目的 探讨不同穿刺法对维持性血液透析患者自体动静脉内瘘的功能状态情况.方法 随机选择2019年5月—2021年5月在福建中医药大学附属第二人民医院透析室进行透析的维持性血液透析患者60例,随机分为向心穿刺组(采用向心穿刺法)及离心穿刺组(采用离心穿刺法),每组30例.比较两组患者一次穿刺成功率,穿刺点渗血率,疼痛程度,穿刺2个月后动静脉内瘘的功能状态和4个月内并发症的发生率.结果向心穿刺组的一次穿刺成功率、穿刺点渗血率、疼痛程度优于离心穿刺组,差异有统计学意义(P<0.05).向心穿刺组患者的动静脉内瘘功能正常者占93.33％,高于离心穿刺组的70.00％,差异有统计学意义(χ2=5.455,P=0.020).向心穿刺组动脉瘤、内瘘狭窄、内瘘阻塞的动静脉内瘘并发症发生率低于离心穿刺组,差异有统计学意义(P<0.05).结论 向心穿刺法易操作,不易出血,穿刺点渗血率低,疼痛程度低,长期使用内瘘功能状态良好,并发症概率要较离心穿刺法低,适合维持性血压透析患者自体动静脉内瘘穿刺.

Objective To explore the application effect of phased teaching in nursing teaching in the operating room.Methods From January to June 2022,a total of 60 nursing students who interned in the operating room of the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine were selected as research subjects and divided into two groups using a random number table method.The control group was given routine teaching,while the observation group was taught in phased.The assessment of theoretical knowledge,basic operational skills,and specialized operational skills,as well as the effectiveness of nursing teaching,critical thinking ability,emergency response ability,and satisfaction with teaching plans were compared between two groups of nursing students.Result After the teaching was completed,the students in observation group showed higher scores in theoretical knowledge,basic operational skills,and specialized operational skills compared to the control group,with statistically significant differences(P<0.001).The students in observation group had a higher nursing teaching effect score(basic job responsibilities and process mastery,common intraoperative nursing points mastery,proficiency in common intraoperative operation cooperation,aseptic concept,risk awareness and occupational protection awareness)than the control group,and the difference was statistically significant(P<0.001).The students in observation group scored higher in critical thinking skills in nursing(cognitive maturity,systematization,self-confidence,open-mindedness,analytical ability,thirst for knowledge,and seeking truth)compared to the control group,with a statistically significant difference(P<0.001);The emergency response ability(emergency handling,surgical cooperation,emergency cooperation,and condition observation)scores of students in observation group were higher than those of the control group,and the difference was statistically significant(P<0.001).The satisfaction with the teaching plan of the students in observation group was higher than that of the control group,and the difference was statistically significant(P<0.05).Conclusion The phased teaching in the nursing teaching in the operating room has a significant effect,which can effectively improve the theoretical knowledge,basic operating skills,and professional operating skills of nursing students.Critical thinking ability and emergency response ability have been significantly improved.The nursing program has been unanimously recognized by nursing students.

新时期外科技术高速发展,医学模式不断变革,促进临床带教工作也逐渐向新的阶段发展.对手术室而言,手术室是医院重要科室之一,手术室集急、危、重症患者为一体,其专业性突出,且对无菌概念的要求,高于其他科室.除此之外,手术室的突发事件较多,且渗透到各式各样的边缘学科中,手术的种类较多,且病情复杂.对于手术室的护理教学而言,其护理内容较为挂件,是护理临床教学的重点,因此,医学的发展对手术室的护理带教提出更严格的要求.信息时代背景下,教学条件及电子技术不断发展,医学方面的教育技术研究不断深入,传统的上课及操作示范教学已然无法满足医学生实习要求,为适应将来护理教育更好发展,为社会输送更多专业性突出的综合性护理人才,下文就探讨将多种教学模式都融入到教学中的临床带教模式,将多种有效的教学模式应用到手术室护理带教中,大大提高实习生手术室护理中的实践操作水平、思维能力、灵活应变能力及综合素质,满足医院发展对专项护理人才的需求.

明天就要做手术,主管医生交代完相关事项,患者依然有许多疑虑和忐忑.以下6个问题,可帮助患者充分理解和配合,减轻术前焦虑,让手术更有序顺利地进行. 问题一: 手术前为何要禁饮食 术前禁饮禁食的目的,是为了防止胃内容物反流误吸.