小儿口腔日间门诊手术的围术期麻醉护理

[目的]探讨小儿口腔日间门诊手术的围术期麻醉护理模式。[方法]选取行插管全身麻醉下日间手术的患儿120例,给予实施日间围术期照护。[结果]113例患儿均顺利完成日间手术,7例患儿经评估暂停日间手术,围术期并发症包括1例患儿术后恢复室(PACU)尿潴留,2例患儿出现高体温,5例患儿出现术后躁动,无严重并发症及不良后果发生。[结论]在围术期对小儿口腔日间门诊手术进行规范化的麻醉护理,可辅助改善小儿日间手术与麻醉流程,是安全度过围术期的保障。     

婴幼儿先心病术后呼吸道管理体会

先天性心脏病患儿多伴有心功能不全，肺功能差，全麻开胸手术后肺功能受到损伤，同时呼吸机的应用影响了呼吸道的正常生理功能，因此，小儿开胸术后极易发生呼吸系统并发症，如护理不当会影响手术效果，严重者可导致患儿死亡。2007年1月～2008年10月，我们对89例先心病患儿进行了全麻体外循环下心脏外科手术，术后通过加强呼吸道管理，避免了呼吸道并发症的发生，取得了良好的临床效果，现将护理体会总结如下。     

快速康复外科理念下日间手术的麻醉与围术期质量控制

日间手术模式是一种加速康复理念下的手术诊疗康复体系,我国的日间手术正处于高速发展状态中,日间手术医疗质量管理也越来越受到重视。本文围绕日间手术的围术期管理进行了阐述,从患者选择、手术麻醉选择、术中管理、术后镇痛、术后恶心呕吐管理和出院随访等方面探讨了日间手术的管理细节,旨在建立统一的日间手术麻醉质量管理模式、进行全面的质量改进,为临床日间手术管理提供更恰当的日间手术管理方法,才能更好地促进日间手术的健康、快速、高效的发展。     

标准操作程序在小儿白内障日间全麻手术中的应用

目的探讨标准操作程序在小儿白内障日间全麻手术护理中的应用效果。方法选取2018年7—12月我院收治的白内障患儿62例(91眼),在患儿围手术期采用小儿白内障日间全麻手术护理标准操作程序护理。结果 62例患儿(91眼)手术顺利完成,均在24 h内出院,未发生护理不良事件,术后未出现并发症,患儿家长满意率达98. 39%(61/62)。结论小儿白内障日间全麻手术标准操作程序的应用能规范护士的护理行为,对保证患儿安全、提高工作效率和家属的照护能力起到重要作用。     

胸外科老年病人围术期夜间呼吸道护理

开胸手术是治疗许多疾病的重要手段，但由于手术时间长、创伤大，术后肺功能损害明显，黏液分泌紊乱和清除障碍，极易导致肺部并发症的发生，而术后肺部并发症是增加术后死亡率的重要因素，加强术后呼吸道护理与管理是防止术后肺部并发症发生的关键。从2006年10月～2008年1月我们对56例老年胸外科术后病人在做好日间护理的基础上，加强夜间呼吸道护理与管理，取得了满意效果，现将护理报道如下。     

人性化护理结合亲情干预对小儿疝气手术患儿疼痛、睡眠质量及并发症的影响

目的：探讨人性化护理结合亲情干预对小儿疝气手术患儿疼痛、睡眠质量及并发症的影响。方法：选取2021年1月至2022年12月福建省厦门市妇幼保健院小儿外科手术治疗的小儿疝气患儿68例作为研究对象,按照随机数字表法分为对照组和观察组,每组34例。对照组患儿根据手术和疾病治疗需求实施常规护理干预,观察组在对照组基础上加用人性化护理结合亲情干预,比较2组患儿术后疼痛、睡眠质量和并发症发生情况。结果：观察组术后12、24、48、72 h Wong-Baker疼痛评分均低于对照组(P<0.05)。观察组术后当天及术后第2、3、4 d阿森斯失眠量表(AIS)评分低于对照组(P<0.05)。结论：人性化护理结合亲情干预可有效改善患儿术后睡眠质量,并可减轻术后疼痛,降低并发症风险,有助于患儿术后顺利康复,应用于疝气手术患儿安全可靠,应用价值较高。     

加速康复外科理念下的日间手术麻醉管理

加速康复外科（enhanced recovery after surgery, ERAS）旨在通过多学科参与的循证干预措施改善围手术期结果，ERAS理念的实施已被证明可减少术后并发症与住院时长。ERAS理念下的麻醉管理是日间手术安全与平稳进行的基础。该文总结了国内外最新临床研究证据，从术前优化、麻醉方式选择、通气策略、液体管理、体温支持、疼痛管理、术后恶心呕吐预防、术后营养支持、改善术后睡眠等方面对ERAS理念下的日间手术麻醉管理进行综述，旨在为日间手术的麻醉管理提供参考。     

以患者需求为导向构建围术期管理移动医疗手机应用软件

目的以患者需求为导向构建应用于日间手术患者的围术期管理移动医疗手机应用软件(m-APP)的内容及功能。方法采用自制问卷调查日间手术患者对围术期管理m-APP的需求,通过医疗与信息技术团队3次头脑风暴,最终确定m-APP的功能及内容。结果日间手术患者对围术期管理m-APP需求较高,根据患者需求将该围术期管理m-APP内容划分为"我的手术""在线咨询""术后随访""健康讲堂""术后康复计划"及"专线服务"6大板块,从功能上支持患者在线预约手术、在线问诊、在线查看检查报告、术后在线随访、术后在线健康教育等围术期相关活动。结论基于日间手术患者需求分析构建的围术期管理m-APP内容与功能较完善、针对性强,最大程度满足患者需求,标志着日间手术"互联网+医疗"围术期管理新模式的启航。     

小儿后腹腔镜肾盂成形术34例围术期护理

目的:探讨肾孟输尿管梗阻性患儿经后腹腔镜肾盂成形术围术期的护理方法.方法:对34例行后腹腔镜肾盂成形术患儿术前做好心理护理、辅助检查、改善营养状况等,术后给予严密病情监护、引流管护理、并发症的防治及出院指导等.结果:患儿术后肾积水症状缓解,术后7～15 d治愈出院.结论:小儿后腹腔镜肾盂成形术的手术成功率高,并发症少,创伤小,恢复快,充分体现了腹腔镜手术的微创优势,加强围术期护理是促进康复的有利措施.     

小儿烧伤整形植皮全麻术后气道护理

目的 探讨小儿整形植皮全麻术后呼吸道护理在减少并发症中的重要作用。方法 对81例整形植皮全麻术后患儿进行呼吸道护理；密切观察病情变化及加强麻醉苏醒后躁动期护理。结果 81例小儿整形植皮全麻术后实施呼吸道护理取得满意效果，无1例并发症发生，均康复出院。结论 有针对性地做好整形植皮全麻术后呼吸道护理是保证小儿整形植皮手术成功关键。     

Ambulatory anesthesia in surgical practice in children

A brief historical overview of the stages of development of outpatient surgery and anesthesiology is provided. It displays features of pre-selection and evaluation of patients for pediatric ambulatory surgery, the relation to the problems of preoperative fasting, anesthesia with concomitant diseases, the relative and absolute contraindications to outpatient surgeries in children. The research discusses the need and form of administration of sedative drugs in premedication in children of different ages, their influence on the recovery time after anesthesia. Compares methods of induction and maintenance of anesthesia, the possible use of volatile and intravenous anesthetics in ambulatory surgery in children, the advantages and disadvantages of given methods, as well as options for their combination with regional blocks. Pays attention to the postoperative analgesia and control of postoperative nausea and vomiting, consider their side effects.     

Effect of choices on breathing exercises post-open heart surgery

Pulmonary complications following open heart surgery are a major cause of morbidity and mortality. Patients, especially pediatric patients, are reluctant to perform postoperative breathing exercises to prevent respiratory complications. This research provides the critical care nurse with a strategy to encourage the children to perform their breathing exercises more willingly.     

Updates in Pediatric Regional Anesthesia and Its Role in the Treatment of Acute Pain in the Ambulatory Setting

Purpose of Review

The purpose of this review is to summarize the latest advances in pediatric regional anesthesia with special emphasis on its role in the ambulatory surgical setting.

Recent Findings

Undertreated pain in children following ambulatory surgery is not a rare occurrence and it is associated with increased morbidity and significant psychosocial harm. Use of regional anesthesia as part of the anesthetic approach in the ambulatory setting is safe when performed on children under general anesthesia and inclusion of certain adjuncts improves block outcomes. Ultrasonographic visualization during blockade improves safety and prolongs duration. Ambulatory continuous nerve blocks in older children are safe, efficacious, and associated with high patient and caregiver satisfaction rates.

Summary

In the ever-growing field of pediatric same-day surgery, safe and efficient flow through the perioperative period necessitates use of a multimodal approach, of which regional anesthesia is but one important component. Perioperative complications are minimized with less opioid use, and yet appropriate pain management must be ensured. Pediatric regional anesthesia has been shown to be exceedingly safe under general anesthesia. Findings demonstrate that advances in ultrasound technology have contributed to safer and longer-lasting analgesia. It facilitates the development of new methods by which regional anesthesia can improve postoperative analgesia in children upon discharge and beyond.

     

Patient care after discharge from the ambulatory surgical center

An important and often forgotten aspect of postoperative care occurs after the patient is discharged from the ambulatory surgical center. With more than 60% of all surgeries and procedures occurring on an ambulatory basis, what happens after the patient is no longer in continuous professional care is of concern to the ambulatory nurse. Numerous physical postoperative complaints are common and expected sequelae of anesthesia and surgery in the ambulatory patient. In this article, important postdischarge complications are reviewed and contemporary management options discussed. The information contained in this review article is valuable to the provider in educating patients regarding their anticipated course of postoperative recovery. OBJECTIVES: -Based on the content of this article, the reader should be able to (1) identify important postdischarge complications to provide patients with comprehensive discharge instructions regarding their continued recovery at home; (2) discuss contemporary management options available to treat postdischarge complications; (3) realize the incidence of specific postdischarge complications and how that relates to patient satisfaction with the surgical experience; (4) recognize signs and symptoms of postdischarge complications; and (5) identify risk factors of patients for developing specific complications in the postoperative phase.     

Surgery: not just for hospitals anymore. Part 2: EMS response to postoperative complications

Patients who have undergone a surgical procedure at an ambulatory surgery center, hospital or physician's office may experience postoperative complications. This article examines the types of postoperative complications that can occur following outpatient procedures, with recommendations for EMS patient care and issues related to patient transport.     

日间手术模式的实践及经验

探讨日间手术模式的运行流程及效果,并对日间手术的管理及优势予以总结。2009年10月一2011年2月,我中心采用日间手术模式对普外、儿外、泌尿、耳鼻喉、眼、消化、肾脏等疾病患者施行手术治疗。顺利完成日间手术约5900余例,日间手术成功率l00％,未发生1例因为迟发并发症而重新人院治疗事件,患者及家属对各自的治疗方案满意。合理的日间手术模式和流程,可以最大限度地减少医疗费用,缩短患者等待入院和行手术时间,提高床位周转率和利用率,符合医患双方的利益。     

日间手术在小儿外科开展的护理体会

目的：凭我院儿科接诊儿科患者资料,分析日间手术的护理体会。方法：对我院小儿外科所有患儿进行建档,抽取其中150例患儿(纳入时间2021年1月～2022年1月),采用骰子法单双数法将患儿分成两组,一般组行常规护理(n=75),护理组行日间手术护理(n=75),对两组患儿的护理及治疗情况进行探索。结果：一般组患儿恶心呕吐、创面感染、创面渗血的发生率高(P＜0.05),用Zung式心理法评估患儿的SDS(抑郁自评量表)、SAS(焦虑自评量),发现护理组的评分低,且患儿家长的护理满意度高(P＜0.05)。结论：日间手术护理具有较好的作用,对患儿预后恢复是有利的,尤其是可降低患儿术后感染的风险,并发症发生率低,患儿家长对整体护理满意度、认可度较高,值得推广。     

miniPCNL治疗小儿上尿路结石18例临床疗效观察

[目的]探讨微创经皮肾镜碎石取石(miniPCNL)治疗小儿上尿路结石的应用价值.[方法]本院2008年4月至2010年12月小儿上尿路结石18例,其中多发性结石10例,鹿角形结石4例.单纯性输尿管上段结石2例,肾结石合并输尿管上段结石2例.患儿均行m-PCNL,采用F16或F14通道,取石后常规顺行放置F4.3DJ管,并留置肾造瘘管.部分患儿术后联合ESWL治疗.1例UPJO(肾盂输尿管连接处狭窄)患儿行m-PCNL同时顺行肾盂输尿管钬激光内切开术.[结果]18例患儿中一期m-PCNL15例,一期成功率83.3%(15/18),3例行二期m-PCNL,2患儿术后联合ESWL治疗.未出现大出血等术后严重并发症.18例患儿术后肾功能均恢复良好,术后随访3个月～2年,未见输尿管狭窄等并发症.[结论]MPCNL是治疗小儿上尿路结石安全、有效的治疗方法;MPCNL联合ESWL成功率更高.     

New approaches in cardiac surgery for the therapy of congenital heart disease

Recent developments in the field of pediatric cardiac surgery and pediatric cardiology have led to significant changes in the surgical approach to the various cardiac malformations. There is a clear trend towards surgical treatment at a younger age of the patient, towards complete correction of malformations instead of staged procedures with initial palliation and delayed correction. Perioperative cardioprotection has improved significantly as has postoperative management in specialized pediatric cardiac intensive care units. As a result of this, mortality and morbidity of pediatric cardiac surgery have been in steady decline, although complexity of cardiac surgery in even smaller children has increased. Preoperative diagnostic work-up of the cardiac malformation can nowadays be achieved in an always increasing number of patients without invasive cardiac catheterization and based exclusively on ultrasound findings alone. A new element comes from the possibilities of therapeutic cardiac catheterization, which now allows for a combined therapeutic approach using therapeutic catheter procedures either to perform preparatory interventions prior to surgery or to treat surgical complications in the postoperative course. Refinements in the use of surgical implants have led to new possibilities of correction of complex malformations early in life, especially with regard to the use of biological prosthesis for valvar or outflow tract replacement.     

A perioperative education program for pediatric patients and their parents

Preparing pediatric patients for surgery is crucial to positive patient and parent experiences. Through preoperative screening, observation, and postoperative feedback, clinical staff nurses at the Yellowstone Surgery Center (YSC) in Billings, Montana, identified a need to provide increased information to pediatric patients and their parents regarding the surgical process and postoperative expectations for recovery. The director of nursing developed a program for patients that includes preoperative education and a hands-on experience. The YSC Kids program is a customizable program that includes nine initiatives designed specifically for children. The program has been shown to successfully educate pediatric patients and their parents about the entire perioperative process, thus easing their anxiety about an unfamiliar situation.