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改良式充气性视网膜固定手术治疗单纯性孔源性视网膜脱离的临床观察

Investigation and sensory control of surface and air pollution in isolation ward of severe COVID-19 patients

ObjectiveTo evaluate the effect of disinfection measures in the isolation ward of ICU in severe patients infected with the Omilkerong variant of the new coronavirus, and to optimize the infection control measures. MethodsReferring to the patient's epidemiological and nucleic acid sample data, nucleic acid sampling was performed on the isolated ward environment by surface sampling method, and the nucleic acid Ct value of virus was detected by parallel fluorescence PCR method. The aerosol was collected by a wet-wall cyclone sampler, and the nucleic acid Ct value of the virus was detected by parallel fluorescence PCR. ResultsBefore daily disinfection, SARS-CoV-2 positive samples were found on the surface of the patient's ward and air sampling after the tracheoscopic tracheostomy. No positive samples of SARS-CoV-2 were found on the surface of articles and air in the patient's ward after daily disinfection. ConclusionThe daily disinfection measures of the hospital can achieve the effect of SARS-CoV-2 disinfection, which suggests that the surface of the articles in the ward after invasive operations such as tracheostomy and tracheoscopy, especially within 2 meters of the tracheostomy and the tracheostomy, is the key part of disinfection, which needs to be paid attention to.

空气灌肠整复小儿肠套叠临床分析

【摘要】 目的 探讨空气灌肠整复小儿肠套叠的方法,提高整复成功率。方法 2007年1月—2008年12月经超声明确诊断小儿急性肠套叠患儿328例,行空气灌肠诊断(压力4～6 kPa)和整复(压力7～14 kPa),分析整复成功率与肠套叠发生时间、套头所在部位、使用解痉药物之间的关系。结果 空气灌肠整复成功306例,成功率93%,其中68例为二次整复。整复率与肠套叠发病时间、患儿全身情况及肠套叠的病理类型、整复压力的掌握及解痉药物的适时选用有关。结论 采用适当的操作方法，利用空气灌肠整复小儿肠套叠能提高成功率。

眼玻璃体切除术继发肺动脉空气栓塞一例

A Comparative Study between Computer-controlled Enema Taxis Instrument and Simple Air Enema Taxis Instrument for Intussusception in Children

目的　比较电脑遥控灌肠整复仪与简易空气灌肠器对小儿肠套叠的整复效果，探讨更有效安全的空气灌肠设备。 方法　2002年11月－2011年11月对确诊的425例小儿肠套叠应用空气灌肠整复，其中198例采用简易空气灌肠器整复，227例用电脑遥控灌肠整复仪进行空气灌肠整复，并对不同病程时间、套叠部位与两种空气灌肠设备整复结果进行回顾性分析。 结果　198例患儿采用简易空气灌肠器整复成功率为71.2%，227例患儿采用电脑遥控灌肠整复仪的方式整复成功率为83.3%，后者成功率明显高于前者（P＜0.005），尤其是病程时间在24 h内，套叠部位位于升结肠或横结肠的后者整复成功率更高（P＜0.05）。 结论　电脑遥控灌肠整复仪比简易空气灌肠器更有效、安全。脉冲式空气灌肠能减轻套叠部位的痉挛与水肿，提高肠套叠的整复成功率。

Retrospective Analysis of Risk Factors for Overhigh Air Bacterial Total Counts in Laminar-flow Operating Room under Dynamic Environments

目的　探讨层流手术室动态空气菌落数超标的高危因素。 方法　回顾分析2010年3月－2011年11月168台次特别洁净层流手术室动态空气样品细菌培养结果的资料，依据层流手术室动态环境下空气样品是否超过10个菌落形成单位（CFU）/m3将168例空气样品细菌培养的资料分别命名为超标组和正常组。超标组有56台次，正常组有112台次。将超标组与正常组就有关手术持续的时间、参与手术的医务人员数量、参观人数、手术过程中开门的次数、是否为污染手术、手术及麻醉设备是否在手术过程中有搬动、是否为接台手术、患者术前1 d是否更衣洗澡以及麻醉方式等因素进行分析比较。 结果　层流手术室动态空气菌落数超标与参观手术的人数、术中开门次数、手术类型、术中有无设备搬动及患者术前1 d是否进行更衣洗澡等因素有关（P＜0.05），而与手术持续时间、参加手术的人员数量、是否接台手术及麻醉方式等无关（P＞0.05）。 结论　参观手术的人数＞3人、术中开门次数＞10次、手术类型为污染手术、术中有设备搬动及患者术前1 d未进行沐浴更衣是层流手术室动态空气菌落数超标的高危因素。

Efficacy and impacts of air tamponade combined with vitrectomy in the treatment of rhegmatogenous retinal detachment

ObjectiveTo evaluate the efficacy and impacts of air tamponadein treating rhegmatogenous retinal detachments (RRD) including inferior breaks after 25G pars plana vitrectomy (PPV).MethodsA prospective non-randomized study. From November 2016 to December 2018, 110 RRD patients receiving PPV in the Ophthalmology Department of Affiliated Hospital of Nantong University were included in the study. All the patients choose the operation mode voluntarily after fully understand the condition and operation mode. There were 90 eyes in the air filling group and 20 eyes in the silicone oil filling group. There was no difference of age (t=－0.082), sex ratio (χ2=1.538), left or right eye (χ2=0.839), average course of disease (Z=－0.276), intraocular pressure (t=3.669), axial length (t=0.765), grade of proliferative vitreous retinopathy (Z=－2.101), high myopia (χ2=0.013), lens state (χ2=1.275), logMAR BCVA (t=－0.681), the scope of retinal detachment (t=0.970), the site (χ2=0.108) and numbers (t=0.158) of the retinal holes, whether involving macula (χ2=1.791) between the two groups (P＞0.05). At 1, 3, and 6 months after surgery, the first retinal reduction rate, BCVA increase rate, visual recovery rate, intraocular pressure, fovea retinal thickness (CFT), ellipsoid and cross sectional area, and the occurrence of postoperative complications in the two groups were observed and compared. Independent sample t test and Chi-squared test, Mann-Whitney U test, and ANOVA were used for data comparision.ResultsAfter the first operation, retinal reattachmnents were achieved in 87 eyes (96.6%) in the air group and 19 eyes (95.0%) in the silicone oil group (χ2=0.130, P＞0.05). In the air group and the silicone oil group, there were 7 and 2 eyes with subretinal holes, whose retinal reattachmnents were achieved. At 6 months after surgery, logMAR BCVA of the eyes in the air group and the silicone oil group were 0.23±0.23 and 0.37±0.23, respectively. All of them were higher than that before operation (t=－2.410, P＜0.001). BCVA in the air group was superior to that in the silicone oil group (P＜0.05). The increase rate of BCVA of the eyes in the air group and the silicone oil group were 0.69±0.28 and 0.48±0.30 logMAR units, respectively (t=－3.225, P＜0.05). The CFT of the eyes in the air group and the silicone oil group were 226.87±42.30 μm and 234.83±36.10 μm, respectively (t=－0.448, P=0.657). In the air group and silicone oil group, posterior cataract was observed in 15 and 4 eyes, subretinal residual fluid in 1 and 2 eyes, and visual object deformation in 3 eyes respectively. In the air group and silicone oil group, posterior cataract was observed in 15 and 4 eyes, subretinal residual fluid in 1 and 2 eyes, and visual object deformation in 3 eyes respectively.ConclusionsAir filling combined with PPV can effectively treat RRD, which is suitable for both superior and inferior holes. The visual acuity recovered well and the complication is less. The time of retinal detachment (especially the time of macular detachment) is an important factor affecting the prognosis.

Clinical outcomes of vitrectomy with internal limiting membrane peeling and air tamponade in the treatment of idiopathic macular hole

ObjectiveTo observe the clinical effect of vitrectomy with internal limiting membrane peeling and air tamponade in the treatment of idiopathic macular hole (IMH).MethodsA prospective, non-randomized controlled case cohort study. Twenty eyes of 20 patients with IMH in Ophthamology Department of The Second Hospital of Jilin University from September 2016 to January 2017 were included in this study. There were 4 males (4 eyes) and 16 females (16 eyes), with the mean age of 60.60±9.50 years and the mean disease course of 9.55±15.5 months. The stage of macular hole ranged from Ⅱ to Ⅳ. All patients underwent BCVA, intraocular pressure, spectral-domain OCT (SD-OCT) and multifocal ERG examinations. The BCVA examination was performed using the international standard visual acuity chart, which was converted into logMAR visual acuity. The minimum diameter (MIN), bottom diameter (BD), height (H), the defective diameter of ellipsoid zone, the defective diameter of external limiting membrane (ELM) of the macular hole were measured by SD-OCT (German Heidelberg). Then the macular hole index (MHI=H/BD), hole traction index (THI=MD/BD) and hole diameter index (DHI=H/MD) were calculated. The response density in P1 wave was detected by mf-ERG. The logMAR BCVA was 1.18±0.54. There were 5 eyes with less than 400 μm MIN, 13 eyes with 400-700 μm MIN and 2 eyes with over than 700 μm MIN. All the patients were underwent vitrectomy with internal limiting membrane peeling and air tamponade. According to the SD-OCT image features after surgery, IMH closure was divided into type Ⅰ closed, type Ⅱ closed and unclosed. The follow-up was equal or greater than 3 months. The closure rate of IMH, BCVA and the changes of microstructure parameters of macular area were observed. Spearman correlation analysis was used to analyze the correlation between BCVA and the wave response density in P1 before surgery and the efficacy after IMH surgery.ResultsClosure rate of IMH: 18 eyes (90.0%) were completely closed (all type Ⅰ closed). The closure rate of macular hole with the MIN less than 400 μm was 100.0% (5/5), 400-700 μm was 92.3% (12/13), and over than 700 μm was 50% (1/2). BCVA: the mean logMAR BCVA at 1 week, 1 month, 3 months after surgery were 0.83±0.54, 0.65±0.41, 0.48±0.34, and there was statistically significant difference between preoperative and postoperative BCVA (t=3.382, 4.459, 5.250; P=0.003, 0.007, 0.004). The outcomes of SD-OCT at 3 months after surgery: 18 eyes (90.0%) with intact ELM. The defective diameter of ellipsoid zone was 260.34±272.08 μm, there was statistically significant difference between before and after surgery (t=13.545, P=0.002). The outcomes of mf-ERG: the P1 wave response density of the ring 1 and ring 2 after surgery were increased compared with before surgery (t=-16.748, -6.151; P＜0.01,＜0.01). The results of Spearman correlation analysis: there was a positive correlation between postoperative BCVA and preoperative MIN, the defective diameter of ellipsoid zone and ELM, and postoperative the defective diameter of ellipsoid zone (r=0.56, 0.59, 0.68, 0.52; P=0.010, 0.006, 0.001, 0.019). The postoperative BCVA was negatively correlated with the P1 wave response density of ring 1 and ring 2 of mf-ERG (r=－0.34, －0.16; P=0.006, 0.020). The IMH closure had a significant negative correlation with MIN and the defective diameter of ELM (r=－0.449, －0.449; P=0.047, 0.047). MHI and THI were positively correlated with the closure of the hole (r=0.474, 0.546; P=0.035, 0.013). Intraocular pressure increased in 2 eyes during the follow-up period, and returned to normal within 1 week after the administration of antihypertensive drugs. There were no complications during or after the operation.ConclusionsVitrectomy with internal limiting membrane peeling and air tamponade in the treatment of IMH is safe and effective. The MIN, MHI THI are significantly correlated with the curative effect after IMH surgery, which could be used as the index to predict and evaluate the curative effect. The response density of ring 1 and ring 2 in P1 wave of mf-ERG is signifi-cantly improved compared with before surgery, and which is negatively correlated with BCVA.

Study on the Tolerance of Two Nebulization Inhalation in Postoperative Patients with Laryngeal Cancer

【摘要】目的探讨喉癌手术后患者对两种不同雾化方式的耐受性,为选择最佳雾化方式提供参考。方法将49例喉癌手术后患者随机分为观察组(25例)和对照组(24例),观察组采用氧气雾化吸入,对照组采用空气压缩泵雾化吸入。分别记录两组患者雾化吸入前及吸入15 min时脉搏血氧饱和度(SpO2)及心率;雾化过程中患者有无心慌、气紧等不适以及雾化后痰液的性质及量。采用SPSS 13.0软件进行统计分析。结果两组患者雾化吸入15 min时的SpO2差异有统计学意义(Plt;001),观察组高于对照组;而两组患者雾化吸入前SpO2、心率、不适主诉及雾化后痰液的性质差异均无统计学意义(Pgt;005)。结论氧气雾化吸入可以提高喉癌手术后患者雾化过程中的SpO2,使患者感觉更加舒适。【Abstract】Objective To investigate postoperative patients with laryngeal carcinoma atomization of two different forms of tolerance, in order to choose the best means of atomization. Methods Fifty postoperative patients with laryngeal carcinoma were divided into observation group using oxygen inhalation and control group using the air compression pump inhalation. Two groups of patients were recorded the value of SpO2 and heart rate before 15 minutes after the inhalation,as well as the discomforts such as flustered,gas tight during the atomization process and the nature and olume of sputum. Results The results of two groups of patients at the time of 15 minutes inhalation SpO2 statistically significant difference (Plt;001), the observation group than in the control group average SpO2 high; and two groups of patients with preinhalation SpO2 average, average heart rate, Discomfort chief complaint and the nature of sputum after aerosol compared no significant difference (Pgt;005). Conclusion Oxygen inhalation in patients with laryngeal cancer can improve the atomization process SpO2 value, so that patients feel more comfortable.

急诊输液室空气消毒方法的探讨

【摘要】目的 探讨急诊输液室空气消毒最佳时机,以确保其室内空气质量达标。 方法 准备面积一样,通风条件相似的输液室两间分别为实验组和对照组,在正常输液时间内随机安排输液患者,实验组采用动态空气消毒机对输液室进行空气消毒,对照组采用通风的方式,3 h为一时间段,时间段内,患者数达到5～9人、10～15人、16～30人时分别采样。结果 试验组空气能够达标,对照组当患者数在3 h内超过15～30人时,空气中菌落数开始增加。 结论 输液室的空气消毒应随着患者数的改变而改变,不能机械地执行每日消毒两次,并且如果采取通风和臭氧联合消毒的方法效果会更好。