【摘要】 目的 探讨小儿外科围手术期抗菌药物应用情况，为儿外科临床合理、规范使用抗菌药物提供参考。 方法 随机抽取儿外科2008年1月-2009年10月出院手术病历763份，对抗菌药物的应用情况进行分析。 结果 763份病历显示，患儿均使用了抗菌药物，应用率高达100%。抗菌药物品种应用最多的是青霉素类518例（48.05%），其次为头孢菌素类336例（31.17%），其他抗菌药物（林可霉素类、硝基咪唑类、大环内酯类等）224例（20.78%）。一联用药574例（75.00%），二联用药147例（19.00%），三联及以上用药42例（6.00%）。其中， 99例（12.98%）做过病原学检测，39例有药敏试验依据（5.11%），以G+中的葡萄球菌为主。 结论 小儿外科围手术期抗菌药物目前应用存在一定的不合理，临床应当严格按照《抗菌药物临床应用指导原则》合理、规范使用抗菌药物。【Abstract】 Objective To investigate the perioperative use of antibiotics in children’s surgery of our hospital to guide it’s reasonable and normal use. Methods A total of 763 patients who discharged from our hospital between January 2008 and October 2009 were sampled randomly for statistical analysis regarding the utilization. Results Of the 763 cases reviewed, all cases (100%) received antibiotics. In terms of the application of antibiotics, penicillins were predominantly used in 518 patients (48.05%), followed by cephalosporins in 336 patients (31.17%) and other antibiotics such as lincomycins nitroimidazoles and macrolides in 224 patients (20.78%). 574 patients (75.00%) received one antibiotic, 147 (19.00%) received two antibiotics and 42(6.00%) received at least three antibiotics concomitantly. Only 99 patients (12.98%) received etiological test and 39 patients (5.11%) received susceptibility test during antibiotic ues, most of them are G+ staphylococcus infected. Conclusion The perioperative use of antibiotics in our hospital is somewhat unreasonable, thus monitoring closely on which should be performed to promote their reasonable and normal use.
ObjectiveTo assess the efficacy and safety of pediatric day surgery (PDS) program. MethodsWe retrospectively analyzed 148 pediatric surgeries between June 2012 and June 2013, including 31 for cryptorchidism, 53 for concealed penis, and 64 for hernia. According to the operation mode, these children were divided into PDS group and in-patient group. Analysis of the postoperative complications and hospital stay, and hospitalization expenses was carried out. ResultsThere was no statistical differences on success rate of operation, re-admission rate, postoperative fever, and postoperation nausea and vomiting between the two groups (P>0.05). But compared with the in-patient group, hospitalization expenses, medical cost, therapeutic treatment fee and hospital stay were significantly lower or shorter in the PDS group (P<0.05). ConclusionPDS is a safe and cost-effective program that reduces the average hospitalization days, reduces the per capita hospitalization cost, increases the turnover of beds, and benefits the child and the family.
Objective To explore the application of the Handbook for the Training Nurses in the standardized training for nurses in pediatric surgery. Methods Twenty-four training nurses trained under the instruction of the Handbook for the Training Nurses in Department of Pediatric Surgery from July 2014 to December 2015 were included as the observation group. Their training effects were compared historically with those of twenty-four training nurses who were trained without the help of the handbook from January 2013 to June 2014 (the control group). Results After the completion of the half-year training, theoretical score of training nurses in the observation group was better than that in the control group, and the difference was significant (87.16±4.18 vs. 83.71±5.46; t=2.492, P=0.016). Meanwhile, the specialist practical skill examination of training nurses in the observation group, such as femoral vein blood collection, replacement of drainage bag and indwelling needle infusion in children, and emergency practical skill examination such as cardiopulmonary resuscitation and the use of simple respirator were higher than those in the control group; and the working performance scores of training nurses in the observation group, such as the ability to adapt to the environment, patient satisfaction, nursing document writing, work efficiency and morning questions were better than those in the control group; the differences were significant (P< 0.05). Conclusion The Handbook for the Training Nurses can help the training nurses to adjust their working environment, master the practical skills and nursing knowledge in pediatric surgery.
ObjectiveTo evaluate the health economics indexes of day surgery mode and traditional specialist hospitalization mode, and to provide reference for the selection of different hospitalization mode of inguinal-type cryptorchidism in children.MethodsThe patients with unilateral cryptorchidism under 5 years old between January 2017 and January 2018 in Chongqing Children’s Hospital were selected in this study. According to different inpatient surgery modes, the included children were divided into day surgery group (day group) and special in-hospital surgery group (specialty group). The general data of patients, treatment indicators, incidence of complications, postoperative testicular atrophy rate, recurrence, nosocomial infection, hospitalization time, hospitalization cost, satisfaction of patients, and other health effect indicators between the two operation modes were compared. The treatment effect indexes and cost-effect ratio of the two modes were statistically analyzed.ResultsA total of 198 children were included, including 83 in the day group and 115 in the specialty group. The patients in both groups underwent orchiopexy by small inguinal dermatoglyph and scrotal incision. There was no statistically significant difference in the affected side, source area, postoperative complications, or nosocomial infection between the two groups (P>0.05). The patients in the specialty group were older than those in the day group [(27.60±11.04) vs. (20.88±9.48) months old; t=4.586, P<0.001]; the bed occupancy time [(118.60±10.80) vs. (23.95±5.90) h; t=72.353, P<0.001] and operation time [(0.45±0.15) vs. (0.38±0.12) h; t=2.946, P=0.004] in the specialty group were longer than those in the day group. The difference was statistically significant in hospitalization expenses between the two groups (χ2=155.374, P<0.001); 92.8% of the children in the day group spent less than 5 000 yuan, while 95.7% of the children in the specialty group spent more than 5 000 yuan. The American Society of Anesthesiologists scores in the specialty group were higher than those in the day group (χ2=44.870, P<0.001). The treatment effect indexes in the day group and the specialty group were 0.99 and 1.01, respectively, and the cost-effect ratios were 3 850 and 6 657, respectively. The economic benefit of the day group was better.ConclusionsThe cost-effectiveness of day surgery is better than that of specialized inpatient surgery. Therefore, this model can be recommended for children who meet the indications of day surgery.