目的 探讨腰椎术后以护士为主导的骨科康复一体化模式的康复效果.方法 选择235例诊断为腰椎退行性变,行单节段腰椎后路植骨融合内固定术的患者,按住院先后顺序分为对照组118例和观察组117例,对照组实施传统康复模式,观察组实施以护士为主导的骨科康复一体化模式,于手术前和手术后7d、1个月、3个月、6个月采用Oswestry功能障碍指数(ODI)和腰椎日本骨科学会(JOA)评分评估腰椎功能,数字疼痛评分法(NRS)评估疼痛程度.结果 2组患者术前及术后7d的NRS评分、JOA评分、ODI评分无统计学差异(P＞0.05);观察组患者术后1、3、6个月NRS评分、ODI评分显著低于对照组(P＜0.05),术后3、6个月JOA评分改善率显著高于对照组(P＜0.05).结论 以护士为主导的骨科康复一体化模式可以缓解腰椎管减压植骨融合内固定术患者的术后疼痛,提高腰椎功能改善率.

目的 探讨老年骨质疏松性椎体压缩性骨折术后使用唑来膦酸患者的预见性护理.方法 对2014年8月～2015年12月172例符合条件的骨质疏松性椎体压缩性骨折术后采用静脉注射唑来膦酸治疗的患者为研究对象,利用随机数字表法进行分组,分别设为实验组和对照组,每组86例.对照组给予常规护理,实验组则实施预见性护理,比较两组患者的药物不良反应、再次用药依从性、护理满意度.结果 实验组患者的药物不良反应明显低于对照组(P＜0.05),再次用药依从性、护理满意度明显高于对照组(P＜0.05).结论 实施预见性护理措施可减轻患者疼痛、减少药物不良反应,提高再次用药依从性和患者满意度,有效预防再骨折的发生.

[目的]探讨集束化护理在预防重症监护室（IC U ）病人失禁性相关性皮炎中的应用效果。[方法]选取入住综合IC U时间＞48 h、每天排便≥4次的病人202例按随机数字表法将病人分为观察组和对照组各101例。观察组采用集束化护理方法，对照组采用硼酸湿敷和锌氧油外涂保护皮肤的护理方法，比较两组失禁性相关性皮炎发生率和愈合时间。[结果]观察组失禁性相关性皮炎发生率和愈合时间均低于对照组，差异有统计学意义（P＜0．05）。[结论]应用集束化护理可有效降低ICU病人失禁性相关性皮炎的发生率，缩短愈合时间。

[目的]探讨医用降温贴对重症病人发生压疮的影响，研究医用降温贴对重症病人压疮的预防作用及其机制。[方法]选择我院重症监护病房收治病人200例，随机分为观察组和对照组各100例。对照组采用常规预防压疮的护理方法，观察组在传统预防压疮的基础上，于皮肤受压处应用医用降温贴。比较两组病人体温、骶尾部皮肤温度及骶尾部压疮发生率。[结果]应用降温贴后，观察组骶尾部温度较对照组下降明显(P <0.01)，且骶尾部压疮发生率低于对照组(P <0.05)。[结论]应用医用降温贴配合常规预防压疮的护理操作可明显降低重症病人压疮的发生。

循证护理是指护理人员在计划其护理活动中审慎的、明确的、明智的应用科学证据，并使之与熟练的临床知识与经验相结合，同时参照患者愿望作出的符合患者需求的最佳护理决策过程[1]。

Objective To investigate the validity of wireless temperature monitoring and location tracking sensor used on patients in ICU. Methods Totally,180 patients in ICU were selected by random.All the patients were taken as self controls: their body temperature was taken by temperature monitoring and location tracking sensor and by mercury thermometer simultaneously.Then the temperature results were compared.We also recorded the nursing time of two temperature measuring methods.Results There were no statistical differences in temperature readings taken at any time points,nor in temperature readings of patients of varied ages,between the two methods(P>0.05 for all).The time needed to take patients′ body temperature had statistical difference between the two methods(P<0.01). Conclusion The use of sensor to measure patients′ body temperature is accurate and safe;it improves the quality of care,saves nursing time and improves work efficiency.

目的 探讨慢性阻塞性肺病(COPD)合并呼吸衰竭(RF)患者应用呼吸机成功撤机的最佳时机、方式及护理,提高撤机成功率.方法 回顾性分析48例COPD合并RF机械通气患者的临床资料,评估其全身情况和呼吸功能,在撤机前后,注意病情观察、呼吸道护理及心理护理,配合营养支持,采用过渡撤机和间断撤机2种撤机方式.结果 48例患者全部撤机成功,其中过渡撤机36例,间断撤机12例.结论 撤机时机和方式的掌握是成功撤机的关键,精心护理是成功撤机的保障.

目的 探讨采用集束化护理预防ICU患者肛周湿疹的发生及促进肛周皮肤恢复的效果.方法 将304例每天排便≥4次的患者根据随机数字表法随机分为观察组和对照组各152例.观察组采用集束化预防护理方法,对照组采用复方锌氧油外涂保护肛周皮肤的护理方法.比较两组肛周湿疹发生率、发生的程度及愈合时间.结果 观察组和对照组的肛周湿疹发生率分别为6.41％,20.39％,观察组Ⅰ度、Ⅱ度、Ⅲ度肛周湿疹分别为10,0,0例,对照组分别为12,10,9例,两组比较差异有统计学意义(Z=7.66,P=0.02).观察组肛周湿疹愈合时间为(1.20±0.13)d,对照组为(5.90 ±0.47)d,两组比较差异有统计学意义(t=35.97,P=0.00).结论 集束化护理可有效预防和促进ICU患者肛周湿疹的皮肤恢复,保护患者肛周皮肤完整,值得在临床推广。

<正>循证护理是一种以有价值的、可信的科学研究成果为依据,提出问题,寻找实证,用实证对患者实施的最佳护理方法[1]。2009年1月-2010年6月,我院骨科对15例寰枢椎旋转半脱位行枕颌带牵引的患儿实施了循证护理,收到良好

<正>百草枯作为农药中的高效除草剂,因其与土壤接触后较快失去活性,无残留且不污染环境,现已成为世界上使用最为广泛的除草剂之一,但其毒性较大,无特效解毒剂,中毒后死亡率极高。[1]我院2010年1月15日收治一名百草枯中毒患者,入院后经积极洗胃,运用血必净联合血液灌流治疗后痊愈出院。现将护理体会报告如下。

目的 探讨ICU标准化护理床旁交接班考评系统临床应用.方法 采用ICU实施标准化护理床旁交接班考评系统,分别收集传统的床旁交接班模式(观察组)与标准化床旁交接班模式(实验组)下护理质量考评结果,并进行对比分析.结果 观察组记录286次(286个床单元),交接班质量不符合规范要求253项,存在241项护理安全隐患.实验组记录288次(288个床单元,交接班质量不符合规范要求84项,存在安全隐患18项,两组对照比较,差异有统计学意义(P<0.05).结论 ICU护士实施标准化护理床旁交接班考评系统明显提高了床旁交接班的质量,减少了护理安全隐患.

呼吸机可以人为地产生呼吸动作,满足人体呼吸功能的需要,广泛应用于麻醉、术后支持及各种原因导致的呼吸衰竭中[1].在ICU应用呼吸机的患者,因无法用语言进行交流,往往感觉痛苦,具有恐惧、孤独等心理障碍[2-4], 对呼吸机的耐受性较差,影响患者术后康复.2008年1月～2008年12月对50例术后使用呼吸机的患者进行心理干预,取得较好的效果,现报告如下.

Objective To investigate the impact of psychological features on the postoperative complications, nursing-time and costs during the intensive care unit (ICU) in children with congenital heart disease (CHD), and to provide scientific evidence for improving the nursing in these patients. Methods 182 children with CHD were divided into the rejection group and the cooperation group based on their psychological evaluation before the operation. Then the postoperative complications, nursing-time and costs during ICU were compared. Results In the rejection group, the postoperative complications (40.6%), nursing-time (26.1± 16.9 h) and costs (4 569.0±4 825.8 Yuan) during ICU were significantly higher than those in the cooperation group (P<0.05). Conclusions The psychological features in children with CHD have a strong impact on the postoperative rehabilitation and health economics. It's necessary to do a psychological evaluation and intensive mental care in preoperative children with CHD to reduce the rejection patients, and in turn to reduce the postoperative complication, promote the rehabilitation, reduce the costs and save the medical resource.

系统性血管炎是一种相对罕见的疾病,病因不明,临床表现主要为急进性肾炎和其他系统病变,病情进展迅速,一旦发生肺部大出血,常常因为顽固性呼吸衰竭而死亡.

Objective To evaluate the effect of disposable balloon catheter application for feces incontinence in critical patients. Methods Fifty-five critical patients with cerebral vascular accident, severe pancreatitis, cerebral trauma, or multiple organ failure, 35 males and 20 females, aged(65 ± 5)(33～87), who suffered from feces incontinence because of antibiotic-associated pseudomembranous enteritis or stress gastrointestinal hemorrhage caused by high-dose adrenal cortex hormone treatment were randomly divided into 2 sex-, age-, and state of illness-matched groups: experiment group (n=35) undergoing insertion of a disposable indwelling balloon catheter to the juncture of sigmoid colon and rectum and deflation every 4～6 hours, and control group (n=20) receiving conventional nursing care. Observation was carried out for 7 days. Results The complication rate of the experiment group was 5.71% , significantly lower than that of the control group (50.00% , P0.05).Conclusion Application disposable balloon catheter for feces incontinence in critical patients effectively reduces the incidence of pressure sores and refractory eczema in critical patients.

ObjectiveTo compare the effects of BD Vacutainer and plastic syringe. on collection of arterial blood samples.MethodsSamples of arterial blood were taken from 60 patients undergoing mechanical ventilation, 38 males and 22 females, aged 30~77, by using BD Vacutainer with the needle containing sodium lithium heparin (BD Vacutainer group) and then were collected by using heparinized plastic syringe at least 10 min later (syringe group). A nurse was in charge in collecting both samples from the same patient. The pain intensity (PI), success rate of single puncture, amount of blood collected, and main results of blood gas analysis, were analyzed between these 2 methods.ResultsThe success rate of single puncture of the BD Vacutainer group was significantly higher than that of the syringe group (P=0.040), The PI for mild pain of the BD Vacutainer group was significantly higher than the syringe group (P =0.043), however, the PI for moderate and severe pain of the BD Vacutainer group was significantly lower than that of the group B (P =0.031). The bubble infiltration rate of the BD Vacutainer group was significantly lower than that of syringe group (P =0.04). The PaCO2 of the BD Vacutainer group was 40.9±2.5, significantly higher than that of the syringe group (38.5±2.7, P<0.001).There were no significant differences in pH and other main blood gas analysis between these 2 groups (all P>0.05).ConclusionSafe and causing less pain, application of BD Vacutainer is recommendable for arterial blood preparation.

Objective To explore the therapeutic effect of infusion of oxygen-enriched liquid on acute lung injury (ALI).Methods Oxygen-enriched liquid was obtained by dissolving high concentrated oxygen in routine infusion liquid.33 ALI patients were given intravenous drip of oxygen-enriched liquid after they failed the 2 h aspiration of high concentrated oxygen.Blood gas was analyzed 1h and 3 h after intravenous infusion and compared with that before treatment.Mechanical ventilation was adopted and intravenous infusion continued if the hypoxemia could not be adjusted and then progressed into acute respiratory distress syndrome (ARDS).Results PaO_2 and PaO_2/FiO_2 in 25 cases increased after 1h and 3 h of intravenous infusion of oxygen-enriched liquid (P<0.01 for each).Hypoxemia was improved by mechanical ventilation and intravenous infusion in 5 of 8 ARDS cases.Conclusion Intravenous infusion of oxygen-enriched liquid has better therapeutic effect on hypoxemia in acute lung injury patients and can prevent acute lung injury from developing into ARDS.

<正> 在急诊抢救急危重症患者时,传统的给氧方法(又称为第一条给氧途径)有3:(1)经鼻导管或面罩吸高浓度氧气;(2)经面罩或人工气道机械通气;(3)高压氧。这些措施在临床应用已久,且疗效确切,各有优劣。近年来,国内临床开展了一种新的输氧技术,即静脉输注高氧液(oxygen-enriched liquidinfusion,简称静脉输氧)的给氧方法。本研究旨在验证静脉输注高氧液在急诊急救时的有效性和安全性。

Objective To investigate the curative effect of oxygen-enriched liquid by infusion of on patients with severe brain trau- ma.Methods One hundred and eight patients with severe brain trauma were randomly divided into two groups:the experimental group trea- ted by oxygen-enriched liquid plus rontine treatment(n=54) and the control group treated only by routine treatment (n=54).The same measures such as srugical operation,hemostasis and transfusion were used in two groups.5% GS 10～20 ml/kg was applied in the control group and oxygen-enriched liquid 10～20 ml/kg injected in the experimental group.The physical signs of life,intracranial pressure or cere- brospinal fluid pressure,blood-gas markers and the severity of cerebral edema were also observed,and consciousness rate(GCS) recorded 7 days after admission and GOS recorded three months later and comparison performed.Results PaO_2 and SaO_2 improved significantly quicker after treating by oxygen-enriched liquid in experimental group than those in control group (P0.01).The physical signs of life were much smooth in experimental group than those in control group.In 7 days after operation,the ICP was lower in experimental group than that in com- trol group(P0.01).On seventh day the incidence rate of severe cerebral edema reduced significantly(P0.01).The duration from co- ma to GCS affer first week and GOS after 3 month in experiment group were higher than those in control group respectively(P0.05～ 0.01).Conclusion Oxygen-enriched liquid by infusion may he an effective measure in patients with severe brain trauma.

目的探讨静脉输氧对全麻术后患者脱机拔管的安全保护作用.方法将高浓度氧气溶解在常规输液用液体内制备成为高氧液,通过静脉输液的方式进行输氧.把120例全麻术后需呼吸机支持并入住ICU监护的患者随机分为两组:对照组(52例),只予常规的有创-无创序贯脱机拔管治疗;治疗组(68例),在常规基础上给予静脉滴注高氧液1000～1500ml/d.监测两组患者的血氧指标变化,观察其成功脱机拔管的时间.结果治疗组患者的血氧指标达到正常水平的时间和成功脱机拔管的时间分别为(4.0±1.3)h和(4.5±1.5)h,对照组分别为(20.0±5.5)h和(21.5±5.3)h,二者比较有显著性差异(P<0.01).治疗组在不同时段脱机拔管的累计成功率亦明显高于对照组(P<0.01).结论静脉输氧能明显提高全麻术后患者的动脉血氧分压(PaO2)和氧饱和度(SaO2),为尽早脱机拔管起到安全保护作用.