4例儿童臂丛神经损伤健侧C(7)椎体前移位直接修复术的护理

总结了4例儿童臂丛神经损伤健侧C(7)椎体前移位直接修复术围手术期的护理体会.术前通过心理护理、预防再损伤及功能锻炼、疼痛护理及术前体位训练等,患者情绪稳定,患者及家属对患者的伤残接受程度提高,患肢未出现再损伤.术后做好体位护理、病情观察、功能锻炼及出院指导,患儿术后康复过程顺利,切口Ⅰ级愈合,能够配合进行功能锻炼.     

Diagnosis and management of medial epicondyle avulsion fracture in a 27-year-old female: A case report

ObjectiveThe purpose of this case report is to describe the diagnosis and management of an adult patient presenting with a rarely reported avulsion fracture of the medial epicondyle of the humerus.Clinical presentationA 27-year-old female sought care following an injury sustained when the elbow gave out on an attempted back flip. The clinical assessment found an indication of elbow fracture with a diagnosis of medial epicondyle avulsion fracture made on radiographic examination.Intervention and outcomeFollowing in-house imaging, the patient was referred for an orthopedic consultation. An MRI was ordered and revealed numerous internal joint derangements. The orthopedist prescribed a hinged brace and followed up in 4 weeks. Physical therapy was ordered by the surgeon with follow-up again in 4 more weeks.ConclusionMedial epicondyle avulsion fractures are extremely rare in adults, and in this case, were accompanied by extensive internal joint derangements in the elbow. Chiropractors should be able to diagnose this condition from x-ray and can be of assistance with rehabilitation therapies.     

The Effects of Minocycline or Riluzole Treatment on Spinal Root Avulsion–Induced Pain in Adult Rats

Spinal root avulsion produces tactile and thermal hypersensitivity, neurodegeneration, and microglial and astrocyte activation in both the deafferented and the adjacent intact spinal cord segments. Following avulsion of the fifth lumbar spinal root, immediate and prolonged treatment with riluzole or minocycline for 2 weeks altered the development of behavioral hypersensitivity. Riluzole delayed the onset of thermal and tactile hypersensitivity and partially reversed established pain behavior. Minocycline effectively prevented and reversed both types of behavioral change. Histologic analysis revealed that both drugs reduced microglial staining in the spinal cord, with minocycline being more effective than riluzole. Astrocyte activation was ameliorated to a lesser extent. Surprisingly, neither drug provided a neuroprotective effect on avulsed motoneurons.PerspectiveImmediate treatment of spinal root avulsion injuries with minocycline or riluzole prevents the onset of evoked pain hypersensitivity by reducing microglial cell activation. When treatment is delayed, minocycline, but not riluzole, reverses pre-established hypersensitivity. Thus, these drugs may provide a new translational treatment option for chronic avulsion injury pain.     

Knowledge and awareness of dental trauma among Indian nurses

AimThe aim of the study was to assess the knowledge and awareness regarding the emergency management of dental traumatic injuries among the present and prospective nurses of KLE Institute of Nursing Sciences and Hospital, Belgaum, India.MethodologyA 15-item questionnaire regarding the clinical situation of tooth avulsion inquiring nurses’ knowledge was administered to 308 nursing professionals, includes nursing interns and staff nurses.ResultsOut of 300 respondents, only 2.2% knew about the storage medium used for storing avulsed tooth. Majority of the participants accepted that they had no knowledge regarding the emergency management of dental traumatic injuries and also that no training had been given to them about this.ConclusionAs nurses stand on the front lines of responding to emergency, it is essential that they also possess adequate knowledge about dental traumatic injuries and its emergency management. As the findings of our study revealed poor knowledge about emergency management of dental trauma, it is concluded that there is a need for mass educational campaign to broaden the nurses’ knowledge about this.     

Avulsion de la tubérosité ischiatique chez l’adolescent : à propos de deux cas cliniques

Ischial avulsion, often diagnosed as a musculotendinous injury, is a traumatic pathology related to physical activity. Treatment of ischial avulsion fractures is not consensual. The authors present two case reports of adolescent football players with an ischial tuberosity avulsion submitted to a conservative rehabilitation programme, with different outcomes. One of the patients returned to competition but the other gave up football due to pain. In these case reports diagnosis, treatment and follow-up results are discussed.     

The management of hamstring injury--Part 1: Issues in diagnosis

Hamstring injuries are the most prevalent muscle injury in sports involving rapid acceleration and maximum speed running. Injury typically occurs in an acute manner through an eccentric mechanism at the terminal stages of the swing phase of gait. Biceps femoris is most commonly injured. Re-injury rates are high and management is a challenge given the complex multi-factorial aetiology. The high rates of hamstring injury and re-injury may result from a lack of high-quality research into the aetiological factors underlying injury. Re-injury may also result from inaccuracy in diagnosis that results from the potential multi-factorial causes of these conditions. Inaccuracy in diagnosis could lead to multiple potential diagnoses that may result in the implementation of variable management protocols. Whilst potentially useful, such variability may also lead to the implementation of sub-optimal management strategies. Previous hamstring injury is the most recognized risk factor for injury, which indicates that future research should be directed at preventative measures. Much anecdotal and indirect evidence exists to suggest that several non-local factors contribute to injury, which may be addressed through the application of manual therapy. However, this connection has been neglected in previous research and literature. This paper will explore and speculate on this potential connection and offer some new contributive factors for hamstring injury management. This first paper of a two part series on hamstring injury will explore diagnostic issues relevant to hamstring injury and the second will investigate various established and speculative management approaches.     

Splenic injury from colonoscopy: a review and management guidelines

Splenic injury is an uncommon complication of colonoscopy. Less than 100 cases are reported in the English language literature. The exact mechanism of injury to the spleen during colonoscopy is unknown; various authors propose several risk factors and possible mechanisms. Splenic injury can be graded or classified according to the extent of laceration and the severity of the resultant hematoma. The management options range from observation to emergency splenectomy. Computed tomography scan is the most important imaging modality to diagnose splenic injury. Early recognition and appropriate management is of paramount importance in the management of this condition. A high index of suspicion in a patient with persistent abdominal pain after colonoscopy is key especially when a perforated viscous is ruled out. This article outlines the clinical presentation of splenic injury after colonoscopy and delineates a management algorithm.     

C1-C2 fractures and dislocations

The management of patients with bony or ligamental injury of C1 or C2 depends on the nature of the fracture or subluxation. Other factors which must be taken into consideration are mechanism of injury, presence of neurological deficit and demonstration of stability. It is the intention of this article to examine bony anatomy of the upper two cervical vertebrae and their relationship to each other. The management of this injury and the role of the nurse in caring for and educating the patient with this type of injury, as well as a case study will be presented.     

中重型颅脑损伤患者精神障碍的临床分析

目的 探讨颅脑损伤患者精神障碍与损伤的关系。方法 回顾性分析94例颅脑损伤患者的临床资料。结果在94例患者中，共有67例出现精神障碍。重型颅脑损伤者的发生率较高。其表现以智能减退为主。而中型颅脑损伤者以神经症综合征多见；颅脑损伤在出现脑挫裂伤并(或)脑内血肿、脑室内血肿时易出现精神障碍，且多部位脑组织损伤者易出现精神障碍。尤其损伤位于额、颞叶时更易发生。结论 颅脑损伤患者在接受专科治疗的同时，也应重视精神障碍的发生并给予相应处理。     

社区护士对开展居家压力性损伤管理认知的质性研究

目的：探讨社区开展居家压力性损伤管理的可预见性问题,并提供解决方案。方法：采取质性研究的现象学研究法,通过立意抽样法对社区护士进行半结构访谈,使用Colaizzi法分析所获资料,根据定性研究的综合标准（COREQ）报告研究结果。结果：社区护士对居家压力性损伤管理必要性认识充分,但管理受到来自家庭照顾者、社区护士及上级管理部门的影响,有待进一步完善。结论：社区护士需在政府、社区服务中心和家庭照顾者等各方的支持下开展居家压力性损伤管理。     

Early intensive care unit intervention for trauma care: what alters the outcome?

This review focuses on early management of multiple trauma patients with traumatic brain injury. Early usage of multislice computed tomography can substantially shorten the time spent on diagnostic workup in the emergency room and, therefore, speeds the initiation of lifesaving interventions for the control of hemorrhage. The important role of hemostatic angiographic embolization and its timing, in addition to surgical control of bleeding in patients suffering from pelvic fracture or organ lesions, is emphasized. The ongoing controversy regarding the strategy of fluid resuscitation is discussed. The concept of permissive hypotension seems to be promising but is absolutely contraindicated in patients with traumatic brain injury. Coagulation management should be guided by coagulation monitoring, including thromboelastography. A novel approach to reduce major bleeding is the application of recombinant factor VIIa. Strong effort should be directed toward the management of traumatic brain injury and the maintenance of cerebral perfusion pressure. The optimization of treatment of patients with multiple trauma, including brain injury, is a multidisciplinary task.     

伤口造口专科护士主导的院内压力性损伤管理

目的探讨伤口造口专科护士主导的院内压力性损伤管理的效果。方法对院内需求进行分析,开展伤口造口专科护士主导的院内压力性损伤的管理,主要包括人才队伍建设,成立伤口造口管理小组,发挥伤口造口专科护士职能,规范压力性损伤的管理流程,建立压力性损伤监控系统等。结果 2016年-2018年,伤口造口专科护士的压力性损伤理论与操作考核优秀率逐年提高(P<0.01),院内压力性损伤发生率逐年下降(P<0.01)。结论伤口造口专科护士主导的院内压力性损伤管理,充分发挥了专科护士在专业领域中的骨干作用,有效提升临床护理人员的专科水平,降低院内压力性损伤的发生,减轻了病人痛苦,提升了医院的社会效益。     

工伤职工职业康复及重返社会的行动研究

目的探讨对工伤职工实施包括职业康复及社区回归在内的完整康复计划的原则与方法。方法从跟进的371例工伤职工中抽取14个深入跟进的康复个案为样本，从性别及家庭角色差异、伤残部位及程度、康复的进展、工伤赔偿方式等方面，分析工伤后的职业康复及回归社区状况，整理出有关工伤职工职业康复及社区回归的影响因素。结果影响工伤职工职业康复和社区回归的因素包括工伤职工残疾部位与程度、性别与家庭角色差异，以及工伤补偿与工伤康复政策和跨专业团队提供的工伤康复服务管理模式等。结论完整的工伤康复计划需要考虑工伤职工的基本医疗康复、职业康复及社区康复需要，及早提供适当的支持和指引，建立一站式全面深入跟进的工伤康复服务管理模式。     

Microsensor and microdialysis technology. Advanced techniques in the management of severe head injury

Neuroscientists continue the search for the "magic bullet" that will prevent the deleterious effects of primary and secondary brain injury. Indirect measurement of the effects of primary and secondary brain injury through the study of ICP- or CPP-directed management, CBF monitoring, Sjo2 monitoring, and TCD monitoring has led to improved care of persons with brain injury. Although the findings from brain injury research using microsensor and microdialysis technology are only preliminary and extensive research is still needed, these technologies have dramatically expanded knowledge about brain injury at the cellular level. Extended neuromonitoring is poised to enter a new and exciting phase because of the growth in knowledge regarding the cellular events associated with brain injury. The recent approval of NeuroTrend by the FDA will further promote this growth. Applications of the technology have already expanded to include uses beyond the management of traumatic brain injury. Microsensor and microdialysis technology is being used intraoperatively to determine "safe" temporary clipping times for aneurysm surgery and is also being used within the critical care setting to improve the monitoring and management of subarachnoid hemorrhage patients who are experiencing vasospasm. The ultimate application of this new technology is to improve long-term outcomes for patients with brain injury through the reduction of secondary brain injury. If that goal is to be accomplished, then it will be important for nurses caring for patients with brain injury to become immersed in this exciting new phase in brain injury monitoring. Nurses must obtain a comprehensive knowledge base of brain injury pathophysiology and how extended neuromonitoring can lead to improved outcomes. Technical proficiency will also be important to ensure that treatment and research conclusions are based on accurate data. Finally and perhaps most importantly, it will be critical for nurses to participate in and develop research studies that explore the impact of interventions, especially nursing care activities, on the injured brain if these exciting new advances are to be translated into tangible benefits for brain-injured patients.     

颈脊髓损伤患者的呼吸道管理

探讨颈脊髓损伤患者呼吸道管理的方法,为提高临床疗效提供有效的保证。对我科2008年6月至2010年10月收治的38例颈脊髓损伤患者的呼吸道管理进行回顾性分析。38例颈脊髓损伤患者进行呼吸道管理后,呼吸功能完全恢复35例,3例发生急性呼吸衰竭死亡。颈脊髓损伤患者的呼吸道管理是颈椎骨折手术成功的关键性因素,合理可靠的呼吸道管理,为患者术后顺利恢复提供了有效的保障。     

Hamstring injury management--Part 2: Treatment

The management of hamstring injuries can be described as vexed at best. One reason for this may be because of a lack of high-quality research into the methods of treatment, rehabilitation and prevention. As a result, an evidence-based approach to injury management does not exist. Management is based on clinical experience, anecdotal evidence and the knowledge of the biological basis of tissue repair. Previous hamstring injury is the most recognized risk factor for injury, which indicates that treatment approaches may be suboptimal under certain conditions. The identification of these risk factors and the methods best designed to manage them should be addressed with future research efforts. Much anecdotal and indirect evidence exists to suggest that several non-local factors contribute to injury. Despite the knowledge that these factors may exist, the literature appears almost devoid of research investigating their possible identification and treatment. Treatment has traditionally been in the form of altering the muscle repair process through the application of electrophysical therapy and various soft-tissue-based and exercise-based techniques. Little research has investigated the role of other forms of manual therapy particularly when directed at non-local structures. This paper will explore and speculate on this potential connection and offer some new contributive factors for hamstring injury management.     

手术室护士压力性损伤管理自我效能感现状及影响因素分析

目的 了解手术室护士压力性损伤管理自我效能感现状及影响因素,为提升护士压力性损伤管理自我效能水平,实施针对性干预提供参考。方法 采用主动性人格量表、关怀行为量表、变革型领导量表、护理临床决策量表和护士压力性损伤管理自我效能感量表对广西、四川、贵州、云南、新疆、重庆10所三级甲等医院的469名手术室护士进行调查。结果 护士压力性损伤管理自我效能得分为(28.71±6.32)分,学历、主动性人格、关怀行为、变革型领导及护理临床决策是压力性损伤管理自我效能的影响因素(P＜0.005),能解释总变异的39.8％。结论 手术室护士压力性损伤管理自我效能处于中等偏上水平,其影响因素较多。护理管理者可通过采取实施变革型领导、建立良好的护理临床决策氛围等有效措施帮助护士提高压力性损伤管理自我效能。     

Diagnostic dilemmas and current controversies in blunt chest trauma

Blunt chest injuries are common encounters in the emergency department. Instead of a comprehensive review of the management of all chest injuries, this review focuses on injuries that can be difficult to diagnose and manage, including blunt aortic injury, cardiac contusion, and blunt diaphragmatic injury. This review also discusses some recent controversies in the literature regarding the use of prophylactic antibiotics for tube thoracostomy and the optimal management of occult pneumothorax. The article concludes with a discussion of the management of rib fractures in the elderly.     

Controversies in the management of the head-injured patient

The management of the patient with severe head injury has changed dramatically and continues to evolve. Through clinical studies on head-injured patients, the effectiveness of some current therapies are being questioned. Modifications of current protocols will continue to be made so that the overall goal of maintaining cellular integrity and preventing secondary injury to the brain can be met. As research continues, more changes are anticipated in the care of head injuries. The critical care nurse must keep abreast of the current trends in head injury management. No one can be sure what the future of head trauma care will be, but it is certain that it will change based on the effectiveness of the therapies on reducing mortality and morbidity for these patients.     

It's a knockout: survey of the management of avulsed teeth

Avulsion of a tooth is a not uncommon childhood injury, with up to 16% of dental injuries involving the loss of a tooth. Although this is an apparently 'minor' injury, for a child there may be long-term psychological and treatment problems. Correct advice in the early stages of this injury, and the recognition that prompt treatment may allow a tooth to be successfully reimplanted are vital in the management of these injuries. Often, nursing staff in the accident and emergency or paediatric department may be asked for advice either professionally or informally, and can influence the long-term dental health for these patients. This paper looks at the knowledge of parents and healthcare professionals in the management of these injuries.