涤痰醒脑承气汤治疗脓毒症脑功能障碍的疗效分析

目的探讨涤痰醒脑承气汤治疗脓毒症脑功能障碍的临床疗效。方法选择我院2012年1月~2013年1月收治的脓毒症脑功能障碍患者120例,随机分为对照组60例,给予常规治疗;观察组60例,在对照组的治疗基础上加用涤痰醒脑承气汤治疗,分析比较两组患者的临床疗效。结果两组患者经治疗后1、3、7天与同组治疗前比较,CRP含量和GOS评分差异均有统计学意义(均P0.05);而且治疗后的CRP含量和GOS评分两组比较差异亦有统计学意义(P0.01)。结论涤痰醒脑承气汤对脓毒症脑功能障碍患者的治疗效果显著,可明显提高预后,促进康复,值得推广。     

针刺治疗竹叶青蛇咬伤局部肿痛临床观察

目的观察针刺疗法对竹叶青蛇咬伤引起局部肿痛的疗效。方法竹叶青蛇咬伤4 h内的患者120例,随机分为两组,均给予常规治疗,治疗组加用针刺疗法。4天后观察两组局部疼痛、肿胀、功能障碍和局部组织坏死的情况并进行比较。结果两组患者的主要症状评分和局部坏死发生率均有显著性差异（P〈0.05）。结论针刺疗法对竹叶青蛇咬伤有显著性疗效。     

压疮局部治疗方法研究进展

<正>压疮(也称压力性溃疡)是指局部组织长期受压,血液循环障碍,组织营养缺乏,致使皮肤失去正常功能而引起组织破损和坏死[1]。压疮是临床常见并发症,与恶病质、持续疼痛、大小便失禁、治疗式病情要求特定体位、高龄、认知及感知障碍、长期卧床患者容易发生。一旦压疮形成,不仅给患者带来了痛苦,且常因久治不愈,给医疗、护理等带来了巨大压力,各国的健康政策与研究机构的调查统计报告均证明了这点[2]。近年来,国内外在压疮的局部治疗方面提出了许多     

上肢骨折后肘关节功能障碍患者的综合康复治疗疗效分析

目的:对上肢骨折后肘关节功能障碍患者的综合康复治疗疗效进行分析。方法:选取我院骨科2013年1月至2014年6月接收的80例患者为本次的研究对象,80例参与研究的人员均为上肢骨折后肘关节功能障碍患者,随机分为观察组和对照组,每组各40例。对照组40例患者进行常规治疗,观察组40例患者进行综合康复治疗。对两组患者的治疗效果进行综合评估。结果:观察组40例患者中36例有效,总有效率为90%,对照组40例患者中26例有效,总有效率为65%。结果显示综合康复治疗效果明显优于常规康复治疗效果。结论:综合康复治疗法能帮助患者尽快痊愈,恢复肘关节功能。     

危型眼镜蛇咬伤致大面积软组织坏死的救治

眼镜蛇咬伤临床上治疗比较困难 ,如治疗不当或延误治疗 ,可致残 ,甚至危及生命。我院近 2年治愈 3 2例眼镜蛇伤病人 ,其中 ,成功救治了 3例危型眼镜蛇咬伤致大面积软组织坏死的病人 ,现报道如下。1　病例介绍　　病例 1 :患者 ,男 ,5 3岁 ,农场工人 ,在田间劳动时被眼镜蛇咬伤左足背 ,蛇被打死 ,证实为眼镜蛇。受伤后被送到个体诊所治疗 ,内服外敷草药 ,病情未控制 ,左足背皮肤及左小腿中段皮肤瘀黑 ,肿胀明显 ,并逐渐坏死溃烂 ,伤后 5 6 h送到本院急诊入院。入院时患者脸色苍白 ,心慌、头晕 ,查体 :体温 3 8.2℃ ,脉搏 5 2次 /分 ,呼吸 3 6…     

中华眼镜蛇咬伤致组织肿胀坏死的中西医结合治疗研究

目的探讨桂中桂北蛇伤基地自主研发的蛇伤灵内服Ⅰ方、外敷Ⅱ方联合早期程序化综合治疗方法对中华眼镜蛇咬伤患者的局部组织坏死与肢体肿胀的临床治疗效果及机制。方法制定蛇伤皮肤组织坏死相关的客观临床评分标准,将纳入研究的60例患者随机分为蛇伤灵方联合早期程序化综合治疗组和早期程序化综合治疗对照组,每组各30例,观察比较两组患者在皮肤组织坏死积分及患肢肿胀程度方面的临床效果。结果治疗组患者的皮肤组织坏死积分与患肢肿胀程度明显低于对照组,组间比较差异具有显著性统计学意义(P0.05)。结论中西医结合治疗方法具有优越性,蛇伤灵方联合早期程序化综合治疗对中华眼镜蛇咬伤所致肢体肿胀、组织坏死程度的效果优于早期程序化综合治疗方法。     

VSD负压引流技术结合游离植皮治疗大面积皮肤缺损的 临床疗效研究

目的：研究VSD负压引流技术结合游离植皮治疗大面积皮肤缺损临床疗效。方法：选择2012年4月至2013年10月入我院接受治疗的大面积皮肤缺损患者65例,将其随机分为观察组（35例）与对照组（30例）。观察组患者术前先采用VSD治疗,游离植皮术后继续给予VSD治疗;对照组患者采取打压植皮或传统打包加压治疗。观察和比较两组患者的皮片成活时间、皮片成活率、术后住院治疗时间、换药次数、疼痛评分及家属满意度。结果：观察组患者的皮片成活时间短于对照组、皮片成活率高于对照组、住院时间短于对照组,换药次数少于对照组,两组之间的差异具有统计学意义（P〈0．05）。此外,观察组患者的疼痛视觉模拟评分明显低于对照组,患者家属的满意度评分明显高于对照组,差异具有统计学意义（P〈0．05）。结论：相对于传统的打压植皮或传统打包加压的技术而言,VSD负压引流技术结合游离植皮在治疗大面积皮肤缺损的临床疗效更好,值得在临床上推广使用。     

针刺联合黄连温胆汤治疗脑卒中后轻度认知功能障碍的临床疗效研究

目的:探讨针刺联合黄连温胆汤治疗脑卒中后轻度认知功能障碍的临床疗效。方法:选择2013年6月至2016年8月在我院进行治疗的脑卒中后轻度认知功能障碍患者100例,随机分为两组,每组50例。对照组患者服用尼莫地平,观察组患者在对照组基础上服用黄连温胆汤并配合针刺治疗。评价和比较两组患者治疗前后的简易精神状态量表(MMSE)以及改良爱丁堡-斯堪的纳维亚神经功能缺损评分量表(MSSS)评分,治疗后神经功能障碍和认知功能障碍的临床疗效及生活质量。结果:治疗后,两组患者的MMSE、ADL评分均较治疗前显著降低(P0.05),且观察组降低的程度显著高于对照组(P0.05);两组患者的MSSS、MBI评分显著升高(P0.05),且观察组升高程度显著高于对照组(P0.05)。观察组患者经治疗后的认知功能障碍及神经功能障碍临床疗效的总有效率均显著高于对照组(P0.05)。结论:黄连温胆汤联合针刺用于治疗脑卒中后轻度认知功能障碍临床疗效显著,且可显著改善患者生活质量。     

脑出血早期康复的临床疗效观察

目的:探讨早期康复治疗对急性脑出血患者偏瘫功能恢复的作用.方法:将186例急性脑出血患者随机分成康复组93例,对照组93例,两组均常规使用内科药物治疗.康复组加以早期康复治疗,比较患者治疗前和治疗1月后的Barthel指数和简式Fugl-Meyer评价法评分.结果:两组治疗前Fugl-Meyer值及Barthel指数测评差异有统计学意义(P＞0.01(,两组治疗1月后Fugl-Meyer值及Barthel指数测评康复组与对照组比较有统计学意义(P＜0.001).结论:早期康复训练对急性脑出血惠肢运动功能恢复和日常生活活动能力具有促进作用,可明显降低患者运动功能障碍程度.     

长期卧床患者的压疮预防及处理措施

压疮是由于患者长期卧床,软组织长期受压,导致组织细胞血液循环障碍,缺血缺氧、坏死而引起皮肤缺损。是临床常见并发症,也是临床护理的一大难题。压疮可使患者病情加重,继发感染,甚至危害患者的生命。现将我科对长期卧床患者的压疮预防及处理措施介绍如下。     

Primary closure of radial forearm flap donor defects with a bilobed flap based on the fasciocutaneous perforator of the ulnar artery

To primarily repair a series of radial forearm flap donor defects, a total of 10 bilobed flaps based on the fasciocutaneous perforator of the ulnar artery were designed at the Chang Gung Memorial Hospital in Kaohsiung in the period from January of 2002 to January of 2003. All patients were male, with ages ranging from 36 to 67 years. The forearm donor defects ranged in size from 5 x 6 cm to 8 x 8 cm, with the average defect being 47 cm. One to three sizable perforators from the ulnar artery were consistently observed in the distal forearm and were most frequently located 8 cm proximal to the pisiform, which could be used as a pivot point for the bilobed flap. The bilobed flap consisted of two lobes, one large lobe and one small lobe. With elevation and rotation of the bilobed flap, the large lobe of the flap was used to repair the radial forearm donor defect and the small lobe was used to close the resultant defect from the large lobe. All bilobed flaps survived completely, without major complications, and no skin grafting was necessary. Compared with conventional methods for reconstruction of radial forearm donor defects, such as split-thickness skin grafting, the major advantage of this technique is its ability to reconstruct the donor defect with adjacent tissue in a one-stage operation. Forearm donor-site morbidity can be minimized with earlier hand motion, and better cosmetic results can be obtained. Furthermore, because a skin graft is not used, no additional donor area is necessary. However, this flap is suitable for closure of only small or medium-size donor defects. A lengthy postoperative scar is its major disadvantage.     

游离皮瓣在晚期颅底肿瘤术后组织缺损中应用效果分析

目的:探讨使用游离皮瓣修复晚期颅底肿瘤术后缺损组织的效果及适应症。方法:选择2009年1月至2013年9月在我院行晚期颅底肿瘤术并且需要进行组织修复的病患74例作为研究对象。根据病患选择的修复方式分为观察组和对照组各37例。观察组采用游离皮瓣,而对照组使用钛网修复。观察两组相应指标,比较不同修复材料的修复效果。结果:观察组手术效果显效率和总有效率为40.54%(15/37)、97.30%(36/37),显著高于对照组,差异有统计学意义(P0.05)。观察组在术中出血量、手术时间以及术后愈合时间等方面均优于对照组,差异有统计学意义(P0.05)。观察组术后出现颅内感染、脑脊液漏和皮瓣坏死比率为8.11%(3/37)、0(0/37)和2.70%(1/37)都少于对照组,差异有统计学意义(P0.05)。结论:采用前臂皮瓣进行晚期颅底肿瘤术后缺损组织修复效果更好,皮瓣存活率更高。比传统钛网修复引起的并发症更少,值得临床推荐使用。     

Management of the hairline using a local flap in total reconstruction for microtia

In cases of microtia with a low hairline, the manner in which hair is removed from the reconstructed auricle must be taken into consideration. This is one of the most common but difficult problems with reconstruction for microtia. The authors describe a new technique that uses a simple regional flap to resolve this problem. The hair-bearing skin in the estimated auricular region and its covering are removed using a local flap from the hairless mastoid region. This is done in the first stage of auricular reconstruction, the costal cartilage grafting is done in the second stage, and elevation of the auricle is done in the last stage. In 38 auricles of 36 patients who were treated from 1993 to 1995, eight auricles of eight patients were treated with this technique. In all cases, the hairless flap healed well, without vascular stasis or skin necrosis. In addition, no complications from using this technique occurred in the later stages of auricular reconstruction. With this technique, the skin of the flap provides a good texture and color match to the auricle. In addition, the skin of the flap has good elasticity for the cutaneous pocket for cartilage grafting. The harvested area of the flap can be hidden behind the reconstructed auricle. The authors initially wondered whether the marginal scar of the transposed flap's position in the auricle would be conspicuous. However, all of the scar became inconspicuous because it was positioned in the scaphoid fossa.     

The prepuce free flap in 10 patients: modifications in flap design and surgical technique

The prepuce free flap was used in 10 oral and oropharyngeal reconstructions. During the course of this study, various modifications took place. Residual penile skin necrosis and skin island necrosis early in the series led to modification of flap design. This solved the donor-site problem by placing the skin island more proximally, to consist of the outer layer of the prepuce and an equidimensional area of penile skin proximal to the prepuce. Identification of the vascular pedicle was greatly facilitated by changing to retrograde dissection, making skin incision in the mons veneris superfluous. Incongruence between donor and recipient artery, together with microsurgical arrogance, resulted in (resolvable) inflow problems in four patients. One flap was lost. After modification, marginal necrosis still occurred in one flap, most likely because of an episode of venous congestion. Although much care was taken to not harvest more skin than in a regular circumcision, penile skin shortage, especially during erection, appeared to be the major long-term shortcoming of this flap. Flap thinness and pliability, both expected strongholds of the flap, were evident during flap inset, but less apparent during follow-up because of postoperative radiotherapy in the majority of the cases. The best indications for this flap include defects in the tonsillar area extending into the soft palate, tongue, lateral oropharynx, retromolar trigonum, gums, and vallecula.     

Sequential vascularized iliac bone graft and a superficial circumflex iliac artery perforator flap with a single source vessel for established mandibular defects

The major problems in dealing with established mandibular loss are severe soft-tissue contracture and a limited number of recipient vessels. The skin portion of the iliac osteocutaneous flap often necrotizes in cases without perforators of the deep circumflex iliac vessel. To overcome these problems, eight patients with established mandibular loss and no skin perforators of the deep circumflex iliac vessel were treated with a sequential vascularized iliac bone graft and a superficial circumflex iliac perforator flap with a single recipient vessel. Regarding the recipient vessels, the ipsilateral cervical vessels were used for four patients, and the contralateral facial and ipsilateral superficial temporal vessels were used for two cases each. The superficial circumflex iliac perforator flaps were 7 to 28 cm in length and 3 to 15 cm in width. The iliac bone grafts ranged from 7 to 13 cm in length, and three cases were repaired with the inner cortex of the iliac bone. There were no serious complications, such as flap necrosis or bone infection and resulting absorption. The advantages of this method are that both pedicles are very close to each other and of suitable diameter for anastomosis. Simultaneous flap elevation and preparation for the recipient site is possible. The skin flap and vascularized bone graft can be obtained from the same donor site. A single source vessel can nourish both the large skin area and bone sequentially. Longer dissection of the superficial circumflex iliac system to the proximal femoral division is unnecessary. A large flap can survive with a short segment of the superficial circumflex iliac system. Only the vascularized inner cortex of the iliac bone needs to be used, and the outer iliac cortex can be preserved, which results in less morbidity at the donor site.     

From the "charretera" to the supraclavicular fascial island flap: revisitation and further evolution of a controversial flap

Wide tissue defects located on the face and neck area often require distant flaps or free flaps to achieve a tension-free reconstruction together with an acceptable aesthetic result. The supraclavicular island flap surely represents a versatile and useful flap that can be used in case of large tissue losses. Because of its wide arc of rotation, which ensures a 180-degree mobilization anteriorly and posteriorly, the flap can reach distant sites when harvested as a pure island flap. The main vascular supply of the flap, the supraclavicular artery, a branch of the transverse cervical artery or, less frequently, of the suprascapular artery, though reliable, is not a very large vessel. In some particular cases, when too much tension or angles that are too tight are present, the vascular supply of the flap can be difficult and special care must be taken to avoid flap failure. To avoid this problem, the authors started harvesting the flap not as a pure island flap but with a fascial pedicle, thin and resistant, which ensures good reliability; also, when a higher tension rate is present, it avoids the risk of excessive traction or kinking of the vessels. Twenty-five consecutive patients with various defects located on the head, neck, and thorax area were treated in the past 2 years using the modified supraclavicular island flap. There was no flap loss or distant necrosis of the flap, and there was marginal skin deepithelialization in only two cases, which only required minor surgery. Postoperative morbidity was low, similar to the classic supraclavicular island flap, with primarily closed donor sites, except for one case, and tension-free scars. The authors show how the modified supraclavicular island flap is a reliable and safe flap that gives a good aesthetic result with low risk concerning the viability of the transferred skin. The technique, similar to supraclavicular island flap harvesting, is easy to perform and is attractive in patients at risk for poor or delayed healing such as smokers or patients with complex medical histories.     

子宫切除术后患者生活质量的变化及家庭关怀度的影响因素分析

摘要 目的：探讨子宫切除术后患者生活质量的变化及家庭关怀度的影响因素。方法：选取2017年1月~2020年1月期间在我院行子宫切除术的158例患者为研究对象,采用生活质量评价量表（SF-36）、家庭关怀度指数问卷（APGAR）对子宫切除术后患者的生活质量、家庭关怀度进行评估。根据患者的APGAR评分分为家庭功能良好组（123例）和家庭功能障碍组（35例）,采用多因素Logistic回归分析子宫切除术后患者家庭关怀度的影响因素。结果：158例子宫切除术后患者的SF-36中得分最高的维度为生理功能（PF）（88.97±9.28）分,最低为心理健康（MH）（62.39±7.93）分,而术前评分中最高为PF（90.89±8.97）分,最低为MH（74.83±8.87）分,术后患者的MH评分有显著下降（P<0.05）。158例患者APGAR总得分为（7.37±2.32）分,其中家庭功能良好（7~10分）患者123例、中度障碍（4~6分）28例、重度障碍（0~3分）7例。经单因素分析显示：两组患者年龄、手术切除方式、原发疾病类型、居住地、文化程度对比无统计学差异（P>0.05）,而两组在切除时长、家庭年收入、婚姻状况、家庭关系方面对比有统计学差异（P<0.05）。经多因素Logistic回归分析显示：切除时长、婚姻状况、家庭关系及家庭年收入均是子宫切除术后患者家庭关怀度的影响因素。结论：子宫切除术后患者生活质量及家庭关怀度均处于中等水平。其家庭关怀度受多种因素的影响,临床中应结合患者实际情况和其可能存在的相关因素进行适当干预,以减少家庭功能障碍的发生风险。     

Decolonisation of MRSA, S. aureus and E. coli by cold-atmospheric plasma using a porcine skin model in vitro

In the last twenty years new antibacterial agents approved by the U.S. FDA decreased whereas in parallel the resistance situation of multi-resistant bacteria increased. Thus, community and nosocomial acquired infections of resistant bacteria led to a decrease in the efficacy of standard therapy, prolonging treatment time and increasing healthcare costs. Therefore, the aim of this work was to demonstrate the applicability of cold atmospheric plasma for decolonisation of Gram-positive (Methicillin-resistant Staphylococcus aureus (MRSA), Methicillin-sensitive Staphylococcus aureus) and Gram-negative bacteria (E. coli) using an ex vivo pig skin model. Freshly excised skin samples were taken from six month old female pigs (breed: Pietrain). After application of pure bacteria on the surface of the explants these were treated with cold atmospheric plasma for up to 15 min. Two different plasma devices were evaluated. A decolonisation efficacy of 3 log(10) steps was achieved already after 6 min of plasma treatment. Longer plasma treatment times achieved a killing rate of 5 log(10) steps independently from the applied bacteria strains. Histological evaluations of untreated and treated skin areas upon cold atmospheric plasma treatment within 24 h showed no morphological changes as well as no significant degree of necrosis or apoptosis determined by the TUNEL-assay indicating that the porcine skin is still vital. This study demonstrates for the first time that cold atmospheric plasma is able to very efficiently kill bacteria applied to an intact skin surface using an ex vivo porcine skin model. The results emphasize the potential of cold atmospheric plasma as a new possible treatment option for decolonisation of human skin from bacteria in patients in the future without harming the surrounding tissue.     

The evaluation of skin disinfection efficacy and its influence on prevalence of surgical site infections in patients subjected to laparoscopic cholecystectomy

Laparoscopic cholecystectomy (LC) is "the method of choice" in the treatment of cholelithiasis and its' complications. LC is not devoid of complications, among others, surgical site infection (SSI) but as a result of minimalisation of surgical trauma and immunosuppression after surgery, percentage of SSI is lower than after conventional cholecystectomy. Skin disinfection carried out before operation is thought to minimalise risk of infective complications after LC. 150 patients who had laparoscopic cholecystectomy carried out, were included in prospective study. Efficacy of skin disinfection was based on microbiological assessment including swabs from the umbiliculus before and after skin disinfection, and samples of exsudate or discharge from surgical site (if any). There were 133 (88.6%) patients with positive result of the umbilical swab before the disinfection of the skin, whereas 26 (17.3%) patients had bacteria isolated from the umbilical swab after the disinfection. Among these 26 patients in 19 (73.1%) cases the same species of bacteria were isolated before and after skin disinfection. Among 19 patients with inefficient skin dissinfection in 2 cases we observed SSI. In one of them the same strains of bacteria were isolated from umbilical swab and surgical site. Analysis of drug sensitivity of these isolates showed strict correlation. There were 16 cases of SSI in the whole group and it's rate was 10,6%. Skin disinfection before LC is not fully efficient. Inefficiency of skin disinfection does not increase risk of SSI. Skin dissinfection reduce microbial flora but does not protect from SSI provoked by these microbials.