永久性肠造口围手术期处理23例

（目的）提高造口者的生存质量。（方法）23例肠造口者，术前对病人做耐心细致的解释和教育工作，让病人了解肠造口并乐意接受肠造口；正确选择造四位置；建造一个合格的肠造口；指导和教会病人管理肠造口，合理选择造口器具；帮助病人尽快形成排便规律。（结果）23例均无严重并发症，8例术后4周即有排便规律，15例术后2个月后形成排便规律，16例恢复正常生活和工作，7例因经济困难或情绪低落未能恢复社交活动。（结论）做好肠造口围手术期处理，能够帮助造口者提高生存质量。     

米非司酮配伍米索前列醇联合己烯雌酚终止12~24周妊娠的临床探讨

目的探讨终止12~24周妊娠最佳药物流产方法。方法观察组用己烯雌酚、米非司酮、米索前列醇联合终止12~24周妊娠,对照组用米非司酮配伍米索前列醇终止12~24周妊娠,两组进行比较。结果观察组成功率100%,宫缩开始时间(0.57±0.24)h,胚胎/胎儿排出时间(7.22±4.91)h,产时出血量(148.99±58.94)ml,恶露干净时间(14.8±7.8)d。对照组成功率92%,宫缩开始时间(0.63±0.37)h,胚胎/胎儿排出时间(9.21±1.96)h,产时出血量(148.99±58.94)ml,恶露干净时间(18.6±9.0)d,两组差异具有显著性(P<0.05)。结论己烯雌酚、米非司酮、米索前列醇联合用药终止12—24周妊娠是安全、可靠、成功率较高,是基层医院采用的一种理想药物流产方法。     

Postnatal development of NR1, NR2A and NR2B immunoreactivity in the visual cortex of the rat

N-Methyl-D-aspartate receptors (NMDARs) are critically involved in some types of synaptic plasticity. The NMDAR subunits NR1, NR2A and NR2B are developmentally regulated, and it has been proposed that developmental changes in their expression may underlie developmental changes in cortical plasticity. Age-dependent change in cortical plasticity is most commonly measured by the monocular deprivation effect, which occurs during a critical period between P22 and P50 in the rat. Although the development of NMDAR subunits has been studied from birth through the fourth postnatal week, there is only meager information from older ages when visual plasticity ends. We hypothesized that there will be significant age-dependent change in expression of NR1, NR2A or NR2B between P22, when the cortex is plastic, and P90, when it is not. We applied specific antibodies recognizing NR1, NR2A and NR2B to the primary visual cortex at P14, P22, P30, P45 and P90. We found age-dependent changes in NR1-IR that were negatively correlated with changes in NR2A-IR; these subunits are not regulated in unison. In contrast, NR2A-IR and NR2B-IR were positively correlated. NR2A-IR and NR2B-IR both passed through a developmental minimum around P45, then recovered to approximately their P22 level. NR1-IR passed through a maximum at P45. There were no significant differences between P22 and P90. These results do not support the simple hypothesis that the loss of plasticity corresponds to a simple transition from juvenile levels of NMDAR subunit proteins to new adult levels. On the other hand, the results do confirm the hypothesis that there are significant changes in processing of NMDAR proteins during the time that plasticity is lost. How these changes of IR relate to synaptic transmission and plasticity needs to be clarified.     

The use of perioperative Sofradex® eardrops in preventing tympanostomy tube blockage: a prospective double‐blinded randomized‐controlled trial

Around 11–12% of tympanostomy tubes are reported to become blocked by middle ear secretions or blood immediately following surgery, and so no longer function. Many otologists routinely instil an antibiotic and steroid‐containing solution at the time of surgery in the belief that this may reduce this complication. The aim of the study was to investigate the efficacy of instilling the antibiotic and steroid‐containing solution Sofradex^® at the time of grommet insertion in preventing grommet blockage. Double‐blind randomized‐controlled trial, comparing rates of grommet blockage in ears treated with Sofradex^® drops against control (no drops) in patients undergoing bilateral grommet insertion. Sixty‐one pairs of results were obtained. There was a significant difference between the rates of grommet blockage in the two groups. Grommets with Sofradex^® drops instilled perioperatively were nine times less likely to be blocked than controls [1.6%versus 13.1%, odds ratio (Sofradex^®/control) = 9.06, 95% confidence interval (CI): 1.04–78.82, P = 0.05]. There was no association between grommet blockage and perioperative bleeding or the nature and presence of middle ear secretions. Sofradex^® eardrops are effective in reducing the rate of grommet blockage when instilled perioperatively.     

Practice variation in perioperative antibiotic use in Japan.

OBJECTIVE: Under the fee-for-service system, the overuse and misuse of perioperative antibiotics have become serious concerns in Japan. The objective of the present study is to investigate practice variations of perioperative antimicrobial prophylaxis between and within hospitals, and to identify any opportunities for improvement. METHODS: We polled 319 surgeons in six specialties employed by 11 teaching hospitals in Japan. We developed questionnaires with vignettes, asking physicians about their practice of antimicrobial prophylaxis in six surgical procedures (gastrectomy, hysterectomy, cataract surgery, clipping of cerebral aneurysm, hip fracture surgery, and coronary artery bypass graft) and utilization of institutional clinical pathways. RESULTS: Average durations of prophylaxis varied by procedure, from 1.6 days for cataract surgery to 5.8 days for clipping surgery. Variation was also observed between institutions for the same procedure, e.g. institutional averages for the duration of prophylaxis for gastrectomy ranged from 2.3 to 7 days. Large intra-institutional variation in prophylaxis duration and inconsistent use of clinical pathways were observed in the cases of gastrectomy, hip fracture surgery, and clipping surgery. At one hospital, 20% of physicians performing gastrectomy indicated the use of an institutional clinical pathway, and prophylaxis duration ranged from 3 to 6 days. For cataract surgery and hysterectomy, clinical pathways were universally applied and intra-institutional practice variation was small, yet prophylaxis duration varied widely between hospitals and third-generation cephalosporins were used extensively. Average length of prophylaxis for hysterectomy ranged from 1.8 to 6 days and 43% of respondents prescribed third-generation cephalosporins. CONCLUSIONS: In Japan, perioperative antimicrobial prophylaxis lacks standardization. Efforts to strengthen an evidence-based approach to antimicrobial prophylaxis need to be made a priority at both the national and institutional levels.     

多孔义眼台植入手术围手术期用药的探讨

目的 探讨多孔义眼台植入手术的围手术期用药管理。方法 对116例患者(116眼)围手术期规范用药后，观察1个月。结果 仅1例凝血因子Ⅶ缺乏的患者出现重度出血和水肿，眼台取出；余均未发生术后严重的反应和并发症。结论 围手术期药物的合理使用可以有效地减轻手术的反应，减少手术的并发症。     

选择性冠状动脉内支架置入术围手术期的配合与护理

目的 :探讨合理配合与正确护理在冠状动脉内球囊成形 (PTCA)及支架置入术中的作用。方法 :冠心病病人184例经冠状动脉造影确诊后 ,根据冠状动脉血管狭窄程度行PTCA加内支架置入术 ,术中除配合操作医师完成介入手术及监护外 ,同时对病人进行心理护理 ,术后康复指导。结果 :184例病人置入1个支架者107例 (58 % ) ,2个支架者62例 (33 % ) ,3个支架者12例 (6 % ) ,4个支架者3例 (约占1 6 % ) ,手术成功率达到99 %。结论 :围手术期的合理配合与正确护理对提高PTCA的成功率 ,减少并发症具有重要的意义     

上海市杨浦区10年流动人口围产儿出生缺陷分析

目的:研究和分析城市流动人口围产儿出生缺陷发生的动态变化,为制定和采取预防措施提供决策依据。方法:按“中国出生缺陷监测中心”制定的出生缺陷诊断及统计标准,对上海市杨浦区1993年1月～2002年12月的流动人口围产儿出生缺陷监测资料,按前5年与后5年两组进行分析。结果:监测围产儿8620例,出生缺陷发生率前5年为17.33‰、后5年为12.06‰,出生缺陷率呈下降趋势。出生缺陷的类型1998～2002年以先天性心脏病占首位,与1998～1999年上海市出生缺陷的顺位一致。结论:开展有效干预措施,使群众自觉参与出生缺陷三级预防。     

胆囊切除术后残余胆囊结石56例诊治及预防

目的:探讨胆囊切除术后残余胆囊结石的诊治和预防方法,减低此并发症的发生率。方法:对56例残余胆囊结石再次手术的病例进行回顾性分析。56例中初次手术行经典胆囊切除术18例,小切口胆囊切除术16例,腹腔镜胆囊切除术22例;急诊手术30例,择期手术26例;初次手术在三级以下医院施行42例,在三级以上医院施行14例。结果:除1例因粘连严重并发门脉高压症,分离时引起大出血被迫终止手术外,55例再次手术成功,切除残留胆囊及结石后,症状均消失,疗效满意。结论:合理掌握胆囊切除术的手术时机、和术式,在术中解剖清楚胆囊管、肝总管、胆总管三管关系,然后距胆总管0.3~0.5cm切断结扎胆囊管,是预防残余胆囊结石的关键。     

尼尔雌醇在绝经后取宫内节育器中的应用

目的:探讨绝经后取宫内节育器前服用尼尔雌醇片的价值。方法:148例绝经后要求取出宫内节育器的妇女,随机分成两组,一组为直接取器组73例,按常规方法直接取出宫内节育器;另一组为服药组75例,顿服4 mg尼尔雌醇片1周后再取出宫内节育器,2组均在B超监测下取器。结果:直接取器组取器成功率为85%,用药组取器成功率为100%,两组有显著性差异(P<0.05)。结论:对于绝经后妇女,直接取器易造成IUD取出困难及失败,通过术前服用尼尔雌醇改善宫颈条件,可以提高取环的成功率。