新生儿24h后脐部暴露的临床效果观察

[目的]探讨新生儿24h后脐部采用暴露护理对新生儿的影响。[方法]将2004年1月-2004年12月出生的新生儿456例作为观察组，新生儿出生24h后脐部采用暴露护理；上年同期出生的新生儿408例作为对照组，采用传统脐部护理疗法。观察两组新生儿脐部出血（渗血），感染发生率及脐带脱落时间。[结果]两组新生儿脐部出血，感染发生率，脐带脱落时间无统计学意义（P〉0．05）。[结论]新生儿出生后24h脐部暴露护理与传统的新生儿脐部护理虽在出血、感染及脱落时间上无统计学意义，但可节约医疗、人力资源，且方法简便易行，值得临床推广采用。     

新生儿24 h后脐部暴露的护理体会

新生儿脐部护理是新生儿护理的重点,新生儿脐部是病原微生物入侵的主要通道,极易发生局部感染[1].2004年以前我们医院采取的新生儿脐部护理是在新生儿出生后48 h第二次剪脐.2004年以后我们对新生儿在出生后24 h,脐部采取暴露护理,取得良好的效果,现报告如下.     

新生儿脐部护理

对100例新生儿脐部护理进行分析与总结,发现脐部轻微炎症与脐粗大,结扎位置太高,剪脐不干净有关,我们提出正确把握三关,即出生时正确的断脐、掌握剪脐的时间和技巧、加强脐带日常护理和健康教育,是避免脐部感染,预防新生儿感染的有效措施.     

新生儿脐部护理体会

新生儿脐部护理是围产期护理的重要内容 ,关系到新生儿的健康 ,也是产科护理质量的体现 ,是防止新生儿脐炎、破伤风、败血症、降低围产儿死亡的关键环节。有资料表明在12 0 0例新生儿败血症中 ,存在脐部感染者占 6 6 .0 %～87.5 % ,而脐部是厌氧菌感染的好发部位[1] 。为了预防新生儿脐部感染 ,我院改革了新生儿脐部护理方法 ,对 898例新生儿采取脐根部结扎法 ,缩短二次剪脐时间 ,防止了新生儿脐部感染 ,收到了显著的效果 ,1999年 1月～ 2 0 0 1年 12月 3年间出生的 898例新生儿无 1例发生脐部感染 ,总有效率为10 0 %。1　临床资料与方法1.1…     

新生儿脐带暴露法的效果观察

新生儿因为断脐时或出生后处理不当脐带残端被细菌入侵、繁殖而引起的急性炎症，称为脐炎。新生儿脐炎的预防在于脐部的良好护理，护理不当甚至可以引起新生儿败血症。为了探讨新生儿脐部的有效护理方法，2002年3～8月我院对310例足月新生儿开展本次临床研究，现将结果报告如下。     

改进新生儿脐部消毒法的临床观察

目的：观察改进新生儿脐部消毒方法的效果。方法：采用3％双氧水加0．5％碘伏消毒脐部与传统方法进行比较，结果：传统法脐部感染率为2．69％；改进法脐部感染率为1．23％。两组比较x^2＝5．395，P＜0．05，差异有统计学意义。结论：3％双氧水加0．5％碘伏消毒新生儿脐部优于传统方法。     

新生儿脐部的家庭护理

我院自1993年开展了产后访视工作,从6 000多例访视中发现,新生儿出生后一般在3～10d出院,而脐带在3～7d脱落为少数.有多为10～20d,20～30d是极少数.有4例从脐带结扎上方脱落.在这段时间里,做好新生儿脐部的家庭护理极为重要.     

新生儿脐部两种护理方法效果比较

2006年1月~2月,我院对136例新生儿采用两种脐部护理方法,并对其效果进行比较。现报告如下。1资料与方法1.1临床资料本组136例,选取2006年2月行新法脐部护理的76例为观察组,并取2006年1月行常规脐部护理的60例为对照组。两组一般资料比较无显著性差异(P>0.05)。1.2方法对照组行常规脐部护理。观察组采用以下新方法。①断脐方法:以往主张脐带结扎部位在距脐轮0.1~1cm处[1],而我院使用脐带夹,紧贴脐轮,紧扣脐带,以不夹住新生儿皮肤为宜,距脐轮约0.1~0.2cm处沿脐夹上沿剪断脐带。2%碘伏消毒断面,将6层无菌纱布覆盖于脐带断端,并用纱布包绕脐夹…     

新生儿脐部护理体会

新生儿离开母体，各项评分良好后，便开始断脐包扎脐带。这看起来是一个很简单的问题。但临床上脐部感染者也偶有发生。对于新生儿脐部的护理应各个环节严格无菌操作，密切观察。为新生儿减轻不必要的痛苦。     

新生儿脐部护理分析与对策

新生儿的脐带残端是和新生儿的血管相通的，如护理不好细菌可能侵入，轻者引起脐周发炎，重者会造成败血症而危及新生儿的生命。我们对230例新生儿脐部护理进行了分析，并在工作中采取相应对策，取得良好效果。现将脐部护理经验报告如下。     

婴儿抚触防治低出生体重儿呼吸暂停的临床观察

[目的 ]探讨婴儿抚触对低出生体重儿呼吸暂停的防治作用。 [方法 ]选择2 0 0 2年 7月— 2 0 0 3年 6月住院的 63例低出生体重儿作为观察组 ,在常规治疗的基础上早期选择性实施抚触按摩。将 2 0 0 1年 7月— 2 0 0 2年 6月住院的 61例低出生体重儿作为对照组 ,给予常规护理。 [结果 ]抚触组 63例低出生体重儿仅 2例发生呼吸暂停 (3 .1% ) ,低于对照组呼吸暂停的发生 (3 1.1% ,P <0 .0 0 5 )。 [结论 ]在条件许可的情况下 ,对低出生体重儿早期实施婴儿抚触 ,能有效防止呼吸暂停的发生。     

Chemokine activation within 24 hours after blunt accident trauma

Chemokines mediate the migration of leukocytes to sites of inflammation. Changes in the plasma concentration of interleukin (IL)-8 and macrophage inflammatory protein (MIP)-1beta have not been investigated in the very early phase starting immediately after unintentional trauma. Enrolled in the study were 94 patients with multiple blunt injuries. Blood samples were collected at the scene of accident, then at regular intervals for 24 h. IL-8 and MIP-1beta plasma levels were determined by commercial test kits. Patients were grouped according to trauma severity, pattern of injury, as well as survivors vs. nonsurvivors. Serious casualties [Injury Severity Score (ISS) > or = 32] revealed a significant increase in IL-8 compared to only a slight elevation in individuals with an ISS < 32. Nonsurvivors showed a highly significant (P < 0.005) increase in IL-8 levels beginning immediately after admission. Trauma resulted in a modest activation of MIP-1beta production without differences regarding trauma severity, pattern of injury, or survival. A very strong trauma stimulus is necessary to activate IL-8 production. In contrast to MIP-1beta, IL-8 levels were significantly elevated in nonsurvivors compared to survivors. Therefore, IL-8 might be an early predictor of survival.     

冠状动脉支架置入24h血清内脏脂肪素变化

背景：冠状动脉支架置入会造成血管损伤和管壁重构,从而引起血管支架内的再狭窄。研究发现内脏脂肪素与炎性反应相关,在急性心肌梗死斑块破裂处表达增高。目的：观察经皮冠状动脉支架置入后早期对冠状动脉粥样硬化性心脏病患者血清内脏脂肪素水平的影响。方法：选取发病12 h内并行急诊冠状动脉支架置入的急性心肌梗死患者30例,同期选取行冠状动脉支架置入的不稳定性心绞痛和稳定性心绞痛患者各30例;同时选择一组仅行冠状动脉造影无需支架置入治疗患者30例,另选未接受任何处理的健康患者30例作为正常对照组。结果与结论：酶联免疫吸附法检测结果显示,急性心肌梗死组、不稳定型心绞痛组、稳定型心绞痛组置入前及置入后30 min,置入后6,12,24 h各时点脂肪素的浓度持续升高,且均高于正常对照组（P 〈0.05）。结果证实,冠脉支架置入后24 h内患者血清脏脂肪素水平持续升高。     

新生儿脐静脉置管两种封管液应用效果比较

目的 探讨新生儿脐静脉置管两种封管液应用效果.方法 将72例留置脐静脉导管的新生儿配对分为两组,分别应用0.9％生理盐水(34例)、10 U/mL肝素盐水(38例)在患儿输液结束后进行封管.比较两组患儿导管留置时间、导管留置相关并发症发生率.结果 两组患儿导管留置天数、脐静脉导管并发症发生率比较,差异无统计学意义(均P＞ 0.05).结论 0.9％生理盐水作为脐静脉置管封管液,能有效维持管道通畅,且更加符合新生儿生理健康需求,值得临床推广应用.     

妊娠期糖尿病产妇分娩的新生儿出生后24小时内血糖变化规律与护理对策

目的探讨妊娠期糖尿病(gestation diabetes mellitus,GDM)产妇分娩的新生儿出生后24 h内母婴同室期间血糖变化规律及影响因素,并提出护理对策。方法回顾性收集2017年12月—2018年9月入住杭州市某三级甲等妇产科医院的884对GDM产妇的一般资料及分娩新生儿的一般资料和出生后3 h、6 h、12 h、24 h的血糖值,并对其影响因素进行相关性分析。结果新生儿出生后3 h、6 h发生低血糖各4例(0.45%),12 h、24 h无低血糖发生;3 h、6 h、12 h、24 h发生临界低血糖(不包含重复发生者)各30例(3.39%)、19例(2.17%)、7例(0.81%)和7例(0.81%)。产妇分娩方式(OR=3.834)、泌乳量(OR=7.006)及新生儿性别(OR=4.014)是新生儿出生后3 h发生临界低血糖的影响因素(P<0.05);产妇泌乳量是各时点发生临界低血糖的影响因素(P<0.05)。结论 GDM产妇分娩的新生儿出生后24 h低血糖、临界低血糖的发生率随时间的延长逐渐降低。多种因素影响新生儿各时间点血糖的变化,择期剖宫产、母乳不...     

新生儿脐静脉置管实时超声引导法的建立

【】 目的 建立一种新生儿脐静脉置管最优实时超声引导方法。方法 通过对需进行脐静脉置管的早产儿62例进行实时超声引导,在引导过程中对超声探头、术中超声快速寻找引导路径以及快速、准确确定导管顶端的位置这三个关键点进行筛选,确定最优引导方案,建立新生儿脐静脉置管实时超声引导法。结果 高频探头 小儿专用心脏探头组合较单用高频探头或小儿专用心脏探头在脐静脉置管过程中图像显示更为清晰更利于引导;以显示门静脉左支囊部的肝左叶纵切面为参照切面较以下腔静脉长轴切面为参照切面来寻找引导路径所需时间更短;术前测量组较术前不测量组的术中超声引导所需时间更短。结论 术前以显示门静脉左支囊部的肝左叶纵切面为参照切面来寻找引导路径,并在脐静脉置管术前用高频探头对引导路径进行超声测量预判导管插入深度,术中应用小儿专用心脏探头进行术中引导的引导方法更有助于我们超声医生快速准确地进行实时超声引导下脐静脉置管。#$NL【关键词】 实时超声引导;脐静脉置管;建立     

Changing heat and moisture exchangers after 96 hours rather than after 24 hours: a clinical and microbiological evaluation

OBJECTIVE: The aim of this study was to determine whether changing heat and moisture exchangers (HMEs) every 96 hrs rather than 24 hrs would affect their efficacy to preserve the heat and moisture of inspiratory gases. The impact of a prolonged use of the HME on its microbial colonization was also assessed. DESIGN: Prospective cohort observational study. SETTING: Intensive care unit of a university hospital. PATIENTS: Thirteen consecutive patients with no previous history of respiratory disease requiring controlled mechanical ventilation with an HME for >4 days were evaluated. INTERVENTIONS: The same HME was used for 96 hrs in each patient. MEASUREMENTS AND MAIN RESULTS: In each patient, during the inspiration phase, the following measurements were performed: peak and mean airway pressures, mean values of temperature, and relative and absolute humidity of inspired gases. In each patient, measurements were performed after 1 hr of HME use and then daily up to the fourth day. On days 1 and 4, microbiological samples were obtained from the patients' bronchial secretions and the ventilator side of the HME. After 96 hrs of ventilation with the same HME, tracheal tube occlusion was never observed. Using the same HME for 96 hrs rather than 24 hrs did not affect its technical performances: temperature at 24 hrs: 32.2 +/- 1.5 degrees C (90.0 +/- 34.7 degrees F), at 96 hrs: 32.1 +/- 1.6 degrees C (89.8 +/- 34.9 degrees F); relative humidity at 24 hrs: 97.9 +/- 2%, at 96 hrs: 98.1 +/- 1.7%; absolute humidity at 24 hrs: 33.1 +/- 2.4 mg H2O/L, at 96 hrs: 33.0 +/- 2.5 mg H2O/L. This analysis was based on a total of 312 measurements performed on the 13 patients. Peak and mean airway pressures did not change during the 96-hr study period, with identical tidal and minute volumes in the study patients. On day 1, ten patients had a positive culture of their tracheal secretions at a colony count of > or = 10(3) colony forming units/mL. After 96 hrs of use with the same HME, only seven patients had a positive culture of their tracheal secretions. Cultures from the ventilator sides of the HMEs were all sterile (13/13) after 96 hrs of use. CONCLUSIONS: In patients free from previous chronic respiratory disorder and ventilated for neurologic reasons, changing the HME after 96 hrs rather than 24 hrs did not affect its technical performance in terms of heat and water preservation of ventilatory gases. There is also some indirect evidence of very little, if any, changes in the HME resistance. No bacterial colonization of the ventilator sides of the HMEs was observed after 96 hrs of use. However, other large clinical trials should be undertaken to confirm the safety of extending the time between HME changes.     

Hemodynamic management of patients in the first 24 hours after cardiac surgery

OBJECTIVE: To describe the physiologic alterations, evaluation, and hemodynamic management of patients in the first 24 hrs after cardiac surgery. DESIGN: A brief review of preoperative and intraoperative events, postoperative physiology, and a discussion of the evaluation and hemodynamic management of cardiac surgery patients postoperatively based on a review of the literature, known physiology, and clinical experience. RESULTS: After cardiac surgery, patients undergo alterations in cardiac performance related to co-morbid conditions, preoperative myocardial insults and interventions, the surgical procedure, and intraoperative management. Predictable responses evolve rapidly in the first 24 hrs after surgery. Monitoring, diagnostic regimens, and therapeutic regimens exist to address the patterns of response and occasional complications. CONCLUSION: By understanding preoperative and intraoperative events and their evolution in the intensive care unit, clinicians can effectively manage patients who experience cardiac surgery.     

新生儿两种留置胃管方法的效果观察及护理

目的比较两种不同新生儿留置胃管方法的效果。方法把需留置胃管的新生儿随机分为两组,经口留置胃管组30例,经鼻留置胃管组25例,比较两组患儿的一次插管成功率、相关并发症。结果两组在一次插管成功率,插管过程相关并发症的发生率比较,差异均有统计学意义,P<0.01。结论新生儿经口留置胃管比经鼻留置胃管插管成功率高,并发症少。