目的 采用已有的4种国际非孕弥散性血管内凝血（DIC）诊断评分标准对产科DIC的诊断进行评估，探索更适合产科DIC诊断的“金标准”。 方法 选择2009年6月－2012年6月期间产科拟诊DIC的孕产妇为研究对象，用日本卫生福利部（JMHW）提出的JMHW、日本危重病协会（JAAM）提出的JAAM、国际血栓与止血委员会（ISTH）提出的ISTH显性和ISTH非显性4种诊断评分标准联合诊断和构建“金标准”，以此评价4种诊断标准对产科DIC诊断的特性。 结果 受试者工作特征（ROC）曲线分析显示ISTH非显性标准、ISTH显性标准、JMHW、JAAM的ROC曲线下面积分别为0.939、0.865、0.867、0.867，ISTH非显性标准灵敏度和特异度与“金标准”在不同诊断界值时较一致，同时优于其他3种诊断标准。 结论 ISTH非显性标准较适合作为临床产科DIC诊断，其对产科这一特殊发病人群的DIC诊断具有更科学的临床诊断价值。
ObjectiveTo explore a better hygienic hand disinfection method to improve hand hygiene compliance, by evaluating and comparing the disinfection effects and the economic and time cost expenditures of three different types of hygienic hand disinfection methods.MethodsFrom March to July 2016, patients undergoing blood collection were randomly divided into three groups, and five blood collection nurses used one different type of hygienic hand disinfection method in each group when performing blood collection operation on the patients, including: direct hygienic hand disinfection (group A); wearing gloves, and doing hygienic hand disinfection without putting off gloves (group B); and changing gloves for each patient, and doing hygienic hand disinfection after putting off gloves (group C). Two hundred and ten specimens of the nurses’ hands or gloves surface after hand hygiene were collected from each group for the comparison of hygienic hand disinfection effect, and the differences in economic cost and time cost were compared.ResultsThe passing rates of the disinfection effect of the three different types of sanitary hand disinfection methods were all 100%. The economic cost of group A, B, and C was 9.66, 21.98, and 185.66 yuan, respectively, and the time cost of group A, B, and C was 5 250, 6 860, and 14 700 seconds, respectively. No sharp injury occurred.ConclusionSince direct hygienic hand disinfection does not implement the standard prevention principle, the method of wearing gloves and doing hygienic hand disinfection without putting off gloves is the best in the three different hygienic hand disinfection methods, which not only has the same disinfection effect, but also can save economic cost and time cost, which may improve the medical personnel’s hand hygiene compliance.
ObjectiveTo investigate whether the technical modifications regarding the risk factors related to the partial necrosis of the distally pedicled sural flap could reduce the partial necrosis rate of the flap.MethodsA clinical data of 254 patients (256 sites) (modified group), who used modified technique to design and cut distally pedicled sural flaps to repair the distal soft tissue defects of the lower limbs between April 2010 and December 2019, was retrospectively analyzed. Between April 2001 and March 2010, 175 patients (179 sites) (control group) who used the traditional method to design and cut the skin flap to repair the distal soft tissue defects of the lower limbs were compared. Various technical modifications were used to lower the top-edge of the flap, reduce the length-width ratio (LWR) of the flap and width of the skin island. There was no significant difference in gender, age, etiology, duration from injury to operation, site and area of the soft tissue defect between groups (P>0.05). The length and width of the skin island and adipofascial pedicle, the total length of the flap and LWR, and the pivot point position were measured and recorded. The top-edge of the flap was determined according to the division of 9 zones in the posterior aspect of the lower limb. The occurrence of partial necrosis of the flap and the success rate of defect reconstruction were observed postoperatively.ResultsThere was no significant difference in the length and width of the skin island, the length of the adipofascial pedicle, total length and LWR of the flap, and pivot point position of the flap between groups (P>0.05). The width of the adipofasical pedicle in modified group was significant higher than that in control group (t=–2.019, P=0.044). The top-edge of 32 flaps (17.88%) in control group and 31 flaps (12.11%) in modified group were located at the 9th zone; the constituent ratio of the LWR more than 5∶1 in modified group (42.58%, 109/256) was higher than that in control group (42.46%, 76/179); and the constituent ratio of width of skin island more than 8 cm in control group (59.78%, 107/179) was higher than that in modified group (57.42%, 147/256). There was no significant difference in the above indicators between groups (P>0.05). In control group, 155 flaps (86.59%) survived completely, 24 flaps (13.41%) exhibited partial necrosis. Among them, 21 wounds healed after symptomatic treatments, 3 cases were amputated. The success rate of defects reconstruction was 98.32% (176/179). In modified group, 241 flaps (94.14%) survived completely, 15 flaps (5.86%) exhibited partial necrosis. Among them, 14 wounds healed after symptomatic treatments, 1 case was amputated. The success rate of defect reconstruction was 99.61% (255/256). The partial necrosis rate in modified group was significantly lower than that in control group (χ2=7.354, P=0.007). There was no significant difference in the success rate between the two groups (P=0.310). All patients in both groups were followed up 1 to 131 months (median, 9.5 months). All wounds in the donor and recipient sites healed well.ConclusionThe partial necrosis rate of the distally based sural flap can be decreased effectively by applying personalized modified technical for specific patients.
Objective To evaluate the disinfection efficacy of alcohol-based hand disinfectants for medical glove surface in continuous operation, and explore approaches of improving hand hygiene compliance. Methods Between March and July 2015, and between March and July 2016, all the nurses (n=5) in Blood Collection Room of Outpatient Department with many patients and frequent sterile operation needed were included in this study. Nurses wearing gloves for hand hygiene and disinfection between March and July 2016 were regarded as the observation group, and those who used alcohol-based disinfectants for routine hand hygiene without gloves between March and July 2015 were designated into the control group. The hand hygiene compliance was compared between the two groups. From March to July 2016, alcohol-based hand disinfectants were used for disinfection on the glove surface during continuous blood sampling by nurses with gloves on their hands. Fifty samples were collected respectively after the gloves were used for 1, 2, 5, 10, and 15 continuous times for blood sampling. Then, the samples were sent to the bacteriology room for culture. Results All of the 250 samples were qualified, and the bacterial colonies on the surface of gloves were equal to 10 cfu/mL2 or lower. NoStaphylococcus aureus,Escherichiacoli or other pathogens were detected on the glove surface. However, after the gloves were continuously used for 15 times, the gloves of two nurses could not meet the research criteria again because of significant sweating. Conclusions In the process of continuous blood sampling, it is effective to use alcohol-based hand disinfectants to disinfect the surface of medical gloves, which can promote hand hygiene compliance to a certain extent. However, there is a certain limit on the times of usage for medical gloves.