追踪方法学在改良皮下注射低分子肝素钙中的应用

目的：探讨追踪方法学在改良皮下注射低分子肝素钙中的应用效果。方法：运用追踪方法学进行护理质量安全管理,成立追踪检查护理质量安全管理小组,通过对皮下注射低分子肝素钙引起皮下出血、硬节疼痛的个案追踪和系统追踪,分析发生原因,制订并实施改进方案。结果：应用追踪管理方法后皮下注射低分子肝素钙引起皮下出血、硬节、疼痛的发生率与实施前比较有明显下降,差异有统计学意义（P〈0．01）。结论：追踪方法学对预防皮下注射低分子肝素钙不良反应的发生起到积极作用,能有效降低不良反应的发生率,保障患者安全,确保护理质量的持续改进。     

追踪方法学在医院压疮风险管理的应用研究

目的探讨追踪方法学在医院压疮风险管理的应用价值。方法收集2014年1月‐2015年6月期间汕头市中心医院院内发生压疮的95例住院患者,根据随机分组的方法,将患者分为观察组和对照组。临床风险护理过程中,给予两组不同的护理管理方法,给予观察组追踪方法护理,给予对照组常规方法管理。结果在接受不同护理管理情况下,两组患者对护理管理满意度比较差异有统计学意义(P0.05)。两组患者压疮发生率比较差异有统计学意义(P0.05)。结论在压疮风险管理过程中,追踪方法的应用价值较大,提高患者的生活质量,值得临床推广和应用。     

追踪方法学在急诊科预检分诊护理质量管理中的应用

目的 探讨追踪方法学对急诊科预检分诊护理质量的影响。方法 选取在急诊科就诊的494例患者为研究对象,其中2020年7月至12月就诊的247例为对照组,2021年1月至6月就诊的247例为观察组。对照组采用常规预检分诊护理,观察组在常规预检分诊护理基础上运用追踪方法学原理对部分指标进行追踪并改进,比较2组预检分诊护理质量和患者的满意度。结果 观察组预检分诊标准的掌握与流程的落实、应用分诊信息系统并详细记录、正确分诊、动态评估筛查潜在危重患者,与对照组比较差异有统计学意义(P<0.05);观察组患者护理满意度高于对照组(P<0.05)。结论 应用追踪方法学能提高急诊预检分诊的护理质量和患者满意度。     

追踪方法学在精神科高风险攻击行为患者防范中的应用

目的:观察追踪方法学在精神科高风险攻击行为患者防范中的应用效果。方法:运用《高风险患者入院评估表》、《攻击行为评估表》,按照追踪方法学的基本步骤,对攻击行为护理防范流程进行失效风险评估及根本原因分析,并制定安全管理持续改进措施。结果:运用追踪方法学对高风险攻击行为患者进行护理质量改进后,使患者的攻击行为发生率下降到历年最低(30.7%),减少了患者和医务人员受伤频率及严重度。结论:追踪方法学在精神科攻击行为防范中具有积极作用。     

追踪方法学在精神科高风险攻击行为患者管理中的对照研究

目的探讨追踪方法学在精神科高风险攻击行为患者中的应用效果。方法将104例高风险攻击行为患者随机分为实验组和对照组,每组52例。实验组按照追踪方法学计划——实施——检查——行动的PDCA循环管理步骤,引用医疗风险失效模式与效应分析(FMEA),对护理管理流程及处置预案进行风险评估、根本原因分析、质量持续改进后,对RPN风险优先指数、NOSIE量表评分、攻击行为发生率、防护约束次数、满意度进行统计学分析。结果 5项主要失效风险模式RPN指数实验组较对照组明显下降(P0.01);1月末、出院前的满意率调查实验组明显高于对照组;循环管理1周末、1月末的NOSIE评分实验组明显高于对照组(P0.01);攻击行为发生率、约束使用率实验组较对照组明显下降(P0.05);具有显著的统计学意义。结论追踪方法学管理方法能有效减少攻击行为发生率,对完善精神科安全管理体系具有重要的参考价值。     

追踪方法学用于精神科医护三级查房效果观察

目的通过应用追踪方法学于精神科护理三级查房,探讨如何进一步提高护士知识技术素质、提高患者满意度和医生满意度及护理管理者的系统思维能力。方法将追踪方法学应用于精神科护理三级查房,设计综合满意度问卷,包含病情掌握、护理措施、防护重点、专业知识及急救技术、健康教育患者知晓率等精神科护理质量要素,进行护理质量指标金标准—患者和医生对护士综合满意度问卷调查、对比。结果患者综合满意度97.12%,χ2=4.17,P<0.01;医生综合满意度91.7%,χ2=11.87,P<0.01,明显高于追踪方法学应用之前。结论追踪方法学用于精神科医护三级查房提高了患者满意度,提高了医生对护士的满意度,提高了护士的业务技术素质,提高了护理管理者的系统思维能力。     

护理风险管理在外科住院患者外出行院内检查的应用

目的 探索外科住院患者外出行院内检查的安全管理措施.方法 对外科患者外出行院内检查时的护理风险进行识别和评估.制定专科患者安全转运护理工作指引,明确转运的责任与分工,各级人员严格落实转运流程护送患者检查.结果 实施风险管理2年来,安全转运1367例患者;患者未出现并发症和护理投诉.结论 通过对外科住院患者外出行院内检查的护理风险管理,能提高护理服务安全性,减少护理纠纷的发生.     

追踪方法学在护理安全管理中的应用进展

追踪方法学是一种追因管理方法，对患者诊疗期间护理过程进行追踪的方法，是一种体现以患者为中心的评价方法，是在护理安全管理中常用的方法。本文基于追踪方法学理论以及在护理安全管理应用的研究成果，对追踪方法学的定义、分类、方法、在护理安全管理中的应用效果以及与传统管理方法的区别进行综述，以供护理管理者借鉴。     

静脉治疗的护理管理相关问题研究

目的研究和分析静脉治疗的护理管理相关问题,明确追踪方法学与细节管理方法在静脉治疗护理管理中的应用价值。方法 2016年1月至12月885例接受静脉治疗的患者作为对照组,采用常规的护理管理,2017年1月1至12月863例患者作为研究组,在原有常规护理的基础上,引入追踪方法学以及细节管理两种静脉治疗护理管理模式,对两组的护理质量进行对比分析。结果引入追踪方法学与细节管理的静脉护理管理中不良情况发生率明显好于常规护理管理的不良情况发生率,研究组不良情况发生率低于对照组21.45%,研究组患者满意度高于对照组24.21%,差异具有统计学意义(P0.05)。结论在静脉治疗的护理管理中,引入追踪方法学与细节管理可以有效的提高护理管理质量,有一定的临床应用价值。     

流程再造及视频教学规范急危重症患者院内转运

目的:探讨高效、安全的急危重症患着院内转运流程,拍摄院内安全转运视频,进行视频教学,以保障转运工作的顺利进行。方法:对2016年1月至2017年3月发生的18例急危重症患者非安全转入ICU的事例,进行回顾性调查及实地调查,分析讨论非安全转运的危险因素和存在的问题,根据院内转运存在的问题细节,重新制定完善的急危重症患着院内转运流程。拍摄急危重症患者安全转运视频,规范院内护士转运行为,评估医护人员对再造后流程及视频教学后的满意度及家属对转运过程的满意度。结果:经规范化培训后护士对流程的掌握程度、医护人员对再造后流程的满意度、患者家属对转运过程的满意度均≥90%。结论:流程再造、视频教学使急危重症患着院内转运更符合高效、安全的标准,可有效提高急危重症患着院内转运的护理质量。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.