ObjectiveTo analyze epidemic characteristics of multidrug-resistant organism (MDRO) in Neurosurgical Intensive Care Unit (NSICU), and to analyze the status of infection and colonization, in order to provide reference for constituting intervention measures. MethodsPatients who stayed in NSICU during January 2014 to April 2015 were actively monitored for the MDRO situation. ResultsA total of 218 MDRO pathogens were isolated from 159 patients, and 42 cases were healthcare-associated infections (HAI) among 159 patients. The Acinetobacter baumannii was the most common one in the isolated acinetobacter. Colonization rate was positively correlated with the incidence of HAI. From January to December, there was a significantly increase in the colonization rate, but not in the incidence of HAI. ConclusionThe main MDRO situation is colonization in NSICU. The obvious seasonal variation makes the HAI risk at different levels. So it is necessary that full-time and part-time HAI control staff be on alert, issue timely risk warning, and strengthen risk management. The Acinetobacter baumannii has become the number one target for HAI prevention and control in NSICU, so their apparent seasonal distribution is worthy of more attention, and strict implementation of HAI prevention and control measures should be carried out.
ObjectiveTo explore the effect of the cluster intervention in new nurses in the Department of Neurosurgery in occupation training, so as to provide reference for the clinical training of new nurses. MethodsEight nurses who entered the Department of Neurosurgery in January 2013 were set as control group and the 8 new nurses entering in January 2014 as the observation group. The control group was adopted the traditional training methods, while the observation group underwent used extra cluster intervention. The differences in the results of theory, technology, operation and the 360-degree evaluation between the two groups were analyzed at the end of year. ResultsIn the observation group, the median theory examination score was 91.50, median operation assessment grades was 95.00, which were higher than those in the control group (82.00 and 83.00). The average scores of 360-degree evaluation in the observation group were higher than those in the control group with a significant difference (P < 0.01). ConclusionsIntensive intervention should be used for new nurses' training. It helps to improve the training effect and new nurses' ability.
【摘要】 目的 分析手术治疗垂体瘤患者长期临床恢复以及生活质量改善情况。 方法 回顾性分析2007年12月-2008年9月手术治疗的103例垂体瘤患者术前以及术后长期随访资料，使用SF-36量表对术前、术后患者生活质量进行评估，分析手术治疗前后患者症状、激素水平恢复情况以及生活质量改善情况，并进一步分析肿瘤大小、侵袭程度对术后生活质量的影响。 结果 术后头痛症状消失52例，视力改善76例，其他症状具有不同程度改善；术后SF-36生活质量评估结果显示，患者除精神健康外的7个维度（生理机能、生理职能、躯体疼痛、一般健康状况、精力、社会功能、情感职能）均有明显改善（P＜0.05），不同肿瘤大小及侵袭程度的患者术后生活质量评分均无统计学意义（P＞0.05），垂体功能完全恢复者生活质量评分高于垂体功能低下者（P＜0.05）。 结论 显微手术治疗垂体瘤患者可明显改善患者的一般症状、提高患者的生活质量，单纯肿瘤的大小和侵袭程度对术后生活质量的影响程度较小，术后垂体功能的恢复程度明显影响患者的生活质量，垂体瘤术后患者的激素长期替代治疗尚需进一步加强。【Abstract】 Objective To analyze the long-term clinical recovery and quality of life (QoL) in patients with pituitary adenoma treated by microneurosurgery. Methods The clinical data of 103 patients undergoing microneurosurgery from December 2007 to September 2008 were retrospectively analyzed, health-related questionnairs (SF-36) were used to assess the QoL. The post-surgery recovery of symptoms, endocrine function, and QoL were compared with those of pre-surgery, then the correlation between tumor size, invasive behavior, and QoL were analyzed. Results Headache disappeared in 52 patients. Visual symptoms improved in 76 patients. Other symptoms were also improved. Seven concepts (physical functioning, role physical, bodily pain, general health, vitality, social functioning, role emotioning) were improved after surgery (Plt;0.05). The eight health concepts of SF-36 showed no significant difference between patients with different tumor size and invasive behavior (Pgt;0.05). Differences were considered statistically significant between normal and abnormal pituitary function groups after surgery(Plt;0.05) in all concepts. Conclusion Microneurosurgical treatment can improve the general symptoms and the QoL. The tumor size and invasion have little influence on the QoL after surgery, but the improvement of hormone deficiency has influence on the QoL significantly. More attention should be given to the long-term hormone replacement therapy after the pituitary adenoma surgery.
目的 探讨幕上手术后远隔幕下部位出血的临床特点、发病原因、影像学表现及相关干预结果。 方法 分析2009年1月－2011年1月2例经幕上手术后出现远隔幕下部位出血的病例的临床资料。1例患者因颅内动脉瘤经翼点入路行动脉瘤夹闭术，术后出现远隔幕下部位出血；1例患者因硬膜下血肿行钻孔引流术，术后出现远隔幕下部位出血。 结果 2例幕上手术患者均在术中或（和）术后大量引流脑脊液，术后发生出血部位均位于远隔幕下,均行积极手术干预，恢复良好，格拉斯预后评分均为4分。 结论 过度引流可能为引起幕上手术后形成远隔幕下部位出血的主要原因，术前、术中、术后应给予高度重视，并通过少量间断引流脑脊液可以尽量避免发生。
In recent years, the system of standardized resident training has been set up and improved gradually in our country.However, the medical specialist training system for neurosurgeons is still at the stage of exploration.It is important to cultivate and select the best neurologic surgery specialists in China.Mayo Clinic is one of the best teaching hospitals in the United States, which has been ranking the second in the United States for the recent 20 years.Analyzing the neurologic surgery specialist training program of the world's top hospital and learning from its advanced experiences are beneficial for the establishment of medical specialist training system and the production of the highest caliber neurosurgeons in the Department of Neurosurgery in West China Hospital of Sichuan University.The Department of Neurosurgery in West China Hospital of Sichuan University is advantageous in its advanced technology and equipment, sufficient operations, rich teaching resources and independent laboratories.Our goal is to establish strict accessing, management and assessment system, perfecting security and feedback system, focusing on the cultivation of humanistic spirit, building neurosurgery specialist personnel, and establishing a unique brand of West China in the field of teaching.
Objective To systematically review the clinical effectiveness and safety of sufentanil-propofol versus remifentanil-propofol during total intravenous anesthesia for neurosurgery. Methods Databases including The Cochrane Library (Issue 3, 2013), the database of the Cochrane Anesthesia Group, MEDLINE, EMbase, PubMed, Ovid, Springer, CNKI, VIP and WanFang Data were electronically searched from inception to May 2013 for the randomized controlled trials (RCTs) of sufentanil-propofol versus remifentanil-propofol during total intravenous anesthesia for neurosurgery. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the quality of included studies. Then, meta-analysis was performed using RevMan 5.1 software. Results Thirteen trials involving 647 patients were finally included. The results of meta-analysis showed that: a) for hemodynamic changes, MAP decreased in the remifentanil-propofol group after induction and decreased 5 minutes after intubation, but no significant difference was found between the two groups; the two groups were alike in MAP changes during craniotomy and extubation, and in HR changes after induction, 5 minutes after intubation, during craniotomy and extubation, with no significant difference. b) The result of intra-operative wake-up test showed that, there was no significant difference in the sedative effect and the time of awaking between the two groups. c) For emergence time and extubation time, compared with the sufentanil-propofol group, emergence time and extubation time were significantly shorter than those in the remifentanil-propofol group. d) For side effects, there was no significant difference in side effects (such as post-operative nausea, vomiting, respiratory depression, restlessness, chills and hypotension) between the two groups. And e) for post-operative pain, compared with the remifentanil-propofol group, post-operative 1-h and 2-h VAS were lower and the number of who need additional analgesic drugs within 24 h after operation was less in the sufentanil-propofol group, with significant differences. Both groups used the similar dosage of propofol with no significant difference. Conclusion Compared with the remifentanil-propofol group, hemodynamics changes in the sufentanil-propofol group is steadier after induction and during intubation. Patients in the sufentanil-propofol group are better in postoperative awakening quality. But they are alike in the incidence of side effects and propofol dosage.
目的 总结神经外科复杂脑脊髓血管病杂交手术的护理配合经验。 方法 回顾分析2011 年4 月－2012 年5月华西医院手术室完成的 56例神经外科杂交手术的临床资料，总结神经外科杂交手术的护理配合经验。 结果 所有手术均顺利进行，未出现明显危及患者安全的情况。 结论 神经外科Hybrid手术治疗复杂脑脊髓血管病较普通手术更为安全有效。但手术护理准备及配合更为复杂，在手术室布局、手术流程方面需要医护协调专门进行优化。有神经外科专业经验的护士经过一段时间专门培训后担任手术巡回及器械护士更有利于手术的顺利、安全进行。