肠造口皮肤黏膜分离合并造口回缩的护理干预

目的 总结肠造口术后患者皮肤黏膜分离并造口回缩的护理经验.方法 行肠造口手术患者64例中,5例术后发生皮肤黏膜分离合并造口回缩,予以积极的全身治疗及心理护理,正确的伤口评估与处理以及营养和健康教育.结果 4例术后18～28 d伤口愈合出院;1例保守治疗效果不佳于术后14 d行造口重建,重建后14 d愈合出院.结论 术后需严密观察造口血运及周围皮肤状况,及时发现和早期处理患者皮肤黏膜分离及造口回缩等并发症,以利于提高患者生活质量.     

肠造口患者围手术期的护理

目的：提高肠造口患者的生活质量。方法：通过对69例肠造口者进行术前评估、术前心理辅导、术后评估、造口及造口周围皮肤并发症的观察和及时对症处理、指导患者掌握造口的护理、合理选择造口用品、做好出院指导。结果：69例患者均能接纳肠造口手术；68例患者出院前能掌握造口护理的方法和技巧，并能进行自我护理造口；6例患者出现造口及造口周围皮肤并发症能及时发现，及时给予恰当的处理，减轻了患者的痛苦。结论：做好肠造口患者的围手术期护理，能促进患者康复，提高患者的生活质量。     

肠造口术后并发症的护理

目的:探讨肠造口术后的患者出现常见并发症的原因及预防措施.方法:回顾性分析16例肠造口术后出现并发症的患者的临床资料,对其进行分析总结原因,制定相应的护理措施.结果:出现肠造口渗血3例,造口皮肤粘膜分离4例,发生造瘘口狭窄者3例,回肠造口回缩者发生龚水性皮炎2例,造瘘口水肿者3例,造口旁疝1例,经过精心的治疗和护理均痊愈出院.结论:对于造口并发症而言术前的详细检查和精确的造口定位也是必不可少的,加上心理护理及术后健康教育也十分重要,加强专科护士培养和社区护士造口知识培训也尤为重要,通过上述处理以减轻肠造口患者的痛苦,提高其生活质量.     

肠造口皮肤黏膜分离合并造口回缩的护理干预

目的总结肠造口术后患者皮肤黏膜分离并造口回缩的护理经验。方法行肠造口手术患者64例中,5例术后发生皮肤黏膜分离合并造口回缩,予以积极的全身治疗及心理护理,正确的伤口评估与处理以及营养和健康教育。结果 4例术后18～28d伤口愈合出院;1例保守治疗效果不佳于术后14d行造口重建,重建后14d愈合出院。结论术后需严密观察造口血运及周围皮肤状况,及时发现和早期处理患者皮肤黏膜分离及造口回缩等并发症,以利于提高患者生活质量。     

微信平台延续肠造口护理对低位直肠癌腹会阴切除术患者的应用效果

目的探讨微信平台延续肠造口护理对低位直肠癌腹会阴切除术(Miles手术)患者的应用效果。方法回顾性分析2018-07—2021-06于郑州大学第二附属医院普外科行Miles手术的76例低位直肠癌患者的临床资料。均按全直肠系膜切除术(TME)原则完成Miles手术。以开始实施微信平台延续肠造口护理时间为分组依据,其中2020-01—2021-06的38例采用微信平台延续肠造口护理方案(延续护理组),重点进行肠造口护理指导,并评估患者肠造口自我护理质量。选择2018-07—2019-12采用常规护理方案的38例患者为常规护理组。比较2组患者的基线资料。评估出院时和出院后3个月时患者的焦虑(SAS)和抑郁(SDS)自量表评分、自我护理能力测定量表(ESCA)评分,以及生活质量量表(QOLQ-30)评分。统计随访3个月期间肠造口并发症发生率和末次随访时患者对护理工作的满意度。结果2组患者的基线资料差异无统计学意义(P>0.05)。出院后3个月时,延续护理组患者的SAS和SDS评分、ESCA评分、QOLQ-30评分均优于常规护理组,随访期间并发症发生率低于常规护理组,末次随访时患者对护理工作的满意度高于常规护理组,以上差异均有统计学意义(P<0.05)。结论微信平台延续肠造口护理能有效改善Miles手术后患者的不良心理、肠造口的自我护理能力,以及生活质量,并可降低肠造口并发症发生率和提高患者对护理工作的满意度。     

出院准备计划方案在老年肠造口患者中的应用研究

目的 探讨出院准备计划用于老年肠造口患者的效果，为临床护理提供参考。 方法 将170例老年肠造口患者根据整群随机法分为两组各85例，对照组实施常规护理，干预组制定和实施出院准备计划方案。 结果 对照组75例和干预组77例完成全程研究。干预组出院准备度得分显著高于对照组；3个月随访期内造口门诊就诊率、非计划入院率及造口周围潮湿相关性皮肤损伤发生率显著低于对照组，自护能力得分及护理依赖得分显著高于对照组（均P＜0.05）。 结论 出院准备计划方案的实施可提高老年肠造口患者出院准备度，增强自护能力，减轻护理依赖，从而一定程度上减少造口并发症的发生，降低患者非计划再入院率及造口门诊就诊率，节约医疗资源。     

膀胱癌术后双侧腹壁造口患者的延续护理

目的提高膀胱癌全膀胱切除双侧腹壁造口患者的自护技能与效果,以提高其生活质量。方法将46例膀胱癌行全膀胱切除并双侧腹壁造口患者随机分为两组各23例,对照组行常规治疗护理、健康教育、出院指导及随访;观察组建立"造口护理服务"微信平台并应用于上述护理中。术后6个月评价效果。结果干预后观察组造口知识及生活质量得分显著高于对照组,术后并发症发生率显著低于对照组(均P0.01)。结论基于微信平台的延续护理,可有效提高患者的造口知识,从而降低造口并发症发生率,提高生活质量。     

结直肠癌患者及照顾者造口护理的预警教育

目的探讨结直肠癌患者及照顾者进行造口护理预警教育的方法及效果。方法将98例肠造口患者随机分为干预组和对照组各49例。对照组给予常规造口健康教育,干预组在此基础上对患者及照顾者实施预警教育。比较干预后3个月两组造口护理依从性,患者焦虑水平及造口并发症发生率。结果干预后3个月后,干预组患者及照顾者造口依从性得分显著高于对照组(均P0.05);患者焦虑得分显著低于对照组,造口并发症(粪水性皮炎、造口黏膜出血及造口周围皮肤湿疹)发生率显著低于对照组(P0.05,P0.01)。结论预警教育可有效提高肠造口患者及照顾者造口护理依从性,降低患者焦虑水平及造口并发症发生率,提高患者的生活质量。     

情景教学在尿路造口患者自我护理教育的应用

目的探讨情景教学模式对尿路造口患者自护能力的影响。方法将60例尿路造口患者按照入院时间分为对照组和干预组各30例。对照组给予常规造口知识健康教育,干预组在此基础上通过情景教学的模式指导患者自我护理,分别于指导前及出院3个月对两组造口患者的自护能力及生活质量进行调查。结果干预后干预组的自护能力及生活质量显著高于对照组(均P0.05)。结论情景教学模式应用于尿路造口患者自我护理教育,能够提高患者的自护能力及生活质量。     

综合护理联合健康教育对直肠癌肠造口患者自护能力的影响

目的 探讨以综合护理、健康教育为联合的护理模式在直肠癌肠造口患者中的应用价值。方法 选取我院2020年1月-2022年9月收治的直肠癌肠造口治疗患者61例作为研究对象,采用随机数字表法分为 对照组30例和试验组31例。对照组实施基础护理,试验组实施综合护理联合健康教育护理。比较两组自我 护理能力、造口护理知识掌握程度以及造口局部皮肤DET评分情况。结果 两组护理后自护能力评分均高 于护理前,且试验组高于对照组,差异有统计学意义（P＜0.05）;试验组造口护理各项知识掌握度高于对 照组,差异有统计学意义（P＜0.05）;试验组造口局部皮肤颜色性状、溃疡状态以及T-组织增生评分均 低于对照组,差异有统计学意义（P＜0.05）。结论 综合护理联合健康教育护理模式可提高直肠癌肠造口 治疗患者的自护能力,且能够提升患者对造口护理知识的掌握水平,进而改善造口附近皮肤情况,值得临 床应用。     

Peritoneal defense in continuous ambulatory versus continuous cyclic peritoneal dialysis.

Several centers have reported a lower rate of peritonitis among adult patients on continuous cyclic peritoneal dialysis (CCPD) as compared to those undergoing continuous ambulatory peritoneal dialysis (CAPD). Preliminary results of our ongoing prospective randomized study comparing CAPD-Y with CCPD also suggest a lower peritonitis incidence among CCPD-treated patients. To investigate whether the two dialysis regimens could result in differences in local host defense, we studied peritoneal macrophage (PMO) function and effluent opsonic activity in eight patients established on CAPD-Y matched with eight chronic CCPD patients. Since short and long dwell times are inherent to both dialysis modalities, and we previously found that dwell time has an impact on PMO function and effluent opsonic activity, patients were studied after both a short (4 hr) and a long (15 hr) dwell time. In both groups PMO phagocytic capacity increased significantly with dwell time (39 +/- 3.3% at 4 hr vs. 58 +/- 4.2% at 15 hr in CAPD patients, and 40 +/- 3.9 vs. 72 +/- 3.3% in CCPD patients; P less than 0.01), as did PMO peak chemiluminescence response (31 +/- 4.9 vs. 77 +/- 7.2 counts.min-1/10(4) cells in CAPD, and 22 +/- 3.9 vs. 109 +/- 21.2 counts.min-1/10(4) cells in CCPD; P less than 0.01) and effluent opsonic activity (41 +/- 7.6 vs. 73 +/- 5.8% in CAPD and 39 +/- 6.2 vs. 70 +/- 5.9% in CCPD; P less than 0.01). However, no significant difference was found in either variable between CAPD and CCPD patients when dwell times were equal.(ABSTRACT TRUNCATED AT 250 WORDS)     

Determinants of vancomycin clearance by continuous venovenous hemofiltration and continuous venovenous hemodialysis

The clearance of vancomycin is significantly reduced in patients with acute, as well as, chronic renal failure. Although multiple-dosage regimen adjustment techniques have been proposed for these patients, there is little quantitative data to guide the individualization of vancomycin therapy in acute renal failure patients who are receiving continuous renal replacement therapy (CRRT). To determine appropriate vancomycin dosing strategies for patients receiving continuous venovenous hemofiltration (CVVH) and continuous venovenous hemodialysis (CVVHD), we performed controlled clearance studies in five stable hemodialysis patients with three hemofilters: an acrylonitrile copolymer 0.6 m2 (AN69), polymethylmethacrylate 2.1 m2 (PMMA), and polysulfone 0.65 m2 (PS). Patients received 500 mg of vancomycin intravenously at least 12 hours before the start of the clearance study. The concentration of vancomycin in multiple plasma and dialysate/ultrafiltrate samples was determined by EMIT (Syva, Palo Alto, CA). The diffusional clearance and sieving coefficient (SC) of vancomycin were compared by a mixed-model repeated-measures analysis of variance (ANOVA) with filter and blood (Q(B)), dialysate inflow (Q(DI)), or ultrafiltration rate (Q(UF)) as the main effects and patient as a random effect. Vancomycin was moderately protein bound in these patients; free fraction ranged from 49% to 83%. The SCs of the three filters were similar and significantly correlated with the free fraction of vancomycin (P = 0.01; r2 = 0.465). Significant linear relationships were observed between the diffusional clearance of vancomycin and Q(DI) for all three filters: AN69 (slope = 0.482; r2 = 0.880); PMMA (slope = 0.853; r2 = 0.966); and PS (slope = 0.658; r2 = 0.887). The slope of this relationship for the PMMA filter was significantly greater than that of the AN69 and PS filters. The clearance of vancomycin, urea, and creatinine, however, was essentially constant at all Q(B)s for all three filters. Thus, the clearance of vancomycin was not membrane dependent during CVVH. However, during CVVHD, membrane dependence of vancomycin clearance was noted at a Q(DI) greater than 16.7 mL/min; vancomycin clearance with PMMA at a Q(DI) of 25 mL/min was 66% and 43% greater than that with the AN69 and PS filters, respectively. CVVH (62% to 262%) and CVVHD (90% to 540%) can significantly augment the clearance of vancomycin in acute renal failure patients. Dosing strategies for individualization of vancomycin therapy in patients receiving CVVH and CVVHD are proposed.     

Intermittent hirudin versus continuous heparin for anticoagulation in continuous renal replacement therapy

BACKGROUND: Besides possible bleeding complications a further problem in anticoagulation during continuous renal replacement therapy (CRRT) is the development of heparin-induced thrombocytopenia type II (HIT II) where further anticoagulation with heparin is contraindicated. The application of continuous hirudin as alternative for heparin caused bleeding complications by comparable filter efficacy. Aim of this prospective-controlled pilot study was to compare the efficacy and safety of intermittent hirudin and continuous heparin for anticoagulation during CRRT in critically ill patients. METHODS: 26 patients receiving CRRT were randomly allocated to two groups: Heparin group (14 patients): continuous administration of 250 IU/h heparin, dose was adjusted in 125 IU/h steps with a targeted activated clotting time (ACT) of 180-210 s. Hirudin group (12 patients): initial bolus application of 2-2-5 microg/kg hirudin, dose was adjusted in 2 microg/kg bolus steps with a targeted ecarin clotting time (ECT) >80 s. Observation time was 96 hours. RESULTS: Measured filter run time was virtually longer for heparin. No bleeding complications were observed in the hirudin group, two bleeding complications in the heparin group. CONCLUSIONS: Intermittent hirudin can be used safely for anticoagulation in CRRT. However, the in tendency better filter survival for heparin elucidates the need for further investigations to find the right dosage equilibrium between filter clotting and bleeding complications.     

Anaesthetic and haemodynamic effects of continuous spinal versus continuous epidural anaesthesia with prilocaine

BACKGROUND AND OBJECTIVE: To compare, using prilocaine, the effects of continuous spinal anaesthesia (CSA) and continuous epidural anaesthesia (CEA) on haemodynamic stability as well as the quality of anaesthesia and recovery in patients undergoing transurethral resection of the prostate gland. METHODS: Thirty patients (>60 yr) were randomized into two groups. Prilocaine, 2% 40 mg, was given to patients in the CSA group, and prilocaine 1% 150mg was given to patients in the CEA group. Incremental doses were given if the level of sensory block was lower than T10 or if needed during surgery. RESULTS: There was a significant decrease in mean arterial pressure in Group CEA compared with Group CSA (P < 0.01). The decrease in heart rate in Group CSA occurred 10 min after the first local anaesthetic administration and continued through the operation (P < 0.05). The level of sensory anaesthesia was similar in both groups. The times to reach the level of T10 and the upper level of sensory blockade (Tmax) were 18.0 +/- 4.7 and 25.3 +/- 7.0 min in Groups CSA and CEA, respectively, and were significantly longer in Group CEA. The duration of anaesthesia was 76.8 +/- 4min and was shorter in Group CSA (P < 0.01). CONCLUSIONS: Spinal or epidural anaesthesia administered continuously was reliable in elderly patients undergoing transurethral resection of the prostate. Continuous spinal anaesthesia had a more rapid onset of action, produced more effective sensory and motor blockade and had a shorter recovery period. Prilocaine appeared to be a safe local anaesthetic for use with either continuous spinal anaesthesia or continuous epidural anaesthesia.     

Improved continuous flow transurethral prostatectomy

We compared 2 continuous flow resectoscopes for transurethral resection of the prostate--a new intrinsic bladder pressure-controlled drainage system and the suction drainage system. In 31 patients undergoing transurethral prostatic resection who were assigned randomly to a pressure-controlled (17) or suction drainage (14) resectoscope group the required irrigant volume and operative blood loss (milliliter per gram resected tissue) were appreciably less with pressure-controlled drainage, while the resection rate (gram per minute) was significantly greater. Irrigant absorption, as evidenced by weight gain and changes in hematocrit, serum osmolality and serum sodium, was minimal in either group, with no significant difference between the 2 methods. In addition, there was no significant difference in intraoperative intravesical pressure between the 2 groups. The suction drainage system led to pump drainage failure in certain rotational positions, resulting in diminished visibility and increased resection time. The pressure-controlled drainage system required no suction devices or adjustments, thus, allowing constant improved visibility and uninterrupted resection. These results suggest that the efficiency and ease of transurethral prostatic resection are superior with the pressure-controlled continuous flow drainage system than with the suction drainage system.     

Infection-resistant continuous peritoneal dialysis catheters

The techniques of bonding of anionic antibiotics by treatment with cationic surfactants were applied to continuous ambulatory peritoneal dialysis (CAPD) catheters. The elution of 14C-penicillin from tridodecylmethylammonium chloride (TDMAC) treated silicone elastomer catheters in dialysis solution was biphasic, with 95% dissociated from the catheter by 48 h. Forty percent of the TDMAC left the catheter surface during the initial 2 days. The ability of the surfactant TDMAC to bind antibiotics after incubation in dialysis solution correlated directly with the amount of surfactant remaining. Rats with intraperitoneal dialysis catheters were inoculated with exit site and intraluminal bacterial challenges. Intraperitoneal catheter tips treated with TDMAC-penicillin were rendered more resistant to colonization after exit site and intraluminal bacterial challenges.     

Lower limb revascularization--a continuous challenge

Revascularization of the lower extremity in patients with diabetes or chronic obstructive arterial disease is a challenging, still unsolved problem. Modern day technique (stem cell therapy, hyperbaric therapy) has yet to deliver satisfactory results. Homogenous (safenous vein) or heterogeneous (terom, dacron, PTFE-teflon) by-pass surgery is limited because of technical difficulty and positive outcomes have a short duration. All these lead to, in most patients, to amputations as first line therapy or as an alternative to failed approaches. By-pass surgery is limited by graft obstruction. One of the current approaches is the use of omental flap autotransplantation.     

Technic of continuous pentothal anesthesia

A method for the administration of intravenous anesthesia is presented. It has proved especially useful in the field since the equipment is compact and easily obtained, but it has been found to be effective in any operating room. A minimum of sterilization is necessary. The anesthetist can easily administer successive and simultaneous anesthetics, and be free to administer oxygen or oxygen and nitrous oxide or give plasma and blood if necessary.