止血带在气管切开外套管固定中的巧用

使用纱布系带固定气管切开外套管是气管切开护理中的常用方法，在日常护理实践中，笔者发现，使用纱布系带固定气管切开外套管存在一些问题，主要是：①气管切开患者套管内咳出的分泌物很容易污染颈部系带，由于清洁困难，污染系带很可能成为细菌的“良好培养基”，同时对颈部皮肤产生不良刺激。②纱布系带较为粗糙，尤其在污染后变得较干硬，更易摩擦患者颈部皮肤，导致颈部局部皮肤发红、破损甚至糜烂，严重影响意识清楚患者的舒适度。③护理人员为减少纱布系带与颈部间的压力以及摩擦力，常在纱布系带与颈部间垫置纱布。     

2种材料在气管切开导管固定中的效果比较

目的通过比较2种材料在气管切开导管固定中的效果,为改进临床医疗护理质量提供依据。方法选取该院2014年3~12月施行气管切开术274例患者,随机分为对照组(137例)和实验组(137例)。对照组患者采用传统棉质系带固定气管切开导管;实验组患者使用头皮针管固定气管切开导管,比较2组患者皮肤损害发生率、发生时间和皮肤损害程度。结果实验组患者皮肤损害发生率为5.1%,低于对照组的16.7%,差异有统计学意义(P0.05),实验组皮损发生时间及皮损程度均低于对照组,差异有统计学意义(P0.01)。结论采用头皮针管固定气管导管的方法操作简易,耗材低廉,取材方便,清洁美观,易于清理,对患者损伤小,值得临床推广应用。     

新型双根止血带联合输液管交叉固定法 在ICU气管切开患者中的应用研究

目的观察新型双根止血带联合输液管交叉固定法在ICU患者气管切开护理中的应用效果。方法将98例患者采取随机数字表分为对照组和观察组各49例。对照组采用传统单根棉质白色系带打死结固定法固定气管切开套管,观察组采用新型双根止血带联合输液管交叉固定法固定气管切开套管。比较两种固定方法在气管切开套管的固定效果、皮肤损害发生率及患者舒适度的差异。结果观察组气管切开套管外移发生情况少于对照组,皮肤损害发生率低于对照组,患者舒适度高于对照组,差异具有统计学意义(P0.05)。结论新型双根止血带联合输液管交叉固定法固定效果更好,能有效地保护患者颈部皮肤,减轻患者不适。     

3种护理方法预防气管切开患者颈部皮肤损伤的效果比较

目的评价3种护理方法在预防气管切开患者颈部皮肤损伤的效果。方法将168例气管切开患者随机分为3组,各56例,分别采用衬垫纱布(Ⅰ组)、粘贴水胶体敷料(Ⅱ组)、衬垫泡沫敷料(Ⅲ组)的方法进行干预;观察3组患者颈部皮肤损伤发生率、衬垫敷料的使用寿命、更换敷料所用时间、更换敷料的难易程度及平均费用,评价3种护理方法预防气管切开患者颈部皮肤损伤的效果。结果Ⅰ～Ⅲ组发生皮肤损伤例数分别为13例、5例、1例,3组皮肤损伤发生率及严重程度比较,差异有统计学意义(P<0.05)。衬垫敷料的使用寿命由低到高分别为Ⅰ组、Ⅱ组、Ⅲ组;更换衬垫敷料所花费时间由低到高分别为Ⅲ组、Ⅰ组、Ⅱ组;更换衬垫敷料的难易程度由低到高分别为Ⅲ组、Ⅰ组、Ⅱ组;平均花费由低到高分别为Ⅰ组、Ⅱ组、Ⅲ组。结论应用泡沫敷料衬垫能有效预防气管切开患者颈部皮肤损伤,同时其使用寿命长,更换时耗时短,更利于临床操作,更适用于气管切开患者,但经济成本稍高。     

安普贴水胶敷料在气管切开患者颈部皮肤护理中的应用

在神经外科患者气管切开护理工作中,因防止气管套管脱出必须使用气管套管固定系带,该系带在防止气管套管滑脱中起到了重要作用,但同时也对患者颈部皮肤构成了潜在的威胁.因气管切开患者痰液多,为防止肺部感染还需要进行气管滴药等护理,系带无法保持干燥柔软,对颈部皮肤刺激大.我科选用安普贴水胶敷料进行颈部皮肤护理,克服了以上弊端对患者的危害,提高了护理质量.     

品管圈在气管切开患者颈部皮肤护理中的应用

目的探讨品管圈在降低气管切开患者颈部皮肤损伤的应用效果。方法选择2014年1-6月收治的54例患者作为对照组,给予常规护理;2014年7-12月收治的58例患者作为研究组,2组均为颅脑损伤行气管切开患者。成立品管圈小组,依次按品管圈活动的程序,通过对实施品管圈活动之前引起皮肤问题的原因分析,开展品管圈活动,设定目标、制定对策。观察2组颈部皮肤微红、湿疹性皮炎、Ⅰ度压疮和Ⅱ度压疮发生率等不良反应。结果研究组患者颈部皮肤不良反应发生率低于对照组(24%比52%;χ2=11.572、P=0.001<0.05)。结论品管圈活动的开展降低了气管切开患者颈部皮肤不良反应率,完善了气管切开患者颈部皮肤护理流程,提升了护理人员的凝聚力和家属的满意度。 更多还原     

改良气管切开套管固定法在神经外科重症患者中的应用效果观察

目的 探讨改良气管切开套管固定法在神经外科重症患者中的应用效果。方法 选取2019年6月—2020年5月神经外科ICU需要气管切开治疗的神经重症患者70例,其中2019年6—11月35例患者为对照组,2019年12月—2020年5月35例患者为观察组。对照组使用传统的常规棉质布带固定气管切开套管,观察组采用改良气管切开套管固定法固定气管切开套管。结果 观察组颈部皮肤损害发生程度、颈部皮肤损伤发生时间、固定带污染情况均优于对照组,差异有统计学意义（P<0.05）。结论 改良气管切开套管固定法能有效预防颈部皮肤的损害,减轻污染,减少护理人员工作量。     

自制棉带固定患者气管套管的临床效果观察

目的:探讨自制棉带固定患者气管套管的临床效果。方法:将126例气管切开的患者随机分为对照组和观察组各63例,对照组采用传统系带固定气管套管,观察组使用自制棉带固定气管套管,比较两组套管脱管移位发生率、局部皮肤损害发生率及更换套管带所需时间。结果:观察组套管脱管移位发生率、局部皮肤损害发生率、更换套管带所需时间均明显低于对照组(P0.05)。结论:自制棉带固定气管切开套管效果良好。     

自制新型气管切开固定带的临床应用与效果研究

目的：探讨自制新型气管切开固定带的临床应用与效果。方法：选取我科2008年3月～2011年3月患者40例为对照组,2011年4月～2014年4月患者40例为实验组。实验组采用自制新型气管切开固定带固定气管切开套管,而对照组采用传统的白纱带固定,比较两组患者颈部压疮、湿疹、过敏和感染发生率、气管导管滑脱、移位以及患者舒适度等方面的情况。结果：实验组颈部压疮发生率明显低于对照组(χ2=0 VS χ2=10.14,P＜0.01);实验组的湿疹发生率(χ2=0 VS χ2=0.213)、感染发生率(χ2=0 VS χ2=2.051)、气管切开套管移位发生率(χ2=0 VS χ2=3.117)虽尚未显著低于对照组(P＞0.05),但呈现下降现象;同样,实验组患者舒适度高于对对照组(χ2=0 VS χ2=2.797),但尚未呈现统计学差异性(P＞0.05)。结论：新型气管切开固定带能有效预防压疮的发生,提高患者舒适度,确保临床护理安全,值得在临床上推广应用。     

凡士林联合高分子体位垫在男性骨科手术患者皮肤保护中的应用

目的:探讨凡士林联合高分子体位垫在男性骨科手术患者皮肤保护中的应用效果.方法:将60例择期行防旋股骨近端髓内钉(PFNA)内固定术男性患者随机分为对照组和实验组各30例.对照组给予常规护理,实验组在此基础上腰骶部、阴囊皮肤给予外涂凡士林联合高分子体位垫.结果:实验组皮肤保护效果明显优于对照组(P<0.05).结论:凡士林联合高分子体位垫可保护PFNA内固定术男性患者腰骶部、阴囊皮肤,预防压疮发生.     

Cervical spine clearance and neck extension during percutaneous tracheostomy in trauma patients

INTRODUCTION: The lack of cervical spine clearance and inability to extend the neck are assumed to be relative contraindications for percutaneous tracheostomy. OBJECTIVE: To determine the necessity of cervical spine clearance and neck extension in trauma patients receiving percutaneous tracheostomy. DESIGN: Prospective analysis of case series from August 1, 1995 to August 31, 1998. SETTING: A university-based Level I trauma center. PATIENTS: A total of 88 consecutive trauma patients receiving percutaneous tracheostomy. Patients were divided into two groups based on the radiographic or clinical status of their cervical spine: cleared and noncleared. RESULTS: The overall success and complication rate were 99% (87/88) and 11% (10/88), respectively. There were no procedure-related deaths. The cleared group consisted of 60 patients; three patients in this group who had "bull" or "thick" necks did not have full neck extension during percutaneous tracheostomy. The noncleared group consisted of 28 patients, 13 of which had known cervical spine fractures; 27 noncleared patients were maintained in the neutral position (no extension) during percutaneous tracheostomy, whereas one patient with low suspicion of spinal injury was partially extended. Of the 13 patients with cervical spine fractures, six patients had been stabilized with a halo or operative fixation, and seven patients were stabilized with a cervical collar at the time of percutaneous tracheostomy. The success rate was 100% (60/60) for the cleared group compared with 96% (27/28) for the noncleared group (p > .05). The complication rate was 13% (8/60) for the cleared group compared with 7.1% (2/28) for the noncleared group (p > .05). We had a 100% success rate and no complications in the seven patients with cervical spine injury who were stabilized with a cervical collar. No patient had spinal cord injury caused by percutaneous tracheostomy. CONCLUSION: Percutaneous tracheostomy can be safely performed in trauma patients without cervical spine clearance and neck extension, including patients with stabilized cervical spine or spinal cord injury.     

An evidence-based evaluation of tracheostomy care practices

Adverse outcomes related to tracheal occlusion and peritracheal skin breakdown stimulated a review of tracheostomy care. An evidence-based practice approach was taken to evaluate the problem. Organizational tracheostomy care policies were reviewed. Subcategories related to tracheostomy care were queried including securing devices, sutures and their removal, type and choice of dressings, prevention of skin breakdown, frequency of care and role delineation, and suctioning. A literature review was done. National experts were surveyed. A geographical survey was taken and vendors of tracheostomy products were interviewed. Collected evidence was scored along a continuum. Costs of supplies were evaluated. Physicians, staff, and patients were interviewed. Skin maceration on the neck was found on multiple audits. The type of tie was identified as a problem. Nurses and respiratory therapists reported difficulty providing tracheostomy care due to suturing technique and securing methods. The stocked dressing was too large to fit under sutures. Several conflicting policies existed regarding tracheostomy care, none of which identified responsibility for performing care: respiratory versus nursing or time standards for care. New supplies were trialed. A list of practice changes were agreed upon by respiratory, nursing, and medical staff. Primary responsibility for tracheostomy care was shifted to the registered nurse.     

奥克喷预防头颈部恶性肿瘤放射性皮肤粘膜炎的临床观察

目的探讨奥克喷预防头颈部恶性肿瘤放射性皮肤粘膜炎临床疗效。方法将头颈部恶性肿瘤患者60例,随机分为治疗组和对照组。治疗组在放射治疗前照射野内皮肤用奥克喷;对照组在放射治疗前照射野内皮肤常规护理,不采用特殊防护措施,并且统计两组放疗患者皮肤黏膜反应发生率。结果治疗组患者放射野皮肤黏膜损伤发生率均低于对照组,差异有统计学意义(P<0.05)。结论奥克喷能有效地预防放射性皮肤粘膜炎的发生,提高患者生活质量,减轻患者痛苦,保证放射治疗的顺利进行。     

泡沫敷料衬垫在气管切开患者颈部皮肤护理中的应用效果

目的 探究泡沫敷料衬垫在气管切开患者颈部皮肤护理中的应用效果.方法 选择接受气管切开手术救治的124例患者作为研究对象,采用随机数字表法将其分为对照组和观察组,各62例.两组患者均给予常规的气管套管护理干预,在干预过程中,对照组使用四层纱布作为颈部皮肤护理衬垫,观察组选用泡沫敷料作为颈部皮肤护理衬垫.比较两组的护理效果...     

芦荟联合维生素E预防放射性皮肤损伤的效果观察

目的 探讨芦荟、维生素E联合外用对放疗时患者皮肤的保护效果.方法 将应用直线加速器首次接受放疗的138例恶性肿瘤患者随机分为预防组(n=70)及对照组(n=68),预防组于每次放疗前将新鲜芦荟汁均匀涂在患者照射野皮肤,待自然干燥后再行放疗,每次放疗结束用冷开水清洁照射野皮肤,涂适量维生素E.出现皮肤损伤后可增加局部用药(芦荟,维生素E)次数;对照组照射野皮肤不采用保护措施,出现皮肤损伤后局部涂氟哌酸或用金因肽外喷.对两组患者照射野皮肤按RTOG急性放射损伤分级标准每日进行评价至疗程结束.结果 预防组放射性皮肤损伤发生率明显低于对照组,损伤程度明显轻于对照组,损伤发生时间比对照组明显推迟,差异均有统计学意义.结论 芦荟与维生素E联合局部给药,对恶性肿瘤放射性皮肤损伤有较好的预防和控制效果.     

Variations in rates of tracheostomy in the critically ill trauma patient

OBJECTIVE: The utility of tracheostomy to expedite weaning and prevent complications in patients with acute respiratory failure is actively debated, with many physicians holding strong opinions regarding the value and timing of this intervention. We postulated that these opinions would be reflected in significant variation in tracheostomy rates across centers. Thus, we set out explore the extent and potential sources of this variation among injured patients cared for in trauma centers in the United States. DESIGN: This is a retrospective cohort study. We used stratification and hierarchical multivariate analysis to evaluate the effect of patient and institutional characteristics on tracheostomy rates and variance decomposition to determine the proportion of variance across institutions explained by patient characteristics. SETTING: Intensive care units within trauma centers participating in the National Trauma Databank. PATIENTS: Injured patients admitted over the years 2001-2003, age >/=16 yrs, with an Injury Severity Score >/=9 and a diagnosis of acute respiratory failure, excluding patients with burn injuries and those with a severe injury to the face or neck who might require tracheostomy for maintenance of an airway. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: There were 17,523 patients meeting inclusion criteria: 4,146 (24%) underwent tracheostomy. The mean tracheostomy rate across centers was 19.6 per 100 hospital admissions with a range of 0-59. This variation persisted after stratification by age, injury mechanism, and severity. Although several patient and injury characteristics were predictive of tracheostomy, there were no identifiable institutional characteristics associated with tracheostomy. Patient characteristics accounted for only 14% of the variance across centers. CONCLUSIONS: There is significant unexplained variation in the rates of tracheostomy in critically injured patients with acute respiratory failure. This variation might reflect preconceived notions of efficacy among physicians practicing in the absence of evidence to guide care. The variation provides evidence of equipoise and emphasizes the need for a well-conducted randomized controlled trial to evaluate the utility of this procedure.     

老年股骨颈骨折患者内固定术后发生股骨头坏死的危险因素

目的探讨老年股骨颈骨折患者经闭合复位内固定治疗后股骨头坏死的发生率及危险因素。方法选取行闭合复位内固定治疗的192例老年股骨颈骨折患者病例资料。统计术后股骨头坏死的发生率,并将患者分为股骨头坏死组(36例)和无股骨头坏死组(156例)。收集患者性别、年龄、基础疾病、骨折侧别、骨折分型、受伤至手术时间、复位质量、内固定物是否取出等影响因素,采用单因素和Logistic多因素分析股骨头坏死的危险因素。结果 192例患者术后随访1~3年,36例(18.8%)发生股骨头坏死,发生时间为(1.1±0.4)年。单因素分析显示:高龄、高骨折分型、受伤至手术时间>1周、复位质量差、内固定物未取出是患者发生股骨头坏死的危险因素。Logistic回归分析显示:骨折移位、受伤至手术时间>1周、复位质量差、内固定物取出是患者发生股骨头坏死的独立危险因素。结论内固定术后老年股骨颈骨折患者易发生股骨头坏死,而骨折移位、受伤至手术时间>1周、复位质量差、内固定物取出是患者发生股骨头坏死的独立危险因素。     

知识转化理论在预防危重患者医疗器械相关性压力性损伤中的应用

目的：探究基于知识转化理论的危重患者医疗器械相关性压力性损伤预防实践的应用效果。方法：依据知识转化理论中循证实践的标准程序，最终形成危重患者医疗器械相关性压力性损伤预防循证实践方案，并将其应用于临床进行效果评价。采用非同期对照试验设计，将2019年7月至9月收治于ICU的具有医疗器械相关性压力性损伤发生风险的危重患者纳入对照组，将2020年7月至9月在相同临床情境收治的危重患者纳入干预组，对照组采用ICU常规护理，干预组在常规护理基础上执行循证实践方案。比较两组患者在ICU期间医疗器械相关性压力性损伤的发生率。结果：两组患者基线资料比较差异无统计学意义（P>0.05）；干预组医疗器械相关性压力性损伤发生率低于对照组，差异有统计学意义（P<0.05）。结论：基于知识转化理论进行危重患者医疗器械相关性压力性损伤预防实践，形成了具备科学性及可行性的预防实践方案，可降低医疗器械相关性压力性损伤发生率，提高危重患者皮肤管理质量。     

A non-derivative, non-surgical tracheostomy: the translaryngeal method

Objective: To present a new technique for non-surgical tracheostomy. Design: An open, clinical trial on patients requiring elective tracheostomy. Setting: Intensive care unit of a community hospital. Patients: 95 adults, mean age 60 years, and 14 infants and children, mean age 26 months (2 months–7 years) with common indications for tracheostomy. Intervention: Through a needle inserted in the trachea, a guidewire is pushed out of the mouth against the usual direction and attached to a special device formed by a flexible plastic cone with a pointed metal tip joined to an armoured tracheal cannula. This device is then pulled back through the oral cavity, larynx and trachea and outwards across the neck wall by the operator applying traction on the wire with one hand and counterpressure on the neck wall with the fingers of the other hand. When the cone and a part of the cannula have emerged, the cannula is cut off from the cone, straightened perpendicular to the skin, rotated and advanced caudally to its final position. Results: The cone-cannula passed smoothly through the vocal cords. The metallic point perforated the neck easily. The dilation did not present any risk of tracheal wall damage because the direction of the manoeuvre was from the inside to the outside of the neck. The tissues tightly adhered to the cannula, thus avoiding infection and bleeding. The use of ventilation systems permitted utilization of translaryngeal tracheostomy (TLT) even in patients for whom apnoea might have carried some risk, because there is no interruption of respiratory assistance during the procedure. Follow-up showed no late obstructive complication at the level of the tracheostoma. Conclusions: By virtue of its greater safety and less trauma to tissues than percutaneous techniques, TLT can also be carried out in infants and children (an important benchmark for any tracheostomy technique) and in very difficult patients from whom other techniques have serious drawbacks. Received: 26 April 1996 Accepted: 26 November 1996