肠内营养支持治疗重型颅脑损伤303例的护理

目的：探讨重型颅脑损伤患者早期肠内营养支持常见并发症及护理方法。方法：对303例患者给予早期肠内营养,密切观察营养支持后反应,做好腹泻、应激性溃疡、高糖血症等并发症的护理。结果：发生腹泻185例,返流40例,误吸8例,高糖血症22例,胃潴留17例,应激性溃疡30例,脱管3例,堵管6例。结论：重型颅脑损伤患者早期肠内营养支持期间,做好各项护理措施,可预防并发症的发生,保证肠内营养支持的安全有效。     

重型颅脑损伤患者肠内外营养支持的并发症分析及护理

目的：研究重型颅脑损伤患者肠内与肠外营养支持的效果及实施过程中的护理干预。方法：将118例重型颅脑损伤患者随机分为胃肠内营养组（EN）和胃肠外营养组（PN）,观察和比较两组并发症的发生率。结果：肠外组应激性溃疡、高血糖、腹泻、腹胀的发生率明显高于肠内组（P〈0．05）。结论：对重型颅脑损伤患者进行早期营养支持及有效的护理,可改善患者营养状况,减少并发症的发生。     

重型颅脑损伤行亚低温治疗早期肠内营养的护理研究

目的 探讨重型颅脑损伤亚低温期间早期肠内营养的护理方法.方法 将72例重型颅脑损伤的患者随机分成EN、PN两组,均在伤后12 h内行亚低温治疗,同时行肠内营养及肠外营养.结果 ①两组病人营养支持前后的营养状况无明显改变(P>0.05);②与肠外营养相比,肠内营养可有效预防应激性溃疡的发生,大大降低静脉炎的发生;③肠内营养组血糖水平较稳定,且对肝功能无损害.而肠外营养组有明显的肝功能损害且易产生高葡萄糖血症.结论 重型颅脑损伤亚低温治疗期间早期行肠内营养具有安全有效、费用低、并发症少等优点,可替代肠外营养.     

重型颅脑损伤行亚低温治疗早期肠内营养的护理研究

目的 探讨重型颅脑损伤亚低温期间早期肠内营养的护理方法.方法 将72例重型颅脑损伤的患者随机分成EN、PN两组,均在伤后12 h内行亚低温治疗,同时行肠内营养及肠外营养.结果 ①两组病人营养支持前后的营养状况无明显改变(P>0.05);②与肠外营养相比,肠内营养可有效预防应激性溃疡的发生,大大降低静脉炎的发生;③肠内营养组血糖水平较稳定,且对肝功能无损害.而肠外营养组有明显的肝功能损害且易产生高葡萄糖血症.结论 重型颅脑损伤亚低温治疗期间早期行肠内营养具有安全有效、费用低、并发症少等优点,可替代肠外营养.     

重型颅脑损伤行亚低温治疗早期肠内营养的护理研究

目的 探讨重型颅脑损伤亚低温期间早期肠内营养的护理方法.方法 将72例重型颅脑损伤的患者随机分成EN、PN两组,均在伤后12 h内行亚低温治疗,同时行肠内营养及肠外营养.结果 ①两组病人营养支持前后的营养状况无明显改变(P>0.05);②与肠外营养相比,肠内营养可有效预防应激性溃疡的发生,大大降低静脉炎的发生;③肠内营养组血糖水平较稳定,且对肝功能无损害.而肠外营养组有明显的肝功能损害且易产生高葡萄糖血症.结论 重型颅脑损伤亚低温治疗期间早期行肠内营养具有安全有效、费用低、并发症少等优点,可替代肠外营养.     

重型颅脑损伤行亚低温治疗早期肠内营养的护理研究

目的 探讨重型颅脑损伤亚低温期间早期肠内营养的护理方法.方法 将72例重型颅脑损伤的患者随机分成EN、PN两组,均在伤后12 h内行亚低温治疗,同时行肠内营养及肠外营养.结果 ①两组病人营养支持前后的营养状况无明显改变(P>0.05);②与肠外营养相比,肠内营养可有效预防应激性溃疡的发生,大大降低静脉炎的发生;③肠内营养组血糖水平较稳定,且对肝功能无损害.而肠外营养组有明显的肝功能损害且易产生高葡萄糖血症.结论 重型颅脑损伤亚低温治疗期间早期行肠内营养具有安全有效、费用低、并发症少等优点,可替代肠外营养.     

重型颅脑损伤行亚低温治疗早期肠内营养的护理研究

目的 探讨重型颅脑损伤亚低温期间早期肠内营养的护理方法.方法 将72例重型颅脑损伤的患者随机分成EN、PN两组,均在伤后12 h内行亚低温治疗,同时行肠内营养及肠外营养.结果 ①两组病人营养支持前后的营养状况无明显改变(P>0.05);②与肠外营养相比,肠内营养可有效预防应激性溃疡的发生,大大降低静脉炎的发生;③肠内营养组血糖水平较稳定,且对肝功能无损害.而肠外营养组有明显的肝功能损害且易产生高葡萄糖血症.结论 重型颅脑损伤亚低温治疗期间早期行肠内营养具有安全有效、费用低、并发症少等优点,可替代肠外营养.     

重型颅脑损伤行亚低温治疗早期肠内营养的护理研究

目的 探讨重型颅脑损伤亚低温期间早期肠内营养的护理方法.方法 将72例重型颅脑损伤的患者随机分成EN、PN两组,均在伤后12 h内行亚低温治疗,同时行肠内营养及肠外营养.结果 ①两组病人营养支持前后的营养状况无明显改变(P>0.05);②与肠外营养相比,肠内营养可有效预防应激性溃疡的发生,大大降低静脉炎的发生;③肠内营养组血糖水平较稳定,且对肝功能无损害.而肠外营养组有明显的肝功能损害且易产生高葡萄糖血症.结论 重型颅脑损伤亚低温治疗期间早期行肠内营养具有安全有效、费用低、并发症少等优点,可替代肠外营养.     

重型颅脑损伤行亚低温治疗早期肠内营养的护理研究

目的 探讨重型颅脑损伤亚低温期间早期肠内营养的护理方法.方法 将72例重型颅脑损伤的患者随机分成EN、PN两组,均在伤后12 h内行亚低温治疗,同时行肠内营养及肠外营养.结果 ①两组病人营养支持前后的营养状况无明显改变(P>0.05);②与肠外营养相比,肠内营养可有效预防应激性溃疡的发生,大大降低静脉炎的发生;③肠内营养组血糖水平较稳定,且对肝功能无损害.而肠外营养组有明显的肝功能损害且易产生高葡萄糖血症.结论 重型颅脑损伤亚低温治疗期间早期行肠内营养具有安全有效、费用低、并发症少等优点,可替代肠外营养.     

重型颅脑损伤行亚低温治疗早期肠内营养的护理研究

目的 探讨重型颅脑损伤亚低温期间早期肠内营养的护理方法.方法 将72例重型颅脑损伤的患者随机分成EN、PN两组,均在伤后12 h内行亚低温治疗,同时行肠内营养及肠外营养.结果 ①两组病人营养支持前后的营养状况无明显改变(P>0.05);②与肠外营养相比,肠内营养可有效预防应激性溃疡的发生,大大降低静脉炎的发生;③肠内营养组血糖水平较稳定,且对肝功能无损害.而肠外营养组有明显的肝功能损害且易产生高葡萄糖血症.结论 重型颅脑损伤亚低温治疗期间早期行肠内营养具有安全有效、费用低、并发症少等优点,可替代肠外营养.     

重症脑出血患者早期营养支持的观察

目的：探讨对重症脑出血患者如何进行营养支持更为有利。方法：48例患者随机分为甲，乙两组，两组患者条件无差异性，在早期（发病）1周内）给甲组患者行肠内营养（鼻饲）支持，给乙组患者行肠外（静脉）营养支持。结果：早期肠内营养支持较肠外营养支持能显著减少患者肝功能及其它方面的异常变化。结论：早期肠内营养支持比肠外营养支持对重症脑出血患者更有利。     

药膳在重型颅脑损伤患者肠内营养支持的疗效观察

目的：了解药膳在重型颅脑损伤患者肠内营养支持的作用。方法：对重型颅脑损伤的患者在肠内营养中添加自制中药流质营养支持，记录患者病情变化参数。结果：实验组营养状况、胃肠功能较对照组明显改善，且并发症减少。感染率及白蛋自在两组闻的差异有统计学意义。结论：药膳在重型颅脑损伤的患者肠内营养中的合理应用，可以有效的提高患者机体免疫力，减少并发症，降低感染率及死亡率。     

奥美拉唑预防急性心肌梗塞发生应激性溃疡的临床研究

目的观察行PCI术及氯吡格雷治疗的急性心肌梗死患者联用奥美拉唑情况,比较不同组别应激性溃疡的发生率,为急性心肌梗死患者预防应激性溃疡合理用药提供临床研究依据。方法本研究共纳入急性心肌梗死成功行PCI术的患者306例,按照使用奥美拉唑情况分为2组:非PPIs组154例、PPIs组152例,比较2组患者住院期间应激性溃疡消化道出血事件的发生率。结果 2组患者住院期间应激性溃疡发生率及消化道大出血发生率有显著差异(P<0.05)。结论急性心肌梗死患者在病程早期(1周内)及时联用质子泵抑制剂(奥美拉唑)可以有效预防发生应激性溃疡引起的消化道出血,尤其是消化道大出血的发生。     

Amputation and mortality in new-onset diabetic foot ulcers stratified by etiology

OBJECTIVE: Foot ulcers and their complications are an important cause of morbidity and mortality in diabetes. The present study aims to examine the long-term outcome in terms of amputations and mortality in patients with new-onset diabetic foot ulcers in subgroups stratified by etiology. RESEARCH DESIGN AND METHODS: Patients presenting with new ulcers (duration <1 month) to a dedicated diabetic foot clinic between 1994 and 1998 were studied. Outcomes were determined until March 2000 (or death) from podiatry, hospital, and district registers. Baseline clinical examination was done to classify ulcers as neuropathic, ischemic, or neuroischemic. Five-year amputation and mortality rates were derived from Kaplan-Meier survival analysis curves. RESULTS: Of the 185 patients studied, 41% had peripheral vascular disease (PVD) and 61% had neuropathy; 45%, 16%, and 24% of patients had neuropathic, ischemic, and neuroischemic ulcers, respectively. The mean follow-up period was 34 months (range 1-65) including survivors and patients who died during the study period. Five-year amputation rates were higher for ischemic (29%) and neuroischemic (25%) than neuropathic (11%) ulcers. Five-year mortality was 45%, 18%, and 55% for neuropathic, neuroischemic, and ischemic ulcers, respectively. Mortality was higher in ischemic ulcers than neuropathic ulcers. On multivariate regression analysis, only increasing age predicted shorter survival time. CONCLUSIONS: All types of diabetic foot ulcers are associated with high morbidity and mortality. The increased mortality appears to be independent of factors increasing ulcer risk-that is, neuropathy and PVD-in patients with established foot ulcers.     

Colostomy as treatment for complications of spinal cord injury

We reviewed our experience with colostomy performed in 20 spinal cord injury (SCI) patients to determine the effectiveness and safety of colostomy when it is performed for a late complication of SCI. Objective evaluation of gastrointestinal function, ie, colonic transit time and anorectal manometry, was performed in six patients with chronic gastrointestinal complaints to identify the site and severity of bowel dysfunction. Twelve patients had colostomy performed for chronic gastrointestinal problems, seven as an adjunct in the treatment of perineal pressure ulcers, and one for rectal cancer. When patients with difficult bowel evacuation or incontinence were considered, colostomy reliably simplified bowel care, relieved abdominal distention, and prevented fecal incontinence. The amount of time spent on bowel care decreased from an average of 98.6 min/day to 17.8 min/day (p less than .05) after colostomy. When performed as an adjunct in the treatment of pressure ulcers, colostomy provided a dry, clean environment, and seven of seven ulcers healed. Colostomy was well accepted by all patients; all patients with chronic gastrointestinal complaints reported that colostomy improved the quality of their lives. Objective testing differentiated between failure of the colon to adequately transport material to the rectum and inability to adequately evacuate the rectum. Testing was useful in choosing the level at which a colostomy was created, and, in one instance, it identified a specific syndrome (ischemic proctitis) which required colostomy.     

Risk factors for early occurring pressure ulcers following spinal cord injury

We carried out a prospective study to determine the association between immobilization in the immediate postinjury period and the development of pressure ulcers in spinal cord-injured patients following their admission to Charity Hospital, New Orleans. Of 39 patients consecutively admitted to the hospital, 23 (59%) developed a grade one ulcer within 30 days, mostly in the sacral region (57%), the peak time of onset being day 4 postinjury (6/23 cases). In partial support of an earlier retrospective study (Linares HA, Mawson AR, Suarez E, Biundo JJ Jr: Association between pressure sores and immobilization in the immediate post-injury period. Orthopedics 1987;10:571-573), duration of unrelieved pressure prior to ward admission was significantly associated with ulcers developing within the first eight days of injury (P = 0.04), but not with ulcers developing during the entire 30-day observation period (P = 0.09). Time on the spinal board was also significantly associated with ulcers developing within 8 days (P = 0.01), but not with ulcers developing within 30 days (P = 0.09). An unexpected finding was the significant inverse association between systolic blood pressure and the development of ulcers both within 8 days (P = 0.03) and within 30 days (P = 0.02), suggesting that reduced tissue perfusion increases the spinal cord-injured patient's susceptibility to pressure ulcers.     

Quality improvement program to reduce the prevalence of pressure ulcers in an intensive care unit

BACKGROUND: Critically ill patients are at increased risk for pressure ulcers, which increase patients' morbidity and mortality. Quality improvement projects decrease the frequency of pressure ulcers. OBJECTIVES: To improve patients' outcomes by reducing the prevalence of pressure ulcers, identifying areas for improvement in prevention of pressure ulcers, and increasing the adoption of preventive strategies in an intensive care unit. METHOD: Quasi-experimental methods were used for this quality improvement project in which 563 surveys of patients' skin were performed during 22 audits conducted during a 26-month period. One-on-one clinical instruction was provided to bedside nurses during the surveys, and pressure ulcer data were displayed in the clinical area. RESULTS: The frequency of pressure ulcers of all stages showed an overall downward trend, and the prevalence decreased from 50% to 8%. The appropriate allocation of pressure-relieving devices increased from 75% up to 95% to 100%. The likely origin of the ulcer (ie, whether it was hospital or community acquired) and the anatomical site of the pressure ulcers did not change during the study period. CONCLUSIONS: This program was successful in reducing the prevalence of pressure ulcers among vulnerable intensive care patients and indicates that quality improvement is a highly effective formula for improving patients' outcomes that is easily implemented by using clinical expertise and existing resources.     

剖宫产术后早期随意卧位的探讨

目的探讨剖宫产术后产妇早期取随意卧位，对术后产妇的主观舒适度、第1次排气时间、第1次下床活动时间、术后并发症及泌乳量的影响。方法选择2007年3月至5月择期行剖宫产的产妇200例，实验组和对照组各100例，实验组在剖宫产术后转入病房即给予低枕平卧位，根据产妇意愿尽早翻身取随意卧位，即平卧位、侧卧位、半侧卧位、低半卧位；对照组按常规术后去枕平卧6h后取随意卧位，观察两组产妇在主观舒适度、第1次排气时间、第1次下床活动时间、术后并发症及泌乳量方面的情况。结果在主观舒适度、第1次排气时间、泌乳量3个方面，实验组优于对照组（P〈0．01）。结论剖宫产术后早期取随意卧位使产妇更舒适、肠蠕动恢复更快、乳汁分泌更充足。     

Prospective endoscopic study of stress erosions and ulcers in critically ill neurosurgical patients: current incidence and effect of acid-reducing prophylaxis

We studied prospectively 40 critically ill neurosurgical patients who required prolonged mechanical ventilation to determine the current incidence of stress-related gastroduodenal erosions and ulcers, and to assess endoscopically the efficacy of acid-reducing prophylactic treatment. Nineteen patients were randomized to receive ranitidine plus antacids if necessary to maintain gastric pH at greater than or equal to 4. The remaining 21 patients were given no drug prophylaxis. Gastric pH was significantly (p less than .001) higher in the treated group: 78% of pH readings were at greater than or equal to 4 as compared to 32% in the control group. However, after five study days, incidence and severity of stress lesions were similar in the two groups: nine patients in each group had more than five erosions, one treated patient had a gastric ulcer, and one control patient had duodenal ulcerations. No patient experienced clinically relevant upper GI bleeding. The lack of severe stress bleeding and the low ulcer rate contrast with results from earlier reports on similar patient populations. Furthermore, drug prophylaxis had no detectable benefit, as assessed endoscopically. These findings suggest that routine stress lesion prophylaxis may not be necessary in critically ill patients with comparable risk factors.