0引言野战手术方舱，可对多种突发急重症的伤病员进行早期就地手术救治，尤其在抢险救灾中发挥着不可替代的作用[1]。野战手术方舱救治患者多来源于急性创伤，其具有创伤重、失血多、伤情复杂的特点，极易发生手术中低体温。现将野战手术方舱中实施手术时所导致术中低体温的主要原因分析及对策总结如下。

Objective To investigate 3D imaging laparoscopy system in surgery. Methods Totally 84 cases of 3D laparoscopic operation from November 2013 to February 2014 were enrolled in the study, including 12 ones of single port cholecystectomy, 15 ones of single port appendectomy, 5 ones of radical resection of rectal carcinoma, 4 ones of radical resection of right colon carcinoma, 4 ones of radical resection of lung cancer, 4 ones of pulmonary lobectomy, 6 ones of adrenal tumor resection, 2 ones of renal cyst decortication, 4 ones of heminephrectomy, 3 ones of radical nephrectomy of renal carcinoma and 25 ones of complete hysterectomy. The data on operating time, blood loss, post-operation hospital stay and etc were summarized. Results All the 84 cases were successfully completed, with the operating time less than that with 2D laparoscope by 30 min to 70 min, transoperative blood loss from 30 m L to 350 m L, and post-operation hospital stay from 2 d to 7 d and the mean one of 5 d. Conclusion 3D laparoscope with preset charge coupled device(CCD)can show clearly 3D visual operative field, vessels, nerves, tissues and anatomical position, and thus decrease the operation difficulty and time. 3D laparoscopy system gains the advantages of laparoscopic and open surgeries, with precision dissection, easy saturation and few complications.

0 引言 随着医院腔镜手术的深入普及,越来越多的学科选择了微创术式.由于腔镜器械精密、昂贵,往往基数配备不足,而传统的高温高压和消毒浸泡又难以满足手术周转的需求.低温等离子灭菌器的诞生解决了这一难题,也使它成为了手术腔镜器械消毒中不可缺少的医疗设备.

<正>现代医院手术室中存在着诸多职业危害因素[1],已成为不可忽视的问题。近年来,手术室人员职业危害已引起广泛重视[2],如何做好手术室人员的职业防护,最大限度地保障手术室人员的身体健康十分重要[3]。现将近几年发现的手术室存在的危

<正>随着医院信息管理建设的发展,采用射频识别(RFID)技术,解决手术室大量手术器械的管理势在必行。我院手术室对手术器械采用了RFID技术管理,实现了手术器械管理信息化、规范化,提高了手

盐酸戊乙奎醚是新型抗胆碱药,已广泛用于临床.近年,有关该药在改善微循环和保护器官方面的研究取得一些进展,本研究拟对其用于体外循环时对肾脏的保护作用进行研究.

Objective To evaluate epidemiology of mutations in the gyrA and parC genes leading to possible increase in ciprofloxacin resistance in clinical isolates of Acinetobacter baumannii.Methods Minimum inhibitory concentration(MIC)of ciprofloxacin to 94 clinical isolates of Acinetobacter baumannii were detected with the Etest method,gyrA and parC genes of these isolates were analysed by PCR-RFLP analysis and DNA sequence.Results Out of the 94 clinical isolates tested,only 38(40.43%)strains were found to be susceptible to ciprofloxacin(MIC≤1 mg/L),the resistant rate of these isolates against ciprofloxacin was near 60%.PCR-RFLP analysis revealed that 56 ciprofloxacin-resistant strains had mutation in gyrA and parC genes,the mutation rate of parC gene(87.50%)was slightly higher than that of gyrA gene(82.14%).Conclusion Resistant to ciprofloxacin of Acinetobacter baumannii is related with the mutations in the gyrA and parC genes,the increase of the mutation in the parC should be paid attention.

Objective To evaluate epidemiology of mutations in the gyrA and parC genes leading to possible increase in ciprofloxacin resistance in clinical isolates of Acinetobacter baumannii.Methods Minimum inhibitory concentration(MIC)of ciprofloxacin to 94 clinical isolates of Acinetobacter baumannii were detected with the Etest method,gyrA and parC genes of these isolates were analysed by PCR-RFLP analysis and DNA sequence.Results Out of the 94 clinical isolates tested,only 38(40.43%)strains were found to be susceptible to ciprofloxacin(MIC≤1 mg/L),the resistant rate of these isolates against ciprofloxacin was near 60%.PCR-RFLP analysis revealed that 56 ciprofloxacin-resistant strains had mutation in gyrA and parC genes,the mutation rate of parC gene(87.50%)was slightly higher than that of gyrA gene(82.14%).Conclusion Resistant to ciprofloxacin of Acinetobacter baumannii is related with the mutations in the gyrA and parC genes,the increase of the mutation in the parC should be paid attention.

Objective To solve the shortage of supplies in the operation module, reduce inventory links, save manpower, and improve the ability of emergency surgery so that the management of operation module is effectively improved. Methods Both sealing management and open management are adopted and compared in the checking time and the unwounded rate in one month before and after using the two methods. Results There was a significant difference (P0.05) in the unwounded rate between the sealing management and open management. Conclusion Sealing management, an effective nursing measures in emergency affairs, can not only improve the control of the quantity and quality of anaesthesia and first-aid medicine and apparatus, but also save the manpower in operation room.

我们分析了103例乳腺癌根治术病人的心理特点并进行了针对性心理指导,促进了身心健康.

OBJECTIVE:To study the risk factors of Acinetobacter baummanii in nosocomial infections, and to verify the nature of Acinetobacter baumannii strains isolated from intensive care unit (ICU).METHODS:A hundred and fourty patients associated with nosocomial infection of Acinetobacter baummanii from four teaching hospitals were selected and compared with controls through a case control study to identify risk factors. The strains isolated from the ICU were typed by polymerase chain reaction (PCR) with the primer M(13) following electrophoresis in agarose gel.RESULTS:The odds ratios (ORs) were: state of the illness (OR = 8.69), using immunosuppressant (OR = 4.85), mechanical ventilation (OR = 3.68) and treatment with 3 kinds of antibiotics (OR = 3.014). Data from PCR studies indicated that these strains were sharing identical band pattern from the five strains.CONCLUSION:Risk factors for nosocomial infection with Acinetobacter baummanii included state of an illness, immunosuppressant, mechanical ventilation, and treatment with antibiotics. A multidrug-resistant strains of Acinetobacter baumannii was identified in ICU.

目的运用重复片段引物PCR的分析方法对鲍曼不动杆菌进行分子分型研究.方法选用肠杆菌科基因间的的重复序列(ERIC)为引物进行PCR扩增,对22株鲍曼不动杆菌进行分型研究,并与生物学分型及抗生素耐药结果进行比较.结果经重复片段引物PCR的方法,分离出6种不同基因型的鲍曼不动杆菌,而生物学分型只有2种,且与抗生素谱较为相关.结论该方法简便易行,且重复性好,适合于医院感染流行病学研究.

目的探讨百特泵镇痛的副作用.方法观察了1994年5月至2001年4月,941例术后应用百特镇痛泵的癌症病人共7个癌种,计算其副作用发生率.结果 941例癌症病人术后采用百特镇痛泵的效果均达到临床要求,病人镇痛满意率达98.0%,但一些病人发生了搔痒,恶心呕吐、低血压、尿潴留等副作用.结论临床应用百特镇痛泵时应重视其引起的副作用.

手术是治疗腹主动脉瘤(AAA)的有效方法,但对于那些小的甚至是无症状的AAA暂不需手术,却又不能任其发展,故近年来寻求药物治疗途径抑制Ⅳ型胶原酶的分泌,以达到阻止AAA的发生、发展的目的.本实验研究消炎痛对AAA中Ⅳ型胶原酶的作用,以探讨其临床应用价值. 　　材料与方法 　　1.实验动物及分组:选用Wistar大鼠24只(由中国医科大学实验动物部提供),体重250～300g,随机分两组,每组为 12只,消炎痛组:术后用消炎痛1.6mg每日皮下注射,至术后 7d处死.盐水对照组:皮下注射等量生理盐水.

目的观察术前心理疏导与否对癌症病人血压、心率的影响.方法30例癌症手术病人简单随机分为两组,年龄与病情等具有可比性,除心理疏导与否外,其它术前准备一致.以Omega1445无创血流自动监测仪记录病人心理疏导前和心理疏导后1、3、5、10、15、30分及术毕的血压心率变化.结果两组有显著性差异.结论癌症病人的术前心理疏导工作应引起临床医护人员的重视.

目的研究手术期间中心吸引器接口污染对肿瘤细胞种植的影响.方法对55例恶性肿瘤手术患者所使用的吸引器上接口(即墙壁接口)管腔内外两面以无菌操作方法取样装入试管,另取一棉签同法在下接口(与手术台连接口)管腔内外两面采样,同时送检.经35℃24小时细胞计数.结果55例恶性肿瘤手术患者所使用的吸引器下接口肿瘤细胞数均＞2CUF/cm2,＞60CFU/cm2者28例,占50.9%(28/55).结论本结果提示手术期间中心吸引器接口的污染对肿瘤细胞的种植有明显影响,应对吸引器下接口的清理有充分的认识,以避免因中心吸引器接口污染而导致肿瘤细胞种植的发生.

目的探讨彩色多普勒超声在慢性肾功不全诊断中的价值及对临床的指导意义.方法应用彩色多普勒成像技术对不同病因慢性肾功不全55例患者的肾脏大小、形态及肾动脉血流分布、频谱特征、血流参数、皮质的厚度进行检测分析.结果在慢性肾功不全时双肾皮质明显变薄,肾动脉及分支血流信号分布有逐渐减弱甚至消失的趋势,主肾动脉显示率96%(53/55),段动脉显示率94%(52/55),弓形动脉显示率0(0/55).各级动脉频谱波峰变钝,舒张期充盈曲线低平,空心层流消失,弓形动脉频谱不易测得.肾动脉血流参数表明,主肾动脉至分支血流速度明显降低呈低速高阻血流,阻力指数、搏动指数增大.结论从肾皮质厚度、血流信号分布、频谱形态及血流参数的异常可以迅速了解病情,监测治疗,评估愈后,为慢性肾功不全的全面诊断提供更加完善的依据.