【摘要】 目的 了解在围手术期术前30 min应用抗生素的情况。 方法 根据2004年卫生部、国家中医药管理局、总后勤部发布的《抗菌药物临床应用指导原则》中围手术期抗生素的使用原则，对四川大学华西医院2010年4-6月500台手术围手术期抗生素的使用情况进行分析。 结果 抗生素在麻醉前输：0台；抗生素末在术前30 min输2台，占0.4%；抗生素末即用即配：0台；抗生素与麻药及其他禁忌药混合输:0台；手术3 h后末及时追加抗生素：0台；特殊患者使用抗生素的注意事项不清楚2台，占0.4%。 结论 该院99.6%的手术实行在手术室术前30 min输入抗生素，确保抗生素达到有效浓度，有效控制感染，保证手术的成功，保障患者安全。【Abstract】 Objective To investigate the application of perioperative antibiotics half an hour before operation in West China Hospital of Sichuan University. Methods According to Clinical Guidance of Antibiotics published by Ministry of Health, State Administration of Traditional Chinese Medicine and General Logistics Department in 2004, we investigated the application of perioperative antibiotics in 500 operations between April to June 2010 in our hospital. Results There was no operation with infusion of antibiotics before anesthesia, 2 operations without infusion of antibiotics half an hour before operation (0.4%), no operation without immediate infusion after preparation, no operation with mixed infusion of antibiotics and anesthesia and other contraindicated drugs, no operation without infusion of antibiotics 3 hours after operation, and 2 operations in which cautious items about the children, pregnancy and old patients were unclear (0.4%). Conclusion About 99.6% operations in our hospital have the infusion of antibiotics 30 minutes before the operation, which is the guarantee of antibiotics with effective concentration, inhibition of infection, success of the operation and safety of the patients.
ObjectiveTo explore the nursing method to avoid rupture of intracranial aneurysm during induction of anesthesia. MethodWe retrospectively analyzed the nursing method for 428 patients with aneurysm during the induction of anesthesia between October 2012 and October 2013. According to the causes of rupture of intracranial aneurysm (anxiety, tension, excitement, sudden elevation of blood pressure, physical labor), we adopted nursing methods to avoid those causes, and implemented targeted nursing methods during induction of anesthesia. ResultsNo intracranial aneurysm rupture occurred in these 428 aneurysm patients during induction of anesthesia. Two patients' absolute value of systolic blood pressure was below 80 mm Hg (1 mm Hg=0.133 kPa) during induction of anesthesia, and the vital signs of other patients kept normal. The number of intraoperative rupture cases was 3. When discharged from hospital, there were 385 patients with good prognosis, 39 patients with bad prognosis, and 4 death cases. ConclusionsTargeted nursing method based on patients' particular situation during induction of anesthesia can effectively control patients' emotion, stabilize fluctuations in hemodynamic indexes, decrease the incidence of aneurysm rupture, improve surgery treatment effect of intracranial aneurysm clipping, decrease complications, and improve patients' prognosis.
ObjectiveTo explore the changes of intraoperative temperature and influencing factors of the short-term prognosis of patients undergoing clipping of posterior communicating artery aneurysms.MethodsThe basic clinic data and intraoperative temperature of patients undergoing elective clipping of posterior communicating artery aneurysms between October 2018 and July 2019 were collected, and the minimum intraoperative temperature was categorized into ≥36.0 and <37.5℃, ≥35.0 and <36.0℃, and <35.0℃. According to the Glasgow outcome scale (GOS) at discharge, the patients were divided into good prognosis group (GOS 4-5) and bad prognosis group (GOS 1-3). Multiple logistic regression analysis was used to obtain the risk factors of short-term prognosis.ResultsA total of 127 cases were involved, and intraoperative hypothermia (<36.0℃) occurred in 64 cases (50.4%). The intraoperative temperature presented classical three-phrase changes, i.e. it dropped rapidly at 1 hour after anesthesia introduction, decreased slowly during 2-3 hours after anesthesia introduction, and then entered the plateau. In the 127 cases, 93 (73.2%) had good prognosis, with an intraoperative hypothermia proportion of 44.1% (41/93); and 34 (26.8%) had bad prognosis, with an intraoperative hypothermia proportion of 67.6% (23/34). Univariate analysis showed that Hunt-Hess grade (χ2=18.999, P<0.001), intraoperative bleeding (χ2=7.074, P=0.008), minimum intraoperative temperature (Z=−3.473, P=0.001), and postoperative complications (χ2=43.060, P<0.001) were related to the short-term prognosis of patients undergoing clipping of posterior communicating artery aneurysms. Multiple logistic regression analysis presented that high Hunt-Hess grade (Ⅳ, Ⅴ) [odds ratio (OR)=6.456, 95% confidence interval (CI) (1.141, 36.532), P=0.035], the minimum intraoperative temperature <35.0℃ [OR=7.552, 95%CI (1.450, 39.345), P=0.016], and postoperative complications [OR=22.866, 95%CI (6.778, 77.142), P<0.001] were independent risk factors of the short-term prognosis. The difference in short-term prognosis between patients with the minimum intraoperative temperature ≥35.0 and <36.0℃ and the ones with the minimum intraoperative temperature ≥36.0 and <37.5℃ was not statistically significant (P>0.05).ConclusionsThe minimum intraoperative temperature<35.0℃ and postoperative complications were changeable factors to effect progonosis of patients undergoing elective clipping of posterior communicating artery aneurysms. Clinical staff should set medical intervention measures based on the individual conditions of patients to improve patients’ quality of life.