术前护理专案在降低术后获得性压力性损伤的作用

目的 对骨科手术患者实施术前护理专案干预，分析在获得性压力性损伤发生率中的作用。方法 选取医院2021年1月至2022年12月本院收治的行手术治疗患者78例，术前实施护理专案干预活动，将其作为观察组；另选取医院同期骨科收治的行手术治疗患者78例，术前实施常规护理干预，将其作为对照组。对两组压力性损伤发生情况、患者满意度情况及护理人员压力性损伤预防专业能力进行统计比较。结果 在获得性压力性损伤发生率及损伤程度方面，观察组发生率5.1%与对照组发生率17.9%比较显著降低（P<0.05）；在满意度方面，观察组患者总满意度97.4%与对照组总满意度79.5%比较显著提高（P<0.05）；在预防专业能力方面，观察组护理人员压力性损伤预防理论知识及操作技能评分均显著高于对照组（P<0.05）。结论 对骨科手术患者实施术前护理专案干预，能够显著降低患者获得性压力性损伤发生率及严重程度，可显著提升患者护理满意度；可提高护理人员压力性损伤预防专业能力，值得临床进一步应用推广。     

神经外科患者术中获得性压力性损伤的多学科团队链式管理

目的 探讨多学科团队链式管理在预防神经外科术中获得性压力性损伤中的效果.方法 将2019年1～10月神经外科患者作为对照组,实施常规的术中获得性压力性损伤管理;2019年11月至2020年9月患者作为干预组,实施包括成立多学科围术期术中获得性压力性损伤链式管理小组、优化临床路径、行跨学科交接班链式管理.结果 干预组高危手术体位安置规范率、术中防护措施达标率显著高于对照组(均P＜0.01);术中获得性压力性损伤发生率显著低于对照组(P＜0.01).结论 多学科团队链式管理能有效促进术中获得性压力性损伤闭环措施落实,降低神经外科术中压力性损伤发生率.     

多学科团队合作预防脊柱后入路手术患者术中压力性损伤

目的探讨多学科团队合作预防脊柱后入路手术患者术中压力性损伤的效果。方法选取2016年1～6月行脊柱后入路手术患者655例作为对照组,2017年1～6月656例作为观察组。对照组采用常规术中压力性损伤防护管理方法,观察组实施多学科团队合作的术中压力性损伤预防管理干预。结果对照组发生术中压力性损伤9例(15处,发生率为1.37%),观察组发生2例(3处,发生率为0.30%),两组比较,差异有统计学意义(P0.05)。结论实施多学科团队合作的术中压力性损伤预防管理,能有效降低脊柱后入路手术患者术中压力性损伤的发生。     

全麻俯卧位头部支撑装置的设计与应用

目的 探讨预防全麻俯卧位手术中头部压力性损伤的有效方法。方法 自行研制全麻俯卧位头部支撑装置，应用于3 515例脊柱外科手术患者（观察组），并与术中应用常规凝胶啫喱垫的3 604例患者（对照组）进行术中压力性损伤发生率的比较。结果 观察组术中压力性损伤发生率显著低于对照组（P＜0.05）。结论 俯卧位手术患者使用全麻俯卧位头部支撑装置有利于降低术中压力性损伤发生率。     

预防肝移植患者肺部感染的集束化护理管理

目的 探讨肝移植围术期预防肺部感染的集束化护理管理效果。 方法 将222例肝移植患者按住院时间分为对照组102例、观察组120例;对照组实施围术期常规护理,观察组实施预防肺部感染集束化护理管理。 结果 住院期间观察组肺部感染发生率显著低于对照组,肺部感染发生时间较对照组显著延迟（P＜0.05,P＜0.01）。观察组护理满意率高于对照组,但差异无统计学意义（P＞0.05）。 结论 实施预防肺部感染集束化护理管理可有效降低肝移植患者肺部感染发生率。     

液体石蜡油涂抹预防腰椎后路手术病人压力性损伤的效果

目的 探讨液体石蜡油在预防腰椎后路手术病人俯卧位皮肤压力性损伤中的效果。方法 选取2017年1月至2019年3月在我院行腰椎后路手术的病人300例,采用随机数字表法分为常规组、石蜡油组和液体敷料组,每组各100例。常规组采取常规俯卧位护理措施;石蜡油组在常规俯卧位护理的基础上,将液体石蜡油均匀涂抹于病人的前额、颧弓、下颌、锁骨、双前胸、髂骨、大腿根部至膝关节等受压部位;液体敷料组在上述涂抹部位采用液体敷料进行干预。记录三组病人术后皮肤受压情况,采用美国国家压力性损伤顾问小组（National Pressure Ulcer Advisory Panel, NPUAP）压力性损伤分期（2016年版）评估压力性损伤分期,比较三组病人的压力性损伤发生率。结果 术后石蜡油组和液体敷料组各有2例发生Ⅰ期压力性损伤,发生率均为2%。常规组有10例发生压力性损伤（Ⅰ期压力性损伤8例,Ⅱ期压力性损伤2例）,发生率为10%。石蜡油组和液体敷料组病人的压力性损伤发生率均显著低于常规组,组间比较差异有统计学意义（F=9.590,P＜0.05）。结论 液体石蜡油可以有效预防腰椎后路手术病人俯卧位皮肤压力性损伤的发生,是一种简单、安全、有效的方法,值得推荐。     

会阴保护方法在预防髋关节镜术中压力性损伤的应用效果

目的 对比新型泡沫敷料联合常规棉垫和单纯采用常规棉垫两种会阴保护方法预防髋关节镜术中压力性损伤的应用效果。方法 选取2017年7月至2018年7月在我科行髋关节镜手术的80例股骨髋臼撞击综合征病人,采用随机数字表法分为观察组和对照组,每组40例。观察组病人会阴部在使用手术室常规棉垫的基础上加用新型泡沫敷料预防压力性损伤,对照组病人会阴部位仅采用手术室常规棉垫预防压力性损伤。观察两组病人术后即刻、24 h和72 h的压力性损伤发生情况。结果 观察组仅术后即刻发生压力性损伤1例（2.5%）;对照组术后即刻和术后24 h共发生压力性损伤9例（22.5%）;两组压力性损伤发生情况比较,差异具有统计学意义（χ²=12.489,P=0.015）。结论 对仰卧牵引位行髋关节镜手术的病人,会阴部加用新型泡沫敷料与仅采用手术室常规棉垫相比,可有效减少术后压力性损伤的发生,对临床护理工作有一定的指导意义。     

围手术期手术患者发生压力性损伤现状及危险因素分析

目的 针对围手术期手术患者压力性损伤发生的现状及危险因素进行总结分析,旨在为压力性 损伤护理管理工作提供参考依据。方法 运用统计学工具采用单因素和多因素分析2021年8月-2022年8月在 我院进行手术的450例患者压力性损伤的发生情况及危险因素。结果 本研究共纳入450例患者,其中16例 发生压力性损伤,发生率为3.55%;单因素分析显示不同性别、术中低血压压力性损伤发生率比较,差 异无统计学意义（P＞0.05）;不同年龄、BMI、手术体位、麻醉时间、手术时间、术前压力性损伤风 险评分（waterlow）、术中出血量、手术体位固定装置、合并症、手术分类压力性损伤发生率比较, 差异有统计学意义（P＜0.05）;经变量赋值后多因素分析结果显示有9个独立性危险因素：①年龄＞ 70岁;②BMI≥27 kg/m2 ;③术中失血量＞80 ml;④术前压力性损伤评分（waterlow）＞14分;⑤麻醉时 间＞3 h;⑥手术时间＞3 h;⑦合并营养不良;⑧合并水肿;⑨手术体位固定装置。结论 受患者自身、手 术、麻醉等多方因素导致围手术期手术患者压力性损伤发生率高,应针对性开展有效的护理措施,以降低 手术室压力性损伤的发生风险。     

老年男性腹股沟疝无张力修补术后围手术期护理体会

目的探讨老年男性腹股沟疝无张力修补术后围手术期护理方法及体会。 方法选取2015年1月至2016年12月吉林大学中日联谊医院116例老年男性腹股沟疝无张力修补术患者,随机分为观察组与对照组,每组58例。对照组使用常规护理,观察组应用临床护理路径,比较2组患者术后住院时间、住院费用、并发症发生率以及对护理的满意度。 结果观察组住院时间低于对照组,差异有统计学意义（P<0.05）;观察组住院费用低于对照组,差异有统计学意义（P<0.05）;观察组并发症发生率4例（6.9%）,低于对照组19例（32.6%）,差异有统计学意义（P<0.05）;观察组护理满意度91.4%,高于对照组70.7%,差异有统计学意义（P<0.05）。 结论临床护理路径能够有效降低老年男性腹腔镜腹股沟疝无张力修补术后患者并发症发生率,缩短住院时间,降低住院费用,能够有效改善患者的预后情况。     

甲状腺术中显露喉返神经对致喉返神经损伤的影响

目的探讨甲状腺术中显露喉返神经（RLN）的手术方法以及对RLN损伤的影响。方法选取2008年12月至2010年12月行甲状腺术患者132例,设为对照组,术中未常规显露RLN;选取2011年1月至2012年12月行甲状腺术患者106例,设为观察组,术中常规显露RLN。比较两组患者的手术时间、解剖RLN所需时间,手术方式、术后病理结果及术后RLN损伤情况。结果观察组与对照组手术时间分别为（65．2±6．1）分钟、（57．8±5．6）分钟,差异具有统计学意义（P〈0．05）;其中观察组解剖RLN所需时间平均为（6．82．1）分钟。两组手术方式、术后病理结果均无统计学差异（P〉0．05）。观察组与对照组术后RLN损伤发生率分别为1．89％、6．82％,差异具有统计学意义（P〈0．05）。术后6个月．观察组与对照组RLN永久麻痹发生率分别为O．00％、5．30％,差异具有统计学意义（P〈0．05）。结论在充分掌握RLN解剖特点、熟悉手术操作技巧的基础上,术中显露RLN可有效降低甲状腺手术中RLN损伤的发生率,对预防甲状腺手术中RLN损伤具有一定的指导借鉴意义。     

FORMAL TEACHING OF BASIC SURGICAL SKILLS

Attainment of the practical skills in surgery is an integral part of surgical training. Basic skills must be mastered prior to attempting more complex tasks and bad habits leamed early are difticult to correct. A survey of advanced surgical trainees at this hospital demonstrated that skills were usually acquired during sessions in the operating theatre. often in an ad hoc manner. We report our experience in establishing a workshop-based skills course. The programme included handling of instruments. knot tying, types and applications of needles and suture materials, wound care, ligation of vessels, and assisting at operation. Following completion of the course and demonstration of their competence, participants were awarded a certificate in basic skills. Participants reported increased confidence and involvement in operative surgery after the course and it increased interest in a career in surgery. We believe the intern year is the most appropriate time to teach such skills, but tuition need not be restricted to this group. Teaching basic surgical skills in the workshop setting is both feasible and advantageous.     

Acquiring surgical skills: the history of surgical teaching at the University of Sydney 1883–2014

There have been at least 10 major revisions of the medical curriculum since the inauguration of the Faculty of Medicine at the University of Sydney in 1883. This study traced the evolution of the teaching of surgery at our institution by examination of the set curriculum of each period; the expectations of student knowledge in the final examination as well as examining some of the insights provided by past students of their surgical experience through their writings. In the early years, medical graduates were qualified to perform operative surgery without any further training, whereas the modern postgraduate medical curriculum provides students with the basis for further surgical training.     

Surgical Revolutions

Many surgical revolutions distinguish the history and evolution of surgery. They come in different sizes and exert a variable effect on the development and practice of the discipline.

As science and technology rapidly evolve, so too does the creation of new paradigms, ideas and innovations or discoveries for the improvement of the surgical sciences.

Surgical revolutions are not new, and have existed for centuries even though they have been more frequently recognized since the middle of the 19th century, 20th century and down to the present.

Surgical revolutionaries are indispensable in the conception and completion of any surgical revolution. However, scientific and technological advances have supported the culmination of each revolution.     

A simple method for irrigation and drainage in neurosurgery

Summary A simple, inexpensive method for drainage of neurosurgical wounds, coupled with continuous irrigation, is described. Obstruction of the drain is effectively prevented with this method.     

Glove and instrument changing to prevent bacterial contamination in infected wound debridement and closure procedures: A prospective observational study

Many surgeons use a single table of instruments for both excisional debridement and coverage/closure of infected wounds. This study investigates the effectiveness of a two‐table set‐up of sterile instruments, in addition to glove exchange, to reduce instrument cross‐contamination during these procedures. This is a prospective, single‐site, institutional review board‐approved observational study of surgical debridements of infected wounds over a 17‐month period. Two separate sterile surgical tables were used for each case: Table A for initial wound debridement (debridement set‐up) and Table B for wound coverage/closure (clean set‐up). Swabs of each table and its respective instruments were taken after debridement but prior to coverage/closure. The primary outcome of interest was bacterial growth at 48 hours. There were 72 surgical cases included in this study. Culture results of Table A demonstrated bacterial growth in 23 of 72 (32%) cases at 48 hours compared with 5of 72 (7%) from Table B (P = .001). These data suggest that there is significant bacterial contamination of surgical instruments used for debridement of infected wounds. Use of a two‐table set‐up reduced instrument cross‐contamination by 78%, suggesting avoidable re‐contamination of the wound.     

How will the introduction of surgical care practitioners affect future surgical training and practice?

Surgical care practitioners (SCPs) are defined as non-medical members of the surgical team who perform surgical intervention, pre-operative and postoperative care after completing a Royal College of Surgeons accredited course. Their role across the modern day National Health Service is becoming more significant due to rising waiting times and the European Working Time Directive placing restrictions on the number of hours worked by surgical trainees. The change in consent law after the judgement of Montgomery versus Lanarkshire Health Board means SCPs can play a vital role in enabling a more individualized and effective consent process, whilst evidence suggests their contribution can reduce waiting times and improve continuity of care. However, concern may arise in the future if surgical trainees see their operating exposure significantly cut due to SCPs being granted-consultant supervised elective lists. Clear guidelines are therefore necessary at local and national level to protect surgical trainees' learning opportunities in theatre and to ensure SCPs achieve their ultimate goal of improved patient care.     

巨大甲状腺肿瘤83例外科治疗分析

目的评价巨大甲状腺肿瘤外科治疗的临床合理性与安全性。方法回顾性分析1985年1月～1999年6月收治83例巨大甲状腺肿瘤外科治疗的临床资料。结果83例巨大甲状腺肿瘤经术后病理组织学证实良性肿瘤56例．恶性肿瘤27例；83例均获随访，随访时间为6个月～10年，其中良性病变56例均存活无复发，恶性病变27例5年生存率达96％（26／27），10年生存率达88％（24／27）。结论外科手术切除是治疗巨大甲状腺肿瘤可靠有效的治疗手段，手术力求术野清楚，操作细柔，防止意外出血，保证手术安全，减少术后并发症的发生。