老年人股骨粗隆骨折围手术期护理

目的：总结老年股骨粗隆骨折围手术期的护理经验。方法：分析16例老年股骨粗隆骨折患者术前进行针对性的心理护理。结果：16例患者均痊愈出院,未发生下肢深静脉血栓形成,髋关节脱位等严重并发症。结论：科学有效的围手术期护理是减少并发症,改善老年患者生活质量及提高手术成功率的重要保证。     

老年性骨折患者围术期的心理护理

目的：通过对老年性骨折患者在围手术期的心理护理,阐明心理护理在老年性骨折患者围手术期护理上的重要性。方法：62例患者随机分成观察组和对照组,观察组在围手术期采取了各种心理护理措施,而对照组只给予常规护理措施。结果：两组在担心麻醉、手术等方面显著差异,对手术满意方面也有明显差异。结论：加强老年性骨折患者围手术期的心理,对手术的成功及促进术后康复具有重要意义。     

股骨颈骨折病人的围手术期护理

目的：探讨股骨颈骨折后的围手术期护理。方法：对25例股骨颈骨折病人的围手术期护理,有针对性地进行心理疏导,消除其急躁等不良心理,积极配合手术;有针对性加强关节活动,进行必要的功能锻炼。结果：25例患者经手术治疗,均能扶拐出院。结论：股骨颈骨折病人通过围手术期的心理、饮食护理及功能锻炼,预防并发症的发生是确保手术成功的重要保证。     

老年股骨转子间骨折围术期护理体会

目的探讨老年股骨转子间骨折患者围手术期的护理方法。方法对89例老年股骨转子间骨折患者根据其生理和心理特点,实施围手术期护理,使病人增加手术的耐受性,预防或减少术后并发症。结果 89例均顺利通过手术,围手术期发生并发症3例,经治疗均治愈出院。术后功能评定：优60例,良27例,差2例。结论老年股骨转子间骨折由于生理及心理特点,手术风险大易出现多种并发症,护理人员有针对性地进行围手术期护理,可提高手术成功率,减轻和减少并发症。     

老年急性心肌梗死急诊介入围术期舒适护理的应用研究

目的：探讨舒适护理对减少老年急性心肌梗死患者在急诊冠状动脉介入术围手术期的作用。方法：将88例老年急性心肌梗死患者随机分成实验组44例与对照组44例。对照组实施常规护理;实验组在常规护理的基础上实施舒适护理。对术后3d内的患者进行调查。结果：实验组不良反应发生率明显低于对照组（P〈0.01）,患者满意度明显高于对照组（P〈0.01）。结论：舒适护理应用在冠状动脉介入围手术期中能显著提高老年患者在生理和心理上的舒适度,对提高老年患者的生活质量具有重要意义。     

老年粗隆间骨折围手术期护理

目的探讨老年粗隆间骨折围手术期有哪些护理。方法根据高龄患者身心特点，术前做好一系列的准备工作，即做好患者的心理护理和健康教育，保持正确的卧位，以免重复受伤而加重骨折移位；术后进行心理护理、皮肤护理、饮食指导，预防感染和栓塞等并发症，有计划地指导肢体功能锻炼，促进术后康复，提高生存质量。结果65例伴有不同程度并发症的老年粗隆间骨折患者，经过有针对性的护理及术后功能锻炼，疗效满意。结论对老年粗隆间骨折患者进行综合护理可明显的缩短疗程，减少并发症的发生，促进惠肢的功能恢复。     

循证护理对老年糖尿病患者围手术期心理状态的影响

目的探讨循证护理对老年糖尿病患者围手术期心理状态的影响。方法 82例老年糖尿病患者分成两组,常规护理组患者接受常规围手术期护理,循证护理组患者接受循证护理,对两组患者的心理状态采用焦虑自评量表（SAS）分别形成焦虑量表,比较两种不同的护理对患者手术前后焦虑状态的影响。结果循证护理组患者在手术前后焦虑分值均小于常规护理组患者的焦虑分值,且差异有统计学意义,说明循证护理措施能够明显地缓解患者的焦虑状态。结论针对老年糖尿病患者围手术期特有的心理特点而进行的循证护理能够使患者处于较好的心理状态,而良好的心理状态使患者更能主动接受手术与配合护理,因此循证护理在一定程度上能保证手术的顺利进行以及减少手术并发症的发生。     

老年髋部骨折患者围手术期死亡高危因素分析

目的分析老年髋部骨折患者围手术期死亡的高危因素。方法笔者2008年1月~2013年12月对收治的976例60岁以上行手术治疗的老年髋部骨折患者的临床资料进行回顾性研究,其中股骨转子间骨折498例,平均年龄72.3岁;股骨颈骨折478例,平均年龄75.6岁;观察围手术期死亡的高危因素。结果围手术期死亡32例(3.2%),其中死于心肺疾病者占78.1%。年龄80岁围手术期死亡10例,≥80岁死亡22例,两者比较差异有统计学意义。股骨颈骨折内固定术治疗患者术后死亡4例,关节置换术治疗患者死亡14例,两者比较差异有统计学意义。结论高龄、心肺疾病和采用关节置换术治疗的老年髋部骨折患者死亡风险更大,多科室的相互协作有助于降低围手术期死亡的风险。     

老年股骨转子间骨折患者围术期输血危险因素分析

目的探讨老年股骨转子间骨折患者围术期输血相关危险因素,为临床合理输血与避免输血相关并发症提供理论指导。方法回顾性分析自2010年9月至2016年12月收治的167例老年股骨转子间骨折患者的临床资料。所有患者均接受手术内固定治疗。根据围术期是否输血,将患者纳入输血组90例与非输血组77例。比较两组患者的年龄、性别、体质量指数、手术方式、术前血红蛋白水平、手术时间、术中失血量、骨折分型,采用Logistic回归分析输血相关危险因素。结果年龄、体质量指数、手术方式、术前血红蛋白水平、手术时间、术中失血量、骨折分型与老年股骨转子间骨折患者围术期输血相关(P<0.05)。术前血红蛋白水平<110 g/L、手术时间≥60 min、术中失血量≥500 ml、骨折类型复杂(A2型+A3型)是影响老年股骨转子间骨折患者围术期输血的独立危险因素(P<0.05)。结论老年股骨转子间骨折患者围术期输血的独立危险因素有术前血红蛋白水平<110 g/L、手术时间≥60 min、术中失血量≥500 ml、骨折类型复杂(A2型+A3型)。因此,术前血红蛋白水平<110 g/L与骨折类型复杂(A2型+A3型)的患者应在术前充足备血,术中尽量缩短手术时间并减少术中失血量,术后及时复查血常规以纠正贫血。     

老年髋部骨折围术期护理临床实践专家共识(2023版)

髋部骨折是老年人最严重的骨质疏松性骨折, 具有高致残率和致死率。手术技术的提高和多学科协作管理模式对改善患者预后具有重要作用, 也对围术期护理提出了更高要求。患者整体功能衰退、器官合并症增多、麻醉及手术对机体储备的二次打击使护理难度增加, 且我国尚缺乏对于老年髋部骨折患者围术期护理的规范来指导临床实践。因此, 中华护理学会骨科护理专业委员会组织相关专家, 基于循证医学方法, 制订《老年髋部骨折围术期护理临床实践专家共识(2023版)》, 围绕老年髋部骨折围术期健康教育、病情监测与观察、并发症风险评估与预防、康复训练等方面提出11条推荐意见, 以指导临床实践, 提升围术期护理质量, 改善老年髋部骨折患者预后。     

Optimization of the system of medical service of students of Cadet Schools of the Ministry of Defense of the Russian Federation

One of the factors of the successful military career guidance Cadet schools students is preserving and promoting their health. Medical support of children and adolescents aged 10-17 years should include the full range of medical and preventive measures defined for this group. The state of providing outpatient care for pupils at the Cadet School in St. Petersburg was studied. These results show that full medical care in accordance with the standards can be based only on children's health clinics. It is important that the organization of medical support pupils cadet schools should be cooperate with civilian health care.     

带状疱疹83例误诊原因分析

带状疱疹是由水痘—带状疱疾病毒引起的皮肤科常见疾病。其主要的病理损害,一是受累神经的严重炎症性浸润,继而导致受侵犯神经节内神经细胞变性、坏死;二是皮肤的水泡。迅速抑制神经节和相应的感觉神经纤维的充血、水肿和坏死,防止粘连形成,达到迅速镇痛、改善皮损,缩短病程及防止后遗症的发生是治疗的关键。因而,尽早明确诊断,     

Estimation of accumulated dose of radiation by method of ESR-spectrometry of dental enamel of mammals

ESR-spectrometry was used to investigate radiation-induced paramagnetic centers in enamel of mammals: carnivores (polar bear and fox), ungulates (reindeer, European bison, moose), and man. Values at half the microwave power saturation of the radiation signal, P_1/2, evaluated at room temperature, was found to range from 16 to 26 mW for animals and man. A new approach to discrimination of the radiation induced signal from the total ESR spectrum of reindeer enamel is proposed. ‘Dose-response’ dependencies of enamel of different species mammals were measured within the dose range from 0.48 up to 10.08 Gy. Estimations of ‘radiosensitivity’ enamel of carnivores and ungulates showed good agreement with radiosensitivity enamel of man by ESR method.     

Analysis of the results of the international comparison of activity measurements of a solution of Fe

The results of an international comparison of activity measurements of a solution of ⁵⁵Fe organized by the BIPM in 2005 are reported and analysed. This exercise, which follows the procedures of the CIPM mutual recognition arrangement to update older comparisons, is a renewal of the comparison organized by the BIPM that took place in 1978. A EUROMET comparison was organized in 1996 specifically to compare activity measurements of a ⁵⁵Fe solution by means of liquid-scintillation techniques. Results of these three comparisons are presented and discussed in this paper.

The radionuclide solution was provided by the NPL, which also distributed the samples to the participants. The activity of the ampoules was measured by 16 laboratories using 12 methods producing 25 results. Some general considerations on uncertainty assessments pertaining to the different techniques used are drawn. The outcome of four different estimators is compared from which the presence of at least one outlier can be confirmed. Further measurements should be made to try to reduce the discrepancy between the results. To date the outcome of the present comparison does not show an improvement to that of the 1996 comparison.     

Evaluation of the results of various technics of non-surgical therapy of varicocele

A new method of non-surgical treatment of varicocele syndrome is described: it consists in sclerotherapy of spermatic vein by trans-femoral percutaneous catheterization with balloon-catheters. In 8 cases venous thrombosis has been induced by direct electric clotting. The techniques and a 6 months follow-up are discussed. It is pointed out that this procedure should be considered as the method of choice for tubular lesions and sub-fertility prophylaxis in young people and in childhood.     

延迟性脾破裂误漏诊原因分析

目的探讨延迟性脾破裂误漏诊原因和预防措施.方法回顾性分析总结12例延迟性脾破裂中的诊断和误漏诊的经验与教训.结果本组延迟性脾破裂的误漏诊5例(41.66%).对多发伤与脾破裂并存可能认识不足,外伤史轻微或伤员隐瞒外伤史,缺乏腹痛-缓解-突然再腹痛的典型病史,缺乏“对冲性脾破裂”力学分析和整体化诊断思路等为其误漏诊的主要原因.结论详细的外伤史和全面系统检查,重视腹以外多发伤掩盖腹内脏器伤及延迟性脾破裂可能.确立外伤-腹内脏器伤-脾破裂整体化诊断思路.不间断地辅以B超检查脾形态学变化和腹内有无积液,腹腔穿刺确定有无血腹、X线胸腹部检查观察左侧胸肋角和膈肌运动情况、必要时CT检查以尽早发现脾包膜下血肿,降低延迟性脾破裂误漏诊率.