目的 观察免冲洗护理清洁液用于重症患者基础护理洗发和擦浴的临床效果。 方法 2012年6月－12月随机选取100 例重症监护患者，应用免冲洗护理清洁液洗发和擦浴，观察患者洗发、擦浴前后清洁情况、生命体征、感观及不良反应，并作微生物检测。 结果 免冲洗护理清洁液清洁效果优良率100%，清洗前细菌数（731.35 ± 49.23）cfu/cm2，清洗后细菌数（7.87 ± 0.39）cfu/cm2，细菌检测下降幅度为99.01%。 结论 免冲洗护理清洁液使用简便、安全，适宜卧床重症患者洁身之用，可在临床推广应用。
Objective To investigate the cl inical outcomes of one stage debridement and closed-suction drainage for treatment of infection after lumbar instrumentation. Methods Between June 2002 and March 2008, 12 patients with infection after lumbar instrumentation were treated with one stage debridement and closed-suction drainage, including 9 males and 3females and aging 35-68 years (48.5 years on average). The disease duration varied from 7 days to 183 days (56 days on average). The segments of internal fixation included 7 cases single segment at levels of L4, 5, 4 cases of double segments at levels of L 4, 5, L5, S1 (2 cases), and L3, 4, L4, 5 (2 cases), and 1 case of three segments at levels of L3, 4, L4, 5, L5, S1. Two patients were treated with internal fixator removal. Results The bacterial culture results of intervertebral discs were positive in 8 cases for Staphylococcus aureus and in 3 cases for Enterobacter cloacae, negative in 1 case. Primary healing of incisions were achieved in all cases. Twelve patients were followed up 18-53 months (34.7 months on average). The white blood cell count, erythrocyte sedimentation rate, and C reactive protein significantly decreased after operation, showing significant differences at 15 days after operation when compared with those before operation (P lt; 0.05). No obvious low back pain was observed. Pathological-changed vertebra-space fused. No displacement and breakage of internal fixator occurred; in 2 patients who were given internal fixator removal, no removal of the instrumentation was performed again. The X-ray films showed that the average kyphosis decreased 0.8° at 18 months after operation. At last follow-up, the visual analogue scale score was 2 ± 1, showing significant difference (P lt; 0.05) when compared with that (10 ± 2) before operation. Conclusion One stage debridement and closed-suction drainage therapy is an effective method for treating infection after lumbar instrumentation. The operation is easy and can reduce hospitalization days.
ObjectiveTo compare the efficacy of different concentrations of saline irrigation in treatment of chronic rhinosinusitis by network meta-analysis. MethodsThe CNKI, WanFang Data, CBM, VIP, Embase, PubMed and Cochrane Library databases were electronically searched to collect randomized controlled trials on different concentrations of saline irrigation in treatment of chronic rhinosinusitis from inception to March 1, 2024. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. The network meta-analysis was performed by using RevMan 5.4 and Stata 17.0 software. ResultsIn total, 935 patients were enrolled in 15 study. The results of network meta-analysis showed that visual analogue scale sore, nasal mucosal ciliary transport rate and Lund-Kennedy sore of hypertonic saline irrigation group were superior to isotonic saline irrigation group. 2.5% hypertonic saline irrigation had best efficacy in terms of visual analogue scale sore, while 3% hypertonic saline irrigation had best efficacy in terms of mucosal ciliary transport rate and 3.5% hypertonic saline irrigation had best efficacy in terms of Lund-Kennedy sore. ConclusionCurrent evidence indicates that hypertonic saline irrigation has more advantages in terms of clinical efficacy rate, visual analogue scale sore, nasal mucosal ciliary transport rate and Lund-Kennedy sore, while 2.5% hypertonic saline irrigation has more advantages in terms of balancing efficacy and acceptability. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
ObjectiveTo explore the clinical efficacy and application significance of continuous irrigation and drainage for intestinal fistula combined with abdominal infection.MethodsClinical data of 62 patients with intestinafistula combined with abdominal infection admitted by Department of General Surgery of The 940th Hospital of The People’s Liberation Army Joint Service Support Force from March 2012 to March 2017 were retrospectively analyzed. All patients were treated with continuous abdominal flushing and drainage after emergency surgery. The duration of peritoneal flushing, antibiotic use, blood picture recovery, fistula healing, and total hospitalization were summarized.ResultsAll 62 patients were treated successfully without death or septic shock. Among them, 49 cases of intestinal fistula were treated with continuous abdominal flushing and drainage, and 13 cases of intestinal fistula were treated by continuous flushing and drainage of the abdominal cavity. There were 6 cases of abdominal abscess, 5 cases of incision infection, 5 cases of pleural effusion, and 2 cases of pulmonary infection after surgery. The continuous abdominal cavity washing time was (45±21) d, antibiotic use time was (14±7) d, blood image recovery time was (16±8) d, the healing time of fistula was (47±24) d, total length of hospital stay was (56±27) d.ConclusionsFor intestinal fistula combined with abdominal cavity infection, peritoneal continuous flushing and drainage is related with curative effect, high cure rate, fewer complications, simple washing equipment, simple technology, lower cost, and convenient nursing, which can create a good condition for the complexity or refractory patients with intestinal fistula, and has a high clinical application significance.
Objective To investigate the effects of normal saline flushing and its frequency on extracorporeal circuit lifespan and solute removal in continuous renal replacement therapy (CRRT) without anticoagulation. Methods Patients undergoing continuous veno-venous hemodiafiltration (CVVHDF) without anticoagulation between June and September 2021 were prospectively collected. The patients were randomly divided into three groups by envelope method, namely 30 min-flushing group (flushing every 30 minutes for extracorporeal circulation), 2 h-flushing group (flushing every 2 hours for extracorporeal circulation), and non-flushing group (no flushing for extracorporeal circulation during treatment). All patients were treated with Prismaflex V8.0 CRRT machine and matched AN69ST-ST150 extracorporeal circuit, through either femoral or internal jugular venous double-lumen catheter. CVVHDF was adopted, the blood pump rate was 200 mL/min, and the rates of replacement fluid and dialysate were both 1 000 mL/h. The replacement fluid was pre-post dilution. Extracorporeal circuit lifespan, treatment time delayed by flushing, overall treatment time of CRRT, actual treatment time of CRRT, proportion of actual treatment time achieved, delayed daily treatment time, and small molecule solute removal efficiency before and after treatment were recorded. Results A total of 83 patients were included, including 24 in the 30 min-flushing group, 30 in the 2 h-flushing group, and 29 in the non-flushing group. There were significant differences in the indexes of extracorporeal circuit lifespan and various treatment time indicators among the three groups (P<0.05). Compared with the 2 h-flushing group and the non-flushing group, the 30 min-flushing group significantly shortened the extracorporeal circuit lifespan, delayed more treatment time by flushing, and delayed the longest daily treatment time (P<0.05). The proportion of actual treatment time in the non-flushing group was significantly higher than that in the 30 min-flushing group and the 2 h-flushing group (P<0.05), and in the 2 h-flushing group was also higher than that in the 30 min-flushing group (P<0.05). There was no significant difference in the blood urea nitrogen clearance rate among the three groups (P=0.570), but the serum creatinine clearance rate was significantly different among the three groups (P=0.020). Compared with the 30 min-flushing group, the 2 h-flushing group had a higher serum creatinine clearance rate, and there was statistical significance (P<0.05). Twenty-five patients had hypotension during treatment. The frequency of 30 min-flushing caused a higher risk of coagulation during cardiopulmonary bypass (hazard ratio=2.502, P=0.001). Conclusion For CVVHDF without anticoagulation, longer extracorporeal circuit lifespan and longer effective treatment time can be achieved without using normal saline flush.
ObjectiveTo investigate the effects of intermittent irrigation of insulin solution combined with continuous drainage of vacuum sealing drainage (VSD) in chronic diabetic lower limb ulcers. MethodsBetween January 2012 and December 2014, 45 patients with diabetic lower limb ulcer were treated with VSD (group A, n=15), with VSD combining irrigation of normal saline (group B, n=15), and with VSD combining irrigation of insulin solution (group C, n=15) after debridement. There was no significant difference in gender, age, course of ulcers, area and depth of wound, glycosylated hemoglobin, and Wagner grade among 3 groups (P>0.05), and the data were comparable. The levels of fasting blood glucose, 2-hour postprandial blood glucose, and random blood glucose were determined everyday during treatment. The contents of insulin growth factor 1 (IGF-1), tumor growth factor α (TNF-α), and nitric oxide (NO) in necrotic tissue after drainage were determined. The coverage rate and thickness of granulation tissue and clearance rate of bacteria in wound were calculated, the granulation tissue in the center of the wound was harvested for pathological observation with HE staining after 6 days of treatment. The second stage operation was performed according to the condition of wounds, and the time to the second stage operation and the method of the second stage operation were recorded and the survival rate of grafted skin or flap was calculated. ResultsThe pathological staining showed that there were a few new microvessels and fibroblasts in group A after treatment;more new microvessels and fibroblasts were observed in group B;and many new microvessels and fibroblasts were found in group C. There was no significant difference in levels of fasting blood glucose, 2-hour postprandial blood glucose, and random blood glucose among 3 groups during treatment (P>0.05). The coverage rate and thickness of granulation tissue and clearance rate of bacteria in group C were significantly higher than those in groups A and B after treatment (P<0.05). The contents of IGF-1 and NO were significantly increased and TNF-α was significantly decreased in group C when compared with those in group A (P<0.05). Compared with group B, IGF-1 and NO contents were significantly increased at 3-6 days and at 2-6 days respectively, and TNF-α content was significantly decreased at 3-6 days in group C (P<0.05). The method of the second stage operation showed no significant difference among 3 groups (χ2=2.920, P=0.230), but the time to the second stage operation in group C was significantly shorter than that in groups A and B (P<0.05), and the survival rate of grafted skin or flap in group C was significantly higher than that in groups A and B (P<0.05). ConclusionThe treatment of diabetic lower limb ulcers with intermittent irrigation of insulin solution combined with continuous drainage of VSD can reduce inflammatory reaction effectively, promote development of granulation tissue, improve recovery function of tissue, increase the rate and speed of wound healing obviously, but it has no effect on blood glucose levels.
目的 探讨自制封闭式负压引流冲洗治疗四肢难愈性创面的护理要点。 方法 对2011年8月－2012年9月收治的38例使用自制封闭式负压引流冲洗+Ⅰ期植皮修复四肢难愈性创面的患者进行护理观察。 结果 34例四肢难愈性创面Ⅰ期成功修复创面，减轻了患者住院期间痛苦，缩短患者治疗时间，住院费用明显下降，4例创面因感染植皮大部分融解，经2次冲洗引流，培养肉芽后再植皮痊愈，无护理并发症发生。 结论 术后患者维持在适应的体位、间歇式冲洗，持续恒定的负压吸引、密切的护理观察和引流管的管理是护理的关键环节。