婴幼儿烧伤后惊厥的原因及防治

目的 回顾性分析74例烧伤后惊厥患儿的临床资料,总结婴幼儿烧伤后惊厥的常见原因及处理方法.方法 给予婴幼儿惊厥常规治疗,在烧伤创面使用湿润烧伤膏换药治疗.结果 74例患儿中,73例患儿烧伤创面治愈后出院,1例患儿死亡.结论 婴幼儿烧伤后及时有效地行抗休克复苏、维持水电解质稳定、正确的换药方法、积极清除坏死组织,可以减少烧伤后婴幼儿惊厥的发生,提高婴幼儿烧伤治愈率.     

A ten-year retrospective review of maternal cardiac arrest: Incidence,characteristics, causes,and outcomes in a tertiary-care hospital in a developing country

ObjectiveMaternal cardiac arrest is rare. We retrospectively reviewed and reported (1) the incidence of maternal cardiac arrests during admissions for delivery; (2) the characteristics and causes of cardiac arrest; and (3) the mortality rate and outcomes in a referral, single-university, teaching hospital in Thailand.Materials and methodsData on 23 cardiac arrests during admissions for delivery in the decade January 2006–December 2015 were retrospectively chart-reviewed. Patients with gestational ages under 24 weeks or cardiac arrests and death occurring before hospital arrival were excluded. The clinical characteristics of the arrests and outcomes were collected.ResultsOf 89,368 deliveries during the decade, 23 women suffered cardiac arrest (incidence, 1:3885), with 3 of those arrests occurring before delivery (incidence, 1:29,789). One patient underwent a perimortem cesarean delivery in the operating theatre. The most common reasons for the arrests were hypertension during pregnancy and cardiovascular causes (30.4% and 21.7%, respectively). Amniotic fluid embolisms were suspected for 2 patients (8.7%) with unidentified causes. The incidence of maternal deaths in peripartum cardiac arrests was 20/23, representing 86.9% (95% CI, 67.9–95.5) or 1:4468 of deliveries. Three patients suffering cardiac arrests after delivery survived to discharge.ConclusionsWe found a high maternal mortality rate following cardiac arrests during hospitalization for delivery. To decrease the incidence of arrests during the peripartum period and diminish the maternal mortality rate, identification of the causes and precipitating factors is vital. High-risk pregnant women require multidisciplinary care to improve the survival-to-discharge rate.     

252例产后出血的临床对策分析

目的研究产后大出血的临床表现,并通过不同的维护与治疗手段来研究正确、有效的预防方式,并为相应的产后大出血的急救以及避免提供可行的方案。方法针对我院从2008~2011年3年内收治的252例产后大出血的案例进行总结性分析,利用统计软件对其出血原因,临床表现等指标进行分析并找到相应的统计学依据。结果在针对不同的出血原因的分析方面得到因为子宫收缩异常而操作的产后大出血占到%的比例,由于胎盘异常而造成的产后大出血为5.6%的比例,由于软产道损伤而造成的产后大出血占到%的比例。结论针对对出血原因的判断在引产与接生的过程中进行及时的预判能够有效的增加对产后出血情况的预测进而降低由于产后出血带来的产妇死亡情况。     

北京市西城区2006-2010年户籍孕产妇死亡状况分析

目的了解孕产妇死亡率、死亡原因,制定相应干预措施,进一步降低孕产妇死亡率。方法采用回顾性研究方法,对北京市西城区2006-2010年户籍孕产妇死亡资料进行分析。结果 5年内西城区户籍孕产妇死亡率平均为16.15/10万,死亡原因以间接产科原因为主,西城区户籍孕产妇死亡主要与医疗保健因素尤其医疗保健人员的知识技能、管理有关。结论加强人户分离孕产妇的保健管理,提高产科技术人员的水平,提高妊娠合并症的综合救治能力是降低孕产妇死亡率的关键环节。     

泰安市大汶河流域2002～2004年育龄妇女主要死因及寿命损失分析

目的:通过对泰安市大汶河流域育龄妇女居民死亡状况的分析,了解育龄妇女的主要死因及其导致的寿命损失年数。方法:应用死亡专率和潜在减寿年数(PYLL)对大汶河主干流域育龄妇女2002～2004年人口死因进行分析。结果:研究区育龄妇女死亡率为1.09‰,对照区为0.89‰,其标化死亡率两区比较,差异有统计学意义(Z=2.83,P<0.01)。肿瘤、损伤与中毒、循环系统疾病、呼吸系统疾病、泌尿系统疾病、传染病是育龄妇女的主要死因。PYLL及PYLL率前6位死因与死亡构成前6位死因一致,但顺位不同。除呼吸系统疾病、传染病和寄生虫病外,其余主要死因研究区与对照区潜在寿命损失年数标化率(SPYLL率)差异有统计学意义(P<0.01)。结论:肿瘤、损伤与中毒、循环系统疾病、呼吸系统疾病、泌尿系统疾病、传染病是导致育龄妇女"早死"的主要死因。     

根因分析法在老年患者跌倒管理中的应用

目的：探讨根因分析法（RCA）在老年患者跌倒中的应用及效果。方法：应用RCA对住院老年患者跌倒个案进行调查分析,确定根本原因,制定并落实改进措施,比较应用RCA前后的实施效果。结果：应用RCA前后老年患者跌倒发生率有统计学差异（P〈0.05）,跌倒率由3.12‰下降到了0.92‰。结论：RCA对预防老年患者跌倒管理具有很好的导向作用。保证环境设施安全是预防跌倒的前提;强化系统安全建立是预防跌倒的根本;指导训练老年患者良好的健康行为是预防跌倒的关键;合理配置夜班护理人力资源是预防跌倒的主要手段。     

老年股骨粗隆间骨折患者围手术期病死原因分析

目的:分析老年股骨粗隆间骨折患者围手术期病死的原因。方法:回顾分析343例股骨粗隆间骨折患者的临床资料,统计围手术期病死原因。结果:343例患者中,存活331例(存活组),围手术期病死12例(病死组),死因以肺部感染所致的心肺功能衰竭以及心脑血管系统疾病为主。病死组隐性失血量、美国麻醉医师协会(American Society of Anesthesiologists,ASA)评分、慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)发病率均高于存活组。其中,COPD患病率与病死有显著相关性(r=3.703,P=0.003)。结论:老年股骨粗隆间骨折患者围手术期死因多为肺部感染诱发的心肺功能衰竭以及心脑血管疾病,在围手术期内对这些疾病的积极防治有重要意义。     

过氧化氢低温等离子灭菌器运行失败原因分析

目的 通过对STERRAD NX低温等离子体灭菌器2291次运行情况的统计分析,查找常见发生故障的原因及解决方法.方法 对手术室2009年8月-2011年7月使用STERRAD NX过氧化氢低温等离子灭菌器2291次运行情况进行回顾性统计分析,通过故障发生的类型、时段、频率,寻找故障发生的具体原因.结果 其中成功2092次,成功率91.3％,发生故障199次,故障发生率为8.7％,等离子系统失败(等离子期)43次占21.6％,过氧化氢传输失败(压力检测2)49次占24.6％,真空系统超时(箱体降压和蒸发器降压)107次占53.8％.结论 发生故障主要原因为误操作,且多发生在设备运行的初期;通过人员培训、规范操作、定期进行设备保养等措施,可以减少或防止故障的发生,确保设备运行正常.     

Reasons for Failure to Construct the Colonic J-Pouch. What Can Be Done to Improve the Size of the Neorectal Reservoir Should It Occur?

PURPOSE: The aim of this study was to determine first, the reasons for failure to construct a neorectal reservoir after anterior resection and coloanal anastomosis for rectal adenocarcinoma and the rate at which it occurred and second, to determine whether the adoption of a new coloplasty pouch-anal anastomosis improved this failure rate. METHODS: From the colorectal cancer database of a single institution, a single surgeons patients who underwent resection and coloanal anastomosis from March 1990 to June 1999 were identified. After thorough chart review those patients who underwent straight coloanal anastomosis, J-pouch-anal anastomosis, and coloplasty pouch-anal anastomosis could be identified. In each case of straight coloanal anastomosis, the cause of the failure to create a neorectal reservoir was sought. The study group was further subdivided into those who had their operation either before or after the introduction of the coloplasty pouch-anal anastomosis. RESULTS: Of 107 patients who fitted the criteria for study, 66 (61.7 percent) had a J-pouch-anal anastomosis, and 13 (12.1 percent) had a coloplasty pouch-anal anastomosis. Twenty-eight patients had a straight coloanal anastomosis when a neorectal reservoir could not be constructed, an overall failure rate of 26.2 percent for the total period of study. Seven reasons were identified for this failure, of which there were a total of 31 episodes. These reasons were 1) technical (narrow pelvis, bulky anal sphincters or need for mucosectomy, diverticulosis, insufficient colon length or pregnancy) and 2) nontechnical (complex surgery or distant metastases present). Failure to construct a neorectal reservoir for the period of study before the introduction of coloplasty pouch-anal anastomosis occurred in 27 of 88 (30.7 percent) patients. This was reduced to 1 of 19 (5.3 percent) patients in the later period of study, a significant improvement (P = 0.022) CONCLUSIONS: Seven factors have been identified which may result in the failure to construct a neorectal reservoir after rectal resection and coloanal anastomosis. This may occur in a sizable minority of patients. The introduction of coloplasty pouch-anal anastomosis has resulted in a significant improvement in this failure rate.     

淄博市 2010~2012 年居民恶性肿瘤死因分析

目的 分析淄博市恶性肿瘤死亡率、死亡年龄、性别分布、死因顺位以及死亡水平变化,为制定防控救治措施提供科学依据.方法 从淄博市疾病预防控制中心调取“全国死因登记报告信息系统”中2010～2012年所有淄博市户籍恶性肿瘤死亡个案,采用SPSS 19.0进行统计分析.结果 淄博市恶性肿瘤人群死亡率为189.36/10万,标化死亡率为149.91/10万;恶性肿瘤死亡主要集中于55～＜75岁年龄组;恶性肿瘤死因前5位依次为肺癌、肝癌、胃癌、结直肠癌和食管癌;恶性肿瘤死亡呈逐年上升趋势.结论 恶性肿瘤已经成为严重危害淄博市居民生命健康的疾病.