新型冠状病毒肺炎疫情期间病房管理实践

总结了新型冠状病毒肺炎疫情期间神经外科病房的管理经验,为最大程度地降低院内感染新型冠状病毒肺炎的风险提供保障.其主要措施包括遵循院部统一调度指挥机制;优化入院与住院制度;合理安排人力、物资、场地等保障各项疫情防治任务的落实.最终在神经外科患者、家属及工作人员(包括医生、护士、工勤人员)中未发生疑似或者确诊感染新型冠状病...     

新型冠状病毒肺炎危重症患者的护理建议

综述新型冠状病毒肺炎危重症患者的护理要点,包括一般护理、气道护理、循环护理、营养管理、镇静镇痛护理、支持设备管理以及人文关怀等,认为做好危重症患者的护理管理,能提高治疗效果,减少死亡率.     

新型冠状病毒肺炎疫情期间综合医院呼吸与危重症医学科病区护理管理实践

总结新型冠状病毒肺炎疫情期间综合医院呼吸与危重症医学科病区的护理管理实践,主要包括组织全科医护人员认真学习新型冠状病毒感染相关防控知识、应急预案、制度流程,重点加强物资管控、个人防护及病区清洁消毒、患者收治及健康宣教等。     

新型冠状病毒肺炎疫情期间血液科病房防控管理实践

总结了新型冠状病毒肺炎疫情期间血液科病房的防控管理体会,防控管理主要包括患者及家属防控宣教和管理、工作人员防控培训和管理、防护物资管理、环境科学管理以及心理健康的关注.认为在新型冠状病毒肺炎疫情期间,该血液科病房防控管理方法有效,可供大家参考.     

新型冠状病毒肺炎疫情期间孕产妇管理探讨

新型冠状病毒肺炎是2019年12月在武汉发现的一种新发传染病。孕产妇是一个非常特殊的群体,是新型冠状病毒肺炎的易感人群。在新型冠状病毒肺炎疫情期间,做好孕产妇的感染防控、确保疫情期间母胎安全非常重要。本文从孕期检查、居家生活管理、前往医院的路上和医院内注意事项、家中消毒及空气净化、住院后的自我防护、产后注意事项等方面做了探讨。     

新型冠状病毒肺炎疫情期间肿瘤内科感染管理实践

肿瘤患者对新型冠状病毒具有更高的易感性,感染后病情重,预后差。肿瘤患者临床表现复杂,增加了疑似病例的筛查难度。本文探讨了新型冠状病毒肺炎疫情期间肿瘤内科的感染管理措施,从工作人员、患者、环境、工作流程、应急预案、临床路径优化等方面进行感染防控和总结。     

1例新型冠状病毒肺炎危重症患者人工气道的管理

目的总结新型冠状病毒肺炎(以下简称新冠肺炎)危重症患者人工气道的管理经验。方法2019年1月28日,某院收治了1例新冠肺炎危重症患者,予紧急有创机械通气治疗。结果经过积极治疗9 d,患者病情逐渐平稳,予试脱机试验。结论人工气道建立前的评估准备、个人防护要点,建立时的注意事项及建立后的气道管理工作的经验,可为以后收治烈性传染病提供参考。     

新型冠状病毒肺炎疫情防控期间手术患者的管理实践

总结新型冠状病毒肺炎疫情期间开展急诊及限期手术的安全防控措施。严格按照疫情期间防控工作流程,就诊前体温测量,流行病学筛查,入院前行相关检查进行新型冠状病毒肺炎筛查,住院期间避免病房人员聚集,手术中做好医护技的必要防护,加强患者家属的管理,术毕做好与各科室患者的交接工作。在新型冠状病毒肺炎期间,共完成254例手术,其中急诊手术184例,限期手术70例,取得了较好的手术效果。     

Secondary bloodstream infection in critically ill patients with COVID-19

ObjectiveSecondary infection, especially bloodstream infection, is an important cause of death in critically ill patients with COVID-19. We aimed to describe secondary bloodstream infection (SBI) in critically ill adults with COVID-19 in the intensive care unit (ICU) and to explore risk factors related to SBI.MethodsWe reviewed all SBI cases among critically ill patients with COVID-19 from 12 February 2020 to 24 March 2020 in the COVID-19 ICU of Jingmen First People''s Hospital. We compared risk factors associated with bloodstream infection in this study. All SBIs were confirmed by blood culture.ResultsWe identified five cases of SBI among the 32 patients: three with Enterococcus faecium, one mixed septicemia (E. faecium and Candida albicans), and one C. parapsilosis. There were no significant differences between the SBI group and non-SBI group. Significant risk factors for SBI were extracorporeal membrane oxygenation, central venous catheter, indwelling urethral catheter, and nasogastric tube.ConclusionsOur findings confirmed that the incidence of secondary infection, particularly SBI, and mortality are high among critically ill patients with COVID-19. We showed that long-term hospitalization and invasive procedures such as tracheotomy, central venous catheter, indwelling urethral catheter, and nasogastric tube are risk factors for SBI and other complications.     

Glycaemic control in critically ill patients with cardiovascular disease

PURPOSE OF REVIEW: The role of hyperglycaemia in the pathogenesis of myocardial damage during cardiac surgery or patients with acute coronary syndromes has been the subject of increasing interest over the past few years. Several further trials and meta-analyses investigating the role of insulin treatment, either aimed at tight control of blood glucose concentration or as part of a regimen including glucose and potassium, have been reported recently and are the subject of this review. RECENT FINDINGS: Good control of blood glucose has been demonstrated to improve outcomes for diabetic patients undergoing cardiac surgery and following acute myocardial infarction. In surgical intensive care patients, tight glucose control improved mortality--a finding that is awaiting confirmation in multicentre studies. The use of glucose-insulin-potassium regimens does not improve outcomes in patients with acute myocardial infarction who have undergone reperfusion therapy, but may be beneficial during cardiac surgery. SUMMARY: Tight control of blood glucose has been shown to be beneficial in several patient groups. The optimal target glucose concentration and glucose and insulin regimens remain to be confirmed or determined in each clinical situation.     

Spiritual care in critically ill patients during COVID-19 pandemic

IntroductionSpiritual care has a positive influence when patients are subjected to serious illnesses, and critically ill situations such as the case of the COVID-19 pandemic.PurposeThe purpose of this study was to investigate the perceptions and attitudes of nurses working at critical care units and emergency services in Spain concerning the spiritual care providing to patients and families during the COVID-19 pandemic.MethodsA qualitative investigation was carried out using in-depth interviews with 19 ICU nursing professionals.FindingsDuring the pandemic, nurses provided spiritual care for their patients. Although they believed that spirituality was important to help patients to cope with the disease, they do not had a consensual definition of spirituality. Work overload, insufficient time and lack of training were perceived as barriers for providing spiritual healthcare.DiscussionThese results support the role of spirituality in moments of crisis and should be considered by health professionals working in critical care settings.     

PICC导管应用于3例新冠肺炎危重症患者的护理

本文回顾了三例危重症新冠肺炎患者,在重症监护隔离病房应用经外周置入中心静脉导管 (Peripherally inserted central catheter, PICC)的经验,包括重症患者应用PICC的指征、穿刺点的选择、穿刺的技巧、穿刺后的维护、抗凝状态下PICC的相关并发症。我们认为,包括新冠肺炎在内的、尤其是接受持续抗凝的重症患者,PICC可作为中心静脉通路的首选方案;术前详尽的超声血管评估和穿刺时正确的超声引导能够提高多重个人防护下的穿刺成功率;在不能停止抗凝的极端情况下,护理PICC相比CVC更加便捷,一旦出现穿刺点渗血等并发症,也能相对简单有效地进行处理。综上所述,我们推荐PICC在重症患者中有指征地应用,尤其是需要持续抗凝的患者中,充分发挥PICC的优势,有技巧地使用超声定位和引导,通过护理手段减少和处理PICC相关并发症。     

新型冠状病毒肺炎危重症患者营养治疗专家建议

当前抗击新型冠状病毒疫情进入决战阶段,危重症患者的营养治疗是降低病死率的关键措施。为了进一步提高危重症患者的营养治疗效果,现结合抗疫前线的临床经验,就危重症患者的营养代谢特点、营养筛查、营养治疗目标量、营养方案和途径的选择,以及营养监测方法等方面做出总结和建议,为危重症患者的救治提供参考。     

重症新型冠状病毒肺炎患者营养支持治疗的专家建议

2019年12月以来,一种新型冠状病毒导致的感染在我国突发,截止目前,我国累计确诊病例已超7万例。2020年2月7日,国家卫生健康委将新型冠状病毒感染的肺炎暂命名为“新型冠状病毒肺炎”(简称:新冠肺炎,Novel Coronavirus Pneumonia,NCP);2020年2月11日,世界卫生组织将新型冠状病毒引发的疾病命名为“COVID-19”(Corona Virus Disease 2019)。     

Challenges in hyperglycemia management in critically ill patients with COVID-19

Hyperglycemia is commonly associated with adverse outcomes especially in patients requiring intensive care unit stay. Data from the corona virus disease 2019 (COVID-19) pandemic indicates that individuals with diabetes appear to be at similar risk for COVID-19 infection to those without diabetes but are more likely to experience increased morbidity and mortality. The proposed hypothesis for hyperglycemia in COVID-19 include insulin resistance, critical illness hyperglycemia (stress- induced hyperglycemia) secondary to high levels of hormones like cortisol and catecholamines that counteract insulin action, acute cytokine storm and pancreatic cell dysfunction. Diabetic patients are more likely to have severe hyperglycemic complications including diabetic ketoacidosis and hyperosmolar hyperglycemic state. Management of hyperglycemia in COVID-19 is often complicated by use of steroids, prolonged total parenteral or enteral nutrition, frequent acute hyperglycemic events, and restrictions with fluid management due to acute respiratory distress syndrome. While managing hyperglycemia special attention should be paid to mode of insulin delivery, frequency of glucose monitoring based on patient and caregiver safety thereby minimizing exposure and conserving personal protective equipment. In this article we describe the pathophysiology of hyperglycemia, challenges encountered in managing hyperglycemia, and review some potential solutions to address them.     

新型冠状病毒肺炎疫情期间血液透析患者心理健康管理与实践

本文总结了新型冠状病毒肺炎疫情期间血液透析患者的心理健康管理措施,通过采取“五位一体”的心理干预框架及相应措施,消除疫情期间血液透析患者的紧张情绪,并给予充分的情感支持,为血液透析中心医护人员应对突发公共卫生事件下患者心理问题及开展心理健康管理提供参考。