SHEA：外科手术切口感染防控措施
可惜是英文的，他认识我，我不认识他啊。英文功底深厚的帮忙翻译一下喽，谢谢了！ Thanks for the document providing! 回复 1# amber78Initiating close blood glucose control请教，这句话是什么意思？{:1_8:}开始结束血糖控制？
In fact, a recently performed randomized controlled trial showed that initiating close glucose control during cardiac surgery may actually lead to higher rates of adverse outcomes, including stroke and death.
心脏手术期间结束血糖控制，会增加中风和死亡等不良反应发生率？
IV. Unresolved issues之一
4. Maintaining normothermia (temperature higher than36.0C) immediately after colorectal surgerya. One randomized trial with 200 patients undergoing
colorectal surgery found that infection rates were significantlyreduced among patients randomized to have normothermiamaintained during surgery.68b. Controversy still exists regarding this recommendation,
because of the following:
i. The trial examined the effect of intraoperative normothermia,not postoperative normothermia, and didnot include risk adjustment for type of procedure.
ii. An observational study showed no impact of normothermia
on infection rates.69
很佩服外国人的严谨态度{:1_7:} 是外文的吗？谢谢分享！！！！！！！ 我也看不懂呀。。。。。。。。。。。 “可惜是英文的，他认识我，我不认识他啊。”同楼上的老师同感， 怪自己英文没学好
{:1_2:} 老师太贵了，因为我太穷了 本帖最后由 樵夫 于 2012-6-28 22:12 编辑
楚楚 发表于 2010-4-25 20:50 static/image/common/back.gif
回复 1# amber78
Initiating close blood glucose control请教，这句话是什么意思？开始结束血糖控 ...
看了一下文章中的出处，找到了该引用的原始研究，原始研究认为在心脏手术中持续使用胰岛素严格将血糖控制在4.4~5.6的干预组比对照组有更高的危险性，包括中风和死亡的发生率（4 deaths vs. 0 deaths; P = 0.061) and (8 strokes vs. 1 strokes; P = 0.020），其结论中提到，在心脏手术中强化胰岛素的治疗不能降低死亡率。 楚楚 发表于 2010-4-25 20:50 static/image/common/back.gif
回复 1# amber78
Initiating close blood glucose control请教，这句话是什么意思？开始结束血糖控 ...
原始研究的摘要如下：
Ann Intern Med. 2007 Feb 20;146(4):233-43.
Intensive intraoperative insulin therapy versus conventional glucose management during cardiac surgery: a randomized trial.
Gandhi GY, Nuttall GA, Abel MD, Mullany CJ, Schaff HV, O'Brien PC, Johnson MG, Williams AR, Cutshall SM, Mundy LM, Rizza RA, McMahon MM.
Source
Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA. gandhi.gunjan@mayo.edu
Abstract
BACKGROUND:
It is not known whether rigorous intraoperative glycemic control reduces death and morbidity in cardiac surgery patients.
OBJECTIVE:
To compare outcomes of intensive insulin therapy during cardiac surgery with those of conventional intraoperative glucose management.
DESIGN:
A randomized, open-label, controlled trial with blinded end point assessment.
SETTING:
Tertiary care center.
PATIENTS:
Adults with and without diabetes who were undergoing on-pump cardiac surgery.
MEASUREMENTS:
The primary outcome was a composite of death, sternal infections, prolonged ventilation, cardiac arrhythmias, stroke, and renal failure within 30 days after surgery. Secondary outcome measures were length of stay in the intensive care unit and hospital.
INTERVENTION:
Patients were randomly assigned to receive continuous insulin infusion to maintain intraoperative glucose levels between 4.4 (80 mg/dL) and 5.6 mmol/L (100 mg/dL) (n = 199) or conventional treatment (n = 201). Patients in the conventional treatment group were not given insulin during surgery unless glucose levels were greater than 11.1 mmol/L (>200 mg/dL). Both groups were treated with insulin infusion to maintain normoglycemia after surgery.
RESULTS:
Mean glucose concentrations were statistically significantly lower in the intensive treatment group at the end of surgery (6.3 mmol/L in the intensive treatment group vs. 8.7 mmol/L in the conventional treatment group; difference, -2.4 mmol/L [-43 mg/dL {CI, -50 to -35 mg/dL}]). Eighty two of 185 patients (44%) in the intensive treatment group and 86 of 186 patients (46%) in the conventional treatment group had an event (risk ratio, 1.0 ). More deaths (4 deaths vs. 0 deaths; P = 0.061) and strokes (8 strokes vs. 1 strokes; P = 0.020) occurred in the intensive treatment group. Length of stay in the intensive care unit (mean, 2 days vs. 2 days ; difference, 0 days ) and in the hospital (mean, 8 days vs. 8 days ; difference, 0 days ) was similar for both groups.
LIMITATIONS:
This single-center study used a composite end point and could not examine whether outcomes differed by diabetes status.
CONCLUSIONS:
Intensive insulin therapy during cardiac surgery does not reduce perioperative death or morbidity. The increased incidence of death and stroke in the intensive treatment group raises concern about routine implementation of this intervention. 日研究发现光线有助于防止感染
作者：新华 来源：新华网 日期：2012-07-02
此文章来源于www.cmt.com.cn
人在受伤后或手术后特别容易感染，特别是药物难以到达的骨组织和关节等部位，病菌容易繁殖，或者变异为耐药性病菌。日本研究人员在动物实验中发现，用光线激活机体自身免疫功能，结合药物就能防止感染。
日本防卫医科大学校等机构的研究人员在新一期网络科学期刊《科学公共图书馆综合卷》上发表报告说，他们在实验中使用的药物在光线照射下会发生化学反应，产生攻击癌细胞和细菌等的活性氧。这种方法此前也被用于治疗一些感染症，但由于只依靠药物产生的活性氧，治疗效果不理想。
研究人员发现，如果将光线的强度和药物浓度调整得恰到好处，当用光线照射的时候，能吞噬病原体的嗜中性白细胞就会聚集到光线照射到的组织周围。
在实验中，研究人员让实验鼠的膝关节感染一种细菌，接着向膝关节附近注射药物并用光线照射，可以观察到细菌逐渐死亡。如果事先注射药物并光照，则实验鼠膝关节即使被注入细菌，也不会感染。
研究人员认为，在这里起关键作用的并不是药物产生的活性氧，应该是药物和光反应后产生的另外的一种化学物质。他们期待这一成果能够催生新的感染预防和治疗方法。
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鞘内抗生素液不等量灌洗对颅脑术后颅内感染疗效好
作者：鲍爱宁摘编 来源：医学论坛网 日期：2012-06-28
此文章来源于www.cmt.com.cn
最近，潍坊医学院附属益都中心医院神经外科的研究人员的一项研究显示，腰大池置管鞘内抗生素液不等量灌洗能快速降低颅脑术后颅内感染患者体温及脑脊液中白细胞和蛋白含量，缩短其住院时间，具有良好疗效，但应尽早、及时、足程应用。该研究发表于2012年第9期《中国实用神经疾病杂志》。
该研究旨在探讨不同方法鞘内用药治疗颅脑术后颅内感染的临床疗效。
研究人员利用腰大池置管鞘内抗生素液不等量灌洗及腰穿脑脊液等量置换鞘内注药法治疗神经外科术后颅内感染患者31例，比较2组体温、脑脊液白细胞变化及脑脊液蛋白含量变化。
结果，不等量灌洗组治愈13例，死亡1例；体温3d内降至正常者8例(57.1%)，2周内降至正常者13例(92.9%)。腰穿组17例均治愈；体温3d内降至正常者3例(17.6%)，2周内降至正常者10例(58.8%)。2组比较差异具有统计学意义(P<0.05)。不等量灌洗组脑脊液中白细胞计数和蛋白含量在治疗后3d内下降率明显高于腰穿组者(P<0.05)。
糖尿病性周围神经病可增加手术部位感染率
作者：高晓方译 来源：医学论坛网 日期：2011-08-09
此文章来源于 www.cmt.com.cn
美国学者一项研究表明，手术部位感染（SSI）和糖尿病慢性并发症显著相关，此结果证实了周围神经病而非糖尿病自身决定了术后感染发生的论断。论文2011年8月4日在线发表于《糖尿病护理》（Diabetes Care）杂志。
此项前瞻性研究共纳入1465例序贯性足部和踝部手术患者，手术均由同一位外科医生实施。受试者伴或不伴糖尿病。
结果显示，总体SSI发生率为3.5%，并且糖尿病患者的感染发生率显著高于非糖尿病患者（9.5%对2.4%；P<0.001）。多变量分析显示，周围神经病、夏科氏神经关节病、当前或既往吸烟以及手术时间延长与SSI显著相关。
链接：
Surgical Site Infections After Foot and Ankle Surgery: A Comparison of Patients With and Without Diabetes
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突然想到了一点，你们英语都不错，有没有在外兼职给别人翻译文献呀？多少钱？ w8618527 发表于 2012-7-2 20:27 static/image/common/back.gif
突然想到了一点，你们英语都不错，有没有在外兼职给别人翻译文献呀？多少钱？
呵呵真是发散思维！{:1_9:} 来来回回看了两次，一个也不认识，号希望有个翻译版 虽然时隔很久，还是来学习一下！
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