护理干预对预防胃肠外科手术患者术后切口感染的效果分析

目的探讨护理干预对胃肠外科手术患者术后切口感染的预防效果。方法选取2012年10月～2013年6月行胃肠外科手术的122例患者,随机分为对照组与研究组各61例,对照组给予常规护理,研究组在常规护理基础上给予系统护理干预,记录两组患者术后1、2、3、4、5周发生切口感染情况。结果术后5周,研究组甲级愈合显著高于对照组,丙级愈合显著低于对照组（P〈0.05）。研究组术后发生切口感染4例（6.55%）,显著低于对照组13例（21.31%）（P〈0.05）。结论加强术前、术中、术后的系统护理干预,可以有效降低术后切口感染的发生率,减轻患者的痛苦,促进患者早日康复。     

163例开放性骨折患者手术切口感染相关因素分析

目的探讨开放性骨折患者手术切口发生感染的相关因素。方法纳入163例因开放性骨折行手术治疗的患者,根据是否发生切口感染分为感染组10例与未感染组153例,应用多因素回归分析进行危险因素分析。结果感染组糖尿病史5例(50.0%),Ⅲ类切口6例(60.0%),手术时间(2.4±1.3)h,住院时间(10.8±3.2)d,白蛋白水平(39.1±3.3)g/L。未感染组糖尿病史33例(21.6%),Ⅲ类切口39例(25.5%),手术时间(1.6±0.3)h,住院时间(7.2±2.5)d,白蛋白水平(42.9±4.4)g/L。两组相比差异显著,上述因素是切口感染的独立危险因素(P<0.05)。结论糖尿病史、Ⅲ类切口、手术时间及住院时间延长、白蛋白水平低下与开放性骨折手术切口发生感染存在相关性。     

外科手术切口感染的危险因素分析及护理对策

目的探讨外科手术切口感染的危险因素分析及护理对策。方法选择2010年1月-2014年1月在我院住院普外科住院治疗的病例120例,入选病例均有完整的临床资料,对切口感染的发生率采用χ^2检验进行单因素分析,同时采用非条件Logistic回归分析进行多因素分析,并针对相关因素采取对应的护理对策。结果入选的120例病例中发生切口医院感染共11例,感染发生率9.17%。年龄、基础疾病、手术时间、切口类型、住院时间、切口长度、切口引流与外科手术切口感染密切相关（P〈0.05）。年龄〉60岁（OR=6.384）、有基础疾病（OR=5.237）、手术时间≥3 h（OR=4.726）、切口类型Ⅲ类（OR=7.153）是外科手术切口感染发生的危险因素。结论年龄、基础疾病、手术时间、切口类型、住院时间、切口长度、切口引流与外科手术切口感染密切相关,其中年龄〉60岁、有基础疾病、手术时间≥3 h、切口类型Ⅲ类是外科手术切口感染发生的危险因素。外科手术切口感染直接影响到手术的质量和患者的生活水平,护理人员应明确引起切口感染的危险因素,同时针对引起外科手术切口感染的危险因素采取有效的护理干预对策,从而有利于降低手术切口感染发生率,促进疾病早日康复。     

护理干预对手术室切口感染的预防效果分析

目的 探究护理干预对手术室切口感染的预防效果.方法 随机选取2012年10月～2013年10月在我院行手术治疗患者128例,按照随机数字表方法分成两组,每组64例,对照组予常规护理,研究组予护理干预,分析两组患者的护理效果、切口愈合和切口感染情况.结果 予不同护理方案后,研究组治疗有效率为96.88％,明显高于照组79.69％,差异具有统计学意义（P＜0.05）;且研究组手术切口的甲级愈合率为81.25％,明显高于对照组60.94％,差异具有统计学意义（P＜0.05）;同时研究组手术切口发生感染3.12％,明显少于对照组,差异具有统计学意义（P＜0.05）.结论 手术室应用护理干预,能够有效提升患者疗效和切口愈合,降低术后切口感染的发生,具有一定临床应用和研究价值.     

负压引流管在处理肥胖患者剖宫产切口中的应用效果分析

目的：分析负压引流管在处理肥胖患者剖宫产切口中的应用效果,旨在改进当前剖宫产切口的处理方法。方法选取2012年5月～2012年12月来广东省东莞市茶山医院产科行剖宫产术的产妇共计60例。随机均分为对照组和试验组（n=30）。对照组采取剖宫产后常规缝合。试验采用脂肪层与筋膜层之间留置负压引流管,然后间断全层缝合皮肤及皮下脂肪层,1～2d拔管,7d拆线。2组缝合后均沙袋压迫6h。比较2组切口愈合情况。结果术后观察两个月,脂肪液化试验组1例,对照组4例。切口皮下硬结试验组2例,对照组5例。切口裂开试验组无,对照组2例。切口皮下血肿试验组无,对照组1例。愈合时间试验组平均（25.5±2.5）d,对照组平均（40.8±4.3）d。各并发症发生率试验组均较对照组低,愈合时间较对照组高,差异有统计学意义（P〈0.05）。结论皮下置负压引流管对肥胖患者剖宫产产妇切口愈合临床效果好且操作简单,应在临床广泛推广。     

Wound tensile strength and contraction rate are not affected by laparotomy or pneumoperitoneum

Background: Many cellular elements responsible for wound healing are affected by laparotomy. The aim of this study was to evaluate the effects of laparotomy and CO₂ pneumoperitoneum on wound healing. Methods: Male Sprague Dawley rats were randomly assigned to one of three experimental groups. Anesthesia control rats underwent no procedure. Pneumoperitoneum group rats were insufflated with CO₂ gas. Laparotomy group rats underwent a 7-cm midline laparotomy incision. The interventions were 30 min long. For the incisional study (n= 30), a 4-cm dorsal full-thickness skin incision was made on each rat and then closed with staples. On postoperative days 7 and 14, an equal number of rats were sacrificed from each group, and wound tensile strength measurements were performed. For the excisional study (n= 45), each group of 15 rats underwent a 2-cm diameter circular dorsal full-thickness skin excision. Blinded measurements of wound area were performed every other day until wounds closed. Results: Wound tensile strength values were not significantly different among experimental groups at either time point. The study had a power of 80% to find a 30% difference at POD 7 and a power of 80% to find a 23% difference at POD 14 to a confidence level of p < 0.05. Wound contraction data from the excisional model were analyzed with the Generalized Estimation Equations statistical approach. When we modeled the treatment group as a covariate, no statistical difference was found between groups, demonstrating equal slopes across time. Conclusions: From the results of these studies, we conclude that wound healing in this model is not significantly diminished following laparotomy or peritoneal insufflation, as compared to anesthesia control. Received: 26 September 1997/Accepted: 27 January 1998     

Closure of trocar wounds in laparoscopic operations

A method of fascial closure utilizing a hypodermic needle as a conduit for threading the suture through the fascia is described. This technique is designed to make use of vertical space rather than horizontal space, which is lacking in the small trocar wounds. The technique is easy to master and teach and has resulted in secure closures in over 150 wounds.     

乳晕缘切口行垂乳上提悬吊固定术

小乳合并垂乳时，为了减少术后横行或垂直切口瘢痕，自１９９３年２月至１９９５年２月，采用乳晕缘切口缝合法行垂乳上提悬吊固定８例，取得满意疗效。     

A meta-analysis of randomised controlled trials comparing the clinical and radiological outcomes following minimally invasive to conventional exposure for total knee arthroplasty

Proponents of minimally invasive total knee arthroplasty (TKA) state accelerated patient recovery and increased patient satisfaction as advantages. However, retractors state a greater incidence of iatrogenic nerve injury, implant mal-positioning and increased rates of revision. This study compares the clinical and radiological outcomes of minimally invasive and conventional exposure TKA using a meta-analysis. A search of published and unpublished literature was performed. Eighteen studies including 1582 TKAs were reviewed: 822 minimally invasive versus 760 conventional exposure TKAs. The findings of this study suggest that whilst incision length was significantly smaller in MIS (p = 0.001), and flexion range of motion was significantly greater following MIS (p = 0.01), there was no statistically significant differences in all other clinical or radiological outcomes between MIS or conventional approach TKA surgery (p>0.05).     

硫酸镁对瑞芬太尼引起痛觉过敏的影响

目的研究大鼠切口痛模型中硫酸镁对瑞芬太尼诱发的痛觉过敏的影响。方法 42只雄性SD大鼠,随机均分为七组:切口痛组(I组)、瑞芬太尼组(R组)、切口痛+硫酸镁组(MgI组)、切口痛+瑞芬太尼+硫酸镁(250、500、1 000 mg/kg)组(MgR1、MgR2、MgR3组)、对照组(C组)。MgI、MgR组均于麻醉前10 min腹腔注射硫酸镁稀释液4 ml,余组给予相应生理盐水4 ml。除C组外,各组均制作切口痛模型。各组均测定并计算出术前24 h(T0),术后6、24、48 h(T1、T2、T3)大鼠右后爪的热缩足反射阈值(PWTL)及机械缩足反射阈值(PMW)。结果与I组比较,T1~T3时R组PWTL值明显缩短,PMW值明显减少(P<0.05);MgI组PWTL值缩短和PMW值减少(P<0.05)。与R组比较,MgR1、MgR2、MgR3组PWTL值缩短和PMW值减少(P<0.05)。结论硫酸镁可减轻大鼠切口周围组织疼痛,并能缓解由瑞芬太尼诱发的切口周围组织痛觉过敏。