沟通在护理工作中的应用

<正>随着人民群众生活水平的快速提高,社会制度的不断完善,使得人们对健康的护理要求也越来越高,在临床工作中,如果护理人员只注重提供专业技术服务,而忽略了护患沟通,不但会妨碍我们的护理效果,还极易导致护患纠纷,因为护士每天与患者密切接触,一言一行都会影响患者的心理状态和行为,所以护患沟通显得越来越重要。     

大型公立医院急诊可持续发展的探讨

“世界危重医学之父”Max Harry Weil曾说过,没有急诊部门能力的提升和积极参与,医院救治重症水平将难以根本性迈进与提高[1].急诊科是医院最为开放、最多界面和最为重要的学科,他全天候、全病种开放,不仅是医院预防、监测、救治的前哨,更应具备“兜底”救治的能力.大型综合医院急诊科一站式诊察救治能力尤其重要.     

针药结合治疗老年原发性高血压伴失眠的疗效观察

目的采用中药汤剂联合针刺治疗原发性高血压合并失眠,观察其临床疗效并评价其实际应用价值。方法选取2020年1月—10月期间于青岛市中医医院(青岛市海慈医院)治未病科就诊的94例老年原发性高血压伴失眠患者,采用随机数字表法将患者分为中药组与联合组,每组各47例。中药组给予中药汤剂治疗,联合组在此基础上加用针刺治疗,4周为1个疗程。1个疗程结束后,采用匹兹堡睡眠质量量表(Pittsburgh sleep quality index,PSQI)评估原发性高血压伴失眠患者睡眠质量,并评价患者睡眠改善情况;检测患者治疗前后血压变化水平,对比两组患者中医证候积分变化情况;检测两组患者治疗前后血清指标25羟维生素D[25(OH)D]、脑源性神经营养因子(Brain-derived neurotrophic factor,BDNF)、去肾上腺素(Noradrenaline,NE)表达水平变化情况,并根据患者治疗期间出现的不良反应评估两种治疗方式的安全性。结果治疗后中药组患者睡眠改善总有效率为75.00%(33/44),联合组患者睡眠改善总有效率为93.48%(43/46),联合组患者睡眠改善情况明显优于中药组(P<0.05)。治疗后两组患者PSQI各项评分,各项中医证候积分,收缩压和舒张压水平均较治疗前均明显降低,差异有统计学意义(P<0.05);且联合组患者PSQI各项评分,各项中医证候积分,收缩压和舒张压水平均较中药组明显降低,差异有统计学意义(P<0.05)。治疗后两组患者血清25(OH)D、BDNF水平均较治疗前明显升高,NE水平较治疗前明显降低,差异有统计学意义(P<0.05);且联合组患者血清学指标改善效果明显优于中药组,两组比较,差异有统计学意义(P<0.05)。治疗期间,两组患者均未出现严重不良反应。结论针药结合治疗可以明显改善原发性高血压伴失眠患者睡眠质量并有效控制患者血压水平,缓解患者临床症状,具有较高的安全性。     

多指标协同应用在危重症合并血小板减少患者诊断DIC中的作用

Objective To observe critical patients with thrombocytopenia,and exam their coagulation function,so as to diagnose disseminated intravascular coagulation(DIC)in the early stage.Methods Totally 56 critical patients complicated with thrombocytopenia were enrolled in the investigation;complete set of DIC tests were performed.A total of 26 cases were diagnosed as DIC according to the criteria from the International Society of Thrombosis Haemostasis(ISTH).The sensitivity,specificity,accuracy,likelihood ratio,predictive value of prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT),fibrinogen(Fg),antithrombin Ⅲ and bleeding signs(including petechia and ecchymosia)were calculated by applying fourfold table.Results The specificity of PT prolongation and Fg reduction was 87.0%;the sensitivity of ATⅢ decrease,and each of PT prolongation,Fg reduction,and bleeding(including petechia and ecchymosis)were as high as 96.0%.Conclusion Multi-markers based on thrombocytopenia are likely to improve sensitivity and specificity of DIC diagnosis.     

神阙穴外敷治疗肠燥便秘50例

骨科病人因长期卧床，活动减少，肠蠕动缓慢，加上情志不舒，气血亏虚，而致经血不足，肠中津液亏乏，极易引起肠燥便秘。2006年1月-2006年6月，我科采用何首乌神阙穴外敷治疗便秘病人50例，收到了良好的治疗效果，无明显不良反应，现报告如下。     

多指标协同应用在危重症合并血小板减少患者诊断DIC中的作用

Objective To observe critical patients with thrombocytopenia,and exam their coagulation function,so as to diagnose disseminated intravascular coagulation(DIC)in the early stage.Methods Totally 56 critical patients complicated with thrombocytopenia were enrolled in the investigation;complete set of DIC tests were performed.A total of 26 cases were diagnosed as DIC according to the criteria from the International Society of Thrombosis Haemostasis(ISTH).The sensitivity,specificity,accuracy,likelihood ratio,predictive value of prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT),fibrinogen(Fg),antithrombin Ⅲ and bleeding signs(including petechia and ecchymosia)were calculated by applying fourfold table.Results The specificity of PT prolongation and Fg reduction was 87.0%;the sensitivity of ATⅢ decrease,and each of PT prolongation,Fg reduction,and bleeding(including petechia and ecchymosis)were as high as 96.0%.Conclusion Multi-markers based on thrombocytopenia are likely to improve sensitivity and specificity of DIC diagnosis.     

骨科急诊手术病人的心理分析及护理对策

骨科急诊手术多为交通事故和突发事件引起，其伤势重，病情急，发病时间短，病人无心理适应过程，易出现恐惧、焦虑、疑虑等不良情绪反应，不能很好地配合手术，从而影响手术的进行和手术后的康复。因此，在术前、术中、术后做好病人的心理护理是保证手术顺利进行的一个重要环节。本文通过对骨科急诊手术病人进行心理分析，并根据心理变化制定了相应的护理对策，使病人顺利地度过手术关，促进机体早日康复。     

护理干预对首次血液透析直接穿刺患者舒适度的影响

2005年4月～2007年5月,我们对78例首次直接穿刺透析的患者除行常规护理外,给予针对性的护理干预,取得满意效果.现报告如下.     

严重脑损伤患者血清降钙素原预测院内感染的临床意义

目的 评估严重脑损伤患者的血清降钙素原(PCT)预测院内感染的临床价值.方法 纳入年龄大于18岁,由于急性脑卒中、颅脑创伤、缺血缺氧性脑病、中毒性脑病等导致的严重脑损伤,需要进入ICU监护的患者45例,检测入ICU时、入ICU第3天时血清PCT和C反应蛋白(CRP)水平及院内感染发生情况.结果 与非感染组相比,感染组患者入ICU时及入ICU第3天时血清PCT水平明显升高,差异有统计学意义(P＜0.01);而CRP水平两组间差异无统计学意义(P＞0.05).结论 PCT测定有助于早期预测严重脑损伤患者院内感染,建议对于入ICU时PCT明显增高的患者,根据病情早期选用抗生素,如PCT仅保持在轻微增高水平,则要排除由于手术、创伤等触发的全身炎症反应综合征(SIRS),防治滥用抗生素,以减少耐药性的发生.