方法采用便利抽样法选择2013年6-10月解放军第309医院神经外科ICU收治的重型颅脑损伤后气管切开早期非机械通气患者40例,采用随机数字表法分为对照组和研究组。对照组采用常规吸痰法;研究组采取改良深部吸痰法,即在吸痰管尖端超过套管末端0.5cm时减慢插入速度,直至患者出现呛咳反射或感觉到气管隆凸阻力时吸痰。观察两组患者气道黏膜损伤情况、吸痰时患者屏气时间、人工气道通畅程度及临床肺部感染积分(clinical pulmonary infection score,CPIS)。结果两组患者气管切开后3、7d时的CPIS均高于气管切开前,差异有统计学意义(P0.05);但3个时间点的组间比较差异无统计学意义(均P0.05)。研究组吸痰时患者屏气时间短于对照组,气道黏膜损伤发生率低于对照组,差异均有统计学意义(P0.01);两组患者人工气道通畅率差异无统计学意义(P0.05)。结论改良深部吸痰法可以降低传统气管切开吸痰造成气管黏膜损伤的发生率,缩短吸痰时屏气时间,能够达到预防和减少肺内感染、保持呼吸道通畅的目的。     

创面菱形分布切开联合负压封闭引流技术对毒蛇咬伤的临床价值

目的 探讨创面菱形分布切开联合负压封闭引流技术（VSD）治疗毒蛇咬伤的临床价值。方法 选取2017年4月—2018年11月雅安市人民医院就诊的毒蛇咬伤指（趾）患者168例。其中,2017年4月— 2017年11月76例患者（A组）采取回顾性分析;2018年4月—2018年11月92例患者采取前瞻性研究。92例患者中采取单纯创面菱形分布减压切开暴露引流55例（B组）,创面菱形分布减压切开联合VSD 37例 （C组）,记录并对比患肢肿胀消退时间、远端局部溃烂坏死、关节功能障碍遗留、创面感染及截指（趾）情况。 结果 3组患者性别、年龄、伤肢肿胀程度及严重程度比较,差异无统计学意义（P?>0.05）。3组患者住院时间、肿胀消退时间、创面感染、皮瓣坏死及功能障碍比较,差异有统计学意义（P?<0.05）。A组住院时间、肿胀消退时间长于B、C组（P?<0.05）。A组出现皮瓣坏死与残留功能障碍例数与B、C组（P?<0.05）;C组在彻底清创以后,未预防性使用抗菌药物,在创面感染控制上优于B组（P?<0.05）。结论 菱形小切口皮瓣切开,能最大限度地解除组织肿胀后皮肤张力,缓解远端供血不足导致溃烂、坏死、截指（趾）,挽救缺血性肌挛缩损害后的关节功能;联合VSD负压吸引技术更利于创面管理,缩短肿胀的消退时间。     

应用整形观念大张网状皮片联合VSD技术治疗深度烧伤

目的:探讨应用整形观念,大张网状皮片联合VSD技术治疗深度烧伤的临床效果。方法:2010年2月-2016年10月,选择40例50%TBSA(ITW30%)以下深度烧伤患者,男28例,女12例,年龄16-50岁,平均年龄32岁,烧伤部位为四肢、躯干,包括手足等关节功能部位,切削痂时间为伤后3-7天,1次手术面积控制在20%-30%以下,切削痂创面应用VSD敷料覆盖,术后2周左右,切削痂创面肉芽组织形成,予以大张网状皮片移植,VSD敷料覆盖,持续负压吸引。结果:切削痂术后2周,肉芽组织新鲜生长良好,植皮术后10-14天观察移植皮片成活率95%以上,3-4周后网状皮片扩展良好,创面全部覆盖,随访6个月-1年,外形良好,无明显瘢痕增生及肢体功能活动障碍,生活质量明显提高。结论:应用整形观念,网状皮片移植结合VSD负压吸引技术是治疗深度烧伤的有效方法。