目的 分析ICU脓毒性休克患者急性皮肤衰竭(Acute skin failure,ASF)的护理管理效果,为临床提供参考依据.方法 回顾性选取2021年1月-2021年12月南京医科大学附属无锡市人民医院15例ICU脓毒性休克患者,通过ASF早期评估、实施低灌注患者翻身策略、积极改善皮肤低灌注、积极处理急性皮肤衰竭危险因素、积极的营养支持、积极处理局部病理因素、提供伤口愈合环境等措施进行护理管理,分析患者ASF的护理管理效果.结果 15例ICU脓毒性休克患者中,发生ASF有6例,其中腹部3例,后枕1例,尾骶2例;经ASF护理管理干预后,5例患者完全愈合,1例患者创面好转(出现肉芽,无脓性分泌物).结论 ICU病房充斥着损害皮肤循环的因素和条件,通过合适的皮肤护理管理措施可改善脓毒性休克患者皮肤护理质量,有利于改善患者ASF结局.
重症急性胰腺炎(SAP)是临床常见急腹症,伴有全身或局部并发症的急性胰腺炎,多由长期酗酒、胆道疾病、暴饮暴食等因素诱发,主要表现为急性腹痛、发热、恶心呕吐、黄疸等症状[1,2].有研究表明,SAP患者发病时,机体处于高分解代谢及高应激状态,迅速消耗营养储备,能量消耗大,禁食禁水可导致营养不良,降低胃肠道吸收,增加并发症风险,营养支持能够补充营养,提高患者的营养支持率,但也增加了感染风险,因此,在空肠营养护理中开展科学合理的护理模式,可有效提高SAP的疗效,降低患者死亡风险,改善患者生活质量[3,4].本文就循证护理模式应用于SAP空肠营养护理进行研究,现报告如下.
重症肌无力(Myastheuia gravis,MG)是一种神经肌肉接头传递功能障碍获得性自身免疫性疾病,主要累及突触后膜乙酰胆碱受体,以部分或全身骨骼肌无力和极易疲劳为特征,通常以眼外肌麻痹为首发症状[1].肌无力危象( Myastheuia gravis cisis,MGS)是指重症肌无力患者急骤发生呼吸肌或(和)由延髓支配的肌肉严重无力,引起呼吸无力、气体交换不足、咳嗽无力,导致严重的呼吸衰竭而危及生命[2].机械通气是治疗重症肌无力危象患者重要的支持手段.
Objective To evaluate the efficacy and safety of citrate anticoagulation for continuous renal placement therapy (CRRT) in septic patients with liver dysfunction. Methods The data of septic patients who needed to CRRT and were admitted into the department of critical care medicine from January 2016 to December 2017 were enrolled in this study. Liver dysfunction was defined as Child-Turotte-Pugh (CTP) score>4. A total of fifty-six patients met the criteria. According to the patient′s actual condition, they were divided into citrate groups (29 cases) and low molecular weight heparin (LMWH) group (29 cases). Patients in LMWH group were given slow molecular weight heparin. The efficacy and safety were compared between the two groups. The filter lifetime, after treatment the activated partial thromboplastin time (APTT),hemoglobin (Hb) were compared between the two groups. Results The average filter lifetime in citrate group was (25.0±12.2) h which was longer than (13.7±4.5) h in LMWH group (t=13.17, P<0.01). The average service life of each filter was (4.2±1.9) h which was lower than (8.7± 3.6) in LMWH group (t=8.395,P<0.05). Conclusions Regional Citrate anticoagulation is a safe and effective option for CRRT in septic patients with liver dysfunction,without causing electrolyte disturbance and internal environment.
[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。
