自20世纪60年代中期，发现仅从静脉给予机体所必需的营养物质，就可以维持幼体动物的生存发育与成长以来，古老的营养支持疗法开始了一个新的辉煌时期。经过近30多年的研究与实践，其内涵得到更大的发展，80年代以后，营养支持在我国普外临床也有较快的进展，当前已成为临床重要的治疗手段。在提高危重患者的治愈率，降低外科手术后并发症，加速术后患者的恢复和减少住院时间起到了很重要的作用，无论在营养支持的基础理论或临床实践都有了更深入的认识。因此，它的应用范围在不断地扩大，其临床地位也日益显得重要。
Ｆｒｏｍ １９９０ ｔｏ １９９３， ｗｅ ｃａｒｒｉｅｄ ｏｎ ａ ｓｅｒｏｅｐｉｄｅｍｉｏｌｏｇｉｃａｌ ｓｕｒｖｅｙ ｏｎ ｈｅｐａｔｉｔｉｓ Ｂ ｖｉｒｕｓ （ＨＢＶ） ｉｎｆｅｃｔｉｏｎ ｏｆ ５２９７ ｇｅｎｅｒａｌ ｓｕｒｇｉｃａｌ ｐａｔｉｅｎｔｓ． Ｔｈｅ ｒｅｓｕｌｔｓ ｓｈｏｗｅｄ ｔｈａｔ ｔｈｅ ｐｏｓｉｔｉｖｅ ｒａｔｅｓ ｏｆ ＨＢｓＡｇ， ａｎｔｉＨＢｓ ａｎｄ ａｎｔｉＨＢｃ ｗｅｒｅ １９．４％ 、３５．９％ ａｎｄ ４１．１％ｒｅｓｐｅｃｔｉｖｅｌｙ， ａｎｄ ｔｈｅ ｏｖｅｒａｌｌ ｒａｔｅ ｏｆ ＨＢＶ ｉｎｆｅｃｔｉｏｎ ｗａｓ ７０．５％， ｗｈｉｃｈ ｗａｓ ｍｕｃｈ ｈｉｇｈｅｒ ｔｈａｎ ｔｈａｔ ｏｆ ｔｈｅ ｇｅｎｅｒａｌ ｐｏｐｕｌａｔｉｏｎ． Ｉｎ ｐａｔｉｅｎｔｓ ｗｉｔｈ ｈｅｐａｔｏｂｉｌｉａｒｙ ｏｒ ｐａｎｃｒｅａｔｉｃ ｄｉｓｅａｓｅｓ， ｔｈｅ ＨＢｓＡｇ， ａｎｔｉＨＢｃ ａｎｄ ｔｈｅ ｏｖｅｒａｌｌ ｒａｔｅ ｏｆ ＨＢＶ ｉｎｆｅｃｔｉｏｎ ｗｅｒｅ ３４．２％、５６．１％、８０．３％ｒｅｓｐｅｃｔｉｖｅｌｙ， ｗｈｉｃｈ ｗｅｒｅ ｈｉｇｈｅｒ ｔｈａｎ ｔｈｏｓｅ ｏｆ ｏｔｈｅｒ ｇｅｎｅｒａｌ ｓｕｒｇｉｃａｌ ｐａｔｉｅｎｔｓ．
ObjectiveTo summarize the methods to prevent pulmonary complications in patients underwent abdominal surgery during perioperative period and provide reference for the prevention of postoperative pulmonary complications.MethodLiteratures on the prevention of pulmonary complications after abdominal surgery were searched and reviewed.ResultsThe prevention of pulmonary complications after abdominal surgery included preoperative measures, intraoperative measures, and postoperative measures. Preoperative measures included preoperative education, patient risk assessment, smoking cessation, and so on. Intraoperative measures included anesthetic measures and surgical measures. Postoperative measures included atomization treatment, elimination of bad feelings, early postoperative activities, and so on. In view of the different basic conditions of patients underwent abdominal surgery, the selection and emphasis of preventive measures were also different.ConclusionThe prevention of postoperative pulmonary complications after general abdominal surgery should not only take preventive measures in perioperative period, but also should carry out individual management according to the patient’s condition and general conditions.
General outpatient surgery is quite common in outpatient department at hospitals. In order to optimize the patient visit flow, the Day Surgery Center, Medical Affairs Department, Outpatient Department, Surgical Anesthesia Center and some relevant departments of West China Hospital of Sichuan University implemente whole process management of patients undergoing general outpatient surgery. Based on the practice of general outpatient surgery, West China Hospital of Sichuan University summarized and drafted the management protocol of general outpatient surgery from the aspects of organizational structure, management system and emergency plan, in order to provide a reference for the standardized development of general outpatient surgery in China.
Objective To investigate the incidence rate, molecular epidemiology and risk factors for methicillin-resistant Staphylococcus aureus (MRSA) infection. Methods A total of 119 Staphylococcus aureus strains isolated from January 2016 to December 2020 in general surgery of this hospital were collected retrospectively and divided into MRSA group and methicillin-sensitive Staphylococcus aureus group according to whether or not resistant to oxacillin. The clinical data of all patients infected with Staphylococcus aureus and drug sensitivity of Staphylococcus aureus were collected. Molecular typing was performed by multilocus sequence typing (MLST), resistance gene, virulence gene and biofilm gene were detected by polymerase chain reaction (PCR) method, and a case-control study was used to identify risk factors for MRSA infection. ResultsThe detection rate of MRSA was 57.98% (69/119), mainly was from pus specimens (80.67%, 96/119). The results of MLST showed that the dominant clone types were ST88 (37.68%, 26/69), ST951 (27.54%, 19/69) and ST59 (18.84%, 13/69). The results of PCR showed that the detection rates of mecA, mecC, Aac (6′ )/Aph (2′ ′ ), Aph (3)-Ⅲ, ant (4′ )- Ⅰ a, tetM, qnrA, panton-valentine leukocidin, fibronectin-binding protein A, staphylococcal enterotoxin A, staphylococcal enterotoxin B, α-hemolysins, intracellular adhesion A, staphylococcal accessory regulators A, and fibronectin-binding protein B in 69 strains of MRSA were 100%, 0.00%, 27.54%, 34.78%, 18.84%, 14.49%, 1.45%, 8.70%, 98.55%, 11.59%, 91.30%, 94.20%, 92.75%, 97.10% and 86.96%, respectively. Multivariate analysis showed that hospital transfer, wound infection, catheter related infection, drainage tube and history of cephalosporin using were risk factors for MRSA infection. ConclusionsThe detection rate of MRSA in general surgery of this hospital is high. ST88 is the most common clone type. The carrying rates of resistant-, virulence- and biofilm-related genes are high. Hospital transfer, wound infection, drainage tube, history of cephalosporin using etc. are high risk factors for MRSA infection. It is advised that invasive operation should be reduced, antibiotics should be used rationally, hand hygiene should be paid attention to, environmental sanitation disinfection should be carried out regularly, and the monitoring of MRSA bacteria should be strengthened, so as to reduce and control the infection and spread of MRSA.