上肢运动功能障碍是脑卒中后常见并发症[1-2],常表现为持续肩痛、手腕痛、肿胀、肩关节活动障碍等.针对此类患者的康复锻炼是通过手臂或手掌活动训练,给予其肌肉组织和神经的刺激,加快其上肢的力量恢复.目前的上肢训练装置主要是握力器、握力杆等自由物品,患者手部的摆放角度和姿势难以达到最好的摆放状态;且体积庞大,不方便使用.作者针对现有产品的不足,改良设计一款计量式上肢训练器,现报道如下.

总结10例行体外膜肺氧合治疗的危重患者院内安全转运的管理体会.组建专业的转运团队,制定转运流程及突发事件应急预案,转运前充分评估病情并做好仪器和用物准备,转运途中做好患者及仪器的安全管理,转运后做好再查工作,均是体外膜肺氧合支持下危重患者院内安全转运的重点.经以上转运方法,6例急性心肌梗死经皮冠状动脉介入治疗术后患者完成IC U与导管室间的转运,3例重症肺炎合并急性呼吸窘迫综合征患者顺利完成C T检查,1例重症肺部感染合并心源性休克心搏骤停患者在急诊科紧急建立体外膜肺氧合后安全转运至IC U.

总结1例主动脉夹层孕妇急诊行Bentall术联合剖宫产术后出现严重低心排血量综合征,应用体外膜肺氧合术联合主动脉内球囊反搏及连续肾脏替代疗法治疗的护理体会.实施的主要护理措施是密切配合医生进行体外膜肺氧合的建立,做好体外膜肺氧合的管道管理,监测患者病情及血流动力学变化,做好液体管理,预防及对症处理出血、血栓、下肢缺血、感染等并发症.经治疗和护理患者各指标显示脏器整体恢复良好,入住ICU 22 d转至普通病房.

Objective To study the one-time success rate and time of offline methods of mechanical ventilation using different offline methods of in elderly patients after abdominal surgery.Methods Ninety-two elderly patients with mechanical ventilation after abdominal surgery were divided into an observational group(n=48) and a control group(n=44) according to the admission order.The patients in the control group received routine offline method.The observational group received direct extubation and non-invasive mechanical ventilation-assisted method.Results The one-time off line success rates in the observational group and the control group were 89.58% and 72.72% respectively.There were significant differences in the offline success rates between the two groups(P<0.05).The offline time in the observational group was significantly shorter than that in the control group(P<0.05).Conclusion Direct extubation and non-invasive mechanical ventilation-assisted method can increase the success offline rate in elderly patients with mechanical ventilation after abdominal surgery and decrease the offline time.