妇科择期手术患者术前预防性应用抗生素现状的调查分析

目的 了解妇科择期手术患者术前预防性应用抗生素的状况,为病房管理提供科学依据。方法对妇科08年1月至4月共171例择期手术患者术前应用抗生素的途径、时间进行统计。结果171例患者术前抗生素使用的途径均为静脉用药;使用时间方面：能在术前2小时以内应用者为63例,占36.8％;超过术前2h者108例,占63.2％。结论妇科择期手术患者术前抗生素的应用存在不合理之处,医护人员应加强对围手术期抗生素应用的认识,推动术前抗生素用药方法日趋规范化。     

外科择期手术预防性应用抗生素的护理研究

目的探讨外科择期手术(Ⅰ、Ⅱ类切口)预防性抗生素的合理应用。方法观察普外科Ⅰ类切口手术(甲状腺肿、腹股沟疝手术)和Ⅱ类切口手术(腹腔镜胆囊切除术),不应用抗生素、预防性应用抗生素及术前与术后使用抗生素后,患者手术切口感染发生情况。结果全部病例愈合良好,无肺炎髙热、腹腔或切口感染并发症;手术前后外周血白细胞无显著性差异(P>0.05);送检的培养标本,无论是伤口分泌物还是胆汁,均无细菌生长。甲状腺肿手术患者,是否预防性应用抗生素,术后体温比较差异无显著性(P>0.05);腹股沟疝手术患者,术前一次性使用抗生素,术后无高热;胆囊切除术,术前一次性使用抗生素与术后连续使用抗生素,在体温上相比较差异无显著性(P>0.05)。结论外科择期手术预防性应用抗生素,对于Ⅰ类清洁切口不主张应用;易受污染切口,术前30min一次性静脉用药(头孢菌素),能达到预防感染的目的。     

剖宫产术前预防性使用抗生素减少切口感染率的发生

目的 观察剖宫产对手术前预防性使用抗生素的必要性，以便合理，有效，安全地使用抗生素，通过对切口部位感染例数检测与观察，确定预防性应用抗生素的效果必要性。结果 切口愈合基本良好，预防用药后，切口感染发生率明显减少。结论 剖宫产术前预防性使用抗生素，能够达到预防感染的目的。     

外科择期手术287例健康教育

2004年1月～2007年12月,我们运用持续性质量改进(CQI)管理模式[1]指导基层护理管理,不断完善和加强全院护理工作的各项管理,取得满意效果.现报告如下.     

预防性使用抗生素对无菌切口的影响

多年来，无菌切口是否应用或如何使用抗生素，一直没有统一观点。围绕这一问题，笔者自1998年8月以来，对接受甲状腺大部分或部分切除术的765例患者及接受疝修补术的994例患者进行统计分析，对使用预防性抗生素做了初步探讨，现报告如下。     

外科择期手术患者心理状态调查及心理护理

目的调查外科择期手术患者心理状态并探讨心理护理方法。方法采用贝克忧郁量表-Ⅱ(BDI-Ⅱ)评估340例择期手术患者心理状态,BDI-Ⅱ评分大于或等于14为抑郁症诊断标准。对明显抑郁或焦虑患者采取针对性心理护理。结果择期手术患者抑郁症发病率较高(达45%),且女性高于男性(P<0.05)。对明显心理障碍患者进行围术期心理护理获得明显效果。结论外科择期手术患者抑郁症发病率较高,针对性的心理护理有助于提高患者对手术的适应性,促进术后康复。     

外科围术期预防性抗生素应用调查分析

2008年7月,我们对外科系统住院患者围术期预防性使用抗生素进行目标性监测,并作合理性评价以提高抗生素合理使用.现报告如下. 1 资料与方法 1.1 临床资料抽取我院外科出院病例210份,未做手术者不在统计范围之内.     

Current practice of antibiotic prophylaxis for catheter procedures

The practice of giving prophylactic antibiotics to patients at the time of urinary catheter insertion, change or removal is variable since guidelines for their use have yet to be established. The use of prophylactic antibiotics to prevent urinary catheter-related infections and the possibility of bacteraemia and septicaemia, despite a lack of evidence for their efficacy, is a matter of concern in light of the reported overuse of, and increased resistance to, antibiotics. This article describes an audit of, and increased resistance to, antibiotics. This article describes an audit conducted in one trust to establish the current practice of antibiotic prophylaxis for urinary catheter procedures. The audit confirmed that in 60% of the recorded catheter procedures, patients were given antibiotics, usually gentamicin. Variations in gentamicin prophylaxis were revealed, including differences in the timing of administration relative to the catheter procedure. This audit revealed that intramuscular gentamicin was given simultaneously with the procedure or after the procedure in a number of cases, suggesting that on these occasions "prophylaxis" was suboptimal.     

Nursing responsibility levels for cardiac surgical procedures

Nursing liability is an issue discussed regularly by both critical care staff nurses and nursing managers. Questions frequently arise regarding practice within the "gray area" of critical care. The high level of patient acuity often necessitates an expanded nursing role. Specific practice issues within the controversial areas of cardiac surgical nursing are addressed in this article, with a discussion of the implications of performing care that may be outside the accepted standard of practice.     

后腹腔镜手术病人的系统化整体护理

目的 对308例泌尿科行后腹腔镜手术病人的整体护理进行总结,为教学和护理水平的进一步提高提供资料.方法 对泌尿外科308例已经手术的病人的整体护理进行回顾性研究,总结在心理、术前准备、术后恢复方面的护理经验.结果 在护士的系统化整体护理下,病人术前能积极配合手术准备,术后恢复顺利,对护理工作非常满意.结论 系统化整体护理对病人是非常必须的,能及时发现问题,促进病人顺利康复,提高满意度.     

后腹腔镜手术病人的系统化整体护理

目的 对308例泌尿科行后腹腔镜手术病人的整体护理进行总结，为教学和护理水平的进一步提高提供资料。方法 对泌尿外科308例已经手术的病人的整体护理进行回顾性研究，总结在心理、术前准备、术后恢复方面的护理经验。结果 在护士的系统化整体护理下，病人术前能积极配合手术准备，术后恢复顺利，对护理工作非常满意。结论 系统化整体护理对病人是非常必须的，能及时发现问题，促进病人顺利康复，提高满意度。     

The effect of antibiotic prophylaxis in vaginal obstetric procedures (author's transl)]

202 cases of vaginal obstetric procedures (forceps and vacuum extraction, breech delivery and manual removal) were reviewed with regard to assessing the value of prophylactic administration of antibiotics. Criteria for the evaluation were fever post partum, duration of stay in hospital and involution of the uterus. The results showed that the prophylactic administration of antibiotics had no significant effect on these parameters, with or without the simultaneous administration of oxytocics. Hence, in view of the risk of allergic reactions, toxicity and the selection of resistant strains the prophylactic administration of antibiotics does not seem to be justified in vaginal obstetric procedures. Scrupulous aseptic precautions during all vaginal or intrauterine procedures are considered essential for the prevention of infection.     

Empowering surgical nurses improves compliance rates for antibiotic prophylaxis after caesarean birth

Title.  Empowering surgical nurses improves compliance rates for antibiotic prophylaxis after caesarean birth.
Aim.  This paper is a report of a study of the effect of empowering surgical nurses to ensure that patients receive antibiotic prophylaxis after caesarean birth.
Background.  Despite the consensus that single dose antibiotic prophylaxis is beneficial for women have either elective or non-elective caesarean delivery, hospitals need methods to increase compliance rates.
Method.  In a study in Israel in 2007 surgical nurses were empowered to ensure that a single dose of cefazolin was given to the mother after cord clamping. A computerized system was used to identify women having caesarean births, cultures sent and culture results. Compliance was determined by chart review. Rates of compliance, suspected wound infections, and confirmed wound infections in 2007 were compared to rates in 2006 before the policy change. Relative risks were calculated dividing 2007 rates by those in 2006, and 95% confidence intervals were calculated using Taylor's series that does not assume a normal distribution. Statistical significance was assessed using the chi-square test.
Findings.  The compliance rate was increased from 25% in 2006 to 100% in 2007 (chi-square test, P  < 0·001). Suspected wound infection rates decreased from 16·8% (186/1104) to 12·6% (137/1089) after the intervention (relative risk 0·75, 95% confidence interval, 0·61–0·92).
Conclusion.  Surgical nurses can ensure universal compliance for antibiotic prophylaxis in women after caesarean birth, leading to a reduction in wound infections.     

腹腔镜胆囊切除术围手术期预防性应用抗生素前瞻性研究

目的 :探讨腹腔镜胆囊切除术围手术期是否需要预防性应用抗生素。方法 :对 13 8例择期LC患者随机分为不预防性应用抗生素组和预防性应用抗生素组两组 ,比较术后患者手术部位感染情况。结果 :不预防性应用抗生素组感染率 2 9% ( 2 /68) ,预防性应用抗生素组感染 4 2 % ( 3 /70 ) ,两组术后手术部位感染率比较无显著性差别 (P >0 0 5 )。两组平均住院时间及住院费用比较均无显著性差别 (P >0 0 5 )。结论 :对年龄在 70岁以下 ,无糖尿病等免疫系统功能障碍 ,无躯体其它部位感染 ,胆囊非急性炎症患者 ,围手术期没有必要使用抗生素预防术后手术部位感染。     

Antibiotic pharmacodynamics in surgical prophylaxis: an association between intraoperative antibiotic concentrations and efficacy

The objective of this study was to characterize the relationship between gentamicin concentrations during surgery and the development of wound infection following colorectal operations. Despite decades of research in surgical prophylaxis, the relationship between intraoperative antibiotic concentrations and postoperative infection and the concentrations required for effective prophylaxis have not been established. A pharmacodynamic analysis was conducted using data from a previous prospective, randomized, double-blind clinical study which compared two dosage regimens of gentamicin plus metronidazole for prophylaxis in connection with elective colorectal surgery. Univariate and multivariate analyses of risk factors for postoperative wound infection were conducted, and the relationship between intraoperative gentamicin concentrations and surgical outcome was characterized. The gentamicin concentration at the time of surgical closure was one of the strongest independent risk factors for infection (P = 0.02), along with the presence of diabetes mellitus (P = 0.02), stoma (P = 0.04), and advanced age (P = 0.05). Gentamicin concentrations at closure of less than 0.5 mg/liter were associated with an infection rate of 80% (representing 8 of 10 patients with concentrations below that level) (P = 0.003). Receiver operating characteristic curve analysis identified a critical closure concentration of 1.6 mg/liter for effective surgical prophylaxis (P = 0.002; sensitivity, 70.8%; specificity, 65.9%). This study provides new and important information on antibiotic pharmacodynamics in surgical prophylaxis. It demonstrates the critical effect of the antibiotic concentration at closure on wound infection and suggests a significant association between the concentration and other well-established risk factors, like the timing of preoperative antibiotic administration and surgery duration.     

Nursing phenomena in inpatient psychiatry

Little is known about the question if the nursing diagnosis classification of North American Nursing Association-International (NANDA-I) describes the adult inpatient psychiatric nursing care. The present study aimed to identify nursing phenomena mentioned in journal articles about the psychiatric inpatient nursing care and to compare these phenomena with the labels and the definitions of the nursing diagnoses to elucidate how well this classification covers these phenomena. A search of journal articles took place in the databases MedLine, PsychInfo, Cochrane and CINAHL. A qualitative content analysis approach was used to identify nursing phenomena in the articles. Various phenomena were found in the articles. The study demonstrated that NANDA-I describes essential phenomena for the adult inpatient psychiatry on the level of labels and definitions. However, some apparently important nursing phenomena are not covered by the labels or definitions of NANDA-I. Other phenomena are assigned as defining characteristics or as related factors to construct nursing diagnoses. The further development of the classification NANDA-I will strengthen the application in the daily work of psychiatric nurses and enhance the quality of nursing care in the inpatient setting.