品管圈在植入式静脉输液港患者护理中的应用

目的探讨品管圈在植入式静脉输液港(IVAP)患者护理中的应用。方法选取本院2018年10月-2018年12月IVAP患者30例作为对照组,2019年1月-2019年3月品管圈活动干预后IVAP患者30例作为观察组。对照组采用常规护理措施,观察组采用品管圈活动干预后的护理措施。比较两组IVAP患者并发症的发生率和对护理工作的满意度。结果观察组导管堵塞1例;并发症发生率为3.33%(1/30)。对照组感染4例,血栓2例,导管堵塞4例;并发症发生率为33.33%(10/30)。观察组并发症发生率低于对照组(P <0.05)。观察组对优质服务、技术水平、关怀、出院指导、护理总满意度评分分别为(42.39±5.27)分、(31.49±4.32)分、(22.25±4.69)分、(20.26±4.91)分、(112.24±10.38)分;对照组分别为(38.65±4.91)分、(28.68±4.26)分、(19.96±4.30)分、(19.94±4.63)分、(103.37±10.12)分;观察组对优质服务、技术水平、关怀、出院指导、护理总满意度评分均高于对照组(P <0.05)。结论通过品管圈活动干预后的护理措施明显降低IVAP患者并发症的发生率,提高患者对护理工作的满意度。     

单孔加一孔联合ERAS在高位直肠及乙状结肠癌中的应用

目的 探讨单孔加一孔腹腔镜手术联合 ERAS 治疗高位直肠及乙状结肠癌的近期疗效。方法 回顾性分析 2017 年 11 月至2018 年 10 月在福建省肿瘤医院胃肠肿瘤外科进行加速康复外科干预的 92 例高位直肠及乙状结肠癌患者资料，根 据手术方式的不同，分为单孔加一孔手术联合快速康复外科组39 例及常规腹腔镜手术联合ERAS 组 53 例，对比两组围术 期情况。结果 两组患者基线资料无明显统计学差异（P ＞ 0.05），且在手术时间、出血量、上下切缘、清扫淋巴结数量及 并发症方面无明显统计学差异（P ＞ 0.05）。但单孔加一孔手术联合ERAS 组较常规手术联合ERAS 组，总切口长度更短 [（6.7±1.1）cm 比（8.5±1.3）cm，P=0.000]，术后首次下床时间更早 [（22.2±5.2）h 比（27.1±7.9）h，P=0.001]，首次排便 时间更早[（70.2±19.8）h比（83.1±20.4）h，P=0.005]，术后第一天C反应蛋白值更低[（43.5±28.6）mg/L比（57.2±33.2） mg/L，P=0.038]，术后住院时间更短 [（7.0±1.7）d 比（8.1±2.1）d，P=0.010]，且术后 2~4 天疼痛评分更低（P ＜ 0.05）。 结论 经验丰富的腔镜医师采用单孔加一孔手术治疗高位直肠及乙状结肠癌并联合 ERAS 干预是安全可行的，且单孔加一孔 手术可减低操作难度，具有疼痛轻、术后恢复快等优势，值得临床推广。     

Use of a dual lumen port for automated red cell exchange in adults with sickle cell disease

Red cell exchange (RCE) is a common procedure in adults with sickle cell disease (SCD). Implantable dual lumen Vortex (DLV) ports can be used for RCE in patients with poor peripheral venous access. We performed a retrospective cohort study of RCE procedures performed in adults with SCD. The main objective of the study was to compare the inlet speed, duration of procedures and rate of complications performed through DLV ports to those performed through temporary central venous and peripheral catheters. Twenty‐nine adults with SCD underwent a total of 318 RCE procedures. Twenty adults had DLV ports placed and 218 procedures were performed using DLV ports. Mean length of follow‐up after DLV port placement was 397 ± 263 days. Six DLV ports were removed due to infection and 1 for malfunction after a mean of 171 ± 120 days. Compared to temporary central venous and peripheral catheters, DLV port procedures had a greater rate of procedural complications, a longer duration, and a lower inlet speed (all P < 0.01). When accounting for the maximum allowable inlet speed to avoid citrate toxicity, 40% of DLV port procedures were greater than 10% below maximum speed, compared to 7 and 14% of procedures performed through temporary central venous and peripheral catheters (P < 0.0001). In conclusion, DLV ports can be used for RCE in adults with SCD, albeit with more procedural complications and longer duration. The smaller internal diameter and longer catheter of DLV ports compared to temporary central venous catheters likely accounts for the differences noted. J. Clin. Apheresis 30:353–358, 2015. © 2015 Wiley Periodicals, Inc.     

Transanal endoscopic microsurgery: risk factors for local recurrence of benign rectal adenomas

OBJECTIVE: Transanal endoscopic microsurgery (TEM) is a minimally invasive technique for excision of selected benign and malignant rectal neoplasms. It is considered a safe and effective treatment but recurrence rates of 1-13% are reported for benign lesions. The aim of this study was to assess risk factors for local recurrence of benign rectal lesions and to evaluate mortality and morbidity following TEM. METHOD: Data were prospectively collected from all patients undergoing TEM for benign adenomas from January 1998 to March 2005. The procedure was performed by a single surgeon and patients were regularly followed up. RESULTS: One hundred and forty-six procedures were included, with a median patient age of 74 years (range 22-92 years). The mean lesion area was 16 cm(2) (range 0.3-150 cm(2)) and the median distance from the dentate line was 9 cm (range 0-17 cm). Immediate complications included bleeding (six) and acute urinary retention (six). There has been one (0.68%) procedure-related death. After a median follow up of 39 months (range 4-89 months) there have been seven recurrences (4.8%), recurring at a mean time of 23.3 months (range 5-48 months). Only microscopic involvement of the circumferential resection margin was found to be significantly associated with recurrence (P = 0.0059). Recurrence was not associated with age, size of lesion, previous treatment, severity of dysplasia or use of the harmonic scalpel. CONCLUSION: TEM is a safe and effective treatment for benign rectal adenomas. Circumferential resection margin involvement is associated with recurrence, which tends to occur late. Therefore extended follow up is recommended.     

袖珍式野战静脉麻醉控制器的研制

介绍一种采用单片机开发的按药代动力学参数控制注射泵注射给药,从而控制手术患者静脉麻醉深度,适合野战条件下使用的小型化静脉麻醉系统.该系统具有控制精度高、功能扩展能力强以及使用方便等特点,并已在临床推广应用.     

九洲港货运港区的鼠密度调查、及灭鼠效果观察

本文报道了1995年春对九洲港货运港区的鼠密度和灭鼠效果调查，结果鼠密度投药后(4．1％)比投药前(24．6％)有明显下降，灭鼠率达83．3％；根据九洲港货运港区鼠患情况，提出防鼠灭鼠建议。     

绥芬河公路口岸附近地区鼠类EHF IgG抗体调查报告

目的 了解绥芬河公路口岸附近EHF亚在鼠类中的流行动态。方法 对鼠类进行EHF IgG抗体监测。结果 检测142只、5种鼠类的血样，检出EHF IgG抗体阳性29例，阳性率为20．42％。其中黑线姬鼠的移抗体IgG抗体阳性率较高，为30．95％。结论 EHF宿主是属于多源性动物宿主，而黑线姬鼠是主要贮存宿主和传染源，提示我们要注意防鼠、灭鼠。     

沈阳口岸入出境人员传染病监测工作报告

本文阐述了1990年-1993年间沈阳口岸入境人员传染病监测工作的基本情况，在对6503名归国人员和2146名外籍人员进行传染病监测体检中，发现HIV感染者41人、隐性梅毒患者1人、开放性肺结核患者1人。     

Staged anterior resection and TEM to preserve rectal function in synchronous malignant and benign rectal lesions

BACKGROUND: Traditionally patients with a high rectosigmoid carcinoma and a synchronous large distal rectal adenoma would be treated by low anterior resection with associated loss of rectal function. METHOD: Four patients with a carcinoma of the upper rectum or distal sigmoid colon and a synchronous distal rectal adenoma were treated by high anterior resection followed by staged Transanal Endoscopic Microsurgery (TEM) thus conserving the distal rectum. Preoperative and postoperative rectal function was assessed using the St. Mark's incontinence score. RESULTS: The proximal carcinomas and distal adenomas were 12-18 cms and 0.5-9 cms respectively from the dentate line. The mean surface area of the distal adenomas was 9.7 cms2. There were no deaths or major complications. There were no recurrences after a mean follow-up of 31.5 months. Rectal function was unchanged in three patients with a minor increase in the score in one. CONCLUSION: Staged high anterior resection and 'rEM offers effective treatment of synchronous rectosigmoid carcinoma and distal rectal adenoma with preservation of rectal function.