简介：AbstractBackground:A surgical site infection (SSI) is a major post-operative complication from elective colorectal surgery; however, few studies have focused on evaluating the risk factors for SSI. This study aimed to analyze the relative correlation of medical and environmental factors as well as patient-related factors that contribute to the incidence of all types of SSI.Methods:A retrospective search for eligible patients was conducted using the patient database of the Gastrointestinal Surgery Center of the Third Affiliated Hospital of Sun Yat-sen University from January 2011 to August 2017. Pre-operative demographic and surgical data were extracted and recoded according to the study protocol. Univariate and multivariate analyses were performed to clarify factors affecting the incidence of SSI. Propensity analysis was conducted to minimize bias in the demographic characteristics to explore the prophylactic effect of pre-operative administration of oral antibiotics.Results:Univariate analysis of the baseline characteristics revealed that younger age (odds ratio [OR]: 0.378; 95% confidence interval [CI]: 0.218–0.657) and pre-operative oral antibiotic use (OR: 0.465; 95% CI: 0.255–0.850) were protective factors, while pre-operative anemia (OR: 4.591; 95% CI: 2.567–8.211), neoadjuvant chemotherapy history (OR: 2.398; 95% CI: 1.094–5.256), and longer surgical duration (OR: 2.393; 95% CI: 1.349–4.246; P = 0.002) were identified as risk factors for SSI. Multivariate analysis indicated that age (P = 0.003), surgical duration (P = 0.001), and pre-operative oral antibiotic use (P < 0.001) were independent factors that affect the incidence of SSI. Furthermore, a propensity-matched analysis confirmed the protective effect of oral antibiotic use, with a 1-day course of oral antibiotic producing a similar effect to a 3-day course.Conclusions:Age, surgical duration, and pre-operative oral antibiotic use were associated with the incidence of SSI. However, pre-operative oral antibiotic use was the only controllable factor. From the results of our study, pre-operative oral antibiotic use is recommended before elective colorectal surgery and a 1-day course is enough to provide the protective effect.

简介：AbstractBackground:About 10% of patients get a surgical-site infection (SSI) after radical gastrectomy for gastric cancer, but SSI remains controversial among surgeons. The aim of this study was to explore the risk factors for SSIs after radical gastrectomy in patients with gastric cancer to guide clinical therapies and reduce the incidence of SSI.Methods:The study was a retrospective cohort study in patients who underwent radical gastrectomy for gastric cancer. SSI was defined in accordance with the National Nosocomial Infection Surveillance System. We evaluated patient-related and peri-operative variables that could be risk factors for SSIs. The Chi-squared test and logistic regression analysis were used to assess the association between these risk factors and SSI.Results:Among the 590 patients, 386 were men and 204 were women. The mean age was 56.6 (28-82) years and 14.2% (84/590) of these patients had an SSI. Among them, incisional SSI was observed in 23 patients (3.9%) and organ/space SSI in 61 patients (10.3%). Multivariate logistic regression analysis identified sex (odds ratios [ORs] = 2.548, and 95% confidence interval [CI]: 1.268-5.122, P = 0.009), total gastrectomy (OR = 2.327, 95% CI: 1.352-4.004, P = 0.002), albumin level (day 3 after surgery) <30 g/L (OR= 1.868, 95% CI: 1.066-3.274, P = 0.029), and post-operative total parenteral nutrition (OR = 2.318, 95% CI: 1.026-5.237, P = 0.043) as independent risk factors for SSI.Conclusions:SSI was common among patients after radical gastrectomy for gastric cancer. The method supporting post-operative nutrition and the duration of prophylactic antibiotics may be important modifiable influencing factors for SSI.

简介：AbstractPurpose:To introduced our experience with progressive extra-axial hematoma (EAH) in the original frontotemporoparietal (FTP) site after contralateral decompressive surgery (CDS) in traumatic brain injury patients and discuss the risk factors associated with this dangerous situation.Methods:This retrospective study was conducted on 941 patients with moderate or severe TBI treated in Daping Hospital, Army Medical University, Chongqing, China in a period over 5 years (2013-2017). Only patients with bilateral lesion, the contralateral side being the dominant lesion, and decompressive surgery on the contralateral side conducted firstly were included. Patients were exclude if (1) they underwent bilateral decompression or neurosurgery at the original location firstly; (2) although surgery was performed first on the contralateral side, surgery was done again at the contralateral side due to rebleeding or complications; (3) patients younger than 18 years or older than 80 years; and (4) patients with other significant organ injury or severe disorder or those with abnormal coagulation profiles. Clinical and radiographic variables reviewed were demographic data, trauma mechanisms, neurological condition assessed by Glasgow coma scale (GCS) score at admission, pupil size and reactivity, use of mannitol, time interval from trauma to surgery, Rotterdam CT classification, type and volume of EAH, presence of a skull fracture overlying the EAH, status of basal cistern, size of midline shift, associated brain lesions and types, etc. Patients were followed-up for at least 6 months and the outcome was graded by Glasgow outcome scale (GOS) score as favorable (scores of 4-5) and unfavorable (scores of 1-3). Student's t-test was adopted for quantitative variables while Pearson Chi-squared test or Fisher's exact test for categorical variables. Multivariate logistic regression analysis was also applied to estimate the significance of risk factors.Results:Initially 186 patients (19.8%) with original impact locations at the FTP site and underwent surgery were selected. Among them, 66 met the inclusion and exclusion criteria. But only 50 patients were included because the data of the other 16 patients were incomplete. Progressive EAH developed at the original FTP site in 11 patients after the treatment of, with an incidence of 22%. Therefore the other 39 patients were classified as the control group. Multivariate logistic regression analysis showed that both the volume of the original hematoma and the absence of an apparent midline shift were significant predictors of hematoma progression after decompressive surgery. Patients with fracture at the original impact site had a higher incidence of progressive EAH after CDS, however this factor was not an important predictor in the multivariate model. We also found that patients with progressive EAH had a similar favorable outcome with control group.Conclusion:Progressive EAH is correlated with several variables, such as hematoma volumes ≥10 mL at the original impact location and the absence of an apparent midline shift (<5 mm). Although progressive EAH is devastating, timely diagnosis with computed tomography scans and immediate evacuation of the progressive hematoma can yield a favorable result.

简介：摘要：文章主要通过对新加坡养老院及新加坡养老系统的分析，结合中国的现状，为中国的养老系统的建立、养老院的设立及管理提供一些可借鉴的经验，以推进中国的养老服务体系的进一步完善。

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简介：【摘要】目的：探讨院前急救护理路径在脑卒中患者院前急救中的作用。方法：选择 2016年 9月 -2017年 1月期间呼救中心接收的 260例脑卒中患者，根据呼救先后顺序分为观察组 130例以及对照组患者 130例。对照组脑卒中患者按照常规护理进行救治，观察组脑卒中患者则根据院前急救护理路径进行救治，比较两组患者的治疗结局。结果：观察组脑卒中患者的呼救至救护车到达时间为 24.61±10.14min，对照组脑卒中患者呼救至救护车达到时间为 30.62±14.15min， P＜ 0.05；观察组脑卒中患者入院接受专科治疗时间为 38.68±10.49min，对照组脑卒中患者入院接受专科治疗时间为 46.72±12.49min， P＜ 0.05；观察组脑卒中患者的致残率和致死率分别为 9（ 6.92%）、 5（ 3.85%）较对照组患者 16（ 12.31%）、 13（ 10%）有明显的优势， P＜ 0.05。结论：脑卒中患者采用院前急救护理路径有效的缩短患者获得急救时间间隔，阻止病情的恶化，改善不良治疗结局。

简介：【摘要】目的：分析急性胸痛患者院前急救的有效方案和价值。方法：回顾性分析2014年6月~2019年6月期间救治急性胸痛患者36例临床资料，按照其是否院前急救分成两组：急救组（18例）与对照组（18例），比较两组治疗效果。结果：急救组患者死亡率及各项并发症发生率皆要较对照组有所降低（P＜0.05）；急救组患者发病至诊断明确、开始治疗时间以及平均住院时间均要较对照组短（P＜0.05）。结论：对急性胸痛患者的院前急救措施采取非常必要，能为其争取更多的抢救时机、有效减小死亡几率。

简介：摘要：重视突发昏厥的院前急救，做好宣传教育，更应做好专业救治，由专业医护人员保障救治的专业性和高质量，降低患者的继发性疾病，为入院全面治疗做好各种铺垫，保障患者生命健康安全。

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简介：【摘要】目的：探讨针对严重创伤患者实施院前和院内急救的应用效果。方法：选择丽江市人民医院于2017年10月至2019年10月两年间收治的112例严重创伤患者，按不同的急救方式，将其随机分为对照组（56例，进行常规急救）和观察组（56例，进行院前和院内急救），对两组患者在救治工作完成后的急救效果进行对比分析，结果：通过比较两组患者的致残、死亡人数，可以看出观察组94.64%的急救成功率远高于对照组的50%，急救效果更好，组间数据存在差异，有统计学意义（P＜0.05）。结论：针对严重创伤患者，实施院前和院内急救的方式能有效提升急救效果，还能尽可能地缩短救援时间，患者生命安全也能得到更可靠的保障，值得推广。

简介：【摘要】乡镇卫生院对构建覆盖城乡的基本公共卫生服务体系具有重要作用，是农村卫生工作的核心， 关注当前乡镇卫生院的现状，突破旧的框架，寻找新的发展， 不仅 可以改 善农村卫生事业现状， 更能 给予农村卫生机构平等发展的机会， 同时也能 维护农民的根本利益。 随着国家一系列新政策的引入，给乡镇卫生院带来新的机遇，在看到目前现状的同时，抓住机遇，谋求新的出路， 积极发挥乡镇卫生院是农村三级卫生服务网络的枢纽作用。

简介：【摘要】目的 探究疫情期间肿瘤在院病人的心理护理方法及效果。方法 纳入 62例 2019.12~2020.2期间肿瘤在院患者进行研究。自 2020年开始针对新型冠状病毒对患者进行心理护理，观察干预前（ 2019年 12月）与干预后（ 2020年 1月 ~2月）患者心理状态变化情况。结果 护理后 SAS、 SDS评分均低于护理前（ P＜ 0.05）。结论 在疫情期间对肿瘤病人加强心理护理能够帮助患者缓解负性情绪，正确面对疫情及疾病。

简介：【摘要】乡镇卫生院对构建覆盖城乡的基本公共卫生服务体系具有重要作用，是农村卫生工作的核心， 关注当前乡镇卫生院的现状，突破旧的框架，寻找新的发展， 不仅 可以改 善农村卫生事业现状， 更能 给予农村卫生机构平等发展的机会， 同时也能 维护农民的根本利益。 随着国家一系列新政策的引入，给乡镇卫生院带来新的机遇，在看到目前现状的同时，抓住机遇，谋求新的出路， 积极发挥乡镇卫生院是农村三级卫生服务网络的枢纽作用。

简介：【摘要】急性心肌梗死是临床的常见心血管疾病，起病急、病情进展快，若不及时施救，患者在短时间内可因恶性心律失常死亡。院前急救是降低急性心肌梗死病死率有效急救措施，是急救过程中第一个环节，是院内急救的基础。本文对急性心肌梗死院前急救研究近况进行了回顾。

简介：摘要：目的：探讨影响院前急救心肺复苏患者复苏效果的因素。方法：回顾性分析2017年2月至2018年4月的114例心搏骤停患者的临床资料，对影响其心肺复苏效果的相关因素进行单因素及logistic回归分析。结果：单因素分析显示，应用面罩通气、持续电除颤时长>5min、救护车到达现场时长>10min、合并冠心病、年龄>60岁是导致复苏失败的危险因素；logistic多因素分析显示，面罩通气、救护车到达现场时长>30min、年龄>60岁是导致复苏失败的独立危险因素。结论：院前急救心肺复苏患者的复苏影响因素主要包括面罩通气、救护车到达现场时长>10min、年龄>60岁等，临床需根据其因素做好对症干预工作。