目的 探讨游离腹壁下深血管穿支皮瓣(deep inferior epigastric perforator flap,DIEP)乳房重建术后引流管留置时间的影响因素.方法 收集44例接受游离腹壁下深血管穿支皮瓣乳房重建术的患者资料,回顾性分析引流管留置时间较长者(>7天)的一般资料差异情况,将有差异项带入Logistic回归方程,分析DIEP乳房重建术后引流管留置时间的影响因素.结果 所选取调查对象中,共有12例患者发生引流管留置时间超过7天,占27.27％.研究发现患者的年龄、身体质量指数(BMI)、重建时机、功能锻炼、接受的疾病知识宣教、饮食指导,发生引流管留置时间延长与未发生引流管留置时间延长对象对比,差异均具有统计学意义(P<0.05).将上述因素带入Logistic回归方程计算发现,上述因素均与引流管留置时间相关.结论 乳腺癌DIEP乳房重建术后引流管留置时间的影响因素包括患者的年龄、BMI、重建时机、功能锻炼、所接受的疾病知识宣教和饮食指导等;因此,应在术前对患者的危险因素进行筛查,及时干预,促进患者早期康复.

[目的]探讨游离腹壁下深血管穿支皮瓣(deep inferior epigastric perforator flap ,DIEP)乳房重建术的护理.[方法]收集44例接受游离腹壁下深血管穿支皮瓣乳房重建术的病人资料,回顾性分析游离腹壁下深血管穿支皮瓣乳房重建病人围术期的护理.[结果]经过规范的护理,42例游离腹壁下深血管穿支皮瓣乳房重建病人术后恢复良好(其中1例于术后第1天出现重建皮瓣血肿压迫,行皮瓣探查清除血肿后恢复良好,1例于术后第2天出现重建乳房皮下瘀血,行皮瓣探查+吻合静脉卡压松解+腹壁深静脉再吻合术后恢复良好);其余2例出现了皮瓣坏死(1例于术后第6天出现皮瓣缺血坏死,行手术清创+背阔肌皮瓣转移术;1例出现部分皮瓣坏死,随访2个月后行皮瓣坏死清创术).[结论]临床护理人员应针对游离腹壁下深血管穿支皮瓣乳房重建术术后护理建立规范标准,以优化皮瓣转归,促进病人康复.

目的:探讨品管圈活动在降低乳腺癌患者PICC导管相关性感染中的应用效果.方法:收集2014年1月~2015年12月PICC导管相关感染发生的情况,分析乳腺癌患者PICC导管相关感染发生的原因,并制定对策,实施改善方案,制定护理标准.结果:活动前773例患者中发生导管相关感染32例,发生率为4.13‰,其中导管穿刺处局部感染25例(3.23‰)、导管隧道感染2例(0.25‰)、导管相关性血流感染5例(0.64‰);活动后761例患者中发生导管穿刺处局部感染13例(1.70‰)、导管隧道感染1例(0.13‰),导管相关性血流感染1例(0.13‰);品管圈活动的干预显著降低了导管相关感染的发生率,活动前后差异有统计学意义(P<0.05).分层回归分析表明,品管圈活动对乳腺癌患者PICC导管相关性感染的干预效果与职业因素及居住地相关,其中品管圈活动对家庭主妇患者、长期居住于乡镇患者的干预效果相较于非家庭主妇患者、长期居住于城镇患者具有显著的统计学意义(P<0.05).结论:品管圈活动可以降低乳腺癌患者PICC导管相关感染的发生率,提高护士及患者对PICC导管的维护意识,从而提高安全给药的指数及患者的生存质量.PICC导管的护理质量亦是衡量专科护理水平的重要指针,通过品管圈活动可以提高护士解决问题的能力,使其在工作中获得成就感,提高安全意识和责任心,从而提高专科护理质量,同时也提升了团队的合作精神.

目的 对运用腹腔镜手术治疗的妇科肿瘤患者手术后的临床效果进行研究.方法 选取我院2017年1月～2017年6月收治的手术治疗的妇科肿瘤患者200例,作为本次研究项目的研究对象,将患者随机平均分成两组各100例,对照组和观察组,两组患者所采用的手术治疗的方式不同.对照组患者使用的手术方法是常规的开腹式手术方法进行治疗,观察组患者使用的是腹腔镜手术方法进行治疗.结果 我们可以发现观察组所使用的腹腔镜手术方法比对照组使用的常规开腹式手术方法,在手术所用时间上相比,差异无统计学意义(P>0.05);在手术中的出血量上相比也比对照组少,在术后排气时间和康复出院时间上相比也少于对照组,差异有统计学意义(P<0.05).结论 在妇科手术中运用腹腔镜手术方式对妇科肿瘤患者进行治疗,可以为患者减轻痛苦,术后康复快并缩短了住院的时间,疗效非常明显,值得推广使用.

Objective To understand the demands for participating in clinical decision-making in patients with breast cancer by the investigation.Methods From September 201 4 to December 201 4,we investigated 1 48 cases of breast cancer patients in Fujian Medical University Union Hospital by the research table of Expectation in Clinical Decision-making Participation.Survey contents include general information,the expectation of participating in clinical decision-making,and so on.Results Patients with breast cancer who were younger and with more income had higher demand of communication (χ2 =4.31 2,9.1 51 ;P <0.05). Patients with higher education level had higher expectations of participating in decision-making(χ2 =3.901 ,P <0.05 ).Conclusions Breast cancer patients at different ages and incomes show different requirements to communicate about clinical decision-making,and patients of different education level also have different demands of participation in decision-making.Clinical nurses should enhance communication between patients and nurses according to the different demands of patients,inorder to meet patients′needs about information, communication and decision-making of treatment,and promote the codetermination decision-making between doctor and patient.

Objective:To investigate the intervention effect of the prophylactic use of antibiotics for type Ⅰ incision operation in one hospital,and to promote the clinical rational use of antibacterial.Methods:The archive records in a hospital type Ⅰ incision were investigated in 2011 according to the special rectification activities of the national clinical use of antibiotics.In the comprehensive intervention measures(since July 1st) by the hospital,the cases from January to June of 2011 were selected as group A(before the intervention) and the cases from July to Decembqr,as group B(after the intervention).The two groups were contrast analyzed.Results:After the intervention,the antimicrobial drug usage,antimicrobial drug costs and their use intensity were significantly reduced.The proportion of the rational use of antimicrobial drugs increased.There were statistically significant differences in the two sets of data(P<0.05).Conclusion:After the intervention,the preventive use of antibiotic was more reasonable in the hospital,but there were also some unreasonable phenomenon in the medication,so some management measures should be improved