Operating theatre etiquette,sterile technique and surgical site preparation

The operating theatre is an unusual environment and understanding the systems in place there is an important part of surgical training. ‘Non-technical skills’ is a term used to describe everything a surgeon does in the operating theatre, other than the technical aspects of the procedure itself. This includes communication, decision-making and leadership. Non-technical skills have become a vital aspect of the development of a surgeon and should form part of training programmes. A fundamental responsibility of the surgeon is the maintenance of sterility. The techniques of the surgical scrub and preparing and draping a patient only become second nature after good teaching and reflection by the surgeon. The purpose of this article is firstly to describe how a surgical trainee can get most out of an operating session. We will describe what non-technical surgical skills are and why they are important. We will focus on safety in the operating theatre and discuss worldwide strategies such as the ‘surgical safety checklist’ which aims to improve this. Finally we will present data on measures to reduce surgical site infection, such as which surgical scrub solution to use and whether drapes or wound protectors work.     

护理干预对于肋骨骨折非手术患者疼痛的影响

目的探讨综合护理干预对肋骨骨折非手术患者疼痛的影响。方法对55例肋骨骨折非手术患者进行综合护理干预,采用0~10数字疼痛量表进行疼痛程度的评估。结果干预后第1、2、3天及以后与干预前比较,疼痛级别明显减轻,与干预前比较差别均有统计学意义。结论综合护理干预可提高肋骨骨折非手术患者镇痛治疗效果,有效缓解疼痛,提高患者舒适度,减少并发症,促进患者康复。     

TEN YEAR REVIEW OF THORACIC AND ABDOMINAL PENETRATING TRAUMA MANAGEMENT

A ten year review of penetrating thoracic and abdominal trauma examined pattern of injury, patient management and outcome. Ninety-six patients were included in the study, 55 with injury to the abdomen, 31 the thorax and 10 with injury to both areas. Fifty-eight cases were managed non-operatively; 5 combined abdominal and thoracic injuries, 26 thoracic and 27 abdominal. Two cases went on to require operative management for intra-abdominal injury. Thirty-eight cases were managed operatively; 5 combined cavity injuries, 5 thoracic and 28 abdominal. Injuries were found in all of the combined cavity and thoracic cavity cases. Of the 28 abdominal cases, nine were found on laparotomy to have no significant visceral or vessel injury, one, however, was performed for omentum protruding through the wound. While a negative laparotomy was a relatively safe procedure, non-operative management had the advantages of a shorter hospital stay without wound-related morbidity. Selective non-operative management was found to be a relatively safe approach in this series.     

老年颅内肿瘤术中并发非手术区域血肿的危险因素分析

目的:分析老年颅内肿瘤术中并发非手术区域血肿的危险因素。方法:选择2010年3月至2017年3月在我院行开颅切除手术且并发非手术区域血肿的老年颅内肿瘤患者31例作为血肿组，随机抽取同期在我院行开颅切除手术无血肿的老年颅内肿瘤患者107例作为对照组。对两组老年患者临床资料进行回顾性分析，采用单因素及多因素Logistic回归分析可能造成非手术区域血肿的危险因素。结果:单因素及多因素Logistic回归分析显示，术前合并脑积水、血浆凝血酶时间、术前合并脑萎缩、患者年龄以及肿瘤大小进入回归模型（P＜0.05）。对照组患者GOS评分显著优于血肿组（P＜0.05）。结论:老年颅内肿瘤术中并发非手术区域血肿对患者术后预后造成不良影响，术前合并脑积水、血浆凝血酶时间、术前合并脑萎缩、高龄以及肿瘤大小是影响患者血肿发生的独立危险因素，针对上述危险因素应采取积极的预防救治措施，以提高治疗效果。     

子宫内膜异位症非手术诊断方法探讨

目的:评价子宫内膜异位症常见临床指标用于非手术诊断的价值。方法:因痛经、不育或盆腔包块住院行腹腔镜手术的育龄患者331例,术前纪录患者年龄、病程、初潮年龄、月经周期、月经期天数、结婚年龄或第一次性交年龄、孕产次、剖宫产史、继发性痛经、慢性盆腔疼痛、性交痛以及不育,阳性体征(宫骶韧带触痛结节、子宫直肠窝触痛结节或附件包块,具有三者之一者即为阳性),超声波检查(包块内部为无回声区并有散在或密集的光点为阳性),血清CA125值。计算各项临床指标单独及联合应用包括平行试验?系列试验诊断内异症的敏感性?特异性?阳性预测率及阴性预测率,并用Logistic回归方法计算诊断卵巢型及腹膜型内异症的公式。结果:单独应用各项临床指标诊断内异症的敏感性较低。超声波?血清CA125以及性交痛对内异症的预测率达90%以上,其他临床指标预测内异症的准确性较差。临床各项指标联合平行试验可明显提高诊断的敏感性(89%),各项指标联合系列试验则可明显提高诊断的特异性。任何3项临床指标联合,诊断内异症的预测率基本达到100%。卵巢型内异症的诊断公式为:1/[1+e-(-2.270+1.304*盆腔痛性结节+1.158*继发痛经+2.168*B超囊内光点+2.580*CA125异常)],腹膜型内异症的诊断公式为:1/[1+e-(-1.631+1.788*盆腔痛性结节+0.789*继发痛经+2.384*CA125异常)]。以结果>0.5为异常,此公式诊断卵巢型及腹膜型内异症的准确性分别为85.9%和84.5%。结论:疼痛症状、不育、盆腔体征、超声波以及血清CA125联合应用是内异症较准确的非手术诊断方法。     

中少量高血压脑出血微创手术治疗的疗效分析

目的 探讨微创手术治疗中少量高血压脑出血的疗效.方法 回顾性分析236例出血量在20～30 mL并伴有神经功能障碍的高血压脑出血患者,根据治疗方式的不同分为微创手术组和非手术组,微创手术组106例采用立体定向微创钻孔引流术,对照组130例采用非手术治疗,治疗后2周采用改良爱丁堡由斯堪的那维亚卒中量表法(SSS)和治疗后...     

腹部钝性损伤出血非手术治疗的病例选择

为了探索腹部钝性损伤出血的非手术治疗指征，总结９７例已诊断为腹腔出血的病例。分为甲乙两组；甲组５２例在Ｂ超及ＣＴ的监测下，密切观察血液动力学变化，１７例非手术治疗成功，３５例手术治疗。乙组４５例，除１例非手术治疗外４４例急诊手术。比较两组非手术治疗率分别为３２７％（１７／５２）和２２％（１／４５）。术前肝脾损伤诊断符合率分别为９５５％（２１／２２）和６２５％（２０／３２）手术单纯探查率分别为５７％（２／３５）和２７３％（１２／４４），以上均有显著差异，认为对于血液动力学稳定，出血量不超过５００ｍｌ，即便是肝脾损伤均可行非手术治疗     

选择性非手术治疗闭合性脾损伤98例临床分析

目的探讨非手术治疗闭合性脾损伤的病例遴选、监测和诊治方法。方法对1999年10月至2011年10月采用非手术治疗的98例闭合性脾损伤患者临床资料进行回顾性总结分析。结果98例患者中,经非手术治疗痊愈出院90例(91.8%);经治疗观察后发现血肿增大和持续渗血而中转开腹5例(5.1%);死亡3例(3.1%),为多发伤合并感染和器官功能衰竭患者。结论大多数Ⅱ级以下脾损伤可通过非手术治疗治愈,只要病例遴选合适、诊治方法得当、监护条件完备,选择性非手术治疗脾损伤是安全可行的。