总结1例重度烧爆伤并发难治性胃瘫患者的护理经验.护理重点为严格的烧伤创面管理,严密监测腹部情况,及时予胃液回输和营养支持,注重感染的防控,同时通过调节室温和悬浮床温度维持患者体温.经治疗和护理,患者病情稳定,烧伤皮肤恢复良好,胃肠功能恢复,康复出院.

淹溺是较常见的意外事故,是世界各地非故意伤害死亡的第三大原因,占所有与伤害有关死亡的7％[1]. 淹溺患者由于大量液体吸入气管进入肺组织,影响肺通气和换气功能,可短时间内对呼吸道造成严重损伤,引起急性肺水肿、吸入性肺炎甚至急性呼吸窘迫综合征( Acute Respiratory Distress Syndrome, ARDS).

大疱性类天疱疮是指慢性泛发性自身免疫性表皮下大疱病,好发于50岁以上中老年人,在外观正常或有红斑的皮肤上出现张力性大疱,疱壁厚不易破,可有血疱,若治疗不及时,可因继发感染导致死亡. 目前尚无有效的根治方法,常需大量使用糖皮质激素治疗数月至数年. 糖皮质激素是一类具有抗炎、免疫抑制等作用的甾体激素,长期使用会诱发或加重感染、皮肤变薄易破、伤口愈合延缓. 本科室于2018年6月收治了1名大疱性类天疱疮继发重症肺炎的患者,由于肺部感染严重,病情危重且进展快,治疗多,操作频繁,加之患者长期使用糖皮质激素治疗后皮肤条件差,极易引发医用粘胶相关性皮肤损伤. 治疗过程中抗生素的使用导致患者肠道菌群失调,出现严重腹泻,容易导致失禁性皮炎的发生. 同时入科室因为疾病的原因发生大面积的皮肤损伤,需要有针对性的护理. 现就该患者的护理作以下汇报.

随着本院血液净化中心的不断发展,对中心的库房建设提出了新的要求.使库房摆脱仅仅是耗材中转站的角色,建立一个真正意义上的二级库房.如何建设二级库房,需要我们在制度上进行规范化管理,做到管理精细化,同时,大力加强数字化建设,从安全、成本、时效等方面助力本院血液净化中心的进一步发展.

<正>血液透析是终末期肾衰竭患者最安全、最有效的维持性治疗方法,近年来随着医疗事业的发展,血液透析治疗得到了广泛的开展[1]。在血液透析治疗中,虽然对具体的上下机等操作有了比较详细的规范,但是在实际操作中还是会遇到一些问题,特别是对一些规范未提及的方面,常会因细节被忽视而影响透析质量甚至透析安全。本文结合浙江大学附属第一医院血液净化中心的实际

Objective To explore the effect of upgrade of dialysate quality on the microinflammation in maintenance haemodialysis (MHD) patients. Methods Fifty-three MHD patients in Kidney Center of the First Affiliated Hospital,Medical College,Zhejiang University in January 2003 were enrolled in the prospectively study.The main end-points were survival at 8 years or weaning from haemodialysis during 8-year period including death, receiving renal transplantation or transferring to peritoneal dialysis.The endotoxin level of dialysate and patients' serum levels of interleukin-6 (IL-6),tumor necrosis factor α (TNF-α),C reaction protein (CRP),and albumin were recorded during the observation period. Results After the upgrade of water management system,endotoxin level of dialysate obviously decreased [(0.046±0.012) EU/ml vs (0.454±0.002) EU/ml,P＜0.01],and serum IL-6 [(3.947±3.624) ng/L vs (13.779±7.106) ng/L,P=0.036],TNF-α [(7.935±3.864) ng/L vs (12.804±8.017) ng/L,P=0.012] as well as CRP [(0.194±0.149) mg/L vs (0.561 ±0.309) mg/L,P＜0.01] decreased significantly,while serum albumin increased [(41.900±6.803) g/L vs (38.140±7.083) g/L,P=0.042].Hemoglobin level did not change significantly after the system upgrade,however,the dose of erythropoietin decreased [(93.0±12.7) U·kg-1·week-1 vs (131.0±10.1) U·kg-1·week-1,P=0.015]. Conclusions The upgrade of central dialysis fluid delivery and water management system by application of double reverse osmosis,high frequency heat disinfection and endotoxin filter can improve the quality of dialysate.Improvement of dialysate quality can ameliorate the microinflammation state of MHD patients.