不同口腔护理液对口咽置管患者口腔内环境的影响

目的探讨4种口腔护理液对口腔内环境的影响。方法将120例口咽置管脑卒中患者随机分为四组各30例,分别采用生理盐水、0.3%过氧化氢、口洁液、2%碳酸氢钠作为护理液进行口腔护理。分别统计口腔pH及口臭和口腔炎发生率。结果过氧化氢组和口洁液组口腔护理后口腔平均pH值在正常范围。碳酸氢钠组、过氧化氢组、口洁液组口臭发生率相对低于生理盐水组。口洁液组口腔感染发生率最低。结论口咽置管患者可首选口洁液进行口腔护理。     

气管插管危重患者口腔护理的循证实践

目的将现有的气管插管患者口腔护理的最佳证据应用于护理实践,促进护士依据循证进行口腔护理实践的行为,提高口腔护理效果。方法根据JBI的最佳实践手册,基于现有最佳证据,制定4条审查标准,对145名护士及199例患者进行基线审查,依据审查对护士进行培训和将证据应用于259例患者口腔护理实践;3个月后进行第2轮审查。结果第2轮审查,4条审查标准执行率从42.1%~68.3%升至100%。护士理论操作考核成绩从51、43分提高到93、89分;患者口腔卫生评分从16.85分降至13.36分、VAP发生率从21.7例/千机械通气日降至7.4例/千机械通气日(P0.05,P0.01)。结论基于循证的质量审查项目改善护士应用最佳证据的执行行为,有效提高气管插管危重患者口腔护理效果。     

The importance of perioperative oral care

Postoperative complications sometimes follow ablasive surgery. Anesthesiologists usually pay much attention to the oral cavity when they intubate. However, they are not fully aware of the importance of perioperative oral care. Perioperative oral care in cooperation with a dental team enables to reduces the risk of postoperative complications and allows the safe and smooth completion of the treatment procedure safely and smoothly. Recently, the comprehensive health care system started, and we had to keep the occurrence of postoperative complications as low as possible and seek the quick recovery from the postoperative stage. Oral care, therefore, is an essential care, and can help guarantee the high quality results with general anesthesia.     

冲洗法在经口气管插管患者口腔护理中的应用

目的 探讨安全、有效的经口气管插管口腔护理的方法.方法 随机将100例经口气管插管患者分为对照组(48例)和观察组(52例).对照组采用传统法行口腔护理;观察组先用浸湿生理盐水棉球擦洗口腔,再用去针头20 ml注射器抽吸生理盐水缓慢冲洗,边冲边用一次性吸痰管吸出口腔内液体.结果 两组患者的口臭、口腔溃疡及口腔霉菌发生率比较,差异有统计学意义(P＜0.05,P＜0.01).结论 冲洗法能降低经口气管插管患者的口臭和口腔霉菌发生,但有增加溃疡发生的风险.     

The importance of beta-lactamase resistance in surgical infections

Substantial costs are associated with the treatment of nosocomial infections, 2 million cases of which occur annually in the United States. Hospital-acquired, gram-negative infection has become an increasing problem, particularly in the intensive care unit where up to 40% of the most frequently isolated strains of Enterobacteriaceae are resistant to standard beta-lactam antibiotics. Among several mechanisms of acquisition of resistance, beta-lactamase production accounts for a high percentage of treatment failures and relapses. By the end of the 1980s, some 10-30% of all nosocomial infections were caused by type-1 beta-lactamase-producing gram-negative isolates, and Enterobacter species had emerged as a major resistant pathogen. The beta-lactam/beta-lactamase inhibitor combinations, such as ampicillin/sulbactam, represent an innovative approach to the problem of beta-lactamase-mediated resistance. Clinical use of these agents has been associated with low rates of resistance and new data suggest they may have a specific role in controlling the emergence and spread of nosocomial infections.     

电动牙刷刷牙冲洗法用于经口气管插管口腔护理

目的探讨应用小儿电动牙刷刷牙冲洗法对经口气管插管患者口腔护理的效果。方法将160例经口气管插管重症患者随机分为观察组和对照组各80例。观察组采用电动牙刷刷洗及负压吸引行口腔护理;对照组采用生理盐水棉球行口腔护理。结果观察组牙菌斑、口腔异味、口腔残留物发生率及口腔细菌阳性率显著低于对照组,口腔pH值显著高于对照组(均P<0.01)。结论对经口气管插管患者采用电动牙刷刷牙冲洗法进行口腔护理效果优于传统棉球擦洗法。     

Health care provision and surgical education in South Africa

Apartheid policies have led to inequalities in the delivery of health care and the training of surgeons in South Africa. The nation's population of 33 million is comprised of 73.6% Blacks, 14.8% Whites, 8.8% Coloureds, and 2.7% Asians. Only 17% of the population are covered by medical insurance (78% of Whites, 28% of Asians, 26% of Coloureds, 4% of Blacks) that funds the private sector which accounts for 46% of the nation's total health care expenditure of 9.2156 million rand. The remainder receive care from curative state hospital based services, which consume 77% of the public expenditure on health. Preventive and promotive health services account for 23%. only 3.2% of South Africa's gross national product is spent on health care provision for 80% of the population-well short of the World Health Organization's recommendation of 5.8%. This figure translates into a per capita expenditure of 138, 340, 356, and 597 rands for Blacks, Coloureds, Asians, and Whites, respectively. Eight medical schools produce just over 900 graduates per year, 80% of whom are white. The medium of instruction is English at five (Cape Town, Witwatersrand, Natal, MEDUNSA, and Transkei) and Afrikaans at three (Pretoria, Stellenbosch, and Bloemfontein). Natal and MEDUNSA are creations of apartheid and have graduated almost all the Black South African doctors, of whom only 15 are practicing surgeons. Many universities are cognizant that dramatic change is needed to redress such imbalances, and admission policies are changing. Schools are addressing the implications of admitting many more Black African students from less privileged educational backgrounds into their medical faculties. Only then will more nonwhite graduates emerge with excellent, well monitored specialist training in surgery, which until now has been the domain of mainly white doctors.

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Resumen Las políticas del Apartheid han resultado en desigualdades en cuanto a la provisión de la atención de la salud y a la capacitación de los cirujanos en Sur Africa. La población del país está conformada por 74% de negros, 14% de blancos, 8% de color y 2% de asiáticos. Sólo el 17% de la población se halla cubierta por seguros médicos (78% blancos, 28% asiáticos, 26% de color, 4% negros) que financian el 46% del total del gasto nacional en atención de la salud, 9.215,6 millones de rand. El resto recibe atención por parte de servicios con base en hospitales que consumen 77% del gasto público en salud. Los servicios de promoción y prevención de la salud representan el 23% del gasto. Sólo 3.2% del GNB de Sur Africa se emplea en la provisión de servicios de salud para el 80% de la población, una cifra muy inferior al 5.8% que recomienda la Organización Múndial de la Salud. Esto se traduce en un gasto per cápita de 180, 340, 356 y 597 rands para los negros, de color, asiáticos y blancos, respectivamente.Ocho facultades de medicina producen algo más de 900 graduados anualmente, 80% de los cuales son blancos. El idioma de la instrucción es el inglés en cinco de ellas (Ciudad del Cabo, Witwatersrand, Natal, MEDUNSA y Transkrei) y el Afrikaan en tres (Pretoria, Stellenbosch y Bloemfontein). Natal y MEDUNSA, como creaciones de apartheid, gradúan casi exclusivamente doctores sur africanos negros, de los cuales solamente 15 son cirujanos en ejercicio.Muchas universidades son conscientes de que se requiere un cambio dramático para corregir tales desequilibrios, y ya las políticas de admisión están en proceso de modificación. Las facultades de medicina se ocupan de estudiar las implicaciones de recibir un número muy superior de estudiantes negros y africanos provenientes de los sectores menos privilegiados. Sólo entonces lograrán muchos de los graduados no blancos ascender a excelentes programas de adiestramiento especializado en cirugía, los cuales hasta ahora han sido monopolio predominante de los doctores blancos.

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Résumé La politique de l'arparthéid a considérablement influencé l'administration des soins et l'enseignement des chirurgiens en Afrique du Sud. La population de la nation est de 33 millions d'habitants, dont 74% sont noirs, 14% sont blancs, 8% de peau rouge et 2% sont des asiatiques. Seulement 17% de la population a une couverture médicale (78% sont des Blancs, 28% sont des Asiatiques, 26% sont des peaux rouges, 4% sont des noirs), assurée par une contribution de fonds privés qui correspond à 46% du total des coûts de la nation, et qui s'élève à quelques 9215.6 millions de rands. Le restant de la population reçoit des soins dans les hôpitaux de l'état qui sont responsbles de 77% des dépenses de santé de la nation. Les services de santé préventifs et éducatifs dépensent 23% des fonds. Seulement 3.2% du produit national brut de l'Afrique du Sud est dépensé pour soigner 80% de la population, bien moins que les 5.8% recommandés par l'O.M.S. Ceci veut dire que les dépenses par habitant sont respectivement de 138, 340, 356, et 597 pour les Noirs, les Rouges, le Asiatiques et les Blancs. Huit écoles de Médecine sont responsables de la formation de 900 diplômés par an, parmi lesquels 80% sont blancs. L'enseignement est fait en Anglais dans cinq écoles (Cape, Witwatesrand, Natal, MEDUNSA et Transkei) et en Afrikaans dans trois (Pretoria, Stellenbosch, et Bloemfontein). Les écoles de Natal et MEDUNSA sont des créations de l'Apartheid et fournissent pratiquement tous les diplômés en médecine noirs. Parmi ceux-là, seulement 15 sont des chirurgiens qui exercent réellement leur métier. La plupart des universités sont conscients qu'il faut réviser cette politique et des changements sont en train de se faire. Plusieurs écoles de médecine étudient acketuellement comment elles peuvent recevoir d'avantage d'étudiants noirs provenant des milieux moins favorisés. A ce monment-là, seulement, verra-t-on sans doute d'avantage de diplômés non blancs provement des écoles de chirurgie dont les enseignants sont reconnus comme spécialistes, postes jusqu'à maintenant reservés aux seuls médecins blancs.

     

微信公众平台在围手术期患者人文关怀中的应用

目的探讨微信公众平台用于围手术期患者人文关怀的护理效果。方法将260例择期手术患者随机分为对照组与观察组各130例。对照组给予常规手术室人文关怀;观察组在手术室微信公众平台上增设人文关怀模块,用于患者术前、术中及术后的人文关怀护理。结果观察组患者术后焦虑程度显著低于对照组,患者及家属满意度显著高于对照组(均P0.05)。结论微信公众平台应用于手术患者及家属人文关怀护理,可有效缓解患者焦虑情绪,提高患者及家属满意度。     

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术后肺部并发症是最常见的，也是外科病人术后最主要的死亡原因。据统计，确诊为院内肺炎的病例中，3／4发生于术后及应用呼吸道器械后，其病死率高达10％～30％。术前已有呼吸道疾病者，术后肺部并发症的发生率要比其他人群高得多，Wightman报道前者约为26％，而后者只有8．2％。创伤合并休克、胸部及颅脑外伤、严重烧伤     

The importance of surgical evaluation of patients with "Turner-like" sex chromosomal abnormalities

Children with "pure" gonadal dysgenesis do not require abdominal explorations to remove their gonads, because the risk of development of malignancy is minimal. Children with "mixed" gonadal dysgenesis, who usually present with sexual ambiguity, need to have gonadectomy because of the high incidence of malignancy in these gonads. We present four children (three adolescents and one two year old) who presented with minimal somatic anomalies, who did not have sexual ambiguity. The prominent features were primary amenorrhea and short stature in the adolescents, and minor dysmorphic features in the small child. On the basis of these physical features, complete genetic evaluation was carried out, and a Y chromosome or an unidentifiable fragment was identified in all four cases. At exploration, bilateral genital streaks were found, and were removed. In addition to the usual microscopic features of the streaks, Leydig cells and tubular structures resembling rete testis were seen in all the gonads. In one gonad, a gonadoblastoma was found. Since this type of gonad is "at risk" for the development of gonadoblastoma, the need for complete genetic evaluation of all females with "Turner-like" chromosomal abnormalities, although phenotypically female, is emphasized. If a Y chromosome or any unusual fragment is identified, exploration should be carried out, and any gonad that is not a normal ovary should be removed.