特重型颅脑损伤患者行标准大骨瓣减压术后的护理

目的通过对特重型颅脑损伤行标准大骨瓣减压术患者进行积极早期护理,探讨减少并发症,改善患者预后、生存质量的方法。方法术后患者常规进行脑科监护,加强基础护理,保持呼吸道通畅,处理高热、应激性溃疡、高血糖等重型颅脑损伤常见并发症,防止坠积性肺炎、褥疮发生。结果患者术后早期患者生命体征平稳,并发症发生率明显降低,经过后期治疗,提高了治愈率,致残率明显降低。结论特重型颅脑损伤患者标准大骨瓣减压术后积极开展早期护理,能减少急性期并发症,提高救治成功率,改善患者预后、生存质量。     

整体护理对宫颈癌手术患者并发症和生存质量的影响

目的:探讨整体护理对宫颈癌手术患者并发症和生存质量的影响.方法:将80例行宫颈癌手术的患者随机分为观察组与对照组各40例.对照组实施常规护理,观察组实施整体护理.观察两组患者术后并发症发生率和出院6个月后的生存质量.结果:观察组尿潴留、尿路感染、深静脉血栓形成的发生率明显低于对照组,生存质量明显高于对照组(P＜0.05).结论:整体护理可以减少宫颈癌手术后患者的并发症,提高其生存质量.     

人工膝关节置换术后的护理体会

目的探讨人工膝关节置换术后的护理要点和疗效。方法对11例行膝关节置换患者的术后护理方法及效果进行回顾总结。结果所有患者手术经过顺利,术后予精心护理。经6~24个月的术后随访,效果满意,优良率达100%,无1例发生感染,无假体松动及关节僵硬等并发症发生。结论对人工膝关节置换者术后行正确有效的护理能预防各种术后并发症,并能促进患肢功能恢复,明显提高患者的生活质量。     

阶段性康复锻炼对脊柱手术患者术后并发症与生活质量的影响

目的探讨阶段性康复锻炼对脊柱手术患者术后并发症及生活质量的影响。方法选取我院2018年3月至2019年3月收治的行手术治疗的脊柱骨折患者84例,随机等分为对照组和观察组,对照组术后实施常规护理,观察组术后实施阶段性康复锻炼,比较两组患者的术后并发症发生率及生活质量。结果观察组术后并发症发生少于对照组(P<0.05);观察组生活质量评分高于对照组(P<0.05)。结论阶段性康复锻炼在脊柱手术患者中的应用,能减少术后并发症,全面提升其生活质量。     

延续性健康教育路径对肝硬化患者出院后生存状态的影响

目的了解延续性健康教育路径对肝硬化患者出院后的生存状态的影响,为提高肝硬化患者生活质量提供有效的健康教育方法。方法将124例肝硬化患者分为研究组与对照组。研究组对患者出院后仍进行系统、动态、连续而有针对性的健康管理。对照组实施肝硬化出院健康指导。观察两组患者出院后的并发症、焦虑状态及生存质量。结果 (1)研究组的上消化道出血、感染、肝性脑病等并发症的发生率小于对照组,差异有统计学意义(P<0.05);(2)研究组的焦虑自评量表(SAS)得分小于对照组,生活质量得分高于对照组,差异有统计学意义(P<0.05);(3)文化程度及合并症是影响患者SAS得分的独立因素,文化程度和并发症是影响患者生活质量的独立因素(P<0.05)。结论延续性健康教育路径可以有效减少肝硬化患者的并发症、提高患者的生活质量。     

Meaning of quality of life among patients with familial hypercholesterolemia

BACKGROUND: Living with a genetic predisposition to disease may influence quality of life. The presence of premature disease can lead to an increased focus on family history and genetic predisposition. OBJECTIVE: The purpose of this study was to describe quality of life in patients with the genetic disease, familial hypercholesterolemia, who are at an increased risk of premature coronary heart disease. METHODS: Interviews from 12 adult patients with FH were analyzed using constant comparative analysis. The findings of this qualitative study revealed that for patients, quality of life was equated with harmony in life, the core category. Attaining harmony in life presumes satisfaction and togetherness. Cognizance of the threat of coronary heart disease and impending mortality is balanced by the support of togetherness and satisfaction that builds harmony in life. CONCLUSION: When caring for patients with familial hypercholesterolemia, it is important to meet each patient on his or her own level, and to support balance and their choices for maintaining or regaining harmony in life.     

Palliative surgery for acute bowel obstruction caused by Kaposi's sarcoma in a patient with AIDS

Patients with human immunodeficiency virus (HIV) infection or acquired immune deficiency syndrome (AIDS) can present with acute abdominal surgical problems, either with intra-abdominal opportunistic infection as a result of their immunosuppression, or with associated malignancies. We report a 39-year-old man who developed intermittent nausea and vomiting, which was originally thought to be a side-effect of the chemotherapy he was receiving for facial Kaposi's sarcoma. However, he was found to have intraperitoneal Kaposi's sarcoma causing small bowel obstruction, which was successfully excised at laparotomy. There were no perioperative complications despite AIDS-related respiratory disease. The patient remained free of abdominal symptoms until his death. HIV infections or AIDS alone should not be contraindications to surgery for such problems, as careful patient selection can yield good results and significantly improve quality of life.     

Comprendre le deuil pour mieux accompagner les proches de patients décédés en réanimation

Intensive care unit (ICU) caregivers are regularly confronted with end-of-life and care for the patients’ relatives who will soon be bereaved persons. Bereavement is not a problem nor a pathology: it is a painful and intense period during which the bereaved person adjusts to living without his/her loved-one, while resuming his/her “normal” course of life. However, grieving can sometimes become a more complex process requiring professional help. This text is designed to understand individual grief and its social implications, its course and its mechanisms, but also its potential complications: the knowledge of this process will enable caregivers to understand the bereaved relatives of ICU patients and to attempt to prevent grieving complications associated with the ICU context and the dying and death process.     

Care of the chronic tracheostomy

A minority of patients with neuromuscular disease require placement of a tracheostomy, usually for the purpose of providing mechanical ventilation. Often the tracheostomy is performed during a hospital admission for an acute illness. The debate about the appropriate timing of tracheostomy in critically ill patients has not been resolved; however, the weight of evidence now favors performing a tracheostomy early (within 7 d of translaryngeal intubation) if the period of mechanical ventilation is likely to be prolonged beyond 3 weeks. For patients with chronic progressive weakness who develop respiratory difficulty, the consensus of opinion is that tracheostomy should be performed in patients with severe bulbar involvement, inability to effectively cough up secretions despite mechanical aids for secretion clearance, or for those who are unable to tolerate or fail noninvasive ventilation. The decision to perform tracheostomy in patients with chronic neuromuscular weakness involves consideration of several factors, including complications, resources, quality of life, ethical issues, cosmetic issues, and cost. Complications from tracheostomy and physician-perceived poor quality of life often lead to a negative bias, such that some patients may be denied this life-saving procedure. Special training is needed to provide long-term tracheostomy care, and an organized approach should be followed to decannulate patients who recover from their acute illness. Appropriate and skilled care could significantly improve the longevity and quality of life of those patients with neuromuscular disease who have a tracheostomy for long-term ventilation.     

围术期临床护理路径在冠心病行冠状动脉支架置入术中的应用

目的探讨围术期临床护理路径对冠心病行冠状动脉支架置入术患者术后并发症发生率及生命质量的影响。方法选择2017年1月至2019年1月我院收治的120例冠心病行冠状动脉支架置入术患者为研究对象,按照随机数字表法将其等分为对照组与研究组,对照组实施常规护理,研究组实施围术期临床护理路径,对比两组患者并发症发生率、生命质量评分。结果研究组并发症发生率低于对照组(P<0.05);干预后3个月,研究组生命质量评分优于对照组(P<0.05)。结论冠状动脉支架置入术过程中实施围术期临床护理路径,能减少术后各种并发症的发生,提升患者心功能恢复效果,提高生命质量。     

Complications arising from cardiac implantable electrophysiological devices: review of epidemiology,pathogenesis and prevention for the clinician

Cardiac implantable electronic devices (CIEDs) which include devices such as permanent pacemakers, implantable cardioverter-defibrillators and cardiac resynchronization therapy devices are well established therapies that have been shown to improve quality of life and prolong survival in appropriately selected patients, and are being increasing utilized across the world. However, CIED implantations are invasive procedures and a thorough understanding of the potential complications is required to prevent deleterious patient outcomes. In this review, we will discuss frequent complications (infection, hematoma or bleeding, and procedural mechanical complications) that may harm patients after CIED implantation, and the steps that can be taken to minimize their risk. This is particularly relevant to trainees/ clinicians who either perform these procedures or refer patients for CIED implantation.     

农村2型糖尿病患者生存质量的调查

目的了解农村2型糖尿病患者的生存质量并找出影响因素,为改善和提高农村2型糖尿病患者的生存质量提供依据。方法本研究采用非实验性的描述性研究便利抽取102例门诊农村2型糖尿病患者,对其生存质量进行调查,进一步分析疾病因素和人口学因素对患者生存质量的影响。结果农村糖尿病患者生存质量总体水平较差,生存质量总评分为（51．40±13．37）分;糖尿病对农村糖尿病患者的心理／精神维度影响最大;年龄、婚姻状况、文化程度、病程、并发症、饮食治疗、医疗费用支付方式、血糖监测等因素对农村糖尿病患者生存质量各维度的影响均有统计学意义（P〈0．05,P〈0．01）。结论农村2型糖尿病患者的生存质量较低,病程、并发症、医疗费用支付方式、年龄、婚姻状况、文化程度、饮食治疗、血糖监测等影响农村2型糖尿病患者的生存质量,提示护理人员应加强对农村糖尿病患者的心理疏导,从疾病因素和人口学因素方面重视改善农村2型糖尿病患者的生存质量。     

优质护理干预对慢性肾衰竭实施腹膜透析患者的生活质量以及并发症的影响

目的研究优质护理干预对慢性肾衰竭实施腹膜透析患者的生活质量以及并发症影响。方法选择行腹膜透析治疗的100例患者作为研究对象,按随机数表法将患者分为2组,对照组50例患者采取传统护理方式,观察组50例患者采取优质护理干预。根据MIS评分和SF-36健康调查简表比较2组患者在MIS评分、各生化指标、健康状况、并发症、治疗效果等各项指标上的差异。结果 2组患者治疗后,观察组的MIS评分、体质量指数、血清白蛋白以及血红蛋白含量均高于对照组,差异具有统计学意义(P0.05)。观察组患者一般健康状况、生理功能、社会功能、感情职能等生活质量指标均高于对照组,差别具有统计学意义(P0.05)。观察组腹膜炎、出口处感染、引流不畅以及水电解失调的发病率均低于对照组(P0.05)。结论优质护理不仅改善肾衰竭患者的肾功能缺陷,同时改善患者的营养状况以及生活质量,有效促进患者的身心健康,减少并发症的发生,值得临床推广应用。     

基于FOCUS-PDCA程序的集束化护理对脊椎骨折术后患者并发症及生活质量的影响

目的探讨基于FOCUS-PDCA程序的集束化护理对脊椎骨折术后患者并发症及生活质量的影响。方法选取2018年1月至2020年1月在我院接受手术治疗的脊椎骨折患者90例,将其按照随机数字表法分为对照组和观察组,各45例。对照组给予常规护理干预,观察组在对照组基础上给予基于FOCUS-PDCA程序的集束化护理干预。比较两组术后并发症发生情况、自我效能感及生活质量评分。结果观察组术后并发症总发生率低于对照组(P<0.05)。干预1个月后,两组自我效能感及生活质量评分均较干预前升高,且观察组高于对照组(P<0.05)。结论基于FOCUS-PDCA程序的集束化护理应用于脊椎骨折手术患者中有助于减少术后并发症总发生率,提高患者自我效能感及生活质量,值得推广。     

鼻内镜下上颌窦窦口开放联合下鼻道开窗入路手术治疗真菌性鼻窦炎的有效性和安全性

目的探讨鼻内镜下上颌窦窦口开放联合下鼻道开窗入路手术治疗真菌性鼻窦炎的有效性和安全性。方法选取2013年9月至2018年8月于我院行手术治疗的真菌性鼻窦炎患者146例,依患者意愿分为对照组(n=69)和研究组(n=77),分别行鼻内镜下上颌窦窦口开放术和鼻内镜下上颌窦窦口开放联合下鼻道开窗入路术治疗,随访3个月。比较两组手术前及随访结束后的鼻内镜评分、生存质量、术后并发症发生情况。结果随访结束后,两组患者的鼻内镜评分和生存质量评分均明显低于手术前,且研究组低于对照组(P<0.05)。两组患者术后并发症总发生率比较,差异无统计学意义(P>0.05)。结论鼻内镜下上颌窦窦口开放联合下鼻道开窗入路术治疗真菌性鼻窦炎可改善患者的临床症状,提高其生存质量,且并发症少。     

Clinical characteristics of patients with diabetic polyneuropathy: the role of clinical and electromyographic evaluation and the effect of the various types on the quality of life

Objective: This study was performed to identify the relationship between the quality of life and polyneuropathy which is one of the complications of diabetes. Methods: Total 111 patients with diabetes mellitus were taken into the study as type 1 and type 2. Patients were accepted having polyneuropathy according to their electroneuromyography (ENMG) results. To evaluate the quality of life in the patients Short Form 36 (SF‐36) and World Health Organization Quality of Life Questionnaire abbreviated version (WHOQOL‐BREF) were used. Results: Clinical polyneuropathy was found in 46% of the patients, while polineuropathy was found in 63% of the patients with evaluation ENMG. The patients with polyneuropathy had poor quality of life according to SF‐36 and WHOQOL‐BREF (p < 0.001). The mean quality of life scores of patients who had sensoriomotor and mix polyneuropathy, were lower than sensory type and axonal polyneuropathy. Conclusion: Diabetic polyneuropathy influences the quality of life in a negative way. The quality of life scores of patients who had polyneuropathy continuing with mixed pathogenesis and sensoriomotor type, become worse for this reason, even if the patients do not have any clinical polyneuropathy, this being evaluated with ENMG.     

外周中心静脉置管在肿瘤化疗患者中的应用体会

目的探讨外周中心静脉置管(PICC)在肿瘤患者化疗过程中的应用方法及效果。方法对86例采用PICC置管的肿瘤化疗患者在操作、维护、健康教育等方面实施规范化管理,预防或减轻并发症。结果 86例患者均顺利度过化疗周期,未发生导管脱出、导管破裂、导管感染及败血症等并发症,患者生活质量得到不同程度提高,效果满意。结论 PICC置管既有保护血管、留置时间长、并发症少等优点,又可以提高护理人员工作效率,并可减轻患者的痛苦,提高患者的生活质量,值得临床推广使用。     

规范化护理流程在早期胃癌内镜下黏膜剥离术患者中的应用

目的：探讨规范化护理流程在早期胃癌内镜下黏膜剥离术患者中的应用效果。方法：将2018年12月1日～2019年12月31日收治的125例早期胃癌内镜下黏膜剥离术患者根据手术期间护理流程不同分为常规组61例和观察组64例。常规组采用常规护理流程进行干预,观察组在内镜下黏膜剥离术治疗期间采用规范化护理流程进行干预。比较两组患者术后疼痛[采用视觉模拟评分法(VAS)]、护理满意情况、临床指标恢复时间、并发症情况及干预前后生活质量[采用健康调查简表(SF-36)]、焦虑[采用汉密顿焦虑量表(HAMA)]、抑郁[采用汉密顿抑郁量表(HAMD)情况。结果：术后两组患者VAS评分均呈下降趋势,而观察组术后6 h、12 h、24 h的VAS评分均低于常规组(P<0.01);观察组护理技术、护理质量、护理态度、健康指导满意情况评分高于常规组(P<0.01);观察组患者肛门排气恢复时间、术后排便时间、肠胃蠕动时间均短于常规组(P<0.01);观察组术后并发症总发生率低于常规组(P<0.05);干预后两组生活质量和负性情绪均有改善,且观察组SF-36生活质量量表评分高于常规组(P<...     

自膨式金属食管支架的临床应用

目的 :探讨自膨式食管支架 (Self-ExpandingMetalStent,SEMS)治疗吞咽困难患者的临床效果、适应症及并发症。方法 :收集我院安置的食管支架患者 32例之临床相关资料。以 5分法记录支架安置前后吞咽困难程度。并发症出现的时间以 30天为界。结果 :吞困难评分由安置前的 3 43降为安置后的 1 15 (P <0 . 0 5 )。食管 支气管瘘全部痊愈 (4例 )。 6例患者支架安置后发生了早期并发症 ;出血 (2例 )、胸骨后疼痛不适 (4例 )。 1例发生了远期并发症 :支架移位。结论 :自膨式食管支架安置能迅速、有效地改善吞咽困难 ,提高患者生活质量 ,延长生存期限。是否适用于良性食管梗阻尚有争议。严格掌握适应症及新型食管支架的问世 ,有望减少安置术后并发症