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妊娠期合并乳腺脓肿行引流术护理一例

Ultrasound Guided Needle Aspiration and Cavity Washing Versus Incision and Drainage to Treat The Breast Abscesses—Meta Analysis

ObjectiveTo evaluate the clinical effect of ultrasound guided puncture irrigation and traditional incision and drainage in the treatment of breast abscess. MethodsCNKI, Wanfang Database, CBM, PubMed, Cochrane Library, Web of Science, and EMbase were searched, at the same time complementary with other retrieval in any language to collect the randomized controlled trials (RCTs) about comparison ultrasound guided needle aspiration with incision and drainage to treat the breast abscesses published by late August, 2015. Data related to clinical outcomes were extracted by two reviewers independently. Statistical analyses were carried out using RevMan5.3 software. ResultsEight studies were included, which involving 373 participants according to the inclusion criteria. The differences were statistically significant about the cure rate [OR=2.51, 95% CI (1.47, 4.28), P=0.000 8〕, effective rate [OR=7.45, 95% CI (2.29, 24.27), P=0.000 9〕, the heeling time [SMD=-1.77, 95%CI (-2.09, -1.44), P < 0.000 01〕, the length of the scar [MD=-2.88, 95% CI (-3.43, -2.33), P < 0.000 01〕, and the complications [OR=0.18, 95% CI (0.05, 0.62), P=0.007〕. Conciusions Compared with traditional methods of incision and drainage, ultrasound guided needle aspiration and wash has the more cure rate, the more effective rate, the less heeling time and scars as well as complications.

Application of continuous drainage with intravenous catheter in breast abscess infected by methicillin resistant staphylococcus aureus

Objective To observe and evaluate the efficacy of continuous drainage with intravenous catheter in the treatment of breast abscess infected by methicillin resistant staphylococcus aureus (MRSA) and to explore the best treatment methods. Methods Sixty cases of breast abscess infected by MRSA were retrospectively analyzed. The patients were divided into continuous drainage group and puncture drainage group according to the treatment. Continuous drainage with 14G intravenous catheter and intermittent aspiration with 20 mL syringe were performed to treat the breast abscesses in the continuous drainage group (n=36) and puncture drainage group (n=24), respectively. Meanwhile, sensitive antibiotics were used according to the results of susceptibility test. The therapeutic effects of the 2 groups were compared. Results There were no significant differences in baseline data between continuous drainage group and puncture drainage group (P>0.05). There was no significant differences of cure rate between the two groups (P=0.717). Compared with the puncture drainage group, the continuous drainage group showed shorter period of time to heal the breast abscess (P=0.001), shorter period of time to control the ache (P=0.038), less punctures (P<0.001) and more daily volume of drainage (P<0.001). No significant differences were found in the period of time to control the fever between the two groups (P=0.127). Conclusions Continuous drainage with intravenous catheter can shorten the course of disease, reduce the suffering of patients, reduce the difficulty of hospital infection prevention and control. It’s an ideal choice for the treatment of breast abscess infected by MRSA.

EnCor 真空旋切加双套管负压引流治疗乳腺脓肿

目的 探讨高频超声引导下 EnCor 真空旋切加双套管负压引流治疗乳腺脓肿的可行性及其临床应用价值。 方法 回顾性分析 2012 年 10 月至 2015 年 10 月期间于南京医科大学附属淮安第一医院治疗的 41 例乳腺脓肿患者的临床病理资料，其中有 20 例行 EnCor 真空旋切加双套管负压引流术（EnCor 组），21 例行常规切开引流术（对照组），比较 2 组患者疗效的差异。 结果 2 组患者在年龄、脓肿直径、脓肿位置等一般资料比较差异无统计学意义（P>0.05）。2 组患者手术治疗顺利，但 EnCor 组中有 2 例在旋切过程中发生出血，局部加压 1 h 后成功完成真空旋切术。2 组的手术时间比较差异无统计学意义（P>0.05）。EnCor 组的切口瘢痕大小、治愈时间、住院时间、换药次数及疼痛评分均明显优于对照组（P<0.05）。所有患者术后均治愈出院，无一例再手术，无术后出血、皮肤损伤、乳糜漏等并发症发生。41 例患者术后随访 3～20 个月，平均 12 个月，无一例失访。查体结合高频超声检查无脓腔残留及复发征象。对照组切口疤痕较明显，有1 例发生乳房变形；而 EnCor 组切口瘢痕微小，患者对术后乳房外形及治疗效果均满意。 结论 本研究的初步结果提示，EnCor 真空旋切辅以双套管负压引流治疗乳腺脓肿安全、可靠、痛苦小且微创。