Analysis of factors affecting the spontaneous closure of a gastrocutaneous fistula

Background/purpose

Few reports have documented the rate of persistence of a gastrocutaneous fistula (GCF) after gastrostomy removal or the reason for the persistence of a GCF. The purpose of this report was to analyze a large group of pediatric patients with a persistent GCF to determine the rate of persistence and any factors that correlate with the persistence of a GCF.

Methods

This was a retrospective review of 1,042 children from The Children’s Hospital, Denver, Colorado who had a gastrostomy constructed between 1992 and 2002. The charts of all children with a persistent GCF after gastrostomy catheter removal were analyzed for correlation between 13 clinical parameters and the persistence of a GCF.

Results

There were 150 children with a persistent GCF for an incidence of 34%. Time elapsed between the creation of the GCF and removal of the gastrostomy appliance (≤8 months versus >8 months) was the only parameter that showed any correlation with persistence of a GCF (P < .05). None of the other parameters studied showed any conclusive correlation with persistence of a GCF.

Conclusions

Time was the only factor that determined whether a surgically created GCF would persist after removal of a gastrostomy appliance.     

小儿人工耳蜗植入手术切口选择及其相关并发症问题

目的探讨小儿人工耳蜗植入手术的切口选择。方法回顾性分析2001年6月～2007年7月开展的5岁以下患儿人工耳蜗植入手术589例,均设计小“S”切口。其中,行澳大利亚CI24M植入174例,切口长3.5cm;CI24CA植入137例,CI24K植入62例,切口均长3.0cm。行美国Bionics90K植入26例,切口长3.5cm。行奥地利MedelCombi40^＋植入190例,切口长6.0cm。均制备两个肌骨膜瓣,一个用于包裹植入体,另一个用于覆盖开放的乳突腔。术后随访6个月～6.5年,观察术后切口愈合状况以及与切口有关的并发症发生情况。结果植入的人工耳蜗均有听觉语言效果。12例于术后1～2年开始沿切口表面出现1.5～3.5mm的瘢痕隆起（2.0%）;4例于术后1～3年出现与皮下感染有关的植入体裸露（0.68%）。通过清除炎症及瘢痕组织、重新固定植入体、颞肌瓣转移覆盖均获痊愈,随访6个月～2.1年,未再出现植入体裸露。结论作者设计的小切口效果满意,可以减小皮肤切口瘢痕的范围,术后植入体裸露的发生率低。     

构建邯郸市脑血管病医疗质控体系

基于脑血管病不同级别、不同专业医院诊治水平参差不齐的现状,运用课题研究型品管圈活动手法,干预神经内科11项关键医疗质量指标,从调配人员、统一技术及流程、构建脑血管病质量控制方案、制定脑血管病质量指标控制方案等4方面进行改进,构建了邯郸市脑血管病医疗质控体系,对脑血管病质量管理水平提升具有积极促进作用。     

降低腹部手术患者围术期非计划性低体温发生率

体温作为人体五大生命体征之一,是影响机体新陈代谢和生命活动的重要因素。手术患者发生非计划性低体温,可造成不同程度的危害。针对腹部手术患者围术期非计划性低体温发生率高的问题,开展品管圈活动。引入了无线体温监测工具,构建了病房、手术室、复苏室智能链式体温监测方案,制定了术前、术中、术后保温策略等,使腹部手术患者围术期非计划性低体温发生率从43.18%降低至8.51%,保障了患者安全,提升了医疗护理服务质量。     

提高病案首页准确性与完整性品管圈应用效果分析

目的探讨品管圈在提高病案首页准确性与完整性的应用效果,为医院管理、医疗安全提供依据。方法选定＂提高病案首页准确性与完整性＂品管圈活动主题,分析原因,制订相应对策,评估实施前后有形效果和无形效果。结果实施后,病案首页基本情况失实漏填、疾病诊断填写欠规范、手术操作填写欠准确的发生率明显低于实施前。团队凝聚力、医务人员责任心、工作积极性、团队合作性、沟通能力、解决问题能力、和谐度等无形成果总评分均明显高于实施前。结论品管圈活动有助于提高病案首页准确性与完整性。     

降低重症患者人工气道湿化不足发生率

目的降低重症患者人工气道湿化不足发生率。方法开展品管圈活动,通过医护双方合作,优化气道管理团队,完善人工气道湿化评估方案,改良气道湿化装置,增加气道湿化途径,实行复合序贯式湿化-排痰护理管理模式等,实现了气道湿化、辅助排痰、气道廓清一体化。结果重症患者人工气道湿化不足发生率从28.57%降低至11.26%,目标达标率为100.58%,进步率为60.59%。结论通过开展品管圈活动,规范了重症患者人工气道湿化方案,降低了气道相关并发症发生率,有效改善了患者治疗结局,提升了医疗质量。     

口内强支抗矫治安氏Ⅱ1错(牙合)拔牙病例的临床研究

目的:评价口内强支抗矫治Ⅱ1拔牙病例的支抗控制效果.方法:选择采用TPA联合Nance腭托口内强支抗的Ⅱ1拔牙病例20例,分析治疗前后头影测量值的变化.结果:PTV-U6增加(1.96±0.8 5)mm,PTV-U1、U1-NA与U1-SN分别减小(5.13±2.38)mm、(15.40±3.32)°和(16.94±4.52)°.结论:使用口内强支抗矫治Ⅱ1拔牙病例,临床支抗控制效果可靠,值得推广.     

Configuration affects parallel stent grafting results

Objective

A number of adjunctive “off-the-shelf” procedures have been described to treat complex aortic diseases. Our goal was to evaluate parallel stent graft configurations and to determine an optimal formula for these procedures.