本文分析超声引导下肌间沟臂丛神经阻滞联合颈浅丛神经阻滞与传统一针法肌间沟臂丛神经阻滞联合颈浅丛神经阻滞在锁骨骨折手术中的麻醉效果差异.收集拟接受手术治疗的锁骨骨折患儿104例,采用前瞻性随机试验方案,将104例锁骨骨折患儿分为超声组和传统组,每组52例患儿,对比两组神经阻滞效果、麻醉效果、平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO2)的动态波动变化情况、肌力参数及两种麻醉方式引起的不良反应情况.感觉、运动阻滞起效时间对比分析,超声组均短于传统组,而镇痛及运动阻滞维持时间均长于传统组(P＜0.05);超声引导下的肌间沟臂丛神经阻滞联合颈浅丛神经阻滞具有更好的神经阻滞效果(P＜0.05);超声组患儿术后2 h、6 h、12 h屈肘关节的肌力评价高于传统组(P＜0.05);术后并发症率比较,超声组低于传统组(P＜0.05).超声引导下肌间沟臂丛神经阻滞联合颈浅丛神经阻滞较传统一针法肌间沟臂丛神经阻滞联合颈浅丛神经阻滞能更准确地进行操作,缩短操作时间,麻醉效果更好,对患儿肌力恢复影响更小,麻醉并发症率更低.

目的 探讨宫颈上皮内瘤变患者术后高危型人乳头瘤病毒(HR-HPV)持续感染的影响因素.方法 选取2018年1月-2019年12月华中科技大学同济医学院附属武汉儿童医院260例宫颈上皮内瘤变(CIN)合并HR-HPV感染患者,所有患者均行宫颈环形电切术(LEEP)治疗,并于手术后1年通过门诊复查的方式,进行HR-HPV复查,观察患者HR-HPV持续感染情况,并分析持续感染的影响因素.结果 术后1年发生HR-HPV持续感染31例,发生率为11.92％(31/260),多重感染转阴率为71.79％(28/39)低于单一感染90.95％(201/221),HPV16感染转阴率为69.33％(52/75)低于其他型别95.68％(177/185)(P<0.05);术前HR-HPV负荷量为1～10 RLU/CO、10～100 RLU/CO、100～300 RLU/CO患者,术后1年HR-HPV持续感染发生率低于负荷量300～500 RLU/CO、>500 RLU/CO患者(P<0.05);术前HR-HPV负荷量对术后1年HR-HPV持续感染预测受试者工作特征(ROC)曲线分析结果显示,当以341 RLU/CO作为截点值时,ROC曲线下面积为0.747,敏感度80.00％、特异性70.00％;术前HR-HPV多重感染、术前HR-HPV16感染、术前病毒载量是患者术后1年HR-HPV持续感染发生的影响因素(P<0.05).结论 LEEP对宫颈HR-HPV清除有一定作用,持续性HR-HPV的发生与单一或多重感染、感染型别、病毒载量有关.

BACKGROUND Breast cancer is the most common malignant tumor affecting women worldwide. Surgery is the main treatment for breast cancer and can obtain a good curative effect. However, it can also entail trauma and stress for patients, leaving them susceptible to negative emotions, poor sleep quality, and various postoperative complications, which can affect the treatment effect and prognosis. Therefore, it is of great significance to explore scientific and effective nursing methods for patients with breast cancer. This study aimed to examine the application effect of whole-process nursing and mind mapping in patients with breast cancer. METHODS The present study enrolled 256 patients with breast cancer who were admitted to the hospital from March 2019 to October 2020. The study participants were divided into a control group (routine nursing intervention) and an observation group (nursing intervention including a whole-process escort playing a relative role combined with mind mapping) according to the random number table method, with 128 cases in each group. At admission and before surgery, the psychological status [Hamilton anxiety scale (HAMA) and Hamilton depression scale (HAMD)], physiological stress [cortisol (Cs) and adrenocorticotrophic hormone (ACTH)], fatigue degree (Piper fatigue scale), and sleep quality [Pittsburgh sleep quality index (PSQI)] were compared between the two groups, and the incidence of complications in the two groups was also compared. RESULTS The psychological status (HAMA and HAMD) scores, physiological stress levels (Cs and ACTH), fatigue degree (Piper fatigue scale), and sleep quality (PSQI) score were all significantly higher before surgery than at admission in both groups, and were significantly lower in the observation group than in the control group (P<0.05). There were no significant differences in the incidence of complications between the two groups (P>0.05). CONCLUSIONS Nursing intervention using a whole-process escort playing a relative role combined with mind mapping can effectively relieve the anxiety and depression felt by patients undergoing breast cancer surgery, and can reduce their physiological stress and fatigue degree, as well as improve their sleep quality. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2100054024.

目的:探讨右美托咪定(Dex)对患儿七氟醚全麻苏醒期躁动和术后不良反应的影响.方法:选取2017年9月～2019年8月期间在武汉儿童医院接受择期手术的84例患儿,年龄2～7岁,美国麻醉医师协会(ASA)I～Ⅱ级.采用简单随机分组法分为Dex组和对照组,每组各42例.Dex组患儿气管插管后首先静脉注射Dex 1μg/kg负荷量,然后以0.2～0.4μg/kg·h的速率持续泵入Dex,对照组气管插管后静脉输注等容量生理盐水,均在10 min内注完.患儿术中吸入2％～4％七氟醚维持麻醉,监测并保持脑电双频指数(BIS)值40～60,心率(HR)和平均动脉压(MAP)变化幅度在基础值的±20％内,酌情调整七氟醚吸入浓度,术毕停止给药送至麻醉苏醒室(PACU).观察两组患儿麻醉诱导后(T0)、术毕(T1)、拔管即刻(T2)、拔管5 min后(T3)和拔管后10 min(T4)时点HR和MAP水平,记录两组患儿拔管时间、苏醒时间、全麻苏醒期躁动量表(PAED)评分、苏醒期躁动(EA)和恶心呕吐发生情况.结果:对照组T2～T4时点HR、MAP均明显高于T0时点,Dex组T1～T4时点HR、MAP波动比较稳定,与T0时点比较差异均无统计学意义,Dex组T2～T4时点HR、MAP均明显低于对照组,差异有统计学意义.两组患儿拔管时间和拔管时间比较均无显著差异,Dex组全麻苏醒期PAED评分显著低于对照组,差异有统计学意义;Dex组EA发生率4.76％显著低于对照组19.05％,差异有统计学意义;两组术后仅出现恶心、呕吐和呼吸抑制等不良反应,症状均较轻,组间不良反应率比较无显著差异.结论:气管插管后给予Dex能有效稳定患儿血流动力学,不延长拔管和苏醒时间,能显著降低患儿七氟醚吸入全麻苏醒期EA发生率,术后不良反应少,值得临床推广应用.

目的 探究手术室细节护理在确保手术室护理安全中的应用效果.方法 现选取2018年1月-2018年12月在本院进行手术治疗的80例患者作为本次对照研究的对象,按照抽签的结果将患者分成对照组和实验组,每组各40例.对照组在本次调查中采用了常规护理方式,实验组采用了细节护理方式.观察对照组和实验组护理效果.结果 实验组护理满意率明显高于对照组,护理安全评分高于对照组,经对比两组之间差异显著(P<0.05).结论 在手术室护理中,可采取细节护理方式,护理效果显著,此方式值得临床应用和推广.

The prevalence of child and adolescent growth and mental-behavior related diseases are increasing, and the pathogenesis are complex. Twins are excellent natural resources for complex chronic diseases research as they share the maternal intrauterine environment, born at the same time and share the same family environment in early years, which could benefit the adjust ment of confounding factors, such as age, genetic factors and early family environmental factors. Birth cohort with twin families involved could be more effective in exploring the genetic and environmental factors for complex chronic diseases at the very beginning of life. This paper summarizes the objective, content, progress, strengths and potential problems of Wuhan Twin Birth Cohort, with emphasis on the overall design and progress of the study.

目的 观察全程护理对腹腔镜先天性胆总管囊肿患儿手术后康复的影响.方法 选取2014年8月~2015年8月我院收治的先天性胆总管囊肿患儿100例作为研究对象,将其分为观察组合对照组,各50例.观察组实施全程护理,对照组实施常规护理,然后对两组患儿实施汉密尔顿焦虑量表和汉密尔顿抑郁量表负性情绪进行有效的评估与分析.观察所有患儿术后的康复情况,测量患儿干预前后的心率及血压.结果 对照组患儿的HAMA、HAMD评分显著高于观察组,差异有统计学意义(P<0.05).结论 对先天性胆总管囊肿患儿实施全程护理,这样可以对患儿的心理应激反应和负面情绪都有一定的改善作用,从而有效促进患儿的康复,所以值得在临床上进行广泛推广.

OBJECTIVE To study the causes and control of excessive planktonic bacteria in the air of laminar flow operation room so as to reduce infection rates .METHODS A total of 100 consecutive operation of laminar flow op‐eration from Jul .2012 to Jul .2014 were detected .Multi‐point sampling in different time period in operation rooms was conducted by planktonic bacteria sampler and dust particle calculating instrument in different areas ,including the operation area and non operation area (peripheral regions) .The planktonic bacteria and dust particle were counted and the causes for excessive planktonic bacteria and dust particle were analyzed to come up with some measures .RESULTS Before surgeries ,numbers of planktonic bacteria and dust particles in laminar flow operation room met the standards .But w hen the operation began ,numbers of planktonic bacteria and dust particle increased rapidly and reached the maximum at the end of the surgery .After that ,the numbers started to reduce and 30 mi‐nutes later regained to the standard .The difference had significance (P<0 .05) .CONCLUSION In the operation room ,the causes for excessive number of dust particles and planktonic bacteria are dynamic operation ,personnel walking ,and surgery operations .The key point to keep a clean operation room is to disinfect strictly and take pre‐ventive measures .

目的:探讨瑞芬太尼主导多维模式分娩镇痛对新生儿Apgar评分的影响及镇痛效果.方法:该院2012年6月～2013年6月共150例符合条件的足月产待产孕妇,将150例孕妇分为单一镇痛组、多维镇痛组和对照组,单一镇痛组孕妇给予瑞芬太尼自控式静脉用药,多维镇痛组给予瑞芬太尼、音乐疗法、经皮神经穴位电刺激疗法联合镇痛,对照组不给予分娩镇痛.比较3组孕妇分娩过程中的疼痛等级、各产程持续时间、对镇痛效果的满意度以及新生儿的Apgar评分.结果:多维镇痛组疼痛等级与单一镇痛组间无统计学差异(P＞0.05),但镇痛效果均显著优于对照组(P＜0.05).多维镇痛组第一产程持续时间显著低于单一镇痛组和对照组(P＜0.05),第二、第三产程持续时间3组产妇间无统计学差异(P＞0.05);多维镇痛组对镇痛的满意度显著高于单一镇痛组(P＜0.05);单一镇痛组1 min、5min新生儿Apgar评分分别为(9.89±0.65)分、(9.85±0.59)分,多维镇痛组分别为(9.83 ±0.58)分、(9.93±0.61)分,对照组分别为(9.86±0.66)分、(9.89±0.57)分,3组新生儿1 min、5 min新生儿Apgar评分无统计学差异(P＞0.05).结论:在瑞芬太尼自控式分娩镇痛的基础上,给予音乐疗法、经皮神经穴位电刺激疗法等多维镇痛,尽管不能降低产妇的疼痛等级,提高新生儿Apgar评分,但能够有效缩短第一产程持续时间,并提高产妇对于分娩镇痛的满意度.

OBJECTIVE To compare the effects of the air purification and disinfection methods in operating rooms and choose the optimal one so as to effectively reduce the infection rate .METHODS A total of 3 000 patients who underwent surgeries in different operating rooms from Jan 2012 to Dec 2014 were enrolled in the study ,then the epidemiological characteristics and incidence of infections were investigated , the participants were divided into three groups according to the way of disinfection :the laminar flow group ,the air purification machine group ,and the simple ultraviolet disinfection group ,with 1 000 cases in each .RESULTS The incidence of infections was the lowest in the laminar flow group (0 .9% ) ,followed by the air purification disinfection machine group (3 .4% ) and the ultraviolet disinfection group (9 .5% ) ,and the difference was significant (P< 0 .05) .The incidence of the typeⅡ incision infections was the lowest (0) in the laminar flow group ,the highest (6 .3% ) in the ultraviolet disinfec‐tion group ;the incidence of the type Ⅲ incision infections was the lowest (5 .4% ) in the laminar flow group ,the highest (6 .1% ) in the ultraviolet disinfection group .In case of the control of a variety of factors ,the disinfection and purification of operating rooms remain the independent influencing factors .CONCLUSION The use of air purifi‐cation machine for disinfection of laminar flow operating rooms is an ideal way of air purification and disinfection of operating rooms ,and it can effectively reduce the incidence of surgical site infections .

目的:探讨产程体位改变对矫正产妇后位胎位不正的临床效果.方法:回顾性分析1 800例自然分娩产妇的临床资料,其中经内诊检查及B超诊断证实为枕后位胎位不正的初产妇128例,随机将患者分为观察组及对照组,每组各64例.观察组孕妇在分娩过程中取侧卧位,并利用羊水浮力、胎儿重力、子宫间隙收缩力等合力的相关作用改变胎头娩出的位置,使得胎头下降时从枕后位转为枕前位,而对照组孕妇不进行体位指导,任意让孕妇卧床或行动,对比分析两组孕妇阴道试产成功率、自然分娩产程、妊娠并发症、新生儿阿氏评分、新生儿死亡率、产中出血量、产后出血量等方面的差异.结果:观察组自然分娩成功率显著高于对照组,而剖宫产率、产钳助产率、宫缩乏力、软产道裂伤率高、发生率显著低于对照组,差异有统计学意义(P＜0.05).观察组潜伏期产程、活跃期加速阶段产程、第二产程以及总产程显著低于对照组,差异有统计学意义(P＜0.05).观察组枕位胎头先露下降速度在潜伏期、加速期、急速下降期显著快于对照组,差异有统计学意义(P＜0.05).对照组新生儿阿氏评分较低、产伤率较高、宫内窒息率高、产中、产后出血量较大,差异有统计学意义(P＜0.05).结论:枕后位胎位不正是引起产妇胎位不正的重要因素,分娩过程中通过改变产妇体位对提高母婴分娩安全具有重要的作用.

常规手术床所配备的截石位固定装置一般都是出厂标准成人型配置.婴幼儿肢体短小,柔软,不可过度牵拉,也不方便固定.本文介绍了一种婴幼儿截石住手术腿部固定保暖垫,配合使用手术床标准头架,应用于实施截石位手术的婴幼儿,舒适、保暖,使用方便,在术中还可以随时观察婴幼儿末梢循环.

<正>婴幼儿由于体温调节中枢系统发育不完善,从而不能如成人一般通过自身调节来维持正常的体温以进行正常生理代谢。手术室环境温度以及手术中消毒、暴露都对于体表面积相对较大、缺乏皮下脂肪、易受周围环境影响的婴幼儿来说,加速了体表的热量散失。我们自行设计了一种保暖胸衣,尽可能保障机体正常生理功能的调节,效果满意,现介绍如下。1材料与方法将棉布做成像有衣袖的棉衣前面部分,长20cm,宽

多关节挛缩症(arthrogryposis multiplex congenita,AMC)是一种病因不明的先天性疾病,因肌肉关节囊及韧带纤维化引起以全身多个关节僵直为特征的综合征[1].主要临床特征为出生后四肢关节呈多发性、对称性、非进行性的屈曲或伸直畸形,下肢关节畸形多见,可合并关节脱位,并可合并全身其他系统的先天畸形.此类患者极其罕见,尤其是先天性多关节挛缩症患儿,国内外文献鲜有报道.如何为多关节挛缩症患儿进行急诊手术,给麻醉和护理带来诸多难题和潜在风险.2012年1月10日我科为1例多关节挛缩症患儿成功实施右嵌顿疝急诊手术,现报道如下。

将手术患者标识、环境标识、药品标识、可移动标识应用到手术室的日常工作的各个环节,极大地降低了护理风险的发生,手术室自应用护理标识后,无1例差错事故发生。护理标识可以将手术室的安全隐患消灭在萌芽状态,提高护理人员对风险识别和防范能力,确保了手术室的医疗工作高效、安全地完成。

目的 探讨先天性肛门闭锁患儿手术期低体温的发生原因及有效的预防护理措施,提高患儿的护理质量.方法 综合分析先天性肛门闭锁患儿手术期发生低体温的影响因素,针对性给予预防护理措施,将60例手术病例分为常规组及保温组,采用机体局部保暖供热、输注加温液体等措施进行护理干预,观察两组术前、术中、术后的生命体征、尿量变化及术后麻醉清醒恢复情况.结果 与保温组相比,常规组新生儿术后清醒延迟,发生并发症及住院天数等明显高于保温组.结论 术中低体温使术后潜在并发症的发生机会增加,术中局部保暖、输注加温液体等预防先天性肛门闭锁患儿手术期低体温的护理措施可行、有效.

目的探讨先天性婴幼儿延迟性黄疸的患儿在腹腔镜辅助下行胆道造影手术配合。方法对8例婴幼儿延迟性黄疸行腹腔镜辅助胆道造影的手术进行回顾性分析,讨论手术配合的要点、方法及体会。结果患儿手术均顺利,术后无大出血及其他并发症发生。结论护士术前访视评估患儿情况,熟悉手术方式,能缩短手术时间,保证手术顺利进行,术中做好患儿的保暖及受压部位的保护工作能提高手术的成功率。

由于新生儿合作能力差,手术时体位的固定极为重要.患儿在全麻状态下,意识全部丧失,肌肉强力减弱.保护性反射作用已大部消失,失去自卫调节能力.因此,改变体位后可导致呼吸循环等生理功能的相应改变,由于身体的负重和支点的改变也可以造成神经血管、韧带和肌肉等软组织的损伤.

在剖宫产手术中运用人性化护理,使产妇以良好心理状态接受手术。"以人为本"的个性化护理在剖宫产手术中发挥了积极的作用,提高了手术患者的满意度,减少了由于不良心理状态所致的手术并发症的发生。

目的探讨术中使用电子输液加热器联合小棉被保温对先天性巨结肠患儿生命体征的影响。方法将60例患儿随机分为观察组和对照组各30例。对照组按常规采用空气加温器使手术室温度保持26~28℃;观察组在此基础上,采用电子输液加热器将静脉滴注液体加热至32~35℃进行输液,同时用小棉被为患儿肢体及胸部保暖。观察并记录两组术中体温、心率、血压变化。结果观察组术中体温、心率、血压均保持正常范围,与对照组比较,差异有显著性意义(均P<0.01)。结论采用电子加热器联合小棉被保温法可维持患儿术中生命体征正常。