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Therapeutic and Management of 25 Cases Gas Gangrene in Earthquake Injury

目的:总结分析25例地震伤致气性坏疽伤员的救治经验，探讨救治方案，为临床工作提高参考。方法:回顾性研究25例地震伤致气性坏疽伤员的早期临床表现，诊断方法，隔离措施、临床管理及其预后。结果:共收治25例气性坏疽伤员，无一例死亡。院外诊断7例，院内诊断18例。截肢18例，开放性截肢12例，非开放性截肢6例；扩创7例。发生急性肾功能衰竭2例，行血液透析治疗后肾功能恢复；无院内交叉感染的发生。结论:早期诊断、治疗、早期隔离及全面、系统护理可以提高临床救治水平，改善患者的预后，避免院内交叉感染的发生。

Clinical Analysis on Diagnosis and Treatment for Patients with Pulmonary Sequestration

目的　总结肺隔离症的临床特点、诊断方法及治疗的经验，降低误诊率，提高治疗水平。 方法　回顾性分析福州总医院2002年7月－2012年6月收治的27例肺隔离症患者的临床诊治手段。 结果　27例肺隔离症患者中，术前确诊仅有18例，误诊为肺部良性肿瘤3例，肺脓肿3例，支气管扩张2例，纵隔肿瘤1例。行外科切除的患者有19例，其中13例经胸腔镜手术，6例开胸手术，均无复发；行支气管动脉数字减影血管造影栓塞术8例，其中再发咯血1例来院行手术治疗。 结论　外科治疗是目前肺隔离症治疗的主要方法。围手术期积极控制感染对治疗的成功有显著意义。

Right visual double lumen endotracheal tube versus common right double lumen endotracheal tube lung isolation technique: A randomized controlled study

ObjectiveTo compare the clinical efficacy between right visual double lumen tube (VDLT) intubation and right common double lumen tube (DLT) intubation in lung isolation technique. MethodsA total of 57 patients undergoing thoracoscopic surgery with right DLT lung isolation technique in the First People's Hospital of Chenzhou City and West China Hospital from June 2020 to June 2021 were randomly divided into two groups: a DLT group (n=29, 16 males and 13 females, with a mean age of 54.3±13.2 years) and a VDLT group (n=28, 18 males and 10 females, with a mean age of 55.1±13.7 years) at 1 : 1 with random number table generated by the computer. The clinical data of the two groups were compared. ResultsCompared with the DLT group, the catheter positioning time in the VDLT group was statistically shorter (74.9±47.5 s vs. 151.6±88.9 s, P<0.001), the right upper lung occlusion rate (21.4% vs. 51.7%) and the intraoperative re-adjustment catheterization rate (14.3% vs. 48.3%) were lower (P<0.05). The quality of lung collapses immediately after thoracotomy (67.9% vs. 24.1%) and 20 minutes after thoracotomy (100.0% vs. 75.9%) were improved (P<0.05). There was no significant difference in the rate of fiberoptic bronchoscope assistance for positioning, or the incidence of pharynx pain and hoarseness between the two groups (P>0.05). ConclusionCompared with common DLT, VDLT is more efficient, accurate and intuitive in the location of right bronchial intubation.

肺隔离症的诊断与外科治疗

目的 总结肺隔离症的诊断及外科治疗经验，以提高治疗效果。 方法 1958年1月至2007年12月共手术治疗肺隔离症患者63例，男36例，女27例；年龄2个月～69岁。63例隔离肺位于左肺39例，右肺24例；肺内型48例，肺外型15例。行左肺下叶切除术28例及并行胸膜纤维板剥脱术1例，右肺下叶切除术19例，左肺楔形切除术7例，右肺楔形切除术3例，右双肺叶切除术2例，左全肺切除术2例，左侧肺段切除术1例。异常血管来源于胸主动脉36例，腹主动脉25例，肋间动脉2例，血管直径1.5~15.0 mm。 结果 围术期死于术后呼吸衰竭1例。发生脓胸1例，经相应的治疗治愈，其余患者均痊愈出院。随访24例，随访时间2个月～5年，其中1例食管癌患者于术后1年因癌肿复发死亡，其余患者恢复正常生活或工作。 结论 CT增强扫描血管成像术等检查能较好地显示肺隔离症的病变特征，其治疗方法以外科手术为主。

咯血患儿肺叶切除术麻醉管理一例

The Diagnosis and Surgical Treatment of Pulmonary Sequestration

Abstract: Objective To summarize the clinical experiences and surgical treatment of pulmonary sequestration (PS) in order to improve the diagnosis and treatment of PS. Methods Between August 1993 and February 2007, our department enrolled 21 PS patients, 8 male patients and 13 female patients, with the age ranging from 13 to 70 years old. The patients were examined by chest radiography, computerized tomography (CT), computerized tomography angiography (CTA), magnetic resonance imaging (MRI), position emission tomographyCT(PET-CT) before the surgery. Sequestrectomy was performed on patients with extralobar sequestration (ELS) and lobectomy was performed on patients with intralobar sequestration (ILS). There were 10 cases of left lower lobectomy, 3 cases of right lower lobectomy, 4 cases of left sequestrectomy, 3 cases of right sequestrectomy and 1 case of total pneumonectomy. Results Postoperative pathology confirmed all cases of PS, including 7 cases of ELS and 14 cases of ILS. Seven patients were diagnosed to have PS by preoperative diagnostic procedures. During the surgery, we found aberrant supporting arteries from the general circulation in 18 cases among which 11 were supported by the thoracic aorta, 6 by the abdominal aorta and 1 by both the thoracic and abdominal aorta. The diameter of the aberrant artery was between 0.2 cm and 1.1 cm (mean 0.7 cm). Double ligation and transfixion were performed during the operation. In addition, we found venous drainage through the inferior pulmonary vein in 3 patients and double ligation was performed. No perioperative death or complications occurred. Followup was done till January 2009 on all the patients but one with a followup rate of 95.2% (20/21). The followup time ranged from 12 to 67 months. All patients survived well except that 1 died from liver metastasis 2 years after the operation because of lung cancer. Conclusion PS is rare and its symptoms are nonspecific, which can cause misdiagnosis and missed diagnosis. The diagnosis of PS mainly depends on CT, CTA, MRI and selected arteriography. Once diagnosed, PS should be removed by surgery. During the surgery, aberrant vessels should be separated and treated with double ligation and transfixion. As for those big aberrant vessels, transfixion can be performed after vascular decompression.

主动脉夹层动脉瘤腔内隔离术后并发急性脊髓缺血损伤一例护理

Investigation and reflection on the hand hygiene status of nursing staff in coronavirus disease 2019 isolation ward

ObjectiveTo investigate the hand hygiene status of nursing staff in coronavirus disease 2019 (COVID-19) isolation ward, find out the difficulties and problems in hand hygiene implementation, and then put forward scientific and feasible suggestions to improve the compliance of hand hygiene.MethodsSelf-designed Questionnaire on Hand Hygiene Status of Nursing Staff in COVID-19 Isolation Ward was distributed through the Wenjuanxing, a platform to collect data. The questionnaire, which included general information, knowledge related to hand hygiene, and the status of hand hygiene in isolation ward, was distributed to the nurses working in isolation wards in Wuhan, Hubei Province from March 15th, 2020 to March 22nd, 2020.ResultsValid questionnaires were collected from 492 nurses. The difficulty in performing hand hygiene in the isolation ward was ranked ≥level 3 by 248 nurses (50.41%), the degree of which was divided into 10 levels (level 1 was no difficulty, level 10 was the most difficult). A total of 369 participants (75.00%) thought that wearing gloves for hand disinfection would damage the gloves. There were 161 participants who thought that gloves should be changed every 2 hours, accounting for the largest proportion (32.72%); while 226 participants actually changed gloves every 4 hours, accounting for the largest proportion (45.93%).ConclusionsThe difficulty of performing hand hygiene in isolation ward should be paid attention to. It is recommended to carry out further research on the replacement time of gloves.

升主动脉隔离装置在升主动脉近端钙化患者非体外循环冠状动脉旁路移植术中的应用

摘要： 目的 评价升主动脉近端隔离装置（Heartstring和Enclose近端吻合装置）在非体外循环冠状动脉旁路移植术（OPCAB）中的应用效果。 方法 2006年1月至2008年2月收治了150例合并升主动脉近端钙化的冠心病患者，其中男102例，女48例；年龄55～78岁，平均年龄69岁。所有患者在冠状动脉旁路移植术中应用升主动脉近端隔离装置，大隐静脉与升主动脉近端共完成251个吻合口，升主动脉近端吻合口1～3个/例，大隐静脉桥血管完成后应用流量仪进行流量测定。术后观察神经系统并发症的发生情况。 结果 术后死于低心排血量综合征1例（067%）；二次开胸止血2例，其中1例为乳内动脉床渗血，1例为胸骨后出血；其余患者术后24 ｈ胸腔引流量为100～200 ml。所有患者均于术后24～48 ｈ内顺利拔除气管内插管；术后均未出现明确的昏迷、肢体偏瘫、语言障碍及运动不协调等神经系统并发症；大隐静脉桥血流量为28.5～70.1 L/min（53.7± 23.9 L/min）。术后随访145例，随访率97.32%，随访时间3个月～1年；4例失访。随访期间患者未发生迟发性脑出血或脑梗死等神经系统并发症。结论 在OPCAB术中应用Heartstring和Enclose升主动脉近端隔离装置，安全、有效，能有效地降低脑卒中的发生率。

21例肺隔离症的外科治疗

目的 总结肺隔离症的外科治疗经验，以提高诊治水平。 方法 回顾分析1990年5月～2006年4月收治21例肺隔离症患者的临床资料，其中叶内型18例，均行病变肺叶切除术；叶外型3例，行肺局部隔离病变切除。术前明确诊断14例，误诊7例。 结果 全部患者均经外科手术治愈,无并发症发生。随访 6个月~9年，2例失访，其余19例无复发，均健在。 结论 肺隔离症是一种少见的先天性肺发育畸形疾病，临床常误诊为支气管扩张、肺囊肿和肺癌。手术治疗肺隔离症是较为有效的方法。