手术室护士在全麻手术中的护理配合

目的总结手术室护士在全麻手术中与麻醉医生、手术医生配合的护理体会。方法加强术前访视、术后随访及心理护理,协助麻醉医生做好围麻醉期的护理配合工作,积极参与、密切配合抢救工作,有效促进手术的顺利进行。结果手术患者均得到良好的护理,手术顺利进行,麻醉复苏成功。结论手术室护士与麻醉医生、手术医生的协调配合,为手术的顺利进行提供安全的保障,并为取得手术满意效果具有十分重要的意义。     

髋关节置换手术患者实施超声定位神经阻滞麻醉的护理

对37例全髋关节置换手术患者实施超声定位神经阻滞麻醉,麻醉科护士对患者进行术前访视与宣教,提前准备麻醉所需仪器、药品和物品,熟悉神经阻滞麻醉的过程,主动配合麻醉医生操作,手术过程中严密监测患者生命体征,协助麻醉医生做好患者呼吸道管理和液体管理,阻滞麻醉后苏醒期观察与评估患者出入液量、疼痛情况、感觉阻滞平面、运动阻滞平面等。结果所有患者神经阻滞效果良好,均顺利完成手术。提出麻醉科护士在超声定位神经阻滞麻醉过程中发挥重要作用,提高了麻醉质量和效率。     

护士参与麻醉门诊术前教育对麻醉恢复期患者的影响

目的 探讨麻醉科护士参与麻醉门诊术前教育对全麻手术患者麻醉恢复期的影响。 方法 将2017年11～12月入麻醉门诊行麻醉评估的96例患者作为对照组,2018年5～6月入麻醉门诊行麻醉评估的96例患者作为观察组。对照组按照常规由麻醉医生进行麻醉风险评估和麻醉术前准备指导,观察组在对照组基础上,增设1名麻醉科护士配合麻醉医生,并开展麻醉术前教育。 结果 观察组气管插管耐受度、拔管配合度显著高于对照组,且患者的疼痛评估时间以及复苏时间显著短于对照组（P<0.05,P<0.01）。 结论 麻醉科护士参与麻醉门诊术前教育,有利于提高全麻手术患者麻醉恢复期对气管插管的耐受度及治疗配合度,同时可缩短患者疼痛评估所需时间及复苏时间。     

围手术期患者死亡事故对麻醉医生的影响

大多数麻醉医生在他们的执业生涯中都会经历过围手术期患者死亡或者是围手术期灾难性事故。但是,麻醉培训过程中并没有教会麻醉医生如何处理不良的应激事件。很多调查表明,不管死亡的结果是否在预料之中,或者患者是否与医生熟识,对75％的医务工作者而言,患者死亡是影响情绪的最主要因素。心理恢复往往需要数周甚至数月,但是这种恢复又容易被缺乏情感和专业的援助所阻碍。资料显示,大多数麻醉医生都希望得到一个更加正式的援助机构的帮助,包括可以选择暂时脱离临床工作。尽管对围手术期事故发生后的职业能力没有一个正式评定系统,但是英国和爱尔兰麻醉协会研究机构制定的指南在不同层面上都推荐了一些援助。并且,麻醉患者安全基金网站上的“不良事件处理方案”也提供了一系列步骤,以期减少患者的损伤,并在麻醉不良事件发生后对原因加以鉴别。这些事件处理不当对医生个人和医疗系统都有重大的负面影响。围手术期的事故对患者及医疗系统短期和长期的影响都需要更深入的研究。同时,在各阶段培训过程中,应该为医生提供如何应对围手术期事故后续影响方面的教育,并有正式的援助体系。     

麻醉医生在快通道外科手术中的作用：从多模式镇痛到围手术期管理

背景提高围手术期效率和手术患者周转率在现代麻醉工作中的重要性日益增强。快通道外科是通过多学科合作加快小手术（不住院）和大手术（住院）患者的手术后康复，以提高围手术期效率的一种方法。本文关注的是麻醉医生在快通道外科中日益重要的作用。方法2005年秋天，一个由多学科临床研究人员组成的小组在McGill（麦吉尔）大学召开会议，探讨目前麻醉科和外科人员在促进患者手术后康复过程中所做的工作。会议指定一组与会者评估相关同行评议的文献，了解麻醉医生作为一名围手术期医生起到的作用。结果麻醉医生作为围手术期医生，在快通道外科中起着关键性作用。麻醉医生需要选择适当的手术前用药、麻醉药物和技术，采用预防性药物将副作用（如疼痛、恶心、呕吐、头晕）降至最低，还可以通过辅助药物，调节患者手术中和手术后主要器官和系统的功能。结论成功开展快通道外科的手术治疗小组必需充分发挥麻醉医生在围手术期的关键性作用。     

我国二级医院麻醉医生对ERAS认知情况和临床实践现状的调查分析

目的采用问卷形式调查我国二级医院麻醉医生对加速康复外科(ERAS)的认知情况和临床实践现状, 为提升ERAS在全国的推广与普及提供参考。方法采用方便抽样方法, 自行设计调查问卷, 于2021年4月至11月对我国二级公立医院麻醉医生开展ERAS认知情况的调查, 并分析其相关影响因素, 同时调查麻醉医生ERAS临床实践现状与继续教育意愿。结果本研究发放问卷879份, 回收有效问卷864份, 回收率98.3%。参与调查的麻醉医生分布于全国31个省级行政区, 其对ERAS认知情况得分(满分18分)为12.00(3.75)分, 麻醉医生认知情况合格(得分≥12分)共563名(65.2%)。不同地理区域、年龄、学历、职称及工作年限的麻醉医生对ERAS认知情况差异有统计学意义(P<0.05)。有817名(94.6%)参与调查的麻醉医生认为ERAS管理对患者是有益, 有778名(90.0%)认为在二级医院也应尽可能开展ERAS管理。有255名(29.5%)参与调查的麻醉医生在临床从未开展ERAS管理, 不同地理区域麻醉医生ERAS管理的开展情况差异有统计学意义(P<0.05)。有848名(...     

非心胸手术成年患者术中通气管理的临床实践：一项区域问卷调查研究

目的问卷调查四川省非心胸手术成年患者术中通气管理的临床实践情况。方法 2020年12月至2021年1月, 向四川省29家大型三甲综合医院的麻醉医生发送电子调查问卷。结果共回收有效问卷1 264份, 回复率78.50%。术中采用小VT通气的麻醉医生比率为90.43%;采用呼气末正压(PEEP)通气的麻醉医生比率为70.73%, PEEP水平控制在1～5 cmH2O的麻醉医生最多, 在腔镜和非腔镜手术中比率分别为77.4%和88.4%。术中实施肺复张手法(ARM)的麻醉医生比率为82.28%。将小VT、PEEP及ARM联合使用的麻醉医生比率为37.03%。98.10%的麻醉医生认为"小VT、适当PEEP或ARM的使用"属于"术中肺保护性通气(LPV)策略"。而对于其他通气参数的设置, 如吸入氧浓度、通气频率及通气模式等, 临床实践存在差异。结论四川省大型三甲综合医院的麻醉医生较为认可的LPV策略包括小VT、PEEP及ARM, 但LPV策略的实际应用情况与理论认识存在差距。     

600例前列腺汽化电切术的麻醉管理体会

目的:总结前列腺手术的麻醉方法及术中麻醉风险分析及管理.方法:分析600前列腺增生手术患者的术前内科合并症及术中医生手术操作对麻醉安全性的影响及对策.结果:585例平稳完成手术,12例严重血糖升高,3例出现电切综合症,处理及时完全好转.结论:经尿道前列腺汽化电切术积极的术前准备、手术医生精准迅速的手术操作、麻醉医生术中密切仔细的监护及对手术并发症的早期发现及处理是降低麻醉风险的重要措施.     

肺移植手术的麻醉处理要点

肺移植手术作为终末期肺疾患治疗的一种方法，国内已经起步，但如何保障这些既往被列为麻醉禁忌患者的手术安全，对麻醉医生来说是一个挑战。我们总结了14例肺移植患者麻醉管理成败的经验，旨在探讨肺移植患者麻醉管理上的要点，以提高此类患者的手术安全性。     

经食管超声心动图无痛检查患者的麻醉护理配合

对60例心血管疾病患者行经食管超声心动图无痛检查,操作前完善对患者的评估,做好心理护理,加强操作前药品、物品准备,配合超声医生进行体位摆放;合理安放仪器设备,术中密切配合麻醉、超声医生的操作,操作人员合理站位及布局,做好常见并发症的观察和护理。60例患者检查操作顺利完成。提出麻醉护士应熟悉该检查的各种探头操作手法,严密观察患者生命体征,及时发现操作中可能出现的各种并发症,做好充分的准备,以便配合医生对突发情况做出积极应对,确保检查顺利完成。     

Multidisciplinary treatment of patients with gender dysphoria

Summary Patients with gender dysphoria are best treated by a multidisciplinary team. Such a team consists of a nucleus of specialists who sees the patient frequently and a peripheral group that sees patients incidentally. The tasks of each team member are described, and the value of the multidisciplinary cooperation is highlighted. Gender dysphoria patients are better treated with a team approach than with treatment by individual specialists who are working independently of one another.     

Implementation of a trauma team

A team approach to the initial assessment, investigation and management of potentially seriously injured patients has been instituted. Team members are alerted through an emergency paging system which is activated when a patient fulfills one of a predetermined list of criteria relating to the injury incident, physiological status of the patients and anatomic injuries. Medical members of the team include surgical, intensive care, anaesthetic, and accident and emergency staff. The surgical representative acts as team co-ordinator. Aspects of the function of the trauma team system were assessed over 4 months during which time 721 injured patients were admitted, 240 patients satisfied the trauma team criteria, and the team was called 152 times. The observed 'false alarm' rate was 38% but the true false alarm rate would have been 46%. Injuries sustained by some patients, who satisfied the criteria but who were not evaluated by the team, were of sufficient severity to justify a greater compliance with the system than was observed at this early stage after its implementation. Although a false alarm rate of 46% is higher than desirable, the number of calls per day would still only average 2 in a hospital with a high trauma patient load. The checklist criteria were highly sensitive (97%) in identifying those patients who should have been evaluated by the trauma team. Although hospitals differ in workload and staffing, this trauma team model is recommended for more widespread use and for further evaluation and modification.     

空心螺钉内固定与人工双极股骨头置换治疗老年股骨颈骨折疗效比较

目的比较空心螺钉内固定和人工双极股骨头置换治疗股骨颈骨折的疗效。方法 65例老年股骨颈骨折患者中,35例采用空心螺钉内固定术（A组）治疗,30例采用人工双极股骨头置换（B组）治疗。观察2组手术时间、术中出血量、术后患者卧床时间及髋关节Harris评分。结果与A组比较,B组术中出血量较多（P〈0.05）、术后患者卧床时间较长（P〈0.05）、髋关节Harris评分较高。结论人工双极股骨头置换和空心螺钉内固定治疗老年股骨颈骨折疗效均可;应根据患者情况选择术式。     

a-L-岩藻糖苷酶与甲胎蛋白联合检测对原发性肝癌诊断的临床评价

目的 探讨a-L-岩藻糖苷酶(a-L-fucosidase,AFU)与甲胎蛋白(alpha fetoprotein,AFP)联合检测在原发性肝癌诊断中的临床意义.方法 对1992年～2000年在普外科和消化内科门诊及住院的358例原发性肝癌,628例良性肝病,52例肝癌介入化疗术后患者,28例转移性肝癌,81例其他肿瘤,251例正常对照者,以AFU＞600(nmol/ml.h)为阳性标准,用酶标法检测.以AFP＞20(ng/ml)为阳性标准,用放免法检测.绘制受试者工作特性曲线(receiver operating characteristic curve,ROC)并计算曲线下面积评价诊断价值.结果 原发性肝癌(primary hepatic carcinom,PHC)组血清AFU水平显著高于其他各组(P＜0.01),AFP水平与慢性肝病组、其他肿瘤组、正常对照组相比差异有统计学意义(P＜0.05).PHC组和转移性肝癌组中AFU的检出率与AFP的检出率相比差异有统计学意义(P＜0.05).结论 AFU可作为诊断PHC的一种较好的血清肿瘤标志物.AFU与AFP联合检测,可提高诊断PHC的敏感性,并可作为对PHC的疗效观察的一项指标.     

Clinical impact of the heart team on the outcomes of surgical aortic valve replacement among octogenarians

ObjectivesThe effectiveness of a multidisciplinary heart team in the management of patients with severe symptomatic aortic stenosis is unknown. This study evaluated the impact of a heart team on the outcomes of surgical aortic valve replacement in octogenarians.MethodsBetween May 2007 and January 2016, 528 patients aged 80 years or more were referred to our institutional heart team for a transcatheter aortic valve replacement. Among these, 101 were redirected to surgical aortic valve replacement (heart team group). These patients were compared with a surgical aortic valve replacement cohort (n = 506) without prior heart team screening (non-heart team group), taken from the same time period. Propensity score matching with bootstrap analysis was performed; 76 heart team patients were matched to 76 non-heart team patients. Early and late outcomes including survival and readmission for cardiovascular causes were compared.ResultsMatched subgroups were largely comparable; congestive heart failure and echocardiographic pulmonary hypertension were more prevalent in the heart team group. In-hospital mortality was significantly lower in the matched heart team group (0% vs 6.0%, bootstrap mean difference 6.0%, 95% confidence interval, 2.2-9.8). The risk of stroke, low cardiac output state, reexploration for bleeding, pneumonia, and prolonged ventilation was also significantly lower in the heart team group. There was no significant between-group difference regarding late survival (hazard ratio, 0.86, 95% confidence interval, 0.55-1.33, P = .49) or readmission for cardiovascular reasons (hazard ratio, 0.70, 95% confidence interval, 0.41-1.20, P = .19).ConclusionsPreoperative multidisciplinary assessment of octogenarians by a heart team was associated with lower in-hospital mortality and adverse events after surgical aortic valve replacement.     

红蓝混合光联合倒模治疗痤疮效果分析

目的:探讨红蓝混合光联合倒模治疗不同级别痤疮的临床疗效。方法:将629例痤疮患者按照病情程度分为Ⅱ、Ⅲ、Ⅳ三级,每级患者随机分为两组。Ⅱ级患者治疗组采用红蓝混合光联合倒模及外用药物治疗,对照组单纯采用外用药物治疗;Ⅲ、Ⅳ级患者治疗组采用红蓝混合光联合倒模及异维A酸治疗,对照组口服异维A酸,两组均使用相同的外用药物。12周后评价疗效。结果:第12周进行随访,三级患者治疗组总有效率分别为96.8%、94.4%、83.3%,对照组总有效率分别为81.1%、83.1%、68.8%。结论:红蓝混合光联合倒模治疗中重度痤疮较常规药物起效快,疗程缩短,效果显著,复发率低。     

Team development and memory training in traumatic brain injury rehabilitation: Two birds with one stone

The need for developing team cooperation procedures when treating patients with traumatic brain injury (TBI) is stated. One approach in promoting team cooperation is to combine team development with a specific training programme. A memory training programme used in a subacute TBI rehabilitation unit is described. A combination of a team development procedure and memory training programme was performed in the unit. A questionnaire to assess team members' attitudes to team cooperation was administered before and after team development, and memory training procedures were implemented. The post-training questionnaire administration indicated a more positive perception among team members of how the team functioned. The efficacy of memory training showed variable results. The programme described may illustrate the advantages of combining a specific treatment programme with efforts to promote team development.     

Preoperative tumour staging with multidisciplinary team assessment improves the outcome in locally advanced primary rectal cancer

Aim Multidisciplinary team meetings have been introduced as a result of developments in preoperative radiological tumour staging and neoadjuvant treatment. Multidisciplinary team recommendations will influence treatment decisions but their effect on patient outcome is unknown. The aim of this study was to assess outcome in relation to preoperative local and distant staging, with or without multidisciplinary team assessment. Methods A population‐based registry of all patients with rectal cancer, treated in the Stockholm region from 1995 to 2004, identified 303 patients with locally advanced primary rectal cancer. The patients were classified into three groups: group 1, preoperative local and distant radiological tumour staging with discussion at a multidisciplinary team meeting; group 2, preoperative staging but no multidisciplinary team assessment; and group 3, no proper preoperative radiological staging. Results Neoadjuvant treatment was more prevalent in groups 1 and 2 than in group 3. The incidence of R0 resection differed significantly between the groups (52% in group 1, 43% in group 2 and 21% in group 3; P < 0.001). Local tumour control was achieved in 57%, 36%, and 19% of patients in groups 1, 2 and 3, respectively (P < 0.001). The estimated overall 5‐year survival of patients was 30%, 28% and 12% in groups 1, 2 and 3, respectively. Conclusion Preoperative radiological tumour staging in patients with locally advanced primary rectal cancer and discussion at a multidisciplinary team meeting increases the proportion of patients receiving neoadjuvant treatment and cancer‐specific end‐points.     

Long-segment tracheal stenosis: slide tracheoplasty and a multidisciplinary approach improve outcomes and reduce costs

OBJECTIVE: Long-segment tracheal stenosis is rare, life-threatening, difficult, and expensive to treat. Management remains controversial. A multidisciplinary tracheal team was formed in 2000 to deal with a large number of children with airway problems referred for management. We review the effect of that service, comparing the era before and after the establishment of the multidisciplinary tracheal team. METHODS: From January 1998 through January 2004, 34 patients with long-segment tracheal stenosis (21 patients with cardiovascular anomalies) underwent surgical intervention. Cardiopulmonary bypass was used in all operations. Before the multidisciplinary tracheal team, pericardial patch tracheoplasty with or without an autograft technique was the preferred method of repair. After the multidisciplinary tracheal team, an integrated care plan preferring slide tracheoplasty was initiated, correcting cardiac lesions simultaneously. RESULTS: Before the establishment of the multidisciplinary tracheal team, pericardial patch tracheoplasty was performed in 15 of 19 patients. Twelve patients had a suspended pericardial patch tracheoplasty, 2 (17%) of whom died late after the operation. Of 3 patients who had had a simple unsuspended patch, 2 (67%) died early after the operation. Four patients were operated on with the tracheal autograft technique, 2 (50%) dying early in the postoperative period. After multidisciplinary tracheal team formation, in the era between 2001 and 2004, 15 patients were operated on with slide tracheoplasty, and there were 2 (13%) early postoperative deaths. A significant reduction in cost and duration of stay has been shown both in the intensive care unit and the hospital. CONCLUSION: Our data suggest that a formalized multidisciplinary team approach and a policy of primary slide tracheoplasty are beneficial in the management of children with long-segment tracheal stenosis.     

Q-开关Nd∶YAG激光联合强脉冲光治疗黄褐斑疗效分析

目的:探讨和评价Q-开关Nd:YAG激光联合强脉冲光(IPL)治疗黄褐斑的疗效和安全性。方法:将患者随机分为三组:Q-开关激光与强脉冲光联合治疗组:40例,先用Q-开关Nd:YAG激光治疗3次,再用强脉冲光治疗3次,间隔时间2个月;Q-开关激光治疗组:32例,采用Q-开关Nd:YAG(1064nm)激光治疗3次,间隔时间2个月;对照组:14例,采用中药祛斑面膜治疗,每周1次,连续4周1个疗程,总共完成6个疗程。所有患者治疗后防晒。结果:Q-开关激光与强脉冲光联合治疗组:治愈9例(22.50%),显效18例(45.0%),总有效率为67.50%;Q-开关激光治疗组:治愈4例(12.50%),显效13例(40.62%),总有效率为53.12%;对照组:治愈0例,显效2例(14.29%),总有效率为14.29%;Q-开关激光组与联合治疗组都取得了显著的疗效。联合治疗组色素沉着2例(5.0%),无增生性瘢痕;激光治疗组色素沉着3例(9.38%);对照组皮肤过敏1例(7.14%)。结论:Q-开关Nd:YAG激光联合强脉冲光(IPL)治疗黄褐斑安全、有效、副作用少,值得推广使用。