任务驱动教学法在急救护理学教学中的应用

目的探讨任务驱动教学法在急救护理学教学中的应用效果。方法按照急救护理学教学大纲要求,将84名学生随机分为实验组（43名）和对照组（41名）。对照组采用传统方法授课,实验组以任务驱动教学法为主、传统方法为辅授课。结果课程结束后,实验组理论及技能考核成绩显著优于对照组（均P〈0．01）;实验组53．5％～95．3％学生认为任务驱动教学法优于传统教授法和有利于提高学习兴趣及学习能力。结论任务驱动法可提升急救护理学教学效果,并受学生欢迎。     

任务驱动教学法在急救护理学教学中的应用

目的 探讨任务驱动教学法在急救护理学教学中的应用效果.方法 按照急救护理学教学大纲要求,将84名学生随机分为实验组(43名)和对照组(41名).对照组采用传统方法 授课,实验组以任务驱动教学法为主、传统方法 为辅授课.结果 课程结束后,实验组理论及技能考核成绩显著优于对照组(均P＜0.01);实验组53.5%～95.3%学生认为任务驱动教学法优于传统教授法和有利于提高学习兴趣及学习能力.结论 任务驱动法可提升急救护理学教学效果,并受学生欢迎.     

临终关怀对患儿生命体征的影响

为探讨临终关怀对患儿生命体征的影响 ,将 48例 (≤ 3岁 )住院的临终患儿进行分组 (对照组和观察组各 2 4例 )护理 ,对照组行常规护理 ,观察组行临终关怀护理。观察两组患儿生命体征变化、情绪状态及生存时间。结果两组患儿体温比较 ,差异无显著性意义 (P>0 .0 5 ) ;呼吸、脉搏、血压比较 ,差异有极显著性意义 (P<0 .0 1) ;观察组患儿较安静 ,且生存时间延长 ,与对照组比较 ,差异有显著性意义 (均 P<0 .0 5 )。提示临终关怀能减轻患儿的痛苦 ,使其安静地度过生命的临终阶段     

任务驱动的参与体验教学对护生老年护理态度及择业动机的影响

目的 探讨任务驱动的参与体验教学对护生老化知识、老年态度及老年护理择业动机的影响.方法 将选修老年护理学的126名护理本科生按行政班随机分成对照组(n=60)和实验组(n=66).对照组采取常规教学法,实验组在常规教学基础上利用任务驱动的参与体验教学在养老机构完成老年健康评估和老年怀旧访谈任务.教学前后采用老化知识问卷...     

气压式血液循环驱动仪治疗对烟雾病术后患者生命体征的影响

目的监测气压式血液循环驱动仪对烟雾病患者生命体征的影响,评估气压式血液循环驱动仪在烟雾病患者中使用的安全性和效果。方法记录98例烟雾病术后患者使用气压式血液循环驱动仪治疗前15min、治疗进行15min、治疗后15min 3个时间点的收缩压、舒张压、脉搏及呼吸。统计治疗期间及治疗前、后各1d即连续5d的上述指标;观察治疗期间患者舒适度,疼痛、感觉异常等不良事件及双下肢深静脉血栓形成情况。结果 98例患者各时间点收缩压、舒张压、脉搏及呼吸比较,差异无统计学意义(均P0.05),舒适度评分为6~10(7.76±1.20)分,未生发下肢深静脉血栓及不良事件。结论烟雾病术后患者使用气压式血液循环驱动仪治疗安全,可有效预防下肢深静脉血栓的发生。     

翻身拍背对重症脑出血病人生命体征的影响

对 37例重症脑出血病人翻身拍背前后的生命体征等进行观察分析 ,结果 2 5例无明显意识障碍和浅度昏迷病人翻身拍背前后生命体征变化不显著 (均P >0 .0 5 ) ,而 12例中、深度昏迷病人翻身拍背前后生命体征变化显著 (均P <0 .0 5 )。提示对于中、深度昏迷病人不主张过早翻身拍背 ,而对无明显意识障碍和浅昏迷病人可积极进行 ,以防止并发症的发生。     

静脉穿刺所致疼痛对新生儿生命体征的影响

目的探讨静脉穿刺时疼痛程度对新生儿生命体征的影响。方法静脉穿刺时应用新生儿疼痛行为评分量表进行疼痛评分,对105例疼痛评分大于5分的患儿应用监护仪动态记录穿刺前和穿刺时的呼吸、心率、血压和经皮血氧饱和度的变化。结果 105例新生儿平均疼痛评分为5.8分,进行穿刺时新生儿呼吸、心率、收缩压和舒张压均有不同程度的上升,血氧饱和度下降(均P<0.05)。结论静脉穿刺所致疼痛对新生儿生命体征的变化有显著影响,应引起临床重视。     

开放性输液对肠梗阻手术患者术中生命体征的影响

目的 探讨开放性输液对肠梗阻手术患者术中生命体征的影响. 方法 将本院2013年1月～2014年9月期间在静-吸复合全身麻醉下行肠梗阻手术的患者60例,采用随机数字表法将其分为两组,每组30例:常规量输液组(N组)和开放性输液组(L组).输液量:诱导前N组和L组患者分别输入4 ml/kg和15 ml/kg乳酸钠林格液,术中两组患者分别输入15 ml·kg-1·h-1和40 ml·kg-1·h-1至缝皮结束.出血患者根据出血量及血红蛋白含量,选择性输入羟乙基淀粉130/0.4氯化钠注射液或浓缩红细胞悬液和新鲜冰冻血浆.分别于患者入室时、肠梗阻解除时、关腹时监测患者心率(heart rate,HR)、平均动脉压(mean arterial pressure,MAP)、中心静脉压(central venous pressure,CVP)、尿量(urine volume,UV). 结果 L组较N组HR[(81±5)次/min比(102±12)次/min]、MAP[(98±10) mmHg比(77±8)mmHg(1 mmHg=0.133 kPa)]、CVP[(9.5±0.7) cmH2O比(6.5±0.5) cmH2O(1 cmH2O=0.098 kPa)]等患者生命体征的波动明显降低(P＜0.05),L组UV也显著高于N组[(320±50) ml比(90±20) ml](P＜0.05);N组中有7例患者需用升压药麻黄素来维持血压的平稳. 结论 对于肠梗阻患者,手术中施行开放性输液治疗有助于维持患者生命体征的平稳,并能保证患者重要器官与组织的充分血液灌注,更有利于保证患者手术期间的生命安全.     

任务驱动教学法在护士哀伤辅导培训中的应用

目的探讨任务驱动教学法在护士哀伤辅导培训中的应用效果。方法将146名护士随机分为两组,70名护士作为观察组,76名护士作为对照组,分别采用任务驱动教学法和传统教学法进行培训教学。比较两组护士培训前、后哀伤辅导水平及两组护士对教学方法的评价。结果培训后两组护士哀伤辅导评分高于培训前,但观察组哀伤辅导水平显著高于对照组,观察组对教学方法的评价显著高于对照组(P 0. 05,P 0. 01)。结论任务驱动教学法对护士哀伤辅导培训有积极作用,教学效果好。     

《基础护理实验报告册》的设计与应用

目的提高基础护理实验教学质量。方法设计包含 19项实验操作的《基础护理实验报告册》(下称《报告册》) ,应用于观察组 (183名专科生 )的教学 ,与同期采用常规教学法的对照组 (184名专科生 )比较理论、操作考试成绩及沟通效果。结果两组理论成绩差异无显著性意义 (P >0 .0 5 ) ;观察组操作成绩、沟通效果显著优于对照组 (均P <0 .0 1)。结论《报告册》的应用能提高学生护理操作水平、沟通能力 ,并对护理程序的掌握和运用起促进作用。     

经尿道前列腺电切围手术期低温对患者生命体征的影响

目的　比较不同灌洗液温度在经尿道前列腺电切 (TURP)围手术期对患者生命体征的影响,探讨手术的有关安全因素。　方法　按使用不同温度灌洗液将患者分为室温组 ( 21℃,n=40)和等温组( 37℃,n=60)。两组年龄、体重、国际前列腺症状评分 (IPSS)、心脑肺并发症比例及术中麻醉方式、灌洗液时间、灌洗液量、切除腺体重量和输血量比较无明显差异。以灌洗时间为参数,动态观察患者在TURP过程中平均动脉压 (MAP),心率,体温,血氧饱和度 (SaO2 )及血渗透量浓度(Oms)的变化。　结果　室温组患者于手术灌洗 45min后,MAP平均降低 7. 6mmHg( 8~13mmHg, 1 mmHg=0. 133kPa,F=1. 334,P=0. 262 );心率平均减缓 21. 6次 /min,P<0. 001, 18例(36% )伴有以期前收缩为主的心律失常。以体温 36℃为临界值,平均降低 0. 75℃ (0. 9~0. 6℃),P<0. 01。等温组患者上述指标变化多出现于灌洗 60min后,两组比较差异无统计学意义。室温组高龄(≥75岁)患者 17例,其中 14例(82% )出现低温及生命体征变化,等温组高龄患者 24例,亦有 9例(38% )出现低体温。高龄作为单一因素与围手术期低温呈相关性 (r=-0.417,P=0. 002)。大腺体(切除腺体重量≥25g)亦与围手术期低温呈相关性 (r=-0. 633,P=0. 001)。　结论　TURP中灌洗液温度可致手术期低体     

The sensitivity of vital signs in identifying major thoracoabdominal hemorrhage

Prehospital and emergency room recordings of hemodynamic vital signs frequently play a major role in the evaluation and treatment of trauma victims. Guidelines for resuscitation and treatment are affected by absolute cutoffs in hemodynamic parameters. To determine the sensitivity of various strata of systolic blood pressure and heart rate in identifying patients with major thoracoabdominal hemorrhage, a 1-year retrospective review was conducted. A third of all patients presented to the emergency department with a normal blood pressure and over three-quarters attained a normal blood pressure during the emergency department evaluation. Although the sensitivity of vital signs in identifying this group of patients improved as the variance from normal increased, standard cutoffs were relatively insensitive. We conclude that normal postinjury vital signs do not predict the absence of potentially life-threatening hemorrhage and abnormal vital signs at any point after injury require investigation to rule out significant blood loss.     

不同镇静治疗对危重患者生命体征及并发症的影响

目的探讨镇静治疗对危重患者生命体征及并发症的影响,为预见性防护干预提供参考。方法统计分析587例入住ICU患者行插管镇静(125例)、短期镇静(194例)、长期镇静(268例)治疗对其脉搏、血压、呼吸的影响及并发症、意外事件发生情况。结果不同镇静治疗患者各时间点血压、心率、呼吸功能比较,差异有统计学意义(P0.05,P0.01)。气管插管镇静治疗患者发生反流误吸4例,输液外渗15例;短期镇静治疗患者发生气管插管脱出5例,气管导管移位2例,导管/引流管脱出8例,输液外渗20例;长期镇静患者发生反流误吸12例、排痰困难15例、意识障碍2例、静脉血栓形成3例、气管插管脱出3例、气管导管移位4例、导管/引流管脱出8例及输液外渗22例。结论不同镇静治疗对患者的循环、呼吸功能有影响,并发症和意外事件因镇静时间的延长而呈增加趋势,也可因镇静不足或过深所致;在镇静治疗过程中护理人员应动态评估患者镇静水平,防止镇静不足或过深,针对不同镇静治疗的特点,准备应急预案,以保证镇静治疗的效果和患者安全。     

Trauma triage--a comparison of the trauma score and the vital signs score

A pilot study of the Trauma Score (TS) was performed from July to September 1983. The Vital Signs Score (VSS) used by the ambulance paramedics, was compared with TS. Of 266 patients suitable for study, TS data was collected for 110. Other exclusions resulted in a detailed analysis of data from 65 patients among whom there were eight deaths. There was a significant correlation between TS and VSS, however, TS more accurately defined the population at risk of death. A score greater than 12 correlated with a mortality of zero for the TS, but for the VSS it correlated with a mortality of 4.4%. A score less than or equal to 12 correlated with a mortality of 61.5% for the TS but only 30% for the VSS. Stepwise regression analysis of the TS, VSS and combinations of their components was performed to determine their capacities to predict death. A combination of three components of the TS, corresponding to the Triage Index of Champion, was a better predictor than the total TS. Neither the VSS nor any combinations of its components had the predictive capacity of the total TS. If the TS and the VSS were used to select high risk patients for a particular rescue or resuscitation protocol, and scores were selected which gave 100% sensitivity with the highest possible specificity, the positive predictive values of the TS and VSS would be respectively 61.5% and 26.7%. The protocol would be administered unnecessarily to 73.3% of patients selected by the VSS, but only to 38.5% of patients selected by the TS. The TS is proposed as an aid to triage.(ABSTRACT TRUNCATED AT 250 WORDS)     

Manual vital signs reliably predict need for life-saving interventions in trauma patients

OBJECTIVE: Various types of diagnostic and monitoring techniques are available in the prehospital environment. It is unclear how increasing complexity of diagnostic equipment improves the ability to predict the need for a life-saving intervention (LSI). In this study, we determined whether the addition of diagnostic equipment improved the predictive power of vital signs and scores obtained only by physical examination. METHODS: Institutional review board approval was obtained for an analysis of 793 prehospital trauma patient records collected during helicopter transport by Emergency Medical Services personnel. Exclusion of severe head injuries and patients with incomplete data resulted in 381 patients available for analysis. Data sets were classified on the basis of the instrumentation requirements for capturing the given measurements and were defined by three groups: Group 1, vital signs obtained with no equipment (radial, femoral, and carotid pulse character; capillary refill; motor and verbal components of the Glasgow Coma Scale [GCS]); Group 2, Group 1 plus eye component of the GCS and pulse oximetry (Spo(2)); and Group 3, Group 2 plus fully automated noninvasive blood pressure measurements, heart rate, end-tidal carbon dioxide, and respiratory rate. LSIs performed during transport and in the hospital were recorded. Data were analyzed using a multivariate logistic regression model to determine which vital signs were the best predictors of LSI. RESULTS: Radial pulse character and GCS verbal and motor components had the best predictive power for the need of a prehospital LSI in Group 1 (receiver operating characteristic [ROC] curve, 0.97). Radial pulse character together with the eye component of the GCS and the motor component of the GCS provided the best prediction of a need for a prehospital LSI for Group 2 (ROC curve, 0.97). Addition of all supplementary vital signs measured by an automated monitor (Group 3) resulted in an ROC curve of 0.97. Given an abnormal radial pulse character (weak or absent) and abnormal GCS verbal and motor components, the probability of needing an LSI was greater than 88%. CONCLUSION: In this cohort of patients, predicting the need for an LSI could have been achieved from GCS motor and verbal components and radial pulse character without automated monitors. These data show that simple and rapidly acquired manual measurements could be used to effectively triage non-head-injured trauma casualties. Similar results were obtained from manual measurements compared with those recorded from automated medical instrumentation that may be unavailable or difficult to use in the field.