糖尿病人术后留置导尿与尿路感染相关性调查

目的研究留置导尿与糖尿病患者术后尿路感染的相关因素,以便采取预防控制措施。方法采用回顾性调查与分组对照的方法,对2005~2008年在该医院外科系统住院过的糖尿病手术患者术后留置导尿者医院感染情况进行了调查,并与非留置导尿患者作平行比较。结果糖尿病患者术后留置导尿组200例女性患者中,留置导尿3 d内尿路感染率43.97%,7 d内尿路感染率81.82%,7 d以上尿路感染率100%;非留置导尿组200例女性患者尿路感染率为8.5%。术后留置导尿组200例男性患者中,留置导尿3 d内尿路感染率21.51%,7 d内尿路感染率41.18%,7 d以上尿路感染率84.62%;非留置导尿组200例男性患者尿路感染率为3.5%。结论糖尿病患者术后留置导尿与尿路感染有密切关系,与非留置导尿组比较差异显著(P<0.01)。     

泌尿系外伤患者留置导尿并发尿路感染危险因素Logistic分析及护理

目的:分析泌尿系外伤患者留置导尿并发尿路感染的危险因素,并制定针对性护理对策。方法:选取2015年1月~2016年1月收治的148例泌尿系外伤患者为研究对象,均留置导尿,比较并发尿路感染和无感染患者一般资料的差异,采用Logistic回归方程进行计算,分析留置导尿并发尿路感染的影响因素,从而提出针对性护理对策。结果:泌尿系外伤患者留置导尿并发尿路感染65例,占43.92%。分析发现,患者在性别、年龄、抗生素的运用、导尿管留置时间、尿道口消毒护理、导尿次数、糖尿病史、损伤程度以及导尿管材料方面比较差异有统计学意义(P0.05)。将上述有差异的资料带入Logistic回归方程计算,发现性别、年龄、抗生素的运用、导尿管留置时间、尿道口消毒护理、导尿次数、糖尿病史、损伤程度以及导尿管材料均是泌尿系外伤患者留置导尿后出现尿路感染并发症的影响因素。结论:泌尿系外伤患者留置导尿后并发尿路感染率较高,而引发尿路感染的危险因素较多,临床医护人员需根据患者实际情况进行针对性护理干预,以达到减少尿路感染的目的。     

高龄剖宫产产妇导尿管相关尿路感染的影响因素与病原菌分布

摘要 目的 研究高龄剖宫产导尿产妇术后导尿管相关尿路感染的影响因素及病原菌分布情况,为实施针对性预防措施提供依据。方法 回顾性分析2016年10月—2020年6月在该院剖宫产的高龄产妇的临床资料,对产妇发生导尿管相关尿路感染的相关因素进行统计分析。结果 228例高龄剖宫产导尿产妇中,有33例术后发生了导尿管相关尿路感染,感染发生率为14.47%。感染患者尿液中检出了45株致病菌,革兰阴性菌所占比例最高(68.89%)。单因素及多因素Logistic回归分析显示,年龄≥40岁、体质指数≥30 kg/m2、合并妊娠期糖尿病、血红蛋白数值<100 g/L、留置导尿时间≥2 d、导尿次数≥2次及既往尿路感染史是高龄剖宫产导尿产妇术后发生导尿管相关尿路感染的危险因素(OR>1,P<0.05)。结论 高龄剖宫产导尿产妇术后导尿管相关尿路感染发生率高,致病菌以革兰阴性菌为主,与产妇分娩年龄、妊娠期合并症、贫血情况、尿管留置时间、是否多次导尿及既往尿路感染史有关。     

肝胆外科术后患者早期拔除导尿管的适宜方法及时间

目的 研究肝胆外科术后患者早期拔除导尿管的适宜方法及时间.方法 将86例肝胆外科术后患者随机分为实验组144例和实验组242例,实验组1术后清醒后夹闭尿管至术后第1天晨有尿意后放松导尿气囊,由患者随排尿动作将尿管排出.实验组2术后第1天晨排空尿液,用生理盐水冲洗膀胱使患者有尿意后夹闭尿管,10 min后放松导尿气囊,随患者的排尿动作将尿管排出.选取2010年7月不同科室的肝癌患者87例作为对照组,对其尿管留置情况进行回顾性调查.比较3组的导尿管留置情况.结果 两实验组的首次排尿成功率分别为77.3％和85.7％,差异无统计学意义.两实验组均未发生拔管后排尿困难,而对照组有8例,3组比较x2值为6.782,差异有统计学意义.3组重置尿管的发生情况比较差异无统计学意义.结论 结合实验组1的排尿方法,肝胆外科患者术后第1天晨拔除导尿管为适宜时间,可在临床推广实施.     

女性留置导尿引流管不同固定位置的效果比较

女性留置导尿是临床常用的侵人性诊疗技术之一,应用于尿潴留、尿失禁的治疗,各种急、危、重症手术的术前准备、术后恢复及尿量的准确记录等,而女性患者留置导尿引流管固定位置不妥可导致多种不良事件的发生。本研究从女性患者的舒适性及临床护理人员操作的方便性考虑,探讨不同固定位置对留置导尿引流管不良事件发生的影响,为改进女性留置导尿管固定位置提供依据。     

护理干预对术后留置自控镇痛泵患者尿潴留的影响

目的:探讨护理干预对术后留置自控镇痛泵患者发生尿潴留的影响.方法:选取我科自2007年6月至2008年5月术后留置镇痛泵患者50例为常规组,2008年6月至2009年5月术后留置镇痛泵患者50例为干预组.常规组按常规的护理指导;干预组除常规护理外,同时实施系统、规范的护理干预,即心理护理、健康教育、卧床排尿训练、术后早期关闭镇痛泵、控制输液速度、及时督促排尿等,观察两组患者术后留置导尿情况并进行比较.结果:常规组留置导尿34例,导尿率68%,干预组留置导尿17例,导尿率34%,两组比较差异有显著性(P<0.01).结论:通过护理干预能预防术后尿潴留发生,降低导尿率.     

Stanford A型主动脉夹层患者术后发生早期不良事件的危险因素分析

目的:分析Stanford A型主动脉夹层患者术后发生早期不良事件的危险因素。方法:选取2017年1月1日～2019年1月31日收治的228例Stanford A型主动脉夹层患者为研究对象,通过回顾性问卷调查方式,对入选对象进行一般资料进行收集。采用单因素和多因素Logistic回归分析法对Stanford A型主动脉夹层患者术后发生早期不良事件的相关影响因素进行分析。结果:在228例患者中术后出现谵妄12例(5.26%),术后72 h内发生低氧血症9例(3.95%),术后24 h出现急性肾功能衰竭8例(3.50%),术后出现肝功能不全6例(2.63%),术后发生脊髓损伤5例(2.19%),术后不良事件发生率为17.54%。单因素分析结果显示,年龄、吸烟史、糖尿病史、高血压史、脑卒中病史、冠心病、手术持续时间、深低温停循环时间、术中最低动脉压、ICU持续时间、纤维蛋白原水平、机械通气时间及白蛋白水平均为Stanford A型主动脉夹层患者术后发生早期不良事件的相关影响因素(P0.05);多因素回归分析结果显示,年龄、术中最低动脉压、纤维蛋白原水平及机械通气时间均为影响Stanford A型主动脉夹层患者术后发生早期不良事件的独立危险因素(OR1,P0.05)。结论:高龄、术中最低动脉压偏低、纤维蛋白原水平低下及机械通气时间延长均为影响Stanford A型主动脉夹层患者术后发生早期不良事件的独立危险因素。     

急性心肌梗死PCI术后患者的血清NT-proBNP、ICTP、MMP-9水平及其临床意义研究

目的分析急性心肌梗死PCI术后患者的血清NT-proBNP、ICTP、MMP-9水平,并分析其临床意义。方法选取2016年2月至2018年8月因急性心肌梗死在本院行PCI手术的300例患者为研究对象,根据术后是否发生心血管不良事件分为发生组和未发生组。比较不同临床特征患者心血管不良事件发生率的差异,分析影响心血管不良事件发生的危险因素。结果300例急性心肌梗死PCI术后患者发生心血管不良事件的例数为40例,心血管不良事件发生率为13.33%;BMI≥24 kg/m2、合并高脂血症、置入支架数目≥2个、支架直径≥3 mm的急性心肌梗死PCI术后患者发生心血管不良事件发生率较高,发生心血管不良事件的患者NT-proBNP较高、MMP-9水平较低,不同年龄、性别、饮酒史、吸烟史、糖尿病史、卒中史、ICTP水平的患者心血管不良事件发生率差别无统计学意义;将单因素分析有统计学差异的因素作为自变量,将是否发生血栓作为因变量,进行多因素Logistic回归分析,结果显示置入支架数目和MMP-9水平的OR值分别为5.204和4.342。结论置入支架数目和MMP-9水平是影响急性心肌梗死PCI术后患者心血管不良事件发生的独立危险因素,提示临床应早期监测血清MMP-9等指标。     

引起腹腔镜术后麻醉苏醒期患者躁动的原因分析与护理对策

目的探讨腹腔镜术后麻醉苏醒期患者躁动的影响因素,并提出预见性护理干预对策。方法选取我院2017年6—12月收治的3326例择期腹腔镜手术患者作为调查对象,其中379例发生苏醒期躁动,2947例患者未发生苏醒期躁动。采用logistic回归分析法对患者置管情况、麻醉情况、用药情况及出血量、疼痛、低体温等情况进行分析,确定引起躁动的影响因素。结果经logistic多因素回归分析发现,麻醉前留置导尿、麻醉维持用药、疼痛、术中低体温为引发腹腔镜术后苏醒期躁动的影响因素。结论腹腔镜患者全麻患者麻醉前留置导尿、麻醉维持用药、疼痛、术中低体温可直接影响患者术后麻醉苏醒期躁动发生,麻醉苏醒室护理人员应及时给予患者超前镇痛、安全防护、术后复温等措施。     

留置导尿与闻歇导尿治疗尿潴留的Meta分析

导尿术是治疗急性尿潴留最直接有效的方法[1],也是临床上常用的护理技术操作,然而导尿所致的尿路感染是医院感染的主要原因.国外资料[2]证实留置2d尿道感染率2%,＞14d感染率100%.间歇性导尿却可减少因长期留置尿管而引发的尿道、会阴、膀胱并发症[3].本文对间歇导尿与留置导尿治疗尿潴留的安全性和有效性进行了系统评价,以期为临床护理选择合理的导尿操作方法提供理论依据,现报道如下.     

利多卡因凝胶在术前静脉穿刺置管术中的应用效果观察

[目的]探讨利多卡因凝胶涂抹对术前静脉穿刺置管术的影响及效果。[方法]选择手术前静脉留置针穿刺保留且意识清楚病人160例,分为观察组和对照组各80例,观察组在静脉留置针穿刺前以2%盐酸利多卡因凝胶涂抹皮肤,2min后再行穿刺置管术;对照组常规静脉留置针穿刺。观察两组病人一次穿刺成功率、病人的疼痛度、满意度。[结果]两组病人一次穿刺成功率比较差异无统计学意义(P0.05),穿刺时疼痛度和满意度比较,差异有统计学意义(P0.05)。[结论]术前静脉穿刺置管时应用2%盐酸利多卡因凝胶涂抹皮肤能缓解穿刺时疼痛,提高病人满意度,无药物不良反应发生。     

肝胆外科术后患者腹腔感染耐碳青霉烯类鲍曼不动杆菌临床因素分析

目的 探讨肝胆外科术后患者腹腔感染耐碳青霉烯类鲍曼不动杆菌（CRAB）的相关临床因素,为预防感染提供依据.方法 回顾性调查肝胆外科术后患者腹腔感染CRAB的临床资料,对其年龄、手术时间、术中出血量和术后广谱抗菌药物特别是碳青霉烯类的抗菌药物的应用情况进行统计分析.结果 肝胆外科术后腹腔感染CRAB的患者中,年龄大于或等于50岁与年龄小于50岁的患者分别为35例（63.64%）和20例（36.36%）;手术时间大于或等于4 h的患者占69.09%（38例）,手术时间小于4 h的30.91%（17例）;术中出血量大于或等于400 mL的患者占72.73%（40例）,出血量小于400 mL的患者为27.27%（15例）;55例患者术后100.00%应用过广谱抗菌药物,其中30例患者应用过碳青霉烯类的抗菌药物,占54.55%,未应用者为45.45%.统计学分析显示,每个临床因素不同分类间比较差异有统计学意义（P〈0.05）.结论 高龄、手术时间长、术中出血多、术后应用过广谱抗菌药物特别是碳青霉烯类的抗菌药物等因素可能是肝胆外科术后患者腹腔感染CRAB的重要因素,肝胆外科医生应加强关注.     

留置尿管时机对全麻苏醒期不良反应的影响

目的探讨全麻手术患者术中留置导尿管的最佳时机,减轻术前患者插尿管的痛苦,减少不良反应的发生,保证医疗护理的安全。方法选择我科2014年6月-2015年10月150例全麻手术术前需导尿的成年患者,按数字表法随机分为A、B、C组,A组患者术前在病房导尿并留置尿管,B组患者在全麻插管后导尿并留置尿管;C组患者在麻醉诱导期为患者进行导尿并留置尿管。比较三组患者导尿前及导尿时的生命体征、全麻复苏期躁动、舒适度的情况及麻醉复苏时间。结果通过分组研究,C组即麻醉诱导期留置导尿管患者在全麻复苏期躁动最少,尿道刺激症状少,舒适度增加,患者的满意度提高。结论麻醉诱导期留置导尿管,既可减少全麻苏醒期躁动的发生,又增加了患者的舒适感,提高患者的满意度。     

纳布啡联合舒芬太尼在肝胆外科腹腔镜术后的镇痛效果

目的探讨纳布啡联合舒芬太尼用于肝胆外科腹腔镜术后患者自控镇痛(PCA)的临床疗效。方法选取2018年1月-2020年1月该院收治的120例腹腔镜肝胆外科手术患者作为研究对象,随机分为舒芬太尼组(S组)、纳布啡组(N组)和纳布啡联合舒芬太尼组(N+S组),每组各40例。S组术后镇痛使用舒芬太尼,N组术后镇痛使用纳布啡,N+S组术后镇痛使用纳布啡联合舒芬太尼,记录3组患者术后不同时间段心率(HR)、平均动脉压(MAP)、视觉模拟评分(VAS)、术后PCA按压次数和不良反应发生情况。结果 N+S组在术后10 min (T_3)、30 min (T_4)和60 min (T_5)的MAP及HR均明显低于S组,且在T_4及T_5时点,N+S组较N组HR及MAP明显降低,两组比较,差异均有统计学意义(P 0.05)。N+S组在术后8 h (T_7)、12 h (T_8)和24 h (T_9)的VAS评分明显低于S组,N+S组术后PCA按压次数明显少于S组,两组比较,差异均有统计学意义(P 0.05)。N+S组的不良反应总发生率明显低于N组及S组,差异有统计学意义(P 0.05)。结论纳布啡与舒芬太尼联合应用于肝胆外科腹腔镜术后镇痛效果良好,且用药安全性高,值得临床推广使用。     

Feasibility of preoperative inspiratory muscle training in patients undergoing coronary artery bypass surgery with a high risk of postoperative pulmonary complications: a randomized controlled pilot study

OBJECTIVE: To determine in a pilot study the feasibility and effects of preoperative inspiratory muscle training in patients at high risk of postoperative pulmonary complications who were scheduled for coronary artery bypass graft surgery. DESIGN: Single-blind, randomized controlled pilot study. SETTING: University Medical Centre Utrecht, the Netherlands. SUBJECTS: Twenty-six patients at high risk of postoperative pulmonary complications were selected. INTERVENTION: The intervention group (N = 14) received 2-4 weeks of preoperative inspiratory muscle training on top of the usual care received by the patients in the control group. MAIN MEASURES: Primary outcome variables of feasibility were the occurrence of adverse events, and patient satisfaction and motivation. Secondary outcome variables were postoperative pulmonary complications and length of hospital stay. RESULTS: The feasibility of inspiratory muscle training was good and no adverse events were observed. Treatment satisfaction and motivation, scored on 10-point scales, were 7.9 (+/- 0.7) and 8.2 (+/- 1.0), respectively. Postoperative atelectasis occurred in significantly fewer patients in the intervention group than in the control group (kappa(2)(DF1) = 3.85; P = 0.05): Length of hospital stay was 7.93 (+/- 1.94) days in the intervention group and 9.92 (+/- 5.78) days in the control group (P = 0.24). CONCLUSION: Inspiratory muscle training for 2-4 weeks before coronary artery bypass graft surgery was well tolerated by patients at risk of postoperative pulmonary complications and prevented the occurrence of atelectasis in these patients. A larger randomized clinical trial is warranted.     

血清sdLDL-C水平与冠心病PCI手术患者预后的关系

目的探讨血清小而密低密度脂蛋白胆固醇(sdLDL-C)与冠心病经皮冠状动脉介入治疗(PCI)手术患者预后的关系。方法选取2015年5月至2019年12月在该院接受PCI手术的冠心病患者195例。采用全自动生化分析仪检测患者血清sdLDL-C水平,根据血清sdLDL-C水平分为3组:<1.35 mmol/L为A组,1.35~<3.00 mmol/L为B组,≥3.00 mmol/L为C组,每组65例。分析sdLDL-C水平与血管狭窄程度的关系。术后随访6个月,观察不良心脏事件发生情况。采用Logistic回归分析冠心病PCI手术患者发生不良心脏事件的危险因素。结果3组在糖尿病史、高血压史方面比较,差异有统计学意义(P<0.05)。C组术前血清sdLDL-C、TG、LDL-C水平,Gemini评分和不良心脏事件发生率明显高于B组和A组,且B组明显高于A组(P<0.05)。相关性分析显示,血清sdLDL-C水平与Gemini评分呈正相关(r=0.582,P=0.003)。Logistic回归分析发现:年龄≥60岁、糖尿病史、高血压史、血清sdLDL-C为1.35~<3.00 mmol/L和血清sdLDL-C≥3.00 mmol/L为冠心病PCI手术患者术后发生不良心脏事件的独立危险因素(P<0.05)。结论血清sdLDL-C水平与冠心病PCI手术患者血管病变程度呈正相关,其高表达为冠心病PCI手术患者术后发生不良心脏事件的独立危险因素,血清sdLDL-C有望成为冠心病患者PCI术后预后评价的生物标志物。     

Postoperative adverse events of common surgical procedures in the Medicare population.

Mortality rates are the most widely used measure in assessing patient outcome from hospitalization. However, they may be an insensitive measure of quality for surgical patients because death is a relatively rare outcome. A random sample of patient data (n = 8126) selected from the Medicare files of seven states was used to identify, through chart abstraction, clinical postoperative complications of surgery that could serve as measures of quality. Four surgical procedures were studied: 1) coronary artery bypass grafting; 2) coronary angioplasty; 3) cholecystectomy; and 4) prostatectomy. Severity at admission was controlled for using severity-of-illness models developed with chart-abstracted data to predict adverse events after these four procedures. 30-day mortality rates ranged from 1.0% to 6.6%, while the prevalence of postoperative adverse events identified from chart review was greater (6.9% to 33.3%). There were significant differences between patients with and without adverse events. For example, coronary artery bypass graft patients with adverse events had prolonged postsurgical lengths of stay (18.5 +/- 13.2 vs. 13.2 +/- 6.2, P less than 0.001) and higher mortality rates (15.2% vs. 2.6%, P less than 0.001). The R-square values using clinical indicators at admission to predict the occurrence of any adverse event ranged from 0.05 to 0.13. Clinically meaningful adverse events of surgery can be successfully identified through chart abstraction and appear to be valid measures of postoperative complications among surgical patients. Severity adjustment at admission only modestly predicts the occurrence of these adverse events.     

Examination of the efficacy of olanexidine gluconate for surgical site infections in colorectal cancer elective surgery

IntroductionThe preoperative skin antiseptic, olanexidine gluconate (OLG), which has been available in Japan since 2015, is also known to be effective against methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and Pseudomonas aeruginosa. This study attempted to clarify OLG efficacy against surgical site infections and antiseptic-related adverse events as compared to conventionally used povidone iodine (PVP–I).MethodsPropensity score matching was performed on 307 patients who underwent surgery for colorectal tumors at our hospital. All 116 cases (58 PVP-I cases, 58 OLG cases) who were diagnosed with colorectal cancer were included. We examined surgical site infection rate after disinfection using PVP-I and OLG, length of hospitalization stay (days) after surgery, adverse events associated with antiseptics, and additional medical costs associated with adverse events caused by antiseptics.ResultsThe surgical site infection rate was 8.6% in both the PVP-I and OLG groups, with no significant difference observed. The number of postoperative hospitalization days in the PVP-I group was 12.9 (±6.9) days and 16.4 (±14.6) days in the OLG group, which exhibited no significant difference (p = 0.10). Although no complications due to antiseptics were observed in the PVP-I group, skin-related side effects were observed in 8 patients (13.8%) in the OLG group. The median additional medical cost was 730 [120–1823] yen.ConclusionsOLG was as effective as the conventional PVP-I for surgical site infections during colorectal cancer elective surgery. However, significantly higher skin disorders occurred in OLG, thereby making it necessary to evaluate antiseptic use in conjunction with patient burden.     

Physiological abnormalities and adverse events during physical therapy in the intensive care unit after cardiac surgery: A prospective observational study

BackgroundAfter cardiac surgery, physiological abnormalities or adverse events might occur in patients in the intensive care unit (ICU) during physical therapy care. Identifying these events may help improve patient safety and care.ObjectivesTo estimate the incidence and the degree of severity of physiological abnormalities or adverse events during physical therapy interventions provided in the ICU after cardiac surgery. To explore the relationship between these events and patients’ characteristics and clinical outcomes.MethodsProspective observational study of adult patients in the postoperative period of cardiac surgery admitted to the ICU of a referenced university hospital. Physical therapy interventions were observed by a team trained to evaluate and register the occurrence of physiological abnormalities or adverse events and grading their consequences. We compared baseline characteristics and outcomes of patients with versus without these events.ResultsWe observed 935 physical therapy interventions in 323 patients, of which 189 (20%, 95% confidence interval: 18, 23%) resulted in physiological abnormalities or adverse events. The highest incidences of these events were observed during endotracheal suctioning (44%), walking (40%), and noninvasive ventilation (37%). Hemodynamic changes were the most frequent events accounting for 74% of all events. Only 2% of interventions resulted in mild harm and 0.2% in moderate harm. The presence of comorbidities was associated (p = 0.03) with the occurrence of these events.ConclusionPhysiological abnormalities or adverse events occurred in 20% of physical therapy interventions in patients in the ICU after cardiac surgery, with 10% of those resulting in negative effects. Only the presence of comorbidities was associated with the occurrence of these events.