开胸术后病人有效深呼吸与咳嗽方法的探讨

目的:探讨开胸患者有效深呼吸、咳嗽方法,以提高开胸患者术后呼吸道护理水平,减少肺部并发症。方法:将1027例开胸患者随机分为观察组514例和对照组513例。对照组给予常规的健康宣教及护理,观察组除上述护理外,入院就对患者进行有效深呼吸、咳嗽训练,术前患者掌握有效深呼吸、咳嗽方法,术后进行有效深呼吸和咳嗽指导。观察患者的深呼吸和咳痰效果。结果:术后观察组深呼吸及有效咳嗽效果明显高于对照组(P<0.01),术后针对患者的具体情况采取相应的有效深呼吸、咳嗽方法,采取两种方法最好。结论:有效深呼吸、咳嗽训练应在入院后就进行训练,术前掌握方法和技巧;健康教育要有针对性,注意检查深呼吸、咳嗽效果;根据患者的具体情况,采取不同的深呼吸训练和咳嗽的方法;使用两种或以上的深呼吸和咳嗽的方法可以达到满意效果;为患者提供深呼吸、咳嗽排痰的有利条件。     

肺功能不全肺癌患者30例围术期的康复护理

总结30例肺功能不全肺癌患者围术期的康复护理体会。护理重点为术前加强病情评估,做好健康宣教,指导规范的束胸式呼吸功能锻炼、束腹式呼吸功能锻炼、深呼吸训练及吸屏气训练,术后及早进行腹式呼吸训练,指导有效的咳嗽排痰,做好体位疗法,并早期进行肢体功能活动,促进病情恢复。     

高龄肺癌患者围手术期呼吸道护理

目的探讨高龄肺癌患者有效的呼吸道护理方法,以提高其手术耐受力。方法对我科1998年10月至2004年10月收治的高龄肺癌患者139例进行呼吸道护理。术前指导患者进行呼吸功能练习、咳嗽、深呼吸训练,术后保持呼吸道通畅,有效咳嗽,湿化呼吸道,鼓励患者早期活动。结果139例高龄肺癌手术患者均实施有效的呼吸道护理,无并发症发生。结论有效的呼吸道护理能够减少高龄肺癌手术患者呼吸道并发症,提高其手术耐受力。     

胸腰椎前路术11例围手术期的护理

我院自2007年以来共行胸腰椎前路手术11例,均康复出院,现将围手术期的护理体会总结如下。1临床资料1.1一般资料本组均为男性,年龄8~52岁。胸椎前路减压加植骨融合术8例,胸椎肿瘤切除3例。1.2护理1.2.1术前呼吸训练及有效咳嗽的指导指导患者每日做深呼吸及腹式呼吸,锻炼肺功能。在进行深呼吸训练时,应使患者体会到分别使用肋间肌和膈肌进行最大吸气时的感觉和两者共同使用时的感觉。这样,术后患者可以使用能尽量减小伤口疼痛的呼吸肌做到充分深呼吸。有效咳嗽训练的关键在于使患者克服喉头发声的“假咳”。嘱患者慢慢深吸气,吸足气后暂屏气数秒钟,然后咳嗽、咳痰。1.2.2术后护理1.2.2.1病情观察术后给予吸氧,24 h连续心电监护,监测血压、呼吸及血氧饱和度。注意引流液及手术创口的渗出情况,发现异常,及时通知医生,备好抢救措施。1.2.2.2卧位卧硬板床。术后6 h内去枕平卧,头偏向一侧。6 h后可适当抬高床头,以利于呼吸和胸腔引流。但不宜取半卧位,要避免脊柱前屈。1.2.2.3呼吸道护理保持呼吸道通畅,鼓励患者咳嗽、深呼吸和吹气球,以利于早日肺复张。患者因伤口疼痛不敢行深呼吸和咳嗽时,护士须协助进行:双手放于伤口两侧...     

全身麻醉患者的呼吸道护理——附50例分析

目的探讨减少全身麻醉病人术后肺部并发症的护理预防措施.方法对50例全身麻醉患术前均采用对病人实施健康教育、训练有效深呼吸和正确咳嗽的方法;术后注重镇痛、早期活动、保持呼吸道通畅等.结果全部病人无一例出现肺部并发症.结论做好术前指导是护理成功的保证,护士应具备良好的技术和丰富的知识.认真指导患者进行深呼吸和有效咳嗽的规范训练,保持呼吸道通畅.     

全身麻醉患者的呼吸道护理——附50例分析

目的 探讨减少全身麻醉病人术后肺部并发症的护理预防措施。方法 对50例全身麻醉患术前均采用对病人实施健康教育、训练有效深呼吸和正确咳嗽的方法；术后注重镇痛、早期活动、保持呼吸道畅通等。结果 全部病人无一例出现肺部并发症。结论 做好手术指导是护理成功的保证，护士应具备良好的技术和丰富的知识，认真指导患者进行深呼吸和有效咳嗽的规范训练，保持呼吸道通畅。     

67例电视胸腔镜下手术治疗先天性心脏病的围术期护理

总结了67例电视胸腔镜下行心脏手术的护理经验。对67例电视胸腔镜下行房、室间隔缺损修补术病人术前做好心理护理,加强深呼吸训练,指导病人练习有效咳嗽和排痰方法;术后严密观察病情,加强呼吸道管理及胸腔引流管的护理,鼓励早期活动,预防可能出现的并发症。本组术后1例发生快速室上性心律失常,2例出现右侧少量气胸,全部病倒术后5~7d痊愈出院。术前、术后严密的护理是预防术后并发症、促进病人康复的基础。     

非体外循环冠状动脉搭桥术患者围术期呼吸道护理

总结非体外循环冠状动脉搭桥术患者围术期呼吸道管理经验,以提高其手术耐受力.对35例非体外循环冠状动脉搭桥手术的患者进行呼吸道护理,术前呼吸道准备,指导患者进行呼吸功能练习:腹式呼吸,咳嗽及深呼吸训练;术后加强呼吸道监护,有效咳嗽,防治肺炎、肺不张、呼吸衰竭等肺部并发症发生.35例非体外循环冠状动脉搭桥手术患者经实施有效的呼吸道护理,均能积极配合医疗与护理,无1例在围手术期发生肺部并发症.术后9～16d均痊愈出院.加强呼吸道护理可使非体外循环冠状动脉搭桥术患者顺利渡过围术期,减少术后呼吸道并发症,有利于患者的康复.     

心外科手术患者呼吸功能锻炼的不同护理模式对比分析

目的 探讨呼吸功能锻炼不同护理措施改善心外科手术患者术后肺功能的效果.方法 选取收治的心外科行手术患者56例,随机分为观察组与对照组,每组28例.两组患者均进行呼吸肌、肺功能相关检查与评估,对照组仅行常规传统护理并指导有效咳嗽与深呼吸运动锻炼;观察组入院当天至手术前1d行沙袋加压腹式呼吸训炼及呼吸操锻炼,术后两组患者均行肺功能康复性指导护理.观察并比较两组患者术后肺功能指标情况.结果 两组患者术后恢复顺利,未出现明显肺部并发症.观察组术后用力肺活量、深吸气量、肺活量、最大通气量、血氧均明显优于对照组（P＜0.05）.结论 心外科手术患者围手术期积极术前评估肺功能并给予呼吸操、沙袋加压腹式呼吸训炼等护理措施能有效改善术后患者肺功能情况,效果显著,能够促进患者术后肺功能的恢复.     

退行性脊柱侧弯患者的围术期护理

目的 探讨退行性脊柱侧弯行后路椎板减压加短节段椎间植骨融合术的围术期护理要点。方法 术前做好心理护理、肺功能训练、唤醒试验训练和体位训练,术后严密观察生命体征,做好肺功能监测及胃肠功能、脊髓神经功能、切口引流液、皮肤的观察和护理,早期指导患者进行正确的术后康复功能锻炼。结果 56例患者术后腰腿痛缓解情况按Oswestry评分,与术前相比有统计学差异（P〈0.05）;Cobb角由术前平均32°矫正到术后的19°,与术前相比有统计学差异（P〈0.05）。结论 合理、有效、标准化的术前后护理可以有效预防术后并发症,使患者安全度过围术期,促进其早日康复。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Clinical Trial Updates and Hotline Sessions presented at the European Society of Cardiology Congress 2007

This article provides information and commentaries on trials which were presented at the Hotline and Clinical Trial Update Sessions at the European Society of Cardiology Congress 2007 in Vienna. The key presentations were performed by leading experts in the field with relevant positions in the trials or registries. It is important to note that unpublished reports should be considered as preliminary data, as the analysis may change in the final publications. The comprehensive summaries have been generated from the oral presentation and the webcasts of the European Society of Cardiology and should provide the readers with the most comprehensive information of relevant publications.     

Balance and Boundaries in Grief Counseling: An Intervention Framework for Volunteer Training

Volunteers or paraprofessional counselors are commonly used to provide supportive care to the bereaved. These counselors generally are trained in basic listening skills, providing a generic, nonspecific approach to intervention that remains to be proven effective. The present paper outlines a framework that provides paraprofessionals with a broader model for intervention with the bereaved. Attention to boundaries as a helper and balance in the grief recovery are central to the model. Interventions are described that provide the paraprofessional counselor with more options for tailoring their counseling strategy to the individual. These include techniques that are presumed to be more specific to the enhancement of grief recovery.     

A new method for the simultaneous analysis of unmodified and modified urinary nucleosides and nucleobases by high performance liquid chromatography

Details are given of a new, rapid and simple pre-fractionation method and an isocratic high performance liquid chromatography system suitable for parallel analysis of nucleosides and nucleobases from urine and other biological fluids. The quantitative recovery and excellent reproducibility of the method is demonstrated by analysis of representative standard RNA catabolites. The advantage of this new method for application to biological samples is discussed.     

Adsorption of Charged Non-albumin Bound Drugs by Amorphous Silica

We investigated the in vitro drug adsorption of PQ 10150 sodium silicate gel (AIS, Santa Clara, CA) with particle size of 230 um and surface area of 400 nr/g. We observed 99% to 88% adsorption of gentamicin; a mean 91 % of disopyramide; a mean 89% of quinidine at low concentration, falling to 75% at higher concentration. Insulin was 88% adsorbed at low concentrations but less so (65%) at higher concentrations. We observed a mean 83 % adsorption of procainamide, a mean 84% of N-acetyl procainamide, 74% oflidocaine, 73% of amitriptyline; and 44% of desipramine. We found an average 14% reduction of total digoxin concentration when serum containing digoxin (2 to 33 ng/mL) was exposed to sodium silicate, while the reduction in free digoxin concentration was 16%. Five percent ethosuximide was also removed. The adsorption of theophylline, phenobarbital, acetaminophen, phenytoin, ethylene glycol, methotrexate, salicylate, thiocyanate and diazepam was minimal and not significant. We conclude that significant amounts of charged, non-albumin bound drugs can be removed by PQ 10150 sodium silicate gel.     

自动化酸碱平衡图在急诊社区获得性肺炎诊治中的应用

目的 探讨自动化酸碱平衡图在急诊科社区获得性肺炎(CAP)患者诊断中的价值.方法 根据病史、肺功能测定结果、慢性阻塞性肺疾病(COPD)诊断标准,将111例CAP患者分为单纯CAP组(56例)和COPD合并CAP组[即慢性阻塞性肺疾病急性加重(AECOPD)组,55例].询问患者病史后即刻抽取动脉血测血气并进行自动化酸碱平衡图分析.结果 血气分析结果显示,AECOPD组动脉血二氧化碳分压(PaCO2,kPa)、HCO3- (mmol/L)、剩余碱(BE,mmol/L)均显著高于CAP组(PaCO2:7.714±2.414比5.896±1.308,HCO3-:30.767±7.185比25.014±3.043,BE:4.345±5.371比-0.354±3.180,均P＜0.01).自动化酸碱平衡图分析结果显示,AECOPD组患者酸碱平衡紊乱高达89.1％,CAP组为66.1％.将AECOPD组和CAP组患者中正常(10.9％、33.9％)、急性呼吸性酸中毒(急性呼酸,12.7％、14.3％)、慢性呼吸性酸中毒(慢性呼酸,49.1％、10.7％)、呼吸性碱中毒(呼碱,7.3％、14.3％)、代谢性酸中毒(代酸,12.7％、17.9％)、代谢性碱中毒(代碱,12.7％、8.9％)综合进行x2分析,差异有统计学意义(x2=24.421,P=0.001),而将正常、急性呼酸、呼碱、代酸及代碱进行x2分析,差异无统计学意义(x2=5.280,P=0.260),提示AECOPD患者慢性呼酸的发生率较单纯CAP患者显著增加.结论 自动化酸碱平衡图能帮助急诊科医师快速识别CAP患者是否存在多重酸碱平衡紊乱,并可快速识别急、慢性呼吸系统疾病.