剖宫产术后发生压疮的原因及护理对策分析

目的 分析剖宫产术后发生压疮的原因及护理对策。方法 选取2021年1月-12月泾县医院剖宫产 术后患者28例，分析患者临床特征、压疮原因及护理结果。结果 28例患者的临床表现主要为皮下损伤（16 例）、红肿（12例）；压疮位置主要为骶尾（17例）、髂骨（11例）；压疮原因主要为单纯某项因素影响 （16例），其中3例由于胎盘早破，7例由于皮肤潮湿，6例由于消毒剂的影响；剩余12例患者为综合因素作 用造成；给予患者有效护理干预后其预期结果情况均好转。结论 引起剖宫产术后压疮的原因较多，给予有 效护理干预是预防压疮的关键。     

A systematic review of nurses' knowledge and related factors towards the prevention of medical device-related pressure ulcers

The aim of this review study is to investigate the nurses' knowledge and related factors towards the prevention of medical device-related pressure ulcers (MDRPUs). An extensive search was conducted in international electronic databases such as PubMed, Web of Science, and Scopus, and Persian databases, such as Iranmedex and the Scientific Information Database from December 1, 2022. During this search, keywords extracted from Medical Subject Headings, such as “Prevention knowledge,” “Nurse,” “Pressure ulcer,” “Equipment and Supplies,” and “Intensive Care Units” were used. The quality of the present studies in this review was evaluated based on the appraisal tool for cross-sectional studies (AXIS tool). A total of 1847 nurses participated in this review from five studies, and the majority of them (82.94%) were female. The mean age of the participants was 31.40 (SD = 5.97). The mean score of MDRPUs prevention knowledge in nurses based on PU2014 scale and researcher-made questionnaires were 16.50 (SD = 3.74) out of 31 and 65.49 (SD = 6.33) out of 100, respectively. The knowledge of nurses is influenced by factors such as age, sex, level of education, work experience, technical titles, type of hospital, level of hospital, and type of ward. Various factors had a significant positive relationship with nurses' MDRPUs prevention knowledge, which includes level of education, work experience, previous training on MDRPU, having a wound care certificate, an online search about MDRPU, and attitude and practise towards MDRPU prevention. At the same time, nurses' knowledge about the prevention of MDRPUs had a significant negative relationship with the time interval since last participating in MDRPU training or workshop. Overall, the level of MDRPUs prevention knowledge among nurses was insufficient to moderate. Therefore, it is suggested to provide facilities for nurses to receive the necessary training.     

李志道教授临床使用鱼际穴(LU10)经验谈

鱼际穴（LU10）为手太阴肺经经脉腧穴，能宣降肺气、疏风清热、化痰平喘以疗虚实喘咳和治疗咽喉肿痛，亦可顺调气机、宽胸行气以缓解抑郁。在现代解剖学上，鱼际穴位于手拇指处肌肉丰厚处，与对指的肌群联系密切，是治疗对指功能障碍的重要靶点。文章介绍李志道教授使用鱼际穴的临床经验。     

French practical guidelines for the diagnosis and management of relapsing polychondritis

Relapsing polychondritis is a rare systemic disease. It usually begins in middle-aged individuals. This diagnosis is mainly suggested in the presence of chondritis, i.e. inflammatory flares on the cartilage, in particular of the ears, nose or respiratory tract, and more rarely in the presence of other manifestations. The formal diagnosis of relapsing polychondritis cannot be established with certainty before the onset of chondritis, which can sometimes occur several years after the first signs. No laboratory test is specific of relapsing polychondritis, the diagnosis is usually based on clinical evidence and the elimination of differential diagnoses. Relapsing polychondritis is a long-lasting and often unpredictable disease, evolving in the form of relapses interspersed with periods of remission that can be very prolonged. Its management is not codified and depends on the nature of the patient's symptoms and association or not with myelodysplasia/vacuoles, E1 enzyme, X linked, autoinflammatory, somatic (VEXAS). Some minor forms can be treated with non-steroidal anti-inflammatory drugs, or a short course of corticosteroids with possibly a background treatment of colchicine. However, the treatment strategy is often based on the lowest possible dosage of corticosteroids combined with background treatment with conventional immunosuppressants (e.g. methotrexate, azathioprine, mycophenolate mofetil, rarely cyclophosphamide) or targeted therapies. Specific strategies are required if relapsing polychondritis is associated with myelodysplasia/VEXAS. Forms limited to the cartilage of the nose or ears have a good prognosis. Involvement of the cartilage of the respiratory tract, cardiovascular involvement, and association with myelodysplasia/VEXAS (more frequent in men over 50 years of age) are detrimental to the prognosis of the disease.     

Computed tomography findings of paranasal sinuses in patients with eosinophilic granulomatosis with polyangiitis: Comparison with other eosinophilic sinus diseases and clinical relevance of their severity

BackgroundAlthough paranasal sinuses are one of the most representative organs affected by eosinophilic granulomatosis with polyangiitis (EGPA), they have not been studied sufficiently. The aim of this study was to compare computed tomography (CT) findings in paranasal sinuses of EGPA with those of other eosinophilic sinus diseases and elucidate the clinical relevance of their severity.MethodsCT findings of paranasal sinuses in EGPA patients prior to therapeutic intervention (n = 30) were evaluated using the Lund–Mackay staging (LMS) system and compared with those of three control diseases [(NSAID-exacerbated respiratory disease (N-ERD), aspirin-tolerant asthma, and eosinophilic chronic rhinosinusitis without asthma (ECRS)]. We divided EGPA patients into three groups based on their LMS scores and examined their association with disease manifestation.ResultsTotal scores of the LMS system in EGPA were significantly lower than those of N-ERD and ECRS without asthma. There was a large variation in total LMS scores in EGPA, suggesting considerable heterogeneity of their sinus lesions. Although EGPA with low LMS system scores showed only minor findings in maxillary and anterior ethmoid regions, those with high LMS system scores were characterized by high scores in the ostiomeatal complex. However, the frequencies of patients with a Five-Factor Score ≥2 and with cardiac involvement were significantly higher for EGPA with low LMS system scores.ConclusionsAlthough paranasal sinus lesions in EGPA were less severe than those of other eosinophilic sinus diseases, their milder CT findings may be associated with a higher frequency of extra-respiratory organ involvement.     

电子喉镜在困难咽喉异物取出术中的临床体会

目的探讨电子喉镜在困难咽喉异物取出术中的临床运用。方法2008年3月=2012年3月的4年间，我科在电子喉镜介入下共处理困难异物97例。结果96例困难咽喉异物一次性经电子喉镜下成功取出。1例患者为假牙牙套且已部分进入食道，最终食道镜下取出。结论电子喉镜具有视野广而清晰无盲点，分辨率高的优点，特别适用于困难咽喉异物的取出，更为准确、方便。     

Biomarkers for the early detection of pressure ulcers in the intensive care setting: A comparison between sub-epidermal moisture measurements and interleukin-1α

Pressure ulcer (PU) prevention in the intensive care unit (ICU) is an important clinical issue as critically unwell patients are at high risk of developing PUs. However, current methods of PU detection are limited, especially for early detection. This study aimed to establish the correlation between Interleukin-1α (IL-1α)/total protein (TP) and sub-epidermal moisture (SEM) measurements in the early identification of PUs in ICU patients. This study employed an observational research design using the STROBE guidelines. Following ethical approval, 53 participants were recruited and sebum was obtained using Sebutape from weight-bearing areas (sacrum, heels and a control site). SEM measurements were taken from the same anatomical sites. Both measures were taken at the same time and participants were followed up for 5 days, or until discharge or death. Correlations between SEM delta measurements, IL-1α, TP and PU incidence and other demographic information were explored using Spearman's correlation for data not normally distributed, and Pearson's R correlation coefficient for normally distributed data. Mean baseline SEM delta measurements indicate abnormal readings for all anatomical sites except the control site, consistent with previous studies. Mean baseline IL-1α/TP readings were higher for the sacrum versus both heels and, on average, readings were higher for the control site versus all other anatomical locations. This is conflicting, given that the control site was non-weight bearing. There were very weak or weak correlations between SEM delta measurements and IL-1α/TP readings. SEM measurements are quick and easy to obtain and results are instant, however Sebutape sampling takes significantly longer and is challenging to conduct among haemodynamically unstable patients. Obtaining SEM measurements is more practical and feasible than Sebutape sampling to assess for the presence of inflammation.     

津沽疮疡学术流派传承创新“给邪出路”理论在疡科方面的应用

津沽疮疡学术流派发祥于天津，具有学术特点突出、坚持中医药为主、中西内外结合的特点。5代人历时一百三十余载始终传承“给邪出路”精神，在疡科的应用上形成了理、法、方、药、技完善的原创系统诊疗体系，并在以“给邪出路”为帜的疡科实践探索中进一步创学术思想之新，制药物、工具之颖，立足津沽，辐射全国，对近代渐进成为主流慢性难治疮面的糖尿病性、周围血管性疮疡仍显示了良好的治疗作用，以最大限度保肢保功，使疮疡疾病患者获得长期满意的疗效，彰显了传统中医药在新时代强大的生命力。     

地塞米松联合盐酸奥布卡因凝胶用于预防鼻内镜术后咽喉痛

目的: 探讨地塞米松联合盐酸奥布卡因凝胶用于预防鼻内镜术后咽喉痛的有效性及安全性。方法: 选择2020年1月至6月60例美国麻醉医师协会(American Society of Anesthesiologist, ASA)Ⅰ~Ⅱ级且年龄18~72岁拟在经口气管插管全身麻醉下接受鼻内镜手术的北京大学第三医院耳鼻喉科患者,随机数字表法分为地塞米松联合盐酸奥布卡因凝胶组(G组,30例)及对照组(C组,30例)。G组于麻醉诱导前静脉给予地塞米松0.1 mg/kg滴入,术前将奥布卡因凝胶涂抹气管导管套囊及前端15 cm范围内,之后进行常规的麻醉诱导、气管插管;C组于麻醉诱导前静脉给予同等体积的生理盐水,术前气管导管套囊及前端涂抹生理盐水,之后进行常规的麻醉诱导、气管插管。记录两组患者手术时间、麻醉时间、苏醒时间、拔管时间、出室时间、术中输液量、术中出血量、丙泊酚、瑞芬太尼、罗库溴铵等用药量;记录术中低血压、心动过缓、术后躁动等不良反应的发生情况。术毕及术后4、8、12、24 h进行咽喉痛随访。结果: 与C组比较,G组患者的苏醒时间[(8.4±3.9) min vs. (10.8±4.7) min]、拔管时间[(8.8±3.7) min vs. (11.9±4.8) min]、出室时间[(20.0±5.3) min vs. (23.0±5.8) min]显著缩短,丙泊酚用量[(11.8±1.8) mg/kg vs. (15.9±4.6) mg/kg]及瑞芬太尼用量[(10.9±4.7) μg/kg vs. (14.1±3.6) μg/kg]显著减少,发生低血压[10%(3/30) vs. 30%(9/30)]、心动过缓[16.7%(5/30) vs. 20%(6/30) ]及术后躁动[6.7%(2/30) vs. 23.3%(7/30)]的比例显著降低,两组患者肌松药的用量差异无统计学意义(P>0.05)。与C组比较,G组术毕即刻、术后4 h、术后8 h、术后12 h及术后24 h的咽喉痛评分[0(0, 1) vs. 1(1, 2),0(0, 0) vs. 1(1, 2), 0(0, 0) vs. 1(1, 2), 0(0, 0) vs. 1(0.75, 1), 0(0, 0) vs. 1(0, 1)]均显著降低。结论: 地塞米松联合盐酸奥布卡因凝胶可以安全有效地用于预防鼻内镜术后咽喉痛。     

A systematic review of nursing students' attitude and related factors towards pressure ulcer prevention

The purpose of this review study is to investigate the attitude of nursing students toward the prevention of pressure ulcers (PUs) and related factors. From February 1, 2023, a comprehensive search was conducted in international and Persian electronic databases such as Web of Science, PubMed, Scopus, Iranmedex, and Scientific information database (SID). The keywords obtained from Medical Subject Headings, including “Attitude”, “Nursing students”, and “Pressure ulcer” were used in this search. The quality assessment of the present studies in this systematic review was based on the appraisal tool for cross-sectional studies (AXIS tool). A total of 6454 nursing students participated in ten cross-sectional studies. All students were studying at the undergraduate level and 81.20% of them were female. Nursing students were in the first (39.27%), second (28.19%), and third and fourth (32.54%) academic years. Among the participants, 49.86% have completed at least 2 clinical units. The mean scores of attitudes toward PU prevention in nursing students based on attitude toward PU prevention (APuP) and researcher-made questionnaires were 75.01% and 68.82%, respectively. The attitude of nursing students was influenced by various factors, including age, sex, academic year, clinical experience, number of clinical units, experience in caring for PU patients, previous courses on PU in the curriculum, and contribution of training to knowledge. Also, in the present study, the positive relationship between the attitude and knowledge of nursing students was shown as the only significant correlation. In sum, the attitude of the majority of nursing students toward the prevention of PUs was at a satisfactory level. Therefore, it is expected to transfer the necessary knowledge to them with proper planning so that preventive actions can be carried out by following the guidelines.