"一站式杂交"房间隔缺损封堵术的手术护理

先天性房隔缺损(ADS)传统手术方法是经胸骨正中劈开或右胸壁切口,在体外循环下直视修补.最近几年,随着腔内介入治疗学和影像医学的发展,一种微创心脏外科学技术应运而生,即"一站式杂交"手术(one-stop hybrid procedures).它的核心内容就是由外科医师使用介入器械,在一个较特殊的手术室,在实时影像学的指引下,结合其他常规心脏外科手术完成心脏病的治疗[1].我院于2006年5～6月收治的5例房隔缺损病人,采用该方法治疗,临床效果满意,现将其手术护理报告如下.     

术前认知疗法对子宫次全切除术病人心理健康的影响

近年来，心理干预在国内外得到广泛应用。术前心理干预可降低手术病人的焦虑和抑郁程度。笔者应用认知疗法加常规术前访视对子宫切除术病人进行术前干预，并与单纯进行常规术前访视的病人进行比较。现将结果报告如下。     

浅谈护理缺陷的原因与防范措施

找出发生护理缺陷的原因进行分析,研究护理人员当时的心情状态和特点,有的放矢地进行教育训练,提出防范措施以预防或者减少护理缺陷的发生,是护理工作中迫切需要解决的实际问题.     

颈椎骨肿瘤前后联合入路全脊椎切除附加内固定术的手术配合

颈椎骨肿瘤多破坏椎体和附件,压迫颈髓和神经根而产生临床症状,如肢体麻木、疼痛和瘫痪等,需要早期手术治疗。我院1998年10月-2005年10月对29例颈椎骨肿瘤患者实施了一期或二期的颈椎前后联合入路全脊柱切除、内固定重建术,均使患者安全度过手术期。现将有关手术室护理配合报告如下。1临床资料本组29例,男20例,女9例。年龄18-69岁,平均39岁。病程2-8个月,平均4个月,颈椎原发肿瘤25例,其中骨巨细胞瘤13例,浆细胞瘤4例,神经鞘瘤侵及椎体1例,软骨肉瘤5例,恶性神经鞘瘤2例;颈椎转移性肿瘤4例。临床表现均有颈部疼痛或上肢麻木,Frankel分级:B级3…     

肝素治疗重型流行性出血热3例

肝素用于治疗流行性出血热屡有报道。但对DIC的诊断要求很严。在基层医疗单位，由于技术设备受到一定限制，只能做到血小板计数。其它如凝血酶原时间、纤维蛋白原、凝血酶时间等均不能做。并结合临床做出DIC的诊断及早期应用肝素对3倒重型出血热的治疗。报告出下。临床资料3例均为男性，年龄42－49岁。发病时间均较急，都以高热、头痛、腰痛、恶心入院。入院查体，体温均在40－41℃，精神委靡，面潮红，是重病容。结膜，咽部充血，背、胸部皮肤潮红，背部有点条状出血点。其它未发现阳性体征。化验血红蛋白13－14．5克，血小板人6－8．4…     

过氧化氢低温等离子体灭菌系统在手术室中的应用

我院手术室于2005年10月开始启用强生公司生产的STERRAD100S过氧化氢等离子灭菌系统，经过6个月使用，效果满意。现将体会总结如下。     

下颌前突畸形矫正术的护理体会

我科从1985年6月——1992年10月采用下颌升枝矢状骨劈开术矫治下颌前突15例，由于我们改用了口内切口方法避免了口外切口瘢痕显露的缺点，但切日在日腔内易于感染，故术后护理是手术的重要环节。现将护理体会介绍如下。临床资料本组15例，男性13例，女性2例。年龄在19－26岁。患者均为真性下颌前突。下前牙反股在0．5-1．3cm。术前准备一、术前常规化验检查：血、尿、便常规、心电图、胸透及出凝血时间等。二、术前照相：本前摄正侧位片，不仅为病史描述的充足补充形象化的资料，还可以将本前术后的照片加以比较观察术后的疗效。三、术前一…     

沙利度胺联合火针治疗结节性痒疹的疗效观察

目的:探讨沙利度胺联合火针治疗结节性痒疹的临床疗效。方法:将90例结节性痒疹患者随机分为3组,每组30例,A组采用沙利度胺联合火针治疗,同时外用卤米松乳膏;B组采用火针和卤米松乳膏外用;C组采用口服沙利度胺和卤米松乳膏外用,疗程8周。结果:3组患者经过8周治疗,A、B、C组痊愈率分别为66.67%、36.67%、40.00%,有效率分别为93.33%、56.67%、56.67%。A组痊愈率和有效率均明显高于B组、C组,差异均有统计学意义(P值均0.05)。结论:沙利度胺联合火针并外用卤米松乳膏治疗结节性痒疹疗效明确,优于单纯火针或沙利度胺并外用卤米松乳膏治疗,且不良反应小,安全性高,值得临床推广。     

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.     

红外线乳腺治疗仪联合仙人掌外敷治疗产后乳房胀痛护理观察

目的:探讨应用红外线乳腺治疗仪联合仙人掌外敷治疗产后乳房胀痛的效果。方法:选择2009年1月至2010年10月在我院妇产科分娩,产后乳房胀痛的200例患者,按患者住院日期单双号随机分为观察组和对照组各100例。观察组以红外线乳腺治疗仪照射30min后取适量新鲜仙人掌洗干净,去刺捣烂,加适量冰片和蜂蜜后环形外敷乳房约20min,然后除去仙人掌,用热毛巾清洁乳房后按摩乳房挤奶,每日2次。对照组采用红外线乳腺治疗仪照射30min后按摩乳房挤奶,每日2次。结果:干预后两组患者乳房胀痛程度及硬度均得到缓解,两组疗效比较差异具有统计学意义(P<0.05);观察组母乳喂养情况较对照组有显著性差异(P<0.05)。结论:应用红外线乳腺治疗仪联合仙人掌外敷治疗产后乳房胀痛及减轻乳房硬度疗效显著,母乳喂养情况改善,且减轻了护理工作强度。