某院外科围手术期抗菌药预防性应用的干预性研究

目的：通过某院外科围手术期抗菌药预防性应用的干预性研究,为临床抗菌药的应用和管理提供依据。方法：分别随机抽取某院手术科室2008年7月和11月出院病人的手术病历各200份,调查分析干预前后围手术期预防性应用抗菌药情况。结果：干预后术前〉2h应用抗菌药的比例由11％减少到4．5％（P〈0．05）,术前0．5～2h应用抗菌药比例由4．5％提高到38％（P〈0．05）,术后开始应用抗菌药比例由84．5％降到57．5％（P〈0．05）;抗菌药平均应用时间由7．3d减少到5．2d。干预后围手术期抗菌药预防性应用的合理性明显提高,伤口感染率及医院感染率无明显改变。结论：本研究所采取的抗菌药预防性应用的干预措施具有可行性和有效性,对促进安全、合理地使用抗菌药起到了积极的促进作用。     

先天性食管闭锁并严重肺炎的围手术期处理

目的 探讨先天性食管闭锁并严重肺炎患儿的围手术期处理经验。方法回顾某院36例先天性食管闭锁并严重肺炎患儿围手术期处理方法。结果36例患儿Ⅰ期治愈33例,吻合口漏保守治疗痊愈1例,死亡2例。结论良好的围手术期处理是先天性食管闭锁并严重肺炎Ⅰ期手术成功的关键。     

Internal fixation in compound type III fractures presenting after golden period

Objective:

Patients often reach the hospital late after passage of golden hours (initial 6 hours) after sustaining high-velocity injuries. The decision of internal fixation in Gustilo''s Type IIIA and IIIB fractures becomes a formidable challenge in patients reaching late. The purpose of the present study was to find out if internal fixation could be safely undertaken in these patients.

Materials and Methods:

Sixty-three patients, having 70 compound fractures (46 Type IIIA and 24 IIIB), which were internally fixed after 6h but within 24h after injury, were included in the present analysis. Follow-up ranged from 18 to 48 months with mean of 28 months.

Result:

Overall infection rate noted was (n = 11) 15.71% (8.7% in IIIA, and 29.16% in IIIB). The difference in deep infection rate between Type IIIA and Type IIIB was found to be statistically significant (P value < 0.01). Nonunion was seen in five fractures. Functional evaluation using Katenjian''s criteria, showed 62.85% (44 fractures of 70) good to excellent results.

Conclusion:

Satisfactory results may be obtained in Gustilo''s Type IIIA and IIIB fractures even if fixed after the golden period, provided strict protocol such as aggressive debridement, prophylactic antibiotic coverage, early soft tissue reconstruction and timely bone grafting is followed. The primary coverage of the wound is discouraged.     

Circadian control of neural excitability in an animal model of temporal lobe epilepsy

We provide experimental evidence for the emerging imbalance in the firing activity of two distinct classes (type 1 and type 2) of population spikes recorded from the hippocampal area CA1 in an animal model of temporal lobe epilepsy. We show that during the latent period of epileptogenesis following status epilepticus inducing brain injury, there is a sustained increase in the firing rate of type 1 population spikes (PS1) with a concurrent decrease in the firing rate of type 2 population spikes (PS2). Both PS1 and PS2 firing rates are observed to follow a circadian rhythm and are in-phase in control rats. Following brain injury there is an abrupt phase shift in the circadian activity of the PS firing rates. We hypothesize that this abrupt phase shift is the underlying cause for the emergence of imbalance in the firing activity of the two PS. We test our hypothesis in the framework of a simple two-dimensional Wilson–Cowan model that describes the interaction between firing activities of populations of excitatory and inhibitory neurons.     

预防性使用抗生素在205例直肠癌围手术期的应用分析

目的 探讨围手术期预防直肠癌术后感染的用药方案.方法 对近10年来205例直肠癌患者围手术期的抗生素应用进行回顾性分析.病例分为三组,A组118例为1991年5月至1993年2月典型的全程应用抗生素病例;B组57例为1996年3月至1997年2月短期应用抗生素病例;C组30例为2000年3月至9月短期肠道准备病例.结果 三组病例术后第三天体温、白细胞总数、切口愈合情况、感染率和肠液培养、血培养阳性率等均无显著差别;C组病例术前服用抗生素用量明显减少(P＜0.01);B组、C组病例抗生素用量较A组明显减少(P＜0.01).结论 直肠癌围手术期短期预防性应用抗生素的方法安全、经济、可靠,有明显的临床应用价值.     

2型糖尿病患者糖化血红蛋白与餐后血脂谱的关系

-C及TG水平可能影响糖代谢控制情况.     

围绝经期妇女重度抑郁症综合康复治疗的临床疗效分析

目的探讨围绝经期妇女重度抑郁症综合康复治疗的临床疗效。方法对26例围绝经期重度抑郁症妇女给予服用尼尔雌醇、氟西汀、解郁汤及心理治疗,采用汉密尔顿抑郁量表（HAMD）和自评抑郁量表（SDS）评分进行治疗前后对比观察和治疗效果评价,同时检测血清雌二醇（E2）、血清促卵泡素（FSH）含量变化。结果经过8周的综合康复治疗后,患者E2水平明显增高（P〈0．01）,FSH含量显著降低（P〈0．01）,HAMD和SDS评分明显降低（P〈0．01）。26例患者经治疗后,治愈16例（61．5％）,显效6例（23．1％）,有效4例（15．4％）,总有效率为100％。结论综合康复治疗围绝经期妇女重度抑郁症疗效好、副作用小,是安全有效的治疗方法。     

3691例围术期抗菌药物预防性应用对比分析

目的:了解我院2006、2009年围术期抗菌药物预防应用情况,并对其合理性进行比较和评价。方法:采用回顾性方法,对我院2006、2009年部分手术患者围术期预防用抗菌药物情况进行对比分析。结果:2个年度手术患者科室构成比及切口类别构成比相似,抽取样本具有可比性;围术期抗菌药物应用率达100%,均采用了静脉给药方式;2006年以头孢菌素类、青霉素类和喹诺酮类居多,2009年选用第1、2代头孢菌素增多,选用第3代头孢菌素、氟喹诺酮类患者明显减少;术前0.5～2h给药患者比例分别为0%和4.6%,手术时间>3h或失血量>1500mL手术患者中,术中追加用药者比例分别占0%和13.3%;Ⅰ、Ⅱ类切口均以单一用药为主,术后用药时间超过48h者均占90%以上。结论:通过干预,我院围术期抗菌药物选择及联用趋于合理,但用药率过高、用药时机不当和术后用药时间过长问题依然突出。     

药学干预前后我院Ⅰ类切口手术预防用抗菌药物比较

目的:评价我院临床药师参与抗菌药物监管前、后Ⅰ类切口手术围术期预防用药情况。方法:采用回顾性方法,对我院2010年3-7月和2010年8-12月Ⅰ类切口手术患者抗菌药物的应用种类、给药时机、用药时限、费用等进行统计、分析。结果:实施药学干预后,我院第2代头孢菌素应用率由28.5%提高到44.0%;术前0.5-2h预防用抗菌药物的比例由74.5%提高到97.0%;术后用抗菌药物时间<48h的比例由12.5%提高到94.0%;平均用药时间由4.5d缩短到1.8d;平均抗菌药物费用由675元降低至270元。结论:实施药学干预可显著提高围术期抗菌药物合理应用比例,提升医院合理用药水平。