专科小组在心脏外科手术中的作用

目的探讨专科小组在心脏外科手术中的作用。方法在手术室护理人员77人中选出50人组合成先心病、冠心病、风心病及大血管组4个专科小组,实施专科小组管理,包括手术配合、学习与培训、器械、仪器管理、手术间管理及人员考核。比较实施前后同期护士专科操作合格率。结果专科护士手术物品准备、无菌单铺置、体位摆放、皮肤保护考核合格率显著高于专科小组管理前(均P<0.05);医生对护士工作满意率达98.8%。结论专科小组管理能显著提高手术室护理质量,改善医护关系。     

Role of nuclear cardiology in advancing cardiac surgery

Cardiac surgeons are commonly faced with issues regarding the balance between the potential risk and the potential benefit of a surgical procedure. Nuclear cardiology procedures [myocardial perfusion SPECT (MPS) and positron emission tomography (PET)] provide the surgeon with objective information that augments standard clinical and angiographic assessments with respect to diagnosis, prognosis, and potential benefit from intervention. Development of the technology and methodology of gated MPS acquisition and interpretation allows assessment of the extent and severity of hypoperfused but viable myocardium, as well as global LVEF and LV volume measurements, diastolic function, and LV geometry. With PET, myocardial metabolism and blood flow reserve can also be measured. This chapter provides insight into the current evidence regarding settings in which nuclear cardiology procedures are helpful to the surgeon in assessment of patients having or being considered for cardiac surgery in the setting of coronary artery disease (CAD). Overall, a risk-benefit approach to MPS results is proposed, with principal focus on identifying patients at risk for major cardiac events who may benefit from a surgical procedure.     

心脏直视手术后心脏骤停患者的抢救及护理

对18例心脏直视手术后心脏骤停的患者,立即予心肺复苏术,同时积极查明心脏骤停的原因,及时给予有效的抢救措施.结果经抢救复苏成功12例,无神经系统并发症 ;6例放弃治疗或死亡.提示快速判断心脏骤停的原因,采取重要脏器的保护等护理措施是提高复苏成功率的重要环节.     

Anaesthesia for specialist surgery in infancy

Common indications for neonatal surgery include inguinal hernias and hypertrophic pyloric stenosis. Less common conditions that have major implications for anaesthesia include tracheoesophageal fistula, congenital diaphragmatic hernia, exomphalos, gastroschisis and congenital lobar emphysema. The anaesthetic management of these conditions is outlined in this article.     

专科护理小组的效能建设

目的探讨专科护理小组的效能建设在专科护理发展及优质护理服务中的作用。方法创新专科护理管理模式,以授权组长、能力建设、激励问责和价值驱动4项核心举措,构建专科护理效能建设框架并在20个临床专科中进行实践。结果专科护理小组能力建设实施1年后,6项主要护理质量评分较实施前显著提高(均P0.01);不良事件发生数下降,患者满意率从90.2%上升至96.5%。结论专科护理小组的效能建设,能充分体现专科护士及专科护理小组的效能价值,对提升临床护理质量、优化护理服务、促进专科型人才培养和护理科研具有良好的推动作用。     

Anaesthesia for specialist surgery in infancy

Specialist surgery in infancy provides unique and significant challenges for paediatric anaesthetists. Both common (inguinal hernias and hypertrophic pyloric stenosis) and less common conditions (tracheo-oesophageal fistula, congenital diaphragmatic hernia, exomphalos (omphalocele), gastroschisis and congenital lobar emphysema) require a sound understanding of the relevant pathology and the particular issues that may be encountered in order to safely anaesthetise these infants. It is important to maintain a high attention to detail and to strive for excellent communication between all members of the perioperative team. In the last decade there has been a rise in the number of procedures in infancy being performed with a minimally invasive technique and this has a wide range of implications for anaesthesia.     

Anaesthesia for specialist surgery in infancy

Common indications for neonatal surgery include inguinal hernias and hypertrophic pyloric stenosis. Less common conditions, that have major implications for anaesthesia, include tracheoesophageal fistula, congenital diaphragmatic hernia, exomphalos, gastroschisis and congenital lobar emphysema. The anaesthetic management of these conditions is outlined in this article.     

临床路径在心脏外科护理实习带教中的应用

目的探讨临床路径在心脏外科护生实习带教中的应用效果,提高实习质量,提升护生对教学的满意度。方法将心脏外科实习的护生按入科时间随机分为实验组66人,对照组58人。实验组实施临床路径带教,分阶段制定并限期完成实习目标。对照组实施传统带教。结果实验组护生出科考试成绩以及带教满意度显著高于对照组(均P<0.01)。结论对心脏外科护生实施临床路径带教可明确教学目标、规范教学流程,提高心脏外科护生的临床教学质量。     

Role of amiodarone in reducing atrial fibrillation after cardiac surgery in adults

Atrial fibrillation is a common occurrence after cardiac surgery and the source of financial expenditure and complications. A critical literature review was undertaken to examine the use of amiodarone therapy to prevent or manage atrial fibrillation after cardiac surgery. Evidence strongly suggests that perioperative treatment of cardiac patients with amiodarone may reduce the incidence of atrial fibrillation with minimal adverse effects. Further study is warranted to determine the optimal timing and dosing, for the drug's most cost-effective use.     

The Danish specialist training in vascular surgery.

OBJECTIVE: to present the Danish training in vascular surgery compared with other European countries. METHODS: analysis of prospectively collected data. Data on number of procedures and supervision was obtained from the Danish Vascular Registry for eighteen trainees (fifteen males, three females) in vascular surgery. Demographic data were obtained by direct contact with the units and from EuReg-Vasc. Vascular surgery has been a mono-specialty in Denmark since 1983. RESULTS: in 2000 the median age of the 45 Danish vascular specialists was 48 years (IQR 45-54, range 40-58) and at end of training the age of the 18 vascular trainees was 42 years (IQR 40-43, range 38-51). Vascular surgery was confined to eleven vascular units - eight with trainees. All vascular procedures in Denmark, besides a few emergency cases, were performed at these units - all by vascular specialists or trainees. The 18 trainees were on average exposed to more than 400 surgical procedures over the three years - and over 300 of nine vascular index operations. The number of assisted, supervised and independent operations was unevenly distributed, with low numbers of certain index operations for some of the trainees. CONCLUSION: the structure of vascular surgery in Denmark as a mono-specialty has almost found its final form. Training is satisfactory overall, but with unacceptable variation among trainees with regard to the number of performed index procedures. A minimum number of index procedures must be defined and logbooks introduced. The relatively short weekly working hours in Denmark is not the prime problem.     

心外科术后患者的早期康复护理流程管理

目的 探讨康复护理小组进行流程管理在心脏外科ICU患者早期活动中的可行性及效果分析。方法 按住院时间先后将心外科术后入住ICU的患者分为对照组（158例）、观察组（127例）。对照组以常规床上康复运动为主,观察组由ICU康复护理管理团队制定针对心脏外科手术后ICU患者的早期渐进式分级活动流程,进行全程康复护理与质量控制。结果 观察组开始进行离床活动时间、ICU停留时间、术后住院时间与对照组比较,差异有统计学意义（P＜0.05,P＜0.01）;观察组出ICU时的肌力评分显著高于术后(P＜0.01)。结论 对心脏外科术后患者实施早期康复流程管理,有利于促进其康复进程。     

Role of kappa opioid receptor in cardioprotection of preconditioning: implications in cardiac surgery

Kappa-opioid receptor mediates both immediate and delayed cardioprotection of ischemic/metabolic inhibition preconditioning. Both PKC and mitochondria ATP-sensitive K+ channel, mediate the protective action of kappa-opioid receptor stimulation. In delayed cardioprotection, PKC-epsilon may produce its effect via mitochondria ATP-sensitive K+ channel, and a stress inducible heat stress protein 70 may also be involved. Metabolic inhibition causes cell death which is accompanied by Ca2+ overload and mobilization of Ca2+ from sarcoplasmic reticulum to cytoplasm. The altered Ca2+ homeostasis is restored partially by kappa-opioid receptor or metabolic inhibition preconditioning. The finding indicates that opioids such as morphine may be used in the treatment of ischemic heart diseases and in open heart surgery.     

我国护理学专业学位研究生教育现状的文献计量分析

目的了解我国护理学专业学位研究生教育研究热点及发展趋势,为相关研究及实践提供参考。方法以中国期刊全文数据库(CNKI)、万方数据知识服务平台和维普中文科技期刊数据库为统计源,对建库至2016年1月国内护理学专业学位研究生教育文献从发表年份、文献分布、作者分布、研究内容等进行计量学分析。结果共检索到180篇文献,其中硕博士学位论文23篇,会议论文15篇,其余142篇文献发表于43种期刊;作者单位遍布我国23个省、直辖市、自治区;研究内容多为研究生能力、实践与评价体系(35.00%)和教育培养现状、对策及发展(32.78%);文献共引文2 576条,被引频次为685;51.11%的文献有基金资助。结论我国护理学专业学位研究生教育近年来发展迅速,但各大院校培养模式尚未统一,培养方向尚不明确,应基于理论框架进行实证研究,加深研究的深度和宽度,以促进该领域的全面发展。     

Modern cardiac surgery: the future of cardiac surgery in Australia

Cardiac surgery is a relatively young specialty and is undergoing many changes presently. The advent of catheter‐based technology, minimally invasive surgery and better information regarding the roles of cardiac surgery in the management of common cardiac disease is changing the way we provide services. In Australia, attention must be turned to the way cardiac surgical services are provided to enable delivery of modern procedures. This has implications for the provision of training. We explore the face of modern cardiac surgery and how this may be taken up in Australia.     

Minimally invasive surgery and the vascular specialist

Surgical Endoscopy -     

Phrenic nerve paralysis following pediatric cardiac surgery. Role of diaphragmatic plication

Eighteen children sustained unilateral phrenic nerve paralysis (PNP) after cardiac surgical procedures. Ten (Group I), under 7 months (mean: 2.9 +/- 2.2), required long-term ventilatory assistance (mean: 23.9 +/- 13.0 days); they failed to be weaned from the ventilator. All underwent diaphragmatic plication (DP). DP was performed late in 7 cases (Group Ia) with a mean time of 30.8 days between surgery and DP, and early in 3 others (Group Ib) with a mean time of 10.2 days. Eight children (Group II), older than 1 year, tolerated PNP better and could be extubated early without diaphragmatic plication. In Group Ia severe lung infections were recorded in 5 before or/and after DP, and two died at 3 and 30 days after plication. Five children from Group Ia and all 3 from Group Ib were late survivors. They could be weaned from ventilatory support in a mean time of 3 days after DP, although those with severe lung infection (Group Ia) took the longest time. All from Group II were late survivors. We conclude: PNP is well tolerated without plication in children older than 1 year. However early DP offers excellent and immediate results in infants with PNP. Early DP in these children avoids or reduces severe lung infections and death.     

临床专科护士科研能力现状调查

目的 了解临床专科护士科研能力现状,为实施针对性培训、提高专科护士的科研能力提供参考。方法 采用护理人员科研能力自评量表对1 199名临床专科护士进行问卷调查。结果 临床专科护士科研能力总分为（55.57±20.47）分,各维度得分从高到低依次为发现问题能力、文献查阅能力、论文写作能力、科研实践能力、资料处理能力和科研设计能力。不同性别、学历、职称、医院级别,是否参与专科护理门诊、疑难病例会诊和主持教学查房的临床专科护士科研能力得分比较,差异有统计学意义（P＜0.05,P＜0.01）。结论 临床专科护士科研能力处于中等水平,护理管理者需重视专科护士科研能力培养,尤其需针对性进行科研设计和资料处理方面的培训,全面提升专科护士的护理科研能力。     

Clinical impact of oncoplastic surgery in a specialist breast practice

Background: Oncoplastic breast surgery is an integral and fundamental component of the clinical management of breast cancer. The aim of this study was to determine the proportion of oncoplastic and reconstructive breast cancer procedures undertaken within a specialist breast practice. Methods: An audit of breast‐related cancer procedures was undertaken for patients with early breast cancer between 1 January 2001 and 31 December 2005, treated at the Royal Adelaide Hospital and in private practice. The proportion of oncoplastic and breast reconstructive procedures was calculated to determine the clinical effects on a specialist breast‐surgical practice. Results: Breast cancer resection procedures accounted for 1514 of 2113 of operations (72%). Most of these (897 of 1514, 59.2%) were wide local excision or re‐excision procedures. Total breast reconstruction operations (i.e. autogenous tissue flaps, tissue expander/implant reconstructions) accounted for 251 procedures. Of these, 67 (26.7%) were carried out at the time of simple mastectomy. Contralateral breast procedures (i.e. reduction mammaplasty, mastopexy and augmentation) accounted for 138 procedures and nipple–areola reconstruction/tattoo accounted for 153 procedures. Oncoplastic procedures, such as skin‐sparing mastectomy, latissimus dorsi miniflap and therapeutic mammaplasty accounted for 57 of 599 procedures (9.5%). Breast reconstruction and oncoplastic operations accounted for 599 of 2113 procedures (28%). Conclusion: Specialist breast surgeons trained in breast reconstruction and oncoplastic techniques can expect a substantial proportion of their breast practice to include such operative procedures (28% in this series). Subspecialist training in breast surgery should incorporate experience in breast reconstructive and aesthetic surgery for trainees who wish to practise as specialist breast surgeons in the future.