运用PDCA循环改进居家养老护理文件书写质量

目的运用PDCA循环的质量管理方法,改进居家养老护理文件书写质量。方法对现存的护理质量不合格项目进行原因分析、制定改进计划、组织实施、效果评价。结果改进后的居家养老护理文件书写合格率达到98%。结论通过应用PDCA循环质量管理工具进行护理质量管理,使该中心居家养老护理文件书写水平得到大幅度提高,同时促进了该中心护理管理质量的提升。     

持续质量改进在体检科护理质量管理中的应用效果探讨

目的探究持续质量改进在体检科护理质量管理中的应用效果。方法该次将该院在2018年7-12月的体检者200名作为研究的对象,视为对照阶段,采取常规护理管理方法;将该院2019年1-6月的体检者200名作为观察阶段对象,在护理管理工作中采取持续质量改进管理模式,进一步对比两个阶段患者对于体检科工作质量的评分。结果在体检工作质量、服务态度、体检满意度这3个模块,观察阶段评分对照阶段比较均明显更高,差异有统计学意义(P<0.05)。结论持续质量改进应用于体检科护理质量管理中,可有效提升体检服务品质,值得推广应用。     

Perioperative management of diabetes

Diabetes is a complex, chronic metabolic disorder affecting approximately 9.3% of the adult population with the estimated number of adults with diabetes worldwide having more than tripled since 2000. This increase has largely been attributed to global urbanization and lifestyle changes. Diabetes affects 10–15% of the surgical population. These patients are frequently elderly, have complex medical co-morbidities and present for both high-risk elective and emergency surgery. This multisystem disease poses a significant challenge to both anaesthesia and surgery with patients with diabetes demonstrating higher morbidity and mortality rates compared to their non-diabetic counterparts. It is crucial that good glycaemic control is maintained throughout the perioperative period as this has been shown to correlate with positive patient outcomes. It is well-recognized that a co-ordinated, multidisciplinary approach aimed at optimizing every point in the patient pathway from GP referral to post-discharge care is required to obtain the best outcomes for the surgical patient with diabetes. The anaesthetist has a key role in the perioperative diabetes multidisciplinary team. Patients themselves are well experienced in manging their own diabetes and should be involved in doing so whenever possible.     

Continuous passive motion following total knee replacement: a prospective randomized trial with follow-up to 1 year

We have carried out a prospective randomised, single blind clinical trial to investigate the effect of continuous passive motion on range of knee flexion, lack of extension, pain levels and analgesic use after total knee replacement surgery. 85 subjects were randomly allocated to control or study group. All subjects followed the existing rehabilitation protocol, which permits immediate active range of motion exercises and mobilisation with the study group using continuous passive motion for 1 h, twice a day. Outcome measures employed were range of motion, pain assessed on a visual analogue scale and analgesic use according to the WHO ladder. Blinded evaluation was carried out preoperatively, at time of discharge from hospital, 6 weeks, 6 and 12 months postoperation. No significant difference was observed between groups at all time intervals for each outcome variable using Wilcoxon Rank sum tests. The results substantiate previous findings that short duration continuous passive motion following total knee arthroplasty does not influence outcome of range of motion or reported pain.     

Spinal epidural hematoma. Report of a case and review of the literature

We report the case of a thoracic epidural hematoma at the T7-T9 level which occurred after placement of spinal epidural catheter for continuous anaesthesia in acute pancreatitis. The male patient felt a sudden back pain after six days of successful analgesia and became paraplegic 24 hours afterwards. An emergency laminectomy and removal of the hematoma were performed; however, the patient recovered only incompletely.We discuss the clinical signs and symptoms of spinal epidural hematoma as well as its diagnostics and therapy. The controversial views from the literature concernings its etiology are critically reviewed.     

使用便携式微量输液泵持续输注氟尿嘧啶的临床观察及护理

目的：探讨使用便携式微量输液泵在肿瘤化疗中持续输注氟尿嘧啶的应用效果。方法：选取我科2006年3月-2008年7月96例癌症化疗病人按入院先后顺序分为对照组和实验组,每组48例。对照组采用传统的化疗方式,采用浅静脉留置针直接从外周静脉输注氟尿嘧啶（5-Fu）连续5天,每天维持6-8小时。实验组采用浅静脉留置针连接便携式微量输液泵持续泵入氟尿嘧啶（5-Fu）120h～135h,两组均以21天为1个周期,观察两组病人化疗毒副反应发生情况。结果：实验组化疗毒副反应发生率明显低于对照组,平均住院时间明显缩短,两组比较差异有统计学意义（P〈0.01）。结论：使用便携式微量输液泵持续泵入氟尿嘧啶能减轻病人的毒副反应,缩短住院时间,提高肿瘤病人生活质量,有效减轻护士的工作负担。     

连续性静脉-静脉血液滤过联合机械通气治疗ARDS的临床观察

目的　观察连续性静脉 -静脉血液滤过 (CVVH)联合机械通气治疗ARDS患者的临床疗效。方法　选择入住ICU符合ARDS诊断标准的患者 4 0例 ,随机分为 2组 :A组 2 1例 ,采用常规治疗 +机械通气 ;B组 1 9例 ,采用常规治疗 +机械通气 +CVVH。分别观察 2组患者在使用呼吸机时间、氧合指数、吸入氧浓度、动脉血氧分压、PEEP水平、心率、血压及病死率等方面的差别。结果　A、B两组患者在病因、年龄、性别、APACHEⅡ评分及平均脏器功能障碍数等方面相似 ,B组患者加用CVVH后 ,各项指标经统计学处理显示 :病死率 ,B组与A组比较 ,差异有显著性意义 (P <0 0 5 ) :其他指标与A组比较 ,差异均有高度显著性意义 (P <0 0 1 )。结论　CVVH疗法可有效清除ARDS患者血管外肺水和各种应激激素、致炎介质 ,明显改善了ARDS患者肺部氧合功能及血流动力学指标 ,提高了抢救成功率     

奥沙利铂持续腹腔热灌注治疗癌性腹水的临床研究

目的研究奥沙利铂(L-OHP)持续腹腔热灌注治疗癌性腹水的疗效和毒副作用。方法将76例癌性腹水患者随机分为三组:奥沙利铂持续腹腔热灌注化疗组(热化组)26例,引出腹水后,在加热的5%葡萄糖溶液2500～3500ml中加入L-OHP200mg/m2,持续体外循环腹腔热灌注,腹腔内温度保持在41～43℃,持续60min;腹腔内注射奥沙利铂化疗组(单化组)26例,常规腹腔穿刺引流腹水后注射L-OHP200mg/m2。单纯腹腔热灌注组(单热组)24例,加热5%葡萄糖溶液2500～3500ml,持续热灌注60min。结果总有效率(CR PR)54%(41/76)。热化组、单化组和单热组的有效率分别为76.9%(20/26)、50.0%(13/26)、33.3%(8/24),P<0.05。急性腹痛:热化组53.8%(14/26),单热组16.7%(4/24)。单化组无急性腹痛病例,P<0.05。麻痹性肠梗阻:热化组19.2%(5/26),单化组7.7%(2/26),单热组16.7%(4/24),P>0.05。结论奥沙利铂持续腹腔热灌注治疗恶性腹水是一种新的有效的治疗方法,毒副作用不大。     

重症急性胰腺炎合并急性肾功能衰竭的临床特点及治疗体会

目的 分析重症急性胰腺炎(SAP)合并急性肾功能衰竭(ARF)的临床特点,并总结治疗体会.方法 ①回顾分析南京军区南京总医院近9年63例SAP合并ARF临床资料,用多元直线回归方法分析影响ARF发生率的相关因素;②63例病人均行肠内营养支持(62.4±20.6d)和连续性肾脏替代治疗(CRRT)(15.6±8.7 d),51例行机械通气(21.7±12.4 d),54例早期腹腔穿刺,34例置鼻胆管或经皮经肝胆囊穿刺引流,18例行腹膜后脓肿穿刺引流,50例手术治疗.结果 SAP合并ARF的死亡率为31.7%,发生率为10.6%,SIRS持续时间、病情严重程度、ARDS、MODS、腹腔间室综合征等是SAP合并ARF的重要影响因素.结论 SIRS持续时间、病情严重程度、ARDS、MODS、腹腔间室综合征等是SAP合并ARF的重要影响因素;早期液体复苏、CRRT、有效维护脏器功能和局部引流是治疗成功的重要环节.     

连续浅缝法修补膜周型室间隔缺损

目的探讨连续浅缝法修补单纯膜周型室间隔缺损(pVSD)法的效果。方法选取2002年1月至2004年10月我院收治的体重10kg以内(≤10kg)50例单纯膜周型室间隔缺损患者,均采用自体心包连续浅缝法修补。结果主动脉阻断时间32±21min(14-52min),体外循环时间56±35min(29-69min)。无°房室传导阻滞发生,9例发生右束支传导阻滞,2例结性心律。2例膜周偏流出道型VSD患者因前上缘残余分流分别为0.4cm和0.3cm,再次手术修补;1例后下缘残留细束样分流,直径0.15cm,随访6个月后自愈;10例膜周偏流出道型VSD患者剪开三尖瓣,8例垂直瓣环,2例平行瓣环;1例三尖瓣中度反流,随访无加重;5例轻度反流,4例轻微反流,随访均无加重;1例心包积液;1例再次进入手术室止血。结论连续浅缝法是修补单纯膜周型室间隔缺损的有效外科纠治方法。