重症监护护理的危险因素及对策

重症监护是指对收治的各类危重病患者,运用各种先进的医疗技术,现代化的监护和抢救设备,对其实施集中的加强治疗和护理。以最大限度的确保病人的生存及随后的生命质量。近年来,重症监护护理工作中存在着很多危险因素,提高护理人员的法律意识及护理工作中的防范能力是重症监护护理人员的首要任务。     

浙江省妇女儿童适宜技术示范基地建设实践与思考

目的 加快推进浙江省基层卫生服务体系建设,确保卫生适宜技术推广应用工作的可持续发展.方法 课题组结合当地实际,对余杭、绍兴、建德妇女儿童适宜技术示范基地进行了建设实践.结果 示范基地在工作机制、技术应用、人才培养、考核评价等方面取得了良好的示范推广效果.结论 本次实践所积累的经验对卫生适宜技术示范基地的建设具有指导作用.     

江苏援疆项目—"润心计划"的实践与体会

目的：探讨“润心计划”在边疆医院开展的意义和成效。方法：通过“组团式”援疆医疗人才和柔性专家团队在边疆医院创新性开展较为复杂的心脏手术,分析其实施过程对医院管理、医疗技术、人才培养、科室执行力和协同力、社会满意度等全面提升的成效。结果：自2016年6月-2019年12月共开展25期“润心计划”,实施了211台心脏手术,全部获得成功,医疗质量和医疗安全全面提升,并培养了心脏外科、心脏内科、麻醉科、重症监护等技术人才15名,患者满意度100%。结论：在心脏病发病率较高的边疆,依托援疆专家,创新性开展心脏手术能够“以点带面”全面提升医疗技术、强化医疗核心制度,取得良好的社会效益。     

慢性病适宜技术示范基地建设的实践与思考

介绍了嘉善县作为慢性病适宜技术示范基地的建设实践情况。总结了以示范基地作为慢性病适宜技术推广的方式在工作机制、技术应用、技术转化创新、人才培养、考核评价等方面取得的良好效果及经验。     

重症加强治疗病房的建设

重症加强治疗病房(Intensive Care Unit,ICU)是重症医学学科的临床基地,对因各种原因导致一个或多个器官与系统功能障碍危及生命或具有潜在高危因素的患者,及时提供系统的、高质量的医学监护和救治技术,是医院集中监护和救治重症患者的专业科室[1].     

浙江省基层卫生适宜技术示范基地建设实践

目的为了加快推进基层卫生适宜技术的推广和应用,提升基层卫生服务能力,探索建立适合浙江省实际的基层卫生适宜技术推广体系和长效工作机制。方法在全省范围内,采用自主申报开展“1＋X”模式基层卫生适宜技术示范基地的建设。结果经过两年的建设,已在全省范围内建设了54家基层卫生适宜技术示范基地,推广技术涉及急救、慢性病、妇女儿童、公共卫生等7类适宜技术,在技术选择、技术培训、推广应用、人才培养等方面取得了良好的效果。结论初步建立了适合浙江省实际的基层卫生适宜技术推广体系和工作机制,对全国基层卫生适宜技术的推广应用和示范基地的建设具有指导作用。     

江苏省助理全科医生培训基地的建设现状分析及对策△

目的：了解江苏省66家助理全科医生培训基地建设中存在的问题,为基地建设提供科学对策。方法：根据《助理全科医生培训基地遴选标准（2020年版）》,对基地的各项指标设计问卷调查表,了解基地的总体情况、全科医学科设置的情况、基层实践基地的条件。结果：江苏省助理全科医生培训基地的建设已经取得一定成效,但是仍存在基地建设不够完善、全科带教师资力量不足等问题。结论：助理全科基地的建设会影响助理全科医生的培养质量,应加强助理全科基地在全科医学科、师资队伍等方面的建设,进一步优化省级培训工作,不断提升培养质量,为基层培养合格的助理全科医生。     

慈溪市职业卫生示范企业创建情况调查

为认真贯彻《中华人民共和国职业病防治法》，全面加强职业卫生工作，积极营造争优创先的良好氛围。卫生部、国家安全监督管理局、中华总工会于2005年联合开展了国家职业卫生示范企业评选活动，取得圆满成功。随后几年，山东、福建、湖北等省份相继仿效开展省级职业卫生示范企业创建活动，均取得不错成效。     

急救基层卫生适宜技术示范基地建设的实践探索

针对基层医疗卫生机构技术水平和服务能力相对较低的现状,论述了基层卫生适宜技术示范基地建设的必要性,并介绍了急救基层卫生适宜技术示范基地建设的经验以及成效,为卫生适宜技术推广提供有益的借鉴.     

浅论实施危重病人护理会诊

我们认为通过实施重症病人的护理会诊,可以提高护理质量、减少重症病人的护理缺陷的发生。为此,我院开展重症病人的护理会诊的做法是：①强化护理技术协作及会诊意识;②成立协作小组,做好会诊的组织管理;③会诊形式有科内、科间及全院会诊３种。我院通过加强护理会诊,取得了好成效：一是促进了专科护理技术建设;二是护理疑难问题得到了解决;三是新的护理技术得到了及时推广与应用。但要做好护理会诊首先是转变观念,其次是规范会诊程序和管理。     

The role of the dietitian in the intensive care unit

PURPOSE OF REVIEW: The role of the intensive care unit registered dietitian has evolved over the past few years to become a vital component of the intensivist-led multidisciplinary intensive care unit team. The purpose of this review is to define the level of clinical practice and skill set of the intensive care unit dietitian, which defines them as a clinician, educator and researcher worthy to practice alongside their colleagues on the intensive care unit team. RECENT FINDINGS: An intensive care unit registered dietitian must be a dedicated professional with advanced training in critical care nutrition, the ability to read critically and evaluate new literature, a willingness to think 'outside the box', the fortitude to be an active participant in the intensive care unit team, the aptitude to educate colleagues and students from all disciplines, and the desire to participate in clinical research. Intensive care unit registered dietitians have published research concerning the nutritional assessment of the critically ill patient, the route of nutritional support, nutritional access, fluid and electrolyte issues, speciality enteral products, and optimal blood glucose control. They continue to attain skills and knowledge to extend their scope of practice and improve the quality of care in the intensive care unit. Recent guidelines adapted to the nutritional care of critically ill patients have been published for guidance. SUMMARY: The scope of practice of intensive care dietitians defines them as clinicians, educators and researchers. Their skill set is a unique and vital component of the intensivist-led multidisciplinary intensive care unit team.     

Hypoglycemia in the intensive care unit

PURPOSE OF REVIEW: To review recent articles and evaluate hypoglycemia as a major complication of intensive insulin therapy in anticipation of emerging data from current clinical studies. RECENT FINDINGS: Following the 2001 landmark Leuven study demonstrating that intensive insulin therapy in the surgical intensive care unit reduces mortality, many studies have evaluated aspects of intensive insulin therapy with respect to improved clinical outcome and the impact of hypoglycemia. Specific risk factors for hypoglycemia in the intensive care unit with intensive insulin therapy are diabetes, octreotide therapy, nutrition support, continuous venovenous hemofiltration with bicarbonate replacement fluid, sepsis and need for inotropic support. In prospective studies with a comparator group, the incidence of hypoglycemia in intensive care unit patients treated with intensive insulin therapy is up to 25%, corresponding to a relative risk of 5.0. In studies without a comparator group, however, the incidence is less than 7%. SUMMARY: Hypoglycemia is associated with adverse outcome in intensive care unit patients. It remains unclear whether intensive insulin therapy-induced hypoglycemia per se is responsible for this adverse outcome. The threat of hypoglycemia is a barrier to intensive insulin therapy in critical care, supporting the need for frequent glucose monitoring, readily available concentrated intravenous dextrose infusions, better training of nurses and technological advances in glucose-sensing and insulin-dosing algorithms.     

Management of patients with metastatic malignancy in the intensive care unit

Intensive care units serve to provide temporary physiologic support to patients with reversible organ failure. However, with increasing frequency, patients with end-stage and terminal illnesses are being admitted to the intensive care unit. Indeed, in the United States, a third of all patients with terminal metastatic malignancy are admitted to the intensive care unit, and 60% of all hospital deaths occur after such an admission. In many instances, admission to an intensive care unit serves only to transform death into a prolonged, painful, and undignified process. In patients with a terminal illness, the focus should be on measures that ensure comfort, and admission to an intensive care unit should generally be avoided. Intensivists, who are charged with making the best use of limited resources, should ultimately be the individuals who determine the appropriateness of admitting such patients to the intensive care unit.     

Refurbishment works in a hospital during normal operation

Background: Construction and renovation work in hospitals pose risks of fungal airborne infections for immunosuppressed patients. If possible, reconstruction work will be postponed to periods without patient treatment. However, in many situations urgent damage demands immediate refurbishment works before the transferring of patients to other wards or closure of wards is possible. Reported here are infection control related measures and implemented procedures after two incidents of water damage which occurred on a surgical ward and an intensive care unit at the University hospital of Essen.Methods: Between January and April 2009 and between September and October 2009, respectively, concentration of air-borne particles and number of viable fungi were measured at two surgical wards and one ICU. Preventive Infection Control Measures included erection of protective walls and HEPA filtration of air from the renovation area.Results: During the renovation work on the surgical ward concentrations of moulds and particles ≥5 μm were significantly higher on the left side of the renovation area than on the right side (p=0.036 and p<0.001). Concentrations of particles ≥1 μm and particles ≥5 μm on both sides of the renovation area were significantly increased when compared with the control ward on the same floor but not when compared with the control ward on the other floor. Particles of all size were significantly elevated on the ICU during the renovation work. Aspergillus fumigatus could neither be cultured of the air of cardiac surgery intensive care unit nor of the intermediate care unit (control ward). During renovation works there was no nosocomial mould infection of patients treated on the two wards.Conclusion: Provided that the renovation area is tightly insulated from the areas of patient care on a ward, closure does not seem to be necessary during renovation works because variation of airborne fungi is similar to that of outdoor or control air. However a multidisciplinary team should be established. This team should perform risk assessment and determine necessary protective measures before starting any construction, renovation or maintenance work in health care settings.     

使用呼吸机与重症监护病房患者下呼吸道感染的相关性分析

目的:分析使用呼吸机与重症监护病房患者下呼吸道感染的相关性。方法:本次实验研究将2018年1月~2019年1月在本院重症监护病房接受治疗并使用呼吸机的患者32例作为实验组,将同期本院重症监护病房收治未使用呼吸机的患者32例作为对比组,比较两组患者下呼吸道感染发生率以及导致实验组患者出现下呼吸道感染的相关危险因素。结果:实验组患者下呼吸道感染发生率明显高于对比组患者(P<0.05);实验组不同机械通气时间、基础疾病数量以及插管方式患者之间出现下呼吸道感染的概率存在显著差异(P<0.05);导致实验组患者出现下呼吸道感染的病菌种类为革兰阴性菌概率显著高于革兰阳性菌与真菌(P<0.05)。结论:使用呼吸机与重症监护病房患者下呼吸道感染的出现呈正相关,且导致其出现下呼吸道感染的危险因素包括机械通气时间、基础疾病数量以及插管方式,革兰阴性菌为主要的致病菌,应该通过针对性预防措施的制定减少下呼吸道感染的出现。     

Malnutrition in critically ill children: from admission to 6 months after discharge

BACKGROUND & AIMS: Little is known about the nutritional status of critically ill children during hospitalisation in and after discharge from an intensive care unit. We set up a prospective, observational study to evaluate the nutritional status of children in an intensive care unit from admission up to 6 months after discharge. A secondary aim was identifying patient characteristics that influence the course of the various anthropometric parameters. METHODS: The nutritional status of 293 children--104 preterm neonates, 96 term neonates and 93 older children--admitted to our multidisciplinary tertiary pediatric and neonatal intensive care unit was evaluated by anthropometry upon and during admission, at discharge and 6 weeks and 6 months following discharge. RESULTS: Upon admission, 24% of all children appeared to be undernourished. Preterm and term neonates, but not older children, showed a decline in nutritional status during admission. At 6 months after discharge almost all children showed complete recovery of nutritional status. Length of stay and history of disease were the parameters that most adversely affected the nutritional status of preterm and term neonates at discharge and during follow-up. CONCLUSION: While malnutrition is a major problem in pediatric intensive care units, most children have good long-term outcome in terms of nutritional status after discharge.     

Intensive Care in Critical Access Hospitals

CONTEXT: Although critical access hospitals (CAHs) have limitations on number of acute care beds and average length of stay, some of them provide intensive care unit (ICU) services. PURPOSE: To describe the facilities, equipment, and staffing used by CAHs for intensive care, the types of patients receiving ICU care, and the perceived impact of closing the ICU on CAH staff and the local community. METHODS: A semistructured interview of directors of nursing at CAHs that provide intensive care services. RESULTS: Two thirds of CAHs that provide intensive care do so in a distinct unit. Most have continuous or computerized electrocardiography and ventilators. Other ICU equipment common in larger hospitals was reported less frequently. Nurse:patient ratio ranged from 1:1 to 1:3, and some or all nursing staff have advanced cardiac life support certification. Most CAHs admit patients to the ICU daily or weekly, primarily treating cardiac, respiratory, gastrointestinal, endocrine, and drug- or alcohol-related conditions. ICUs are also used for postsurgical recovery. Respondents felt that closure of the ICU would be burdensome to patients and families, result in lost revenue, negatively impact staff, and affect the community's perception of the hospital. CONCLUSIONS: Intensive care services provided by CAHs fall along a continuum, ranging from care in a unit that resembles a scaled-down version of ICUs in larger hospitals to care in closely monitored medical-surgical beds. Nurse to patient ratio, not technology, is arguably the defining characteristic of intensive care in CAHs. Respondents believe these services to be important to the well-being of the hospital and of the community.     

重症监护病房护理小组工作模式的案例研究

目的 :探索目前重症监护室病房(ICU)护理小组工作模式的运行情况,分析不同小组工作模式的作用。方法 :采用案例研究法。用目标抽样法,采用滚雪球的方法选取上海市、北京市和广东省7家医院的8个ICU,每个选取1名护士,通过半结构式访谈收集资料。用内容分析法分析资料。结果 :ICU的小组工作模式分为小组长管床和不管床两种模式。结论 :ICU护理小组工作模式中,与管床模式相比,不管床模式能更好地体现组长的作用,体现分层管理,保证护理质量。     

Optimizing nurse capacity in a teaching hospital neonatal intensive care unit

Patients in intensive care units need special attention. Therefore, nurses are one of the most important resources in a neonatal intensive care unit. These nurses are required to have highly specialized training. The random number of patient arrivals, rejections, or transfers due to lack of capacity (such as nurse, equipment, bed etc.) and the random length of stays, make advanced knowledge of the optimal nurse a requirement, for levels of the unit behave as a stochastic process. This stochastic nature creates difficulties in finding optimal nurse staffing levels. In this paper, a stochastic approximation which is based on the required nurse: patient ratio and the number of patients in a neonatal intensive care unit of a teaching hospital, has been developed. First, a meta-model was built to generate simulation results under various numbers of nurses. Then, those experimented data were used to obtain the mathematical relationship between inputs (number of nurses at each level) and performance measures (admission number, occupation rate, and satisfaction rate) using statistical regression analysis. Finally, several integer nonlinear mathematical models were proposed to find optimal nurse capacity subject to the targeted levels on multiple performance measures. The proposed approximation was applied to a Neonatal Intensive Care Unit of a large hospital and the obtained results were investigated.     

责任制带教模式在重症监护室实习护生带教中的效果观察

目的研究分析在重症监护室实习护生的带教工作中采用责任制带教模式管理的效果。方法随机抽选2018年1-8月在该院重症监护室实习的护生资料共计56名开展对照分析,抽签法分组为观察组以及对照组,每组28名。对照组实习护生接受功能制教学模式带教,观察组实习护生接受责任制带教模式,分析两组实习护生的理论考核、病历书写、护患沟通、规范操作以及平均成绩分数差异。结果观察组中实习护士的理论考核、病历书写、护患沟通、规范操作以及平均成绩分数均显著高于对照组(P<0.05)。结论在医院重症监护室的带教工作中,针对实习护生采取责任制带教模式有利于提升其理论水平以及实践操作能力,进而显著提升护理教学质量,具有较高的临床推广价值。