护理干预对防治老年骨折患者便秘的作用

目的探讨减少骨科围术期老年患者便秘发生率。方法对86例老年骨科手术病人采取系统的饮食指导等护理干预措施。结果本组便秘发生率明显减少,仅为7.5%。结论早期护理干预可减少老年骨折患者便秘的发生。     

高龄股骨颈骨折病人围手术期护理体会

目的回顾高龄股骨颈骨折病人围手术期护理措施及效果,总结护理经验。方法回顾性分析86例70岁以上股骨颈骨折病人的临床和护理资料,依据高龄老年人的病理生理及心理特点,制定针对性护理措施,预防并发症,进行功能锻炼。结果 86例病人均平稳度过围手术期。结论高龄病人手术风险相对较大,根据高龄老年人的生理特点和心理特点,针对性实施围手术期护理措施是提高手术成功率,预防和减少并发症、改善生存质量的重要保障。     

子宫切除术病人的术前访视与护理干预

目的探讨术前访视与护理干预对子宫切除病人的影响。方法对72例子宫切除病人术前访视,发现病人存在心理问题,主要是焦虑恐惧、抑郁和失去信心。并有针对性地进行护理干预。结果72例子宫切除病人的焦虑恐惧紧张心理减轻,主动配合手术并平稳顺利地渡过手术关。结论术前访视与护理干预能有效地缓解手术病人的焦虑、恐惧情绪是保证子宫切除病人顺利进行手术的有效措施。     

特殊医学用途配方食品对围手术期病人营养干预的意义

减少围手术期病人空腹期和给予合理的营养干预,可优化病人的代谢状态,使手术和临床效益最大化;包括在麻醉过程中保持最佳代谢状态,改善胰岛素敏感性和减少肌肉的分解代谢,最终降低术后并发症发生率和缩短住院时间。围手术期管理,包括针对性分析、评估和处理围手术期风险、营养状况和并发症,正确把握手术适应证和时机[1-2]。对围手术期病人营养干预的研究和应用处于不断发展状态。因此,无论医师、护士和营养师都需要拓     

穴位电刺激对腹部术后胃肠功能恢复的疗效观察

腹部手术后尽快恢复胃肠道功能,尽早排气排便,是减少术后肠粘连等并发症、促进病人早日进食、早日康复的有效措施。连续硬膜外麻醉下施行腹部手术,术后胃肠蠕动的恢复一般需要数日时间。作者利用胃肠治疗仪对３０例腹部手术病人术后进行穴位电刺激治疗,促进胃肠蠕动的...     

麻醉规范化心理支持对围术期应激反应水平的影响

外科手术是一种强烈的应激源,由手术带来的心理生理康复问题,对手术的预后有直接影响。如何在围术期尽可能的降低心理应激反应,从而减少围术期并发症,缩短住院时间,越来越受到关注。我们自2006年以来,形成了一套规范化的措施,对择期手术的病人实施系统的心理干预,达到预期效果。1资料与方法1.1一般资料纳入标准：择期手术完善相关检查并定于3d内手术的病人。     

音乐干预减轻乳腺肿瘤病人门诊手术前焦虑的研究

目的探讨音乐干预对减轻乳腺肿瘤病人门诊手术前焦虑的作用。方法将112例乳腺肿瘤病人随机分为实验组和对照组,调查患者的音乐背景及爱好,制定个体化音乐干预方案;手术前1h至手术结束,实验组通过耳机欣赏选定音乐,对照组只戴耳机不听音乐;对两组进行焦虑评分,测量两组心率、收缩压及舒张压的变化。结果两组病人音乐背景及喜好比较差异无统计学意义;实验组干预后焦虑评分、收缩压、心率降低,与对照组相比差异有统计学意义(P<0.05),舒张压在干预前后无明显改变。结论根据病人喜好进行个体化音乐干预可减轻乳腺肿瘤病人门诊手术前焦虑,音乐干预是术前心理护理的有效措施之一,能发挥独立的辅助性治疗作用。     

肠内营养及微生态免疫营养在围手术期的应用

近年来,围手术期营养干预在外科重症病人中应用越来越受到重视,选择合理的围手术期营养干预将有助于提高病人预后。给予围手术期病人肠内营养(enteral nutrition,EN)可保护病人肠黏膜、促进营养吸收以及增强免疫功能等,因此EN已成为外科重症病人围手术期一种重要的营养支持。不仅如此,在肠道微生态重要性日益凸显的背景下,微生态免疫营养的临床研究也越来越广泛。本文将论述围手术期肠内营养及微生态免疫营养的应用。     

预防成人腹股沟疝修补术后复发策略

复发是腹股沟疝修补术后常见的并发症之一,引起腹股沟疝修补术后复发的原因包括病人自身的因素和医源性因素,其中部分因素可通过临床干预而改变。重视对腹股沟疝修补术后病人宣教和管理随访,尤其是治疗引起的腹内压增高相关疾病;加强外科医师的系统学习和技术培训,提高理论和技术水平,规范手术准入制度,强调手术质量控制;根据病人的具体情况和术者的技术经验选择合适的手术方式;术中游离充足的空隙并选择相匹配大小的补片,严格遵守无菌操作和确切止血,减少术后发生感染和出血。采取上述措施可有效减少腹股沟疝术后复发的危险因素。     

合并呼吸功能不全病人肺功能评估及风险因素

应客观、正确评价合并呼吸功能不全病人的肺功能,充分估计手术风险,设计合理的手术方案,制定围手术期治疗措施,尽可能改善肺功能,以提高其对麻醉和手术的耐受性。肺功能评估主要包括呼吸功能检查及心肺储备功能检查。了解合并呼吸功能不全病人的相关风险因素, 有助于判断术后肺部并发症的高危病人,利于选择恰当的检查方法及治疗措施,降低肺部并发症的发生率。     

腹腔镜直肠癌根治术(Dixon)

在结肠系膜与后腹膜移行处切开后腹膜,分离系膜至肠系膜下动脉根部,清扫253组淋巴结,在距腹主动脉根部1 cm处夹闭并切断血管,切断肠系膜下静脉。由内侧向外侧分离结肠系膜至结肠旁沟,切开其左侧后腹膜,将降结肠及乙状结肠系膜从后腹壁游离。沿直肠固有筋膜与盆壁筋膜的间隙按照TME原则锐性分离直肠系膜,先游离后壁,再游离两侧壁及前壁,直至盆底。在肿瘤下方2 cm处用阻断夹夹闭肠管,冲洗远端直肠,用切割缝合器切断直肠。取脐部弧形切口。提出近端肠管,于肿瘤近端15 cm处离断肠管。近端置入管型吻合器抵钉座,还纳腹腔,重建气腹。经肛置入管型吻合器,在腹腔镜直视下作乙状结肠－直肠端端吻合,冲洗腹腔,置引流管,手术结束。     

Crystalloids,colloids, blood,blood products and blood substitutes

Understanding the physiology of fluid distribution within the human body is fundamental to the practice of anaesthetists and intensivists of all grades. There is a necessity to recognize the range of actions and consequences of the commonly infused intravenous fluids if safe patient care is to be provided. There are many historical and on-going trials surrounding fluid therapy and it is important for the physician to keep up to date with current guidelines.There is a continued drive to improve the safety of donor blood and prevent transfusion errors. Knowledge of how blood products are collected separated and stored is essential to prevent harm to patients through transfusions. Work in producing blood substitutes is progressing, but to date, trials have failed to market a product in Europe and the USA with an acceptable risk profile.     

Principles of pressure transducer function and sources of error in clinical use

The invasive measurement of physiological pressures is a common requirement in anaesthesia and intensive care medicine. From arterial blood pressure to intracranial pressure, these calculated variables give a swift graphical and numerical representation of a patient's current physiological status. This allows us to respond rapidly to conditions outside our preferred parameters and to carefully titrate treatment to target effects. These systems are, however, not infallible. An understanding of the principles of their function will promote appropriate use and an ability to recognize and react to sources of error. This article aims to furnish the reader with this level of understanding in order to inform their academic and clinical practice.     

Clonidine as an adjuvant to intrathecal local anesthetics for surgery: systematic review of randomized trials

BACKGROUND AND OBJECTIVES: Clonidine is added to intrathecal local anesthetics to improve intraoperative analgesia and to increase the duration of sensory and motor block. The aim of this systematic review is to quantify beneficial and harmful effects of clonidine when used as an adjuvant to intrathecal local anesthetics for surgery. METHODS: We included data from 22 randomized trials (1,445 patients) testing a large variety of doses of clonidine, added to intrathecal bupivacaine, mepivacaine, prilocaine, or tetracaine. RESULTS: Clonidine 15 to 150 microg prolonged in a linear, dose-dependent manner, the time to 2 segment regression (range of means, 14 to 75 minutes) and the time to regression to L2 (range of means, 11 to 128 minutes). The time to first analgesic request (median 101 minutes, range 35 to 310) and of motor block (median 47 minutes, range 6 to 131) was prolonged without evidence of dose-responsiveness. Time to achieve complete sensory or motor block, and extent of cephalic spread remained unchanged. There were fewer episodes of intraoperative pain with clonidine (relative risk, 0.24; 95% confidence interval [CI], 0.09-0.64; number needed to treat, 13) but more episodes of arterial hypotension (relative risk, 1.81; 95% CI 1.44-2.28; number needed to harm, 8) without evidence of dose-responsiveness. The risk of bradycardia was unchanged. CONCLUSIONS: This study may serve as a rational basis to help clinicians decide whether or not to combine clonidine with an intrathecal local anesthetic for surgery. The optimal dose of clonidine, however, remains unknown.     

Jaundice

Jaundice is a yellow discoloration of body tissues usually observed in the skin secondary to excess bilirubin in the serum. This occurs due to imbalance between production and clearance of bilirubin. It is important to understand the pathophysiology of jaundice to understand its aetiology. Careful history and physical examination, together with appropriate urine and blood tests will guide further investigations to obtain an appropriate diagnosis. It is important to assess and address associated sepsis, dehydration, electrolyte imbalance and clotting abnormality to reduce morbidity prior to instituting any treatment plan. This often involves specialists from the multidisciplinary team.     

A laboratory training model for interhemispheric-transcallosal approach to the lateral ventricle

Laboratory training models are essential for developing and refining surgical skills before clinical application of microneurosurgery. Our aim is to train residents of neurosurgery to be familiar with a basic microneurosurgical technique in access to the lateral ventricle via a transcallosal approach. The training material consists of a 2-year-old fresh cadaveric cow cranium. A four-step approach was designed to simulate microneurosurgical dissection along the falx to visualize cingulated gyri, callosomarginal and pericallosal arteries in order to perform callosotomy and access to the lateral ventricle, and finally to the foramen of Monroe. We conclude that the model perfectly simulates standard microneurosurgical steps in interhemispheric-transcallosal approach to the lateral ventricle and to the area of the foramen of Monroe.     

Decision-Making Capacity and Disaster Research

The extent to which victims of a disaster are able to make capacitated and voluntary decisions to enroll in research is an important and virtually unexplored question. Although there are no compelling data to suggest that experiencing a severe trauma, in and of itself, renders all or even most individuals incapable of making autonomous decisions, the assessment of decision-making capacity (DMC) for research participation warrants serious consideration. This paper provides a framework for and procedural approach to the assessment of DMC in research with individuals exposed to disaster. Particular attention is paid to the implementation of additional safeguards to protect subjects who are vulnerable by virtue of impaired DMC. Recommendations are offered to clinical investigators, ethical review boards, and policymakers with regard to the design, review, and conduct of research in the aftermath of disaster.     

住院患者忠诚度及其影响因素的研究

目的了解住院患者忠诚度及其影响因素,为提供更高品质的医疗服务质量提供参考。方法通过方便抽样法抽取某三甲医院住院〉5d的患者281例,采用自行设计的问卷进行调查。结果71．5％患者愿意再次购买该医疗机构医疗服务,60．1％患者愿意向亲朋好友推荐;影响住院患者再次购买意愿的因素按影响大小排列为：诊疗水平、医疗费用、医院品牌、就医环境;影响住院患者推荐意愿的因素按影响大小排列为：诊疗水平、医院品牌、他人推荐、治疗效果。结论住院患者再次购买意愿高于向他人推荐意愿,影响忠诚度的因素多样;医院应加强患者感知服务质量的管理与控制,重视品牌管理,提高住院患者忠诚度。