Effect of anti-vasculitis powder on indwelling catheter induced phlebitis

目的 观察脉炎散局部外敷留置针静脉炎的临床疗效.方法 将90例行留置针静脉输液导致静脉炎的患者随机分为两组,观察组50例发生静脉炎后用脉炎散外敷;对照组40例发生静脉炎后用50％硫酸镁温热湿敷.观察静脉炎的转归,痊愈时间及过敏反应情况.结果 观察组有效率(95.9％)显著优于对照组(75.0％),疗程显著短于对照组(均P＜0.01);对照组无皮肤过敏现象,观察组发生1例.结论 脉炎散治疗留置针静脉炎安全,疗效优于50％硫酸镁温热湿敷.     

Career plateau among nurses working at a top-notch hospital in Yunnan province and the related factors

目的 了解云南省护士的职业高原现状,为针对性干预提供实证依据.方法 采用护士职业倦怠量表(简化版)和自拟的8个相关条目对某三级甲等医院118名护士进行问卷调查.结果 护士职业倦怠量表5个维度得分为(27.2士8.8)～(47.6士11.4)分;不同护龄护士压力源、职业倦怠、应对方式得分比较,差异有统计学意义(P＜0.05,P＜0.01);不同编制护士压力源、人格特征、应对方式得分比较,差异有统计学意义(P＜0.05,P＜0.01);8个相关条目得分为(2.0士0.6)～(3.2士0.8)分,其中人员不足、工作处于超负荷状态,护士没有外出学习机会及晋升高级职称机会少排前三位.结论 护士职业高原呈现中等水平;人员不够,学习晋升机会少等是主要影响因素.护理管理者应引起高度重视,并采取针对性干预措施,以降低护理队伍的职业高原水平.     

改良直置式套管针替代导入鞘法在新生儿PICC置入中的应用

目的评价改良直置式套管针替代安全型撕裂式导入鞘法置入新生儿PICC的可行性和安全性。方法对135例新生儿应用20G直置式套管针置入PICC(观察组),与应用导入鞘置入PICC的128例新生儿(对照组)进行对比,比较两组穿刺时间、第1次换药时间、穿刺成功率及留置时间。结果两组穿刺时间、穿剌成功率及导管留置时间比较,差异无统计学意义(均P>0.05);观察组较对照组第1次换药时间延长(P<0.01)。结论在新生儿PICC置管中,经济简便的直置式套管针可以替代安全型撕裂式导入鞘使用。     

1 ml注射器辅助法在桡动脉穿刺置管中的应用

目的探讨一种新型穿刺法即1 ml注射器辅助法在桡动脉置管的应用,观察其置管成功率与穿刺所需时间。方法选取300例重大手术需动脉穿刺置管的患者,随机分为两组,Ⅰ组采用直接穿刺置管法,Ⅱ组采用1 ml注射器辅助穿刺法。结果Ⅰ组穿刺成功123例,Ⅱ组穿刺成功141例,两组相比,有显著统计学意义(P<0.01);前者用时(56±10.4)s,后者(34±9.3)s(P<0.01)。结论1 ml注射器辅助穿刺是简单、快速、安全且损伤较小的动脉穿刺方法。     

咪唑安定复合瑞芬太尼丙泊酚用于小儿腭裂修复术麻醉的临床观察

目的观察咪唑安定复合瑞芬太尼丙泊酚麻醉是否较单纯瑞芬太尼丙泊酚麻醉在小儿腭裂修复术中使用更为安全合理。方法30例择期行腭裂修复术患儿,随机分为两组：Ⅰ组为咪唑安定复合瑞芬太尼丙泊酚麻醉组（MRP组）,Ⅱ组为瑞芬太尼丙泊酚麻醉组（RP组）。每组15例。比较两组麻醉各时段血流动力学变化、瑞芬太尼丙泊酚使用剂量及苏醒情况。结果两组在术中维持及拔管前血压及心率较基础值均降低（P〈0.05）;Ⅱ组在插管时血压升高明显,与Ⅰ组相比统计学上有意义（P〈0.05）。Ⅱ组使用丙泊酚量较Ⅰ组显著增加（P〈0.05）,瑞芬太尼用量也有增加趋势但统计学上无意义（P〉0.05）。Ⅰ组拔管期躁动的患儿比例也较低。两组拔管时间差异统计学上无意义（P〉0.05）。结论瑞芬太尼丙泊酚麻醉是一种有效的小儿腭裂麻醉方法,而复合咪唑安定则更为安全、经济。     

Modified one-stage posterior/anterior combined surgery with posterior pedicle instrumentation and anterior monosegmental reconstruction for unstable Denis type B thoracolumbar burst fracture

Purpose

This study aimed to evaluate the clinical and radiological results in patients with unstable Denis type B thoracolumbar burst fractures treated by modified one-stage posterior/anterior combined surgery.

Methods

Thirty-one patients with unstable Denis type B thoracolumbar burst fractures were enrolled in this study. The patients underwent one-stage posterior/anterior combined surgery with posterior instrumentation using pedicle screws and anterior monosegmental reconstruction utilizing titanium mesh cages. The mean follow-up period was 38.3 months. Clinical outcomes, radiological parameters, and treatment-related complications were assessed.

Results

The mean age of the patients was 36.4 years. The mean operative time and blood loss were 230 min and 645 ml, respectively. The VAS pain score was significantly improved after surgery, and the improvement was maintained until the final follow-up. In 23 patients with neurologic dysfunction, 20 (87 %) patients had improvement after surgery. By the final follow-up, 27 patients had returned to work; 18 of the 27 patients returned to a similar job. The mean sagittal kyphosis was corrected from 21.2° preoperatively to 2.5° postoperatively, which increased slightly to 4.3° at the final follow-up. Minimal subsidence and tilt of the titanium mesh cage were observed during the follow-up period. Solid bony fusion was achieved in all patients. One patient developed a posterior surgical site infection, which was resolved by antibiotic treatment and surgical debridement.

Conclusion

Modified one-stage posterior/anterior combined surgery for Denis type B unstable thoracolumbar burst fractures can produce good clinical and radiological outcomes.

     

En Bloc Resection with Major Blood Vessel Reconstruction for Locally Invasive Retroperitoneal Paragangliomas: A 15-Year Experience with Literature Review

Background

Retroperitoneal paragangliomas (PGs) are a rare subgroup of neuroendocrine tumors that are commonly located alongside the abdominal aorta. Complete tumor resection is thought to be restricted in patients with major blood vessel involvement. However, no study has specifically focused on aggressive surgical treatment in such patients. We evaluated the value of en bloc resection with major blood vessel reconstruction for locally invasive retroperitoneal PGs.

Methods

Twenty-nine patients with retroperitoneal PGs with major blood vessel involvement were included in this retrospective study. Survival was compared between patients who underwent en bloc resection with major blood vessel reconstruction and those who underwent medical treatment. Prognostic predictors were analyzed in patients who underwent en bloc resection with major blood vessel reconstruction.

Results

All 11 patients who underwent medical treatment obtained a pathological diagnosis by computed tomography-guided percutaneous needle biopsy. All 18 patients who underwent en bloc resection with major blood vessel reconstruction achieved complete tumor resection. Overall survival was higher in patients who underwent complete tumor resection than in those who underwent medical treatment (p < 0.05). No perioperative mortality occurred in patients who underwent complete tumor resection. Patients with no metastasis, no organ invasion, R0 resection, a Ki-67 index of ≤3%, and a tumor diameter of ≤11.7 cm showed better tumor-free survival (p < 0.05).

Conclusions

En bloc resection with major blood vessel reconstruction can be successfully performed and provide satisfactory outcomes for patients with locally invasive retroperitoneal PGs. This technique may become a standard surgical strategy for properly selected patients.

     

护理研究生姑息护理认知的研究

目的了解护理研究生的姑息护理认知水平,辨别对姑息护理的误解,为推进护理研究生教育、制定姑息护理培训内容提供参考。方法采用姑息护理知识问卷对183名护理研究生进行调查。结果护理研究生姑息护理知识问卷总分(8.54±2.44)分,各条目答题正确率为3.3%~92.3%;对姑息护理的误解较多,分散在3个维度,最大的误解是"家属成员陪伴在患者床旁直至死亡是至关重要的"。结论护理研究生的姑息护理认知水平偏低,需加强相关的教育与培训。     

神经外科重症患者急性胃肠功能损伤管理模式的构建及实施

目的探讨神经外科重症患者急性胃肠功能损伤的有效管理模式。方法将421例神经外科ICU重症患者按时间段分为对照组203例、观察组218例,对照组采用常规治疗护理,观察组建立医护共同参与的急性胃肠功能损伤管理模式并用于患者管理。实施6个月后评价效果。结果观察组急性胃肠功能损伤程度、肠内营养等待时间、达到全量营养时间显著低于、短于对照组(均P0.01)。结论急性胃肠功能损伤管理模式的实施可减轻神经外科ICU重症患者急性胃肠功能损伤程度,使患者早期获得有效营养。     

The comparison of adductor canal block with femoral nerve block following total knee arthroplasty: a systematic review with meta-analysis

Purpose

Although several studies have compared the clinical efficacy of an adductor canal block (ACB) to that of a femoral nerve block (FNB) for analgesia after total knee arthroplasty (TKA), disputes mainly exist in the recovery of quadriceps strength and mobilization ability between the two methods. The aim of the present study was to compare, in a systematic review and meta-analysis, the clinical efficacy of ACB with that of FNB.

Methods

We systematically searched randomized controlled trials comparing FNB with ACB for analgesia after TKA in Pubmed and the Cochrane Library from inception to April 30th 2015. There was no limitation of publication language. Trial quality was assessed using the modified Jadad scale, and eligible data were pooled for meta-analysis.

Results

Five studies of 348 patients were included. Outcomes showed that patients who received ACB had similar or better recovery of quadriceps strength and mobilization ability than those that underwent FNB. Similar efficacy was found between the two strategies regarding adductor strength, pain scores [at rest (p = 0.86), at or after knee flexion (p = 0.31)], opioid consumption (p = 0.99), opioid-associated adverse effects (p = 0.60), length of hospital stay (p = 0.42), patient satisfaction (p = 0.57), and success rate of blockade (p = 0.20).

Conclusions

The present study suggests that TKA patients who receive ACB can achieve similar or even better recovery of quadriceps strength and mobilization ability than those treated with FNB. Taken as a whole, ACB may be a better analgesia strategy after TKA at present.