颅内肿瘤术后延迟性脑脊液漏16例诊疗分析

目的探讨颅内肿瘤术后延迟性脑脊液漏的发病机制和诊疗特点。方法回顾性分析2007年11月至2011年5月16例颅内肿瘤术后延迟性脑脊液漏患者的临床资料。结果 8例经保守治疗治愈,1例好转,7例行手术修补治愈,无手术并发症。结论颅内肿瘤术后延迟性脑脊液漏的主要原因是硬脑膜破口及颅骨缺损。对经过2周保守治疗未愈者,应积极手术治疗。     

Before the onset of interstitial cystitis/bladder pain syndrome,the presence of multiple non-bladder syndromes is strongly associated with a history of multiple surgeries

Objective

Certain functional somatic syndromes (FSSs) such as fibromyalgia and irritable bowel syndrome are accompanied by diffuse pain amplification. Women with interstitial cystitis/bladder pain syndrome (IC/BPS) have numerous FSSs, as well as other non-bladder syndromes (NBSs) that are linked to the FSSs. They also report multiple surgeries. Since pain is a common indication for surgery, we tested the hypothesis that NBSs were associated with surgeries.

Methods

We interviewed 312 incident IC/BPS cases and controls on NBSs and number of surgeries before the index date (for cases, IC/BPS onset date). Poisson and logistic regression analyses adjusted for age, race, educational level, and menopause.

Results

Number of surgeries increased with number of NBSs in both cases and controls whether chronic pelvic pain (CPP), the only NBS generally accepted as an indication for surgery, was present or not. Logistic regression analysis showed that among cases CPP was the only individual NBS associated with a history of multiple surgeries, and then only modestly [odds ratio (OR) 1.9, confidence intervals (CI) 1.06, 3.2]. By far the strongest association was the number of NBSs. The OR for multiple surgeries increased with number of NBSs: for cases with 4–5 NBSs the OR was 14.1 (1.8, 113) and with 6–9 NBSs, 33.1 (3.9, 279). Controls had fewer syndromes and fewer surgeries and this linkage was less prominent.

Conclusion

Among IC/BPS cases, the number of NBSs was strongly correlated with the number of surgeries. Understanding temporal relationships will be necessary to explore causal linkages and may modify surgical practice.     

Outcome of Complex Adult Congenital Heart Surgery in the Developing World

Background. There is scanty information on the outcome of adult congenital heart disease surgery from the developing world. Methods. This was a retrospective chart review of the surgical outcome of 153 adults with congenital heart disease over a 5‐year period. Surgical atrial septal defect closure was considered “simple” while all other surgeries were considered “complex.” Results. There were 102 patients in the “simple” group and 51 in the “complex” group. Only three (2%) patients had prior operations. The “complex” group had longer bypass time and cross clamp time. Intensive care unit stay, ventilation time, and inotrope administration were longer. Major complications were more common and there were two deaths in the “complex” group. Age more than 30 years, cyanosis, and New York Heart Association class more than II were predictors of longer stay in the intensive care unit. Surgical repair of Tetralogy of Fallot in adults tended to have a longer ventilation time and intensive care unit stay with a mortality of 4%. At follow up, all patients were in New York Heart Association class I or II. Improvement of the functional class with negligible adverse events was noted in both groups. Conclusions. A retrospective evaluation of 153 adults with congenital heart disease who underwent open heart surgery at a single center in India showed strikingly fewer reoperations compared with large European studies. There was a similar prevalence of complex lesions. Surgical mortality was low, and long‐term functional outcome was gratifying.     

口内反光镜专用清洗篮筐的制作及应用

目的 针对口内反光镜清洗消毒存在的不足,自行研发口内反光镜专用清洗篮筐,探讨其应用后的清洗消毒效果。方法 选取全新大号口内反光镜480件,随机分成2组,每组各240件,临床上依次使用后统一送消毒供应中心进行机械热力清洗消毒,实验组采用自制的口内反光镜专用清洗篮筐装载清洗消毒,对照组采用普通清洗篮筐装载清洗消毒,比较两组目测清洗合格率、三磷酸腺苷生物荧光阳性率、划痕率、装载量等指标。结果 实验组目测清洗合格率为97.91%,对照组为80.41%,两组比较,差异有统计学意义（χ ²=38.045,P<0.001）。实验组三磷酸腺苷生物荧光测试阳性率为0.84%,对照组为18.75%,两组比较,差异有统计学意义（χ ²=43.611,P<0.001）。第1次清洗消毒后,实验组划痕率为0.42%,对照组为15.00%,两组比较,差异有统计学意义（χ ²=35.813,P<0.001）。第2次清洗消毒后,实验组划痕率仍为0.42%,对照组为26.67%,两组比较,差异有统计学意义（χ ²=70.625,P<0.001）。实验组一次最多可装载120件口内反光镜,对照组一次只能装载9件口内反光镜。结论 在机械热力清洗消毒口内反光镜时采用口内反光镜专用清洗装载篮筐,可以明显提高清洗消毒质量及装载量,同时有效减少划痕。     

口服复方聚乙二醇电解质散进行外科手术前肠道准备的效果观察

目的：探讨在进行外科手术前,口服复方聚乙二醇电解质散在肠道清洁上的效果以及伴随症状。方法：在2012年5月-2014年5月期间收集需要做术前肠道准备的患者,经患者同意后按照肠道清洁的方法不同分为观察组和对照组各30例。观察组口服1000 m L复方聚乙二醇电解质散,对照组采用肥皂水清洁灌肠法。观察并比较两组患者服药后的排便情况、肠道清洁度、有无不良反应以及心理变化。结果：两组均都有良好的肠道清理效果,虽然观察组排便次数明显多于对照组,但是均能达到理想效果。观察组肠道准备中伴随的不良症状少于对照组,排便情况优于对照组,差异有统计学意义（P〈0.05）,紧张恐惧心理比较差异有统计学意义（P〈0.05）。结论：相比之下,在肠道清洁、排便情况上复方聚乙二醇电解质散优于传统的肥皂水清洁灌肠法,而且出现的不良反应也少,是优秀的肠道清洁用药,值得推广。     

护理干预对预防截石位手术中老年患者并发症的影响

目的 探讨护理干预对预防截石位手术中老年患者并发症的影响.方法 对传统截石位和改良截石位的四肢摆放进行比较.选取在我院住院且没有神经和心血管系统疾病的140例截石位手术中老年患者,随机分成对照组和干预组,对照组采用传统截石位,干预组采用改良截石位,将患者双上肢以自身床单固定于身体两侧,术毕头低脚高位,双下肢间隔3 min先后平放,记录体位改变前后血压和心率的变化,对比两种方法对术后并发症的影响.结果 对照组在改变体位后收缩压(SBP)和舒张压(DBP)均明显下降(P＜0.05),心率的变化无统计学意义;干预组与对照组相比,SBP及DBP下降程度明显减少(P＜0.05);对照组压疮的发生率、下肢麻木、肿胀等不良反应明显高于干预组.结论 改良截石位双上肢、下肢的摆放方法可以显著减少血压下降程度,避免上肢外展导致臂丛神经受损,有利于预防中老年人术后并发症的发生.     

腹腔镜经腹腹膜前疝修补日间手术的临床价值分析

背景与目的:腹股沟疝修补术是日间病房最常见的手术之一.随着现代腹股沟疝手术和麻醉技术的发展,越来越多的腹股沟疝手术可以在日间病房完成.然而,对于日间腹股沟疝手术方式及麻醉方式的选择,目前尚无统一标准.腹腔镜经腹腹膜前疝修补术(TAPP)具有创伤小、恢复快、舒适度高、复发率低等优势,目前已经成为临床治疗腹股沟疝的主要方式...