三种不同时机下术前导尿配合手术室护理对全麻手术患者苏醒期躁动的影响

摘要 目的 观察三种不同时机下术前导尿配合手术室护理对全身麻醉（全麻）手术患者苏醒期躁动的影响。方法 选择2017年1月～2018年12月于我院行择期全麻手术的患者100例，根据术前导尿时机分为3组：A组（手术当日清晨在病房导尿，33例）、B组（麻醉前在手术室导尿，30例）、C组（麻醉平稳后在手术室导尿，37例）。记录并比较3组麻醉时间、术中输液量、术中出血量、苏醒时间及导尿前后收缩压（SBP）、舒张压（DBP）及心率（HR）变化，比较3组一次性导尿成功率、术后导尿管适应度及苏醒期躁动发生情况，采用自拟问卷调查患者护理满意度。结果 3组麻醉时间、术中输液量、术中出血量及苏醒时间比较，差异无统计学意义（P>0.05）；A组导尿后SBP、DBP、HR较导尿前均显著升高（P<0.05），B组和C组SBP、DBP、HR与导尿前比较，差异无统计学意义（P>0.05）；A组一次性导尿成功率显著低于B组和C组，术后导尿管适应度显著差于B组和C组（P<0.05）；A组苏醒期躁动发生率显著高于C组，苏醒期躁动分级显著高于C组P<0.05）；A组护理满意度评分显著低于B组和C组，差异有统计学意义（P<0.05）。结论 在麻醉前后于手术室进行导尿的效果明显优于手术当日清晨在病房导尿，配合手术室护理干预可有效提高患者术后对导尿管的适应度，降低苏醒期躁动发生率，提高患者护理满意度。     

带管病人病员服的研制与临床应用

引流管是手术后最常用的基本措施之一，常用的引流管一般有2～3根，多者为5～6根，如胸腔引管、T管、导尿引流管和负压引流。引流管的基本原理是消除积液，消除有害物质，解除管腔阻塞，以达到治疗疾病和伤口愈合的目的。     

留置导尿新方法在男性尿潴留患者中的应用

目的探索提高急性尿潴留导尿困难患者导尿成功率的措施。方法回顾性分析2011年1月至2011年12月我院常规导尿术失败的男性急性尿潴留患者62例,通过适当的局麻和充分的润滑后采用内置输尿管导管的Foleys导尿管进行再次导尿,成功52例;失败10例中7例借助带半鞘的尿道镜直视下留置尿管成功。结果除3例患者留置尿管导尿失败后行耻骨上膀胱穿刺造瘘术外,其余59例通过新方法再次导尿均获成功,并且无明显血尿及尿道疼痛,成功率达95.16%。结论应用新方法导尿置管有助于提高男性尿潴留患者留置尿管的成功率。     

两种深静脉置管术在 ICU 临床应用观察

目的：观察锁骨下和股静脉较两种深静脉置管术的难易程度及其主要的并发症。方法选择ICU内需做深静脉置管的患者300例,随机分为锁骨下静脉（A组）150例,股静脉（B组）150例,通过比较2组的穿刺的成功率及其主要并发症等指标,从而明确两个部位穿刺的优缺点。结果股静脉穿刺组成功率高,与锁骨下静脉组比较差异有显著性（P＜0．05）。锁骨下置管并发导管移位、气胸最高（P＜0．05）,而股静脉置管并发误入动脉,感染,及堵管较高（P＜0．05）。导管脱出并发症两者无显著性差异（P＞0．05）。结论2种置管方法各有其优缺点,操作者可以根据置管的目的,患者情况以及个人对两种置管术操作的熟练程度,合理选择置管方法,减少置管出现的并发症的可能。     

Validation of the self-confidence scale of nursing care in urinary retention

Objective:

to validate an instrument to measure self-confidence of nursing care in urinary retention.

Methods:

methodological research study, carried out after ethical approval. A Likert-like scale of 32 items related to nursing care in urinary retention was applied to students of the graduate nursing course. For instrument validation, analysis of the sample adequacy and main components, Varimax orthogonal rotation and internal consistency analyses were developed.

Results:

in a sample of 305 students, there was high correlation of all items with the total scale and Cronbach''s alpha of 0.949. The scale items were divided into five factors with internal consistency: Factor 1 (0.890), Factor 2 (0.874), Factor 3 (0.868), Factor 4 (0.814) and Factor 5 (0.773), respectively.

Conclusion:

the scale meets the validity requirements, demonstrating potential for use in evaluation and research.     

先天性心脏病对儿童心理行为的影响

目的 研究先天性心脏病对儿童心理行为的影响,并对照研究介入治疗与外科手术对先天性心脏病患儿术后心理行为的影响. 方法 采用徐韬园1992年修订的Achenbach儿童行为量表对232例先天性心脏病患儿进行心理行为检测. 结果 先天性心脏病儿童心理行为异常检出率显著高于对照组.先天性心脏病各组患儿心理行为总粗分显著高于对照组(P＜0.01),先天性心脏病患儿心理行为粗分均值亦高于对照组(P＜0.01或P＜0.05).男孩主要表现在抑郁、交往不良、体诉(各种躯体不适的反应)、社会退缩、违纪及攻击方面,女孩主要表现在抑郁、社会退缩、体诉、违纪方面.术后测试,男、女两治疗组心理行为总粗分分别显著低于治疗前(P＜0.01).介入组男孩术后总粗分及攻击行为粗分分别低于外科组,差异具有统计学意义(P＜0.05),介入组女孩术后心理行为总粗分及抑郁、社会退缩和违纪行为粗分分别低于外科组,差异具有统计学意义(P＜0.05).心理行为因子异常检出率与病程呈正相关,病程越长检出率越高. 结论 先天性心脏病患儿存在着明显的心理行为问题,应引起重视.早期治疗以及采用介入治疗方式可较明显改善先天性心脏病患儿的心理行为状况.     

超声引导经皮穿刺置管建立儿童体外膜肺氧合初步观察

目的评价超声引导下经皮穿刺置管用于建立儿童体外膜肺氧合(ECMO)的作用与安全性。方法回顾性分析2016年5月至2021年4月上海交通大学附属儿童医院重症医学科完成的66例非心脏手术ECMO支持患儿的临床资料。收集患儿一般情况、ECMO支持模式、动静脉插管类型与尺寸、置管方式、操作时间和置管并发症等。根据置管方式分为经皮穿刺置管组与外科切开置管组, 比较两组患儿年龄、体重、置管操作时间、ECMO支持时间、ECMO撤机成功率和出院存活率等。组间比较采用χ2检验或非参数秩和检验。结果 66例患儿中男38例、女28例, 年龄44.5(12.0, 83.5)月龄, 体重15.0(10.0, 25.0)kg。床旁超声引导下经皮穿刺置管21例(32%), 成功20例(95%), 1例穿刺失败改为外科切开置管。最终经皮穿刺置管组20例, 年龄70.5(23.8, 109.5)月龄, 体重23.2(13.6, 37.0)kg。经皮穿刺置管组置管操作时间明显短于外科切开血管置管组[26.0(23.3, 30.3)比57.0(53.8, 64.0)min, Z=6.31, P<0.001]。经皮穿刺...     

Influence of nifedipine on left ventricular systolic and diastolic function: Relationships to manifestations of ischemia and congestive failure

In addition to the favorable effects of calcium antagonists on symptoms related to coronary spasm, we recently documented preclusion of ergonovine-induced coronary spasm angiographically in four patients with proved Prinzmetal's angina.To determine whether nifedipine has similar “relaxing” or negative inotropic actions on left ventricular myocardial function, we studied 19 patients with various degrees of left ventricular dysfunction before and after nifedipine (20 mg sublingually) during cardiac catheterization. Left ventricular afterload was reduced, with a significant (13 percent) decline in arterial pressure; left ventricular diastolic pressures were unchanged. Left ventricular ejection function was augmented, with significant increases in ejection fraction (14 percent), mean velocity of circumferential fiber shortening (41 percent), systolic ejection rate (25 percent), and end-systolic $\text{pressure}\text{volume}$ ratio (19 percent). Cardiac index increased significantly by 16 percent. Early diastolic relaxation, diastolic pressure-volume relations and end diastolic stiffness remained unchanged after nifedipine. When patients were categorized (Group I: left ventricular end-diastolic volume ≤ 90 ml/m², end-diastolic pressure ≤ 20 mm Hg; Group II: end-diastolic volume > 90 ml/m², end-diastolic pressure > 20 mm Hg), highly pertinent differences were apparent. Nifedipine significantly reduced left ventricular preload and end-diastolic pressures in Group II but not in Group I patients. Enhancement of left ventricular ejection function in Group II patients was significantly more prominent than that in patients with normal baseline function. Although diastolic properties were insignificantly changed overall, the left ventricular diastolic pressure-volume relation was displaced downward by nifedipine in Group II, but not in Group I patients. Both systemic and pulmonary vascular resistance declined significantly more in Group II patients, whereas cardiac index was increased 25 percent compared with a negligible change in group I patients. These results indicate beneficial effects of nifedipine on myocardial oxygen requirements, particularly in patients with impaired left ventricular function in whom left ventricular preload and afterload were both significantly reduced, cardiac index augmented and the pressure-volume relation shifted downward.To confirm predicted symptomatic benefits in 13 other patients with fixed coronary, disease, incremental atrial pacing to anginal threshold was performed before and 30 minutes after nifedipine (20 mg sublingually). Mean paced heart rate at onset of angina increased 19.3 percent after nifedipine. Concomitantly, aortic pressure decreased significantly by 22.1 percent at the onset of angina; double product was unchanged at the anginal threshold. Thus, although left ventricular afterload was reduced by nifedipine, the anginal threshold was unchanged in terms of myocardial oxygen requirements.In concert, these results indicate that therapeutically effective influences of nifedipine in patients with fixed coronary disease are attributable basically to hemodynamic alterations consequent upon left ventricular afterload reduction. Nevertheless, such effects imply therapeutic benefit, the reduced afterload concomitantly permitting greater exercise-induced tachycardia before the anginal threshold is reached.