肝胆外科具有手术时间长、手术创伤大等特点,这些特点造成术后较容易发生感染。术区感染（SSI）增加了住院时间、资源利用率和再入院率,造成相当大的经济负担[1]。肝切除术后胆汁渗漏和胰腺切除术后胰腺瘘是肝胆胰腺手术患者器官及腹腔间隙术区感染的常见原因[2-3]。重要的危险因素包括超重状态、造口、伤口种类≥Ⅲ级、美国麻醉医师协会（ASA）生理状况≥3及手术时间延长。

Objective:To explore the application effect of problem-oriented nursing intervention model in patients after laparoscopic-assisted radical gastrectomy for stomach neoplasms.Methods:Using the convenient sampling method, 96 patients who underwent laparoscopic-assisted radical gastrectomy for stomach neoplasms in China-Japan Union Hospital of Jilin University from January 2017 to January 2019 were selected as the research objects. According to the random number table method, they were randomly divided into the control group and experimental group, with 48 cases in each group. The control group was given routine nursing, while the experimental group was given problem-oriented nursing. The recovery time of gastrointestinal function was compared between the two groups after operation. Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) were used to compare the psychological status of patients in the two groups.Results:The time of first feeding, bowel sound recovery, first exhaust and first defecation in the experimental group were shorter than those in the control group, and the differences were statistically significant ( P< 0.01) . On 7 days after surgery, SAS and SDS scores of patients in the experimental group were lower than those in the control group, and the differences were statistically significant ( P<0.01) . Conclusions:The application of problem-oriented nursing intervention model in patients after laparoscopic-assisted radical gastrectomy for stomach neoplasms can accelerate their postoperative recovery and eliminate bad emotions, which is worthy of clinical promotion and application.

Objective:To explore the effects of Danlou tablets combined with Omaha case management model in patients with chronic stable coronary heart disease (SCAD) .Methods:Using the convenient sampling method, 120 SCAD patients who were treated in Department of Cardiology in China-Japan Union Hospital of Jilin University were selected. According to the random number table method, they were divided into the routine group and the combined group, with 60 cases in each group. Both groups were given the Omaha system-based case management intervention. The routine group was given basic treatment, while the combined group was given Danlou tablet treatment on this basis. Both groups were given continuous treatment and nursing for 8 weeks. The curative effects of the two groups after treatment were observed and compared. The vascular endothelial function, serum myoglobin (Mb) , cardiac troponin I (cTnI) before and after treatment as well as complications during treatment were compared.Results:The significant efficiency and total effective rate of the combined group were 53.33% (32/60) and 98.33% (59/60) , higher than 35.00% (21/60) and 81.67% (49/60) of the routine group, and the differences were statistically significant ( P<0.05) . The brachial artery blood flow-mediated diastolic function (FMD) and serum endothelin-1 levels after treatment in the two groups were higher than those before treatment, and those of the combined group was higher than the routine group, the differences were statistically significant ( P<0.05) . The serum levels of nitric oxide, high-sensitivity C-reactive protein, Mb, cTnI in the two groups after treatment were lower than those before treatment, and those of the combined group was lower than the routine group, the differences were statistically significant ( P<0.05) . The incidence of complications in the combined group was lower than that in the conventional group, and the difference was statistically significant ( P<0.05) . Conclusions:Danlou tablets combined with Omaha case management model can improve the vascular endothelial function of SCAD patients and effectively reduce serum Mb, cTnI. It has high safety and significant clinical curative effects, which is worthy of promotion.

Objective? To explore the effects of integrated nursing in heart failure patients with Vitacamphorae injection. Methods? From December 2016 to December 2017, we selected 160 heart failure patients with Vitacamphorae injection of Cardiovascular Department in Sino-Japanese Friendship Hospital of Jilin University as subjects by convenience sampling. All of the patients were divided into control group and experimental group with the random numbers, 80 cases in each group. Control group received routine nursing, while experimental group carried out integrated nursing. We compared the scores of European Heart Failure Self Care Behavior Scale (EHFSCB) and Minnesota Living with Heart Failure Questionnaire (MLHFQ) between two groups before and after intervention. Results? After intervention,the scores of EHFSCB and MLHFQ of experimental group were lower than those of control group with statistical differences (P＜ 0.05). Conclusions? Application of integrated nursing in heart failure patients with Vitacamphorae injection can improve their self-care ability and quality of life.

目的：探讨心外科住院患者院内感染相关因素及其细节管理的措施与效果。方法：对所有患者的研究资料进行回顾性分析，包括患者的基本资料、病程记录、细菌培养、用药情况、体温单，比较两组患者变量的差异。结果：与对照组对比，观察组在年龄、手术时间、引流时间的数据明显更高，二者的数据比较差异具有统计学的意义（P ＜0.05）。结论：年龄、手术时间、住院时间、切口引流与心外科院内感染密切相关。

Objective In order to summarize the nursing experiences and improve nursing quality,we explore the perioperative nursing methods in patients reconstructing skin defects with posterior interosseous artery flaps. Methods The 13 patients with skin defects were treated with debridements and vacuum sealing drainage system,and then the skin defects were covered with posterior interosseous artery flaps. In the perioperative period,we give united nursing interven-tion to the patients,including basic nursing,psychological nursing,controlling infection,carefully observing the vascular crisis,instructing exercise,and discharge guidance. Results All the 13 flaps survive well. Conclusion The effects of posterior interosseous artery flaps covering skin defects of hand is well. Based on the characteristics of the blood supply of this flap,we carry out comprehensive perioperative nursing,and can judge the occurance of vascular crisis effectively. United nursing intervention is effective in improving the surviving rate of the posterior interosseous artery flap.

Objective To explore the complications in the nursing work of implanted venous portand its causes, so as to explore the preventive methods. Methods We collected the clinical data and the nursing data of 102 patients with implanted venous port in our department from November 2013 to November 2015. Nursing records during the maintain period were recorded, common complications were summarized, the reasons were analyzed, and nursing interventions were explored and made. Results Among 102 patients, the following-up time was 7-31 months, and the median follow-up time was 19 months. There were 38 cases ( 37. 25%) of complications occurred 2 weeks after operation and 11 cases ( 10. 89%) of complications occurred during discharge maintenance, the difference was statistically significant ( P<0. 05 ) . The common complications included the sweeling of neck and limps, incision complication and blochage in catheter. Conclusions The incidence of complications within 2 weeks after implanting surgery is higher than that during the maintain period. Among all the complications, catheter associated thrombosis, damaged base and ectopic catheter are the most serious and they can cause the discontinue use of port. By following the recommended operating procedures during the implementation of nursing work, bettering the health education, and improving the patients′understanding of implanted venous port, we can reduce the incidence rate of complications, and ensure the safety use of venous port.

目的：探讨自制双腔T型引流管用于胆汁回输的安全性、可行性以及回输过程中的护理方法和经验。方法2012年5月—2014年7月对52例胆道手术患者应用自制双腔T型引流管引流的同时行胆汁回输治疗，与同期普通T管引流患者52例进行比较。结果自制双腔T型引流管组手术时间、术中出血量、术后拔管时间与普通T管差异有统计学意义(P<0.05)；自制双腔T型引流管组术后并发症与普通T管组比较差异有统计学意义(P<0.05)；自制双腔T型组术后通便时间、住院时间显著短于开腹组，差异有统计学意义(P<0.05)。结论自制双腔T型引流管自体回输，有助于肠道功能恢复，保护肠黏膜，改善营养状况，是一种主动、安全有效、廉价和低并发症的途径，配合肠内营养支持，在临床上有很好的应用价值。

主要介绍心外科重症监护室护理管理，包括重症监护室的必要设施和医护人员的必要素质，并根据整体的医疗护理情况，进一步完善心外科重症监护室的监护流程管理，不断提升心外科重症监护室的水平，尽量协助重症患者，使患者在监护室里能得到有效的帮助，推动医疗效果。优化心外科重症监护室的管理手段，并在重症室监护理念上做到与时俱进，不拘泥于刻板的固有规律，结合患者的实际情况，在治疗重症患者的过程中起到良性推动作用。

目的：探讨医院应急护理队员的规范化培训对提高应急护理人员的应急处置能力的效果。方法选取我院的应急队员38名，组成三个内科组，三个外科组，进行为期3个月的规范化培训，培训内容包括急诊急救、应急救援理论知识及急救综合技能，培训采用理论授课、情景模拟、示教、带教等多种形式。比较培训前后的理论及技能的考核成绩，同时评定培训前后应急队员的自我效能感。结果与培训前比较，应急护理队员急诊急救、应急相关理论及急救综合技能考核成绩均显著提高（均P＜0．001），同时应急队员培训前后的自我效能总量表平均得分分别为20．24分、37．25分。结论通过护理应急队员的规范化培训，极大提高了护理人员的应急处置能力，同时护士的自我效能感也得到提高。

OBJECTIVE To explore the risk factors for catheter‐related bloodstream infections (CRBSI) and put for‐ward the prevention countermeasures so as to reduce the incidence of the bloodstream infections .METHODS A to‐tal of 153 patients with CRBSI who were treated in the hospital from Dec 2008 to Dec 2013 were enrolled in the study .The incidence of the infections was recorded ,the related risk factors for the infections and the distribution of pathogens causing infections were observed ,and the monitoring data were summarized and analyzed by using MINKE nosocomial infection management system .RESULTS Totally 21 patients were infected within 7 days of catheterization ,accounting for 13 .72% ;132 patients were infected after the catheterization for 7 days ,accounting for 86 .28% ;153 patients had sin swelling and purulence .The causes of CRBSI included the inappropriate opera‐tion procedure ,non‐standard nursing after catheterization ,inappropriate catheterization site ,prolonged catheter indwelling time ,and individual factors of the patients .A total of 312 strains of pathogens were isolated ,including 248 (79 .49% ) strains of gram‐negative bacteria ,58 (18 .59% ) strains of gram‐positive bacteria ,and 6 (1 .92% ) strains of fungi .CONCLUSION It is an effective way to improve the level of management of nosocomial infections , carry out the operations according to the rules and regulations ,and strengthen the nursing after the catheterization so as to control the CRBSI .

目的：研究心脏外科手术患者术后发生精神障碍的有关影响因素，并分析了相应护理干预中临床效果情况。方法通过医院的系统平台，主要选取60例符合要求的患者，随机分成对照组和干预组，各30例。对照组采用常规心脏围手术期护理；干预组在对照组护理的基础上，再根据患者的病情的特征配合护理干预，观察比较两组患者效果，并探讨相关原因。结果干预组护理效果较好；在手术后，对照组出现了抑郁、焦虑、谵妄等精神障碍情况8例（26.67%），干预组2例（6.7%），差异有统计学意义（P＜0.05）。结论对心脏外科手术患者进必要护理干预可以实现减少患者术后精神障碍的发生率，应大力推广应用。

目的 探讨标准化皮肤护理流程在比亚芬防治保乳术后放疗皮肤损伤的应用效果。 方法 选取我院保乳术后放疗患者128例,采用数字随机法分为对照组和观察组,每组64例。对照组患者放疗后即按药品说明书涂抹比亚芬,观察组患者放疗后照射区皮肤按照标准化皮肤护理流程涂抹比亚芬。比较两组患者的皮肤损伤程度、皮肤反应发生剂量、慢性皮肤纤维化情况、皮肤损伤治疗情况、护理满意度情况。 结果 观察组患者皮肤损伤程度、皮肤反应发生剂量分布情况均明显好于对照组(均P<0.05),患者皮肤反应发生剂量、护理满意度均明显高于对照组(均P< 0.05),患者慢性皮肤纤维化发生率明显低于对照组(P< 0.05),患者皮肤损伤治愈时间明显少于对照组(P<0.05)。 结论 标准化皮肤护理流程在比亚芬防治保乳术后放疗皮肤损伤中的应用效果显著,可明显减轻患者的皮肤反应程度及患者皮肤反应发生剂量,降低患者慢性皮肤纤维化发生率,且减少皮肤损伤治愈时间。

目的 探讨循环质量管理护理模式在PICC护理中的应用效果。方法选取行PICC治疗的肿瘤化疗患者60例，随机分为观察组和对照组，每组30例。对照组给予常规护理，观察组应用循环质量管理（ PDCA）护理模式给予护理。比较两组患者并发症发生情况及护理满意度。结果观察组患者并发症发生率明显低于对照组（P＜0.05），护理满意度明显高于对照组（P＜0.05）。结论 PDCA护理模式在PICC护理中的应用效果显著，可明显减少并发症发生，提高患者的护理满意度。

目的:总结呼吸机依赖患者撤机时的护理技巧。方法:3例呼吸机依赖患者应用自主间歇指令通气加压力支持辅助通气的呼吸模式,实施生命体征及各项指标的监测,观察撤机前后pH、PaCO2、PaO2的变化。实施心理护理、呼吸机的锻炼、呼吸道的管理、吸痰的管理、气管插管的管理。结果:3例患者顺利撤机。其呼吸频率<30次/min、心率和血压稳定、血气分析结果撤机前后无明显变化、SaO2>90%。结论:合理的撤机前、撤机时、撤机后的护理是顺利撤机的关键因素。