剖宫产术后留置尿管定期开放与长期开放对排尿的影响

目的:观察剖宫产术后留置尿管两种放尿方法对膀胱功能的影响.方法:选择184例剖宫产留置导尿患者随机分成实验组(定期开放)92例;对照组(长期开放)92例,分别观察拔除尿管后第一次排尿情况.结果:两种放尿方法对膀胱功能的影响有显著差异(P＜0.1),实验组自行排尿顺利率明显高于对照组.结论:剖宫产手术后留置导尿采用定期开放法(术后用止水夹夹紧尿管,当产妇有尿意时放尿一次)较常规的长期开放法对膀胱功能的影响小,有利于患者术后康复并且减少再次下尿管的几率.     

剖宫产术留置双腔气囊导尿管产妇的护理体会

目的总结剖宫产术留置双腔气囊导尿管产妇的护理体会。方法对50例剖宫产术留置双腔气囊导尿管的产妇,做好心理、疼痛、拔管、健康指导等护理措施。结果 50例产妇双腔气囊导尿管均一次留置成功。其间未发生尿路感染及严重不适感、尿管堵塞、拔出困难等。拔出尿管后均恢复正常自行排尿。结论对剖宫产术留置双腔气囊导尿管的产妇,加强心理疏导和健康教育、做好并发症的观察及预防等护理措施,有利于提高双腔气囊导尿管成功留置率、减轻患者的不适感及减少尿路感染发生率,为拔出尿管后顺利恢复正常自行排尿提供可靠保证。     

选择性关闭镇痛泵对剖宫产术后患者排尿的影响

目的探讨选择性关闭镇痛泵预防剖宫产术后发生尿潴留的效果。方法将800例剖宫产术后留置镇痛泵的产妇随机分为观察组和对照组各400例。观察组在拔除尿管的同时暂时关闭自控镇痛泵,待自主排尿后立即重新开放镇痛泵;对照组常规持续开放镇痛泵。结果两组再次导尿率、拔管后首次自主排尿时间比较,差异有统计学意义(P<0.05,P<0.01)。两组术后疼痛程度比较,差异无统计学意义(P>0.05)。结论剖宫产术后拔除尿管的同时暂时关闭镇痛泵,有助于预防尿潴留的发生,且不影响产妇镇痛效果。     

剖宫产术后自控静脉镇痛泵患者拔除尿管时机探讨

目的探讨剖宫产术后自控静脉镇痛泵(PCIA)镇痛患者拔除尿管最佳时机。方法将剖宫产术后自控静脉镇痛泵患者随机分为实验组和对照组各100例。两组均于术后第1天6:00(术后满10h)拔除尿管,实验组拔除尿管时保留静脉镇痛泵,对照组尿管与静脉镇痛泵一同拔除。观察两组自然排尿情况及膀胱刺激症状。结果两组拔除尿管后自然排尿成功率比较,差异有统计学意义(P0.05),膀胱刺激症状发生率比较,差异无统计学意义(P0.05)。结论剖宫产术后拔除尿管的最佳时机是术后10～24h,拔除尿管后可保留PCIA镇痛泵24～48h,以缓解患者疼痛,促进康复。     

剖宫产术后留置尿管时间对尿液分析的影响及康复情况

目的:留置导尿是剖宫产术后不可或缺的护理法子,也是临床上最根基的诊疗手艺,留置导尿除给产妇带来不适外,还增添了传染的机缘.据文献报道,获得性传染中40％为尿路传染.留置导尿管是剖宫产术前一项常规操作,也是临床上最基本的诊疗技术,以往术后常规留置尿管并持续开放24小时,其目的除了便于手术操作,避免术中损伤膀胱外,同时可以预防术后膀胱过度充盈而妨碍子宫收缩,导致产后大量出血.剖宫产术后传统留置导尿时刻为24h,但从大量的临床实践看,许多产妇难以忍受,我科将术后24h留置导尿提前至10～12h.探讨剖宫产术后留置尿管时间对尿液分析的影响及康复情况.方法:病人随机分为观察组116例,对照组116例,通过缩短留置尿管时间,选择膀胱较充盈时拔除尿管,观察两组产妇尿液分析的影响及康复情况等进行比较.结论:提前撤除尿管尿液分析中的白细胞显著减少,康复时间显著缩短.     

不同润滑剂润滑导尿管对患者舒适度的影响

目的 提高全麻清醒后留置尿管患者的舒适度.方法 将全麻下行上腹部手术的89例患者随机分为两组,对照组(n=46)采用液体石蜡润滑导尿管,实验组(n=43)采用利多卡因凝胶润滑导尿管,均在麻醉诱导气管插管成功后留置导尿,比较两组一次置管成功率,麻醉恢复期的疼痛程度及不能耐受拔除尿管的比例.结果 实验组术后麻醉清醒恢复期的疼痛程度显著低于对照组(P<0.05).结论 利多卡因凝胶作为尿管润滑剂能有效提高全麻恢复期患者留置尿管期间的舒适度.     

老年前列腺增生患者睾丸切除姑息术后拔尿管时机的研究

目的 探讨老年前列腺增生患者睾丸切除术后拔除尿管的适宜时机.方法 将96例睾丸切除术后留置尿管的前列腺增生患者按入院时间分为三组各32例,A组患者术后2～3 d或有尿路不适即拔除尿管,B组术后7 d拔除尿管,C组术后14 d拔除尿管,观察患者排尿情况.结果 A、B、C组患者拔除尿管后排尿成功率分别为15.62%、40....     

肛肠术后拔除尿管最佳时机的临床分析

目的:探讨肛肠术后留置尿管拔除的最佳时机.方法:将120例肛肠术后置尿管的患者随机分组为3组各40例.甲组在膀胱充盈时拔管,乙组随机拔管,丙组在膀胱空虚时拔管.结果:乙组和丙组自行排尿成功率低于甲组(P＜0.01).乙组和丙组自行排尿成功率无差异性(P＜0.05).结论:采用膀胱充盈时拔除尿管更能恢复排尿功能,减少尿潴留发生.     

围术期心理支持联合盆底肌训练预防初产妇剖宫产术后尿潴留的效果观察

目的 探讨围术期心理支持联合盆底肌训练预防初产妇剖宫产术后尿潴留的临床效果。方法 回顾性分析西平县人民医院产科2020-04—2022-01行剖宫产手术的63例初产妇的临床资料。以实施围术期心理支持联合盆底肌训练干预开始时间为分组依据,其中2021-03—2022-01采用心理支持联合盆底肌训练干预的32例产妇作为观察组。选择2020-04—2021-02采用常规护理干预的31例产妇作为对照组。比较2组产妇的基线资料。统计2组产妇术后拔除尿管后的首次自主排尿时间、首次自主排尿量、拔管后残余尿量,以及术后尿潴留发生率。结果 2组产妇的基线资料差异无统计学意义(P>0.05)。观察组产妇术后拔除尿管后的首次自主排尿时间短于对照组、首次自主排尿量高于对照组、拔管后残余尿量少于对照组,术后尿潴留发生率低于对照组,差异均有统计学意义(P<0.05)。结论 对初产妇剖宫产手术的围术期应用心理支持联合盆底肌训练干预,能够显著减轻和缓解产妇不良心理、疼痛等引起的排尿障碍,提高其排尿信心,促进早期自主排尿,减少尿潴留的发生率。     

中老年男性腰椎病围术期留置尿管患者的全程护理

目的 探讨中老年男性腰椎病围术期留置尿管患者的护理方法.方法 将100例中老年男性腰椎病患者随机分为对照组和干预组各50例.对照组予常规护理,干预组给予全程护理干预,即入院做好生活细节指导;术前训练床上排便;留置尿管时尽量减少损伤;预防尿路感染;训练膀胱的舒缩功能;留置尿管期间和拔除尿管后口服哈乐胶囊降低膀胱颈和尿道平滑肌痉挛,降低排尿时盆底肌紧张性疼痛等.结果 两组拔除尿管后排尿障碍发生率、再置管率、第一次排尿时间比较,差异有统计学意义(均P＜0.01).结论 对中老年男性腰椎病患者围术期留置尿管进行全程干预,能促进患者术后自主排尿功能的恢复.     

Palliation after operation and after radiotherapy for cancer of the esophagus

Because of the negligible cure rate in cancer of the esophagus, treatment is aimed principally at providing good palliation. This paper compares the degrees of palliation achieved after the two main treatments for symptomatic carcinoma of the esophagus. The degree of palliation was measured by a grading system designed to assess only the subjective responses of each patient. The results show that palliation as defined and measured in this study is the same after radiotherapy as after surgical excision. Since the expected survival is the same after radiotherapy as after operation, the expected morbidity and mortality of radiation are lower and radiotherapy may be used where operation is not possible, the authors suggest that radiotherapy is the better primary treatment for symptomatic squamous cancer of the esophagus.     

Function after arthrodesis of the knee

A long-term follow-up of 30 patients with knee arthrodesis, mostly for arthrosis, revealed that 24 were satisfied with the operation, while six were not satisfied, two because of persistent pain. Twenty-three patients were at work at the time of operation, 18 were able to go back to work, while three were allowed disability pensions and two old age pensions. Many patients had problems in attending public performances and in using buses and trains.

We conclude that two-thirds of the patients are totally relieved of pain after knee arthrodesis. Most patients accept the stiff joint, some have problems in social life, and a few have to give up working.     

Osteopenia after osteotomy of the tibia

Summary Previous studies have shown a persisting bone mineral loss of 25% at the distal femoral and proximal tibial metaphysis after fractures of the tibia. This is likely to increase the risk of later fracture. In the present study, the evolution of regional osteopenia after valgus osteotomy of the proximal tibia was investigated. In 20 patients, the bone mineral content (BMC) on both sides was determined by single-energy photon absorptiometry in the distal metaphysis; distal, mid, and proximal diaphysis of the tibia; and the distal metaphysis and diaphysis of the femur preoperatively and 6, 16, 34, 52, and 104 weeks postoperatively. A moderate fall in BMC was found at all measured levels of the extremity. In the tibia, the greatest fall in BMC (10%) was seen in the diaphysis near the osteotomy, but a considerable regeneration of bone mineral occurred later. A persisting loss was found in the distal tibial (8%) and femoral (11%) diaphysis. At these levels a fall in BMC on the contralateral side led to similar values on the two sides after 2 years.     

Rehabilitation after fractures of the hand

Rehabilitation after a hand fracture begins during the early phases of fracture healing and continues until skeletalintegrity and hand function are restored. The rehabilitation plan is tailored according to the stage of healing. The emphasis of therapy during the early reparative stage of healing is on edema control, pain management, preservation of motion at the uninvolved joints, protective splinting and positioning to prevent disruption of fracture healing, and to prevent joint contracture. The next phase of therapy begins when clinical healing is present and emphasizes the active mobilization of the joints immediately adjacent to the fracture that were incorporated in the cast or splint. Tendon gliding exercises are also stressed at this time to restore flexor and extensor tendon excursion. The final phase of therapy begins when the fracture is well healed. The focus of therapy at this time is the development of strength and hand function and the resumption of activities of daily living and work tasks. General rehabilitation techniques appropriate for all hand fractures include positioning and splinting, edema and pain control, joint and soft tissue mobilization techniques, and tendon gliding and strengthening exercises.     

Complications after surgery of the hallux

The great toe is affected by many congenital and acquired conditions including arthritis, hallux valgus, and hallux rigidus and disease of the hallucal sesamoids. Many surgical procedures have been described for the treatment of these conditions. With the increased popularity of forefoot surgery comes the potential for complications even when the surgery is done meticulously by an experienced surgeon under well-planned conditions. When a complication occurs, it can present difficult and challenging problems. It is, therefore, important to recognize a complication early so it may be analyzed and treated successfully. When recognized, a plan should be developed to identify, quantify, control, and resolve the problem. The current review defines some common complications and treatment options. Several problems may exist at the same time. A solution addressing all aspects of the problem must be designed so as not to augment the presenting complications. Salvage operations and long-term treatment are included to provide a perspective on treatment of residual deformity. It is important to realize that there often are several solutions to a difficult problem. Many factors influence the surgeon's choice and implementation of a solution, but the ultimate outcome always depends on a well thought out plan.