【摘要】 目的 探讨在重症监护病房（intonsive cane tmit，ICU）行选择性消化道脱污染（selective digestive decontamination，SDD）的临床实用价值。 方法 选取2007年1月—2010年1月危重症患者376例，随机分为两组，对照组予常规口腔护理治疗，治疗组予选择性消化道脱污染治疗，比较两组患者病情疗效的参数。 结果 治疗组院内获得性肺炎发生率为18.4%、院内获得性肺炎发生时间（7.2±3.2）d、人工气道（气管插管/切开）保留天数（10.5±3.8）d、机械通气天数（8.4±3.1）d、入住ICU天数（14.7±4.8）d、病死率11.6%；对照组院内获得性肺炎发生率为30.1%、院内获得性肺炎发生时间（5.6±3.6）d、人工气道（气管插管/切开）保留天数（12.5±4.6）d、机械通气天数（10.2±4.2）d、入住ICU天数（17.2±6.2）d、病死率19.4%；两组比较差异均有统计学意义（Plt;0.05）。 结论 在ICU内行选择性消化道脱污染可有效控制院内获得性肺炎，改善患者病情，减少住院天数，降低病死率。【Abstract】 Objective To discuss the clinical value of selective digestive decontamination in the intensive care unit (ICU). Methods From January 2007 to January 2010, 376 critically ill patients were randomly divided into two groups. Patients in the control group received conventional oral cavity nursing treatment, and those in the treatment group underwent the selective digestive decontamination. Then, we compared the curative effect parameters of these two kinds of procedures for the two groups of patients. Results For patients in the treatment group, the rate of hospital-acquired pneumonia (HAP) was 18.4%, the occurring time of HAP was (7.2±3.2) days, the time of retaining artificial gas channel (trachea cannula / incision) was (10.5±3.8) days, the time of mechanical ventilation was (8.4±3.1) days, ICU stay time was (14.7±4.8) days, and the mortality rate was 11.6%. For the control group, the correspondent parameters were respectively 30.1%, (5.6±3.6) days, (12.5±4.6) days, (10.2±4.2) days, (17.2±6.2) days, and 19.4%. The differences of these parameters between the two groups were significant (Plt;0.05). Conclusion For patients in the ICU, the selective digestive decontamination can effectively control the occurrence of HAP, improve patient conditions, reduce hospitalization time, and decrease mortality rate.
Objective To develop a high-accuracy, better-safety and low-cost cervical pedicle locator system for guiding cervical pedicle screw placement. Methods Cervical pedicle screw locator system was made of stainless steel. Ten cervical specimens from voluntary donation were divided into two groups according to compatibil ity design: control group inwhich 60 screws were planted into C2-7 by free hand; and experimental group in which 60 screws were planted into C2-7 under the guidance of three-dimensional locator system. The condition of screw insertion was observed and the accuracy was evaluated by the integrity of pedicle walls. Results In the control group, 32 screws (53.33%) were placed inside the pedicles and 28 (46.67%) were outside; 9 screws (15.00%) led to nerve root injury, 5 screws (8.33%) caused vertebral artery injury and no spinal cord injury occurred; and the qual ification ratio of screw insertion was 76.67% (excellent 32, fair 14, poor 14). While in the experimental group, 54 screws (90.00%) were placed inside the pedicles and 6 (10.00%) were outside; 1 screw (1.67%) caused vertebral artery injury and no nerve root injury and spinal cord injury occurred; and the qual ification ratio of screw insertion was 98.33% (excellent 54, fair 5, poor 1). There was significant difference between the two groups (P lt; 0.05). Conclusion Cervical pedicle screw locator system has the advantages of easy manipulation, high accuracy of screw placement and low cost. With further study, it can be appl ied to the cl inical.
ObjectiveTo explore the risk factors for cerebral thrombosis due to interventional embolization of intracranial aneurysms.MethodsThe clinical data of 240 patients with intracranial aneurysms treated by interventional embolization in Department of Neurosurgery, Renmin Hospital of Wuhan University between January 2015 and December 2019 were collected retrospectively. According to whether cerebral thrombosis occurred after embolization, the patients were divided into the cerebral thrombosis group and the non-cerebral thrombosis group. Univariate analyses and multivariate logistic regression analysis were used to analyze the independent risk factors for cerebral thrombosis due to interventional embolization of intracranial aneurysms.ResultsOf the 240 patients, 55 (22.9%) had postoperative cerebral thrombosis confirmed by MRI, and 15 (6.2%) had neurological symptoms. There were significant differences in age, hypertension, hyperlipidemia, operative duration, and procedure methods (simple coiling, balloon or stent-assisted coiling) between the cerebral thrombosis group and the non-cerebral thrombosis group after embolization of intracranial aneurysms (P<0.05). Multivariate logistic regression analysis showed that only operative duration [odds ratio=1.036, 95% confidence interval (1.018, 1.054), P<0.001] was the independent risk factor for cerebral thrombosis after interventional embolization of aneurysms.ConclusionsOperative duration is the independent and adjustable risk factor for cerebral thrombosis after embolization of intracranial aneurysms. Improving the surgical skills of neurointerventional surgeons and shortening the procedure time will be helpful to reduce the occurrence of cerebral thrombosis after interventional treatment of aneurysms and improve the prognosis of patients.