腹部器官簇移植患者的术后监护

本文介绍2例腹部器官簇移植患者术后的监护,认为加强SICU的监护能够有效地提高救治率和减低术后并发症,护士应具备敏锐的观察能力及熟练的抢救技术,严密监测生命体征及伤口引流情况,并做好移植器官功能的监测,是术后监护的重点.     

胰肾联合移植术后监测及护理

总结8例胰肾联合移植术后的ICU监测内容及护理，包括循环系统监测，移植器官监测，保护性隔离，心理护理，观察有无出血倾向等护理，认为SPKT术后严密监测循环系统、细致观察移植器官功能、感染预防以及适当的心理护理是术后恢复的关键。     

再次肝移植术后患者的ICU监护

目的 探讨再次肝移植术后的监护.方法 对23例再次肝移植患者进行复温、循环系统 及并发症等监护.结果 14例病情稳定后转出SICU,4例死于多器官功能衰竭,1例死于多器官感染及功能衰竭,4例分别在术后4、8、21 d放弃治疗而出院.结论 再次肝移植是移植肝功能衰竭的有效治疗方法,术后严密的监护和正确处理是提高再次肝移植患者存活率的关键.     

再次肝移植术后患者的ICU监护

目的探讨再次肝移植术后的监护。方法对23例再次肝移植患者进行复温、循环系统及并发症等监护。结果14例病情稳定后转出SICU,4例死于多器官功能衰竭,1例死于多器官感染及功能衰竭,4例分别在术后4、8、21 d放弃治疗而出院。结论再次肝移植是移植肝功能衰竭的有效治疗方法,术后严密的监护和正确处理是提高再次肝移植患者存活率的关键。     

中国一类捐献供体应用体外膜肺氧合技术的配合与监护

总结了本院8例中国一类捐献供体应用体外膜肺氧合(ECMO)技术的护理配合与监护要点,主要包括对ECMO运行前的护理配合及运行过程中心率及血压的监测、出血及凝血的监测、ECMO系统维护及各参数的监测及对供者器官功能的维护等。器官捐献者在脑死亡后等待心跳停止的过程中全部应用ECMO,ECMO的支持时间为376min,成功获取有效肝脏8例用于8例受者、有效肾脏16个用于14例受者,其中2例受者是双肾移植,移植受者术后肝肾功能恢复满意,均痊愈出院。认为在脑死亡器官捐献中应用ECMO,对捐献者的严密监测,ECMO系统的维护及捐献者器官功能的维护是护理工作的重点。     

马凡氏升主动脉瘤的术后监护

目的 :探讨马凡氏升主动脉瘤用带瓣人造血管完全替换升主动脉和主动脉瓣并同时移植左、右冠状动脉术患者术后监护的措施。方法 :对 4例手术患者术后进行 7个方面的护理即循环系统监护、严密监测出血现象、呼吸功能的监护 ,维持水、电解质平衡、判断吻合口是否通畅 ,感染的监测和心理护理 ,重点介绍术后循环系统及出血的监护。结果 :4例患者除 1例因术中大出血死亡外 ,3例痊愈出院。结论 :术后加强监护是提高手术成功率、保障患者安全的重要措施     

腹部器官联合移植术的术后护理

总结腹部器官联合移植术的术后护理.回顾性分析5例患者的病例资料,2例行胰肾联合移植术患者,1例术后生命体征稳定,病情恢复良好,1例术后第3天死于心脏猝死;3例行肝肾联合移植术患者,1例术后出现移植肾急性肾衰,经血透治疗3周后肾功能恢复正常,其余2例恢复良好.认为腹部器官联合移植术后严密监测生命体征、细致的移植器官功能观察、排斥反应监测以及感染预防是术后恢复的关键.     

小儿肝移植术后病情观察与护理

1963年,Starzl进行了世界上首例人体肝移植术。并随着手术技巧,抗排斥药物、免疫研究的发展,成人肝肾移植技术日趋成熟,已成为终末期器官治疗的手段。而小儿脏器移植,特别是2岁以下婴幼儿的脏器移植,在目前仍是一个较大的挑战。术后重症监护室（ICU）监护是其中的重要环节,对患儿实施严密的重症监护是手术成功的重要保证,我院于2002年实施了首例小儿亲体肝移植手术。现对我院自2002年以来进行的11例小儿肝移植术后重症监护要点报道如下。     

同种异体肝肾联合移植加脾切除术后监护及并发症防治体会

目的：总结同种异体肝肾联合移植加脾切除术后监护及并发症的防治。方法：患者移植术后即转入重症监护病房(ICU)，对全身重要脏器功能和症状体征进行监测，及时发现并发症并正确处理。结果：术后主要并发症有腹腔内出血、移植肾周出血、积液、急性心衰、严重心律失常、急性肺水肿、细菌和真菌感染、黄疸、精神症状、双侧胸腔积液，均经及时正确处理后治愈。结论：肝肾联合移植加脾切除术后易并发全身各重要脏器及系统的并发症。严密的ICU监护，合理的防治措施，及时正确处理并发症是移植成功的关键。     

大隐静脉移植重建颈内动脉患者的术后护理

总结了大隐静脉移植重建颈内动脉患者的术后护理经验。5例颈内动脉瘤患者实施了颈内动脉瘤切除术、大隐静脉切取术、大隐静脉移植血管重建术,术后加强监护,保持适当的体位,可预防或减轻脑水肿发生及防止移植血管扭曲;注意观察舌下神经和迷走神经功能,进行吞咽训练,预防误吸。认为护理工作者应该对于此类及其相关疾病有一定的认识,在护理工作中注重疾病健康教育、术后并发症监测以及康复护理。     

The Intensive Care Unit diary — A significant complement in the recovery after intensive care. A focus group study

ObjectivesThe aim of this study was to gain an increased understanding of the intensive care unit diary and how it affects patients’ recovery after intensive care.Methodology/designThe study had a qualitative design and was conducted by two focus group interviews in October 2021 and was analysed with thematic analysis.SettingVentilator treated intensive care patients with a length of stay ≥ 72 hours who had received a written diary were included. The study was conducted at two university hospitals in the south of Sweden.FindingsThe intensive care unit diary can be an important complement to the medical record and notes taken by family members by enhancing understanding of critical illness. The patients experience several prominent feelings from reading the diary such as guilt, fear, and anxiety as well as feelings of being cared for. The design and content of the diary can be important used as a tool in patients’ recovery after intensive care.ConclusionUnderstanding their critical illness and the time in intensive care seems important to former intensive care patients. In this respect, the intensive care unit diary on its own does not provide significant information and thus need to be complemented by information from the medical record and notes taken by family members. Therefore, the diary can be used as a complement that might increase patients' sense of coherence and facilitate recovery after intensive care.     

骨髓移植病人留置锁骨下静脉导管的护理

笔通过8例骨髓移植病人留置锁骨下静脉导管的护理，认为其护理措施包括：做好导管穿刺部位的护理，加强导管本身的护理，预防导管相关感染等并发症的发生，做好患心理护理，使其适应导管的存在，延长导管留置时间。留置锁骨下静脉导管保证了骨髓移植的顺利进行。     

Dynamic prevalence of sleep disturbance among critically ill patients in intensive care units and after hospitalisation: A systematic review and meta-analysis

BackgroundSleep disturbance is a common complaint among critically ill patients in intensive care units and after hospitalisation. However, the prevalence of sleep disturbance among critically ill patients varies widely.ObjectiveTo estimate the prevalence of sleep disturbance among critically ill patients in the intensive care unit and after hospitalisation.MethodsElectronic databases were searched from their inception until 15 August 2022. Only observational studies with cross-sectional, prospective, and retrospective designs investigating sleep disturbance prevalence among critically ill adults (aged ≥ 18 years) during intensive care unit stay and after hospitalisation were included.ResultsWe found 13 studies investigating sleep disturbance prevalence in intensive care units and 14 investigating sleep disturbance prevalence after hospitalisation, with 1,228 and 3,065 participants, respectively. The prevalence of sleep disturbance during an ICU stay was 66 %, and at two, three, six and ≥ 12 months after hospitalisation was 64 %, 49 %, 40 %, and 28 %, respectively. Studies using the Richards–Campbell Sleep Questionnaire detected a higher prevalence of sleep disturbance among patients in intensive care units than non-intensive care unit specific questionnaires; studies reported comparable sleep disturbance prevalence during intensive care stays for patients with and without mechanical ventilation.ConclusionSleep disturbance is prevalent in critically ill patients admitted to an intensive care unit and persists for up to one year after hospitalisation, with prevalence ranging from 28 % to 66 %. The study results highlight the importance of implementing effective interventions as early as possible to improve intensive care unit sleep quality.     

The physiological after-effects of critical care

After a stay in intensive care, patients may suffer physiological after effects, such as muscle wasting, polyneuropathies, disturbed sleep, itching and poor mobility. The care that patients receive whilst on intensive care may contribute to the severity of some of these physical problems. Raising awareness amongst critical care nurses may help reduce the severity of some of the physiological after effects. Increased awareness amongst nurses on the wards about the physical impact of intensive care may lead to a greater understanding of the needs of this group of patients and may improve discharge planning.     

Long-term follow-up of ICU patients.

Critical care medicine programs must provide outpatient experience for their fellowship trainees. We have developed an unusual follow-up plan allowing critical care fellows to contact their patients months after their intensive care unit stay. We evaluated responses of 46 patients after a mean interval of 8.6 months since their initial intensive care unit stay. Patients were stratified by severity of disease by using the APACHE scoring system. Diagnostically, the patients represented the typical medical-surgical intensive care unit population. Patients were asked 11 questions concerning their health and socio-emotional status as it related to their hospitalization and intensive care unit stay. Our results established a practical method of providing outpatient follow-up that may fulfill residency review requirements for critical care fellowships, confirmed previously speculative ideas about ICU experiences, and suggested future research opportunities to study intensive care unit patients following discharge.     

An evaluation of the preoperative information given to patients by intensive care nurses

In many hospitals it is common practice for nurses working in intensive care units to visit patients on the ward when a stay in the intensive care unit is anticipated following elective surgery. The purpose of the preoperative visit is to minimise fear and anxiety by preparing patients for their admission by providing information about the unit, the equipment used and responding to any questions. However, although there is extensive evidence to support the advantages of information — giving prior to stressful events the author could find no evaluation of the type of information given by intensive care staff.The purpose of the study was three fold. Firstly to discover the type of information patients would like to receive. Secondly to use this data in compiling a booklet which could be used to supplement the preoperative visit. Thirdly to evaluate the contents of the booklet.Postoperatively 20 patients evaluated the booklet by means of a self-administered questionnaire. These were completed 48h after their transfer from the unit. Overall patients were satisfied with the information contained in the booklet but felt they required additional advice about their proposed surgery and needed more time to absorb the information they had been given.     

Intensive care unit-acquired infections: is postdischarge surveillance useful?

OBJECTIVE: To assess the added value of surveying patients after discharge from the intensive care unit. DESIGN: Prospective cohort study. SETTING: Medical intensive care unit of a large teaching hospital. PATIENTS: All patients admitted to the intensive care unit for 48 hrs or more from October 1995 to November 1997. MEASUREMENTS AND MAIN RESULTS: We prospectively surveyed 1,068 patients during their intensive care unit stay and for 5 days after intensive care unit discharge. We detected 554 intensive care unit-acquired infections, yielding an infection rate of 70.7 per 1,000 patient days. Of these, only 31 infections (5.6%) in 27 patients were detected after intensive care unit discharge. If postdischarge surveillance was targeted on patients who had had a central vascular catheter while in the intensive care unit, only one infected patient would have been missed, but only 554 out of 889 would have been followed up (sensitivity, 96.2%; specificity, 38.7%; negative predictive value, 99.7%). CONCLUSIONS: Surveillance of all patients discharged from the medical intensive care unit is not recommended, as it is resource demanding and allows the detection of few additional infections. However, targeted postdischarge surveillance could be a rational alternative, and selection criteria need to be refined and validated.     

山西省9所三级甲等医院聘用护士重症监护能力及影响因素调查

[目的]了解临床聘用护士重症监护能力现状及影响因素。[方法]采用分层整群抽样方法,选取在山西省9所三级甲等医院临床工作的330名在编护士及388名聘用护士,用中文版护理行为六维度量表进行调查。[结果]在编护士与聘用护士重症监护能力评分比较差异有统计学意义(P<0.01),影响聘用护士重症监护能力的因素主要有护龄、月收入、婚姻状况、年龄和参与教学情况。[结论]山西省三级甲等医院聘用护士重症监护能力总体得分低于正式在编护士,各医院应通过多种途径提高聘用护士的整体能力,进而提高护理质量。     

重症监护专科护士培训的实践与效果分析

目的总结重症监护(ICU)专科护士培训班的经验,以提高ICU专科护士的培训效果。方法对来自全军的55名学员进行为期3个月的重症监护培训,自行设计调查问卷,内容包括重症监护理论知识、护理技术操作和常用仪器使用等三方面,分别在培训前后发放调查问卷,对培训效果进行总结分析。结果培训后学员在重症监护理论知识、护理技术操作和常用仪器使用熟练掌握方面均有了显著性提高(P<0.05)。结论ICU专科护士培训是提高护士整体监护技能的有效途径,科学高效的培训模式是确保ICU专科护士培训质量的有力保证。