浅谈手术室护理带教

现代手术室护理工作改变了传统手术室护理工作模式,从单纯的手术配合扩展到围术期的全面整体护理,手术室护士走人病房,为患者提供术前指导、术中配合及术后回访等“以人为本”的全方位护理服务。在护理实习生带教方面,也必须将整体护理观念贯穿于带教过程中,以培养出符合现代化医院要求的护理人才。     

探讨整体护理在手术室的应用

随着＂以疾病为中心＂的功能制护理逐步向＂以病人为中心＂的整体护理模式的转变,整体护理的概念由模式病房向手术室拓展。整体护理要求手术室的护理工作不仅局限于手术室内,而应包括从患者入院、接受手术以及麻醉苏醒期直至出院的全过程。手术室整体护理的开展密切了护患关系,有利于患者的手术配合及术后康复,提高了患者对护理工作的满意度。手术室作为外科治病救人的一个不可或缺的场所,以及手术室本身的特殊性决定了手术室护理更需要有一个整体的系统的护理理念。     

1例股骨干骨折术后骨不连切开复位植骨术的护理

随着社会的进步，以疾病为中心的传统护理模式正逐渐被以人为中心的现代护理模式所取代。这就要求手术室护理工作不能仅限于配合手术等单纯的技术操作，而更应注重以人为中心的手术全过程护理。手术室护理围绕手术这一特定时期针对手术和麻醉对患者造成的心理、生机功能紊乱而采取各种护理措施。因此对患者手术全过程实施人性化服务，以满足患者的需要，确保整体护理的完整性、连续性和系统性。我院实施1例股骨干骨折术后，骨不连，切开复位植骨术，现将手术护理报告如下。     

手术室护士在麻醉中的配合

随着现代护理学的不断发展,“以病人为中心”是一种新的医学模式,亦是对护理学的基本要求。现代护理学科的发展对手术室护理提出了更高的要求,手术室护理不仅仅是配合手术为主的单纯技术操作,更是在手术室的工作内容和程序中充分体现临床科室普遍实施的“以病人为中心”的整体护理。手术室是进一步完善病人整体护理的一部分,是“以病人为中心”的整体护理的体现。以术前防视、术中护理及术后随访来适应和满足病人要求,确保整体护理的连续性、完整性和系统性。1术前护理1·1术前访视术前访视是整体护理的一个重要组成部分,是生理、心理医学模…     

浅谈围术期整体护理

医学模式的发展和护理服务理念的转变极大地推动了手术室整体护理的进程，改变了传统的机械地配合完成手术的护理模式，由单纯的手术配合转向围术期护理。近年来，我院施行了包括术前访视、术中配合、术后随访3个环节的围术期整体护理工作模式，取得了良好的成果。     

浅谈手术室开展整体护理的做法及体会

随着医学模式的转变 ,护理模式已由传统的“以疾病为中心”逐渐转变为“以病人为中心”的整体护理。手术室护理工作也在不断地拓宽和充实 ,由单纯以配合手术为主的以疾病为中心的护理向以病人为中心 ,对病人实施多元化、多层次的护理 ,以满足病人的需要 ,解决病人的身心健康问题为内容的整体护理方向发展。为了使手术室工作适应新的护理模式 ,进一步提高手术成功率 ,我们运用护理程序对手术病人实施了包括手术前、手术中、手术后的整体护理 ,受到病人的一致好评。现将实施方法及体会介绍如下。1　实施方法　　手术室收到次日手术通知单后 ,…     

谈手术患者术前术后访视的心理护理

在科学技术发展的今天，医护工作也发生了深刻的变化，以“疾病为中心”的传统护理模式正逐渐被“以人为中心”的现代护理模式所取代，更加注重人的心理因素、环境因素和预防保健。为了提高患者对护理工作的满意度，减少医患纠纷，护士应该更新观念，立足于以人为本，突出护理工作“服务”的特点，为此手术室开展了以人文主义为首的术前术后访视工作，强化优质服务，不断提高护理人员的服务意识、服务态度、服务技能、服务效率，力争让手术患者得到最好、最全面的服务，从而取得了患者的欢迎和认可。     

舒适护理在手术室的应用

随着现代医学护理模式的转变，手术室的护理不再是单纯的配合手术步骤的完成，而是注重“以人为本，以患者为中心。”的手术全过程的整体护理。舒适护理模式又称“萧氏双C护理模式”，是台湾华杏出版机构总裁萧丰富先生于1998年提出的，其目的是使患者在生理、心理、灵性、社会上达到最愉快的状态或缩短降低其不愉快的程度。为了解除手术患者术前恐惧心理，改善其心理状态，减少术中的不舒适感，促进患者术后恢复，通过开展舒适护理，我院手术室自2005年将舒适护理与整体护理相结合，取得良好效果。这样既保证了手术安全、高效、顺利通过，为患者康复创造最优良的条件，也进一步提高了护理的服务质量。     

烧伤患者的围手术期整体护理

随着医学模式的转变,新的医学模式“以病人为中心”的整体护理是我国护理学科上的又一次改革,只有从实际出发,提高护理质量,改善服务态度,建立术前一术中一术后一条龙服务,才能将“以病人为中心”的整体护理落到实处。经过1年对282例手术患者的围手术期整体护理,不但提高了手术患者的痊愈率,而且提高了手术室的护理质量。     

手术室开展优质护理服务的实践与体会

优质护理服务是为了提高我国整体护理质量,卫生部对护理人员提出的新要求。这项活动以患者满意、社会满意、政府满意为目标[卫生部．优质护理服务示范工程活动方案,2010．]。本文就手术室开展优质护理服务的实践,从术前访视实施方法、手术时的细心护理、进行术后回访三方面进行阐述,对其进行了效果分析。手术室通过开展优质护理服务,更新了护理人员的服务理念,变被动服务为主动服务,使手术室护理不再是简单的器械传递、操作配合,从而丰富了工作内涵,体现了“以病人为中心”的“人性化服务”理念,提高了患者的满意度。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.