肤阴洁湿巾用于会阴侧切的临床效果分析

会阴侧切术是产科分娩中最常见的手术，可缩短第二产程、加快胎儿娩出，减少新生儿窒息，但同时也给产妇带来痛苦。为减轻产妇痛苦，提高会阴切口甲级愈合率，作者采用前瞻性方法对会阴切口进行肤阴洁湿巾局部外敷，总结如下。     

浅析会阴侧切伤口的感染

会阴切开及缝合术是产科最常用的手术，切开的方式有斜切开及正中切开，我科自１９９２年１月至１９９６年１２月止共行会阴侧切１９６１例，切口感染６７例，感染率为３．４１５，单纯会阴侧切口１９９８例，感染４９例，感染率２．５６％，会阴例切口＋撕裂５３例，感染２０例，感染率３７．７３％，二者相比Ｐ〈０．０１。在各种分娩方式中，产钳助产１６例，切口感染６例，感染率３７．５％，胎头吸收９０２例，臀位产１２９例，     

肤阴洁湿巾外敷预防产妇会阴切口感染

肤阴洁湿巾外敷预防产妇会阴切口感染方春梅产妇分娩后会阴切口常规以消毒于纱布覆盖，我院切口感染率为７％～９％。为降低会阴切口感染率，我院自１９９３年６月起对产妇应用肤阴洁湿巾外敷会阴切口。经临床应用１７０例，效果满意，现报告如下。１临床资料与方法本组病...     

浅析会阴侧切伤口的感染

会阴切开及缝合术是产科最常用的手术，切开的方式有侧斜切开及正中切开。我科自１９９２年１月至１９９６年１２月止共行会阴侧切１９６１例，切口感染６７例，感染率为３４１％。单纯会阴侧切１９０８例，感染４９例，感染率２５６％，会阴侧切＋撕裂５３例，感染２０例，感染率３７７３％，二者相比Ｐ＜０．０１。在各种分娩方式中，产钳助产１６例，切口感染６例，感染率３７５％；胎头吸引９０２例，臀位产１２９例，正常产９１７例，切口感染分别为４６例、４例、１３例，感染率分别为５０９％、３１０％、１４２％，产钳助产与后三者相比Ｐ＜０．０１。     

会阴侧切伤口护理的体会

采用不同的消毒液对２００例会阴侧切患者给予分组护理，并对其严重感染率进行比较，差异不显著；再将分组护理与用０．２％的ＰＰ溶液组的总感染率进行比较，差异也不显著，分析３－９月份每月的严重感染率，有逐渐下降的趋势。认为：预防产后会阴侧切伤口的感染，重点不在于使用何种消毒液，而在于加强术后的基础护理及保持会阴部清洁。     

肤阴洁湿巾预防会阴切口感染的疗效观察

1996年1月～1997年12月对927例产妇及对照组340例分别采取1‰新洁尔灭冲洗会阴加敷湿巾及单纯使用1‰新洁尔灭冲洗．对照观察治疗效果如下。     

肤阴洁湿巾预防会阴切口感染的疗效观察

１９９６年１月～１９９７年１２月对９２７例产妇及对照组３４０例分别采取１‰新洁尔灭冲洗会阴加敷湿巾及单纯使用１‰新洁尔灭冲洗,对照观察治疗效果如下。１资料与方法将会阴侧切阴道分娩的１２６７例初产妇,随机选择９２７例应用１‰新洁尔灭冲洗会阴加敷湿巾,对照组仅用１‰新洁尔灭冲洗会阴。两组均选择顺产侧切产妇,会阴切口均以丝线“８”字缝合,会阴冲洗２次／ｄ、治疗组冲洗后外敷湿巾,７２ｈ后拆线。两组分别于出院前和产后４２ｄ复查观察会阴切口愈合情况。２结果　会阴伤口愈合情况治疗组９２７例,１例轻度感染,１例…     

应用物理疗法于会阴侧切伤口的效果观察

目的 观察新型材料会阴冷敷垫冷敷以及频谱仪照射在分娩后减轻会阴伤口疼痛及促进会阴伤口愈合中的效果,为针对性的护理干预提供依据。方法 将我院2011年1月-8月自然分娩且行会阴侧切缝合术的初产妇203人次,分成实验组98人、对照组105人,两组产后均用无痛碘棉球擦洗会阴伤口每天两次共4天,实验组另于产后24小时内使用会阴冷敷垫冷敷会阴,分娩24小时后用宽频谱治疗仪（周林牌）照射会阴部,每次30分钟,每天两次共3天。结果 对实验组及对照组分别于产后24小时,48小时、72小时、96小时进行疼痛等级评估,实验组疼痛等级明显低于对照组,并于产后第四天对会阴伤口愈合程度进行评估,实验组甲级愈合率达98.9%,对照组甲级愈合率达86.1%,实验组乙级愈合率仅为1.05%,对照组乙级愈合率为13.9%,实验组切口愈合情况明显优于对照组（P＜0.01）。结论 通过对产后会阴部伤口的冷敷以及频谱治疗仪照射产生的热疗和微波作用,证明物理疗法的护理干预能明显减轻产后会阴伤口疼痛,促进会阴伤口愈合,从而减轻患者痛苦,值得推广应用     

改良会阴侧切缝合术在产科的应用及护理

目的 探讨改良会阴缝合法的临床应用效果及护理方法.方法 将110例自然分娩行会阴左侧切开缝合的产妇随机分为改良组和传统组各55例,会阴切口分别采用无损伤可吸收线连续不打结皮内缝合法和常规丝线间断皮外缝合法,比较2组切口愈合情况.结果 改良组采用的无损伤可吸收线连续不打结皮内缝合法在促进切口愈合方面明显优于传统组的常规丝线间断皮外缝合法.结论 改良会阴皮内缝合,具有术后切口反应轻,产妇痛苦小,不需拆线,住院时间短等优点,加强护理可提高疗效.     

凡士林纱条应用于肠造瘘病人灌肠

在临床护理工作中 ,需对肠造瘘病人进行灌肠 ,特别是暂时性肠造瘘者行二期回纳术 ,术前必须进行清洁灌肠[1 ] 。由于肠造瘘口与正常肛门不同 ,对成形粪便有一定的控制作用 ,但对稀便无法控制 ,致使灌肠液不能在肠腔内停留 ,从而达不到治疗目的。凡士林纱条是在临床应用中必不可少的[2 ,3] 。除常规地用于覆盖创面 ,还将浸透酒精的油纱条覆盖手术切口[4 ] 。我科自1 998年 1 1月— 2 0 0 0年 1 0月 ,将凡士林纱条应用于 32例肠造瘘病人灌肠中 ,取得了满意效果。1　使用方法　　常规准备灌肠物品 ,另准备 3条～ 4条已消毒的凡士林纱条 ,长约 1…     

The Efficacy of Factor VIIa in Emergency Department Patients With Warfarin Use and Traumatic Intracranial Hemorrhage

Objectives: The objective was to compare outcomes in emergency department (ED) patients with preinjury warfarin use and traumatic intracranial hemorrhage (tICH) who did and did not receive recombinant activated factor VIIa (rFVIIa) for international normalized ratio (INR) reversal. Methods: This was a retrospective before‐and‐after study conducted at a Level 1 trauma center, with data from 1999 to 2009. Eligible patients had preinjury warfarin use and tICH on cranial computed tomography (CT) scan. Patients before (standard cohort) and after (rFVIIa cohort) implementation of a protocol for administering 1.2 mg of rFVIIa in the ED were reviewed. Glasgow Coma Scale (GCS) score, Revised Trauma Score (RTS), Injury Severity Score (ISS), INR, and Marshall score were collected. Outcome measures included mortality, thromboembolic complications, and INR normalization. Results: Forty patients (median age = 80.5 years, interquartile range [IQR] = 63.5–85) were included (20 in each cohort). Age, GCS score, ISS, RTS, initial INR, and Marshall score were similar (p > 0.05) between the two cohorts. Survival was identical between cohorts (13 of 20, or 65.0%, 95% confidence interval [CI] = 40.8% to 84.6%). There were no differences in rate of thromboembolic complications in the standard cohort (1 of 20, 5.0%, 95% CI = 0.1% to 24.9%) than the rFVIIa cohort (4 of 20, 20.0%, 95% CI = 5.7% to 43.7%; p = 0.34). Time to normal INR was earlier in the rFVIIa cohort (mean = 4.8 hours, 95% CI = 3.0 to 6.7 hours) than in the standard cohort (mean = 17.5 hours, 95% CI = 12.5 to 22.6; p < 0.001). Conclusions: In patients with preinjury warfarin and tICH, use of rFVIIa was associated with a decreased time to normal INR. However, no difference in mortality was identified. Use of rFVIIa in patients on warfarin and tICH requires further study to demonstrate important patient‐oriented outcomes. ACADEMIC EMERGENCY MEDICINE 2010; 17:244–251 © 2010 by the Society for Academic Emergency Medicine     

女性尿道综合征病人的护理

女性尿道综合征 (femaleurethralsyndrome ,FUS)又称无菌性尿频 -排尿不适综合征 ,是指仅有尿频、尿急和或尿痛的症状 ,而中段尿细菌定量培养阴性 ,并排除结核、真菌及厌氧菌尿路感染者[1] 。本症在女性中最常见 ,是泌尿系统的一种常见病 ,其机制尚不清楚。尿道解剖异常、免疫因素、心理因素以及尿道细菌感染是FUS的致病因素。国外近年趋向于采取生物反馈行为治疗、电刺激、盆底肌肉训练等方法重建下尿路功能[2 ] 。国内倾向于采取综合治疗。自 2 0 0 0年— 2 0 0 2年我科共收治住院FUS病人 60例 ,现将护理体会介绍如下。1　资料及方法1…     

女性尿失禁的社区康复

尿失禁是指排尿失去意识控制或尿液不自主地流出[1] 。尿失禁的发病率随着年龄的增加而增加[2 ,3 ] 。在任何年龄段 ,女性发生率均为男性的 2倍[4] 。近年来的许多研究表明 ,尿失禁是一种可以改善或控制的症状。然而 ,许多女性病人常常羞于谈及此问题 ,有些甚至认为是“正常现象”或“无法改变”。医学工作者特别是社区和养老机构的护理工作者 ,接触此类病人的机会最多 ,对此应给予足够的重视。本文就尿失禁的分类和针对女性病人的康复措施综述如下 ,供广大同行参考。1　分类目前有关尿失禁的分类仍不统一。综合美国卫生政策研究院以及美国…     

Complement Activation in Emergency Department Patients With Severe Sepsis

Objectives: This study assessed the extent and mechanism of complement activation in community‐acquired sepsis at presentation to the emergency department (ED) and following 24 hours of quantitative resuscitation. Methods: A prospective pilot study of patients with severe sepsis and healthy controls was conducted among individuals presenting to a tertiary care ED. Resuscitation, including antibiotics and therapies to normalize central venous and mean arterial pressure (MAP) and central venous oxygenation, was performed on all patients. Serum levels of Factor Bb (alternative pathway), C4d (classical and mannose‐binding lectin [MBL] pathway), C3, C3a, and C5a were determined at presentation and 24 hours later among patients. Results: Twenty patients and 10 healthy volunteer controls were enrolled. Compared to volunteers, all proteins measured were abnormally higher among septic patients (C4d 3.5‐fold; Factor Bb 6.1‐fold; C3 0.8‐fold; C3a 11.6‐fold; C5a 1.8‐fold). Elevations in C5a were most strongly correlated with alternative pathway activation. Surprisingly, a slight but significant inverse relationship between illness severity (by sequential organ failure assessment [SOFA] score) and C5a levels at presentation was noted. Twenty‐four hours of structured resuscitation did not, on average, affect any of the mediators studied. Conclusions: Patients with community‐acquired sepsis have extensive complement activation, particularly of the alternative pathway, at the time of presentation that was not significantly reversed by 24 hours of aggressive resuscitation. ACADEMIC EMERGENCY MEDICINE 2010; 17:353–359 © 2010 by the Society for Academic Emergency Medicine     

The Use of Impedance Cardiography in Predicting Mortality in Emergency Department Patients With Severe Sepsis and Septic Shock

Objectives: Pulmonary artery catheterization poses significant risks and requires specialized training. Technological advances allow for more readily available, noninvasive clinical measurements of hemodynamics. Few studies exist that assess the efficacy of noninvasive hemodynamic monitoring in sepsis patients. The authors hypothesized that cardiac index, as measured noninvasively by impedance cardiography (ICG) in emergency department (ED) patients undergoing early goal‐directed therapy (EGDT) for sepsis, would be associated with in‐hospital mortality. Methods: This was a prospective observational cohort study of patients age over 18 years meeting criteria for EGDT (lactate > 4 or systolic blood pressure < 90 after 2 L of normal saline). Initial measurements of cardiac index were obtained by ICG. Patients were followed throughout their hospital course until discharge or in‐hospital death. Cardiac index measures in survivors and nonsurvivors are presented as means and 95% confidence intervals (CI). Diagnostic performance of ICG in predicting mortality was tested by receiver operating characteristic (ROC) curve and areas under the ROC curves (AUC) were compared using Wilcoxon test. Results: Fifty‐six patients were enrolled; one was excluded due to an inability to complete data acquisition. The mean cardiac index in nonsurvivors (2.3 L/min·m², 95% CI = 1.6 to 3.0) was less than that for survivors (3.2, 95% CI = 2.9 to 3.5) with mean difference of 0.9 (95% CI = 0.12 to 1.71). The AUC for ICG in predicting mortality was 0.71 (95% CI = 0.58 to 0.88; p = 0.004). A cardiac index of < 2 L/min·m² had a sensitivity of 43% (95% CI = 18% to 71%), specificity of 93% (95% CI = 80% to 95%), positive likelihood ratio of 5.9, and negative likelihood ratio of 0.6 for predicting in‐hospital mortality. Conclusions: Early, noninvasive measurement of the cardiac index in critically ill severe sepsis and septic shock patients can be performed in the ED for those who meet criteria for EGDT. There appears to be an association between an initial lower cardiac index as measured noninvasively and in‐hospital mortality. ACADEMIC EMERGENCY MEDICINE 2010; 17:452–455 © 2010 by the Society for Academic Emergency Medicine     

会阴短侧切术在阴道分娩中的应用

目的探讨缩短会阴侧切口对产妇的影响。方法将100例需要会阴侧切的产妇随机分为观察组和对照组两组各50例,观察组采用短会阴侧切术,对照组采用传统会阴侧切术,比较两组术中出血量,手术缝合时间,术后局部疼痛时间(h),伤口愈合时间(h)及术后住院天数。结果短会阴侧切术出血少、缝合简单快捷、愈合快、住院时间短。结论短会阴侧切出血少,缝合简单快捷,愈合快、无需拆线,能有效减轻切口的疼痛给产妇带来的痛苦及诸多的不良影响。