针对性手术室护理在腹腔镜胆囊切除术中的应用

目的探讨针对性手术室护理在腹腔镜胆囊切除术中的应用效果。方法 130例行腹腔镜胆囊切除术的患者随机分为对照组和观察组,各65例。对照组实施手术室常规护理,观察组实施针对性手术室护理。观察2组护理满意度及术后并发症发生情况。结果观察组满意度为95.38%(62/65),对照组为84.62%(55/65),2组差异有统计学意义(P0.05)。观察组并发症总发生率为9.23%(6/65),显著低于对照组的23.08%(15/65),差异有统计学意义(P0.05)。结论对腹腔镜下胆囊切除术患者实施针对性手术室护理,不仅能提高患者满意度,还能减少并发症发生风险。     

优质护理模式对妇科腹腔镜手术效果影响

目的探讨优质护理模式对妇科腹腔镜手术效果影响。方法选择2019年1月至2019年12月在本院行妇科腹腔镜手术治疗的600例患者作为研究对象,按照随机平行对照方法分为对照组和研究组各300例。对照组给予常规护理,研究组在对照组护理的基础上提供全程优质护理,对比两组护理效果。结果研究组术后并发症发生率为9.67%(29/300),明显低于对照组的28.33%(85/300),两组结果比较差异具有统计学意义(P<0.01);两组术后恢复结果(包括住院时间、肠功能恢复时间、下床活动时间)比较差异具有统计学意义(P<0.01);研究组总满意度93.33%显著高于对照组的65.00%,两组满意度调查结果差异具有统计学意义(P<0.01)。结论全程优质护理可以提高妇科腹腔镜手术病人在手术过程中的舒适度,减少病人对手术的恐惧感,提高护理质量,加速病后恢复,值得应用。     

经皮椎间孔镜下髓核摘除术治疗腰椎间盘突出症疗效观察

目的探讨经皮椎间孔镜下髓核摘除术(PTED)与小切口椎板间开窗髓核摘除术(SIIF)治疗腰椎间盘突出症(LDH)的近期效果及对腰椎功能的影响。方法按照髓核摘除方式的不同将124例LDH住院患者分为2组。对照组62例患者行SIIF术,研究组62例患者行PTED术。观察2组患者手术优良率、手术指标、腰椎功能及手术并发症的发生情况。结果研究组手术优良率为87.10%(54/62),对照组为82.26%(51/62),2组比较差异无统计学意义(P 0.05);研究组手术切口长度、术中出血量均显著优于对照组(P 0.05);研究组手术时间、住院时间均显著短于对照组(P 0.05); 2组术后JOA评分显著提高,术后ODI评分显著降低,但研究组术后JOA评分和术后ODI评分变化幅度均显著大于对照组(P 0.05);研究组术后并发症发生率为3.23%(2/62),显著低于对照组的16.13%(10/62)(P 0.05)。结论 2种手术治疗LDH的疗效相当,但PTED能显著改善手术指标,恢复腰椎功能,降低并发症发生率。     

术中危机事件促发点前瞻控制护理在肺癌胸腔镜手术患者中的应用

目的观察术中危机事件促发点前瞻控制护理在肺癌胸腔镜手术患者中的应用效果。方法选取术中危机事件促发点前瞻控制护理实施前(2016年3—12月)和实施后(2017年1—10月)我院接受胸腔镜治疗的肺癌患者各40例作为研究对象,实施前后肺癌患者分别设为对照和试验组,对照组接受肺癌胸腔镜常规护理,试验组在对照组基础上采用术中危机事件促发点前瞻控制护理,比较两组患者术中并发症发生率和护理模式满意度评分。结果试验组患者术中并发症发生率显著低于对照组,试验组医护患护理模式满意度评分显著高于对照组(P0.05)。结论采用术中危机事件促发点前瞻控制护理对肺癌胸腔镜手术患者进行干预,可显著降低该类患者术中并发症风险,提高患者满意度。     

综合性护理干预应用于结肠癌患者围手术期的护理效果分析

目的探讨综合性护理干预在结肠癌患者围手术期的护理运用效果。方法将我院2014年1月~2015年9月收治的124例结肠癌手术患者按随机数字法分为观察组和对照组,每组各62例。对照组予以常规护理干预,观察组予以综合性护理干预。比较两组患者手术耐受性、并发症发生率、伤口愈合时间、住院时间和护理满意度评分。结果观察组手术耐受性优良率为100%(62/62),显著高于对照组93.55%(58/62)的优良率(χ~2=4.133,P0.05);观察组并发症发生率为9.68%(6/62),显著低于对照组24.19%(15/62)的并发症发生率(χ~2=4.644,P0.05);观察组伤口愈合时间、住院时间显著短于对照组(t=4.853、4.760,P0.05);观察组护理满意评分显著高于对照组(t=5.942,P0.05)。结论在结肠癌患者围手术期予以综合性护理干预,可以显著提升患者手术耐受性,降低术后并发症,促进伤口愈合、缩短住院时间,并有效提升患者对护理的满意度。     

损伤控制性手术对严重创伤性肝破裂患者的抢救效果及并发症观察

目的分析损伤控制性手术(DCL)对严重创伤性肝破裂患者的抢救效果及并发症观察。方法回顾性分析2016年1月至2018年12月106例严重创伤性肝破裂患者的临床资料,依据手术方法分为两组,将接受一次剖腹探查手术治疗的50例患者做为对照组,将接受DCL治疗的56例患者做为观察组。观察两组手术及住院时间、抢救成功率、并发症。结果观察组手术、住院时间短于对照组,差异有统计学意义(P0.05);观察组并发症发生率(8.93%,5/56)低于对照组(28.00%,14/50),抢救成功率(87.50%,49/56)高于对照组(66.00%,33/50),差异有统计学意义(P0.05)。结论严重创伤性肝破裂患者接受DCL治疗利于提升抢救成功率,缩短手术时间、住院时间,且术后并发症较少。     

肌肉骨骼超声引导在胫腓骨骨折手术中的应用研究

目的:探究肌肉骨骼超声引导在胫腓骨骨折手术中的应用效果。方法:选取2018年1月—2020年4月我院收治的胫腓骨骨折患者60例,随机分组,对照组按照经典手术路径治疗,研究组在肌肉骨骼超声引导下实施手术,观察两组术前术后胫腓神经连续性及神经血管损伤等并发症发生率。结果:研究组术后合并神经、血管损伤1例,神经血管损伤发生率为3.33%(1/30),低于对照组(P<0.05);两组术后胫前动脉、胫后动脉、腓动脉管壁厚度差异无统计学意义(P>0.05);研究组手术并发症发生率(3.3%)低于对照组(P<0.05),骨骼肌肉超声用于胫腓骨骨折手术患者中可有效提升手术安全性。结论:在超声引导下行胫腓骨骨折手术治疗,有效减轻手术创伤、减少手术失血量及神经损伤风险。     

纽曼系统干预在老年胃癌术后患者中的应用

目的分析纽曼系统干预在老年胃癌术后患者中的应用。方法选取2019年4月～2019年10月我院行常规护理的老年胃癌手术患者44例纳入对照组,将2019年11月～2020年5月于我院行纽曼系统干预的老年胃癌手术患者45例纳入研究组,对比两组术后胃肠功能恢复、并发症和护理满意度的影响。结果研究组术后首次排气时间、首次排便时间和肠鸣音恢复时间均短于对照组,差异有统计学意义(P0.05);研究组并发症发生率为2.22%,低于对照组的18.18%,差异有统计学意义(P0.05);研究组护理总满意度为97.78%,高于对照组的77.27%,差异有统计学意义(P0.05)。结论纽曼系统干预可促进老年胃癌术后患者胃肠功能恢复,降低术后并发症,利于提高护理满意度。     

改良截石位在达芬奇机器人辅助全子宫切除手术中的应用

目的 探索在达芬奇机器人辅助全子宫切除手术中实施改良截石位的效果。方法 选取2019年12月—2020年10月在本科室进行达芬奇机器人辅助全子宫切除手术的76例患者为研究对象，将2020年6月—2020年10月入院的38例患者作为试验组，术中实施改良截石位；将2019年12月—2020年5月入院的38例患者作为对照组，术中实施常规截石位。比较两组患者的术中情况(手术时间、术中调整位置和术中机械臂撞击躯体情况)、首次下床时间、术后并发症发生率和术者对体位的满意度。结果 试验组的手术时间较对照组缩短，机械臂撞击躯体次数较对照组减少，首次下床时间早于对照组，术后24 h下肢不适情况少于对照组，眼睑水肿和肩部疼痛发生情况低于对照组，试验组术者对体位的满意度高于对照组，差异均有统计学意义(P<0.05)。结论 改良截石位能充分暴露手术部位，加速手术进程，避免术中机械臂压伤患者躯体，减轻患者不适，提升术者满意度。     

围术期三步护理模式对结肠癌患者手术耐受、身心应激及手术结局的影响

目的探讨围术期三步护理模式对结肠癌患者手术耐受、身心应激及手术结局的影响。方法选取2020年5月—2021年5月医院收治的结肠癌患者110例为研究对象,按照组间基线资料可比的原则分为对照组和观察组,各55例。对照组实施常规护理,观察组实施围术期三步护理模式,比较两组患者身心应激情况、术后康复及并发症发生率。结果实施围术期三步护理模式干预后,观察组焦虑、抑郁评分均低于对照组;观察组术后康复情况优于对照组,并发症发生情况低于对照组;观察组手术耐受情况优于对照组,比较差异均有统计学意义(P<0.05)。结论围术期三步护理模式可有效稳定患者围术期心理情绪,减轻患者身心应激反应,增强手术耐受程度,降低术后并发症风险,促进术后康复进程,提高手术有效性与安全性。     

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.