指压穴位法缓解胆绞痛的临床观察

2002年5月至2007年5月,我科采用指压背部穴位法缓解胆绞痛80例,取得了满意疗效,现总结如下. 1 资料与方法 1.1 一般资料本组120例,住院患者95例,门诊患者25例;其中胆囊结石62例;胆囊及胆管炎51例,胆管结石7例.病例选择:胆区突发性疼痛,常伴有恶心或呕吐,疼痛向右肩背部放射,在右背部常可找到明确的压痛点.全部病例均经B超检查,部分病例经X线检查证实.将全部病例随机分为2组,治疗组80例,男35例,女45例,年龄25～71岁,平均45.9岁;对照组40例,男17例,女23例,年龄27～69岁,平均43.2岁;两组一般资料差异无统计学意义(P>0.05).     

多次连续拍背法在小儿支气管肺炎护理中的疗效观察29例

支气管肺炎是儿科冬春季节发病率较高的一种疾病，自2003年10月至2004年3月我科让家长和医护配合在呼吸道护理中用多次连续拍背法取得满意效果，现报告如下：     

穴位注射维生素K3治疗胆绞痛的观察与护理

胆囊炎、胆囊结石伴颈部嵌顿是临床胆道系统常见疾病之一，其临床表现为急性阵发性右上腹绞痛。目前，临床上对胆结石嵌顿无特殊有效的方法，只有保守治疗观察，如果胆结石不能回纳，继发感染则需手术治疗，对患者创伤较大并造成一定的经济负担。我们采用维生素K3穴位注射治疗急性胆绞痛21例，现报告如下。     

对老年肺部感染患者拍背排痰的护理观察

对52例老年肺部感染患者采取有效翻身、拍背促使咳嗽排痰,观察测定排痰前后血氧饱和度（SO_2）,经拍背排痰护理,SO_2增值4±2．8%,P＜0．05,差别有显著性,增值达4%,有临床意义。     

硝酸甘油治疗胆绞痛的临床观察

目的评价硝酸甘油治疗胆绞痛的疗效及安全性。方法胆绞痛患者110例随机分为治疗组和对照组,分别给予硝酸甘油舌下含服和山莨菪碱静脉滴注,观察用药1h后的疗效及不良反应。结果硝酸甘油组和山莨菪碱组有效率分别为83．3％和84．0％,两者差异无统计学意义;副作用发生率分别为6．7％和70．0％,两者差异有显著性。结论硝酸甘油治疗胆绞痛疗效确切,安全性好。     

临床护理路径在骨科俯卧位手术中的应用

目的:探讨临床护理路径在俯卧位手术中的应用,利用临床护理路径,预防和解决手术中遇到的护理问题.方法:将临床护理路径应用在骨科俯卧位手术中,采用改善俯卧位体位垫、头托,细致的术前评估和术中的巡视等措施,减少和杜绝术中并发症的发生,为手术患者提供安全、有效的护理.结果:护理问题明显减少或消除.讨论:临床护理路径应用到手术室的护理工作中,能使患者得到优质、有效的护理,减轻不适,降低并发症的出现.     

滚动法轴线翻身安置俯卧位法在俯卧位脊柱手术体位护理中的应用

目的探讨滚动法轴线翻身安置俯卧位法在俯卧位脊柱手术体位护理中的应用效果。方法选取行俯卧位脊柱手术的患者110例作为实验对象,按照数字随机原则分组,各55例,对照组患者采用传统的护理措施安置俯卧位,观察组患者则采用滚动法轴线翻身护理干预进行体位的安置操作,对比两种不同体位安置方法所需要的时间、特殊情况发生率、对患者的影响等。结果观察组患者体位安置时间较对照组显著缩短,导管滑脱等特殊情况发生率显著低于对照组,安全性方面优于对照组,差异有统计学意义(P0.05)。结论在俯卧位下行脊柱手术的患者体位安置时采用滚动法轴线翻身护理方法,能够缩短体位安置的时间,提升干预的安全性,因此值得临床推广应用。     

心脏术后实施俯卧位通气的护理观察

2001年我科护理组对4例心脏术后患者实施了俯卧位通气,获得了较好的效果。现将护理体会报告如下:1 对象和方法1.1 对象 心脏病手术后住ICU患者4例,年龄分别为6/12岁、10/12岁、1岁、63岁,呼吸机应用时间7～41d,平均25 d。其中室缺、肺动脉高压术后合并心衰1例;冠状动脉右室瘘再次手术1例;全肺静脉异位引流矫治术后合并双侧     

Transport of Mechanically Ventilated Patients in the Prone Position

Objective: We present seven cases of patients with severe respiratory failure refractory to conventional ventilation who were safely transported in the prone position. Methods: We describe all cases of patients transported by a regional critical care network in the prone position from January 2010-June 2015. All patients were mechanically ventilated for respiratory failure and transported by specialized nonphysician critical care teams. Utilizing direct medical oversight and real-time technical support from the clinical department, each patient underwent a thorough bedside evaluation, transport ventilator trial, and transfer to a transport stretcher either with the endotracheal tube secured by an anesthesia pillow or overhanging the stretcher. Results: Seven patients with acute respiratory distress syndrome were transported in the prone position. Four were female (57%), with a median weight of 78 kg (range 58-131) and median age of 53 years (range 37-78). Initial vital signs demonstrated a median oxygen saturation of 94% (range 90-97%) supported with a FiO₂ of 100% for all patients with a median positive end-expiratory pressure (PEEP) of 16 (range 14-20). Seven patients were transported, six by helicopter and one transported by ground ambulance. The median transport time was 36 minutes (IQR 19, 51). There were no deaths or major incidents (tube dislodgement or line displacement) during patient transport. Conclusion: The transport of mechanically ventilated patients with respiratory failure in the prone position is feasible and safe, with minimal complications identified in this case series.     

俯卧位通气对急性呼吸窘迫综合征患者影响的Meta分析

目的评价俯卧位通气对急性呼吸窘迫综合征(acute respiratory distress syndrom,ARDS)患者的影响。方法计算机检索the Cochrane library、PubMed、Embase、Medline、Ovid、CBM、CNKI、维普数据库中截至2013年12月1日所有公开发表的关于ARDS患者俯卧位通气影响的随机对照试验(randomized controlled trial,RCT),并通过纳入文献的参考文献进行引证检索,纳入文献的质量由两名经过专业医学循证培训的医学生完成,对符合质量标准的文献进行Meta分析。结果共纳入12篇RCT,其中7个RCT的研究结果显示,俯卧位通气对患者氧合指数的提高有显著影响[OR=69.65,95%CI(37.13~102.7),P0.0001];另外8个研究结果表明,俯卧位通气对降低病死率有显著效果[OR=0.63,95%CI(0.51,0.78),P0.001]。结论俯卧位通气可以有效地改善ARDS患者的氧合指数,降低病死率。     

间苯三酚注射液治疗胆绞痛的临床观察

目的 评价问苯三酚治疗胆绞痛的疗效及安全性.方法 胆绞痛患者240例随机分为治疗组和对照组,分别给予问苯三酚和山莨菪碱静脉滴注,观察用药1h后的疗效及不良反应.结果 间苯三酚组和山莨菪碱组有效率分别为86.7%和84.2%,两者差异无统计学意义;不良反应发生率分别为2.5%和79.2%,两者差异有显著统计学意义.结论 间苯三酚治疗胆绞痛疗效确切,安全性好.     

不同角度头高脚低俯卧位对后路腰椎手术病人眼压的影响

目的 观察不同角度头高脚低俯卧位病人在俯卧位前后眼压的变化,研究不同倾斜角度对俯卧位病人眼压的影响,为临床寻找一种简单有效的降低俯卧位手术病人眼压的方法,以减少术后视力障碍的风险.方法 选择后路腰椎手术病人,随机分为3组,0°组手术床水平位,2.5°组手术床头高脚低倾斜 2.5°,5°组手术床头高脚低倾斜5°;分别于手术前术后测量各组病人眼压,统计各组病人的术前气道压、术中失血量、术中输液量、尿量以及病人俯卧位持续时间.结果 各组病人术前气道压、术中输液量、术中出血量、尿量、俯卧位持续时间差异均无统计学意义.术前眼压值3组病人间差异无统计学意义(P>0.05);各组病人术后眼压较术前均有升高,差异有统计学意义;术后3组病人眼压的差异有统计学意义,组间两两比较0°组与2.5°组、2.5°组与5°组间差异无统计学意义,0°组与5°组差异有统计学意义.结论 倾斜5°的头高脚低俯卧位可在不影响手术操作的情况下,降低后路腰椎手术病人眼压,以避免术后视力损害风险.     

ACTION头垫联合赛肤润对俯卧位颅脑手术患者面部皮肤的保护作用

目的探讨联合应用ACTION头垫和赛肤润保护俯卧位颅脑手术患者面部皮肤的效果。方法2012年1月至2014年6月,便利选取326例符合条件的颅脑手术患者,并采用随机数字表法将其分为对照组(普通海绵垫组)80例、观察1组(ACTION头垫组)84例、观察2组(赛肤润组)80例和观察3组(ACTION头垫联合赛肤润组)82例,分别于手术结束后即刻及术后30min观察患者受压部位皮肤情况。结果手术时间≤4h的患者中,3个观察组的皮肤保护效果均优于对照组(P0.05),3个观察组间差异无统计学意义;手术时间4h的患者中,3个观察组的皮肤保护效果优于对照组(P0.05),观察3组的皮肤保护效果优于观察1组和观察2组(P0.05)。结论 ACTION头垫联合赛肤润能有效保护俯卧位颅脑手术患者的面部皮肤,减少术中压力性溃疡的发生,尤其是手术时间较长的患者。     

眼科术后俯卧位患者非手术眼眼压升高的临床分析及护理

目的探讨眼科术后俯卧位患者非手术眼眼压升高的发生率及诱发因素,并提出护理对策。方法眼科行复杂性玻璃体视网膜手术后持续俯卧位的173例患者,排除术前高眼压或青光眼,检查非手术眼前房角、屈光状态、前房深度、瞳孔有无阻滞、眼轴直径、角膜直径,将上述项目均正常的患者纳入正常组,其余纳入异常组,术后连续测量眼压7d,统计两组患者术后非手术眼高眼压发生率并进行比较。结果全部患者非手术眼术后高眼压发生率为8．7％,正常组为2．6％,异常组为13．7％,两组比较差异有统计学意义（P〈0．05）。结论玻璃体视网膜术后俯卧位患者合并小角膜、前房浅、眼轴短、瞳孔阻滞、窄房角、高度近视等,其非手术眼眼压升高率较高,对术后俯卧位患者非手术眼眼压进行早期观察及护理非常重要。     

坐位手术体位对患者循环功能影响的分析及护理

采用ＳｗａｎＧａｎｚ漂浮导管对３２例坐位手术体位患者术前、术中进行了心指数、右房压的检测,得出两组参数,体位坐起４５°、９０°与平卧位比较有很大差别,说明坐位手术对患者心输出量影响较大。测得的肺动脉压平均值及呼气末二氧化碳分压,为观察术中并发气栓提供了依据。由此提出：①采取缓慢调整体位（不少于２０ｍｉｎ）、腹部应用腹带缚压、双下肢缠绕弹力绷带能增加回心血量,有利于血压的维持;②术前插入ＳｗａｎＧａｎｚ漂浮导管监测病情变化,并可及时抽出进入肺内的气体。本组６例８次行血管内抽气１～３２ｍｌ,术后无一例死亡。     

A Double-blind Randomized Clinical Trial Evaluating the Analgesic Efficacy of Ketorolac versus Butorphanol for Patients with Suspected Biliary Colic in the Emergency Department

Objectives: Patients presenting to the emergency department (ED) with suspected biliary colic often require intravenous (IV) analgesia. The choice of IV analgesia typically includes opioids and ketorolac. Although ultrasound (US) is the initial diagnostic study in these patients, nondiagnostic scans and a high clinical suspicion may require the patient to undergo hepatobiliary scintigraphy (HIDA). Opioids such as morphine interfere with the HIDA scan and thus may limit its value as an analgesic in the ED for these patients. Analgesics that do not interfere with HIDA scanning include ketorolac and butorphanol, an opioid agonist–antagonist. This study evaluates the efficacy of IV ketorolac compared to butorphanol for the treatment of biliary colic pain in the ED. Methods: Between June 2005 and February 2007, a convenience sample of patients presenting to the ED with abdominal pain suspected to be biliary colic were randomized to receive either 30 mg of IV ketorolac or 1 mg of IV butorphanol. Pain level was assessed using a 1 to 10 “faces” visual analog pain scale initially, as well as 15 and 30 minutes after medication infusion. Side effect profiles and the need for rescue analgesia were also assessed. Patients and clinicians were blinded to the study drug given. Results: Forty‐six patients were enrolled in the study. Both groups had similar demographics and baseline pain scores. The mean (±standard deviation [SD]) pain score in the butorphanol group decreased from 7.1 (±1.7) to 2.1 (±2.2) after 30 minutes. The mean (±SD) pain score in the ketorolac group decreased from 7.4 (±2.0) to 3.1 (±3.3) after 30 minutes. Both groups had similar needs for rescue analgesia. Side effects included dizziness and sedation with butorphanol and nausea with ketorolac. Conclusions: Although limited by small sample size and convenience sample, this study demonstrates that both ketorolac and butorphanol provide pain relief in biliary colic. Both agents should be considered reasonable options in the ED treatment of biliary colic, especially in patients that may undergo HIDA.     

基于氧合指数指导下的进阶式肺康复训练结合俯卧位通气对重度老年ARDS患者心肺功能及血气指标的影响

目的 探究基于氧合指数指导下的进阶式肺康复训练结合俯卧位通气对重度老年急性呼吸窘迫综合征(ARDS)患者心肺功能及血气指标的影响.方法 选取128例重度老年ARDS患者,采用随机数字表法将患者分为对照组和观察组,每组64例,对照组给予俯卧位机械通气和肢体被动活动,观察组增加基于氧合指数指导下的进阶式肺康复训练,对比2组...