Objective:To investigate the clinical effect of 10°reverse-Trendelenburg position combined with dolasetron on preventing postoperative nausea and vomiting (PONV) in female patients undergoing thyroid surgery.Methods:A total of 150 female patients who underwent thyroid surgery at the Affiliated Hospital of Xuzhou Medical University from January 2021 to February 2021 were selected using convenience sampling method. According to the random number table methods, they were divided into two groups ( n=75): a control group (group D) and an observation group (group T). Patients in group D received dolasetron alone for preventing PONV, while those in group T received 10°reverse-Trendelenburg position combined with dolasetron. Then, their incidences of PONV within 48 h after surgery were compared. The blood loss, incidence of intraoperative hypotension, Visual Analog Scale (VAS) scores, incidences of dizziness and headache, use of rescue antiemetics, length of hospitalization stay, scores of the quality of recovery, and surgeon satisfaction were recorded. Results:The incidence of PONV was 34.7% (25/72) for group D and 12.5% (9/72) for group T, with statistical difference. The relative risk of PONV incidence between group T and group D was 0.36 [(95% confidence interval (CI) 0.18, 0.72), P=0.002]. Group T had significantly less blood loss than group D ( P=0.001). No statistical difference was found in the incidence of intraoperative hypotension, VAS scores, and the incidences of dizziness and headache between the two groups ( P>0.05). Patients in group T required less rescue antiemetics than group D ( P=0.002). There was no statistical difference in the length of hospitalization stay between the two groups ( P>0.05), and the scores of the quality of recovery was significantly higher in group T than those in group D ( P<0.001). There was no statistical difference in surgeon satisfaction between the two groups ( P>0.05). Conclusion:The 10°reverse-Trendelenburg position combined with dolasetron is more effective than dolasetron alone in preventing postoperative nausea and vomiting in female patients undergoing thyroid surgery.

对国外抑郁症协作护理模式的类型、应用效果、优势及不足之处进行综述，旨在为我国抑郁症协作护理模式的发展提供依据。

目的:研制一款智能腔镜器械电气绝缘安全检测仪,提高腔镜带电器械绝缘性能检出率,降低电外科电灼伤的发生率.方法:选取医院循环使用的240件带电源腔镜器械,分别使用肉眼结合放大镜检测方法及智能腔镜器械电气绝缘安全检测仪进行绝缘性能检测,统计并对比绝缘检出率以及检测每件器械的平均耗时,评价其临床应用价值.结果:肉眼结合放大镜检测方法和智能腔镜器械电气绝缘安全检测仪的绝缘检出率分别为10％(24/240)和20.83％(50/240),两者比较差异有统计学意义(x2=6.075,P<0.05).肉眼结合放大镜检测方法和智能腔镜器械电气绝缘安全检测仪的检测平均耗时分别为(27.65±8.79)s和(10.97±2.06)s,两者比较差异有统计学意义(t=14.313,P<0.05).智能腔镜器械电气绝缘安全检测仪检测的时间成本投入显著低于肉眼结合放大镜检测方法.结论:使用智能腔镜器械电气绝缘安全检测仪对带电源腔镜器械绝缘性能进行检测,能够有效提高腔镜带电器械绝缘情况的检出率,比肉眼结合放大镜检测方法更高效,从而降低因腔镜带电器械因绝缘性能原因而造成的电外科电灼伤发生率.

目的 研制一款智能腔镜器械电气绝缘安全检测仪以确保腔镜手术带电器械术中绝缘性能安全,并探讨其应用效果.方法 在原型机基础上进行升级改造,研发配套软件管理系统并将两者进行整合,研发一款全新国产的智能腔镜器械电气绝缘安全检测仪.于2019年8月～2020年10月进行临床试用,与传统人工目检法进行比较和评估,并对相关数据统计分析.结果 利用人工目检法和智能腔镜器械电气绝缘安全检测仪两种方法对190件腔镜电外科器械的绝缘破损点以及绝缘破损检出率进行统计,人工目检法共检出绝缘破损点数量7件,智能腔镜器械电气绝缘安全检测仪检出绝缘破损点数量共39件,显著高于人工目检法(P<0.05).人工目检法和智能腔镜器械电气绝缘安全检测仪检出的绝缘破损率分别为3.68％(7/190)和20.53％(39/190),两者之间差异有统计学意义(P<0.05).人工目检法的工作人员数量为4位,平均检测用时分别为(40.78±2.63)s/件,智能腔镜器械电气绝缘安全检测仪工作人员数量仅需1位,平均检测用时分别为(10.86±0.00)s/件,智能腔镜器械电气绝缘安全检测仪检测的人力成本投入明显优于人工目检法.检测结果记录平均耗时分别为(29.18±2.91)s/10件和(5.15±0.00)s/10件,智能腔镜器械电气绝缘安全检测仪检测的时间成本投入明显优于人工目检法.人工目检法和智能腔镜器械电气绝缘安全检测仪法医护满意度分别是72.86％和96.71％,两者之间差异有统计学意义(P<0.05).结论 智能腔镜器械电气绝缘安全检测仪可以提供更为安全高效的检测,提高医院的工作效率和安全质量.

介绍术中病人体温监测最新方法和最新保温措施,以激发临床工作者的创新思维,为更好地预防手术病人术中低体温提供依据,从而降低术中病人低体温发生率,促进病人康复.

目的 了解湖州市电外科相关科室护士对电外科设备的安全使用认知情况,并探讨影响安全使用认知的主要因素.方法 2019年9—10月,采用分层便利抽样方法 ,采用一般资料问卷、美国外科能量设备网络培训课程问卷(FUSE)、知识需求问卷对湖州地区202名护士进行调查电外科设备安全使用认知情况、知识需求进行调查,并对结果 进行统计分析.结果 电外科相关科室护士对电外科设备安全使用认知的正确率为65.55％.年龄、医院级别以及不同科室的护士电外科设备安全使用认知正确率比较,差异有统计学意义(x2=8.701、7.345、8.031,P=0.034、0.025、0.018),而性别、工作年限、职称、学历比较,差异无统计学意义(P>0.05).护士希望得到的培训内容排名前三位的是电外科设备的正确操作流程、存放及维护以及使用注意事项.最希望获得的培训方式中对"老师传帮带"的需求最低,最高的是厂家授课.结论 电外科相关科室护士对电外科设备安全管理认知水平整体有待提高,需要针对护士开展相应的电外科设备相关知识培训,以提高临床安全.

对国外手术中断的研究现状进行综述,阐述手术中断的概念、发生情况、后果及干预对策,以期为我国手术中断的研究及管理提供参考.

医院职业暴露已是临床一线工作者面临的主要难题之一,而实习护生处于从学校走向社会的过渡期,其缺乏相应的防护知识和经验,操作技能不够娴熟,自我防护意识薄弱,因此实习护生的职业暴露发生率高,暴露后对护生的身心健康及职业态度均产生了消极影响.目前护生职业防护教育研究仍处于摸索阶段,大部分院校未开设护理职业防护相关课程,也无相应的专业教材.现阶段的防护教育来源于护理学课程中某些章节的学习或是专题讲座,教学内容零星散乱,缺乏系统性和完整性.因此,本文就实习护生职业暴露情况及其教育现状的研究进展进行综述,以期为职业防护教育的进一步开展提供参考.

目前,国内拥有独立的日间手术中心的医院比较少,大多医院开展日间手术主要还是依靠手术室.日间手术室是开展日间手术的基本条件,随着日间手术模式在国内越来越受欢迎,日间手术开展的数量也呈逐年上升的趋势,因此对日间手术室各方面也提出了更高的要求.

OBJECTIVES: Hypoxia leads to endothelial cell inflammation, apoptosis, and damage, which plays an important role in the complications associated with ischemic cardiovascular disease. As an oxidoreductase, p66Shc plays an important role in the regulation of reactive oxygen species (ROS) production and apoptosis. Ketamine is widely used in clinics. This study was designed to assess the potential protective effect of ketamine against hypoxia-induced injury in human umbilical vein endothelial cells (HUVECs). Moreover, we explored the potential mechanism by which ketamine protected against hypoxia-induced endothelial injury. METHODS: The protective effects of ketamine against hypoxia-induced injury was assessed using cell viability and adhesion assays, quantitative polymerase chain reaction, and western blotting. RESULTS: Our data showed that hypoxia reduced HUVEC viability, increased the adhesion between HUVECs and monocytes, and upregulated the expression of endothelial adhesion molecules at the protein and mRNA levels. Moreover, hypoxia increased ROS accumulation and upregulated p66Shc expression. Furthermore, hypoxia downregulated sirt1 expression in HUVECs. Alternatively, ketamine was shown to reverse the hypoxia-mediated reduction of cell viability and increase in the adhesion between HUVECs and monocytes, ameliorate hypoxia-induced ROS accumulation, and suppress p66Shc expression. Moreover, EX527, a sirt1 inhibitor, reversed the protective effects of ketamine against the hypoxia-mediated reduction of cell viability and increase in adhesion between HUVECs and monocytes. CONCLUSION: Ketamine reduces hypoxia-induced p66Shc expression and attenuates ROS accumulation via upregulating sirt1 in HUVECs, thus attenuating hypoxia-induced endothelial cell inflammation and apoptosis.

Hyperglycemia-mediated endothelial inflammation participates in the pathogenesis of cardiovascular complications in subjects with diabetes. Previous studies reported that phosphatase and tensin homolog deleted on chromosome ten (PTEN) and SET8 participate in high glucose-mediated endothelial inflammation. In this study, we hypothesize that SET8 regulates PTEN expression, thus contributing to high glucose-mediated vascular endothelial inflammation. Our data indicated that plasma soluble intercellular adhesion molecule-1 (sICAM-1) and endothelial selectin (e-selectin) were increased in patients with diabetes and diabetic rats. PTEN expression was augmented in the peripheral blood mononuclear cells of patients with diabetes and in the aortic tissues of diabetic rats. Our in vitro study indicated that high glucose increased monocyte/endothelial adhesion, endothelial adhesion molecule expression and p65 phosphorylation in human umbilical vein endothelial cells (HUVECs). Moreover, high glucose led to endothelial inflammation via upregulation of PTEN. Furthermore, high glucose inhibited SET8 expression and histone H4 lysine 20 methylation (H4K20me1), a downstream target of SET8. SET8 overexpression reversed the effects of high-glucose treatment. shSET8-mediated endothelial inflammation was counteracted by siPTEN. Furthermore, SET8 was found to interact with FOXO1. siFOXO1 attenuated high glucose-mediated endothelial inflammation. FOXO1 overexpression-mediated endothelial inflammation was counteracted by siPTEN. H4K20me1 and FOXO1 were enriched in the PTEN promoter region. shSET8 increased PTEN promoter activity and augmented the positive effect of FOXO1 overexpression on PTEN promoter activity. Our in vivo study indicated that SET8 was downregulated and FOXO1 was upregulated in the peripheral blood mononuclear cells of patients with diabetes and the aortic tissues of diabetic rats. In conclusion, SET8 interacted with FOXO1 to modulate PTEN expression in vascular endothelial cells, thus contributing to hyperglycemia-mediated endothelial inflammation.

对老年腹腔镜胆囊切除术病人围术期快速康复的研究进展进行概述,为今后的临床护理实践提供参考.

新型冠状病毒在相对密闭的环境中长时间暴露于高浓度气溶胶情况下存在经气溶胶传播的可能,手术室工作环境的特殊性,使手术患者与手术室工作人员成为新型冠状病毒肺炎的易感人群.从气溶胶的概念、气溶胶在疾病传播中的作用以及手术室气溶胶的形成、减少手术室气溶胶产生、加速手术室气溶胶排除以及手术室医护人员应对气溶胶的个人防护等方面进行综述,为新型冠状病毒肺炎期间手术室医护人员应对气溶胶污染提供参考.

Objective:To explore the effects of perianesthesia position nursing model based on enhanced recovery after surgery (ERAS) in patients undergoing thoracoscopic surgery.Methods:Totally 100 patients undergoing thoracoscopic pulmonary surgery in Huzhou Central Hospital between July and December 2019 were selected by convenient sampling and divided into the control group and the experimental group according to the random number table, with 50 cases in each group. Patients in the experimental group received perianesthesia position nursing, while patients in the control group received conventional position nursing. The time of position placement, number of placement personnel, intubation time, comfort and pain were compared between the two groups.Results:There were statistically significant differences in the placement time and number of placement personnel between the two groups ( P<0.05) . The GCQ score of the experimental group was higher, while the VAS score was lower than that of the control group, and the differences were statistically significant ( P<0.05) . Conclusions:The perianesthesia position nursing model based on ERAS can shorten the time of posture placement, reduce the pain, and improve the comfort in patients undergoing thoracoscopic surgery.

目的 探讨颜色标签在手术室纸塑袋无菌物品管理中运用效果.方法 采用颜色标识法及垂挂式标签法合二为一管理手术室纸塑袋无菌物品,设计用红、黄、蓝、绿、白、紫6种颜色的不干胶标签纸分别代表6个月份时间,标签上内容包含纸塑袋内物品信息,一式两份,一份垂挂式标签贴于纸塑袋塑面右下缘垂挂于袋外,以便纸塑袋在贮物架上水平摆放时,能在不翻动纸塑袋的情况下看到标签内容;另一份贴于塑面,作为留底用,以防长时间垂挂标签脱落失去标识作用.培训护理人员通过观察纸塑袋上垂挂的不同颜色的标签,直观快速地识别纸塑袋的有效期及袋内物品.观察手术室应用颜色标签管理纸塑袋无菌物品后的效果.结果 实施颜色标签法管理后,检查有无过期无菌物品时间与实施前所花时间比较,差异有统计学意义(p＜0.05);检查发现过期物品、纸塑袋破损情况明显低于对照组,差异有统计学意义(p＜0.05).结论 将标签垂挂于纸塑袋侧面的方法管理无菌纸塑物品,能减少人为对纸塑袋的接触,可缩短查找时间,提高工作效率,减少护理人员的工作量、降低纸塑袋的带菌量、过期率及破损率.

总结37例无充气腋窝经路完全腔镜下甲状腺肿瘤切除术的手术配合要点及安全风险防范策略.包括术前访视、术中密切配合、感染控制、严格执行隔离技术 、无菌技术及患者的安全管理等,手术均顺利开展,取得了较好的效果.

目的 探讨全身麻醉气管导管拔管后的体位干预在老年胸腔镜肺癌手术后复苏的影响.方法 选择2016年1-12月在我院行胸腔镜手术的老年患者85例,入选对象均采用全身麻醉,并根据接受治疗时间按照随机数字表分为观察组(42例)和对照组(43例):观察组在患者手术结束,气管导管拔出后予25°～30°的半卧位,而对照组在气管导管拔出后,常规平卧位.观察两组拔管后10 min、30 min的氧合指数,停留复苏室的时间、舌后坠、患者舒适度.结果 观察组在拔管后10 min、30 min的动脉血氧分压明显高于对照组,而停留复苏室的时间明显少于对照组,患者舒适度也明显优于对照组,差异有统计学意义(P＜0.05).结论 体位干预明显加快了老年患者胸腔镜手术后的复苏,提高了患者的舒适度,值得临床运用和推广.

Objective To explore the effects of the three-level management model in Operation Room (OR) management.Methods A vertical management system covering head nurses, special team leaders and team members, namely, a three-level management model, was built. The general management conducted in 2015 were selected as a control group, while the three-level management model adopted in 2016 was investigated as an observation group. Then the nursing quality aspects such as preoperative material preparation, skilled procedure coordination, timely passing of instrument, professional knowledge and aseptic processing as well as the satisfaction among doctors, patients and instrament respair rate, damage rate and loss rate in OR were compared between the two groups.Results After the three-level management model was adopted, patients, doctors showed higher satisfaction in their self-evaluation than before (P<0.05). Instrument respair rate, damage rate and loss rate were lower than before the implementation(P<0.05).Conclusions The three-level management model, when applied in OR management, can improve the nursing quality and motivate OR nurses, thus accelerating the cultivation of OR nursing staff and specialized construction.

Objective:To design a device for detecting laparoscopic equipment electric leakage is to prevent the secondary viscera injury from electric leakage of laparoscopic equipment. Methods: On the basis of patent technology, the new detector was designed to detect the electric leakage of laparoscopic instrument accurately for leakage detection and leakage point of rod-shaped endoscopic devices. And surgical endoscopic equipments were tested by the new detector in the hospital between 2013 and 2015.Results: We tested over 6500 pieces of laparoscopic instruments by the electric leakage detector and found 1138 pieces of laparoscopic instruments due to insulation cracking. The detection rate was 17.5%. This new device could reduce the electric leakage of surgical laparoscopic instruments to avoided secondary viscera injury significantly.Conclusion: It is effective and practical for operation and safety management and maintenance of surgical laparoscopic instruments. This device could set up the base for establishment of tracing system of endoscopic instrument to achieve closed-loop management of endoscopic equipment. It’s worth to being popularized.

目的:探究情景模拟教学法在手术室护生带教中的应用效果.方法:浙江省湖州市中心医院自2014年2月起,在手术室护生带教过程中开始实施情景模拟教学法,比较分析实施前后对护生的带教效果及教学满意度.结果:实施情景模拟教学方法之后,护生带教效果较之前明显提高(P＜0.05).实施之后护生对教学的满意度,较之前明显提高(P＜0.05).结论:情景模拟教学法在手术室护生带教中效果显著,不仅能够有效提高带教的效果,还可以提高护生对教学的满意度.