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find Keyword "清创" 25 results
  • 心脏大血管手术后胸骨感染的外科治疗

    目的 总结心脏大血管手术后胸骨感染的外科治疗经验。 方法 回顾性分析2003年2月至2010年7月8例心脏大血管手术后发生胸骨感染患者的临床资料,男7例,女1例;年龄30~60岁(44.8±10.9)。8例患者均采用彻底清创,包括清除坏死皮缘和增生组织、彻底止血、搔刮胸骨、咬除感染胸骨、清除胸骨后的感染脓腔、用1%碘伏纱布浸泡,抗生素液反复冲洗,留置滴液入管和胸骨后引流管等处理;对胸骨后感染严重(有脓腔)者,彻底清创后经膈肌切口将带蒂(胃网膜有动脉分支的)大网膜上引放置在胸骨后,同时留置滴液入管和胸骨后引流管。 结果 胸骨伤口Ⅰ期愈合5例,Ⅱ期愈合2例,感染未控制1例。Ⅱ期愈合者合并糖尿病,均使用双侧乳内动脉行冠状动脉旁路移植术;分别经局部换药或再次清创2周后愈合。随访8例,随访时间1~3个月,1例主动脉夹层全弓置换术患者因胸骨感染未控制术后3个月死于人工血管继发感染、破裂大出血,其余患者胸骨感染无复发,恢复正常生活或工作。 结论 对心脏大血管手术后发生胸骨感染患者应积极行外科手术清创,采用放置滴液入管,并持续用碘伏冲洗以及带蒂大网膜或肌瓣充填,可尽快控制感染,促进伤口愈合。

    Release date:2016-08-30 05:57 Export PDF Favorites Scan
  • CLINICAL EVALUATION OF VACUUM SEALING DRAINAGE FOR TREATMENT OF DEEP INFECTION AFTER HIP OR KNEE REPLACEMENT

    Objective To investigate the method and effectiveness of vacuum seal ing drainage (VSD) combined with debridement for treatment of deep infection after hip or knee replacement. Methods Between September 2006 and May 2010, 13 cases of deep infection after joint replacement surgery were treated, including 5 males and 8 females with an average ageof 62.5 years (range, 56-78 years). Infection occurred at 7 days to 1 year and 2 months (median, 14 days) after joint replacement surgery. The time from infection to admission was 8 days to 4 years and 6 months (median, 21 days). Purulent secretion with or without blood were observed in all patients; sinus formed in 5 cases; and unhealing of incision or drainage opening disunion were observed in 8 cases. The size of skin defect at secretion drainage or sinus opening site was 5 mm × 3 mm to 36 mm × 6 mm; the depth of drainage tunnel or sinus was 21-60 mm. The histopathological examination in 11 patients showed acute infection or chronic infection with acute onset in 10 cases, and tuberculosis in 1 case. In 6 cases of secretion culture, Staphylococcus aureus was isolated from 5 cases. After thorough debridement, wound irrigation was performed during the day and VSD during the night in 10 cases. VSD was merely performed in 3 cases. Results In 1 case after revision total hip arthroplasty, the wound bled profusely with VSD, then VSD stopped and associated with compression bandage, VSD proceeded again 3 days later with no heavy bleeding. All the patient were followed up 1 year to 4 years and 5 months (mean, 2 years and 11 months). Infection were controlled 7-75 days (mean, 43 days) after VSD in 10 cases. In these cases, prosthesis were reserved, no recurrent infection was observed, wound were healed, limb function were reserved. VSD was refused in 1 case because of hypersensitive of the pain at the vacuum site, infection control was failed and amputation at the thigh was proceeded. The effect was not evident in 1 case with tuberculosis infection, then the prosthesis was removed and arthrodesis was proceeded followed by complete union. In 1 case, infection was cured with VSD, recurrent infection happened after 9 months, antibiotic-impregnated cement spacer was used at end, and no recurrence was observed 1 year and 4 months later. Conclusion VSD combined with debridement can drainage deep infection sufficiently, promote wound healing, reduce recurrent infection rate, maximize the possibil ity of prosthesis preservation.

    Release date:2016-08-31 05:42 Export PDF Favorites Scan
  • BACTERIAL BIOFILMS AND CHRONIC OSTEOMYELITIS

    Objective To overview the effect of bacterial biofilms (BBF) on the formation of chronic osteomyel itis and the treatment measure. Methods The original articles in recent years about the relationship between BBF and chronic osteomyel itis were reviewed. Results The diagnosis and treatment of chronic osteomyel itis was very difficult, besides hyperplasia oflocal scar, poor blood supply, drug-resistant, forming of BBF also was an important reason. BBF formed on the surface of necrosis soft tissue and dead bone. Due to the protection of BBF, the bacterium were far more resistant to antimicrobial agents, which caused the recurrence of chronic osteomyel itis. The forming of BBF included three processes which were adhesion, development and maturity. As the major pathogens of chronic osteomyel itis, staphylococcus had its own characteristic. Designing therapeutic programmes according to these characteristics had become the trend of anti-infection treatment of BBF. Conclusion Although there are lots of studies on anti-biofilm due to the key factors during the forming of BBF, the most effective way of anti-biofilm is still debridement.

    Release date:2016-08-31 05:47 Export PDF Favorites Scan
  • Effect of Choledochoscope for Treatment of Parapancreatic Abscess

      Objective To expand the utilization of minimally invasive technologies for parapancreatic abscess, and summarize the application experience of choledochoscope for treatment of parapancreatic abscess.   Methods The clinical data and treatment effectiveness of 36 patients with parapancreatic abscess from Dec. 2000 to Dec. 2008 were analyzed retrospectively. These patients had experienced percutaneous puncture and been placed drainage tube under the ultrasound guidance first, then expanded the sinus tract gradually, and performed debridement by choledochoscope. The flexibility of choledochoscope was used to remove the necrotic tissue and pyogenic membrane repeatedly by clamping, netting and vacuum aspiration in every domain.   Results Thirty-six patients were performed percutaneous puncture and placed drainage tube, 3 cases were given canalis singularis, 7 cases were double tube, 26 cases were over three tube. The debridement times were 3-14 by choledochoscope, average 5.6 times. There were 6 cases with improving systemic symptoms, blood routine and temperature recovering normal, and drink and food recovering, then discharged from hospital with tube after 1-2 times of debridement. Length of stay was 25-132 d, average 76 d. The curing rate was 91.7% (33/36). Two cases were turned into open surgery because of broad necrotic tissue range combined with many abdominal cavity abscess with good postoperative recovery and cured. One case was dead of severe multiple organ failure combination. There were 2 patients with hemorrhage, 3 patients with external intestinal fistula.   Conclusions The debridement of choledochoscope for parapancreatic abscess treatment is a simple, flexible and effective method. It changes the viewpoint that parapancreatic abscess can be cured only by operation drainage, decreases the patients’ trauma and accomplishes the idea of damage control by minimally invasive technologies.

    Release date:2016-09-08 10:52 Export PDF Favorites Scan
  • Application of Minimally Invasive Technique to Every Stage of Severe Acute Pancreatitis (Report of 101 Cases)

    Objective To explore and summarize the application of minimally invasive technique to every stage of severe acute pancreatitis (SAP). Methods The treatment of 101 SAP patients admitted to our hospital between January 1995 and December 2008 were retrospectively analyzed. After calculi were removed by endoscopic retrograde cholangiopancreatograpy (ERCP) and endoscopic sphincterotomy (EST), endoscopic nasobiliary drainage (ENBD) were applied, then rhubarb liquid was perfused into gut with a nutrient canal and ultrasound-guided abdominal drainage tube were simultaneously placed at the early stage. Some patients received continuous renal replacement therapy (CRRT) at the same time. Laparoscopic cholecystectomy (LC) was performed at the subacute stage, and choledochoscope was introduced to remove parapancreatic necrotic tissues at the late stage of SAP.Results Of all the 101 cases treated by the method mentioned above, 75 cases received ERCP (or EST) and ENBD, and 31 cases underwent rhubarb liquid perfusion with a nutrient canal. Eight cases underwent continuous renal replacement therapy (CRRT). Forty-eight cases underwent LC and ultrasoundguided abdominal drainage. Thirtysix cases with infected peripancreatic tissue or abscess underwent debridement under choledochoscope 3 to 14 times at the later stage. Five cases died of multiple organ failure (MOF) and acute respiratory distress syndrome (ARDS). The hemobilia ocurred in 2 patients during choledochoscopy and was cured under direct visualization by electric coagulation. Intestinal fistula happened in 3 cases and cured by drainage. Pancreatic pseudocyst was latterly seen in 3 cases and treated by the anastomosis of cyst with jejunum through selective operation. After the hospitalization of 9-132 d (mean 24 d), 96 cases completely recovered. Conclusion Timely application of minimally invasive technique to every stage of SAP can avoid the defects of traditional operations, decrease the injury and interference to the maximum, and raise the cure rate.

    Release date:2016-09-08 10:54 Export PDF Favorites Scan
  • 美盐在Ⅳ期压疮早期清创中的应用及效果观察

    目的探讨美盐在Ⅳ期压疮早期的清创效果。 方法选择2010年7月-2011年10月因骨折入院,同时伴有Ⅳ期压疮的22例患者,随机分为观察组及对照组,各组11例。使用压疮愈合计分表(PUSH)进行伤口评估,观察组在外科清创的基础上使用美盐,对照组在外科清创的基础上使用生理盐水纱布覆盖创面,两组均24 h换药1次。坏死组织全部清除并转变为红色肉芽组织。仔细观察并记录每处压疮从清创开始至完成清创所需的时间。 结果观察组在换药15.5 d后腐肉及黑痂范围明显缩小,对照组在换药24.5 d后腐肉及黑痂范围明显缩小。观察组治疗10 d后压疮面积、组织类型、渗液量及PUSH评分均优于对照组(P<0.05)。 结论Ⅳ期压疮早期的创面,往往都有腐肉及结痂覆盖,在外科清创的基础上使用美盐,能够加快Ⅳ期压疮的清创过程,对后期压疮的愈合有着积极的作用。

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  • Research on the Application of 10% Sodium Chloride for Stage-Ⅲ Pressure Ulcer Debridement

    ObjectiveTo explore the application of 10% sodium chloride for stage-Ⅲ pressure ulcer debridement. MethodsAccording to the standard, 68 stage-Ⅲ pressure ulcer cases were selected from January 2011 to December 2014. All the patients had yellow surface and positive bacterium cultivation suggesting wound infection. They were randomly divided into control group and trial group. The control group used traditional treatment for debridement, while the trial group used 10% sodium chloride, until the end of debridement where the granulation became fresh and bacterium cultivation negative. Then we compared these two groups in terms of debridement time, wound drainage, wound smell, granulation growth, pain score and cost. ResultsThe control group debridement time was 18-32 days, averaging (22.4±10.8) days, and the trial group debridement time was 5-13 days, averaging (11.6±4.0) days (P<0.05). The control group wound drainage ratings score was 6.70±2.87, while the trial group wound drainage ratings score was 3.65±1.23 (P<0.05). In terms of the wound smell, the control group had a score of 2.74±1.62, and the score for the experimental group was 1.26±0.51 (P<0.05). The average cost of the control group was (975.00±10.29) yuan, while the experimental group was (626.00±8.18) yuan (P<0.05). ConclusionThe application of 10% sodium chloride for stage-Ⅲ pressure ulcer debridement can shorten debridement time, promote the growth of granulation and reduce the economic burden, which is worth clinical promotion.

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  • 超声水刀在糖尿病慢性难愈性溃疡中的清创效果观察

    目的探讨超声水刀在糖尿病慢性难愈性溃疡中的清创效果。 方法选取2012年5月-2014年4月59例糖尿病慢性难愈性溃疡患者,采用超声水刀清创,观察清创时的创面疼痛、清创后的创面分期、渗液变化和创周炎症反应,以及继续交换敷料后溃疡的愈合情况。 结果59例患者中,47例患者清创前和清创时均无明显疼痛感;6例患者清创前感觉轻度疼痛,经局部麻醉止痛后,清创时无明显疼痛感;3例患者清创前感觉中度疼痛,经局部麻醉止痛后,清创时仅感觉轻度疼痛;3例患者清创前感觉重度疼痛,经创面涂抹1%盐酸丁卡因凝胶联合肌肉注射布桂嗪或哌替啶后,清创时感觉轻度疼痛。黑期、黄期为主的创面在经过3~7次/例、4~10 min/次清创后肉芽组织增加,逐渐过渡为红期为主、少至大量脓血性渗液转为少至中量血性,创周未出现因清创引起的红肿或原有红肿加重。最后有8例溃疡愈合;50例溃疡基本愈合后转往当地医院继续换药;1例溃疡在创面床准备充分后转入骨科行皮瓣移植术。 结论在重视改善糖尿病患者全身因素的基础上,采用超声水刀能达到清创彻底、杀菌和减轻细菌负荷、改善创面微循环的作用,有助于创面床准备,是一种能促进糖尿病慢性难愈性溃疡愈合的清创方法。

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  • Clinical Outcomes of the Treatment of Sternal Dehiscence after Cardiac Surgery

    ObjectiveTo summarize the experiences of surgical treatment of sternal dehiscence after cardiac surgery. MethodsFrom January 2011 to January 2014, 7 patients with sternal dehiscence after cardiac surgery were admitted to our hospital. There were 4 male patients and 3 females with an age of 35-72 (52.5±13.4) years old. Two patients accepted coronary artery bypass, 4 underwent mechanical valve replacement and 1 underwent Sun’s procedure. The necrotic bones were debrided and sternal wires completely removed. After the original wires were completely extracted, the infected tissues behind the sternum were removed. Part of the pectoralis major was released with free tension on both sides when suturing was carried out over the sternal defect. Negative pressure drainage tube was used for full drainage. ResultsAll the patients were discharged from hospital with very good recovery. The sternal wound was healing well with normal thoracic appearance, and none of the patients had recurrent infections. ConclusionsPatients with sternal dehiscence after cardiac surgical procedure should undergo surgical debridement. Stabilizing the sternum, rich blood supply and improvement of overall condition of the patients are very important for recovery.

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  • Clinical Effects of Two Different Autolytic Debridement on Subcutaneous Wounds

    ObjectiveTo evaluate the effects of two different autolytic debridment on subcutaneous wounds. MethodsThirty-eight patients with subcutaneous wounds treated from January to December 2015 were numbered according to the sequence of admission, and were randomly divided into trial group and control group, with 19 patients in each group. All the patients had yellow surface. Patients in the control group were treated with amorphous hydrogel, while those in the trial group were treated with both amorphous hydrogel and alginate dressing. Then, we compared the two groups in terms of the debridement time, frequency of changing dressing, granulation growth, wound contraction rate at the end of debridement period, and leakage rate. ResultsThe debridement time in the trial group was (21.11±5.86) days, and it was significantly shorter than that in the control group[(26.69±9.68) days] (P<0.05); the frequency of changing dressing was (7.21±2.12) times, which was less than that in the control group[(9.37±3.32) times] (P<0.05); and granulation growth was better than that in the control group (2.58±0.61 vs. 1.95±0.71, P<0.05). The wound contraction rate at the end of debridement period in the trial group was (47.00±26.24)%, which was higher than that in the control group[(29.03±22.62)%] (P<0.05); and the leakage rate (0.0%) was lower than the control group (3.3%) (P<0.05). ConclusionUsing amorphous hydrogel and alginate dressing for subcutaneous wounds is better than amorphous hydrogel alone for autolytic debridement, and can lower the leakage rate.

    Release date:2016-10-02 04:54 Export PDF Favorites Scan
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