临床护理人员对下肢深静脉血栓的认知现状和预防措施落实情况的调查

目的调查某地三级甲等综合性医院临床护理人员对下肢深静脉血栓(deep venous thrombosis,DVT)的认知现状以及DVT预防措施的落实情况,以期为进一步提高护理人员下肢DVT的预防和护理水平提供依据。方法 2016年9月,便利抽样法选取某地市区8所三级甲等综合性医院临床护理人员1166名为研究对象。采用自行设计的"临床护理人员对下肢DVT认知现状和DVT预防措施落实现状的调查问卷"对其进行调查。结果本调查中1166名护理人员对下肢DVT相关知识的认知得分为71~240分,平均(181.24±32.04)分。不同年龄、学历、护龄、能力层级、职称、职务、有无下肢DVT患者护理经验及有无阅读相关指南经历的护士,其下肢DVT相关知识认知评分差异均有统计学意义(均P0.05)。护理人员临床下肢DVT预防措施落实情况得分为33~115分,平均(100.45±14.17)分。不同学历、有无下肢DVT患者护理经验及有无阅读相关指南经历护士,其临床下肢DVT预防措施落实情况评分的差异均有统计学意义(均P0.05)。护理人员下肢DVT相关知识的认知现状得分与下肢DVT预防措施落实现状得分之间呈正相关(r=0.584,P0.001)。结论临床护理人员下肢DVT相关知识掌握情况处于中等水平,下肢DVT预防措施落实情况较好。医院应重点加强对工作时间5年以内、中专学历的低年资护理人员的培训和学历教育。     

脱细胞猪真皮基质敷料覆盖治疗小儿特重度烧伤深Ⅱ度创面的护理

目的总结脱细胞猪真皮基质覆盖治疗小儿特重度烧伤深Ⅱ度创面的护理重点。方法回顾性分析2015年4月至2016年4月广州市红十字会医院烧伤重区收治的9例特重度烧伤小儿应用脱细胞猪真皮基质敷料覆盖深Ⅱ度创面的临床资料和护理措施。结果 9例特重度烧伤患儿均平稳渡过休克期,于2~3周全部治愈。结论脱细胞猪真皮基质急诊覆盖治疗小儿特重度烧伤深Ⅱ度创面可以促进创面愈合,护理重点在于生命体征观察与输液护理、疼痛管理与心理护理及术后加强创面生物敷料观察与护理。及时发现、去除脱细胞猪真皮基质敷料下积液、积脓,维持敷料的干燥,防止脱细胞猪真皮基质敷料缩窄影响肢端血运。     

A Review of Agents for Palliative Sedation/Continuous Deep Sedation: Pharmacology and Practical Applications

Continuous deep sedation at the end of life is a specific form of palliative sedation requiring a care plan that essentially places and maintains the patient in an unresponsive state because their symptoms are refractory to any other interventions. Because this application is uncommon, many providers may lack practical experience in this specialized area and resources they can access are outdated, nonspecific, and/or not comprehensive. The purpose of this review is to provide an evidence- and experience-based reference that specifically addresses those medications and regimens and their practical applications for this very narrow, but vital, aspect of hospice care. Patient goals in a hospital and hospice environments are different, so the manner in which widely used sedatives are dosed and applied can differ greatly as well. Parameters applied in end-of-life care that are based on experience and a thorough understanding of the pharmacology of those medications will differ from those applied in an intensive care unit or other medical environments. By recognizing these different goals and applying well-founded regimens geared specifically for end-of-life sedation, we can address our patients' symptoms in a more timely and efficacious manner.     

塔中某井区扭力冲击器应用效果分析

塔中某井区平均井深6000m 以上, 地层岩石抗压强度高, 研磨性强, 可钻性差。为了提高钻井速度, 控制 钻井成本, 该井区引入了“PDC+扭力冲击器” 钻井工艺。扭力冲击器通过把钻井液的能量转化成高频冲击力作用在钻 头上, 增加瞬时扭矩, 减少钻头卡滑效应, 提高钻头破岩效率。应用表明: 从二叠系到奥陶系井段, 使用PDC 扭力冲 击器较常规钻井工艺平均提速可达35%, 并节省3 趟起下钻时间, 其中在卡拉沙依组、巴楚组提速高达62%, 取得了显 著的提速效果, 为优化提速钻井工艺提供了一定的参考。     

塔里木油田超深裸眼水平井完井模拟通井优化技术

常规偏心分层注水会导致区块欠注严重, 难以满足超深双台阶水平井分层注水;并且难以满足不动管柱实现注水井的分层注水及分层酸化。为此研制了针对双台阶水平井分层注水及酸化的一体化管柱及配套工具, 管柱主要由封隔器、注水酸化一体化配水器等组成;测调过程中测调仪器与管柱中的配水器采用同心对接, 投劳成功率高;并且通过与特制酸化芯子配合可实现不动管柱分层酸化。利用WELLCAT 软件模拟出注水、酸化、停注时各封隔器的受力、管柱收缩长度以及管柱整体强度, 为封隔器及伸缩管的选择提供理论依据。现场试验表明, 研制的注水酸化一体化管柱及配套工具设计合理, 测调成功率高, 能够满足双台阶水平井的分层注水及酸化要求。     

Low Rate of Intrahospital Deep Venous Thrombosis in Acutely Ill Medical Patients: Results From the AURELIO Study

Objective

To evaluate the effect of hospitalization on deep venous thrombosis (DVT) rate by the cumulative incidence of DVT in the proximal venous tract of the lower limbs at admission and discharge.

康复治疗对股骨头坏死术后患者功能恢复的影响

目的：探讨康复治疗对大转子骨瓣移位术后功能恢复的影响。方法：50例股骨头坏死患者采用带旋股内血管大转子骨瓣移位术，术后施行康复治疗。术前、康复治疗后对关节疼痛、关节活动度及日常生活能力进行评定。结果：经过6个月康复治疗，50例患者髓关节疼痛改善，关节活动度及日常生活能力与治疗前比较有显著提高（均P〈0．01）。结论：康复治疗有利于股骨头坏死大转子骨瓣移位术后患者肢体功能的恢复。