床旁多普勒超声引导下经皮气管切开术在重症脑出血患者中的应用

目的探讨床旁多普勒超声引导下经皮气管切开术（PDT）在重症脑出血患者中的应用价值。方法选取2014年1月—2019年4月南方医科大学附属小榄医院重症医学科监护治疗的重症脑出血患者126例，在ICU床旁采用超声引导下行PDT。术前采用超声进行检查，明确气管位置、周围组织及血管情况，确定穿刺部位及深度，指导术前气管导管退管。术中实时超声引导，确保手术安全。术后超声确认气管切开套管位置，筛查排除气胸等相关并发症。观察操作时间（从皮肤穿刺到成功置入气管套管时间）、一针穿刺成功率、置管成功率、气管插管意外脱管率；观察术中及术后并发症：出血量、血管/甲状腺损伤、气管后壁损伤、皮下气肿、气胸、低氧血症发生率等。结果126例患者手术均一次操作成功，一针穿刺成功率及置管成功率均为100%，未发生气管插管意外脱管。操作时间5~12 min，平均操作时间7.5 min。术中及术后未发生难以控制的大出血、严重低氧血症、血管/甲状腺损伤、气管后壁损伤、皮下气肿及气胸等并发症。结论对重症脑出血患者行床旁实时超声引导下行PDT，提高了手术的可视性、操作性和安全性，提高PDT成功率，降低相关并发症，具有良好的临床价值。     

Evaluation of bedside blood glucose monitoring by the phlebotomy team in an acute general care hospital

A feasibility study was undertaken to evaluate laboratory phlebotomists performing bedside glucose monitoring (BGM) over a 3-month period on a medical and surgical floor. Specific questions included: feasibility of providing testing on a 24-h basis, accuracy, appropriate utilization, effect on patient care, and an analysis of cost. In all, 1975 tests were performed on 114 patients. BGM results were within 15% of the laboratory's result 97% of the time. Patient and physician satisfaction was high. Although the cost of BGM is slightly higher than a laboratory glucose test, its use appeared to reduce the length of hospital stay by 0.47 days. Practical information on initiating a highly successful BGM program is provided.     

新型冠状病毒肺炎患者床旁血液净化治疗的感染防控

目的 探讨新型冠状病毒肺炎(corona virus disease 2019,COVID-19)患者隔离病区床旁血液净化治疗的感染防控策略,评价感染防控的效果。方法 通过回顾性分析2020年2月8日至2020年3月31日期间在武汉华中科技大学同济医学院附属同济医院中法新城院区COVID-19隔离病区床旁血液净化治疗患者的临床特征、感染情况和转归,总结所采取的感染防控措施,分析医护人员和患者COVID-19交叉感染情况以及患者之间血源性病原体交叉感染的情况,评估各项感染防控措施在控制交叉感染发生和传播中的作用。结果 研究期间该隔离病区累计收治101例COVID-19患者,其中10例(占9.90%)开展床旁血液净化治疗,采取的血液净化治疗方式均为连续性血液透析滤过(continuous venovenous hemodiafiltration, CVVHDF), 累计床旁血液净化治疗79例次。采取的感染防控管理措施包括病区隔离分区、患者行为隔离和患者安置、操作人员个人防护和手卫生,透析废液、空气、物体表面、医疗器械和医用织物等环境物品管理。无1例医护人员感染COVID-19,所有医护人员两次咽拭子COVID-19病毒核酸检测(两次采样间隔>1 d)均为阴性;开展床旁血液净化治疗的患者中2例COVID-19疑似病例在住院期间多次咽拭子病毒核酸检测及血清COVID-19病毒抗体IgG、IgM均阴性,胸部CT无病毒性肺炎表现;患者未发生血源性病原体的院内交叉传播。结论 在COVID-19隔离病区开展床旁血液净化治疗,通过采取有效的感染防控管理,能够有效控制院内交叉感染的发生和传播,可以为呼吸道传染病隔离病区患者诊治和感染防控提供一定的经验。     

Agfa新一代数字X线成像系统DX-S在小儿胸片中的应用

目的：探讨Agfa新一代X线成像系统（DX-S）在儿童胸片应用中的临床价值。方法：选择年龄3-4岁，体重在12-15公斤患儿100名，将这100名患儿随机分成2组，分别使用市场上同级别品稗CR和Agfa DX-S进行胸部摄片．由放射科有经验的医师3名在双盲前提下对这100张胸片进行分析，评价胸部特定的8个解剖区域（周围肺实质、中心肺实质、肺门、心脏、横膈、上纵隔，骨骼和软组织），应用5分指标对所有100张胸片进行胸片质量分析比较，进行统计学分析。并对这100张胸片所用曝光条件千伏（KV），毫安秒（mAs）进行比较。结果 Agfa DX-S图像质量高于该品牌，更有利于诊断，同时Agfa DX-S使用的曝光条件明显低于市场上同类产品。结论：Agfa新一代数字X线成像系统DX-S值得在儿科放射领域推广应用。     

Intensive care nurses’ perceptions of Inter Specialty Trauma Nursing Rounds to improve trauma patient care—A quality improvement project

BackgroundTrauma patient management is complex and challenging for nurses in the Intensive Care Unit. One strategy to promote quality and evidence based care may be through utilising specialty nursing experts both internal and external to the Intensive Care Unit in the form of a nursing round. Inter Specialty Trauma Nursing Rounds have the potential to improve patient care, collaboration and nurses’ knowledge.ObjectivesThe purpose of this quality improvement project was to improve trauma patient care and evaluate the nurses perception of improvement.MethodsThe project included structured, weekly rounds that were conducted at the bedside. Nursing experts and others collaborated to assess and make changes to trauma patients’ care. The rounds were evaluated to assess the nurse’s perception of improvement.ResultsThere were 132 trauma patients assessed. A total of 452 changes to patient care occurred. On average, three changes per patient resulted. Changes included nursing management, medical management and wound care. Nursing staff reported an overall improvement of trauma patient care, trauma knowledge, and collaboration with colleagues.ConclusionsInter Specialty Trauma Nursing Rounds utilizes expert nursing knowledge. They are suggested as an innovative way to address the clinical challenges of caring for trauma patients and are perceived to enhance patient care and nursing knowledge.     

An audit to estimate the quality of practices followed during bedside blood transfusion in a tertiary care hospital and role of continuous medical education in it

Blood transfusion is an integral component of the health Service system and it becomes imperative that its benefits, risks as well as prospective and viable alternatives of this common medical intervention are explained explicitly to the patients. Appropriate compliance to bedside blood transfusion practices can also help in avoiding adverse transfusion outcomes. At the same time, it is also crucial to document a patient's valid consent based on their decision after evaluation of the risk to benefit ratio. This audit aims to assess the compliance and adherence to bedside blood transfusion practices in a tertiary care hospital and role of Continuous Medical education (CME) on it. The study involved collection of data for blood transfusion services and practices in two periods, for adults and children, who received transfusion from the month of June 2021 to October 2021 and a re-audit beginning from November 2021 to February 2022 following few CMEs in between involving doctors and nurses. A total of 3240 transfusion procedures were assessed in this duration. In them 1500 (46.3%) took place before CME and remaining 1740 (53.7%) procedures took place after CME. There were statistically significant differences between pre-CME and post-CME bedside transfusion practices. During CME/training session, pre-training and post training knowledge has been evaluated by test which also showed statistically significant difference in knowledge of transfusion medicine & bedside transfusion practices. Our study recommends that there is a need of frequent audit on bedside transfusion practices to check the quality and standards associated with it and also points out the need of continuous medical education on this issue.     

颅脑CT和床旁超声在重型颅脑损伤去骨瓣减压术后监测中的应用

目的 对比分析颅脑CT和床旁超声在重型颅脑损伤去骨瓣减压术后监测中的诊断效能。方法 回顾性分析2016年3月至2018年9月行去骨板减压术治疗的140例重型颅脑损伤的临床资料，术后均行颅脑CT和床旁超声检查。结果 床旁超声脑挫裂伤、脑梗死、硬膜外血肿、硬膜下血肿、脑内血肿的检出率与颅脑CT监测无统计学差异（P>0.05），但其总检出率明显低于颅脑CT检查（P<0.05），诊断阳性率为88.06%。床旁超声在诊断出血量、中线位移动距离、脑室宽度绝对值、血肿大小等与颅脑CT监测无统计学意义（P>0.05）。结论 床旁超声在重型颅脑损伤去骨瓣减压术后监测中具有一定的优势，可在一定程度上替代颅脑CT检查，临床应用价值较高。     

床旁颅脑超声对新生儿脑室参数测量的应用研究

目的探讨新生儿脑室参数测量在疾病诊断和脑发育评估中的应用价值。方法采用床旁超声诊断仪对出生后3 d内的新生儿颅脑进行常规检查,主要行冠状及矢状面扫描,对扫查参数进行统计分析。结果新生儿各项测定值在性别上的差异均不显著;新生儿侧脑室大小与头围呈正相关(r=0.310 0,P0.05),与新生儿体重及身长无相关性。结论床旁颅脑超声可作为常规检查手段,通过对新生儿脑室参数的测量来评估脑损伤类型和程度、评估脑的发育情况。