目的:探讨整合式护理干预在门诊中老年骨质疏松症患者中应用效果.方法:选取在医院门诊就诊的85例中老年骨质疏松症患者,按照随机数表法将其分为对照组与观察组.对照组42例,进行常规护理干预;观察组43例,于常规护理基础上实施整合式护理干预,观察比较两组干预前后自我效能各维度(摄钙效能、运动效能)、健康信念各维度(骨质疏松症严重性、摄钙益处、易感性、运动益处、健康动机、运动障碍、摄钙障碍)、平衡功能的平衡量表(BBS)评分及骨密度变化情况,并统计两组生活质量各维度(心理、生理、独立性)评分及护理满意度.结果:干预后观察组摄钙效能及运动效能评分高于对照组,差异有统计学意义(t=6.361,t=5.326;P<0.05);干预后观察组骨质疏松症严重性、摄钙益处、易感性、运动益处、健康动机、运动障碍及摄钙障碍健康信念各维度评分高于对照组,差异有统计学意义(t=3.037,t=2.387,t=3.786,t=5.245,t=3.719,t=2.977,t=3.313;P<0.05);干预后观察组BBS评分及骨密度高于对照组,差异有统计学意义(t=6.798,t=2.429;P<0.05);观察组干预后心理、生理及独立性维度生活质量评分高于对照组,差异有统计学意义(t=4.863,t=7.129,t=5.591;P<0.05);观察组护理满意度为95.35％(41/43),高于对照组的78.57％(33/42),差异有统计学意义(x2=5.308,P<0.05).结论:整合式护理干预可提高社区中老年骨质疏松症患者健康信念与自我效能,有助于提高其骨密度及身体平衡能力,进而提高患者生活质量及护理满意度.

膝关节置换是临床治疗膝关节疾病的主要方法 ,能完成膝关节屈曲、畸形关节的重建 ,恢复其肢体功能[1 ] .但膝关节置换术后 ,患者常伴有不同程度的关节肿胀和疼痛 ,影响其治疗护理依从性和术后生活质量[2 ] .本研究采用以信息 -动机 -行为技巧 ( information-motivation-behavioral skills , IMB)模型[3]为理论基础的干预护理对老年膝关节置换患者进行信息、动机、行为的综合干预 ,引导其完成心理及行为改变 ,获得了显著效果.现将研究具体报告如下.

Objective:To study the application of infusion pump in the replantation patients with postoperative infusion management, and reduce the incidence of replantation referring to the blood circulation crisis.Methods: With the method of random number group, 216 cases of amputation patients admitted in our hospital orthopaedic were divided into the observation group and control group, each with 108 cases. On the basis of the same treatment and nursing measures, fluids in the observation group was controlled by infusion pump throughout the day, to ensure uniform input liquid for 24 hours. The control group was infused all liquid by routine intravenous feeding. After 1 week, incidence of replantation referring to the blood circulation crisis was compared two groups between the two groups.Results: 107 cases were survival in the observation group, and 1 case was found blood circulation crisis. 99 cases were survival in the control group, and 1 case was found blood circulation crisis. The differences were statistically significant between two groups (x2=6.71,P<0.01). Conclusion:To control constant infusion speed of postoperative patients with replantation by infusion pump could reduce the incidence of replantation referring to the blood circulation crisis, and it was advantageous to the replantation to be survival.

Objective:To explore the clinical significance of the teaching method of scene simulation exercises to improve the ability of nursing staff in the treatment of trauma.Methods:44 nurses were taken as the research objectives in the department of orthopedics of our hospital. They were divided into A group and B group according to the area. Each group had 22 nurses. A group was in the East ward and they trained trauma care knowledge by scenario simulation. B group was in the West ward and they used traditional teaching methods to train trauma care. In the same training content and the same time, the differences were compared in training simulation examination and operation time between two groups of nurses.Results:Two groups of nurses’ average examination results have improved after the scene simulation teaching method and the differences were considered to be statistically significant (t=2.507, P<0.05). The average rescue operation time of the A group was less than that of the B group and the differences were considered to be statistically significant (t=2.276,P<0.05). To a certain extent, it improves the analysis judgment and decision making ability in the emergency situation.Conclusion: Scene simulation has certain advantages in improving the ability of nursing staff of battle trauma, and it is also an innovation of the operation teaching. It is worth for further promotion and application.

Objective:To study application effect of self-made triangle turn pad for preventing postoperative pressure ulcers of intertrochanteric fracture in aged patients.Methods: 92 cases over 90-year-old patients with intertrochanteric fracture were selected and divided into the observation group and control group by using stochastic indicator. There were 46 patients in each group. The observation group used triangle turn pad to roll over and the control group used ordinary soft pillow to roll over. Through the comfort questionnaire and the incidence of pressure sores of postoperative patients after one week, the comfort of triangle turn pad and the effect of prevention of pressure ulcers were evaluated.Results: After analysis of three patients with comfort index (pain degree, safety, convenient degrees) and the incidence of pressure ulcers between the two groups, the differences were statistically significant (t=2.212, t=2.113,t=2.268;P<0.05). And there were significant differences in the incidence of pressure ulcers after operation (x2=2.476,P<0.05).Conclusion: Triangle turn pad can increase the comfort of patients after change posture, reduce the pressure of local stress, and it has important significance to prevent and improve pressure sores.

Objective To study the nursing strategy of the contralateral C 7 nerve transfer via ante-verte-bral transposition .Methods Clinical data of 30 cases patients with traumatic brachial plexus injury were retrospective analyzed .All patients were accepted contralateral C 7 nerve transfer to repair the injury via ante-vertebral canal .Strengthen psychological nursing before surgery ,and pay attention to body nursing , equipment protection and health guidance after surgery .Results Patients recovered well after surgery , the muscle strength was increased positively after 1 -2 years follow-up .Conclusion Contralateral C 7 nerve transfer via ante-vertebral transposition was effective to recover injured brachial plexus ,and the postoperative intensive care was the key step for an early recovery .

Objective:To evaluate the effect of refined service in extended military outpatient service for enhancement of military staff satisfactory. Methods: We made better consulting environment for 53800 military staff, built first class medical team, and provide satisfactory nursing service. Results: The satisfactory rate of consulting military staff had improved to100% monthly. Conclusion: After extension, our military outpatient service had all kinds of functions and put refined service into outpatient services. We improved the satisfactory rate of military service.

目的 探讨目测比色法配制高锰酸钾坐浴溶液在直肠肛管疾病患者术后中的应用和护理体会.方法 41例直肠肛管手术后患者应用目测比色法配制的0.02％(1∶5000)高锰酸钾溶液坐浴,观察手术创面及肛周皮肤、黏膜损伤情况.结果 41例直肠肛管术后患者使用由目测比色法配制的1∶5000浓度的高锰酸钾溶液坐浴,达到预期疗效,未发生皮肤溃破、黏膜损伤等不良反应.结论 目测比色法配制高锰酸钾坐浴溶液安全有效,操作便捷,易于推广.

2013年2月16日我院收治1例右下肢巨肢症患儿,总结其围手术期护理,现报道如下. 病例介绍 患儿,女,7岁,出生时发现右下肢较对侧大,以右足最为明显,随着年龄的增长,右下肢增大明显,跛行,并出现患侧肢体经常酸胀,右髋部不适.于2岁曾在北京积水潭医院行"右足缩容+右侧背阔肌游离移植术",4岁行"右臀部及大腿减容术+坐骨神经探查术",于5岁行"右小腿减容术+右足跖骨骨骺融合术",患儿右下肢仍臃肿,于2013年2月16日在我院门诊就诊,以"右下肢巨肢症"收入我科.并于2013年2月26日行右下肢减容术,术中发现股二头与股外侧肌之间的肌间隙中有较多的脂肪组织,取组织送病理检查发现为单纯性浸润性脂肪组织.

目的 介绍游离股薄肌移植重建屈肘屈指功能障碍的护理经验.方法 回顾分析15例臂丛神经损伤后屈肘屈指功能障碍患者的临床资料,采用游离股薄肌移植重建肢体功能,加强围手术期管理,注意肌皮瓣血液循环的观察、石膏护理及药物不良反应的观察.结果 肌皮瓣成活良好,经过1～2年的随访,15例患者屈肘屈指都有不同程度的恢复.结论 围手术期的精心护理,可以提高肌皮瓣的成活率,有助于术后屈肘屈指功能的恢复.

目的 探讨健侧颈7神经根经椎前路转位治疗婴儿臂丛神经损伤的术后护理方法.方法 回顾性分析总结收治的30例4～12个月臂丛神经损伤的婴儿,采用健侧颈7神经根经椎前路转位重建受损的臂丛神经,术后通过体位、饮食、肢体、支具、伤口敷料、预防并发症等各个环节的护理,并将对家属的健康宣教融入其中.结果 患儿术后恢复良好,30例患儿无一例出现严重护理并发症.结论 患儿年龄小,且表达能力差,严密观察患儿病情,积极与患儿家属沟通,可有效降低护理并发症。

目的介绍责任制护理工作记录单的设计及应用。方法采用表格式记录单简化责任制护理工作文书的书写,并向骨科护士发放调查问卷40份,回收40份,统计使用责任制护理工作记录单前后护理记录书写时间有无缩短。结果传统书面书写34份,书写护理记录时间>30 min;护理工作记录单40份,书写时护理记录时间<10 min,差异具有统计学意义(P≤0.01)。结论责任制护理工作记录单规范简洁,缩短了护理文书的书写时间,使护士有更多时间回归患者床旁。

目的探讨老年髋部骨折术后并发精神障碍的预防及护理的经验。方法回顾总结152例老年髋部骨折术后的临床资料,观察对老年髋部骨折术后采取心理护理及围手术期严密监测的效果。结果 152例患者,只有术后11例老年患者出现并发精神障碍,且经过我们细心护理,患者5~7 d症状消失,无后遗症状。结论加强对老年髋部骨折术后患者的心理护理及围手术期严密监测,减少术后并发精神障碍的概率。

目的 探讨做好宝石能谱CT冠状动脉造影检查的相关护理工作,对冠脉造影检查的影响.方法 对530例疑为冠心病且行宝石能谱CT冠状动脉造影检查的受检者,分别于检查前、检查中及检查后采用相应的护理措施,并对相关图像资料进行回顾性分析.结果 517例(97.5%)患者的图像能满足影像学评价.在2 120支冠状动脉分支中1级血管分支共1 340支(75.3%),满足诊断要求的血管分支共2 080支(98.1%).结论 规范、高效的护理能提高宝石能谱冠脉造影的图像质量,确保检查成功。

目的探讨老年髋部骨折术后褥疮的预防及护理经验。方法回顾总结第二炮兵总医院骨科160例老年髋部骨折患者的临床资料,观察对老年髋部骨折患者采取预防褥疮的综合性护理措施的效果。结果 160例老年患者入院术后未见褥疮发生。结论预防褥疮的综合性护理措施在临床护理中切实可行,效果值得肯定。

抢救护理记录是重要的法律依据,也是医疗事故技术鉴定最重要的基本材料.笔者设计了一种表格式抢救记录单,包括患者的一般信息、时间、用药、各项抢救措施和效果评估.护士只需在相应栏内填写数字、英文符号即可,与传统的纯手工记录相比,书写内容减少90%以上,使记录更为快捷、准确。

目的比较断肢再植术后应用半导体激光照射与否对患者康复的效果。方法随机抽取第二炮兵总医院骨科施行断肢再植手术的患者50例,分成试验组、对照组各25例。采用国产LHH-500IVB型半导体激光治疗仪局部外照射10 min,2次/d。临床疗效的观察指标为患肢的血循环、手术切口的愈合。结果试验组与对照组抽样的总体差异有统计学意义。结论断肢再植术后实施常规显微外科术后护理联合半导体激光照射患肢优于单纯实施常规显微外科术后护理。

<正>厌氧链球菌存在口腔、肠道和阴道里,不耐热(55~60℃下30min即可杀死),易被各种常用消毒药杀灭,在痰﹑渗出物及动物排泄物中可生存数周,在尘埃中无日光照射时可生存数日,当人体抵抗力下降或出现某种诱因时,极易被感染。我院骨科于2008年10月收治1例大腿厌氧链球菌感染性肌炎的患者,经精心护理和严格消毒隔离,

目的:总结10例老年膝关节置换术后并发静脉血栓患者的护理经验。方法:通过合理健康指导,定期观察肢体血运,使用溶栓药物,同时减少各种对静脉血栓的刺激源。结果:10例并发静脉血栓的患者经过溶栓和辅助治疗,无一例出现肺栓塞,全部治愈。结论:加强对静脉血栓患者的病情观察,尤其指肢体血运和呼吸循环情况,可以及早发现病情变化,防止栓子脱落,可以降低静脉血栓的危害性。

随着医学的发展,婴幼儿臂丛神经损伤手术的开展逐年增加,年龄及手术范围不断扩大,手术风险性也随之增多.由于臂丛神经损伤可引起肩关节外展及屈肘功能障碍,导致患儿上肢完全或不完全瘫痪,且不能完全恢复正常,严重影响个人的生活自理能力,给家庭及社会带来沉重的负担.能否使婴幼儿臂丛神经损伤手术顺利进行并取得满意手术结果,术前、术后护理配合发挥重要的作用。