降低高血压脑出血术后死亡的几点体会

目的 :总结降低高血压脑出血病人术后病死率的方法。方法 :分析 36例高血压脑出血病人救治经过。结果 :36例中死于肺部感染 9例 ,再出血 7例 ,消化道出血 6例 ,术后颅高压未解除 5例 ,肾功能衰竭 5例 ,其他 4例。结论 :严格掌握高血压脑出血手术指征 ,选择正确手术方法 ,术后合理用药及护理能降低高血压脑出血手术后病死率 ,改善预后。     

相对湿度对空调环境至适温度影响的研究

本文研究空调室内相同温度（夏季：２４℃，２８℃：冬季：１９℃；２２℃）条件下相对湿度（分别为３０～７０％；８５～９５％）对至适温度的影响。以健康成年人为研究对象，以体温、皮温、皮温差、温热感和舒适感为观察指标。结果表明：空调室内气温相同时，皮温差、温热感、舒适感均随气湿不同而出现差异。夏季空调温度为２８℃、气湿为８５～９５％时，皮温差（２．１℃）已超出生理至适范围，温热感（１２．５％）和舒适感（０％）也随湿度增高而下降（Ｐ＜０．０１）。提出在制订空调至适温度卫生标准时，应考虑空气湿度对至适温度的影响。     

体重指数对全膝关节置换术后功能的影响

目的回顾性分析体重指数(BMI)对骨关节炎(OA)患者全膝关节置换术(TKA)后功能的影响.方法由同一组医生使用同一种假体对320例(520膝)骨关节炎患者行全膝关节置换.按体重指数分为4组非肥胖组(BMI＜25.0 kg/m2)、超重组(BMI 25.1～27.0 kg/m2)、肥胖组(BMI 27.1～30.0kg/m2)和病理性肥胖组(BMI＞30.0 kg/m2),分别记录术前及随访时HSS膝评分、功能评分、膝关节最大屈曲、伸直度数和并发症.结果术前超重组、肥胖组和病理性肥胖组功能评分较非肥胖组低(P＜0.05),但膝评分差异无显著性.通过平均28.3个月的随访,无论膝评分和功能评分各组术后均明显提高,各组提高的幅度比较差异无显著性.虽然超重组、肥胖组和病理性肥胖组术后最大屈曲、伸直度数较非肥胖组小,但是改善幅度仍相当,差异无显著性(P＞0.05).肥胖组和病理性肥胖组围手术期并发症明显增高(P＜0.05),在总共93例(181膝)中,有14膝(9.2%)出现伤口并发症,其中1膝(0.5%)感染,感染发生于术后10周内,与伤口并发症有关;2膝(1.3%)内侧副韧带损伤.超重组166例(258膝)中有6膝(2.3%)出现伤口并发症,无感染及内侧副韧带损伤病例.非肥胖组61例(81膝)中有1膝(1%)出现伤口并发症,无感染及内侧副韧带损伤病例.结论TKR是进展期OA患者有效的治疗措施,肥胖并不是膝关节置换手术的障碍.但围手术期并发症增多,包括伤口愈合、感染、内侧副韧带损伤,应注意伤口缝合技术和保护内侧副韧带.     

国产丁丙诺啡PICA术后镇痛的临床应用

目的：观察国产丁丙诺啡静脉病人自控镇痛(PICA)术后镇痛的疗效。方法：30例肿瘤患者术后应用伟氏PICA泵，每次0.5ml，舍丁丙诺啡0．03-0．06mg，并观察镇痛效果、时间和不良反应。结果：30例患者采用丁丙诺啡PICA镇痛均取得满意疗效。平均镇痛时间1．5～2小时。所有病例均未出现眩晕、嗜睡等严重不良反应，2例出现呕吐，1例出现恶心。结论：国产丁丙诺啡PICA术后镇痛方法简单、疗效满意。     

噬菌体抗体库固相筛选条件的初步研究

目的:探讨噬菌体抗体库的固相筛选条件,为筛选方案的设计提供实验依据。方法:利用多种针对HEVNE2蛋白的特异性噬菌体人源抗体和非特异性噬菌体人源抗体,对噬菌体抗体与抗原的结合时间、抗原包被的浓度、洗涤强度和洗脱方式等多种筛选的条件进行初步探索。结果:阳性噬菌体抗体与抗原反应1min,就可较好结合,洗涤次数为20～30次、洗涤液的pH为5时,筛选得到的阳性率最高。包被抗原的浓度对筛选的阳性率没有明显影响,用10mg/L抗原竞争洗脱60min,可得到较高的阳性率。结论:噬菌体抗体库的筛选是一个非常复杂的过程,其中的各个条件之间有着密切的联系,应该根据具体情况进行调整。     

Influence of statins on postoperative wound complications after inguinal or ventral herniorrhaphy

The lipid-lowering agents, statins, are the most commonly prescribed class of drugs in the western world. Because of their widespread use, many patients undergo surgical procedures while on statins. Statins, in addition to cholesterol-lowering effects, also have anticoagulant, immunosuppressive, and antiproliferative properties that may affect the risk of local wound complications. This study investigated the relationship between statins and postoperative wound complications in a large cohort of patients undergoing inguinal or ventral hernia repair. Data mining was performed in the Veterans Integrated Service Network (VISN)16 Data Warehouse. This database contains clinical and demographic information about all veterans cared for at the ten VA Medical Centers that comprise the South Central VA Healthcare Network in the mid-south region of the US. Aggregate data (age, body mass index, smoking history, gender, race, history of diabetes, statin use, and postoperative wound complications) were obtained for all patients who underwent inguinal or ventral hernia repair during the period October 1, 1996–November 30, 2004. During the period of the query, 10,782 patients (10,676 male, 106 female), 1,242 (11.5%) of whom received statins, underwent herniorrhaphy. Statin use did not affect the risk of wound infection or delayed wound healing. Statin use was, however, associated with an increased rate of local postoperative bleeding complications (P=0.01). When the type of hernia, age, smoking, diabetes, and body mass index were included in a multivariate analysis, statins remained borderline significant as an independent predictor of wound hematoma/postoperative bleeding (P=0.04), odds ratio 1.6 (95% CI 1.03–2.44). Patients who undergo inguinal herniorrhaphy while on statins have an increased risk of postoperative wound hematoma/hemorrhage. Focus on additional factors that may affect the propensity to postoperative bleeding and on meticulous intraoperative hemostasis are particularly important in such patients.     

酱油卫生状况模糊评价模型的建立

目前酱油卫生状况采用单项的评价方法，存在着轻重不分等不科学因素。如食盐超标与大肠菌超标及重金属超标有着极大的差别。为了消除这种差别，根据模糊数学原理、建立Ｍ（·＋）综合评价模型［１］对宁德地区１９８９年酱油抽查检验结果进行卫生学评价取得了满意结果，从而为酱油卫生综合评价建立了有效的评价模型。     

Could bipolar vessel sealers prevent bile leaks after hepatectomy?

BACKGROUND AND AIMS: The aim of this work was to test the feasibility of using a bipolar low thermal acting system inducing collagenic sealing but not protein coagulation to secure hepatic parenchyma cutting. MATERIALS AND METHODS: Thirty consecutive hepatectomies were carried out using kellyclasy plus ligatures and clips (controls), while the following 50 hepatectomies used kellyclasy plus bipolar vessels sealer (BVS). Blood loss, duration of hepatic pedicle clamping, length of hospital stay, and complications were recorded. RESULTS: There was no statistically significant difference in blood loss and duration of clamping between controls and BVS. Specific complications (9/21 in the control group vs 1/49 for the BVS group, p<0.00045) and length of hospital stay (14 days in the control group vs 11 days in the BVS group, p<0.014) were statistically lower in BVS group than in the controls, mainly due to prevention of bile duct leakages. CONCLUSIONS: Our data suggest that BVS may be particularly efficient to achieve bilistasis leading to the highest level of safety in performing hepatectomies. Further studies are now needed to confirm its superiority on the classical biliary ducts occlusion techniques.     

Fast Track—Different Implications in Pancreatic Surgery

Concepts in “fast-track” surgery, which provide optimal perioperative care, have been proven to significantly reduce complication rates and decrease hospital stay. This study explores whether fast-track concepts can also be safely applied and improve the outcomes of major pancreatic resections. Perioperative data from 255 consecutive patients, who underwent pancreatic resection by means of fast-track surgery in a high-volume medical center, were analyzed using univariate and multivariate models. Of the 255 patients, 180 received a pancreatic head resection and 51 received distal, 15 received total, and 9 received segmental pancreatectomies. The patients were discharged on median day 10 with a 30-day readmission rate of 3.5%. The in-hospital mortality was 2%, whereas medical and surgical morbidities were 17 and 25%, respectively. Fast-track parameters, such as first stools, normal food, complete mobilization, and return to normal ward, correlated significantly with early discharge (p < 0.05). Patients’ age, operation time, and early extubation proved to be independent factors of early discharge, shown through multivariate analysis (odds ratio: 4.0, 2.0, and 2.8, respectively; p < 0.05). Low readmission, mortality, and morbidity rates demonstrate that fast-track surgery is in fact feasible and safe and promotes earlier discharge without compromising patient outcomes.