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Objective:To study the effect of heated carbon dioxide pneumoperitoneum on the prognosis of patients undergoing pancreaticoduodenectomy by Da Vinci robot.Methods:A total of 307 patients who underwent pancreaticoduodenectomy by Da Vinci robot from January 2016 to December 2018 were selected as subjects. 140 patients who underwent pancreaticoduodenectomy from January 2016 to April 2017 were selected as the control group, and room temperature carbon dioxide pneumoperitoneum was used. From May 2017 to December 2018, 167 patients were set as the intervention group, and heated carbon dioxide pneumoperitoneum was used. Body temperature, heart rate and blood oxygen saturation of the two groups were compared after entering the operating room, before anesthesia, before the establishment of carbon dioxide pneumoperitoneum and after the closure of carbon dioxide pneumoperitoneum, and the duration of operation, intraoperative blood loss, postoperative anesthesia recovery time, hospitalization time and postoperative complication rate were recorded.Results:There was no significant difference in body temperature after entering the operating room, before the establishment of carbon dioxide pneumoperitoneum between the two groups ( P>0.05). After the closure of carbon dioxide pneumoperitoneum, the decline range of the body temperature of the control group was(1.24±2.36) ℃, which was significantly higher than that of the intervention group (0.60±0.25) ℃, and the difference was statistically significant ( t value was 6.892, P<0.05). There were no statistically significant differences between the two groups in terms of operation duration, number of cases with blood oxygen saturation < 0.90, incidence of gastrointestinal fistula and incision infection ( P>0.05). The intraoperative blood loss, resuscitation time, drainage time was (291.08±265.42) ml, (27.04±10.89) min, (8.69±6.64) d in the intervention group and (364.29±309.28) ml, (32.60±12.17) min, (10.76±6.25) d in the control group, and the difference was statistically significant ( t value was 2.232, 7.294, 2.789, P<0.05 or 0.01). There was statistically significant difference in The incidence of pancreatic fistula and biliary fistula, and length of hospital stay was 20 cases, 7 cases, (27.62±17.30) d in the intervention group, and 31 cases, 15 cases, (32.38±12.22) d in the control group, and the difference was statistically significant ( χ2 value was 4.653, 4.870, t value was 6.284, P<0.05). Conclusions:Warming carbon dioxide pneumoperitoneum can reduce the incidence of perioperative hypothermia and improve the prognosis of patients undergoing pancreaticoduodenectomy by Da Vinci robot.
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Objective To investigate the status quo of surgical instrument maintenance at 549 hospitals nationwide and analyze the existing problems,so as to lay a foundation for further development of relevant standards.Methods In January 2019,549 hospitals of different grades in 33 provinces,autonomous regions and municipalities were surveyed by a convenience sampling.The survey covered the basic information,the cognition of the management personnel on instrument maintenance,and the status quo of surgical instrument maintenances of the hospitals.Descriptive analysis was carried out on the data,and the number and percentage of counting data were described.Results 368 (59.74％) hospitals were manned with special post for cleaning precision surgical instruments,426 (69.16％) were manned with special post for cleaning quality inspection,and 382 (62.01％) were manned with special post for assembly and packaging.347 (56.33％) for manufacturers training,299 (48.53％) for self-study manufacturers instruction,420 (68.18％) by department internal training;116 (18.83％) for manual cleaning,413 (67.05 ％)for manual and ultrasonic cleaning,87 (14.12％) for mechanical cleaning;High pressure steam sterilization was used in 518 (84.10％),hydrogen peroxide plasma sterilization was used in 398 (64.61％),and ethylene oxide sterilization was used in 222 (36.04％) hospitals.Conclusions The maintenance of surgical instruments should be carried out by professional personnel,relevant training should be carried out,management personnel should strengthen the inspection,and relevant standards and norms should be formulated to unify the management of surgical instruments.
ABSTRACT
Objective@#To investigate the status quo of surgical instrument maintenance at 549 hospitals nationwide and analyze the existing problems, so as to lay a foundation for further development of relevant standards.@*Methods@#In January 2019, 549 hospitals of different grades in 33 provinces, autonomous regions and municipalities were surveyed by a convenience sampling. The survey covered the basic information, the cognition of the management personnel on instrument maintenance, and the status quo of surgical instrument maintenances of the hospitals. Descriptive analysis was carried out on the data, and the number and percentage of counting data were described.@*Results@#368(59.74%)hospitals were manned with special post for cleaning precision surgical instruments, 426(69.16%) were manned with special post for cleaning quality inspection, and 382(62.01%) were manned with special post for assembly and packaging. 347(56.33%)for manufacturers training, 299(48.53%)for self-study manufacturers instruction, 420(68.18%)by department internal training; 116(18.83%)for manual cleaning, 413(67.05%)for manual and ultrasonic cleaning, 87(14.12%)for mechanical cleaning; High pressure steam sterilization was used in 518(84.10%), hydrogen peroxide plasma sterilization was used in 398(64.61%), and ethylene oxide sterilization was used in 222(36.04%) hospitals.@*Conclusions@#The maintenance of surgical instruments should be carried out by professional personnel, relevant training should be carried out, management personnel should strengthen the inspection, and relevant standards and norms should be formulated to unify the management of surgical instruments.
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OBJECTIVE To control the quality of cleaning and sterilization of rent instruments and to secure medical safety of patients undergoing operations.METHODS We randomly chose 60 pieces of rent instruments and divided them into two groups,machinery wash group and hand wash group.Occult blood test was performed before and after washing and rinsing.RESULTS Positive rate of occult blood tests was 86.67% before either machinery or hand wash.While after machinery wash and hand wash it was 0% and 6.67%,respectively.Both wash methods had significant effect on depleting occult blood(P0.05).CONCLUSIONS Hospitals must enhance the management of rent instruments cleaning which is of poor quality at present by regulating the procedure and monitoring methods so as to ensure the quality of rent instruments cleaning and secure patients safety.