目的:为肿瘤骨转移患者压疮预防的方法进行总结评价以达到对临床肿瘤压疮进行指导。方法:采用改良后的诺顿评估表（信度0.80，效度0.84）作为压疮易患患者评估工具。评估内容包括患者年龄、身体状况、意识、活动能力、运动受限情况、疼痛、皮肤情况、大小便失禁、饮食、进食能力、口腔情况、牙齿及患者血色素、蛋白等资料。评估时间从患者入院开始，对30例肿瘤全身多处骨转移患者进行评估，有预见性、计划性，针对性及个体化对患者制订护理计划及措施，并督促实施，对效果进行评价分析。结果:≤25分高危险性患者（难以避免）发生率50％，26～29分中度危险性患者（可避免）发生率0，≥30分低危险性患者发生率14.2％。效果评价:压疮预防评估对肿瘤骨转移患者压疮的预防是有效的，压疮评估有助于规范护理行为和护理管理；通过分析找出护理过程中的薄弱环节，以利于指导临床工作。
Objective To investigate the clinical effect of polylactic acid membrane in prevention of epidural scar and adhesion. Methods From July 1998 to April 2000, 62 patients with lumbar disc herniation were randomly assigned into two groups. All were treated surgically with discectomy by fenestration or laminectomy.One group were placed with a thin of polylactic acid membrane covering the interlaminar space(n=32). The thickness of the film was 0.1mm. The other group was blank control(n=30). After 2 weeks of operation, we observed the local and systemic reactions. After 6 months clinical symptoms were revaluated and the degrees of epidural scar and adhesion were determined by CT scans. Results After 2 weeks, we found no adverse systemic reactions in all patients. Wound healing was excellent. No abnormalities of hepatic and renal functions as well as blood for routine were found. Temperature after operation was normal. After 6 months, the curative effects were as follows in experimental group and in control group: excellent in 27 patients and in 24 patients, good in 4 patients and in 4 patients, fair in 1 patient and in 1 patient, and poor in 0 patient and in 1 patient, respectively. There are no significant difference between two groups. The CT scans showed no adhesion between the epidural scar and the dural sac in all patients of experimental group. There existed various extents of adhesion in control group. Conclusion The results demonstrate that the polylactic acidmembrane can effectively prevent the epidural scar adhesion with a good biocompatibility and no toxity. Its clinical application was promising.
目的:探讨腹腔镜胆囊切除术(LC)中胆管损伤的原因及防止。方法:回顾性分析我院531例成功487例LC患者的临床资料。结果:术中胆管损伤7例:其中胆总管横断3例,胆总管灼伤2例,右胆管损伤1例,副肝管损伤1例。结论:腹腔镜胆囊切除术(LC)术中正确判断解剖关系,正确解剖和显露Calot三角是防止损伤的技术关键,防止盲目电凝、钳夹止血,以及及时的中转开腹是预防胆管损伤的有效措施。
目的:探讨胆石症再次手术的原因及预防措施。方法:对我院过去5年收治的134例胆石症再次手术病例的临床资料进行回顾性分析。结果:胆石症再次手术主要原因为结石残留或复发(86.57%),医源性胆管损伤(4.48%),拔除T管后胆汁性腹膜炎(4.48%),残留胆囊炎伴结石(2.99%),胆肠吻合口狭窄伴结石(1.49%)等。再次手术方式以胆总管切开取石胆道镜检查取石“T”形管引流术、胆总管十二指肠侧侧吻合术,肝胆管空肠Roux-en-Y吻合术,肝叶段切除,残留胆囊切除术为主。本组患者痊愈131例,死亡3例,死亡率2.29%,术后残石率5.17%.结论:对于胆石症,无论是首次手术还是多次手术,均应做好术前检查,制定周密的手术计划,利用胆道外科和肝脏外科技术,努力贯彻去除病灶,解除梗阻,通畅引流三原则,力争将残石率、复发率、再手术率降低到最低限度。
预防和提高放射防护水平的关键在于获得放射照射的准确信息和有效的防护管理。放射防护涉及多方面的政策法规和影响因素,有国家和医疗机构对加强患者防护意识的培养,也有关于放射肿瘤学医生、放射物理师和技师需要掌握的信息,还有用于放射诊断、计划和治疗的放射设备学知识。这些不同门类的信息和方法应该在一个较好的管理平台上进行分类和运用,并给予有效地整合,才能降低临床工作中辐射的危害,获取医患双方的最大利益。