目的:探讨营养支持护理在重症监护病房(ICU)重症患者护理中的应用效果.方法:选择 2016 年 10 月至 2019 年 9 月我院收治的 ICU重症患者 100 例,按随机数字表法分为两组,各 50 例.对照组实施常规护理,观察组在此基础上应用营养支持护理,对比两组营养指标及并发症发生情况.结果:观察组干预后白蛋白、转铁蛋白、血红蛋白水平均高于对照组,并发症发生率低于对照组,差异有统计学意义(P＜0.05).结论:营养支持护理能够有效改善 ICU 重症患者的营养状况,减少并发症的发生.

目的 探究不同口腔护理方案对ICU经口气管插管机械通气患者预后的影响.方法 选取ICU经口气管插管机械通气患者96例,随机分为观察组和对照组,分别接受个性化口腔护理和传统口腔护理.比较两组患者ICU住院天数和气管插管天数、护理前后口腔观察指标、口腔护理效果及呼吸机相关性肺炎(VAP)发生率.结果 观察组患者护理后ICU住院天数和气管插管天数均明显低于对照组(P＜0.05).两组患者护理后口腔情况较护理前显著改善(P＜0.05),且观察组改善情况明显优于对照组(P＜0.05).观察组患者护理后口腔异味、口腔炎症发生率均低于对照组,仅口腔异味和霉菌感染所致炎症发生率比较差异显著(P＜0.05).观察组患者气囊上滞留物量显著低于对照组(P＜0.05),观察组VAP发生率低于对照组(P＜0.05).结论 个性化口腔护理可以显著改善口腔问题,减少呼吸机相关性肺炎发生,有利于患者预后.

目的 探讨综合康复护理在脑出血治疗后神经功能缺损患者中的应用效果.方法 选取2017年4月至2018年6月于本院接受治疗的89例脑出血治疗后神经功能缺损患者作为研究对象,按照红蓝球将其随机分为对照组(44例)与试验组(45例).对照组采用常规护理,试验组采用综合康复护理.比较两组的干预效果.结果 干预后,两组的躯体角色、机体疼痛、活力、社会功能、躯体功能、情绪角色、心理健康、总体健康状况评分均升高,且试验组高于对照组(P<0.05).干预后,两组的CSS评分均降低,且试验组低于对照组(P<0.05).试验组的肢体功能优于对照组(P<0.05).试验组的护理满意度高于对照组(P<0.05).结论 综合康复护理应用于脑出血治疗后神经功能缺损患者中,可降低患者的神经缺损程度,改善其机体功能,提高生活质量及护理满意度.

Objective To analyze the effects of extended care on treatment compliance and quality of life in patients with chronic atrophic gastritis.Methods A total of 86 patients with chronic atrophic gastritis were divided into two groups according to the random number table according to the time of admission.Among them, 43 patients in the control group were given routine nursing measures, and 43 patients in the study group were combined with continuous nursing measures on the basis of the control group.The total effective rate of treatment, treatment adherence, rehospitalization rate, and quality of life score were compared between the two groups.Results After treatment, the total effective rate of the study group was 93.0％significantly higher than that of the control group 79.1％ (P＜0.05).After treatment, the treatment compliance of the study group was significantly higher than that of the control group, and the rate of rehospitalization was significantly lower than that of the control group (P＜0.05).Before treatment, there was no significant difference in the quality of life scores and total scores between the two groups (P＞0.05).After treatment, the scores and total scores of the two groups were significantly higher, and the study group was better (P＜0.05).Conclusion Extended care for patients with chronic atrophic gastritis can effectively improve the treatment efficiency of patients, increase treatment compliance, and improve their quality of life.Patients have lower re-hospitalization rate and higher clinical application value.

目的:总结给予急性心肌梗死患者分型护理的体会.方法:将640例急性心肌梗死患者,根据全球心肌梗死分型分别给予相应的护理对策,评估1型患者的危险程度、完善经皮冠脉成形术(PCI)术前及术后的流程对并发症进行护理;对于2型患者进行原发性疾病的护理;对于3型患者需认真识别高危患者并给予高质量的心肺复苏;对于4型患者,术后应严密观察其病情、加强专科及心理护理.结果:640例患者中589例患者恢复正常并出院,51例患者死亡(占7.97％).结论:基于病因分型定义的急性心肌梗死患者的针对性强、护理效果好.

Objective:To investigate protective effect of leosimendan on the myocardial injury in patients with septic shock.Methods:149 cases with septic shock from Jan. 2013 to Dec. 2017 in our hospital were chosen,who were divided into the observation group (73 cases) and control group (76 cases),the control group were given routine treatment and intravenous administration of dobutamine for 48 h,the observation group were given routine treatment,intravenous injection of dobutamine for 24 h and intravenous injection of leosimendan for 24 h. The cardiac function parameters,hemodynamic index,troponin,lactate,norepinephrine,mechanical ventilation and ICU mortality of two groups were compared. Results:Before treatment,the left ventricular ejection fraction,left ventricular diastolic final volume index and left ventricular systolic final volume index of two groups had no significant different (P＞0.05). After treatment,the cardiac function parameters were got improved in the observation group (P＜0.05),while there was no defference in the control group (P＞0.05). The cardiac output,each stroke index,left ventricle per beat index in observation group were all higher than control group,while the central venous pressure were lower than control group (P＜0.05). The troponin and lactate levels after treatment were all lower than before treatment,while the observation group was obvious lower than control group (P＜0.05),the total amount of norepinephrine,mechanical ventilation and ICU mortality between groups had no significant difference (P＞0.05). Conclusion:Leosimendan had myocardial protective effect on patients with septic shock,which could improve the heart function,optimize hemodynamics,while have could not decrease the ICU mortality.

Objective To analyze the efficacy of continuous blood purification treatment for severesepsis complicated with acute respiratory distress syndrome.Method50 patients with severe sepsis complicated with acute respiratory distress syndrome in our hospital were selected for the retrospectively analysis from January 2015 to December 2016.All patients were divided into a control group(30 patients)and an experimental group(20 patients)according to whether received continu-ous blood purification.The patients in the control group were given conventional treatment,and the patients in the experi-mental group receivedwith continuous blood purification except conventional treatment.The clinical efficacy of the two groups was observed and analyzed.Result:Oxygenation index PaO2/FiO2 at48 hours and 72 hours after treatment in the experimental group was higher than that before treatment and much higher than that in the control group (P ＜ 0.05).The serum PCT level at 24 hours,48 hours and 72 hours after treatment in the experimental group was significantly lower than that in the control group (P＜0.05),and APACHEII score at 24 hours,48 hours and 72 hours after treatment in the ex-perimental group was significantly lower than that in the control group (P＜0.05).The weaning success rate and the 28 day survival rate of the experimental group were significantly higher than the control group (P＜0.05).Conclusion:The treat-ment of severe sepsis with ARDS by CBD can earlyimprove Oxygenation,andmarkedly improvethe weaning success rate and survival rate.

目的 探讨施他宁联合血必净治疗重症急性胰腺炎的疗效及其对患者血清白细胞介素10(IL-10)、白细胞介素18(IL-18)、肿瘤坏死因子α(TNF-α)水平的影响.方法 选择2016年9月～2017年2月我院接诊的80例重症急性胰腺炎患者为研究对象,按照抽签法将患者分为实验组和对照组,每组40例.对照组在常规治疗的基础上给予施他宁治疗,实验组在对照组治疗方案基础上联合血必净治疗.比较两组治疗中的临床症状减轻及恢复时间,血栓结果,尤其是血清淀粉酶的指标恢复;另外,比较两组血清IL-10、IL-18、TNF-α水平.结果 治疗前,两组血清淀粉酶、血尿素氮、血糖、白细胞记数,IL-10、IL-18、TNF-α比较差异无统计学意义(P＞0.05);治疗后,实验组总有效率高于对照组(P＜0.05),血清淀粉酶、血尿素氮、血钙、血糖、白细胞记数治疗前后差值大于对照组(P＜0.05).治疗后,两组血清IL-10显著上升,IL-18、TNF-α显著下降,实验组IL-10、IL-18、TNF-α治疗前后差值大于对照组,差异均有统计学意义(P＜0.05).结论 施他宁联合血必净治疗能提高重症急性胰腺炎的疗效,能够有效恢复血清IL-10水平、降低血清IL-18、TNF-α水平.

目的 探讨重症医学科(ICU)患者多重耐药鲍曼不动杆菌(MDR-AB)医院感染的危险因素,为临床上预防和控制感染提供依据.方法 以某院ICU确诊为MDR-AB医院感染的病例40例为观察组,同期确诊为非MDR-AB医院感染的病例40例为对照组,分析耐药鲍曼不动杆菌医院感染多重耐药的危险因素.结果 对基本情况和侵入性操作因素相关差异因素进行多因素Logisic回归分析显示,患者入住ICU的时间、抗菌药物碳青霉烯类、抗菌药物使用时间、气管插管、气管切开和切口引流管是导致MDR-AB医院感染发生独立危险因素.结论 对于入住ICU时间较长患者,临床应警惕抗菌药物使用和侵入性操作可能诱发MDR-AB医院感染风险.

Objective:To explore the risk factors and preventive measures of surgical site infection(SSI)in or-thopedic patients.Methods:A retrospective analysis was performed on 2316 surgical patients admitted to orthopedic ward in our hospital.To detect the risk factors and pathogens of SSI and explore preventive strategies.Results:The infection rate of SSI was 1.6%(37/2316)in 2316 patients,of which the infection rate in class I incision was 0.45%(10/2214),class III incision was 26.09%(24/92),the SSI rate was 30%(3/10)in class IV incision.Risk factors for s SSI including:combine underlying diseases,emergency,surgical level and operating room environmental,and patients with underlying diseases and operating room environment were independent risk factors for SSI.The patho-gens for SSI were 23(62.16%)G- bacilli,of which 8(34.78%)were Escherichia coli,7(30.43%)were Klebsiella pneumoniae,4(17.39%)were Acinetobacter baumannii,14(37.84%)G+cocci,including 6(42.86%),Staphylo-coccus aureus,5(35.71%)coagulase-negative Staphylococcus.Conclusions:The risk factors of SSI in orthopedic surgery affected by basic disease,emergency,operation class and operating room environment.The pathogens which found in SSI are vary.The underlying diseases and operating room environment are independent risk factors for SSI. Preventive measures should be developed to reduce the incidence of SSI.

目的 探讨无创正压通气联合氧气驱动雾化吸入对慢性阻塞性肺疾病(COPD)并呼吸衰竭患者的影响.方法 选取2014年9月—2017年10月陕西省人民医院收治的COPD并呼吸衰竭患者82例,根据治疗方式分为对照组与研究组,每组41例.在常规治疗基础上,对照组患者给予无创正压通气治疗,研究组患者在对照组基础上给予氧气驱动雾化吸入治疗;两组患者均连续治疗7 d.比较两组患者临床疗效,治疗前及治疗后7 d动脉血气分析指标、血清炎性因子水平,撤机成功率,治疗后28 d存活率,并观察两组患者治疗期间不良反应/并发症发生情况.结果 (1)研究组患者临床疗效优于对照组(P<0.05).(2)治疗前两组患者pH值、动脉血二氧化碳分压(PaCO2)、动脉血氧分压(PaO2)比较,差异无统计学意义(P>0.05);治疗后7 d研究组患者pH值、PaO2高于对照组,PaCO2低于对照组(P<0.05).(3)治疗前两组患者血清C反应蛋白(CRP)、内毒素(LPS)、降钙素原(PCT)水平比较,差异无统计学意义(P>0.05);治疗后7 d研究组患者血清CRP、LPS、PCT水平低于对照组(P<0.05).(4)研究组患者撤机成功率、治疗后28 d存活率高于对照组(P<0.05).(5)治疗期间研究组患者不良反应/并发症发生率低于对照组(P<0.05).结论 无创正压通气联合氧气驱动雾化吸入能有效提高COPD并呼吸衰竭患者临床疗效,改善患者通气功能,降低血清炎性因子水平,提高撤机成功率及近期存活率,且安全性较高.

目的 探讨针对性护理干预在ICU重症颅脑损伤患者中的应用效果.方法 选择我院2016年11月至2017年10月收治的ICU重症颅脑损伤患者100例,根据护理方法分为常规护理组与针对性护理组,各50例.常规护理组予以常规方法护理,针对性护理组采用针对性护理干预,两组均进行7 d护理,比较两组的护理效果.结果 护理后7 d,两组患者的NIHSS评分均降低,Fugl-Neyer运动量表及Barthel指数评分均升高,且针对性护理组优于常规护理组(P<0.05).针对性护理组患者的并发症总发生率明显低于常规护理组(P<0.05).结论 针对性护理干预应用于ICU重症颅脑损伤患者中,有助于改善患者神经功能、运动能力及日常生活能力,降低并发症发生率,值得推广应用.

Objective: To study on the effect of PICCO in patients with septic shock.Methods: 80 patients with septic shock were treated in ICU of our hospital,the observation group (n=42) were treated with PICCO,while the control group were treated with conventional liquid resuscitation (n=38).The clinical efficacy was compared.Results: After treatment,the HR,lactic acid level,APACHE II score and CVP、MAP、PaO2/FiO2 in the observation group were significantly lower than that in the control group (P<0.05),while physiological indexes (CVP、MAP、PaO2/FiO2) were higher(P<0.05).The relevant indicators about clinical efficacy were significantly lower(P<0.05).Conclusion: PICCO monitoring can effectively guide the clinical application of fluid resuscitation in patients with septic shock,the effect is significant,it is worthy of recommendation.

Objective To evaluate the clinical value of the level of plasma procalcitonin,blood lactic acid an1 endotoxin in patients of severe pneumonia complicated with sepsis.Methods The 40 cases of severe pneumonia complicated with sepsis(observation group)were analyzed retrospectively,they were divided into survival group included 20 cases and the death group included 20 cases.Meanwhile the 20 cases of healthy persons were selected as control group.The worst score of Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) within 24 hours after admission were record.The level of plasma procalcitonin,blood lactic acid and endotoxin were compared between three groups.In addition do a correlation study between the above indexes and the score of APACHE Ⅱ.Results The level of plasma Procalcitonin,blood lactic acid and endotoxin of observation group increased significantly compared with the control group [(0.02±0.01 ng/ml,0.87 ± 0.27 mmol/L,4.15±1.63 pg/ml) vs (18.29±11.02 ng/ml,6.55 ± 3.02 mmol/L and 15.5±10.38 pg/ml),t=10.48,11.79,6.75,all P＜0.05].The level of plasma procalcitonin,blood lactic acid and endotoxin of the death group increased significantly compared with the survival group [(9.52±2.93 ng/ml,4.26±1.78 mmol/L,7.62±3.04 pg/ml) vs (27.06±8.88 ng/ml,8.84± 2.14 mmol/L and 23.39± 9.00 pg/ml),t=8.39,7.35,7.42,all P＜0.05].In the all patients of severe pneumonia complicated with sepsis,there was positive correlation among plasma procalcitonin,blood lactic acid,endotoxin and the score of APACHE Ⅱ (r=0.919,P=0.001;r=0.914,P=0.002;r=0.909,P=0.004).Conclusion The level of plasma procalcitonin,blood lactic acid and endotoxin are very important indexes in assessment of the severity and the prognosis of severe pneumonia complicated with sepsis,that has important value in clinical application.

Objective To investigate the clinic effect of glucocorticoid combined with hemoperfusion in treating MODS caused by severe bee sting.Methods 66 patients with MODS caused by severe bee sting admitted to our hospital from June 2014 to March 2016 were selected and divided into observation group and control group,33 cases in each group.Control group was given regular treatment and HP.Observation group was given glucocorticoid based on control group.Clinic data of the two groups were retrospectively analyzed.The clinical efficacy and safety of glucocorticoid combined with hemoperfusion (HP) in the treatment of multiple organ dysfunction syndrome (MODS) caused by severe bee stings were compared and analyzed.Results No significant difference was detected between the two groups in the mortality rate (P＞0.05).No significant differences were detected in the levels of Scr,BUN,ALT,AST,CK-MB,CRP and Hb-related biochemical indexes between the two groups before treatment (P＞0.05).The levels of Scr,BUN,ALT,AST,CK-MB,CRP and Hb-related biochemical indexes were statistically significant different (P＜0.05).No significant difference was detected between the two groups in the incidence of oliguria,uremia and polyuria (P＞0.05).Significant difference was detected between the two groups in the duration of polyuria and the recovery time of renal function (P＜0.05).Conclusion The combination of glucocorticoid and hemoperfusion in the treatment of multiple organ dysfunction syndrome (MODS) caused by severe bee stings is more effective,which is beneficial to the recovery of organ function,shorten the treatment time and improve the patients prognosis.

Objective To explore the effect of non nutrition sucking and massage on gastrointestinal function in very low birth weight infants in NICU.Methods A total of 62 very low birth weight infants in NICU of our hospital were selected as study subjects.According to the order of entering NICU time,they were divided into observation group (33 cases) and control group (29 cases).The control group only treated with gastric tube feeding and the observation group was treated with non nutrition sucking and massage on the basis of the control group.The changes of body weight and gastrointestinal function in two groups were analyzed and compared.Results There was no significant difference in birth weight of the neonates in two groups at birth (P ＜0.05).At 7th,14th and 28th day after birth,the body mass of the observation group were significantly higher than those of the control group (P ＜ 0.05).The indicators of defecation and feeding in the observation group were better than that of the control group (P ＜ 0.05).In addition,the incidence rates of vomiting,abdominal distention,gastric retention and pathoglycemia of the observation group during feeding period were significantly lower,and the symptoms improved times were significantly lower than that in the control group (P ＜ 0.05).Conclusion Non nutrition sucking and massage can promote maturation of gastrointestinal function,reduce the occurrence of feeding intolerance,accelerate the early growth and development of very low birth weight infants.

目的:探讨中药大黄芒硝对老年重症急性胰腺炎(SAP)的胃肠功能及APACHEⅡ评分的影响分析.方法:收集老年S A P患者40例,将其分为常规治疗组(抗感染、抑制炎症反应、抑酸抑酶、持续床旁血液净化、无创或有创呼吸机辅助通气等综合治疗)20例和大黄芒硝治疗组(常规治疗基础上给予大黄10 g鼻饲,3次/d,同时按生大黄粉:芒硝1:4比例混匀装入缝制布袋中外敷上腹部)20例,比较两组胃肠功能恢复情况,以及前后急性生理与慢性健康评分(APACHEⅡ评分).结果:大黄芒硝治疗组胃肠功能恢复较快,与常规治疗组比较,腹痛腹胀缓解时间、肠鸣音恢复正常时间、发病后首次排便时间较早[(2.60±1.12)、(4.00±1.07)、(1.93±0.70)d],差异有统计学意义(P<0.05);大黄芒硝治疗组,治疗3 d、7 d后与治疗前比较评分值明显下降[(21.53±2.32)、(16.33±2.12)、(13.53±1.96)分],差异有统计学意义(P<0.05).结论:中药大黄芒硝可通过多种作用机制早期减轻老年SAP炎症反应,减轻肠壁水肿,增加胃肠蠕动,缩短治疗疗程.

目的 探讨经口进食与鼻饲对吞咽困难患者的营养效果,以便为患者提供科学的营养供给途径和方法.方法 将74例通过吞水试验筛选的吞咽困难的患者随机分成试验组和对照组,给予匀浆饮食,分别于住院次日、住院1周及2周进行上臂紧张围及肱三头肌皮褶厚度测量,同时监测患者血红蛋白及血清白蛋白量的变化,并判断2组患者的营养状况.结果 观察组胃部返流、误吸及肺部感染等并发症的发生率均明显低于对照组,差异有统计学意义(P＜0.05);治疗1周后患者各项营养评价指标有差异但不明显,治疗2周后观察组明显高于对照组,差异有统计学意义(P＜0.05).结论 鼻饲肠内营养支持营养效果明显优于经口进食患者,此法对改善预后和促进疾病康复有积极的促进作用,且并发症及感染发生率低,安全有效.

Objective To investigate the objective factors of the quality of care patients bed unit.Methods Designed questionnaire,random QC checks each packet member ward bed unit the quality of care, improve specific impact before and after comparison of various factors. Results Improve quality of care bed unit was better than before improvement (P<0.05).Ward conditions improve before there was statisti?cally significant difference (P<0.05);no significant difference after improvement (P>0.05).Quality of care unit beds in different conditions before and after improvement were statistically significant (P<0.05).There was significant difference in inspection period between two groups before improvement(P<0.05);no significant difference after improvement(P>0.05).Conclusion Ward conditions directly affect the quality of care bed unit,but through the intervention of a larger room for improvement. The severity of the patient are important factors in whether or not the intervention factor bed care unit,severe illness of bed unit is better than the quality of care of the mild bed unit;for morning inspection time factor analysis shows that the quality of care is lower than in the afternoon.

目的 探讨连续性静脉血液透析滤过(CVVHDF)联合血液灌流(HP)治疗蜂蜇伤患者中临床血清磷酸肌酸激酶同工酶(CK-MB)、总胆红素(TBil)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、肌红蛋白(Mb)、尿素氮(BUN)和肌酐(Scr)生化指标的变化研究及CVVHDF联合HP在蜂蜇伤中的临床应用价值.方法 选取陕西省人民医院25例蜂蜇伤患者,分为常规组(局部处理、抗感染、抗过敏、抑制炎症反应、营养心肌、保肝保肾、营养支持等综合治疗)10例和CVVHDF联合HP治疗组(上述常规综合治疗+CVVHDF联合HP)15例,比较两组治疗前和治疗后24,48 h的血清CK-MB,TBil,ALT,AST,Mb,BUN和Scr.结果 常规组经48 h治疗后上述生化指标与治疗前比较变化不明显(P＞0.05),CVVHDF联合HP治疗组经24,48 h治疗后上述生化指标与治疗前比较有所降低,差异有统计学意义(P＜0.05).结论 CVVHDF联合HP治疗蜂蜇伤患者早期血清CK-MB,TBil,ALT,AST,Mb,BUN和Scr生化指标水平明显降低,能尽早恢复患者各脏器功能,是临床治疗蜂蜇伤患者的有效手段,具有重要临床应用价值.