Foreign research status of the influence of nurse factors on patient mortality / 中国实用护理杂志

Mortality is a key index for assessing technical level and treatment quality of hospital. We filtered and analyzed the literatures about the influence of nurse factors on patient mortality out of China in recent years to guide the study within China. We found the nurse factors impacting mortality included workload, configuration of nursing staff, education status and working environment. Those findings point out the direction of the research on relationship between nurse factors and patient mortality in China, which has great significance.

Nosocomial Infections: Investigation and Analysis of 2 409 Cases / 中华医院感染学杂志

OBJECTIVE To prevent and control the incidence of nosocomial infection,and improve the inner quality of nosocomial infection management.METHODS A total of 49 363 cases of inpatients in the recent four years were retrospectively analyzed.RESULTS Of them 2 409 cases were infected,the incidence was 4.88%.The lower(respiratory) tract ranked the first place (34.16%) and the highest infected rate was in medicine(department)((8.29%).) Totally 505 isolates of bacteria were found,of which Gram-negative ones accounted for 45.15%,(Gram-)positives 25.15%,fungi were for 29.70%.CONCLUSIONS The incidence of nosocomial infection is(connected) with following factors such as age,inpatient factor,invasive diagnosis and treatment manipulation,the misusage of(antibiotics),and the environment quality.

Laparoscopic operation using an ultrasonic scalpel for Hischsprung’s disease in infants and children: Report of 20 cases / 中国微创外科杂志

Objective To summarize the value of laparoscopic operation using an ultrasonic scalpel for the radical treatment of Hischsprung’s disease (HD) in infants and children. Methods Laparoscopic operation was performed in 20 infants and children with HD under general anesthesia from February 2003 to January 2006. The CO_2 pressure of pneumoperitoneum was set at 10~12 mm Hg. By way of three abdominal ports, the diseased colon and rectum were mobilized by dissecting the supplying vessels and severing the peritoneal reflection in the pelvic floor. The modified Soave pull-through procedure was employed to incise and mobilize the rectal mucosa at 0.5 cm above the dentate line. The lateral ligament of rectum was severed and the intraabdominal cavity was reached through the peritoneal reflection. The diseased colon was pulled through the anus passing the level of the transition zone for resection. Then coloanal anastomosis was made between the proximal colon and the cutting edge of the anal canal above the dentate line. Results All the procedures were completed smoothly. The operation time was 120~210 min (mean, 132 min). The length of resected colon was 20~55 cm (mean, 35 cm). The intraoperative blood loss was 5~20 ml (mean, 14 ml), with no need of blood transfusion. Enterocolitis happened in 2 cases postoperatively. Follow-up observations in the 20 cases for 3~36 months (mean, 12.5 months) found no complications. The patients had 1~2 times of fecal discharge per day during follow-up. Conclusions Laparoscopic pull-through procedure using an ultrasonic surgical scalpel has advantages of minimal invasion, little hemorrhage, simple performance, quick recovery, and low complication rate.

Laparoscopic pyloromyotomy for infantile hypertrophic pyloric stenosis: A report of 50 cases / 中国微创外科杂志

Objective To summarize the experience of l ap aroscopic pyloromyotomy for the treatment of infantile hypertrophic pyloric sten osis (IHPS). Methods Laparoscopic pyloromyotomy was employed i n 50 cases of IHPS from April 2001 to April 2004. The patients aged 12~90 days ( mean, 35 days). Three 3-mm-diameter trocars were introduced into the abdominal c avity via the left, right and upper abdominal wall, respectively. A non-traumati c grasping forceps was inserted through the left trocar to manipulate the gastri c wall near the pylorus. Through the right trocar, a retractable pyloromyotomy s calpel, a stripper and a dissecting forceps were in turn utilized to complete py loromyotomy. Results The operation was completed under laparos cope in 48 cases, while a conversion to open surgery was needed in 2 cases (1 c ase of prepyloric membrane and 1 case of pyloric mucosal injury, which were cure d by open repair). The operative time was 15~45 min (mean, 25 min). The nasogast ric tube was removed and oral feeding with milk was attempted 6 hours after the operation. The patients were discharged at 3~5 postoperative days. Follow-up for 3~6 months (mean, 4.5 months) in 42 cases showed that the patients were normall y developed. Conclusions Laparoscopic pyloromyotomy can be wel l performed in the presence of experience in open surgery, technical skills in l aparoscopy, effective anesthesia and proper surgical instruments.

Two-port Laparoscopy-assisted Resection of the Meckel’s Diverticulum in Children / 中国微创外科杂志

Objective To investigate the feasibility of two-port laparoscopy-assisted resection of the Meckel’s diverticulum in children. Methods Resection of the Meckel’s diverticulum was performed under a laparoscope in 13 children in our hospital from July 2002 to March 2006. Two 5-mm trocars were introduced at the infraumbilical ring and the right lower abdomen, respectively. When the Meckel’s diverticulum was found, the incision was prolonged to 2 cm long along the inferior border of the umbilicus, the diverticulum was removed externally and the intestine was anastomosed. Results The operation was completed successfully without conversion to open surgery. The mean operation time was 50 min (range, 40-70). The intestinal function of the patients recovered 24 hours after the operation, and then liquid food was given at 3 days postoperatively, and the patients was discharged from hospital within 5-7 days after the operation. The patients were followed up for 6-48 months (mean, 13), during which no one had recurrence, intestinal adhesion, or intestinal obstruction. Conclusions Two-port laparoscopy-assisted resection of Meckel’s diverticulum is safe and feasible for children. The recovery time and hospital stay are short after the procedure.

Laparoscopic Ladd’s procedure for intestinal malrotation in children / 中国微创外科杂志

Objective To explore the feasibility of laparoscopic Ladd’s procedure and its indications for intestinal malrotation accompanying midgut volvulus. Methods Laparoscopic Ladd’s procedure was performed in 15 children from July 2002 to March 2006. The procedure was performed using three trocars. Under laparoscopic visualization, the midgut volvulus was untwisted by grasping and pulling the intestine, the Ladd’s band was divided and broadened, the duodenum and the small intestine were mobilized, and finally an appendectomy was performed through an abdominal wall port. Results Laparoscopic Ladd’s procedure was completed successfully in the 15 children. Of them, 1 patient with duodenal web, 1 patient with paraduodenal hernia, and 1 patient with ectopic pancreas also had a concomitant procedure. The operative time was 45~150 min (mean, 75 min). The patients began to take food on 1~3 postoperative day. There was no surgical complications. The length of postoperative hospital stay ranged 4~6 days (mean, 5 days). Follow-up observations in 12 patients for 1~42 months (mean, 21 months) showed normal development and free of symptoms.Conclusions Laparoscopic Ladd’s procedure is a safe and effective technique. It can be performed in neonates and applicable subacute midgut volvulus, but may be unadvisable for acute volvulus with abdominal distention.