手术室护理干预在颌面外伤清创缝合术中的效果观察

目的 分析手术室护理干预在颌面外伤清创缝合术中的效果。方法 选取2023年1月-12月湖南中南 大学湘雅口腔医院行颌面外伤清创缝合术患者88例,随机分为对照组和观察组,每组44例。对照组接受常规 护理,观察组接受手术室护理干预,比较两组伤口Ⅰ期愈合情况、术中依从性、抑郁和焦虑程度、护理满 意度、并发症发生情况。结果 观察组伤口Ⅰ期愈合率为95.45%,高于对照组的72.73%（P＜0.05）; 观察组术中总依从率为97.73%,高于对照组的81.82%（P ＜0.05）;两组干预后SAS和SDS评分均低于干预 前,且观察组干预后SAS和SDS评分低于对照组（P ＜0.05）;观察组护理满意度各维度评分和总分均高于 对照组（P＜0.05）;观察组并发症发生率低于对照组（P ＜0.05）。结论 手术室护理干预能够促进颌面外 伤患者伤口愈合,缓解负性情绪,提高术中依从性,降低并发症发生率,且患者满意度较高。     

An Experimental Model of Heat Storage in Working Firefighters

Objective. Develop experimental models to study uncompensable heat stress (UCHS) in working firefighters (FFs). Methods. FFs ingested core temperature (Tc) capsules prior to performing sequential tasks in 40°C andpersonal protective ensemble (PPE), or 18°C andno PPE. Both trials were conducted in an environmental chamber with FFs using self-contained breathing apparatus (SCBA). Results. FFs exercising in heat andPPE reproduced UCHS conditions. For every FF in both trials for whom the capsules worked, Tc was elevated, andTc_max occurred after completion of study protocol. Trials with PPE resulted in a mean maximum temperature of 38.94°C (± 0.37°C); Tc_max reached 40.4°C. Without PPE, maximum Tc averaged 37.79°C (± 0.07°C). Heat storage values ranged from 131 to 1205 kJ, averaging 578 kJ (± 151.47kJ) with PPE and210.83 kJ (± 21.77kJ) without PPE. Conclusions. An experimental model has been developed that simulates the initial phases of an interior fire attack to study the physiology of UCHS in FF. The hot environment andPPE increase maximum Tc andheat storage over that due to the exertion required to perform the tasks andmay decrease time to volitional fatigue. This model will permit controlled studies to optimize work-rest cycles, rehab conditions, andphysical conditioning of FFs.     

Confirmation of correct tracheal tube placement in newborn infants

Tracheal intubation remains a common procedure during neonatal intensive care. Rapid confirmation of correct tube placement is important because tube malposition is associated with serious adverse outcomes. The current gold standard test to confirm tube position is a chest radiograph, however this is often delayed until after ventilation has commenced. Hence, point of care methods to confirm correct tube placement have been developed. The aim of this article is to review the available literature on tube placement in newborn infants. We reviewed books, resuscitation manuals and articles from 1830 to the present with the search terms “Infant, Newborn”, “Endotracheal intubation”, “Resuscitation”, “Clinical signs”, “Radiography”, “Respiratory Function Tests”, “Laryngoscopy”, “Ultrasonography”, and “Bronchoscopy”. Various techniques have been studied to help clinicians assess tube placement. However, despite 85 years of clinical practice, the search for higher success rates and quicker intubation continues. Currently, chest radiography remains the gold standard test to confirm tube position. However, rigorous evaluation of new techniques is required to ensure the safety of newborn infants.     

环球航行不同气温对24 h动态心电图变化的影响

目的：观察海军水面舰艇编队环球航行不同气温对24h动态心电图变化的影响。方法：98名参加环球航行人员在气温〈30℃和≥30℃时的24h动态心电图监测，分析窦性心律、对早搏、ST段、QT间期离散度和心率变异性的时域、频域和非线性指标变化进行分析。结果：与气温〈30℃时比较，气温≥30℃时的平均心率加快，最高心率减慢，最低心率加快，停搏次数增多，最长停搏时间延长，早搏增多，MV5导联ST段明显压低、压低持续时间延长，QTd、QTc、QTcd明显增高，SDNN、SDANN、SDNN指数、RMSSD、NN50、PNN50、三角指数、VLF、HLF、VAI及VLI明显降低（P〈0．01）。结论：气温≥30℃时海军水面舰艇编队环球航行时，对人体有支配心脏的自主神经功能可能有影响。     

术中护理对髋关节置换手术患者下肢深静脉血栓形成的影响

目的：探讨术中护理对髋关节置换手术患者下肢深静脉血栓形成的影响。方法选择2013年6月~2014年12月湖北省鄂州市中心医院收治的157例髋关节置换手术患者,按住院号单双分为观察组83例,对照组74例。对照组采用常规术中护理,观察组采用改进术中护理。比较两组手术前后血液流变学和凝血功能变化及下肢深静脉血栓形成情况。结果观察组出血量、术中输血量明显少于对照组(P<0.05)。观察组术后1 d全血高切黏度、全血低切黏度、血浆黏度、红细胞聚集指数均明显低于术前1 d和对照组(P<0.05),凝血酶原时间、纤维蛋白原略低于术前1 d和对照组,但差异无统计学意义(P跃0.05);对照组术后1 d全血高切黏度、全血低切黏度、血浆黏度、红细胞聚集指数、凝血酶原时间、纤维蛋白原与术前1 d比较差异无统计学意义(P跃0.05)。观察组术后2例(2.41%)发生下肢深静血栓,对照组8例(10.81%)发生下肢静脉血栓,两组比较,差异有统计学意义(P<0.05)。结论改进术中护理提高手术室护理质量可有效改善髋关节置换患者血液高凝状态,降低术后下肢深静脉血栓形成发生率。     

袋装输液种类、温度对胰岛素吸附作用的实验研究

目的：探讨软聚氯乙烯塑料袋装溶液影响胰岛素吸附的相关因素。方法；用放射免疫测定法监测5％葡萄糖胰岛素混合液及0．9％氯化钠胰岛素混合液在不同温度（10、20、30℃）、不同时间（0、30、60、90及120min）的胰岛素吸附率。结果：不同溶液在不同的温度、时间中对胰岛素吸附均呈不均一性变化，在30min时吸附量最大，以后逐渐减少；温度越高胰岛素吸附量越大；5％葡萄糖胰岛素溶液中胰岛素吸附量比0．9％氯化钠胰岛素大。结论：不同液体、温度、时间对5％葡萄糖及0．9％氯化钠胰岛素混合液输入过程中的吸附量有影响。     

Briefing guide study: preoperative briefing and postoperative debriefing checklists in the Veterans Health Administration medical team training program

Background

The purpose of this study was to examine the outcomes of checklist-driven preoperative briefings and postoperative debriefings during the Veterans Health Administration (VHA) medical team training program.

Methods

A briefing score (1, never started; 2, started then discontinued; 3, maintained on original targeted cases; 4, expanded to other services; 5, briefing all cases, all services) was established at 10.1 ± .3 months after introduction of the checklist. Outcomes included antibiotic and deep venous thrombosis prophylaxis compliance rates before and after use of the checklist.

Results

Antibiotic (97.0% ± .1% vs 92.1% ± 1.5%; P = .01) and deep venous thrombosis (95.7% ± .8% vs 85.1% ± 4.6%; P = .05) prophylaxis compliance rates were higher after initiation of a surgical checklist.

Conclusions

Checklist-driven preoperative briefings and postoperative debriefings are associated with improvements in patient safety for surgical patients.     

鼻窦内窥镜下低温等离子治疗腺样体肥大56例报道

目的探讨鼻窦内窥镜下低温等离子腺样体切除术对小儿腺样体肥大的治疗效果。方法对56例腺样体肥大患儿行鼻内镜下低温等离子腺样体切除术,观察其疗效。结果合并扁桃体肥大患儿术后1~4周,鼻塞、打鼾、张口呼吸症状明显缓解;30例合并分泌性中耳炎患儿术后随访半年,其中完全治愈23例,占76%;好转5例,占16%;无效2例,占8%,总有效率93.3%。结论治疗患儿腺样体肥大,鼻窦内窥镜下低温等离子腺样体切除术能在直视下进行,增加了手术的安全性和准确性,手术疗效显著。     

The effect on maternal temperature of delaying initiation of the epidural component of combined spinal-epidural analgesia for labor: a pilot study

Background

Labor epidural analgesia is associated with maternal hyperthermia. This pilot study compared the effects on maternal temperature during labor of different timing of initiation of the epidural component of combined spinal–epidural analgesia.

Methods

After induction of analgesia with intrathecal bupivacaine 2 mg and fentanyl 20 μg, healthy term nulliparas in spontaneous labor were randomized to receive immediate epidural analgesia (n = 26) or delayed epidural analgesia after the return of pain (n = 28), by patient-controlled epidural analgesia with 0.125% bupivacaine and fentanyl 1 μg/mL. Maternal tympanic temperature, visual analog scale pain score and dermatome block level were measured hourly during labor.

Results

The duration of labor for most parturients (83.3%) was <5 h. Mean maternal temperature gradually increased over time but did not significantly differ from either from baseline or between the two groups. There was no significant difference in the incidence of maternal fever (?38°C) between the two groups. At 2 h post spinal analgesia the visual analog scale score was higher (P = 0.03) and the dermatome block level was lower (P = 0.005) in the delayed epidural analgesia group compared to the immediate epidural analgesia group.

Conclusions

Delaying the epidural component of combined spinal–epidural analgesia did not significantly affect maternal temperature in the study population of whom 83.3% had a labor of <5 h. However, this study was underpowered to detect a difference in the incidence of fever and a larger prospective study is required.     

低温等离子射频消融治疗腰椎间盘突出症初步探讨

目的评价低温等离子刀射频消融术治疗腰椎间盘突出症的临床疗效。方法 2006年1月～2009年12月应用低温等离子射频消融治疗腰椎间盘突出症共44例,男20例,女24例;年龄30～52岁,平均40岁。局部麻醉,在C型臂引导下操作。共46个椎间隙：单间隙42例,双间隙2例。术后随访近期效果。结果全部病例均获得随访,随访时间6～48个月,平均24个月。VAS评分术前（8.40±0.50）分,术后1周（2.60±0.53）分,末次随访（2.80±0.34）分。Oswestry评分术前（59.00±1.90）分,术后1周（30.00±1.80）分,末次随访（34.00±1.50）分。各指标术后及末次随访时与术前比较有显著性差异（P〈0.05或P〈0.01）,而术后两次随访差异无统计学意义（P〉0.05）。患者满意度80%,无任何并发症。结论经皮低温等离子刀髓核消融术是治疗腰椎间盘突出症行之有效的方法,这种技术简单、微创、安全、疗效肯定。关键是选择合适的适应证。