推进整体护理提高护理质量

介绍了四川省以点带面开展整体护理的做法,取得的成效,存在的问题与对策,并提出了下一步的工作目标与计划设想.要求转变观念,加强培训;保证人力配备,提高综合素质.     

开展社区卫生服务 促进基层医院发展

论述了开展社区卫生服务的必要性,提出开展社区卫生服务是基层医院和乡镇卫生院摆脱困境,取得新的发展的一条重要途径。在此基础上指出,开展社区卫生服务需要政府的高度重视和有关部门的大力支持;需要合理的区域规划,防止卫生资源的浪费;需要花大气力培养全科医生,提高业务素质;需要提高认识,转变观念,增强服务功能;需要加强管理,拓展服务范围,规范服务方式。     

Wide Awake Open Carpal Tunnel Release: The Effect of Local Anesthetics in the Postoperative Outcome

Introduction  Wide awake open carpal tunnel decompression is a procedure performed under local anesthesia. This study aimed to present the effect of various local anesthetics in peri and postoperative analgesia in patients undergoing this procedure. Materials and Methods  A total of 140 patients, with 150 hands involved, underwent carpal tunnel release under local anesthesia. Patients were divided in five groups according to local anesthetic administered: lidocaine 2%, ropivacaine 0.75%, ropivacaine 0.375%, chirocaine 0.5%, and chirocaine 0.25%. Total 400 mg of gabapentin were administered to a subgroup of 10 cases from each group (50 cases totally), 12 hours before surgery. Patients were evaluated immediately, 2 weeks and 2 months after surgery according to VAS pain score, grip strength, and two-point discrimination. Results  In all patients, pain and paresthesia improved significantly postoperatively, while the use of gabapentin did not affect outcomes. Grip strength recovered and exceeded the preoperative value 2 months after surgery, without any difference between the groups. No case of infection, hematoma, or revision surgery was reported. Conclusion  Recovery after open carpal tunnel release appears to be irrelevant of the type of local anesthetic used during the procedure. Solutions of low local anesthetic concentration (lidocaine 2%, ropivacaine 0.375%, and chirocaine 0.25%) provide adequate intraoperative analgesia without affecting the postoperative course.     

普外科术后不良结局风险评估工具研究现状

普外科手术是最常见的手术之一,其术后不良结局主要集中在一部分高危患者。风险评估工具可以识别出这部分高危患者,为后续的临床干预和资源配置提供参考。目前存在多种评估工具,且具有各自的优缺点,充分了解这些工具是临床应用的前提。通过回顾目前一般常用评估工具、针对急诊普外患者的评估工具和机器学习方法在评估工具上的应用,阐明风险评估工具的基本特征、应用现状和发展趋势。     

When laparoscopy for fertility preservation prior to gonadotoxic treatment of an anterior mediastinal mass is a dilemma: A case report

IntroductionThe management of anterior mediastinal masses is a challenge for anesthesiologists. Recommendations for their management in the context of diagnostic or curative surgery are well described. The added risk of laparoscopic surgery for fertility preservation has however never been discussed in the literature.Presentation of caseWe present the case of a 32-year-old female patient with a large malignant anterior mediastinal mass. She was referred for anesthesia evaluation before laparoscopic ovarian tissue harvesting as part of fertility preservation prior to gonadotoxic treatment. The patient presented dyspnea at rest. Chest computed tomography revealed a tracheal deviation and a partial obstruction of the left mainstem bronchus. Transthoracic echocardiography showed a pericardial effusion. Proceeding to high risk anesthesia for a non-curative surgery in a patient with a highly symptomatic mass was considered unacceptable and the procedure was postponed. The patient received a single cycle of neoadjuvant chemotherapy. Clinical and radiological improvement were shown after this single dose and laparoscopic surgery was performed under general anesthesia without complications.ConclusionIn the context of an anterior mediastinal mass and fertility preservation a thorough benefit-risk analysis must be undertaken before non-curative laparoscopic surgery. In case of severe symptoms, surgery should be postponed until the patient’s condition improves after the minimum necessary chemotherapy treatment. So far it is impossible to say whether the risk exceeds the expected benefit in this difficult situation. Further studies need to be conducted in this area.     

艺术大学生自我效能、主观幸福感及其关系的研究

目的研究艺术大学生自我产能与主观幸福感的关系。方法用幸福感指数量表、一般自我效能感量表494艺术大学生进行了测量。结果①艺术大学生的主观幸福感和自我效能感有显着的独生和性别差异。②艺术大学生的高、低自我效能与主观幸福感存在显着的差异和相关。结论自我效能是影响幸福感的重要因素。     

Diabetic autonomic neuropathy: Abnormal cardiovascular reactions under general anesthesia

Summary The influence of diabetic autonomic neuropathy upon the behavior of the circulatory system was investigated in 56 patients who had undergone ophthalmological surgery. A standardized test combination (variability in heart rate during deep breathing, Valsalva ratio, 3015 ratio, change in blood pressure from lying to standing, sustained handgrip test) was used to study the patients' cardiovascular reflectory reactions. The patients were then divided into the following groups: Group I, non-diabetics Group II, diabetics without autonomic neuropathy Group III, diabetics with autonomic neuropathy The anesthetic (induction by barbiturates and conduction by inhalation agents) and the surgical procedure (pars plana vitrectomy) were standardized and always identical. During anesthesia patients in group III experienced hypotensive reactions (systolic blood pressure below 90 mm Hg) significantly more often (72.2%) than patients in group I (25%). In order to achieve stability in blood pressure the patients of group III had to be given vasoactive drugs much more often (77.8%) than the patients of group I (12.5%) and those of group II (35.7%). We found a significant correlation between the degree of autonomic dysfunction and the largest drop in blood pressure under narcosis (r=–0.60,P<0.001). However, marked variability in heart rate and cardiac rhythm disorders during anesthesia were seen only in patients of groups I and II. These results prove the atypical hemodynamic behavior and especially the extreme instability in blood pressure in diabetic autonomic neuropathy under general anesthesia. Therefore we consider it to be very helpful to check the cardiovascular reflectory status of diabetics preoperatively.Abbreviations AN autonomic neuropathy - AV atrioventricular - BP blood pressure - bpm beats per minute - cm centimeter - f female - HR heart rate - m male - PD diastolic blood pressure - PS systolic blood pressure     

Reduction in cadmium in blood and dietary intake among general populations in Japan

Blood samples and 24-h duplicates of food were collected in the years around 1980 and then in 1990's from inhabitants of nonpolluted regions in Japan. The 1990 study is still in progress with 286 blood samples and 125 food duplicates already collected from 7 regions. A preliminary analysis is made in the present study with the data obtained from the 7 study regions where the survey was conducted in 1980 and then in 1990, to examine possible changes in dietary cadmium intake (Cd-D) and consequently cadmium levels in blood (Cd-B) during this 10 year period. The food duplicate analysis showed that Cd-D in 1980 was 47.1 g/day (1.74):65 [GM (GSD):N] for men and 27.7 g/day (1.75):65 for women. The counterpart values in 1990 were 29.5 g/day (1.66):40 for men and 23.8 g/day (1.73):85 for women; the difference between the two values for the same sex is significant (P<0.05) both=" in=" men=" and=" in=" women,=" suggesting=" that=" there=" occurred=" about=" 37%=" and=" 14%=" reduction=" in=" dietary=" cadmium=" intake=" during=" this=" 10=" year=" period=" in=" men=" and=" in=" women,=" respectively.=" comparison=" in=" cd-b=" showed=" that=" cd-b=" for=" men=" and=" women=" in=" 1990=" were=" 1.79=">g/l (2.01):121 and 1.84 g/l; (1.67):165, respectively, whereas the counterpart values in 1980 were 3.84 g/l (1.64):123 and 3.57 g/l (1.42):141, respectively, indicating significant (P<0.01) reduction=" in=" cd-b=" in=" both=" sexes=" in=" parallel=" to=" the=" reduction=" in=" cd-d.=" the=" role=" of=" rice=" as=" a=" major=" source=" of=" cadmium=" among=" japanese=" population=" together=" with=" recent=" reduction=" in=" the=" importance=" is=" discussed;=" cd=" in=" rice=" accounted=" for=" 72%=" in=" late=" 1970's,=" whereas=" it=" is=" about=" 35%=" in=" the=" present=">