整体护理在手术室的应用体会

随着现代护理学的不断发展,“以患者为中心”是一种新的医学模式,亦是对护理学的基本要求。现代护理学科的发展对手术室护理提出了更高的要求,手术室护理不仅仅是配合手术为主的单纯技术操作,更是在手术室的工作内容和程序中充分体现临床科室普遍实施的“以患者为中心”的整体护理。手术室是进一步完善患者整体护理的一部分,是“以患者为中心”的整体护理的体现。以术前访视、术中护理及术后随访来适应和满足患者要求,确保整体护理的连续性、完整性和系统性。     

健康教育在手术室护理中的作用

随着医学模式的转变和护理学的发展，长期以来“以疾病为中心、以执行医嘱为主的功能制护理”逐渐被“以病人为中心、以新的护理观为指导、以护理程序为框架的整体护理”所取代。健康教育是整体护理的重要组成部分，它的目的是改变人的健康行为或问题，使患者的行为有利于向康复的方向发展。健康教育贯穿于从患者人院到出院的全过程。手术室不同于其他临床科室，其护理对象有其特殊性，手术患者有不同程度的紧张、恐惧心理，严重者可直接影响手术的顺利进行。所以，加强对手术患者的健康教育是手术室整体护理中至关重要的，也是必不可少的。     

手术室开展整体护理的做法和体会

随着医学模式的转变,传统的以“疾病为中心”的护理模式正在被一种新的“以病人为中心”的护理模式所替代。以往手术室的护士工作仅以手术中的配合为主,而忽视病人的整体护理。手术室是对病人进行抢救与治疗的重要场所,而手术作为一种应激反应,对病人的心理、生理等各方面都会产生影响,护士工作质量的好坏,直接影响病人治疗的效果及预后,因此,手术室护士应全面了解病人心理、生理等各方面的需求,对病人术前、术中及术后实施护理尤为重要。现就手术室开展整体护理的做法和体会介绍如下。     

手术室护理综合目标的质量管理责任

随着医学科学的发展及医学模式的转变 ,在实施“以病人为中心 ,以质量为核心”的整体护理过程中 ,我院自 1996年以来 ,为进一步提高手术室质量管理责任的综合目标 ,实施手术室整体护理 ,采取了手术室护理管理责任到人的工作方式。这种工作方式 ,对调动手术室护理人员的工作积极     

外科手术病人的整体护理

为适应新的护理模式,我科把传统的以疾病为中心的护理模式逐渐转变为以病人为中心的整体护理模式,从病房到手术室的病人均实施整体护理.现将具体内容介绍如下.     

护理教育中影响整体护理实施的2个突出问题

1　整体护理实施中存在的2个与护理教育相关的问题11　整体护理实施中护士缺乏与之相适应的整体护理观念由于长期以来传统的功能制护理模式的制约,护理工作受以疾病为中心、护理任务局限于执行医嘱,打针、发药等具体护理措施的影响根深蒂固,相当多的护理工作者对实施整体护理缺乏感性、理性的认识和内在动力。一些护理人员没有从护理发展的角度来认识整体护理中当前医学护理模式转变的结果,是从“以疾病为中心”向“以病人的健康问题为中心”的观念的转变,只是单纯地认为整体护理使得护理工作变得繁琐了,比起原来增加了许多“额外”的工作,…     

手术室护士在麻醉中的配合

随着现代护理学的不断发展，“以病人为中心”是一种新的医学模式，亦是对护理学的基本要求。手术室护理不仅是配合手术为主的单纯技术操作，更是在手术室的工作内容和程序中充分体现临床科室普遍实施的“以病人为中心”的整体护理。以术前防视、术中护理及术后随访来适应和满足病人要求，确保整体护理的连续性、完整性和系统性。     

整体护理与护士素质

随着医学模式的转变，社会的发展，人们对健康要求的提高，护理工作必须从以前的“以疾病为中心”的护理向“以病人为中心”的整体护理转变。适应新的医学模式，由过去以疾病为中心单纯护理模式向生理、心理、社会多元化护理模式发展，宗旨是“以病人为中心，以现代护理为基础，以护理程序为手段，为病人提供优质的整体护理”。现将我在护理工作中的几点体会，总结如下：     

高原地区整体护理在手术室的实施与体会

随着医学模式的转变，一种新的护理观——“以病人为中心”的整体护理模式已在我国广泛开展”。我院是一所中心医院，地处西藏高原，海拔3600m，空气干燥，气候恶劣。由于地理环境和客观条件的影响，制约了我院护理工作的发展。我院的现代护理教育起步较晚。一直以来手术室护士主要限于在手术室内配合手术医师完成任务，忽视了患者心理社会因素。随着护理工作由单一护理向整体护理的改变。整体护理服务有了更高的标准。我院在手术室开展了“以病人为中心”的整体护理，对患者实施了术前访视、术中护理、术后随访，不仅向患者提供服务，还需与患者及其家属保持良好的沟通，让他们对手术有足够理解并积极配合，在获得最好疗效的同时并得到尊重，现将实施方法和体会介绍如下。     

ICU护士核心能力的研究进展

随着医学模式由“生物医学模式”向“生物一心理一社会医学模式”的转变,护理模式也随之由“以疾病为中心”的护理模式向“以病人为中心”的责任制整体护理模式转变。护理模式的改变对护士能力提出了更高的要求,需要护士有较强的学习能力、应用能力和创新能力等,     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.