手圈在查对手术患者中的应用

查对手术患者是手术室安全管理的关键环节。为了确保手术室护士在繁忙的工作中对手术患者做到准确无误的查对，杜绝差错，我院采取为患耆佩带手圈的办法，使用3年来，效果满意。现介绍如下。     

介绍一种输血查对单

输血是临床上应用较多的治疗方法之一,可以起到补充血容量、纠正贫血、补充血液成分等作用[1]。在输血过程中,护理人员须密切观察病情,严格执行无菌操作和查对制度,以保证患者的安全,防止发生输血反应。目前,临床上惯用的方法为:输血前、中、后各有2名护士口头核对,输血过程中严密观察病情,相关的书面记录是在护理记录单上注明血型、量,并由记录者签名。我们学习新的《医疗事故处理条例》后,认为现有的记录方法不全面,于2003年2月起在我院试用一种自制的输血查对单,有效地保障了临床用血安全,且简单易行,临床反映好,介绍如下。1输血查对单内…     

手术确认表在患者安全管理中的应用

目的探讨手术小组确认手术患者记录表在患者安全管理中的应用效果。方法自行设计手术小组确认手术患者记录表,内容包括手术患者身份、手术部位、手术方式以及麻醉与手术前实施“暂定”程序四部分,随机选择2008年10月为除局麻外择期手术患者实施手术的50个手术小组250人为观察对象,比较手术确认表应用前后确认手术患者执行率。结果手术确认表应用后确认执行率均为100％,应用前为44．0％～100．0％,应用前后比较,差异有统计学意义（P〈0．05．P〈0．01）。结论手术小组确认手术患者记录表的应用有效提高了手术小组确认手术患者的准确性和依从性。确保手术患者安全。     

手术确认表在患者安全管理中的应用

目的 探讨手术小组确认手术患者记录表在患者安全管理中的应用效果.方法 自行设计手术小组确认手术惠者记录表,内容包括手术患者身份、手术部位、手术方式以及麻醉与手术前实施"暂定"程序四部分.随机选择2008年10月为除局麻外择期手术患者实施手术的50个手术小组250人为观察对象,比较手术确认表应用前后确认手术患者执行率.结果 手术确认表应用后确认执行率均为100%,应用前为44.0%～100.0%,应用前后比较,差异有统计学意义(P<0.05,P<0.01).结论 手术小组确认手术患者记录表的应用有效提高了手术小组确认手术患者的准确性和依从性,确保手术患者安全.     

根本原因分析法在控制骨科手术部位感染中的应用

【摘要】〓目的〓分析骨科手术部位感染危险因素,采取有效措施降低手术部位感染率。方法 采用根本原因分析方法对骨科手术部位感染相关危险因素进行分析,并采取相关措施,对比处理前后的干预效果。结果〓调查阶段共进行骨科手术578例,发生手术部位感染13例,感染率2.2%。干预阶段共进行骨科手术375例,发生手术部位感染2例,感染率0.5%。结论〓应用根本原因分析法干预可有效降低骨科手术部位感染的发生。     

腹壁吻合器联合经脐单部位腹腔镜杂交手术在小儿阑尾炎中的应用

目的:探讨腹壁吻合器联合经脐单部位腹腔镜杂交手术治疗小儿阑尾炎的应用价值。方法:收集2021年4月至2022年5月手术治疗的阑尾炎患儿的临床资料,其中22例行腹壁吻合器联合经脐单部位腹腔镜杂交手术(杂交组),22例行传统三孔法腹腔镜手术(对照组),对比分析两组患儿术前、术后相关症状、体征、实验室检查、术后并发症、疼痛视觉模拟评分及切口美观满意度。结果:两组患儿手术均获成功。杂交组手术时间、住院时间、手术费用、术后24 h与48 h疼痛评分低于对照组,切口满意度评分高于对照组,差异有统计学意义。结论:腹壁吻合器联合经脐单部位腹腔镜杂交手术治疗小儿阑尾炎具有独特优点,但应注意适应证范围,术中如遇困难应适时中转手术方式。     

新生儿身份确认单的设计与应用

新生儿病房是一个无陪伴病区,临床常采用腕带、床头卡等方式对患儿进行身份标识及安全核对,临床工作发现,患儿家长对此种身份识别与身份确认方式心存疑虑。     

单一部位切口腹腔镜手术在巨大卵巢肿瘤中的应用

目的探讨单一部位切口腹腔镜手术(laparoendoscopic single-site surgery,LESS)在巨大卵巢肿瘤(直径>10 cm)中的应用价值。方法对2017年4月~2018年12月在我院因巨大卵巢囊肿行卵巢囊肿剔除或患侧附件切除的46例资料进行回顾性分析,其中LESS 23例,肿瘤直径(16.32±5.06)cm,传统三孔腹腔镜手术23例,肿瘤直径(14.08±2.78)cm,2组差异无显著性(t=1.861,P=0.069)。比较2组手术时间、术中出血量、手术并发症、术后24 h疼痛视觉模拟评分(Visual Analogue Scale,VAS)、住院时间、术后满意度。结果LESS组行卵巢囊肿剔除18例,患侧附件切除2例,卵巢肿瘤分期手术(大网膜部分切除+盆腔及腹主动脉旁淋巴结活检)3例;三孔组分别为16例、6例、1例。2组手术过程顺利,均无术中及术后并发症。LESS组无囊肿破裂,三孔组囊肿破裂5例(21.7%),差异有显著性(P=0.049),2组术式、手术时间、术中出血量、术后住院时间差异无显著性(P>0.05),但术后切口疼痛VAS评分LESS组[(4.17±1.24)分]高于三孔组[(3.47±0.94分)](t=2.157,P=0.036)。术后6个月2组满意度差异无显著性(P>0.05)。结论对于巨大卵巢肿瘤,LESS手术难度低,探查全面,安全可行,患者满意度高,具有一定的应用价值。     

单切口腹腔镜手术在前列腺手术中的应用进展

腹腔镜技术已广泛应用于临床,人们正在寻求通过改进腹腔镜技术进行更为微创的手术方式。腹腔镜技术的优势在于手术切口小、操作精细,而进一步缩小穿刺切口能够在减少并发症发生的同时进一步提高手术的美容效果。单切口腹腔镜手术的出现在不影响手术效果的同时满足了患者对美容方面的要求。目前,泌尿外科领域已经进行了一些手术尝试,现对该技术在前列腺疾病治疗中的应用进行综述。     

开放式提问表格在术前查对中的应用

应用开放式提问表格对手术患者进行术前查对。结果实施1年来，杜绝护理差错65例次。提示开放式提问表格能有效引导患者主动参与术前查对，促进护患交流，避免患者在未听清楚问题的情况下误听误答所造成的无效查对和手术错误的发生。     

Computers in surgical education and the operating room.

Medicine has gone through major changes over the last 50 years. Today it is recognized that medical knowledge doubles every 6-8 years. It is also true that with the advent of many new medical procedures, surgeons must continue to learn new techniques throughout their careers; this was not the case in the past. Significant changes have also occurred during the same period in computers. It has recently become apparent that there exists a synergy between these two industries - computers can be used to assist surgeons in both initial education and in learning new skills. The National Capital Area Medical Simulation Center is a unique resource that makes use of state-of-the-art computer resources to teach resuscitation and other skills. Both computerized mannequins and virtual reality training devices are used to teach surgical principles and technical procedures. The natural progression of this technology will be for virtual reality simulations to be used for selecting, training, certifying, and recertifying surgeons. Ultimately, surgeons will practice operative procedures using 3D data sets of the patients they plan to operate the next day and then use recordings to play back their optimal procedure robotically on their patients.     

手术室与病房联合质量督查在手术患者交接中的应用

目的探讨降低手术患者交接缺陷的有效方法,保障患者安全。方法对223例胃肠手术患者(观察组)实施手术室与病房科护士长联合督查,促进流程再造,细化制度,制订相关规范,手术室、病房共同参与,完成手术患者的交接;并与实施常规手术交接的223例患者(对照组)进行比较。结果观察组手术患者交接过程中缺陷发生率显著降低,接送患者时间缩短,患者满意度提高;与对照组比较,差异有统计学意义(均P<0.01)。结论手术室与病房联合质量督查手术患者交接工作,能使多部门密切配合,提高手术患者交接的安全性。     

Improving on-time surgical starts in an operating room

Background

Operating rooms are expensive to run, and hospitals strive to be efficient. The purpose of this study was to evaluate an initiative to improve starting on time in the operating room in an academic pediatric hospital.

Methods

We used an 8-step approach to transforming an organization. A multidisciplinary team defined on-time starts, identified reasons for delays and instituted changes, including improving the same-day admission process, instituting a huddle of operating room staff each morning and providing feedback about on-time starts to staff.

Results

The most common reasons for delay were surgeon and anesthesiologist unavailability and lack of preparedness of patients. The percentage of operations that began on time, defined as the patient being in the room, increased from about 6% to 60% over a 9-month period.

Conclusion

A targeted, multifaceted and multidisciplinary approach can increase the percentage of operations that begin on time in a pediatric hospital.     

妇科患者在手术室期间的隐私保护

探讨妇科患者在手术室期间涉及的隐私、可能泄露的途径以及保护隐私的方法。提出应加强手术室护士保护患者隐私的意识,从多方面保护患者隐私,减少医疗纠纷。     

FDA regulation of technology and surgical devices in the operating room

Federal regulation of medical devices began in 1976 with the signing of the Medical Device Amendments to the Food, Drug and Cosmetic Act. For the purpose of regulating medical devices, the Food and Drug Administration is divided into various divisions and branches, including the Office of Device Evaluation. The evolution of the Food and Drug Administration's regulations of laparoscopic devices is described. Also described is the technology of laparoscopic surgical devices and how they are regulated by the Office of Device Evaluation. Trends towards the future of laparoscopic devices, and their regulation, are reviewed.     

达芬奇机器人手术护士基于清单管理的培训

目的 探讨基于清单管理的培训在达芬奇机器人手术护士中的应用效果.方法 将准备纳入机器人小组的34名护士,按照培训时间顺序分为常规培训组和清单培训组各17人,分别给予常规培训和基于清单管理的培训.结果 培训后,两组知识技能考核成绩、术前用物准备时间、安装机械臂保护套时间、术前患者推车移至到指定目标位置时间、术中故障识别及...     

Operating room assist: surgical mentorship and operating room experience for preclerkship medical students

BACKGROUND: Despite the importance of preclerkship experiences, surgical education has essentially remained confined to the third-year operating room experience. According to experience-based learning theory, the acquisition of new clinical knowledge is a dynamic process of social enculturation and professional identity development that requires active participation, clinical applicability, and direct interaction with doctors and other members of the medical team. In conjunction with a previously described surgical skills elective, we created a new clinical elective in which preclerkship medical students were assigned a surgical mentor and invited into the operating room to assist in surgeries. METHODS: The elective paired 36 first-year students with 24 surgeons and instructed students to participate in at least 2 surgeries over the 3-month elective period. Students, surgeons, and operating room nurses filled out questionnaires after each surgery. RESULTS: Although 6 students failed to enter the operating room, 30 students scrubbed and gowned for a total of 62 procedures during the elective period. Although most students reported the operating room to be a comfortable learning environment in which they were actively included, students consistently underrated their performance and contribution to the surgical team compared with the surgeons' and nurses' ratings. With 75% of students who reported using a previously learned surgical skill during each surgery, this elective succeeded in allowing preclerkship medical students the opportunity to participate actively in the operating room. CONCLUSIONS: Early surgical exposure is critical for attracting student interest in careers in surgery. We believe that these early clinical experiences, combined with strong mentorship from the surgical faculty, will eventually lead to greater success during clerkships and greater interest in surgery as a career.     

硬质灭菌盒在手术室的使用探讨

总结硬质灭菌盒术前的包装、灭菌转运方法,术中的使用方法,以及术后的转运与交接方法。发现硬质灭菌盒作为一种新型的手术室耗材产品,可提高手术室护士工作效率,节约成本;手术器械的回收更快,更安全;热传导效果好,干燥效果佳。提示合理使用硬质灭菌盒既有效保护器械,也减轻手术室护士工作量,有利于手术室护理工作质量的提高。     

人文关怀在手术室护理中的应用

目的 探讨人文关怀在手术室护理中的应用效果.方法 对2009年7～9月2 106例非全麻择期手术患者采取改善护理服务环境,营造人文关怀气氛,优化护理服务流程,施行无缝隙护理及其他人文细节关怀等措施,连续3个月后评价效果.结果 患者及医生对护理满意度分别由94.99%、83.33%提高至98.01%、96.67%.结论 ...