脊柱手术患者发生压疮的手术室相关原因以及护理对策分析

【】　目的　探讨脊柱手术患者发生压疮的手术室相关原因并提出相应的护理对策。方法　回顾性分析276例脊柱手术患者的手术资料,探讨发生压疮的手术室相关原因,并针对性地提出护理对策。结果276例脊柱手术患者中,术中及术后3天内共发生Ⅰ期压疮5例,压疮发生率为1.81%;不同手术指标的脊柱手术患者间压疮发生率比较俯卧位、手术时间过长、皮肤有液体浸润、术中发生低氧血症、术中低血压时间占手术时间较长者术后压疮发生率(2.14%、6.82%、4.55%、4.55%、3.33%、9.09%), 明显高于仰卧位、皮肤无液体浸润、术中未发生低氧血症及术中低血压时间占手术时间较短者。结论 脊柱手术患者术后发生压疮是多种因素作用的结果,针对压疮发生的相关原因,术中加强预防性措施,有助于降低术后压疮发生率,保证手术患者的安全,提高护理质量。     

腹腔镜直肠癌手术压疮发生相关因素及护理对策

[目的]探讨腹腔镜直肠癌手术病人发生压疮的相关原因并给予积极护理干预,减少或杜绝压疮发生。[方法]回顾性分析2011年6月—2011年12月74例病人行腹腔镜直肠癌手术治疗后发生Ⅰ期、Ⅱ期20例压疮(压疮发生率为27%)的原因,对2012年1月—2014年2月150例腹腔镜直肠癌手术病人采取术前、术中、术后预防压疮的护理干预,包括减少手术体位变化次数,缩短手术时间,避免术中出现低血压、低氧血症、低体温,避免局部皮肤潮湿等。[结果]压疮发生率由27.03%降为2.67%。[结论]腹腔镜直肠癌手术病人术后发生压疮是多种因素作用的结果,有针对性地做好术前、术中、术后预防性护理,能减少压疮的发生。     

压疮风险评估会诊单在手术室压疮高危患者管理中的应用

目的：探讨手术室压疮高危患者压疮管理的方法,以降低高危患者在体位安置时压疮的发生率。方法：采用手术室压疮高危患者压疮风险评估会诊单对手术患者进行评估,并对护理干预进行有效管理。结果：236例压疮高危患者中,220例无压疮发生,16例术后发生难免性压疮。结论：手术室压疮高危患者压疮风险评估会诊单的应用,能有效降低因为体位安置不当导致的压疮发生率。     

手术患者发生压疮的手术室相关危险因素分析及护理策略

目的分析手术患者发生压疮的手术室相关危险因素,并探讨相关的护理策略。方法选择2017年1月～12月我院进行手术治疗的患者290例,对出现压疮的患者采用单因素分析发生压疮的可能原因,经Logistic多因素回归分析发生压疮的相关危险因素,并制定相应的护理措施。结果 86例患者发生不同程度的压疮,压疮发生率为29.66%,其中Ⅰ期41例,Ⅱ期27例,Ⅲ期18例,Ⅳ期压疮0例;单因素分析显示,年龄≥60岁、BMI≥25kg/m2、手术时间≥2.5h、合并症如糖尿病、气管内全麻、侧卧/俯卧、出血量≥80ml/h的患者压疮发生率较高(P<0.05);经Logistic多元回归分析显示,年龄、BMI、手术时间、术中出血量与压疮形成呈正相关(P<0.05)。结论年龄、BMI、手术时间、术中出血量、合并症如糖尿病、麻醉方式、术中体位均为手术患者发生压疮的危险因素,应及时采取积极的护理措施,降低压疮的发生率。     

试用修订版Braden评分方法预警干预术中压疮的效果评价

目的 探讨在手术室整体护理中试用修订版Braden评分方法预警干预各外科四类及以上手术患者术中压疮的效果。方法 建立术中压疮预警体系,术前访视应用修订版Braden评分方法对外科四类及以上手术患者实行压疮发生风险的评分,根据分值进行术中预警性分层护理干预,术后1～6d回访观察患者皮肤情况。结果 实施预警干预的1381例手术患者中,用修订版Braden评分提示压疮高风险组122例,低风险组1259例;术后回访其中有14例发生Ⅰ度压疮、2例发生浅Ⅱ度压疮,压疮发生率为1．15％;2007年用传统护理方法时术中压疮发生率为4．59％,两者比较压疮发生率有明显下降。结论 在手术室整体护理中应用修订版Braden评分方法预警干预术中护理措施,可有效降低各外科四类及以上手术患者术中压疮的发生。     

腹腔镜下直肠癌合并糖尿病患者术中压疮预防的护理干预

目的探讨护理干预对预防直肠癌合并糖尿病患者行腹腔镜手术术中压疮的效果。方法选取本院2012年1月~2014年1月共98例直肠癌合并糖尿病行腹腔镜手术的患者,分为对照组48例与干预组50例。两组均给予常规护理措施,干预组在上述护理基础上加用手术室综合干预性护理措施。观察比较两组压疮的发生率。结果对护理干预前后压疮发生率进行比较,干预后的压疮发生率明显低于干预前的压疮发生率,两组比较差异有统计学意义(P0.05)。结论正确的护理干预能够有效地防治患者手术过程中压疮问题的出现,提升手术室整体护理质量。     

手术患者术中压疮发生的相关危险因素及护理对策

目的探讨手术患者术中压疮发生的相关危险因素及其护理对策。方法回顾性分析2019年2月-2021年2月在我院行手术治疗的186例患者临床资料,分析手术患者术中发生压疮的相关危险因素。结果手术患者术中压疮发生率为13.98%(26/186);单因素分析结果显示,年龄、低蛋白血症、体重指数(BMI)、糖尿病病史、手术时间、术中出血量与手术患者术中发生压疮相关(P<0.05);多因素Logistic回归分析结果显示,年龄≥60岁、低蛋白血症、BMI≥24kg/m^(2)、糖尿病病史、手术时间≥4h、术中出血量≥60ml是手术患者术中发生压疮的危险因素(P<0.05)。结论手术患者术中压疮发生与年龄大、低蛋白血症、BMI高、糖尿病病史、手术时间长、术中出血量多密切相关,依此制定相应的干预措施,可有效预防术中压疮发生。     

胸腔镜辅助食管癌根治术患者发生手术压疮的相关因素及护理对策

目的:探讨胸腔镜辅助食管癌根治术患者手术压疮发生的相关因素和护理对策。方法:选取138例择期行胸腔镜辅助食管癌根治手术患者,分析胸腔镜辅助食管癌根治手术患者发生压疮的相关因素,并提出相关护理对策。结果:患者的体重指数(BMI)、是否低蛋白血症、手术时间、术中是否低血氧饱和度(Sp O2)、鼻咽温、受压部位是否潮湿、术中低血压对压疮发生率有显著性差异(P0.05)。结论:通过术前对患者进行全面的评估,术中对高危患者的重视及易发因素的预防,能有效预防胸腔镜辅助食管癌根治手术压疮的发生。     

手术室护士和病房护士皮肤合作评估及管理在手术高危压疮患者中的应用

目的探讨手术室护士和病房护士皮肤合作评估及管理在手术高危压疮患者中的应用效果。方法 2016年1月-6月选择本院收治的实施手术的高危压疮患者709例设为对照组,手术过程护士采用3S压疮风险评估表对手术患者皮肤进行评估及护理,手术后手术室护士与与病房护士对患者手术过程皮肤情况进行口头交接班。2016年7月-12月选择本院收治的实施手术的高危压疮患者680例设为观察组,观察组患者手术过程皮肤评估与压疮防护护理措施与对照组相同,但术后3S压疮风险评估表一式两份,手术室留存1份,病房护士留存1份,并由手术室护士按评估表内容向病房护士详细交代患者术中皮肤情况,术后共同管理患者术后皮肤。比较两组高危压疮患者术后当时及术后24h、48h、72h内压疮发生率。结果两组高危压疮患者术后当时压疮发生率比较,P0.05,差异无统计学意义;两组高危压疮患者术后24h、48h、72h内压疮发生率比较,均P0.05,差异有统计学意义,观察组压疮发生率均低于对照组。结论手术室护士和病房护士皮肤合作评估及管理在手术高危压疮患者中的应用,能有效预防患者压疮的发生及发展,值得临床推广应用。     

手术患者压疮发生的手术室相关原因和护理对策

目的：探讨手术患者出现压疮的手术室相关因素以及相应的护理措施.方法：选择2011年1月～2013年1月我院进行手术的患者2560例,其中有37例患者出现压疮,对这些患者发生压疮的手术室相关原因进行分析,同时研究其相关的护理措施.结果：本组压疮发生部位依次为骶尾部、髂部、足跟部、踝部、肩胛部、胸部,手术护理人员不良习惯是手术患者压疮发生的最重要原因.结论：手术患者出现与手术室相关的压疮主要与手术室护理人员没有在思想上产生足够的重视,评估不足,手术护理人员不良习惯,麻醉因素以及药物影响等相关,解决以上问题可以有效降低患者发生压疮的几率.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.