普外科护士工作压力、应对策略与主观幸福感的差异及相互关系

目的 普外科护士在医院上承受大量的工作压力,而心理健康与主观幸福感能帮助护士改善精神状态。本文旨在探讨普外科护士的工作压力、应对策略、主观幸福感的评分及相互关系。方法 采用横断面调查方案,以本地区普外科护士为主要母群体,采用分层抽样法选出2家医院普外科护士人员为研究对象。结果 普外科护士工作压力与对应策略呈低度正相关;工作压力与主观幸福感呈低度负相关;对应策略与主观幸福感呈中度正相关。普外科护士工作压力、对应策略与主观幸福感各年龄群及教育程度皆有统计学意义,大学教育程度普外科护士工作压力较大,对应策略最低,幸福感最低。不同护龄的对应策略与主观幸福感有统计学意义;其中对应策略以6~10年护龄护士高于11~20年护龄护士;主观幸福感得分在1~5年护龄及超过21年护龄的护士高于6~10护龄者。结论 创造良好的组织气氛、合理的护理人力配置、加强自我的肯定,提供面对压力的对应策略等措施,可以有效提升普外科护士的主观幸福感。     

Extraction of dislocated lenses using vitrectomy techniques

In fourteen eyes in thirteen patients, dislocated lenses into the vitreous were extracted using the techniques of vitreous surgery. Our surgical techniques of the extraction, as well as the indication and the prognosis, were described in this paper. Techniques of the lens extraction were basically Barraquer's method, but in modified form. Vitrectomy was carried out by open sky approach (in 2 cases) or pars plana approach (in 12 cases). In cases complicated by acute phacolytic uveitis, excellent results were obtained by these surgical techniques after the complete control of inflammation with steroid. Before surgical extraction, intraocular pressure had been elevated over 21 mm Hg in eight cases. But in all these cases intraocular pressure was controlled without medication after surgery. Visual acuity was improved unless chorioretinal atrophy or glaucoma were not accompanied. From these surgical results, it seems to be reasonable to extract surgically the dislocated lens before the eye is severely damaged.     

压力性尿失禁手术治疗现状

女性压力性尿失禁是一种常见疾病,其发生率随妇女年龄的增长而增加,影响着妇女的生活质量和身心健康.压力性尿失禁定义为腹压的突然增加导致尿液不自主漏出.压力性尿失禁是由于腹内压升高并下传到膀胱使膀胱内压的升高超过膀胱颈和尿道括约肌产生的压力而导致漏尿.压力性尿失禁以手术治疗为主,手术治疗方案很多.该文主要综述目前可行的几种手术方式和临床观察的数据,新的手术方式及对材料的近期观察结果显示出了良好的治愈率和较高的患者满意率及较低的并发症发病率,但目前尚缺乏关于新术式和新材料长期有效的观察数据.     

分层换药治疗Ⅱ期压疮患者的疗效观察

目的观察分层换药方法在Ⅱ期压疮患者中的应用效果,为临床治疗压疮提供参考。方法将2009年6月～2012年2月收治的40例下肢骨折伴有Ⅱ期压疮的患者随机分为实验组(分层更换创面敷料换药组)与常规组(外科常规换药组),每组20例。比较两组患者换药时疼痛程度、伤口治愈时间及满意度。结果两组患者换药时疼痛程度、伤口治愈时间及满意度比较,实验组优于常规组(p<0.05),差异具有统计学意义。结论分层更换敷料换药法对Ⅱ期压疮患者临床疗效优于常规外科换药法,值得在临床中推广应用。     

Are surgical stainless steel wires used for intracranial implantation of PrPsc a good model of iatrogenic transmission from contaminated surgical stainless steel instruments after cleaning?

Transmissible spongiform encephalopathies are a group of fatal, neurodegenerative diseases commonly known as prion diseases. Prion diseases can resist traditional inactivation strategies and may be iatrogenically transmitted by surgical instruments through the human population. These properties have led to the need for a suitable detection method of the prion infectious agent, and increased pressure regarding the development of anti-prion cleaning methodologies that would ensure the safety of surgical instruments. Although other techniques have been applied, the animal bioassay remains the 'gold standard' method for assessing infectivity. As the vast majority of surgical instruments are made of stainless steel, and in order to test this surface using the animal bioassay, the application of very thin surgical stainless steel wires has been widely adopted. These wires are easily inoculated and may be reimplanted into animals without the requirement for elution of the residual material. However, their comparability to the dimensions, shape and size of surgical instruments is questionable. This article shows how such contaminated wires (residual protein between 6.3 and 16.0 ng/mm(2)) can be cleaned more easily than flat metal surfaces (residual protein between 63.9 and 89.3 ng/mm(2)) under comparable conditions using recommended cleaning agents. These results indicate that the application of wires as a realistic means of assessing the removal or inactivation of the prion infectious agent from surgical instruments should be treated with caution.     

Managing pregnancies, neonates, pediatric asthma, and CHF with the touch of a telephone

There's a new and emerging picture of telemedicine developing, a technology that can now not only read a patient's blood pressure from a remote location, but gives nurse case managers the ability to assess surgical wounds and lung capacity for asthma patients. A device that operates on a single telephone line is making a big difference for patients and may become a valuable adjunct to disease management programs.     

高眼压状态下青光眼手术治疗的安全性及有效性探讨

目的 探讨持续高眼压状态下青光眼手术方法,以及手术的必要性与临床疗效。方法分析近3年来83例（83眼）高眼压下行小梁切除术及联合白内障超声乳化、人工晶体植入术患者术后情况,观察其手术效果。结果随访6～12个月,术后眼压控制≤21mmHg者67眼（80．72％）,联合局部用药眼压控制≤21mmHg者16眼（19．28％）;术后视力不同程度提高者78眼（93．98％）,保持不变者5眼（6．02％）。结论高眼压状态下青光眼手术治疗是安全有效的,治疗过程中应严格掌握手术时机,做好术前准备,选择有效手术方式,术中熟练操作,术后正确用药并严密观察。     

内科保守治疗急性脑出血疗效分析研究

目的 探讨内科保守治疗高血压脑出血的临床疗效,提高临床治疗效率.方法 回顾性分析2009年6月至2011年6月我院采用内科保守方法进行治疗的68例高血压脑出血患者的临床资料,并以同期我院神经外科采用外科方法治疗的68例患者为对照组,比较2组起效时间、治疗效果、患者住院时间、不良反应、手术并发症发生率以及治疗费用.结果 2组总有效率组间比较差异有统计学意义(P＜0.05).观察组颅内压恢复至正常时间和住院时间均长与对照组,组间比较差异具有统计学意义.结论 内科保守治疗高血压脑出血疗效肯定,但应严格掌握适应证,对于无手术禁忌的患者应及早采取手术治疗.     

内科保守治疗急性脑出血疗效分析研究

目的探讨内科保守治疗高血压脑出血的临床疗效,提高临床治疗效率。方法回顾性分析2009年6至2011年6月我院采用内科保守方法进行治疗的68例高血压脑出血患者的临床资料,并以同期我院神经外科采用外科方法治疗的68倒患者为对照组,比较2组起效时间、治疗效果、患者住院时间、不良反应,手术并发症发生率以及治疗费用。结果2组总有效率组间比较差异有统计学意义（P〈0．05）。观察组颅内压恢复至正常时间和住院时间均长与对照组,组间比较差异具有统计学意义。结论内科保守治疗高血压脑出血疗效肯定,但应严格掌握适应证,对于无手术禁忌的患者应及早采取手术治疗。     

快速康复外科护理对心脏瓣膜置换术患者术后压疮及不良反应的影响

目的 研究快速康复外科护理对心脏瓣膜置换术患者术后压疮及不良反应的影响。方法 研究对象为2017年4月—2019年4月于某医院行心脏瓣膜置换术患者106例,依据随机数表法分为对照组和观察组,每组53例。对照组选用常规外科术后护理,观察组在对照组基础上实施快速康复外科护理。对比分析两组患者的术后恢复、并发症及压疮发生情况。研究两组患者的护理满意度。结果 观察组下床时间、排便时间、排气时间早于对照组,总满意率(98.11%)高于对照组(83.02%),住院时间短于对照组,不良反应发生率(3.77%)低于对照组(15.09%),差异均有统计学意义(P<0.05)。结论 对行心脏瓣膜置换手术患者实施快速康复外科护理,能够提升术后恢复效率,降低压疮等并发症发生率,具有且较高的患者满意率。     

Contraceptive methods and adequacy of hormonal oral contraceptive use in the city of Pelotas, Rio Grande do Sul, Brazil: 1992-1999

A cross-sectional study was conducted to assess contraceptive methods and the adequacy of oral contraceptive use by women aged 20 to 49 years in the city of Pelotas. The results were compared with another cross-sectional study performed in 1992. A sample was randomly selected, including 766 women aged 20 to 49 years. Some 495 of the sample (64.6%) used a contraceptive method, in the following order: oral contraceptives (55.4%), surgical sterilization (22.2%), condoms (10,5%), and IUD (7.7%). Among users of oral contraceptives, 62 (22.2%) had some contraindication. Incorrect use of contraceptive methods was associated with age but not with socioeconomic status. As compared to the previous study, there was a reduction in the use of oral contraceptives. Meanwhile, other methods such as surgical sterilization, condoms, and IUD were used more frequently than in 1992.     

Percutaneous implantation of a pulmonary valve in 3 children with surgically corrected cardiac anomalies

An 11-year-old girl, a 15-year-old boy and a 12-year-old girl all underwent percutaneous implantation of a Melody pulmonary valve prosthesis to replace a stenotic and insufficient homograft in the pulmonary artery. Preoperatively, 2 of the children suffered from fatigue and dyspnoea on exertion The homografts had been implanted between the ages of 1-2, to establish surgical continuity between the right ventricle and the pulmonary artery. The anomalies were tetralogy of Fallot, pulmonary atresia with intact ventricular septum and pulmonary atresia with a ventricular septum defect. Percutaneous pulmonary valve replacement was successful in all 3 patients. After implantation, right ventricular pressure decreased to 30% of systemic pressure and regurgitation was not observed. All patients were discharged in a good condition on the day after the implantation. Percutaneous pulmonary valve replacement is a promising technique with good short-term results. In selected patients this percutaneous technique can substitute or postpone the surgical replacement ofa stenotic or insufficient homograft.     

双侧平衡去骨瓣减压治疗重型闭合性颅脑损伤的疗效和安全性分析

目的分析双侧平衡去骨瓣减压治疗重型闭合性颅脑损伤的疗效和安全性。方法选取我院于2011年12月至2013年12月收治的96例重型闭合性颅脑损伤患者,根据不同手术方法将其随机分成双侧组和单侧组,各48例,对两组患者的治疗效果及术后不良反应进行分析比较。结果两组患者在术后1 d、3 d的颅内压均比治疗前显著降低,双侧组患者的颅内压下降幅度更为显著,两组结果比较其差异具有统计学意义(P<0.05);双侧组的术后并发症明显少于单侧组,差两组结果比较其差异具有统计学意义(P<0.05);治疗结束后双侧组的生存质量显著高于单侧组,其差异具有统计学意义(P<0.05)。结论采用双侧平衡去骨瓣减压对重型闭合性颅脑损伤进行治疗,能够有效地将颅内压降低,且提高了患者术后的生存质量,值得临床推广与应用。     

五家医院负性事件发生率比较分析

采用“中国医疗质量指标体系（CQIS）”中部分负性事件评价指标,对北京市5家大型综合医院的医疗质量进行了比较分析。结果表明,医院E在压疮发生率、与手术、操作相关感染发生率和择期手术病人”肺部感染”发生率3个指标均明显高于其他医院,且医疗质量问题比较多;其他4家医院也存在不同程度的质量问题。负性事件评价指标可以帮助医院发现医疗质量存在的问题,并找到相应的质控点,进而采取针对性措施。     

Prevalence of malnutrition and vitamin A deficiency in the Diourbel, Fatick, and Kaolack regions of Senegal: feasibility of the method of impression cytology with transfer

The evaluation of the prevalence of ophthalmological diseases and vitamin A deficiency in Senegalese preschool-aged children enabled us to confirm the method of impression cytology with transfer (ICT) and to assess the impact of ophthalmological diseases on the cytological appearance of conjunctival cells. A simplification of the ICT method consisted of transferring cells present on a strip of paper to a glass slide by finger pressure. Harris-Schorr staining of the sample papers confirmed the results obtained by the transfer. Inflammatory trachoma influenced the results of the test. This simple method will prove very helpful for detection of vitamin A deficiency in children in underdeveloped areas.     

手术切除与术后压力治疗54例耳部瘢痕疙瘩的临床疗效分析

目的观察探讨手术切除与术后压力治疗耳部瘢痕疙瘩的临床效果,并总结其临床意义。方法选自我院2011年2月至2012年4月收治的耳部瘢痕疙瘩患者108例,将其随机分为观察组和对照组各54例,其中观察组使用手术切除与术后压力治疗,对照组使用常规手术治疗,观察对比两组患者的临床治疗效果,并对两组临床治疗效果的相关数据进行统计分析。结果观察组术后患者Ⅰ期痊愈的有38例占70.4%,延迟愈合的有14例占25.9%,无效的有2例3.7%,其中有1例患者出现复发的症状,有1例出现术后感染,总有效率为96.3%,对照组术后Ⅰ期痊愈的有24例占44.4%,延迟愈合的有15例占27.8%,无效的有15例占27.8%,出现反复症状的有10例,其中有2例出现术后感染,总有效率为72.2%,两组患者的治疗效果比较差异显著(P<0.05),具有统计学意义。结论使用手术切除与术后压力治疗耳部瘢痕疙瘩的效果更为显著,术后的成功率高,复发率少,术后感染率低,安全可靠,值得临床推广使用。     

A multi-centre evaluation of two chlorhexidine-containing formulations for surgical hand disinfection

Many experimental methods have been used to assess the efficacy of products intended for surgical hand disinfection. In this study, a modification of the Peterson glove juice method was used to compare two chlorhexidine-based surgical hand disinfectants, 'Hibiscrub' and an experimental formulation, F.6115. The study was performed by four independent laboratories and data merged for analysis. There was found to be no significant difference between the two formulations. The results illustrate that this modified Peterson glove juice method has the potential to form the basis of a standard method for testing surgical hand disinfectants which is both relevant to the practical situation and reproducible in different laboratories.     

磁共振T2WI压脂及T1WI压脂增强序列在肛痈及肛漏诊断中的价值

目的：分析磁共振T2WI压脂及T1WI压脂增强序列在肛痈及肛漏诊断中的价值。方法：41例肛痈及肛漏患者均行常规及Gd—DTPA增强磁共振检查,经手术证实,对以上各磁共振扫描序列组合对各种类型肛痈、肛漏及其内口的检出率进行统计分析。结果：肛痈32个,肛漏26个。对于肛痈、肛漏检出率,矢状位平扫及增强T1w1压脂序列与手术结果比较差异均有统计学意义（P〈0．05）。矢状位平扫及增强T1W1压脂序列对肛漏、肛痈的检出略高于轴位T2WI＋冠状位T2WI序列和轴位T2WI压脂＋冠状位T2WI压脂序列,但差异无统计学意义（P〉0．05）。结论：轴位联合冠状位T2WI压脂序列及T1wI压脂增强扫描序列可明显提高肛痈、肛漏临床诊断正确率,为手术方式的最佳选择提供科学信息。     

腹膜后巨大副神经节瘤1例诊治分析

目的：研究副神经节瘤的临床特点及治疗方法。方法：总结分析腹膜后副节瘤的诊治经验，探讨术前准备及手术操作的注意事项。结果：术前检查难以定性诊断，术中血压波动较大，手术治疗有效。结论：腹膜后副神经节瘤罕见，缺乏典型临床表现，诊断困难，误诊率高。手术切除是目前唯一有效治疗方法，术中及术后应重点观察血压变化。