We aimed to develop and validate a nomogram for predicting the risk of intraoperatively acquired pressure injuries (IAPIs) in children undergoing cardiac surgery with cardiopulmonary bypass (CPB). This study retrospectively included 208 children aged 21 days to 8 years who underwent cardiac surgery with CPB in a tertiary hospital in China between January 2020 and October 2023. All patients’ data were collected from the hospital’s medical record system and randomly divided into the training (n = 146) and validation (n = 62) cohorts by a ratio of 7:3. Logistic regression analysis was conducted in the training cohort to identify independent risk factors and establish the nomogram. Finally, calibration curves, receiver operating characteristic (ROC) curves, and decision curve analysis (DCA) were performed in both cohorts to validate the predictive ability of the nomogram. 43 (14.7

Objective:To summarize the clinical application value of color Doppler ultrasound (CDU) in the nursing observation of flap vascular circulation after free flap transplantation.Methods:From September 2018 to November 2020, 18 patients with skin defect of limbs treated by free flap transplantation in the Second Affiliated Hospital of Wenzhou Medical University were monitored by skin color, skin temperature, skin tension, capillary reaction time and CDU. When the vascular circulation disorder was found, the patients should be treated with volume expansion, rehydration, local massage of the flap, anticoagulation and microcirculation improvement. Positive drainage under the flap to prevent infection, combined with hyperbaric oxygen treatment, accurate and timely exploration of vascular crisis to avoid flap necrosis.Results:Postoperatively, CDU monitoring found that 2 cases had regional vascular circulation disorder, 1 case had complete embolization of the main vessels and perforators in the flap, the flap was thinned and changed to full thickness skin grafting, the deep tissue exposed area was healed by dressing change, and 1 case had incomplete embolization of the flap′s reflowing vein. After operation, the venous crisis was relieved and the flap survived completely.Conclusions:Comprehensive observation is needed after free flap transplantation. Combined with four routine vascular circulation indexes, CDU monitoring of flap blood flow can provide more objective, accurate and detailed basis for vascular circulation status, and can accurately find the vascular circulation disorder after free flap transplantation in early stage, and understand the vascular flow status of the flap, so as to effectively avoid the continuous progress of vascular crisis, to avoid flap necrosis and improve the survival rate of flap.

目的 研究个体化护理与右美托咪定滴鼻结合对小儿吸入麻醉诱导的影响效果.方法 选择2019年1月至2020年12月本院收治的符合条件的192例患儿.按照随机数字表法,分为右美托咪定组、个体化护理组、联合组与常规组,各48例.比较各组患儿的等待时间与入睡时间,配合程度与镇静水平,面罩诱导质量评分,生命体征变化情况.结果 联合组患儿的等待时间明显长于右美托咪定组、个体化护理组、常规组患儿,入睡时间明显短于其余3组(P<0.05).研究组入室后的行为评分与其余3组相比明显偏低,镇静评分与HR明显高于其余3组(P<0.05).联合组患儿的面罩诱导质量评分、父母分离评分明显低于其余3组(P<0.05).结论 个体化护理与右美托咪定滴鼻联合干预对小儿吸入麻醉诱导有显著影响效果.

手术室是医生挽救患者生命的战场,手术室的护理工作极其重要.良好的护理不仅使得患者恢复健康的速度有所增加,更为树立医院的良好形象立下功劳.在手术前对患者进行术前访视很有必要,可以有效降低患者的手术压力,帮助患者排解内心的不良情绪.

由于现代社会医疗技术的发展及新材料的使用,大量医疗器械应用到手术治疗中,并发挥着越来越重要的作用.但是医疗器械无论是在正常使用状态下,还是在故障状态下,都存在一定的风险.为了最大程度降低手术室医疗器械使用过程中的危险性,对其实施风险管理,是重要的手段.文章主要分析当前手术室医疗器械管理的现状,提出风险管理的概念,并且针对性地制定实际的风险管理办法,为临床安全使用手术室医疗器械提供参考借鉴.

目的：探讨不同护理干预在学龄前期患儿手术期的应用。方法：90例学龄前期行择期手术的患儿被随机分为3组：术前术后阅读疗法组（A组）、术中积极心理学疗法组（B组）、术前术后阅读疗法+术中积极心理学疗法组（C组），每组30例。测定并记录患儿诱导期合作程度以及手术后2、24 h疼痛强度。结果：C组的诱导期合作程度高于A组和B组，A组和B组术后疼痛强度高于C组。结论：术前术后阅读疗法联合术中积极心理学疗法能降低学龄前期患儿术后疼痛程度及提高配合度。

随着我国逐渐进入老龄化社会，髋部骨折发生率逐年增加。老年人髋部骨折严重影响其生活质量，导致各种并发症发病率及病死率增加[1]。术后谵妄是常见的并发症之一[2]，不同地区的研究报道其发病率为5%~61%[3-5]。术后谵妄严重影响患者的治疗效果及预后，而30%~40%的围手术期谵妄状态是可以预防的。目前关于术后谵妄的风险因素研究较多[6-7]，笔者收集65岁以上老年髋部手术患者363例，进一步分析老年患者术后谵妄发生的危险因素，并进行针对性的护理干预及治疗措施，从而改善预后。

随着生活节奏的加快和社会竞争的日益激烈，对医疗护理质量及服务质量提出了更高的要求。护士在工作中所承受的压力已成为一种职业性危险，而手术室护士又是护士中较为特殊的群体，专业技术性强，意外及紧急情况多，常在高度紧张状态下持续工作，且手术室作为一个特殊的治疗场所，存在着职业暴露危险，这些特点决定了手术室护士面临着特殊的职业压力。本文就手术室护士工作压力与相关因素作一调查分析，并提出应对策略，为相应的管理机构提供参考。

Objective To evaluate the effect of alfacalcidol on bone mineral density(BMD) and bone turnover markers in postmenopausal women.Methods A total of 67 postmenopausal women aged from 55-75 years with low BMD or osteoporosis from Sep.2009 to Dec.2011were enrolled into the study.They were randomly divided into 2 groups.Subjects in experimental group were taking Osteoform 1000 mg/d and alfacalcidol 0.25 μg/bid orally,while those in control group were only taking osteoform 1000mg/d.After 48 weeks of medication,BMD of femoral neck,the greater trochanter,Ward′s triangle area and lumbar1-4 were measured by X-ray.Meanwhile,some biochemical markers of bone turnover such as bone alkaline phosphatase(BALP),Tartrate-resistant acid phosphatase(TRACP)and 25-hydroxychole calciferol[25(OH)D3]were also measured by enzyme linked immunosorbent assay(ELISA).Results There was no significant difference of BMD between two groups(P0.05) prior to treatment.The BMD of every bone measured increased significantly in experimental group after treatment(P0.05),while only BMD of lumbar 2-4 showed improvement after treatment in control group.There was a statistically difference for BMD of every measured bone between two groups after treatment(P0.05).We also found that before treatment there were no differences in terms of the serum levels of BALP,TRACP and 25(OH)D3 between two groups(P0.05).But the differences were significant after treatment(P0.05).In experimental group,the serum level of BALP,TRACP and 25(OH)D3 changed from 26.52±6.07 μg/L,2.84±0.97 U/L and 53.91±19.04 nmol/L before treatment to 21.85±5.96 μg/L,2.37±0.88 U/L and 57.87±19.24 nmol/L after treatment,while they did not change a lot in control group before and after the treatment(P0.05).Conclusions Alfacalcidol could be used for the treatment of postmenopausal osteoporosis by increasing bone mineral density and reducing bone turnover markers.

目的评价替勃龙对围绝经期及绝经后妇女骨质疏松症的影响。方法选择2009年7月至2011年12月,本院老年门诊经BDM测量诊断为骨量减少或骨质疏松的绝经后妇女中征集志愿者,经筛选后共77例,随机分为两组,实验组:口服替勃龙1日1.25mg+复方氨基酸鳌合钙1日1000mg;对照组:口服复方氨基酸鳌合钙1日1000mg。两组均连续服药48周。治疗前、后采用双能X线吸收法测定腰锥1～4节(L1～L4)、股骨颈、大粗隆及Ward's三角区骨密度(BMD);同时抽血清检测FSH、E2及血脂水平。结果两组在治疗48周后临床疼痛等症状均明显改善与好转,有效率分别为87.81%和63.89%,有显著差异(P<0.05);试验组股骨颈、大粗隆、Ward's三角区及平均骨密度均较治疗前显著提高(P<0.05),两者增幅为0.82%、1.11%、1.71%和0.84%;治疗前两组FSH及E2差异均无统计学意义(P>0.05),治疗后实验组E2水平明显升高,与对照组及治疗前自身比较,差异均有统计学意义(P<0.05)。治疗前后自身比较,实验组:TG降低,ApoA1水平升高,差异有统计学意义(P<0.05),对照组:CHO水平升高,有统计学意义(P<0.05);治疗后,两组间比较:TG、CHO、LDL、ApoA1、FSH、及E2差异有统计学意义(P<0.05)。结论应用替勃龙能有效增加绝经后妇女骨密度及改善血脂成分。