成人膜部室间隔缺损Amplatzer封堵器介入治疗并发症护理

报道58例成人膜部室间隔缺损患者应用Amplatzer封堵器介入治疗,成功55例,成功率95％。本组患者并发心律失常13例（其中三度房室传导阻滞5例）,迷走神经反射2例,伤口出血1例,发热6例。护理要点包括监护心律、心率的变化,发现异常及时处理;防治迷走神经反射;做好伤口出血的防护及发热患者的病情观察及护理。本组5例传导障碍性心律失常患者,通过心电监护、血压监测,及时发现处理问题,4例病情很快恢复,1例经安装临时起搏器后情况良好。其他并发症经及时处置都顺利康复。     

对包皮手术患者实施健康教育效果观察

目的 探讨健康教育对门诊包皮手术患者伤口愈合效果的影响。方法将360例包皮手术患者分为常规组和观察组各180例。观察组对患者术前术后实施健康教育，让病人及家属懂得伤口护理的目的及方法；常规组采用外科伤口的常规护理以及讲解手术后注意事项。结果常规组患者伤口水肿较为严重，水肿持续时间也较长，一些人甚至出现伤口撕裂，伤口愈合延迟。观察组患者伤口水肿程度减轻，水肿持续时间缩短，伤口愈合快。结论认为做好术前术后健康教育，并进行准确恰当的康复指导，对手术的成功促进伤口愈合至关重要。     

小儿脊髓栓系综合征的围手术期护理

目的探讨小儿脊髓栓系综合征（TCS）手术治疗的围手术期护理要点。方法对35例TCS患儿进行手术治疗。术前做好家长心理护理,消除恐惧忧虑;加强患儿俯卧位练习,严格清洁皮肤;术后生命体征监测,保持适当体位,密切观察伤口情况,注意皮肤护理和康复训练。结果35例患儿术后无压疮发生。经过精心护理,均安全度过围手术期。随访临床症状消失24例,好转3例,无改善7例,临床症状加重1例。结论做好小儿脊髓栓系综合征的围手术期护理,为医生提供术后早期并发症的诊治依据,对患儿治疗康复起到了重要作用。     

骶骨肿瘤切除与骶骨重建围手术期并发症的预防与护理

目的探讨骶骨肿瘤切除与骶骨重建围术期并发症的预防与护理对策。方法术前充分了解该手术常见并发症,做好预防与护理,包括心理护理,改善患者一般状况,术中大出血的预防,括约肌功能训练及肠道和皮肤准备等。术后严密监测生命体征,观察脊髓神经功能,加强体位护理、伤口、引流管护理,早期进行康复指导及肢体功能锻炼。结果本组13例患者均安全度过围手术期,未发生护理并发症。结论重视并发症的预防与护理,给予正确的治疗方法及完善的护理措施,是确保手术成功及患者康复的重要保证。     

大面积烧伤合并创面脓毒症40例临床分析

目的:总结烧伤合并创面脓毒症的临床特点和防治措施。方法:回顾性分析我科2007年1月至2012年12月收治的烧伤合并创面脓毒症40例的临床资料。结果:治愈32例,死亡8例。结论:烧伤早期休克渡过不平稳及创面早期处理不当易致创面脓毒症,预防强调积极有效的液体复苏、早期肠道营养、加强代谢与免疫调理、尽早封闭创面及加强多器官功能保护与支持,治疗强调以创面处理为核心的综合治疗策略,尽早手术覆盖封闭深度创面是救治成功的关键。     

Tetanus.

Tetanus is a preventable disease with proper immunization. The marked decline in the incidence over the past several decades has resulted from widespread use of tetanus prophylaxis and improved wound management in the emergency department. Emergency physicians are among the most frequent providers of tetanus vaccination. We can stress the importance of proper immunization and encourage patients to keep accurate immunization records. This can maximize protection of patients from tetanus, and minimize adverse reactions from excessive administration of booster. Tetanus can be fatal even with proper treatment. Vital treatment measures can easily be completed in the emergency department.     

28例糖尿病足患者的护理

目的:总结对糖尿病足患者的护理经验,早期预防、早期综合治疗及护理,降低致残率。方法:根据糖尿病足不同分级,采用全身及局部溃疡处综合治疗及护理措施,即良好血糖控制、局部创面护理、合理饮食、适量运动、心理护理、健康教育等。结果:28例2~5级糖尿病足患者取得良好的临床治疗效果,有26例患者经治疗创面愈合,1例患者由于创面较大,转入外科行植皮术,有1例患者感染严重,全足坏疽,行截肢手术,治愈率92.9%。结论:糖尿病足早期发现、早期进行综合治疗及护理多能治愈。     

Effect of Cord Blood Platelet Gel on wound healing capacity of human Mesenchymal Stromal Cells

BackgroundWound healing is a dynamic process, involving the recruitment of growth factors, cytokines, chemokines and cellular populations. Recently, the Cord Blood Platelet Gel (CBPG) has been applied successfully in wound closure and tissue regeneration. Moreover, its proper combination with stem cell populations such as Mesenchymal Stromal Cells (MSCs) may positively improve the wound healing process. Based on the above data, this study aimed to the evaluation of wound healing capacity of MSCs combined with CBPG under in vitro conditions.MethodsInitially, CBPG was developed from Cord Blood Units (CBUs). The determination of wound healing ability of MSCs was performed using the scratch wound assay. In addition, the morphological features, immunophenotypical characteristics and differentiation capacity of MSCs were evaluated.ResultsScratch wound assay results showed, that CBPG could positively stimulate the MSCs migration. Moreover, MSCs cultured in presence of CBPG were characterized by elongated shape and improved stemness properties as it was indicated by flow cytometric analysis and differentiation process.ConclusionThese results clearly showed the beneficial effect of CBPG in combination with MSCs in wound healing. The proper combination of CBPG with stem cells strategy may enhance the healing process in patients with skin erosions.     

Wound care for elderly patients: advances and clinical applications for practicing physicians

Chronic ulcers (wounds) are commonly encountered in medical practice, particularly in elderly patients who have chronic medical conditions. Health care providers must be adept at diagnosing chronic ulcers and optimizing medical treatment. We describe the best medical practice for the 4 common types of chronic ulcers: pressure ulcers, ischemic ulcers, venous ulcers, and neuropathic ulcers. We emphasize the importance of nutrition and proper wound care as a foundation for the management of all chronic ulcers. There is a unique therapeutic goal for each chronic ulcer. Pressure relief should be provided for both pressure ulcers and neuropathic ulcers. Ischemic ulcers require revascularization. Patients with venous ulcers need adequate edema control. We outline advances in each of these areas and discuss the newest developments in wound care, including growth factors, hyperbaric oxygen, and vacuum-assisted devices. Chronic ulcers in elderly patients can heal with proper diagnosis and good medical care.     

颈椎前路手术后切口血肿的风险评估及对策

目的：观察行颈椎前路手术后切口血肿压迫的临床表现,评估其风险因素,以尽早采取预防措施。方法：对2012年1月—2013年6月行颈椎前路手术的226例患者,行前路颈椎体次全切除植骨融合术（ACCF）85例,行前路颈椎间盘切除植骨融合术（ACDF）119例,ACCF＋ACDF＋人工颈椎间盘置换术（ADR）22例,术后对颈部切口血肿的风险因素进行分析并采取相应对策。结果：在后两种手术方式中有10例患者在术毕关闭伤口时评估术中损伤大,创面渗血较多,在术后安置冲洗管,术后引流液性质清亮后改接负压引流管。226例中4例出现术后切口血肿,在床旁立即把伤口全层打开,畅通气道后,急诊行血肿清除术。所有患者均康复出院,无一例死亡。结论：颈部血肿是颈前路术后最严重的早期并发症之一,对患者采取的手术方式、患者的既往史、术后生命体征观察、呼吸道和切口的护理等因素的正确评估、严密观察并全过程采取积极有效对策,是减少血肿发生率的关键。     

冠状动脉旁路术中不同旁路材料的应用体会

目的 :总结冠状动脉旁路移植术中目前几种常用旁路材料的临床应用。方法 :2 0 0 0年 1月～ 2 0 0 2年 3月连续 5 6例行冠状动脉旁路移植术 ,旁路材料包括左乳内动脉 (5 6根 )、游离右乳内动脉 (2 1根 )、桡动脉 (3 2根 )和大隐静脉(4 3根 )。回顾分析不同旁路材料的手术结果。结果 :桡动脉移植后旁路血管“线样征”1例 ;无胸骨、前臂并发症 ;下肢切口感染 2例 ,均为糖尿病、大体重患者 ,治疗后痊愈 ;死亡 3例 ,与旁路材料无关 (非体外循环手术因循环状态不稳死亡 1例 ,鱼精蛋白过敏 1例 ,顽固性心律失常 1例 )。结论 :注意旁路材料的取制技巧 ,针对不同病变冠脉血管选取应用不同旁路血管 ,以及术后及时监护处理是保证良好手术结果的关键     

人工心脏起搏器安装术后病人足底推拿的效果评价

目的探讨足底推拿对人工心脏起搏器安装术后病人便秘、体位性低血压、伤口愈合时间、睡眠时间、伤口疼痛的作用效果。方法将60例人工心脏起搏器安装术后病人,采用分层随机抽样法分为对照组30例和实验组30例,对照组予常规护理(止血、心电监护、皮肤护理、心理疗法等),实验组在对照组的基础上应用足底推拿护理技术。结果两组病人采用不同的护理方法对病人术后伤口疼痛、睡眠时间、便秘、体位性低血压、伤口愈合时间有显著性差异(P<0.01)。结论足底推拿能有效疏通全身经络,加速血液循环,改善全身症状,减少术后病人伤口疼痛和改善失眠,防止便秘,减少下床活动时体位性低血压等并发症,有利于提高病人的生活质量,加快了术后康复。     

102例心房颤动抗凝治疗的护理体会

目的：探讨护理工作在心房颤动抗凝治疗中的重要性，最大限度减少血栓栓塞等并发症的发生，降低死亡率，提高生活质量。方法：对通过十二导联心电图及24h动态心电图确诊的102例心房颤动患者按医嘱给予抗凝治疗，并做好用药前的知识宣教，用药中严密监测，用药效果及不良反应观察记录，出院后随访1年。结果：经过正规的治疗和护理，102例患者除2例因心衰死亡，1例迁居外地，其余无1例血栓栓塞及大出血情况发生，护理效果满意。结论：心房颤动患者需长期抗凝治疗，用药过程中的严密监测和坚持遵嘱服药及自我监测和护理是避免出现并发症及不良反应的必要保证。     

A systematic approach to laceration repair. Tricks to ensure the desired cosmetic result

An organized, systematic approach to wound repair based on the mnemonic LACERATE can jog the memory and ensure a successful outcome. This stepwise approach consists of looking at the wound to assess repair options, anesthetizing and cleaning the wound, setting up equipment, selecting the proper repair technique, assessing results, determining the patient's tetanus immunization status, and educating the patient about wound care.     

Wound healing in the patient with diabetes mellitus

Reports of an increased incidence of wound complications in surgical patients with diabetes mellitus may actually reflect the increased incidence of general surgical risks or metabolic abnormalities associated with diabetes mellitus. Factors such as age, obesity, malnutrition, and macrovascular and microvascular disease may contribute to wound infection and delayed wound healing especially in the type II diabetic patient. In addition, hyperglycemia caused by decreased insulin availability and increased resistance to insulin can affect the cellular response to tissue injury. Studies of the immune cells necessary for wound healing, such as PMN leukocytes and fibroblasts, as well as studies of injured tissue suggest that there is a delayed response to injury and impaired functioning of immune cells in diabetes mellitus. There is evidence that these impairments may be the result of both an inherent (genetic) defect as well as decreased insulin availability and increased blood glucose concentration. At the time of hospital admission, little can be done to affect most of the risk factors or inherent cellular defects. However, blood glucose levels can be controlled with the use of bedside blood glucose monitoring and frequent adjustment of insulin dosing. Nurses have traditionally played an important role in monitoring recovery from surgery and watching for signs of infection and wound complications. These nursing functions are especially important in the diabetic patient. In addition, frequent evaluation of the effectiveness of insulin therapy is an important nursing function throughout the perioperative period. Through improving management of blood glucose levels in surgical patients, nurses can have a major impact on the incidence of wound complications in diabetes mellitus.     

糖尿病足的护理及预防

阐述糖尿病足的临床表现及病理改变,总结糖尿病足的护理及预防措施,强调应控制血糖及其他并发症,加强足部检查、足部日常护理、适当锻炼、创面处理、心理护理、健康教育以及识别并预防糖尿病足危险因素。     

异种(猪)脱细胞真皮基质治疗小儿Ⅱ度烧伤的护理

目的:探讨异种(猪)脱细胞真皮基质一次性覆盖创面治疗患儿Ⅱ度烧伤的护理。方法:159例Ⅱ度烧伤患儿采用真皮基质覆盖创面后,加强生命体征的监测、准确补液抗休克、密切观察创面情况及加强营养供给。结果:159例患儿全部安全渡过休克期,真皮基质包扎治疗Ⅱ度烧伤患儿,疗效好,愈合时间缩短,疤痕增生轻。结论:正确的创面处理方法,及时有效的护理措施及准确无误的病情监测等是增进患儿烧伤治疗效果的关键,真皮基质是一种良好的生物敷料,值得推广。     

Fungi and bacteria as a pathogenic factor in wound healing in patients after orthopaedic surgeries

Background: Complications of postoperative wound healing delay or limit implementation of rehabilitation therapy. In an attempt to determine the source of the delayed healing we usually focus on searching for bacteria, forgetting, however, to perform mycological tests. Local or systemic reactions to physiotherapeutic procedures may result not only from such disorders as a decreased level of plasma proteins and enzymes, vitamin deficiency, dehydration, reduction of oxygen pressure and diffusion in the wound, high doses of steroids, but also from a secondary bacterial and fungal infection, leading in consequence to deterioration of wound healing. The presence of these microorganisms in the skin adjacent to the wound or in other ontocenoses seems to be of considerable importance, as it may cause impairment of the proper course of rehabilitation. Thus, the aim of the present study was to search for bacteria and fungi in patients with delayed wound healing, subject to rehabilitation following orthopaedic surgeries of the locomotor system. Material and Methods: Mycological investigations were carried out in 24 patients with delayed wound healing after orthopaedic surgery (alloplasty of hip and knee joints, open fracture repositions, lengthening of lower extremities). The material for assessment was taken from the wound, surrounding skin and oral cavity. The results of routinely performed laboratory examinations were used in the bacteriological analysis. The differentiation of strains and fungi was performed on the basis of morphological and biochemical characteristics. Multifocal infections of fungi were looked for in the group of patients studied. Results: Bacteria were detected in 10 (41.6%) patients. In 7 (29.1%) patients, they occurred in the wound ontocenosis together with fungi. Fungi were found in 19 (79.2%) patients in at least one ontocenosis. Out of the whole sample studied, fungi were isolated from the wound in 9 (37.5%) patients, from the wound-surrounding skin in 10 (41.6%) patients, and from the oral cavity in 17 (70.8%) patients. It should be emphasised that the occurrence of fungi was more frequently observed in two or three ontocenoses (89.4%) simultaneously than in one (10.6%). Conclusions: In wound ontocenosis of orthopaedic patients with delayed wound healing, fungal infection concomitant with bacterial one should be taken under consideration. Out of all bacteria found in the wound ontocenosis, the most frequent one was Staphylococcus aureus, whereas in fungi the most common species was Candida albicans. In (3/4) of the cases, fungi were observed simultaneously in two or three ontocenoses, which could have influence on endogenic expansion, making treatment difficult and delaying initiation of physical exercises.     

'Heal not hurt': piloting an initiative on wound pain assessment

As a number of consensus and position documents have made clear, wound pain is an issue that all nurses involved in wound care should take seriously. Based on the 'Heal not hurt' initiative supported by MoInlycke, a wound assessment tool has been adopted by East Riding of Yorkshire PCT. This article gives an overview of the documentation and argues that thorough assessment is essential in wound care and proper documentation is the key to successful clinical outcomes.     

Practical tips for office surgery. Commonsense advice from a plastic surgeon

Performing office surgery well is an art. You can accomplish this by being attentive to several factors. These include, but are not limited to, providing an office environment that is pleasant, restful, and happy; using proper lighting, instruments, and suture techniques; using gentle techniques for local infiltration and handling of tissue; and providing patients with written instructions on postoperative wound care.