浅谈65例甲亢患者行甲状腺大部分切除术的术中护理配合体会

甲状腺功能亢进简称甲亢,系各种原因所致正常甲状腺素分泌的反馈控制机制丧失,引起循环中甲状腺素异常增多,出现以全身代谢亢进为主要特征的疾病总称.     

不同液体复苏对肺内、外源性急性呼吸窘迫综合征幼猪早期氧代谢及胃黏膜pH值的影响

目的 观察不同液体复苏对肺内、外源性急性呼吸窘迫综合症(ARDS)幼猪早期氧代谢和胃黏膜pH的影响.方法 将24只幼猪随机给予盐酸肺灌洗或油酸静注造模后,分为ARDSp (A组)和ARDSexp(B组),组内再据EGDT方案分别给予限制性[CVP,3 cm H2O(1 cm H2O=0.098 kPa),A1、B1组]或非限制性(CVP,10 cm H2O,A2、B2组)液体复苏,观察并比较氧合指标及pHi的变化.结果 2组造模成功后,氧合指数＜200,pH,＜7.32(P＜0.05).液体复苏过程中,A组氧合指数仍降低,pHi升高;B1组氧合指数升高(P＜0.05),pHi较A1组比较,升高不显著.结论 ARDSexp限制性液体复苏利于水肿的减轻,氧合的改善,但仍存在器官灌注不足的风险.     

临床护理教学的体会

随着以病人为中心的整体护理的深入发展 ,过去那种以单纯授课形式 (老师讲 ,学生以听、记为主的教学方法 ) ,已不能适应护理模式变革的需要。临床护理教学需要教育者采用创造性的方法把理论与实践完善地结合起来 ,达到培养临床合格护理人才的目的。我院作为医科大学的附属医院 ,每年承担着本科生、夜大生、中专生的课堂教学和临床教学任务。现将 10年来临床教学的体会与护理同仁共同探讨。1　专题教学法1 1　专题选定　按教学大纲的要求 ,突出重点、难点、疑点等问题 ,列出与知识重点相关联项目 ,选定若干个重点题项 ,分别备课。1 2　专题专…     

实行护理人员按职上岗的体会及设想

护理人员按职上岗是现代化医院护理管理的必然趋势,是深化护理队伍改革的重要措施之一。所谓按职上岗是根据护士的职务、职称及业务能力等条件分为不同级别和层次的标准化管理与目标管理。达     

肥胖因素对大鼠呼吸机相关性肺损伤的影响

目的评价肥胖因素对大鼠呼吸机相关性肺损伤(VILI)的影响。方法清洁级雄性SD大鼠45只,6～8周龄,按照体重分为3组(n=15):正常体重对照组(C组)、正常体重VILI组(CV组)和肥胖VILI组(FV组)。C组和CV组体重为233～267 g,FV组体重为288～332 g。C组潮气量VT 10 ml/kg,CV组和FV组潮气量VT 40 ml/kg,通气频率40次/min,吸呼比1∶ 2,PEEP 0 mmHg,FiO2 21%,机械通气4 h,制备大鼠VILI模型。分别于气管插管前即刻和机械通气4 h时采集动脉血样行血气分析,记录PaO2;剩余血样收集血浆。机械通气4 h时采血后处死大鼠,分离两侧肺组织,收集支气管肺泡灌洗液(BALF)。采用ELISA法检测血浆瘦素浓度、血浆及BALF中TNF-α、IL-1β、IL-6的浓度。测定肺组织湿重/干重(W/D)比值,HE染色后观察肺组织病理结果并进行肺损伤评分,采用Western blot法检测肺组织NF-κB p65表达水平。结果与C组和CV组比较,FV组血浆瘦素浓度升高(P<0.01)。与C组比较,CV组和FV组机械通气...     

Effect of High Frequency Oscillatory Ventilation on EVLW and Lung Capillary Permeability of Piglets with Acute Respiratory Distress Syndrome Caused by Pulmonary and Extrapulmonary Insults

The effect of high frequency oscillatory ventilation(HFOV) at early stage on hemodynamic parameters, extravascular lung water(EVLW), lung capillary permeability, CC16 and s ICAM-1 in piglets with pulmonary or extrapulmonary acute respiratory distress syndrome(ARDS) was explored. Central vein pressure(CVP) and pulse indicator continuous cardiac output(Pi CCO) were monitored in 12 anesthetized and intubated healthy piglets. Pulmonary ARDS(ARDSp) and extrapulmonary ARDS(ARDSexp) models were respectively established by lung lavage of saline solution and intravenous injection of oleic acid. Then the piglets received HFOV for 4 h. EVLW index(EVLWI), EVLW/intratroracic blood volume(ITBV) and pulmonary vascular permeability index(PVPI) were measured before and after modeling(T0 and T1), and T2(1 h), T3(2 h), T4(3 h) and T5(4 h) after HFOV. CC16 and s ICAM-1 were also detected at T1 and T5. Results showed at T1, T3, T4 and T5, EVLWI was increased more significantly in ARDSp group than in ARDSexp group(P<0.05). The EVLWI in ARDSp group was increased at T1(P=0.008), and sustained continuously within 2 h(P=0.679, P=0.216), but decreased at T4(P=0.007) and T5(P=0.037). The EVLWI in ARDSexp group was also increased at T1(P=0.003), but significantly decreased at T3(P=0.002) and T4(P=0.019). PVPI was increased after modeling in both two groups(P=0.004, P=0.012), but there was no significant change within 4 h(T5) under HFOV in ARDSp group, while PVPI showed the increasing trends at first, then decreased in ARDSexp group after HFOV. The changes of EVLW/ITBV were similar to those of PVPI. No significant differences were found in ΔEVLWI(P=0.13), ΔPVPI(P=0.28) and ΔEVLW/ITBV between the two groups(P=0.63). The significant decreases in both CC16 and s ICAM-1 were found in both two groups 4 h after HFOV, but there was no significant difference between the two groups. It was concluded that EVLWI and lung capillary permeability were markedly increased in ARDSp and ARDSexp groups. EVLW could be decreased 4 h after the HFOV treatment. HFOV, EVLW/ITBV and PVPI were increased slightly at first, and then decreased in ARDSexp group, while in ARDSp group no significant difference was found after modeling. No significant differences were found in the decreases in EVLW and lung capillary permeability 4 h after HFOV.     

不同剂量瘦素对大鼠机械通气肺损伤的影响

目的评价不同剂量瘦素对大鼠机械通气肺损伤的影响。方法健康清洁级SD雄性大鼠48只,6～8周龄,采用随机数字表法分为四组:气管切开保留自主呼吸的假手术组(A组)、机械通气模型组(B组)、瘦素10μg/kg组(C组)和瘦素50μg/kg组(D组),每组12只。采用10%水合氯醛3.5 ml/kg麻醉大鼠,疼痛反射消失后C组腹腔注射瘦素10μg/kg,D组腹腔注射瘦素50μg/kg,A、B组腹腔注射等容量生理盐水,注射后即刻进行气管切开,插管机械通气。A组气管插管后保留自主呼吸,B、C、D组机械通气建立VILI模型,参数设置:V_T 20 ml/kg,RR 80次/分,I∶E 1∶1,FiO_2 21%,PEEP 0 mmHg,通气时间4 h。分别于基础状态、通气结束时抽取股动脉血进行血气分析。通气结束后放血处死大鼠,在4℃下取肺组织并收集支气管肺泡灌洗液(bronchoalveolar lavage fluid, BALF),光镜下进行中性粒细胞计数,采用ELISA法测定TNF-α、IL-6、IL-1β浓度;取肺组织称重,计算肺湿干重比(W/D);观察肺组织病理改变并进行病理评分;采用Western blot检测肺组织研磨液中NF-κB p65含量。结果与A组比较,B、C、D组W/D、肺损伤评分、BALF中性粒细胞计数、TNF-α、IL-6、IL-1β浓度及肺组织NF-κB p65含量明显升高(P0.01)。与B组比较,C、D组BALF中性粒细胞计数、TNF-α、IL-6、IL-1β浓度及肺组织肺损伤评分、NF-κB p65含量明显降低(P0.05)。与C组比较,D组BALF中性粒细胞计数、TNF-α、IL-6、IL-1β浓度及肺组织肺损伤评分、NF-κB p65含量明显降低(P0.05)。结论瘦素可降低大鼠机械通气肺损伤中炎性因子的表达水平,减轻肺损伤,50μg/kg较10μg/kg作用明显。     

小儿肠套叠的术后观察与护理体会

肠套叠是小儿外科常见的急腹症,多见于2岁以下的小儿,是引起婴幼儿肠梗阻的首要原因。临床表现为患儿腹痛、腹胀、伴有呕吐及排果酱样大便[1]。当患儿病情不超过48h,全身情况良好,可选用非手术治疗空气灌肠复位[2]。非手术治疗不成功或发病时间超过48h,一般情况差则选用手术治疗[2]。2007年1月至2010年6月,我院收治36例肠     

多元文化与现代护理

从人们日益增长的医疗卫生保健需求出发,提出应将多元文化应用于护理之中,并阐述了护士在多元文 化中应充当的角色。     

哈尔滨市12所三级甲等医院护理管理者变革型领导行为调查

目的:通过对哈尔滨市12所三级甲等医院的护理管理者进行测评,了解目前哈尔滨市护理管理者变革型领导行为的情况。方法:应用中国台湾地区陈秀琴根据美国管理学家Kouzes和Ponser研究形成的领导实践量表(Leadership Practice Inventory,LPI)调查哈尔滨市12所三级甲等医院343名护理管理者,通过对变革型领导行为的测量,对所得的数据进行统计学分析。结果:哈尔滨市临床护理管理者的变革型护理管理行为处于中等水平,其中"授权他人"得分最高,其次为"榜样作用",其他依次为"共启前景""激励作用""挑战过程"。结论:哈尔滨市的护理管理者多从临床优秀护士中提拔,大多未经过系统的管理理论知识的培训,护理管理者应不断地学习,改进和创新护理管理的模式和方法,提高管理水平。