医用射线防护喷剂预防头颈部皮肤急性放射性损伤

目的 探讨医用射线防护喷剂预防头颈部急性放疗皮肤反应的效果.方法 将69例头颈部肿瘤放疗患者随机分为观察组(35例)和对照组(34例),对照组用维生素B12、庆大霉素生理盐水溶液湿敷放射野,观察组用医用射线防护喷剂于放疗野内皮肤喷雾,0.1 ml/cm2,两组均3次/d,从放疗开始至结束后7～10 d.观察两组皮肤急性放射性损伤的发生时间及严重程度.结果 两组皮肤急性放射性损伤的发生时间比较,差异无统计学意义(P＞0.05);但观察组发生放射性皮肤反应的程度显著低于对照组(P＜0.01).结论 医用射线防护喷剂防治放疗引起的急性皮肤损伤效果好,使用方便、安全.     

医用射线防护喷剂对预防皮肤放射性损伤效果观察

目的:探讨"医用射线防护喷剂"对预防皮肤和黏膜急性放射性损伤的效果。方法:将符合入选标准的62例放疗患者随机分为观察组(n=30)和对照组(n=32),观察组于放疗期间照射野皮肤用"医用射线防护喷剂";对照组:不行任何治疗。结果:观察组皮肤黏膜损伤程度显著轻于对照组(P<0.05);观察组中皮肤黏膜辐射损伤耐受剂量明显高于对照组(P<0.05)。结论":医用射线防护喷剂"对急性皮肤黏膜放射性损伤有明显的防护作用。     

放射损伤防护剂2号预防放射性皮肤损伤的临床研究

为了预防放射性皮肤损伤，１９９６年６月至１９９７年３月，将放射损伤防护剂２号（ＲＰ－２）应用于接受＾６０Ｃｏγ射线照射的肿瘤病人，分观察组和对照组观察。     

冰袋联合皮肤防护剂局部应用预防放射性皮肤损伤

目的 探讨冰袋联合皮肤防护剂局部应用对放射性皮肤损伤的预防作用.方法 选择31例双侧面颈部均需接受放射治疗的头颈部肿瘤患者为研究对象,采用自身对照方法将左侧面分为对照组,右侧面为观察组.对照组采用常规护理,观察组在常规护理的基础上局部应用冰袋和皮肤防护剂,比较两组皮肤的变化.结果 两组放射性皮肤损伤程度及色素沉着、干性皮炎发生率比较,差异有显著性意义(P＜0.01,P＜0.05).结论 冰袋联合皮肤防护剂局部应用对预防放射性皮肤损伤有较好的疗效.     

皮肤防护膜预防放疗后皮肤损伤的护理观察

目的:观察皮肤防护膜对放疗后皮肤损伤的防护作用.方法:将46例接受放射治疗乳腺恶性肿瘤病人随机分为两组,23例使用皮肤防护膜者为观察组;23例按常规皮肤护理及健康教育者为对照组.观察两组病人放疗后皮肤损伤的情况,比较两组皮肤反应发生率.结果:观察组皮肤损伤程度明显低于对照组,皮肤防护膜能推迟皮肤反应发生的时间.结论:皮肤防护膜能提高皮肤辐射的耐受性,减轻皮肤损伤,降低严重皮肤损伤的发生率.     

预防老年患者医用粘胶相关性皮肤损伤的皮肤管理策略

目的探讨皮肤管理策略用于预防PICC老年患者医用粘胶相关性皮肤损伤(MARSI)的效果。方法选取2018年3～7月于PICC门诊进行换药的PICC老年患者350例为对照组,按照常规维护。另选取2018年8～12月于PICC门诊进行换药的老年患者400例为观察组,在常规维护基础上,运用皮肤管理策略预防MARSI发生。比较两组MARSI发生率。结果观察组MARSI发生率为4.50%,显著低于对照组9.71%(P0.01)。结论根据PICC老年患者MARSI发生原因,制定皮肤管理策略应用于PICC换药,能降低PICC老年患者MARSI发生率。     

医用粘胶相关性皮肤损伤现况调查

目的了解医用粘胶相关性皮肤损伤发生及处理现状,为预防和治疗医用粘胶相关性皮肤损伤提供参考。方法采用自行设计的调查表对河南省12所三级医院65个应用粘胶产品科室进行调查,并统计其住院患者医用粘胶相关性皮肤损伤发生情况(共观察1 166例,每例观察7d或至出院及转诊)。结果医用粘胶相关性皮肤损伤发生率为3.9%~4.9%,发生原因主要为张力性粘贴(41.3%)、出汗(41.2%)、未塑形(8.2%)、快速大角度撕除(8.0%)、消毒剂未干粘贴(1.3%)。结论医用粘胶相关性皮肤损伤较普遍,护理人员在粘胶选择及应用方法上存在不足,处理措施也不甚规范,应制定和完善医用粘胶相关性皮肤损伤的预防及处理措施。     

开展品管圈活动减轻头颈部肿瘤患者放射性皮肤损伤

目的 探讨开展品管圈对减轻头颈部肿瘤患者放疗所致皮肤损伤的作用.方法 科室成立品管圈小组,以减轻头颈部肿瘤患者放疗所致的皮肤损伤为活动主题,通过现状调查,要因分析,拟定对策及实施等步骤开展品管圈活动.结果 品管圈实施后患者护理知识知晓率由实施前的88.7％提高到96.2％,护理服务满意度由89.6％提高到99.1％;患者皮肤损伤分级情况实施后显著优于实施前(P＜0.05,P＜0.01).Ⅱ级及以上皮肤损伤发生率35.8％,低于目标值.结论 品管圈活动降低了头颈部肿瘤患者放疗所致皮肤损伤的程度,提高了其放疗护理知识知晓率和护理服务满意度.提出开展品管圈活动是护理质量持续改进的一种有效手段.     

婴幼儿头皮医用粘胶相关性皮肤损伤 防护方案的构建与应用

目的 降低视频脑电图监测婴幼儿头皮医用粘胶相关性皮肤损伤。方法 采用历史对照设计,将2018年1月至2019年12月入住癫痫监测单元行头皮视频脑电图监测的患儿856例纳入对照组,实施常规皮肤护理;将2021年1月至2022年12月入住癫痫监测单元行头皮视频脑电图监测的患儿851例纳入观察组,构建和实施医用粘胶相关性皮肤损伤防护方案。比较两组头皮医用粘胶相关性皮肤损伤发生率。结果 观察组头皮医用粘胶相关性皮肤损伤发生率显著低于对照组(P<0.05)。结论 婴幼儿头皮医用粘胶相关性皮肤损伤防护方案的应用,可有效降低婴幼儿头皮医用粘胶相关性皮肤损伤发生率。     

易孚治疗头颈部急性放射性皮肤溃疡疗效观察

放疗是治疗肿瘤的重要手段,也是鼻咽癌病人的首选治疗,放射线在杀灭肿瘤细胞的同时可损伤正常组织细胞,导致放射性皮炎.重者皮肤溃烂渗出,严重影响病人生活质量,甚至需要中止放疗,我们应用易孚凝胶(重组人表皮生长因子)治疗鼻咽癌放疗导致的头颈部急性放射性溃疡(湿性放射性皮肤损伤)28例,收到良好效果,报道如下.     

Effects of Concomitant Spinal Cord Injury and Brain Injury on Medical and Functional Outcomes and Community Participation

Background:

There are limited data on the interactions between concomitant spinal cord injury (SCI) and traumatic brain injury (TBI) in terms of medical, psychological, functional, and community outcomes.

Objective:

To investigate the hypothesis that in addition to SCI-associated sensory-motor impairments, people with dual diagnosis would experience additional TBI-associated cognitive impairments that would have a negative impact on community reintegration.

Methods:

Cross-sectional, case-matched study comparing a consecutive sample of participants with dual diagnosis (n = 30) to an SCI group (n = 30) and TBI group (n = 30). Participants who were on average 3.6 years postrehabilitation discharge were interviewed using a battery of standardized outcome measures.

Results:

Length of rehabilitation stay was significantly longer in SCI and dual diagnosis participants. Fatigue, pain, sexual dysfunction, depression, and sleep disturbances were frequently reported by all groups. Similar levels of anxiety and depression were reported by participants in all groups, however TBI participants reported higher stress levels. All groups achieved mean FIM scores > 100. The dual diagnosis and SCI groups received more daily care and support than TBI participants. Similar levels of community reintegration were achieved by all groups with a high level of productive engagement in work, study, or volunteer activities.

Conclusions:

The findings of this study do not support the hypotheses. Postrehabilitation functioning was better than anticipated in adults with dual diagnosis. The contribution of rehabilitation factors, such as longer admission time to develop compensatory techniques and strategies for adaptation in the community, may have contributed to these positive findings.Key words: community participation, functional outcomes, rehabilitation, spinal cord injuries, traumatic brain injuriesThe reported incidence of concomitant spinal cord injury (SCI) and traumatic brain injury (TBI) (hereafter termed dual diagnosis) varies between studies. Literature from the last 40 years reports incidence rates from 16% to 59%.^1,2 The marked variability in these rates results from differences in sample populations and varying diagnostic methods.¹ In other studies, dual diagnosis may remain undiagnosed.^1,3Although the frequency of concomitant SCI and TBI is high, few studies have compared the rehabilitation outcomes of individuals with dual diagnosis to those with single diagnosis SCI. There is no identifiable research comparing dual diagnosis to TBI. Studies comparing dual diagnosis and single diagnosis SCI during acute and inpatient rehabilitation have generally indicated lower motor and cognitive FIM⁴ scores for people with dual diagnosis^5,6 and greater clinical resource utilization by patients in the dual diagnosis group.⁶ Recent findings have challenged these outcomes by identifying a potential interaction of co-occurring TBI severity and level of SCI. In a prospective study of 189 adults with SCI, tetraplegia with co-occurring TBI was not related to FIM motor outcomes despite cognitive impairments. Further, in adults with paraplegia, only presence of severe TBI impacted FIM motor outcomes, whereas presence of mild or moderate TBI did not appear to impact motor outcomes.⁷When considering postrehabilitation outcomes, it has been speculated that the addition of TBI in people with SCI will exacerbate adjustment and behavior difficulties, possibly leading to social isolation.⁸ One examination of community outcomes reported that people with dual diagnosis experienced greater personal and family adjustment difficulties than matched individuals with SCI.⁹ Factors associated with community integration and participation in single diagnosis SCI or TBI include environmental barriers,^10–12 social context,^11,13–15 severity of brain injury,^14,16 challenging behavior,¹⁶ and level of disability.^16,17 It is hypothesized that these factors along with the previously reported motor and cognitive deficits in adults with dual diagnosis would lead to poorer community reintegration. This may have significant implications when planning services for people with dual diagnosis, considering their additional health care needs or increased care and support requirements. The current research aimed to evaluate this hypothesis by comparing the medical, psychological, functional, and community outcomes of adults with dual diagnosis during the first several years post discharge from rehabilitation.     

黄五醇溶液治疗皮肤损伤效果观察

目的探讨中药黄五醇治疗皮肤损伤的效果。方法对43例患者用自制的黄五醇溶液直接涂搽皮肤损伤处或用浸湿黄五醇液的无菌敷料湿敷皮肤损伤处,1~2次/d,隔日更换敷料1次。结果用药(7.0±0.5)d,治愈41例,显效2例,治愈率为95.3%,总有效率为100.0%。结论黄五醇溶液治疗皮肤损伤疗效确切。     

The Effects of Medical Ozone Therapy on Renal Ischemia/Reperfusion Injury

Introduction: This study was designed to investigate the possible beneficial effects of medical ozone therapy (OT), known as an immunomodulator and antioxidant, on the renal function, morphology, and biochemical parameters of oxidative stress in kidneys subjected to ischemia/reperfusion injury (IRI). Materials and methods: Thirty male Sprague–Dawley rats were classified into three groups: control, renal IRI, and renal IRI + OT. The IRI group was induced by bilateral renal ischemia for 60 min, followed by reperfusion for 6 h. After reperfusion, the kidneys and blood of rats were obtained for histopathologic and biochemical evaluation. Results: Renal IRI increased the tissue oxidative stress parameters (lipid peroxidation, protein oxidation, and nitrite plus nitrate) and decreased the antioxidant enzyme activities (superoxide dismutase and glutathione peroxidase). The serum neopterin levels showed correlation with oxidative stress parameters. All these parameters were brought to control values in the treatment group. Histopathologically, the kidney injury in the treatment group was significantly lesser than in the renal IRI group. Conclusions: Our results clearly showed that OT has beneficial effect to protect kidney against IRI. The serum neopterin levels might be used as a marker to detect the degree of renal IRI.     

Medical Malpractice in Nerve Injury of the Upper Extremity

Background: Medical malpractice accounts for more than $55 billion of annual health care costs. Updated malpractice risk to surgeons and physicians related to upper extremity peripheral nerve injury has not been published. Methods: A comprehensive database analysis of upper extremity nerve injury claims between 1995 and 2014 in the United States was conducted using the Medical Professional Liability Association Data Sharing Project, representing 24 major insurance companies. Results: Nerve injury in the upper extremity accounted for 614 (0.3%) malpractice claims (total of 188 323). Common presenting diagnoses included carpal tunnel syndrome (41%), upper extremity fractures (19%), and traumatic nerve injuries to the shoulder or upper limb (8%). Improper performance (49% of total claims) and claims without evidence of medical error (19%) were the most common malpractice suits. Orthopedic surgeons were the most frequently targeted specialists (42%). In all, 65% of nerve injury claims originated from operative procedures in a hospital, 59% of claims were dismissed or withdrawn prior to trial, and 30% resulted in settlements. Thirty-three percent of claims resulted in an indemnity payment to an injured party, with an average payout of $203 592 per successful suit. Only 8% of claims resulted in a completed trial and verdict, and verdicts were overwhelmingly in favor of the defendant (83%). Conclusions: Most malpractice claims from peripheral nerve injuries in the United States arise from the management of common diagnoses, occur in the operating room, and allege improper performance. Strategies to reduce malpractice risk should emphasize the management of common conditions and patient-physician communication.     

头部按摩对初产妇心理及分娩方式的影响

目的探讨自制大便失禁引流装置的护理成本及应用效果。方法将40例大便失禁患者随机分为对照组和观察组各20例。对照组按常规随时清理溢出大便、清洗肛周皮肤、涂鞣酸软膏等方法护理患者。观察组使用自行研制的大便失禁引流装置引流大便,每日常规清洗肛周2次。比较两组护理成本和肛周皮肤炎性反应情况。结果对照组每日护理材料消耗为（80.87±10.72）元、每日护理工时为（10.60±2.32）h,观察组分别为（50.99±4.56）元、（2.75±1.57）h,两组比较,差异有显著性意义（均P〈0.01）。观察组肛周皮肤炎性反应发生率显著低于对照组（均P〈0.01）。结论应用自制大便失禁引流装置引流大便,可降低护理成本,减少患者肛周皮肤炎性反应的发生。     

自制大便失禁引流装置的护理成本及应用效果

目的 探讨自制大便失禁引流装置的护理成本及应用效果.方法 将40例大便失禁患者随机分为对照组和观察组各20例.对照组按常规随时清理溢出大便、清洗肛周皮肤、涂鞣酸软膏等方法护理患者.观察组使用自行研制的大便失禁引流装置引流大便,每日常规清洗肛周2次.比较两组护理成本和肛周皮肤炎性反应情况.结果 对照组每日护理材料消耗为(80.87±10.72)元、每日护理工时为(10.60±2.32)h,观察组分别为(50.99±4.56)元、(2.75±1.57)h,两组比较,差异有显著性意义(均P＜0.01).观察组肛周皮肤炎性反应发生率显著低于对照组(均P＜0.01).结论 应用自制大便失禁引流装置引流大便,可降低护理成本,减少患者肛周皮肤炎性反应的发生.     

中药雾化吸入治疗肺癌继发肺炎疗效观察

为观察中药雾化吸入对肺癌继发肺炎的治疗效果,将104例肺癌继发肺炎病人随机分为观察组与对照组。观察组52例采用中药雾化吸入治疗;对照组52例采用抗生素加激素雾化。结果观察组与对照组的显效率分别为42.3％和9.6％,总有效率分别为84.6％和75.0％,两组比较,差异有显著性意义(X2=16.46、19.15,均P<0.01)。提示中药雾化吸入治疗肺癌继发肺炎的效果明显优于传统的药物雾化法。