子宫肌瘤合并糖尿病围术期的护理干预

目的探讨子宫肌瘤合并糖尿病的围术期护理干预方法。方法对78例行手术治疗的子宫肌瘤合并糖尿病患者的临床资料进行回顾性分析,总结其围术期的护理干预方法。结果 78例患者切口Ⅰ期愈合60例,Ⅱ期愈合18例,除Ⅱ期1例发生伤口继发感染外,无其他严重并发症发生。结论对合并有糖尿病的子宫肌瘤患者,采用恰当必要的综合护理措施,可以减少并发症的发生,加快患者的恢复进程。     

胃肠道肿瘤合并糖尿病82例围术期护理

目的：探讨胃肠道肿瘤合并糖尿病患者围术期的护理方法。方法：对82例胃肠道肿瘤合并糖尿病患者采用手术治疗，通过精心围术期护理，积极控制血糖水平，防止发生糖尿病酮症酸中毒等严重并发症，做好切口及引流管的护理，术后合理饮食，预防感染。结果：82例患者术后均无严重并发症发生，无手术死亡。结论：加强胃肠道肿瘤合并糖尿病患者围术期的护理，能使患者顺利度过围术期，减少术后并发症的发生，提高手术治疗效果。     

胃肠道肿瘤合并糖尿病82例围术期护理

目的:探讨胃肠道肿瘤合并糖尿痛患者围术期的护理方法.方法:对82例胃肠道肿瘤合并糖尿病患者采用手术治疗,通过精心围术期护理,积极控制血糖水平,防止发生糖尿病酮症酸中毒等严重并发症,做好切口及引流管的护理,术后合理饮食,预防感染.结果:82例患者术后均无严重并发症发生,无手术死亡.结论:加强胃肠道肿瘤合并糖尿病患者围术期的护理,能使患者顺利度过围术期,减少术后并发症的发生,提高手术治疗效果.     

子宫肌瘤合并2型糖尿病30例围术期护理

目的:探讨子宫肌瘤合并2型糖尿病的围术期护理方法.方法:对30例子宫肌瘤合并2型糖尿病患者行经腹子宫全、次全切术,术前给予全面的护理评估、心理护理、监测血糖、严密观察病情、预防感染等措施,术后加强生命体征监测及镇痛泵、并发症的观察与护理等.结果:本组患者均痊愈出院.结论:重视子宫肌瘤合并2型糖尿病患者的围术期护理,对预防并发症、促进患者康复有重要意义.     

胃癌合并糖尿病患者围术期的饮食调护

目的 探讨胃癌合并糖尿病患者围术期护理的营养供给和饮食调护.方法 回顾性分析42例胃癌合并糖尿病患者的围术期饮食护理的临床资料.结果 42例患者择期手术,36例患者经控制血糖后施行胃癌根治术,6例采用姑息性切除手术;术中均顺利,术后出现各种并发症6例,无酮症酸中毒及死亡病例.结论 在术前、术后及出院指导中加强饮食调护,严格监测控制血糖,更有利于胃癌合并糖尿病患者安全度过围术期、延长生存期.     

子宫肌瘤合并糖尿病的围术期护理

子宫肌瘤是女性生殖器官最常见的良性肿瘤,一般采用手术治疗。子宫肌瘤合并糖尿病患者术前后容易促发或加重糖尿病的各种并发症,影响手术效果。因此,加强子宫肌瘤合并糖尿病患者的围术期护理非常重要。我科自2007年1月至2009年12月对40例合并糖尿病的子宫肌瘤患者进行手术治疗,经精心护理,效果满意,现将围术期护理体会报道如下。     

胃肠外科合并糖尿病患者围手术期的护理

胃肠科患者手术前需控制饮食，术后需先禁食，再逐渐恢复至普通饮食。此类手术创伤大，尤其合并糖尿病的患者可能因手术应激、术后禁食而加重糖尿病的症状，发生酮症酸中毒等危重并发症，如术后愈合延缓，甚至造成切口感染，吻合口瘘。因此，此类患者在围手术期各阶段应严密观察，精心护理并加强宣教，使患者血糖控制平稳，安全度过围手术期。本文报道对31例胃肠外科合并糖尿病患者围手术期的护理情况。     

专科护理干预在子宫肌瘤合并糖尿病围术期中的应用

目的:探讨子宫肌瘤并发糖尿病患者围术期护理干预方法及效果。方法:将行手术治疗的60例子宫肌瘤并发糖尿病患者随机分为对照组和观察组各30例,对照组给予围术期常规护理,观察组给予子宫肌瘤专科护理干预,严格控制围术期糖尿病病情,制定详细护理计划。结果:术后3 d观察组FBG、肛门通气恢复时间、恢复下床活动时间及住院时间明显少于对照组(P<0.05),观察组自主排尿例数和切口一级愈合例数明显多于对照组多(P<0.01)。结论:对子宫肌瘤并发糖尿病患者进行围术期专科护理干预和糖尿病控制,能明显改善术后恢复情况,减少并发症,值得推广。     

全髋关节置换术合并糖尿病患者的围手术期护理

目的:探讨全髋关节置换术合并糖尿病患者的围手术期护理。方法:对本院骨关节科2009年1月～2010年1月收治的31例全髋关节置换术合并糖尿病患者,根据患者的具体情况,制定恰当有效的护理方案,进行围手术期护理、控制和监测血糖、术后预防并发症及康复训练等。结果:31例患者均无并发症的发生,术后切口甲级愈合,病情好转出院。结论:对于全髋关节置换术并糖尿病患者,进行强化围手术期护理和严格控制血糖等措施干预,术后早期康复训练,有利于术后切口愈合,降低并发症的发生,促进患者康复。     

口腔癌合并糖尿病患者游离皮瓣移植术的围手术期护理

目的:探讨口腔癌合并糖尿病患者行游离皮瓣移植术的围术期护理方法。方法:回顾分析2010年1月~2013年12月在我院完成的20例口腔癌合并糖尿病患者行游离皮瓣移植术的病例,研究其围手术期的护理方法。结果:所有患者顺利完成手术,手术时间(6.5~13.5)h,平均手术用时(8.9±1.8)h。I期愈合16例,II期愈合4例。3例出现不同程度的血管危象,4例发生切口感染,1例出现3/4坏死,2例出现低血糖反应。结论:加强口腔癌合并糖尿病患者行游离皮瓣移植术围术期的护理能预防、减少术后并发症,提高治疗成功率。     

影响糖尿病足坏疽愈合的因素与针对性护理

目的了解影响糖尿病足坏疽（diabetic foot gangrene,DFG）愈合的因素,探讨针对影响因素的护理。方法对106例糖尿病足坏疽的影响因素如患者血浆蛋白、年龄、微循环障碍程度、足骨质破坏情况、对糖尿病知识的了解情况等进行分析。结果年龄、微循环障碍、糖尿病肾病、足骨质破坏情况等对糖尿病足坏疽愈合影响有明显的差异。一般护理与全面的护理对糖尿病足坏疽愈合影响有明显差异。结论根据患者存在的影响愈合的因素采用针对性的护理有利于患者的早日愈合、减少截肢,提高患者的生活质量。     

经股动脉持续溶栓治疗糖尿病足患者的围手术期护理

目的探讨经股动脉持续溶栓治疗糖尿病足患者的围手术期护理要点。方法对2006年2月至2011年8月收治的78例糖尿病足患者采用经股动脉持续输注尿激酶治疗,术前进行心理护理、教育干预、物品准备,建立“糖尿病足持续溶栓护理观察与评估指标”,采取动态评价。结果78例糖尿病足溃疡全部愈合,无一例发生出血、感染等严重并发症。结论围手术期专业的心理、教育干预,充分的物品准备为确保疗效奠定了基础,“护理观察与评估指标”的建立与应用可有效减少术后不良事件发生,促进溃疡面愈合,是溶栓治疗成功的关键。     

Understanding the multifaceted etiopathogenesis of foot complications in individuals with diabetes

Diabetes mellitus, a chronic disease of metabolism, is characterized by a disordered production or cellular utilization of insulin. Diabetic foot disease, which comprises the spectrum of infection, ulceration, and gangrene, is one of the most severe complications of diabetes and is the most common cause of hospitalization in diabetic patients. The aim of this study is to provide an evidence-based overview of diabetic foot complications. Due to neuropathy, diabetic foot infections can occur in the form of ulcers and minor skin lesions. In patients with diabetic foot ulcers, ischemia and infection are the main causes of non-healing ulcers and amputations. Hyperglycemia compromises the immune system of individuals with diabetes, leading to persistent inflammation and delayed wound healing. In addition, the treatment of diabetic foot infections is challenging due to difficulty in accurate identification of pathogenic microorganisms and the widespread issue of antimicrobial resistance. As a further complicating factor, the warning signs and symptoms of diabetic foot problems can easily be overlooked. Issues associated with diabetic foot complications include peripheral arterial disease and osteomyelitis; accordingly, the risk of these complications in people with diabetes should be assessed annually. Although antimicrobial agents represent the mainstay of treatment for diabetic foot infections, if peripheral arterial disease is present, revascularization should be considered to prevent limb amputation. A multidisciplinary approach to the prevention, diagnosis, and treatment of diabetic patients, including those with foot ulcers, is of the utmost importance to reduce the cost of treatment and avoid major adverse consequences such as amputation.     

Observation of the effect of one-to-one education on high-risk cases of diabetic foot

BACKGROUNDDiabetes is a common chronic disease, and its global incidence is on the rise. The disease is directly attributed to insufficient insulin efficacy/secretion, and patients are often accompanied by multiple complications. Diabetic foot is one of the most common complications of diabetes. Diabetic feet have ulcers and infections, which can eventually lead to amputation. Basic nursing care, such as lowering blood pressure and preventing foot skin infections in clinical nursing work, has positive significance for the prevention and control of diabetic feet.AIMTo explore the positive significance of one-to-one education in high-risk cases of diabetic foot.METHODSThis observation included 98 high-risk cases of diabetic foot in our hospital during the period from August 2017 to October 2019, and these patients were randomly divided into the basic nursing group and the one-to-one education group with 49 patients per group. The basic nursing group only received routine basic nursing, while the one-to-one education group gave patients one-to-one education on the basis of basic nursing. After nursing, the self-care ability and compliance behavior of the two groups were evaluated and compared between these two groups. The knowledge mastery of the patient and the satisfaction of nursing were accounted.RESULTSThe assessment results of patients (self-care responsibility, self-care skills, self-concept and self-care knowledge) were significantly higher in the one-to-one education group than in the basic nursing group. The scores of compliance behaviors (foot bathing, shoes and socks selection, sports health care) in the one-to-one education group were significantly higher than those in the basic nursing group. Patients in the one-to-one education group had a significantly higher level of knowledge mastery and satisfaction of nursing than the basic nursing group.CONCLUSIONOne-to-one education for high-risk cases of diabetic foot is helpful to improve the cognition and self-care ability of patients with diabetic foot, to ensure that patients follow the doctor’s advice of self-care and to improve their nursing satisfaction.     

直肠癌合并糖尿病患者的围手术期护理

目的探讨直肠癌合并糖尿病患者的围手术期护理经验。方法术前评估病情,合理制订护理计划及健康宣教,加强饮食调节,术后严密观察病情变化,做好围手术期血糖监控、治疗,预防感染,防止并发症的发生。结果44例患者切口恢复良好,I期愈合36例,II期愈合8例,无1例死亡,平均住院日17.1d。结论周密的围手术期护理对预防并发症的发生,提高糖尿病合并直肠癌患者手术的安全性具有重要的意义。     

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.     

子宫肌瘤合并糖尿病患者的围术期护理研究

目的探讨子宫肌瘤合并糖尿病患者围术期的护理。方法选取本院子宫肌瘤合并糖尿病患者120例,采用随机数表法分为观察组与对照组各60例,观察组给予自护理论护理,对照组给予常规护理,观察比较2组患者遵医行为、自理能力、胰岛注射、饮食控制自己血糖检测情况、术后肛门排气时间、切口愈合时间、首如厕时间以及术后下床活动时间、排尿情况。结果护理后,观察组患者的遵医行为、自理能力、胰岛注射、饮食控制自己血糖检测情况均优于对照组患者(P0.05);护理后,观察组患者术后肛门排气时间、切口愈合时间、首如厕时间以及术后下床活动时间均短于对照组(P0.05);术后观察组能够自主排尿的患者显著高于对照组(P0.05),尿潴留以及需要诱导排尿的患者均低于对照组(P0.05)。结论在子宫肌瘤合并糖尿病患者中应用自我护理措施,可促进患者身体早日康复,提高护理效果。     

Inpatient Management of Diabetic Foot Disorders: A Clinical Guide

The implementation of an inpatient diabetic foot service should be the goal of all institutions that care for patients with diabetes. The objectives of this team are to prevent problems in patients while hospitalized, provide curative measures for patients admitted with diabetic foot disorders, and optimize the transition from inpatient to outpatient care. Essential skills that are required for an inpatient team include the ability to stage a foot wound, assess for peripheral vascular disease, neuropathy, wound infection, and the need for debridement; appropriately culture a wound and select antibiotic therapy; provide, directly or indirectly, for optimal metabolic control; and implement effective discharge planning to prevent a recurrence. Diabetic foot ulcers may be present in patients who are admitted for nonfoot problems, and these ulcers should be evaluated by the diabetic foot team during the hospitalization. Pathways should be in place for urgent or emergent treatment of diabetic foot infections and neuropathic fractures/dislocations. Surgeons involved with these patients should have knowledge and interest in limb preservation techniques. Prevention of iatrogenic foot complications, such as pressure sores of the heel, should be a priority in patients with diabetes who are admitted for any reason: all hospitalized diabetic patients require a clinical foot exam on admission to identify risk factors such as loss of sensation or ischemia. Appropriate posthospitalization monitoring to reduce the risk of reulceration and infection should be available, which should include optimal glycemic control and correction of any fluid and electrolyte disturbances.The implementation of an inpatient diabetic foot service should be the goal of all institutions that care for patients with diabetes. The objectives of this team are to prevent problems in patients while hospitalized, provide curative measures for patients admitted with diabetic foot disorders and to optimize the transition from inpatient to outpatient care. Pathways for the outpatient management of diabetic foot disorders are available; however, little has been written on the inpatient management of these disorders while patients are hospitalized. A multidisciplinary group was assembled on the basis of their experience in treating patients with diabetic foot disorders and tasked with preparing a guideline to assist practitioners who care for hospitalized patients. Medical specialists (infectious disease, hospital medicine, and endocrinology), surgical specialists (podiatry, plastic surgery, and orthopedic surgery), diabetes educators, and nursing staff contributed to this article. Members were assigned to research and write on their areas of expertise using an evidence-based approach and incorporating their own expert opinions when a lack of evidence existed.The lower extremity manifestations of diabetes are multifactorial, and the approach to treatment and prevention of complications should take each of the key factors into consideration. Physicians, surgeons, nurses and other staff play a central role in the management and screening of the inpatient with diabetes (1). Although the staffing of this team might vary from region to region, or even over time, the skill sets required remain constant. For patients with diabetes whose primary admission is not for a lower extremity wound, provisions should be made during the hospitalization to screen for diabetic foot complications and implement preventative care practices. Nondiabetic patients presenting with foot lesions, particularly if neuropathic and/or ischemic, should be screened for diabetes: foot ulcers and infection may be the presenting sign of diabetes.     

腹腔镜子宫肌瘤剔除术联合子宫动脉阻断术患者围手术期护理

目的对腹腔镜子宫肌瘤剔除术联合子宫动脉阻断术患者围手术期护理护理方法及经验进行总结。方法对86例患者开展腹腔镜子宫肌瘤剔除术联合子宫动脉阻断术,按照规范进行围手术期护理。结果术后随访1~18个月,86例患者症状明显改善,所有患者围手术期无1例发生护理并发症。结论腹腔镜子宫肌瘤剔除术联合子宫动脉阻断术需要责任护士高度的重视及熟练的护理技能,对病情变化要严密观察和及时处理,防止、减少并发症的发生,保证手术的成功。     

利用足部护理箱开展老年糖尿病患者糖尿病足的健康教育

目的：提高老年糖尿病患者足部护理能力。方法对80例住院老年糖尿病患者,应用足部护理箱,开展有关糖尿病足相关知识的健康教育。内容包括对糖尿病足的早期筛查,糖尿病足日常护理,足部的检查,选择合适的鞋袜,促进肢体血液循环的锻炼和糖尿病足部常见问题等。结果干预2周采用自制“糖尿病足部自护能力评估表”评价80例患者的足部自护能力。结果显示：教育后,患者对足部糖尿病各项相关知识知晓率达到91%～96%,患者都建立了自己的足部护理箱。结论采用图、文及教育工具相结合的教育方式,符合老年人的特点,能激发患者学习兴趣,有效提高健康教育效果和患者的足部护理能力。