The electric grinder or osteotome technology applied in the decompression operation of thoracolumbar side anterior approach generates high temperature and causes severe damage on patients' local tissue,in addition,it has great difficulty in operation and takes a long operation time.In view of this,this study researched a trepan for anterior decompression which is applicable to anterior lateral decompression operation.The trepan for decompression of thoracolumbar anterior approach was consisted of a trepan,a control handle and a positioning rod.Through repeated simulation experiments and 28 cases of clinical application,satisfactory results were received.This trepan had advantages of simple structure,easy manufacture and low cost;and can be disassembled and assembled,which was convenient for carrying and easy operation in practical application.It could effectively prevent damages on thoracic and lumbar spinal cord and nerves in surgery.It could not only be used in trauma surgery,orthopedic and spine surgery,but also suitable for surgery in tough field conditions like field battle and disaster relief.

尿毒症患者如果不进行肾移植,常需要血液透析或腹膜透析。血液透析患者需要血管穿刺进行透析,透析结束后又要严格谨慎地压迫止血,否则会导致所穿刺的动脉或造瘘后动脉化的静脉大出血危及生命。传统弹力绷带压迫止血,常会不同程度地阻碍远端动脉供血及向心静脉回流,因此每10~20 min需要拆开弹力绷带1~2 cm,每例血液透析患者要连续拆解3~4次,增加医护人员的工作强度,为患者和医护人员带来困扰,且没有防漏功能,吸附性能差,在所穿刺的动脉或造瘘后的动脉化的静脉导致的大出血时,现有的止血带不能很好地吸附血液且不能及时止血,导致血液从止血带一侧漏出,不能满足使用要求。

In view of the nonstandard unsealed delivery of excreta for clinical medical inspection, this paper designed a disposable sample collector, which mainly consisted of sampling barrels and sample containing barrels. The sampling barrel was equipped with plunger inside and connected with collecting handle. With its lower part sealed, the upper part of the sample containing barrel was connected with the sampling barrel so that the collector could be sealed after sampling and ensure the sealed status during its preservation and delivery for inspection. The practical clinical application demonstrated its convenience in calculation and measurement of excreta samples, accurate sample collection and safe delivery for medical inspection, which could effectively prevent nosocomial infections and deserved wider clinical promotion.

目的探讨心理应激、焦虑、抑郁对急进高原官兵睡眠质量的影响。方法采用匹兹堡睡眠质量指数量表、军人心理应激自评问卷、焦虑自评量表、抑郁自评量表对550名急进高原官兵进行调查。结果急进高原官兵睡眠质量总分及各因子得分均显著高于正常成人;睡眠紊乱显著高于失眠症患者,总分及其余各因子得分显著低于失眠症患者;除睡眠效率外,睡眠质量各因子均与心理应激、焦虑、抑郁呈显著正相关;心理应激对睡眠质量总分、主观睡眠质量、入睡时间、睡眠时间、睡眠障碍有显著正向预测作用;焦虑对催眠药物、日间功能障碍有显著地正向预测作用;抑郁对睡眠质量总分、主观睡眠质量、睡眠障碍有显著地正向预测作用。结论急进高原官兵睡眠质量不佳,降低心理应激水平、减少焦虑、抑郁发生是提升其睡眠质量的有效途径。

我院子2013年02月引入医疗机构评审联合委员会国际部(joint commission in-temational,JCI)评审标准,将其理念和方法引入到医院护理管理工作中,建立相应的政策、制度和工作流程,实现了护理管理工作质量的提高.

目的：观察针刀结合整脊手法对部队汽车驾驶员腰骶部疼痛的治疗效果。方法：通过针刀对106例部队汽车驾驶员腰骶部疼痛患者采用针刀剥离粘连、松解挛缩、疏通堵塞，切开疤痕，腰椎整脊手法恢复椎小关节序列，达到满意疗效。结果：治愈89例，有效11例，无效6例。结论：针刀结合整脊手法治疗汽车驾驶员腰骶部疼痛疗效较好。

我院于2010年起,将品管圈(quality control circle,QCC)的工作方法运用于各级护理人员,结果2011年度共组圈16个,护理人员培训参与率为99％,直接参与率为85％；护理人员对品管圈活动的知晓率为98％；品管圈活动项目共完成16项,目标达标率15项,成果临床应用率10项,项目检讨合格率11项.提高了工作效率,改善护理质量,收到满意效果.

目的:以建设《全军泌尿外科护理示范基地》为龙头,促进军队医院优质护理服务工程的实践和全面建设,培养高素质的护士队伍.方法:贯彻卫生部“优质护理服务示范工程”,建立完善和实践专科示范基地的支持系统、培训机制.结果:两年来向全军培训输送34名专家型专科护士,促进了医院护理技术特色形成,全员优质护理服务水平提升,效果显著.结论:专科护理示范基地的建设,是全面开展“优质护理服务示范工程”有效的、以点带面的,节约、共享护理资源的途径.

目的：探讨分析面对面授课、电话交谈及自学干预模式在轻度认知障碍患者中的应用效果。方法选取196例轻度认知障碍患者，将所有患者随机分为试验组与对照组，两组均为98例。对照组采用自学的模式，试验组在对照组的基础上增加面对面授课与电话交谈，比较两组的干预效果。结果经过干预，试验组长时记忆、短时记忆、数字记忆及语言记忆的评分要明显优于对照组（P＜0.05），且数字快速拷贝、汉字快速比较的能力及心算答案回忆的评分与等级均明显优于对照组（P＜0.05）。干预3周及6周后，试验组MoCA得分要明显优于对照组（ P＜0.05）。结论面对面授课、电话交谈及自学干预模式能够有效改善MCI患者的认知功能，值得推广。

目的：分析高原地区不同层次医院护理人员对灾害救护培训内容的共性及个性需求。方法采用高原地区护理人员灾害救护知识需求调查表调查甘肃省、青海省各级医院304名护理人员，使用 Ridit分析法分析结果。结果在共性知识需求中，重要的有11项，不重要的有2项。个性需求：一级医院对培训内容的需求主要集中在急救护理能力与高原护理能力的相关知识；二级医院为高原护理能力与灾后护理能力的相关知识；三级医院为灾后护理能力的相关知识。结论高原地区三个级别医院的护理人员对灾害救护培训内容既有共性需要，又各有侧重，运用Ridit分析法可予以区分，据此开展培训，可提高培训效果。

目的 探讨模拟机动车船动态条件下护士静脉输液训练效果.方法 对30名护士进行机动车船模拟训练,包括能力素质评估、适应性训练、动作分解训练和动作合成训练4个阶段,并与传统训练方法进行比较.结果 护士静脉输液操作成绩和满意度均高于对照组(P＜0.01或P＜0.05).结论 模拟战时和突发应急事件环境组织训练,提高了护士综合素质和应对突发事件的能力.

随着我国急救系统建设的日趋规范,如何提高伤员的抢救成功率,已成为当前紧急救护中共同关注的热点问题.军队医院不仅承担军地医疗服务的任务,同时还肩负着应对平时、战时及突发性灾害事件卫勤保障的重要职责.我院地处1517 m高海拔地区,大气氧分压比平原下降20 mmHg(1 mmHg=0.133 kPa)以上.由于其独特的自然地理情况和缺氧环境,人体会发生一系列病理生理改变.在此基础上如发生急危重症及严重创伤,机体所产生的病理反应和临床表现往往更加严重[1].2010年1月7日兰州石化分公司发生316号罐区爆炸,在此突发事件批量伤员救治中,我院采取平战结合方式,应用军事医学发展中的理论与实践[2],快速启动护理应急分队及外勤中心为一体的院内救护路径,保证了伤员得到及时有效的救治,现将体会报道如下.

目的：探讨针刀、针灸配合治疗过敏性鼻炎疗效。方法：将患者随机分成两组，对照组给予西医常规治疗，治疗组采用针刀、针灸配合治疗。结果：治疗组疗效优于对照组，差异显著P<0.05。结论：针刀、针灸配合治疗过敏性鼻炎有较好疗效。

目的探讨警示护理对预防骨科卧床患者发生压疮的效果。方法应用Braden"压疮危险评估表"对2011年两家医院骨科收治的2 380名卧床患者进行评估,其中轻度压疮危险892例,中度压疮危险602例,高度压疮危险221例,实施压疮警示护理,提醒护士根据不同颜色床头牌进行分级护理,执行不同警示级别预防压疮护理预案,统计压疮发生率并与2009年数据相比较。结果两组数据比较,患者压疮发生率差异有显著性(P<0.01),表明实施警示护理后患者临床压疮的发生率显著降低。结论对存有压疮危险因素的患者,若及时启动警示护理,给予监控、干预,可降低压疮的发生率,减轻患者痛苦,节省医疗护理资源和费用。

Objective To investigate the clinical application of quality control path in the alpine region emergency pre-hospital transport,and to evaluate the clinical effect.Methods Totally 278 patients for hair emergencies in high altitude alpine region from July 2008 to September 2012,were divided into observation group and the control group.The observation group patients were given with quality control and the control group patients were given for routine care.The speed,first aid,the success rate of the visits,satisfaction,and the error rate of the two groups were compared.Results The patients on-scene time in observation group was (15 ± 4)min and the control group was (25 ± 5) min.The observation group visits was faster (P ＜ 0.05) ; Emergency success rate of the observation group was 84.9％ (118/139),the first aid success rate of the control group was 62.5％ (87/139),the first aid success rate of the observation group was higher than that in control group (P ＜ 0.05).Satisfaction of the observation group[92.1％ (128/139)] was higher than that of control group[72.6％ (101/139)] (P＜0.05) ; The error rate of the observation group[8.6％ (12/139)] were lower than those in the control group[25.2％ (35/139)]between the two groups,the difference was statistically significant (P ＜ 0.05).Conclusion Quality control paths in high altitude alpine region emergency pre-hospital emergency transport in the application effect can improve the efficacy in patients with first-aid efficiency.

Objective To investigate the application effect of care organization and management in critically ill pa tients with pre-hospital emergency transport in high altitude alpine region.Methods 145 cases of critically ill patients transferred to our hospital from June 2008 to May 2010 were taken as the control group,133 cases of critically ill pa tients transferred to our hospital from June 2010 to May 2012 were taken as the observation group.The control group underwent conventional hospital care before transporter.The observation group implemented a complete care organiza tion and management on the basis of the usual care measures of control group.The rate of emergency transport acci dent,mortality rate and complaint rate were compared,and the effect of care was evaluated in our hospital.Results The rate of emergency transport accident,mortality rate and complaint rate in observation group were 9.0%,0.8% and 5.3%,respectively,lower than 33.1%,7.6%,17.9% of the control group,the comparison between the two groups were statistically significant(χ2=17.360,5.701,8.303,P0.05).Conclusion Intensive care of organization and management,to enhance the professional skills of the visiting nurse,strain the capacity of the emergency response capacity and processing risk,can improve security of pre-hospital emergency transport for critically ill patients in plateau alpine region.

<正>面神经麻痹病因尚不明确,中医称为"吊线风"或"口角斜",严重影响患者形象,并带来心理问题。现代医学认为可能是与局部组织的神经、血管供养不良,受风寒而发生痉挛有关,可导致该区域神经组织缺血、缺氧、水肿或受压而致病。针刀医学认为本病是由电生理系统的线路发生了故障,局部电流量增强或改变所

目的:分析并评价安排专人护理在提高肠造口患者自我护理能力方面的应用效果。方法:将我院2010年2月～2012年4月收治的64例开展肠造口术的患者随机分成试验组和对照组各32例。试验组患者入院后实施各项检查,由1名高年资的护理人员专职负责健康教育和造口术护理任务;对照组患者未安排固定的专职护士负责,而是安排当班护士给予护理,在手术前后的护理以及出院随访工作均与试验组相同。比较两组患者在理解并掌握造口相关知识、造口袋粘贴与更换技术所需时间以及造口四周皮肤并发症发生率方面的差异。结果:试验组患者在理解并掌握造口相关知识方面高于对照组、掌握造口袋粘贴与更换所需时间方面短于对照组,造口四周皮肤并发症发生率低于对照组,两组比较均有统计学意义(P<0.05)。结论:开展专人护理能够显著提高肠造口患者的自我护理能力,降低肠造口与四周皮肤发生并发症的几率,显著增强患者的生活质量。

目的观察针刀对膝关节内侧副韧带损伤的治疗效果,提高新兵冬训率。方法通过针刀对53例冬训新兵膝关节内侧副韧带损伤患者采用针刀剥离粘连、松解挛缩、疏通堵塞,达到满意疗效。结果治愈41例,有效8例,无效4例。结论针刀治疗新兵膝关节内侧副韧带损伤有疗效较好。

目的观察针刀治疗偏头痛的临床疗效。方法 67例患者采用针刀疏通经络堵塞、剥离松解挛缩粘连,恢复颈部的生理平衡。结果痊愈54例,好转11例,无效2例,总有效率97.01%。结论针刀治疗偏头痛有较好疗效。