甲状腺手术患者术前访视方法的改进

目的 探讨改进甲状腺手术患者术前访视的方法及效果.方法 将240例行手术治疗的甲状腺惠者随机分为观察组和对照组各120例,对照组按照常规进行术前访视,观察组由巡回护士与病房护士共同进行术前访视、心理干预及放松训练,并于术后回访.结果 两组患者入手术室20 min后焦虑评分及收缩压、心率比较,差异有显著性意义(均P<0.01);观察组因高度紧张需延迟手术及术中增加麻醉辅助用药者显著低于对照组,患者满意度显著高于对照组(P<0.05,P<0.01).结论 改进后的访视方法,能有效缓解甲状腺手术患者的术前焦虑,减少血压、心率的波动,使患者以最佳状态接受手术,提高了患者对手术室护理工作的满意度.     

甲状腺手术患者术前访视方法的改进

目的探讨改进甲状腺手术患者术前访视的方法及效果。方法将240例行手术治疗的甲状腺患者随机分为观察组和对照组各120例，对照组按照常规进行术前访视．观察组由巡回护士与病房护士共同进行术前访视、心理干预及放松训练．并于术后回访。结果两组患者入手术室20rain后焦虑评分及收缩压、心率比较．差异有显著性意义（均P〈0．01）；观察组因高度紧张需延迟手术及术中增加麻醉辅助用药者显著低于对照组。患者满意度显著高于对照组（P〈0．05．P〈0．01）。结论改进后的访视方法，能有效缓解甲状腺手术患者的术前焦虑，减少血压、心率的波动，使患者以最佳状态接受手术．提高了患者对手术室护理工作的满意度。     

术前护理访视的方法与体会

术前护理访视是手术室整体护理的重要环节,是病房整体护理的延续和补充.手术室护士通过术前访视,让病人及其亲属了解手术治疗的基本情况、围术期注意事项、手术室环境等,在一定程度上可缓解病人的心理压力,从而达到缓解压抑、焦虑的情绪,积极配合手术的目的.我院于2005年1月开展术前访视工作,4年来收到满意效果.     

术前访视对白内障手术患者焦虑状态的影响

目的 探讨术前访视对白内障手术患者焦虑的影响.方法 将101例白内障手术患者随机分为观察组(53例)和对照组(48例),观察组接受术前访视,对照组行常规术前准备及宣教,手术前1 d及术晨采用状态-特质焦虑量表(STAI)测量两组患者焦虑状况,同时测量其血压、心率.结果 观察组术晨焦虑评分、收缩压、心率显著低于对照组(P＜0.05,P＜0.01),且血压及心率波动小.结论 术前访视能有效缓解白内障手术患者术前焦虑,减少血压、心率的波动,使患者以最佳状态接受手术.     

术前访视对老年患者心理问题的影响

术前访视是从“以病人为中心”的整体护理角度出发，其目的和意义是有效地缓解患者的恐惧和紧张心理，并帮助其维持最佳的身心状态。随着人口结构的老龄化，老年手术患者逐渐增多，手术对于病人尤其是老年病人来说，无疑是一种严重的心理刺激，手术室护士只有具有敏锐的观察力、娴熟的技术、良好的沟通能力、正确的判断力，才能够将围术期老年患者的护理上升到一个新高度，     

术前心理护理访视对子宫切除患者焦虑水平的影响

目的:探讨术前心理护理访视对子宫切除患者焦虑水平的影响.方法:选择首次接受手术,择期行子宫切除术患者90例,ASAⅠ或Ⅱ级,随机等分为3组.无访视组(A组):不进行术前访视;常规访视组(B组):术前一日下午进行简单术前护理访视;心理护理访视组(C组):按照心理护理方法进行术前访视.测量并记录术前一日8时,入室后即刻及镇静吸氧后的平均动脉压(MAP)、心率(HR)、呼吸频率(RR)和脉搏血氧饱和度(SpO2)值,并行焦虑视觉模拟评分(AVAT).结果:A组和B组入室后即刻的MAP、HR、RR和AVAT值均明显高于术前基础值及C组同时值(P＜0.05或P＜0.01).在镇静吸氧后,A组和B组的MAP、HR和RR值较入室后即刺均有明显降低(P＜0.05或P＜0.01),而三组的SpO2值则均有显著升高(P＜0.01).结论:术前心理护理访视能有效降低子宫切除术患者的术前焦虑水平,既提高了护理质量,又有利于麻醉和手术的安全顺利实施.     

专职护士实施手术前后访视探讨

随着护理观念的更新,手术室护理工作不仅是以配合手术为主的单纯技术操作,而且要保证患者在生理、心理上处于满足而舒适的状态,得到完整、系统、连续的护理.术前访视是手术室整体护理的重要内容[1].我科2005年11月至2006年11月改进访视方法,应用于1 227例手术患者,取得满意的效果,现报告如下.     

多学科集中式术前访视在甲状腺手术患者的应用

目的探讨多学科集中宣教式术前访视模式应用于甲状腺手术患者的效果。方法将173例行甲状腺切除术择期手术患者按照病区分为观察组100例和对照组73例,观察组应用Delphi法确立访视内容,进行多学科集中式术前访视;对照组采取传统一对一访视模式干预。比较两组患者术前准备完善度,疼痛、焦虑评分及患者满意度。结果观察组术前准备完善率及患者满意度显著高于对照组,术后焦虑评分显著低于对照组(P0.05,P0.01)。结论通过实施多学科集中式术前访视,能有效减轻患者负性心理,提高术前准备完善率及患者满意度。     

乳癌手术患者实施心理查房的效果及评价

目的:了解乳癌患者的心理状况,采取针对性的心理疏导及护理干预,确保患者顺利配合手术.方法:回顾分析200例乳癌手术病人的不同心理状态给予相应的护理干预并进行前后评估.结果:心理状态的发生率均有下降,效果显著.结论:对乳癌手术患者进行心理疏导及护理干预,分析其相关性,有助于减轻患者的焦虑、抑郁心理,以健康平和的心态接受手术,并有利于术后康复.     

择期手术患者的术前访视

为了适应现代医学模式的发展和护理观念的转变,使患者更好地配合医师完成手术,顺利度过手术关,国内医院手术室普遍开展术前访视工作,价值已得到充分肯定.我院自实施"手术室护士术前访视制度"以来效果显著.现将方式报告如下:     

回压静脉法在静脉穿刺困难患者中的应用

目的：提高术前访视效果。方法：将112例行手术治疗的乳癌患者随机分为观察组（58例）和对照组（54例），对照组行常规访视，观察组由手术室巡回护士及病区管床护士共同进行术前访视和心理支持，并于术后回访。结果：术后1d观察组焦虑评分显著低于对照组（P＜0．01）；术后3d观察组心理状态评分及患者满意度显著优于对照组（均P＜0．01）。结论：改进后的访视方法能有效降低乳癌患者心理应激水平及焦虑水平，提高手术室护理满意度。     

The Importance of Preoperative Breast MRI for Patients Newly Diagnosed with Breast Cancer

Abstract:  The use of preoperative breast magnetic resonance imaging (bMRI) for patients newly diagnosed with breast cancer has been criticized for increasing the number of therapeutic mastectomies performed, as well as increasing the cost of treatment. The purpose of this report is to examine one surgeon's practice and to describe the MRI findings for patients with breast cancer to determine if those findings changed the therapeutic options for those patients in. Data were collected prospectively between August 2003 and January 2006 for patients newly diagnosed with breast cancer. Diagnoses were made by core biopsy or fine-needle aspiration; all lesions were intact at the time of MRI. Twenty-five percent of patients were found to have previously occult, but suspicious lesions on MRI that required additional diagnostic evaluation, including ultrasound, core biopsy, excisional biopsy, or any combination; for approximately half of these patients a separate cancer was confirmed. For most of these patients, the new lesion was ipsilateral and multicentric, and most required mastectomy. For the remaining 75% of patients, MRI confirmed the index lesion was the only area of concern, and appropriate surgical treatment was completed. Preoperative bMRI for patients newly diagnosed with breast cancer identified previously occult and separate tumors in 13% of patients, resulting in surgical treatment change for many.     

Overuse of Preoperative Staging of Patients Undergoing Neoadjuvant Chemotherapy for Breast Cancer

Annals of Surgical Oncology - Guidelines of the American Society of Clinical Oncology (ASCO), the National Comprehensive Cancer Network (NCCN), and the European Society for Medical Oncology (ESMO)...     

术前访视对老年胃癌患者心身的影响

目的 探讨术前访视对老年胃癌患者心身的影响.方法 将128例住院行择期手术的老年胃癌患者随机分为观察组和对照组各64例.对照组给予常规护理,观察组在此基础上,手术前1 d由研究者进行访视,评估患者生命体征和心理状况的变化,根据患者情况给予针对性护理,尤其注重健康教育和心理护理;手术日由研究者接入手术室后介绍手术情况和术后注意事项.结果 手术前后心率、血压比较,差异有显著性意义(均P<0.05);两组术后焦虑、抑郁评分比较,差异有统计学意义(均P<0.05);术后3 d睡眠质量、睡眠时间、睡眠效率、睡眠障碍、安眠药物、日间功能障碍、PSQI总分比较,差异有统计学意义(均P<0.01).结论 术前访视可有效减轻老年胃癌患者手术引起的应激反应,维持患者生理和心理状况的稳定.     

Improved Lymphatic Mapping Technique for Breast Cancer

Abstract: Breast sentinel lymph node biopsy is becoming more common. However, the best injection technique is not well established. Currently the gold standard is peritumoral injection. However, for upper outer quadrant tumors there is considerable axillary “shine through” which makes the identification of the radioactive sentinel lymph node difficult. We undertook a study to compare an injection in Sappey's subareolar plexus to the gold standard of peritumoral injection. Between December 1997 and March 1998, 85 patients with breast cancer were enrolled in the study. All patients were injected with 2 cc of normal saline containing 1.0 mCi of unfiltered technetium sulfur colloid in Sappey's subareolar plexus in the clock position of the breast cancer. In the operating room the patients underwent a peritumoral injection of 5 cc of 1% isosulfan blue. All blue and radioactive lymph nodes were identified and removed. The majority of the tumors were in the upper outer quadrant and were diagnosed by core biopsy. Only half of the patients had palpable tumors and approximately 25% had previous upper outer quadrant biopsy incisions. Peritumoral blue dye injection yielded an identification rate of 94%, with 99% of these being blue and radioactive. Three patients had radioactive lymph nodes with no blue lymph nodes identified. One of these patients had a micrometastasis. Injection in Sappey's subareolar plexus in the clock position of the tumor drained to the same sentinel lymph node as peritumoral injection. This injection technique solved the two major problems confronting the wide adoption of sentinel lymph node biopsy for breast cancer staging. First, it eliminates axillary “shine through” which will allow nonspecialist surgeons to more easily identify the radioactive axillary sentinel lymph node. Second, it allows for easier isotope injection by the technician or nuclear medicine physician, by eliminating the need for three-dimensional localization. This new technique should allow the majority of breast cancer patients who are treated by nonspecialist surgeons to be offered this less morbid, more accurate procedure.     

我国乳腺癌主要术式的评估

手术治疗是乳腺癌的主要治疗方法之一,其发展过程大致可划分为以外科解剖学概念为指导的和以生物学观点为指导的两个阶段。其中经过了１９世纪初的Ｈａｌｓｔｅｄ根治术、２０世纪５０年代的扩大根治术、６０年代的改良根治术和８０年代以来的保乳手术这４种主术式的演变＾〔１〕。现结合我国的具体情况就以下几种目前广泛应用于临床治疗的主要术式作一简要评述。     

Preoperative Chemotherapy Alone and Combined with Preoperative Radiotherapy in Small-Size Breast Cancer

Abstract: Breast conservation surgery is an effective and safe treatment for many breast carcinomas. It may be possible to further limit the extent of resection (or expand the indication for breast conservation) by the application of preoperative chemotherapy and radiotherapy. We explored the feasibility of this in a pilot study.
Seventy-three patients (mean age 48, 63% premenopausal) with confirmed breast cancer, less than 2.5 cm, received chemotherapy (Group A) or chemotherapy plus radiotherapy (Group B) prior to limited resection (tumorectomy). Axillary dissection was always performed. Results: In 6/31 (19%) Group A and 17/42 (40%) Group B patients the tumor was not palpable after preoperative treatment, with complete pathological remission in 1 and 3 cases respectively. Histologic grading, mitosis, cellular alteration, and cellularity evaluations indicated a consistently greater therapeutic effect with chemoradiotherapy than with chemotherapy alone.
In conclusion, radiotherapy appears useful in the preoperative treatment of breast cancer and its use in association with various drug combinations should be further explored.