计算机在血液透析中心的应用

我们血液透析中心的医护人员参考各医院计算机的护理管理软件，研制出了适合血液透析中心的计算机模块，并广泛应用，从而提高了工作效率，降低了劳动强度，减轻了医护人员的工作压力，提高了护理人员及患者的满意度，也提高了表格书写合格率。     

基于职业导向性的高职护理校本整合课程开发

改革开放以来,我国高等职业教育的改革与发展取得了一定成绩,积累了一定的经验,但仍面临许多问题亟待解决,其中高职专业课程设置所存在问题尤为突出,主要表现为:其一,过多延续了大学的相关课程,虽然应用高职高专护理专业规划教材,但也只是一种普遍性的教材[1],教材内容仅仅是专业本科教材的精简或提炼,过多承继了本科教材中学科型特点,忽略了职业教育的专业导向性,缺乏针对性和实用性.其二,沿用了中专教育特点,过多强调了能力的培养,而忽略了专业知识的应用,局限了知识拓展范围,难以适应以后的知识更新,阻碍了持续发展的空间.因此,适合岗位需求的高职专业校本课程开发迫在眉睫.     

住院病人告知流程的探讨

总结了住院病人的告知流程,包括入院告知,疾病相关知识的告知,检查与消费的告知,重点环节的告知和出院告知。认为告知流程的实施督导了护士主动告知,体现了人性化护理服务过程,构建了和谐的护患关系,减少了医疗意外与纠纷,加强了护理安全管理。     

博弈论在协调医护关系中的应用

将博弈论应用于协调医护关系后,加强了医护之间的沟通,提高了医疗工作质量;做好了医疗缺陷互补工作;增强了医学沟通;提供了更加优质的护理服务,提高了病人满意度;医护之间形成了交流-协作-互补型合作关系。     

护士双向选择与竞争上岗的实践与思考

通过护士与不同科室护士长之间的双向选择、竞争上岗 ,打破了分配用人制度的单一局面 ,给予了护士一定的选择权 ,扩大了护士长的用人自主权 ,加强了护士长的责任感和护士的危机感 ,调动了广大护士的积极性和工作热情 ,增强了科室的凝聚力及团队精神 ,提高了护理质量。     

康复治疗学专业本科学历教育的探讨

为了争取与国际康复医学教育接轨,我院在康复治疗学专业教育方面进行了不断的改革与探索,重新制订了符合国际标准和国内本科教育标准要求的课程设置和教学计划,优化了教学内容与课程体系,完善与修订了教学大纲和实习指导,进行了教学方法改革,形成了与该专业人才培养模式相适应的理论教学体系和实践体系,探索了符合中国国情的办学模式.     

白衣飘飘

天微微亮了,林枫揉了揉眼睛起床了,虽然昨天在网上查信息查到很晚,可是一想到今天是白班,还是早早地起来做饭,装上自己与老公的饭盒,急匆匆地吃了一些,就来到医院了。换好了白大衣,走进办公室,看了一眼患者一览卡的牌子,心里一边在隐隐的痛,一边又觉得有什么东西让她的心坚硬了起来。     

纯真年代

1985年,我家里病了两个人,我的妹妹两岁了,突发高烧,竟然连路也不会走了,父母连夜把她送到了本市的中心医院,住了两周院,妹妹出院时虽然苹果样小胖脸瘦成了尖脸,还是像往常一样活泼好动。到了八月份时,我的奶奶被人骑自行车撞了,当时人事不知,骑自行车的人见机跑了,我父母又把她送到了中心医院,住了20天,奶奶回来后照样下地上山,与住院前差不多。     

皮试仪临床使用小技巧

随着皮试仪进入临床,它替代了传统的皮内注射进行皮试的方法,为护理工作带来了很大的方便,同时也给病人带来了更大的实惠。主要表现在以下3个方面：（1）它简化了皮试液的配制流程,节省了护理工作的时间,提高了工作效率;（2）它的自动定时系统弥补了护士因为工作忙而忘记了看皮试结果的时间;（3）它改变了传统的皮内注射进行皮试的方法,不损伤病人的皮肤,减轻了病人的痛苦。     

低压微电网技术应用研究

本文介绍了微电网系统的基本组成，阐述了各组成设备的参数、性能，给出了微电网系统的应用案例，总结了微电网应用的意义。     

体外与非体外循环冠状动脉搭桥术临床对比及护理研究

目的观察比较体外循环冠状动脉搭桥术（CPABG）和非体外循环冠状动脉搭桥术（OPCAB）的疗效，探讨其护理措施。方法选取65例冠脉搭桥术患者，随机分为两组，33例行OPCAB，32例行CPABG，对两组患者分别行相应的护理，包括术后严密监测生命体征，严密心电监护，加强呼吸系统的监护，维持血压稳定，患肢动脉血栓预防，华法林的合理使用等，观察比较两组患者手术情况，术后恢复及心功能改善情况。结果OPCAB组患者手术时间及出血量均明显低于CPABG组，两组比较差异具有统计学意义（P〈0．05）。两组患者手术前后心功能分级，组间比较差异无统计学意义（P〉0．05）；术后与术前相比，心功能均显著改善，差异均有统计学意义（P〈0．05）。OPCAB组患者ICU留住时间，辅助呼吸时间，并发症发生情况，拔纵隔、心包引流管时间，住院时间及住院费用均明显低于CPABG组，差异均有统计学意义（P〈0．05）。结论OPCAB较CPABG治疗冠心病患者术后恢复快，疗效更为显著；护士掌握手术相关知识及护理要点，为患者提供优质高效专业的护理，是保证手术成功的关键。     

熵指数应用于非体外循环冠脉搭桥手术麻醉的临床研究

【目的】探讨熵指数（En）在非体外循环冠脉搭桥手术（OPCAB）麻醉应用的可行性。【方法】择期在异丙酚-舒芬太尼麻醉全身麻醉下行OPCAB患者70例,随机分成试验组和对照组,每组35例。试验组在En监测下,调整异丙酚、舒芬太尼输注速率使手术过程状态熵（SE）维持在45～55,反应熵（RE）-SE差小于10;对照组患者维持心率（HR）和血压（BP）变化不超过基础值的25％。记录手术过程、麻醉药用量、拔管时间、在ICU停留时间、住院时间、术中知晓情况等。测量患者血浆促肾上腺皮质激素（ACTH）和皮质醇浓度。【结果】试验组麻醉过程中SE平均数为50±5,显著高于对照组（P〈0．05）;与对照组比较,试验组异丙酚、舒芬太尼用量显著减少（P〈0．05）,拔管时间显著减小,但血管活性药物用量显著减少（P〈0．05）,但两组患者ACTH和皮质醇浓度比较无显著差异（P〉0．05）,均无术中知晓发生。【结论】熵指数监测指导0PCAB麻醉安全可行,可以减少麻醉药用量。     

老年非体外循环冠状动脉搭桥术9例术后监护研究

目的：探讨老年患者非体外循环冠状动脉搭桥术（OPCAB）的术后监护特点和护理方法。方法：收集2003年1月～2005年8月行OPCAB9例老年患者的临床资料,分析术后血流动力学监测、血管活性药物应用、呼吸系统监护、出入量、电解质及术后恢复情况。结果：9例全部治愈出院,无护理并发症发生,均未用升压药。心绞痛缓解率100％。结论：OPCAB术后可在常规体外冠状动脉搭桥术监护原则的基础上早期行康复活动,以提高老年患者的生活质量。     

Preoperative insertion of an intra-aortic balloon pump improved the prognosis of high-risk patients undergoing off-pump coronary artery bypass grafting

This study investigated the efficacy and safety of preoperative insertion of an intra-aortic balloon pump (IABP) in high-risk coronary atherosclerotic disease patients undergoing off-pump coronary artery bypass grafting (OPCAB). A total of 232 patients were recruited to the study, of whom 107 underwent percutaneous insertion of an IABP prior to OPCAB. The remaining 125 patients underwent OPCAB alone. Pre-, peri- and postoperative parameters were compared between the two groups. Preoperative insertion of an IABP was associated with a shorter stay in intensive care, decreased incidence of postoperative dialysis and acute heart failure, and a reduction in postoperative mortality compared with OPCAB alone. There were no between-group differences in terms of haematocrit level, number of distal anastomoses, volume of postoperative drainage or incidence of reoperation for bleeding and postoperative stroke/cerebrovascular accident. In conclusion, preoperative insertion of an IABP improved the prognosis of high-risk CAD patients undergoing OPCAB.     

Routine intraoperative transesophageal echocardiography identifies patients with atheromatous aortas: impact on "off-pump" coronary artery bypass and perioperative stroke.

BACKGROUND: Patients with severe atheromatous aortic disease (AAD) undergoing coronary artery bypass grafting (CABG) have increased operative risks. The "off-pump" CABG (OPCAB) technique was evaluated in patients given the diagnosis of severe AAD by routine transesophageal echocardiography. METHODS: A total of 5737 patients underwent CABG, with 913 having transesophageal echocardiography findings of severe AAD. Of the patients with severe AAD, 678 (74.3%) had conventional CABG and 235 (25.7%) had OPCAB. RESULTS: Hospital mortality was 8.7% for conventional CABG and 5.1% for OPCAB (P =.08). Multivariate analysis revealed that increased mortality was significantly associated with acute myocardial infarction, conventional CABG, age, renal disease, history of stroke, and ejection fraction < 30%. Neurologic complications occurred in 6.3% of patients undergoing CABG and in 2.1% undergoing OPCAB (P =.01). Freedom from any complication was significantly greater with OPCAB. CONCLUSION: Routine intraoperative transesophageal echocardiography identifies patients with severe AAD. In these patients, OPCAB technique is associated with a lower risk of death, stroke, and all complications.     

A comparison of several variables of off-pump coronary artery bypass procedures versus myocardial revascularization utilizing cardiopulmonary bypass

An investigation was conducted to compare several variables of off-pump coronary artery bypass (OPCAB) procedures with those using cardiopulmonary bypass (CPB) for myocardial revascularization by two surgeons. The patients were divided into four groups: group 1 patients received CPB for their myocardial revascularization performed by surgeon A; group 2 patients received the OPCAB procedure performed by surgeon A; group 3 patients received CPB for their myocardial revascularization performed by surgeon B; and group 4 received the OPCAB procedure performed by surgeon B. The same anesthesia technique and postoperative management were employed for all patients in this study. The CPB procedures received the same perfusion circuit and conduct. Postoperative laboratory values, including hemoglobin, hematocrit and platelet counts for the OPCAB groups, were higher than the CPB groups. Chest tube drainage was similar for both the OPCAB and CPB groups, but postoperative urine outputs were significantly higher in the CPB groups for both surgeons. Positive fluid balance was statistically greater in the CPB groups compared to the OPCAB groups for both surgeons. Ventilator times, length of stay in the intensive care unit (ICU) and length of hospital stay were not statistically significant for the groups in this study. Postoperative weight gain for both surgeons was higher in the CPB groups. Intraoperative packed red blood cell (PRBC) usage for surgeon B was similar for both the OPCAB and CPB groups, but the OPCAB group for surgeon A had greater intraoperative PRBC usage than the CPB group.     

1386例不停跳冠状动脉旁路移植术经验总结

目的 总结2002年1月至2008年3月全国多中心1386例冠心病患者实施不停跳冠状动脉搭桥术的经验.方法 常温下全身麻醉气管插管,胸骨正中切口,取左侧乳内动脉、桡动脉及大隐静脉,行不停跳冠状动脉旁路术.70岁以上患者占32.35%,年龄最大为99岁,急诊或亚急诊手术111例,二次冠状动脉旁路术52例.结果 围术期死亡24例,总病死率1.73%,其余患者均痊愈出院,术后心绞痛症状明显缓解,生活质量较术前明显提高.结论 不停跳冠状动脉旁路移植术对高龄及合并其他慢性老年疾病患者是可行的,熟练的手术技术,对手术适应证的把握,积极的围术期处理是手术成功的关键.     

151例非体外循环冠状动脉旁路移植术围术期处理体会

目的：总结非体外循环下冠状动脉旁路移植术（OPCAB）的临床应用经验。方法：对151例非体外循环冠状动脉旁路移植术患者的临床资料、手术情况及术后并发症情况进行总结、分析。结果：1．51例患者均在非体外循环心脏跳动下完成手术，人均旁路移植3．28根；术后出现低心排4例，低氧血症18例，胸骨哆开3例，快速房颤15例，经治疗后均治愈，无围术期死亡，疗效满意。结论：严格掌握手术适应证，熟练的外科手术技巧，妥善细致的围术期处理，及时发现和处理术后并发症，是提高OPCAB成功率的关键。     

非体外与体外循环冠状动脉旁路移植术的效果及成本比较

[目的]比较非体外循环冠状动脉旁路移植术(OPCAB)与体外循环冠状动脉旁路移植术(CCABG)的效果和成本。[方法]对2003年1月—2005年8月在我院行OPCAB的病人45例及CCABG的病人35例进行回顾性非随机临床对照,对两组病例在手术时间、输血量及出血量、气管插管及留住ICU时间、术后住院时间、并发症、总住院费用等方面进行对比总结。[结果]两组病人的手术时间有统计学意义(P<0.05),输血量、出血量、留住ICU时间、并发症、总住院费用等OPCAB组均少于CCABG组,但无统计学意义(P>0.05)。在气管插管时间、术后住院时间OPCAB组明显短于CCABG组,有统计学意义(P<0.01)。[结论]OPCAB组比CCABG组术中心脏创伤小,术后心脏功能恢复快,并发症少,并能缩短ICU留住时间和住院时间,减少住院费用,降低医疗成本,病人近期生活质量提高。     

Thrombelastographic changes in OPCAB surgical patients

The purpose of this study was to determine whether thrombelastography could detect hypercoagulability in the off-pump coronary artery bypass (OPCAB) patient. Seventeen OPCAB and six cardiopulmonary bypass (CPB) patients were studied pre- and postprocedure, as well as on each of the first three postoperative days (POD). In the OPCAB patients, there was a small reduction in the postprocedure coagulation index (CI). This was followed by an increase in the CI on each of the next three POD, reaching a level exceeding the mean preprocedure CI by 2.32 units, indicative of a state of relative hypercoagulability. The mean CI for the CPB patients decreased significantly in the postprocedure sample. Over the next 72 h, the CI increased to a level that nearly equaled the preprocedure 'baseline'. We concluded that our study identified a state of relative hypercoagulability in the OPCAB patient 72 h after surgery. The mechanism of this hypercoagulation, as well as the clinical significance of this finding, is yet to be determined.