动物严重致伤患者的护理

狂犬病（又名疯狗病）是由弹性病毒科的狂犬病毒引起的人畜共患的传染病,主要通过狂犬、疑似狂犬或狂犬病宿主动物抓伤、咬伤、舔舐皮肤或黏膜破损处而感染。病毒侵入人体后沿经神经末梢上行进入中枢神经系统,引起几乎不可逆转的脑脊髓炎。人一旦发病,没有有效的临床治疗手段,几乎100％死亡。在动物致伤患者中尤以严重致伤者即狂犬病Ⅲ级暴露者发病率最高,是一组高发人群。狂犬病Ⅲ级暴露是指：单处或多处贯穿性皮肤咬伤或抓伤（肉眼可见出血）;破损皮肤被舔：黏膜被动物体液污染。根据WTO推荐的方案,处理Ⅲ级暴露者必须在使用疫苗的基础上加用狂犬病人免疫球蛋白（HRIG）的方法,以提高免疫成功率。本中心预防保健门诊从2005年开始使用HRIG,在几年的工作中逐步摸索出一些成功的经验,现将对动物严重致伤患者的临床处置情况报告如下。     

2012年郫县动物致伤就诊者分析

目的了解动物致伤的流行特征,为加强狂犬病防制提供依据。方法对2012年郫县动物致伤就诊者的资料进行分析。结果2012年全县动物致伤就诊者合计7652例,其中犬致伤的占84．62％,猫致伤者占10．76％,其他动物致伤者占4．62％;就诊时间1～12月分别占5．23％、5．53％、6．61％、10．59％、11．84％、11．24％、10．53％、11．51％、8．23％、7．65％、6．01％、5．03％。动物致伤就诊者占全县居民总数的1．01％,这一比例,男性为1．07％,女性为0．96％（P〈0．01）;0～岁为2．06％,10～岁为0．72％,20～岁为0．57％,30～岁为0．89％,40～岁为1．16％,50～岁为1．48％,≥60岁为1.27％（P〈0．01）。7652例动物致伤就诊者中,致伤级别Ⅰ度的占1．03％,Ⅱ度的占23．03％,Ⅲ度的占75．94％;致伤头面部的占4．55％,致伤上肢的占39．95％,致伤下肢的占45．75％,致伤躯干的占9．75％;24h内到犬伤门诊就诊的占86．92％;患者均注射了狂犬病疫苗,其中全程接种者占98．25％,4．35％的就诊者注射了人用狂犬病免疫球蛋白。结论郫县动物致伤就诊者以犬致伤居多,犬只管理与免疫、动物致伤者处置等环节存在薄弱之处。     

石家庄市社区居民动物致伤情况调查

目的了解2008年石家庄市社区居民动物致伤的流行现状,为相关部门制定预防措施提供可靠依据。方法选取石家庄市2个区的1 471名常住居民进行调查。结果石家庄市社区居民动物致伤发病率为1.7%,不同年龄组间社区居民动物致伤发病率差异无统计学意义(确切概率法P=0.455>0.05),其中10～19岁年龄组的动物致伤发病率最高(3.5%),不同性别间动物致伤发病率差异无统计学意义(χ2=0.001,P=0.978>0.05);引起动物致伤的动物主要有狗(60.0%)和猫(24.0%),致伤地点主要为家中(40.0%),致伤部位主要为下肢(52.0%),伤后处理主要为医院门诊处理(52.0%)和自行处理(48.0%),严重程度主要为轻伤(60.0%),致伤者96.0%痊愈。结论石家庄市社区居民动物致伤发病率较高,狗、猫为主要致伤动物。     

7354例动物致伤的狂犬病分析

７３５４例动物致伤的狂犬病分析朱以方１９７９年７月１９日，萧县杜楼镇刘村发生狂犬咬人和牲畜。后经徐州医学院病理教研组检查，发现该犬脑组织的内基氏小体（Ｎｅｇｒｉｂｏｄｙ），遂将该犬确诊为狂犬病犬，把刘村定为狂犬病疫区［１．２］。后疫情逐年扩散蔓延，到...     

天津市动物致伤病例的流行病学分析

为更好地服务于动物致伤患者 ,控制天津市狂犬病的发生 ,现将天津市卫生防病中心预防医学门诊 2 0 0 1年接诊动物致伤病例进行流行病学分析。1.资料与方法 :动物致伤病例资料来源于 2 0 0 1年 1月 1日～ 12月 31日全部门诊病历登记 ,项目包括 :姓名、性别、年龄、职业、致伤动物、药物过敏史、致伤部位、处置意见等内容。本门诊 2 4h开诊 ,无假日 ,由主治医师以上接诊 ,病历资料详实。所有病例的伤口均用 2 0 %皂液及生理盐水彻底清洗后 ,伤口局部涂碘酊进行消毒。Ⅱ级暴露 :轻咬裸露的皮肤、轻度抓伤或擦伤但未出血、舔到有伤口的皮肤 ,按…     

2005-2007年北京市西城区动物致伤门诊处理动物致伤情况

近几年，随着城市居民生活水平的提高以及业余生活多样化，养宠物成为一种时尚，城区养犬、养宠物日益增多，狂犬病疫情上升明显。为了解北京市西城区及周边地区动物致伤及其狂犬病疫苗接种情况，2005～2007年对到西城区动物致伤门诊就诊的19251名动物致伤者及狂犬病疫苗接种情况进行调查。     

动物致伤门诊病例流行病学分析

目的 探讨动物致伤门诊病例流行病学情况,预防狂犬病的发生。方法 以2021年4月—2022年3月天津市河西区挂甲寺街社区卫生服务中心收治的2 000例动物致伤患者为研究对象,对其流行病学进行调查统计。结果 该社区2 000例动物致伤病例中,一年四季均可发生,6—8月份达到高峰;其中老旧小区1 234例,占61.70%,多于高档住宅的766例,占38.30%;致伤者6～15岁及51～70岁最多,人数分别为782例及612例,分别占39.10%及30.60%;动物致伤者职业分布情况可知,最多的为退休,共756例,占37.80%;受伤部位以上肢居多,共1 192例,占59.60%;肇事动物以猫类最多,共1 008例,占50.40%;Ⅰ级暴露102例,占5.10%,Ⅱ级暴露1 310例,占65.50%,Ⅲ级暴露588例,占29.40%,其中Ⅲ级暴露者注射狂犬病免疫球蛋白185例,占总人数的9.25%;正确的方法处理伤口患者1 180例,占59.00%;动物致伤后,24 h内到门诊就诊且及时注射疫苗者1 590例,占79.50%。结论 相关部门应采取有效的防控措施,提高儿童家长的防护意识,加强健...     

动物致伤救治中心猫犬咬伤急诊救治情况调查

目的 调查分析本院动物致伤救治中心的患者在被猫犬咬伤后的急诊救治情况。方法 选择本院2020年4月-2021年9月急诊科动物致伤救治中心收治的3012例猫犬咬伤病例,对其一般资料进行调查,统计猫犬咬伤的基本情况,汇总调查结果。结果 发病情况以男性发病为主,猫犬咬伤患者集中在中青年人群;猫犬咬伤的原因以突然咬伤为主;咬伤的时间在春季与冬季常见;猫犬咬伤部位以上下肢的部位常见;猫犬咬伤暴露等级以二级暴露占比高;在猫犬咬伤的就诊时间方面,大多数患者可以在发生咬伤后24h内进院就诊;大多数患者会采取正确处置措施,同时大多数能够及时地进入专业机构进行处置;猫犬咬伤有无死亡情况（暂没有死亡病例）;二级暴露及三级暴露的狂犬病疫苗接种率为100%;猫犬咬伤患者接种疫苗后,并发症发生率为1.49%。结论 急诊救治上部分猫犬咬伤的患者仍旧存在延迟入院诊治情况,需要进一步加强对疾病诊治的规范化管理,有效防范从而保证患者的生命健康。     

4056例动物致伤病例分析

目的了解狂犬病免疫预防门诊被动物致伤人群的流行病学特征,为预防狂犬病制定措施。方法对动物致伤门诊就诊者资料进行分析。结果 4 056例狂犬病免疫预防门诊就诊者中,男性占48.82%,女性占51.18%;年龄16天～89岁,其中≤15岁的占10.18%,15～60岁的占79.46%,≥60岁的占10.36%。以5—10月份居多,致伤动物以犬为主,咬伤部位以上肢为主。结论加强犬只管理和免疫接种,加大狂犬病相关知识宣传,加强预防接种门诊工作技术培训是有效预防狂犬病的有效措施。     

阳春市动物致伤人群的流行病学分析

[目的]了解阳春市动物致伤人群流行病学特征,为制定防制措施提供科学依据。[方法]分析2008年阳春市动物致伤病例分布特征。[结果]致伤动物主要是犬类(73.5%),其次是猫(21.5%)、鼠(4.1%);受伤者男性高于女性;儿童少年高于成人;受伤部位下肢占52.0%,上肢占38.4%;5~12月为致伤高峰期;伤后全程接种疫苗95.7%,注射狂犬病免疫球蛋白占22.3%。[结论]应加强对重点人群进行狂犬病知识宣传,提高人群的防病意识,及时、全程和足量注射狂犬病疫苗是防制狂犬病的有效措施。     

心理干预对冠心病患者康复的影响研究

目的探讨心理干预对冠心病患者康复的影响。方法将120名冠心病住院患者分为干预组和对照组各60例,对照组只给予临床常规药物治疗,干预组同时进行心理干预,运用自测健康评定量表和西雅图心绞痛调查量表分别于心理干预前及结束时对两组患者进行评定。结果两组患者在实施心理干预前SRHMS评分和SAQ评分差异无统计学意义(P0.05)。实施心理干预后,干预组在自测健康的生理健康(t=2.772,P0.01)、心理健康(t=7.779,P0.01)、社会健康(t=6.403,P0.01)3个维度和总分(t=7.035,P0.01)上的干预前后差值及在心绞痛发作状态(t=4.015,P0.01)、治疗满意度(t=8.774,P0.01)和疾病认识程度(t=6.771,P0.01)3个维度及西雅图总分(t=9.972,P0.01)上的干预前后差值都高于对照组。干预组和对照组的临床疗效差别有统计学意义(χ2=16.536,P0.01)。结论心理干预不仅能够提高冠心病患者自身健康水平和生活质量,而且能够提高冠心病患者的疗效,有效促进其临床康复。     

临终肿瘤病人心理护理研究现状

肿瘤病人临终和死亡问题越来越受到人们的关注,优终和优逝成为生命质量提高的一种重要体现。本文阐述了肿瘤病人临终阶段的心理特点,临终心理护理的意义,归纳了肿瘤临终病人心理变化的影响因素及该类病人心理的护理干预措施,以期为开展适合我国国情的临终护理工作提供参考。     

老年慢性病人家庭病床与住院治疗的费用差异及主要影响因素

目的 研究老年慢性病患者家庭医疗护理的费用支付情况及其主要影响因素,为广泛开展社区卫生服务提供参考。方法 以老年慢性疾病患者为对象,实施家庭医疗与护理。以同类病人的住院结果为对照,比较分析了两组病人各项费用支出的平均水平和可能的影响因素。结果 社区家庭医疗护理病人的平均医疗费用为312．8元,95％,95％参考范围是25－34335元,日平均费用为5．2元,均低于同类病人住院费用的平均3水平。在各种收费项目中,药品费在总费用中占了86．95％。对社区医疗费用影响较大的是病人的病情和收入情况。结论 社区家庭医疗护理不但可以达到同类病人住院治疗的相同效果,且经济、方便、可以满足多数老年慢性病患者的住院难题。     

老年患者锁骨下静脉置管的护理

目的：探讨老年患者锁骨下静脉置管的护理方法。方法：对61例置管的老年患者进行全面评估,个性化护理。结果：3例局部皮肤发红,1例堵管,予及时拔除。其余57例临床应用效果好。结论：个性化护理可减少并发症,以保证最大限度的临床效果。     

舒适护理在CT增强扫描患者中的应用

目的探讨舒适护理在CT增强扫描患者中的应用效果。方法将2010年4月至12月实施舒适护理后的64例CT增强扫描患者设为观察组,将2009年7月至2010年3月未实施舒适护理的60例CT增强扫描患者设为对照组。对我院CT室实施舒适护理前后CT增强扫描患者的护理服务满意率进行比较分析。结果观察组护理服务满意度为84.4%,明显高于对照组的68.3%,两组比较,差异具有统计学意义(P<0.05)。结论舒适护理应用于CT增强扫描患者中效果良好,能够改善患者就诊环境,融洽护患关系,提升患者对护理服务的满意度,值得关注。     

Frames of Reference in the Care of Migrant Patients

Those who organise and deliver health services to migrants are predominantly of Anglo-Celtic origin. They have had little opportunity either through their life experiences or through their professional training to become aware of the political, economic and social conditions that existed in Australia following the second world war. This paper describes the five main phases of post World War II immigration and explores the origins of social attitudes that underpin the responses of some members of the receiving society to the arrival of successive waves of immigrants. While the ethic upon which migration has been based has moved from assimilationist through integrationist, to that of ethic minorities with minority's rights, the ethic informing the delivery of health services seems to have remained, predominantly, in the assimilationist mould. Structural changes which have occurred, such as interpreter services, tend to entrench further existing health care delivery practices, averting the need for far reaching change. The experiences of some therapists attached to the Occupational Therapy Industrial Unit of Royal South Sydney Hospital are reviewed and some strategies to reduce the impact of an “accident victim syndrome” through preventative intervention at the workplace are discussed. It is suggested that more documentation of the experience of therapists caring for patients with a migrant background may lead to improved patient care.     

Health Resource Utilization and Medical Care Cost of Acute Care Elderly Unit Patients

OBJECTIVE: In this study we compared the readmissions, medical care cost, and health resource utilization (HRU) of acute care elderly (ACE) unit patients and usual medical care patients. METHODS: Retrospective case-control design was used. Patients admitted to ACE unit (n = 680) between 1999 and 2002 with primary admitting diagnosis of pneumonia, congestive heart failure, or urinary tract infection were randomly selected from the health-care system's administrative database. Equal number controls (n = 680) were selected from usual medical care services and were matched by DRG, age, ethnicity, and Charlson comorbidity score. Data on HRU, annual number of admissions before and after index admission, length of stay (LOS), and medical care cost were obtained. Bootstrap, t-test, and Wilcoxon test were used to compare cost, LOS, and number of readmissions between ACE and non-ACE unit. Multivariate log-linear and Poisson regressions were used to assess the impact of ACE unit on incremental cost and number of readmissions, respectively. RESULTS: Mean LOS was 1 day shorter for ACE unit (4.9 vs. 5.9 P = 0.01). Mean cost of ACE unit was 9.7% lower than that of non-ACE unit (Dollars 13,586 vs. Dollars 15,040, P = 0.012). Both groups had similar costs of pharmacy, diagnostic and therapeutic procedures. Multiple log-linear and Poisson regression models indicated that ACE unit patients had 21% lower cost and 11% lower annual readmissions. CONCLUSIONS: Our results confirm the hypotheses that ACE unit patients have lower medical care cost, shorter LOS, and fewer readmissions. Thus, ACE unit may be a beneficial model for improved inpatient care of elderly.     

Generational Cohorts Hold the Key to Understanding Patients and Health Care Providers: Coming-of-Age Experiences Influence Health Care Behaviors for a Lifetime

The health care landscape is ever changing. Medical groups are experiencing challenges in recruiting staff, dealing with managing effective clinical teams, and tempering the growing tensions among partnerships and medical groups. Additionally, all clinicians report many patients are now approaching them differently than in the past. They come armed with medical information from the Internet and a more questioning attitude toward the clinician's directive for care. What accounts for these behavioral changes and management challenges within health care organizations? These issues may be best understood and addressed through generational cohort analysis.     

Home First! Identification of Hospitalized Patients for Home-Based Models of Care

ObjectivesTo determine the proportion of hospitalized inpatients suitable for an acute and subacute home-based inpatient bed substitutive service, to examine the ability of treating teams to identify suitable patients for this service, and to examine potential barriers toward inpatients receiving home-based care.DesignProspective point prevalence study over 2 days in April 2019; analysis of responses to survey questionnaires regarding the suitability for home-based care among inpatients with multiday admissions to acute and subacute wards in the Royal Melbourne Hospital (RMH), an Australian metropolitan tertiary referral center.Setting and ParticipantsWard treating teams, clinicians affiliated with the home-based service called RMH@Home, and inpatients who were subsequently identified as being suitable for home-based care.MeasurementsPoint prevalence and characteristics of inpatients suitable for a home-based bed substitutive service; identified by either treating teams or RMH@Home clinicians; and barriers to the provision of home-based care among ward inpatients.ResultsSurvey responses were received for 620 of 635 inpatients [median age 69 years (interquartile range 53–81), 53% male], of which 69 (11.1%) were identified as being suitable for home-based inpatient bed substitution care. Treating team clinicians identified 26 patients, clinicians affiliated with RMH@Home identified a further 43 suitable patients. The most commonly reported barrier (38.1%) toward receiving home-based care was functional disability impeding ability to live at home.Conclusions and ImplicationsA substantial proportion of hospitalized older patients could use home-based inpatient bed substitutive services. Clinicians experienced in home-based care are more skilled than ward-based clinicians in identifying suitable patients for this care model.     

急性心力衰竭患者院前急救措施探讨

目的：探讨对急性心力衰竭患者进行院前急救的措施及效果。方法：回顾性分析笔者所在医院急诊收治的52例急性心力衰竭患者的病例资料,所有患者均给予迅速建立静脉通道、吸氧、评估疾病等综合措施进行急救,并安全转运到医院进行急诊就治。结果：所有患者经综合措施急救后,50例（96．2％）患者救治成功,2例死亡,死亡率为3．8％。结论：采取综合有效的急救措施可有效降低患者的死亡率,保障患者的生命。