老年病患骨科护理实践经验骨科护理

目的:探讨老年骨科的护理特殊性,降低老年护理的风险,为老年患者提供优质舒适的护理服务.方法:通过分析100例老年骨科患者的护理体验,分析老年骨科患者的特点.结果:100例老年骨科病人对护理比较满意,并发症的发生率降低.结论:根据老年骨科病人的特殊性,实施有效的有针对性的护理,能降低护理的风险,明显提高老年骨科病的治愈率.     

老年骨科患者并存内科系统疾病调查分析

目的调查老年骨科患者合并内科系统疾病情况,为临床评估手术与麻醉风险提供依据。方法通过病史、体检、实验室和影像学检查对404例老年骨科患者的内科并存疾病进行调查。结果1.在404例老年骨科患者中,合并高血压病、冠心病、糖尿病、脑血管意外病史和慢性支气管炎、慢性阻塞性肺疾病的发生率分别为:48.0%、30.4%、15.1%、12.6%和10.9%。2.高龄患者(年龄≥75岁)合并冠心病、脑血管意外病史几率明显增高(P=0.001和P=0.019)。3.老年骨科患者中女性合并冠心病和糖尿病的比例高于男性(P=0.011和P=0.002)。结论老年骨科患者最易合并的内科疾病为高血压病,高龄女性骨科患者更易合并冠心病、糖尿病和脑血管意外病史。     

我国医院开展新型养老护理模式的探讨

介绍了几种新型的养老模式,探索在医院开展老年人养老护理模式的方法,并分析其优势与存在的问题,提出相应的建议。呼吁全社会关心老年群体,发展老年护理事业,让老年人老有所养、病有所医,全面提高其生活质量。     

骨科患者治疗方法的选择

目的研究不同病况的骨科患者应该如何正确选择适合自身的治疗方案。方法回顾性分析笔者所在医院治疗各种骨科疾病的102例患者的临床资料。结果医护人员根据不同情况的骨科患者给予正确的医治方案,使患者们都能够在最短的时间内康复,疾病的治愈率和患者的满意度都十分显著。结论针对患者在治疗骨科疾病期间存在的不同顾虑如时间、自身的经济状况、方法等,医护人员有责任也有义务耐心的为患者选择一种或者几种适合的治疗方案。为不同的骨科疾病患者选择一种最适合他的治疗方案的做法,大大提高了临床治疗效果,可以应用于相关疾病的治疗中。     

老年骨科患者护理风险的原因分析及对策

目的 探讨降低老年骨科患者护理风险的发生率,为患者提供安全优质的服务.方法 通过分析89例老年骨科患者存在的风险问题,根据老年患者的特点,护理人员的因素,提出护理风险管理的对策.结果 各种护理差错事故、护理风险投诉明显减少,患者满意度提高.结论 通过实施护理风险管理制定各科护理风险的防范对策,更新服务理念,降低老年骨科...     

人性化护理在骨科老年病人护理工作中的应用

目的:随着医学护理模式的转变,整体护理的开展和人们生活水平的提高,对护理工作的要求越来越高,范围越来越广。在治疗和护理疾病时,要了解病人在患病时社会的、心理的和生理的因素,开展个性化、人性化护理。笔者主要针对老年病人护理,从老年人的生理特点和心理特点为护理重点,经过近几年临床实践,得到满意的护理效果。     

SLIPA喉罩全麻在老年骨科手术中的应用

目的：探讨SLIPA喉罩全麻在老年骨科手术中的临床应用。方法：59例全麻老年骨科手术患者随机分为SLIPA喉罩组（H组29例）和气管插管组（G组30例）,于诱导前（T0）、诱导后3min（T1）、置管即刻（T2）、置管后3min（T3）、拔管前（T4）、拔管即刻（T5）、拔管后5min（T6）监测SBP、DBP、HR,及术后不良反应发生率、降血压药物使用率。结果：G组T2、T3、T5、T6时段的HR、SBP、DBP变化明显高于T0和H组,G组的术后并发症及降血压药物使用率明显高于H组（P〈0.05或P〈0.01）。结论：SLIPA喉罩全麻用于老年骨科手术,能减轻血流动力学变化,减少术后并发症发生。     

LBL-PBL-LBL模式在骨科教学中的应用

目的分析比较LBL-PBL-LBL与LBL-PBL两种教学模式对于骨科学教学效果的影响,验证LBL PBL-LBL模式在临床骨科教学中的优势。方法将2009年在我科学习的上海交通大学医学院临床医学系7年、8年制学生192人随机分为两组,组1采用LBL-PBL-LBL模式进行教学,组2(对照组)以PBL-LBL模式进行教学。两组分别随机抽取30份出科考试成绩单和30份学生教学反馈评分表,对获得的数据进行对照比较,并作统计学分析。结果接受两种教学模式的学生之间出科考试成绩无统计学差异(P0.05),但在学生教学反馈评分上,LBL-PBL-LBL组明显高于LBL-PBL组(P(0.05),具有统计学意义。结论 LBL-PBL-LBL与LBL-PBL两种教学模式在骨科教学中均具有重要价值。但从本组数据判断,采用LBL-PBL-LBL教学模式在出科考试成绩上与对照组相当,但更能激发学生的专业兴趣和学习热情。     

骨科老年患者跌倒风险评估与干预流程的实施

目的降低骨科老年患者跌倒发生率,保障患者住院安全。方法对照组(110例)采用常规跌倒预防护理措施;观察组(118例)使用骨科老年患者跌倒风险评估表进行跌倒风险评估,依据风险级别采取相应的护理干预措施。结果对照组发生跌倒6例,观察组无跌倒病例,两组比较,差异有统计学意义(P<0.05);观察组患者或家属对护士预防跌倒各项指标的满意率达93.1%～100%。结论依据跌倒风险评估结果实施预防跌倒干预措施,提高了护士参与跌倒预防的积极性及老年患者对跌倒风险因素的认知,从而降低了跌倒发生率。     

骨科无痛病房模式的建立与探讨

目的探讨骨科无痛病房的工作模式及其对减轻患者痛苦的作用。方法将180名患者随机分成2组,对照组(n=90例)给予常规宣教和护理,干预组(n=90例)加强医护人员的培训,提高无痛的思想观念,及时、有效地予以患者镇痛药物,加强心理、无痛护理,在无痛病房的模式下进行护理。结果干预组患者疼痛评分均小于对照组,干预组满意度(95%)明显高于对照组(85%),差异均有统计学意义(P0.05)。结论通过创建骨科无痛病房,提高医护人员的疼痛管理能力,完善疼痛管理措施,能减轻患者的痛苦,提高了患者的满意度。     

疝的治疗方案讨论

<正>对修订腹股沟疝、股疝手术治疗方案的建议近些年来,随着补片修补腹股沟疝、股疝病例的增多、随访时间的延长及学术研究的深入,有关腹股沟疝的手术治疗有不少新观点和新认识。诸如:关于手术适应证,探讨是否没有症状的腹股沟疝病人都需手术治疗?研究选择适     

Administration-time-dependent effects of antihypertensive treatment on the circadian pattern of blood pressure

PURPOSE OF REVIEW: Many studies show that the extent of the nocturnal blood-pressure decline is deterministic of cardiovascular injury and risk. Accordingly, there is growing interest in how to tailor the treatment of hypertensive patients according to their circadian blood-pressure pattern. RECENT FINDINGS: Differences in efficacy depending on the time of day of drug administration lead to differences in effects of antihypertensive drugs on the nocturnal decline relative to the diurnal mean of blood pressure. Thus, bedtime dosing with nifedipine gastrointestinal therapeutic system (GITS) is more effective than morning dosing, while also reducing significantly secondary effects. Bedtime administration of trandolapril results in a safe and effective means of controlling morning blood pressure without inducing excessive reduction nocturnally. The dose-response curve, therapeutic coverage, and efficacy of doxazosin GITS are all markedly dependent on the circadian time of drug administration. Moreover, valsartan administration at bedtime as opposed to upon wakening results in improved day/night blood-pressure ratio, a significant increase in the percentage of controlled patients after treatment, and a significant reduction in urinary albumin excretion. SUMMARY: Nocturnal hypertension increases one's risk of cardiovascular and cerebrovascular events, nephrosclerosis, and progression to end-stage kidney failure in renal patients. Normalization of the circadian blood-pressure pattern is considered an important clinical goal of pharmacotherapy because it may slow the advance of renal injury. Chronotherapy provides a means of individualizing treatment of hypertension according to the circadian blood-pressure profile of each patient, and constitutes a new option in optimizing blood-pressure control and reducing risk.     

垂体微腺瘤的诊断和治疗探讨

目的 探讨垂体微腺瘤（直径≤５ｍｍ）的诊断和治疗方法。方法 总结经ＣＴ垂体薄层扫描加矢,冠状重建诊断的垂体微腺瘤（直径≤５ｍｍ）２８例,全部采用经口鼻蝶窦入路显微手术切除。随访临床资料和内分泌改变,定期复查ＣＴ。结果 ２８例中病理证实２６例为垂体腺瘤,１例为炎症、１例为增生,诊断率达到９２．８％。汪变的术中定位成ＣＴ立体定位所见的位置完全符合。术后全部病例病情痊愈或好转,无手术死亡和并发症。２２例     

下肢慢性静脉功能不全外科治疗的现状与争议

下肢慢性静脉功能不全(chmnic venous insuffciencv，CVI)是常见的血管外科疾病，多种静脉疾病均可导致静脉功能不全，按其病因可分为原发性、继发性、先天性；按解剖范围可分为浅、深和交通静脉3个系统。下肢CVI的外科治疗主要用于原发性CVI和部分继发性CVI的病例。虽深静脉瓣膜重建术对纠正深静脉反流确有一定疗效，     

Expansion-assisted treatment of male pattern baldness

Scalp expansion has been combined with scalp reduction and flap procedures for the treatment of male pattern baldness. Expansion offers the advantages of a safe and reliable procedure, as well as more coverage in a shorter period of time. The techniques described involve bilateral temporal parietal occipital (TPO) expanders followed by either a frontal TPO flap and contralateral scalp reduction or bilateral TPO flaps. Both procedures leave areas of baldness in patients with more extensive losses (Juri classes II and II). Further expansion may be used for further coverage of residual bald areas.     

慢性胰腺炎的CT表现对治疗选择的意义

目的探讨慢性胰腺炎CT形态学分型及其对治疗选择的指导作用。方法回顾分析经治疗证实的59例慢性胰腺炎的CT影像和治疗方法,结合文献总结讨论不同病理形态改变的慢性胰腺炎在治疗方法选择上的区别。结果59例中27例（46％）表现为全胰腺萎缩伴不同程度胰实质钙化,采取内科保守治疗：7例为单或多发囊肿型（12％）表现为胰腺及其周围多发假性囊肿形成,对最长径大于5cm者行切开引流和吻合：7例（12％）表现为胰管狭窄或扩张,行胰管减压引流术;5例（8％）为表现为胰头胰腺局限性软组织样肿块,全部手术切除。13例（22％）为以上两种或以上的混合表现,以外科手术为主。对合并有胆道梗阻的病例做减压引流。结论慢性胰腺炎可分萎缩钙化型、假性囊肿型、胰管狭窄或扩张型、肿块型、混合型5型,CT形态学分型对治疗方案选择及明确病因有一定的意义。     

腹部外科围手术期并存病的处理——腹部外科患者并存高血压的围手术期处理

原发高血压（以下简称高血压）是腹部外科围术期常见并存病，其围术期处理已有报道。由于相关理论研究的深入，临床经验的积累和认识的提高，从而对围术期管理有了更全面的考虑。本文就个人临床经验和学习体会，再试做简述。     

The impact of cerebral metastases growth pattern on neurosurgical treatment

The surgical resection of cerebral metastases is one key element in a multimodal therapy of brain oligometastatic patients. Standard surgery alone is often not sufficient to achieve local control. Various reasons have been discussed including microscopic and macroscopic tumor rests after surgery and different growth patterns of cerebral metastases: In this review, we assessed the surgical standard technique and then analyzed the growth pattern of cerebral metastases and discussed its oncologic impact and new strategies in the surgical management of cerebral metastases. A major percentage of cerebral metastases are not sharply delimitated but show an irregular tumor-brain interface or even an infiltrative growth pattern. Different patterns of adjacent brain invasions have been described and may correlate with the prognosis of patients with cerebral metastasis. Even metastases of the same histological subtype and the same origin show a heterogeneous brain invasion pattern. Future therapeutic strategies might have to take this heterogeneity into account. An infiltrative growth pattern of cerebral metastases might be one reason for their extraordinary high local recurrence rate and might have an influence on the individual overall survival. An intraoperative detection of residual tumor and development of more radical surgical techniques is therefore an important neurooncological challenge and might result in better tumor control. Supramarginal resection of cerebral metastases is a promising approach.