心肺脑复苏(Cardiopulmonary-cerebral Resuscitation,CPCR)是抢救心跳骤停(Cardiac Arrest)患者的重要手段,而早期氧疗(Acute Oxygen Therapy)是提高心肺脑复苏成功率的重要辅助措施.以往人们一直认为CPCR后应尽早给予患者高浓度氧疗;然而,近年认为早期氧疗不当非但达不到挽救心跳骤停患者生命、降低致残率之目的,反而会降低复苏成功率.基础研究和临床研究提示,与暴露于正常空气或低浓度氧气组相比,大脑缺氧后早期暴露于高浓度氧气中的动物或患者,脑组织损伤更加严重.其可能机制主要有高浓度氧含量引起的氧化应激和乳酸堆积造成的脑组织损伤.此外,复苏后高浓度氧疗还可造成心肌损伤,其主要机制有大量活性氧簇(Reactive Oxygen Species,ROS)造成心脏的继发性损伤、Ca2+通道激活,引起血管收缩加重心肌缺血、K+ATP通道关闭,造成心肌受损、血管紧张素Ⅱ释放增多和缩血管物质20-HETE生成增多,加重心肌缺血等.因此,在对复苏后病人进行氧疗过程中,目前主张限制复苏后早期氧疗.

总结1例腹腔镜下取大网膜移植修复右下肢深度创面的手术配合.手术由2个科室协作完成,护士必须做好充分的术前准备工作,加强医护间交流；巡回护士要确保仪器安全使用,保持手术间温度避免血管痉挛,术中加强观察,及早发现病情变化；器械护士要熟悉手术操作器械及步骤,准确传递器械.

Objective To investigate the effects of physical activty on the health-related quality of life (HRQOL) in liver transplant recipients.Methods According with the standard of physical activity participation in cardiovascular exercise one or more times per week for 30 min,totally 110 liver tranplantation recipients from Xi Jing Hospital,Affiliated to the Fourth Military Medical University between January 2004 and December 2011 were divided into active group ( 26 cases ) and inactive group ( 84 cases).And the patients were investigated with the medical outcomes study short form 36 (SF-36).The general datas,coexisting medical conditions and participation in regular physical activity were collected additionally.Results Significant differences between active and inactive subjects in the scores for the following scales were found:total score of SF-36 [ (65.89 ±24.57) vs (49.92 ±20.59) ],PCS[ (69.24 ±29.64) vs (40.71 ±20.96)],PF[(81.35 ±32.53) vs (34.56 ±17.40) ],RP[(75.12 ±39.27) vs (55.85 ±29.26) ],BP[ (60.26 ±27.68) vs (27.23 ±16.69)],GH[(61.29±25.32) vs (46.02±22.58)],VT[(54.84±20.45) vs (44.25±25.83)] (x2 =3.31,2.13,9.57,4.57,7.61,2.94,1.92,respectively; P ＜ 0.05 ).But the score of RE,SF and MCS has no difference between active and inactive group( x2 =1.39,0.47,1.71,respectively; P ＞ 0.05).Compared with active group,the morbidity of hypertension,arthritis and osteopotosis and the value of BMI index of inactive group were higher.Multiple regression analysis indicated the related main factors of the recipients' physical health and HRQOL were physical activity,time posttransplantation,BMI and the morbidity of arthritis and osteopotosis.Conclusions Physical activity is very important to maintain physical health and improve HRQOL for liver transplant recipients.

目的 探讨骨科术后肺栓塞患者的护理方法.方法 回顾并总结2008年2月至2009年11月第四军医大学西京医院收治的11例骨科术后发生急性肺栓塞患者的临床资料.结果 经医护人员精心治疗与护理,11例患者中9例患者治愈出院,2例患者好转出院,无一例患者发生严重并发症.结论 护理人员应加强对骨科术后患者的病情观察,对肺栓塞做到早预防、早诊断、早治疗,以降低肺栓塞患者的病死率.

2007年6月23日,我院成功为一位13岁女孩实施异位辅助性活体肝部分移植术.移植的肝脏功能良好,创新术式增加了手术的安全性,为先天性代谢性肝病和急重肝病治疗提供了新的思路和方法.现将护理体会报告如下.

1临床资料 2002-10/2004-10,我院共完成断指再植手术350例,计464指. 其中,术后发生血管危象28指,经过密切观察,妥善处理,成活23指,成活率为85%. 血管危象的判断: 血管危象分为动脉危象和静脉危象. 动脉危象又分为动脉痉挛和动脉栓塞. 因静脉血管平滑肌少,很少会发生血管痉挛,故静脉危象多为静脉栓塞. 动脉危象的表现: 再植指肤色苍白或呈浅灰色,皮温下降,指腹张力下降,指压充血反应不明显,指端皮肤小切口出血. 微型超声Doppler检查不到血流声. 静脉栓塞表现: 再植指肤色暗红、发紫,起水泡,早期指端小切口溢出暗紫色血液,无指充血反映. 皮肤张力增高,皮温逐渐下降,超声 Doppler检查时声音减弱至消失.