儿童眼肌手术呕吐原因与护理对策

为探讨影响儿童眼肌手术呕吐的因素,并为预防呕吐采取针对性的护理措施,我们从1998年4月至1999年12月对107例不同麻醉方式的眼肌手术患儿进行了观察和分析,报道如下.     

儿童腹股沟疝日间手术模式的安全性和有效性

目的探讨儿童腹股沟疝日间手术模式的安全性及可行性。 方法回顾性分析2018年1月至2019年6月山东大学附属济南市中心医院收治的腹股沟疝患儿共158例,按照诊疗模式分为常规手术组患儿80例,日间手术组患儿78例。所有患儿均在全身麻醉下行腹腔镜手术,观察2组手术时间,总住院时间,术后并发症,住院费用、患儿家长及医护的满意度。 结果2组患儿均顺利完成手术,日间手术组总住院时间[（16.27±3.53）h]、住院费用[（7276.09±1599.90）元]较常规手术组[（70.40±13.48）h、（7860.43±1406.66）元]显著偏低,日间手术组医护满意度（非常满意+满意度,91.0%）、患儿家长满意度（非常满意+满意度,97.4%）较常规手术组（78.8%、87.5%）偏高,差异均有统计学意义（P<0.05）;2组手术时间、术后并发症差异无统计学意义（P>0.05）。 结论儿童腹股沟疝日间手术是一种安全有效的手术模式,可提高医护及患儿家属满意度,符合快速康复外科理念。     

宫腔镜日间手术的护理体会

<正>"日间手术(Ambulatory/Day Surgery)"是指需手术的患者于手术当日到医院施术,术后经恢复、观察后于24 h内回家[1]。妇科日间手术具有"短、平、快"的特点。宫腔镜是当代微创外科的主流技术之一,具有直观、准确、无创、术后康复快等优点,已逐步成为许多妇科疾病诊断的金标准及手术治疗的新模式[2]。2010年8月至2012年10月我科顺利完     

儿童日间手术苏醒期躁动的危险因素

目的 筛选儿童日间手术苏醒期躁动的危险因素。 方法 收集2019年1月至2019年6月在我院行日间手术患儿的病历资料。根据患儿是否发生苏醒期躁动分为躁动组和非躁动组。将单因素分析差异有统计学意义的变量进行logistic回归分析,筛选儿童日间手术苏醒期躁动的危险因素。 结果 共纳入患儿102例,其中51例发生了苏醒期躁动,发生率为50.0%。躁动组和非躁动组患儿性别比例、年龄、BMI、看护人状态焦虑评分及特质焦虑评价比较差异有统计学意义( P<0.05)。logistic回归分析结果显示：年龄是儿童日间手术苏醒期躁动发生的独立危险因素( P<0.05)。 结论 年龄是儿童日间手术苏醒期躁动发生的独立危险因素。     

腹股沟疝日间手术模式及疗效分析

目的 探讨腹股沟疝日间手术模式及疗效。 方法 回顾性分析仁济医院普外科2009年1月至2013年12月3 852例经手术治疗腹股沟疝患者的临床资料及随访结果,其中急诊手术患者予以剔除。 结果 所有患者术后均进行门诊与电话随访,随访率98.6%,随访12～60个月,平均随访时间32.6个月。日间病例组1 575例,平均手术时间(43.84±12.35)min,平均下床活动时间(1.12±0.91)d,平均恢复工作时间(5.78±1.12)d,平均住院天数(1.34±0.48)d,平均住院费用(7 546.49±2 962.57)元。择期组511例,平均手术时间(48.59±14.52)min,平均下床活动时间(2.43±1.38)d,平均恢复工作时间(7.46±2.62)d,平均住院天数(4.80±2.91)d,平均住院费用(9 165.16±4 281.83)元。两组在手术时间( P＝0.000)、平均下床活动时间( P＝0.000)、平均住院天数( P＝0.000)、平均住院费用( P＝0.000)和平均恢复工作时间( P＝0.000)上差异有统计学意义,日间组均优于择期组。择期组术后感染率及再入院率高于日间组( P＝0.000)。两组在复发率及慢性疼痛方面差异均无统计学意义。 结论 腹股沟疝行日间手术是安全可行的,并且能显著缩短住院天数,降低住院费用。     

腹腔镜胆囊切除日间手术后患者延迟出院护理对策

目的探讨日间手术腹腔镜胆囊切除患者术后延迟出院原因及护理对策。方法回顾性分析我院日间手术病房1 853例日间手术腹腔镜胆囊切除患者的临床资料,其中延迟出院患者46例,延迟出院率2.48%(46/1 853),分析其延迟出院的原因,提出护理措施。结果 46例延迟出院的原因为术后疼痛15例、恶心呕吐13例、尿潴留2例、腹腔血浆引流管9例、发热2例及患者自身因素5例。结论腹腔镜胆囊切除日间手术患者术后延迟出院与手术、麻醉及患者因素等相关.加强围术期护理干预,可预防术后并发症,降低延迟出院率,保障患者术后康复与顺利出院。     

集中式日间手术管理模式下的排班管理

目的探讨集中式日间手术管理模式下的手术排班管理方法,以提高工作效率,保证手术安全。方法在集中式日间手术管理模式下采用制度化的管理手段、信息化的手术排班方式、流程化的操作和合理的人力资源配置进行日间手术排班。结果2013年4~12月,顺利完成日间手术7 740台,日均40台,单日最高手术量61台,未发生1例差错事故。结论信息化手术排班方式能节约大量物力,减少档案的收集与调阅时间,提高管理工作效率,节约人力。合理排班和人员安排是日间手术顺利开展的前提,更是手术安全的有力保障。     

儿童腹股沟疝日间手术护理体会

儿童腹股沟疝是一种常见病,多发病,80％的患儿于出生后3个月内发病,斜疝发病率较高,约99％。现将河南省漯河疝外科医院2011年2月至2012年1月收治的1826例腹股沟疝患儿,在时间手术围手术期护理以及出院随访等方面的体会报道如下。     

儿童急性中毒原因分析及预防对策

回顾分析125例急性中毒患儿中毒原因。结果儿童自身因素、家长安全意识不强、经济文化水平低、药品市场监管力度不够是中毒的主要原因。提出需加强儿童安全监护、大力开展宣传教育、强化安全意识,以避免儿童中毒的发生。     

Validation of statistical methods to compare cancellation rates on the day of surgery

We investigated the validity of several statistical methods to monitor the cancellation of electively scheduled cases on the day of surgery: chi(2) test, Fisher's exact test, Rao and Scott test, Student's t-test, Clopper-Pearson confidence intervals, and Chen and Tipping modification of the Clopper-Pearson confidence intervals. Discrete-event computer simulation over many years was used to represent surgical suites with an unchanging cancellation rate. Because the true cancellation rate was fixed, the accuracy of the statistical methods could be determined. Cancellations caused by medical events, rare events, cases lasting longer than scheduled, and full postanesthesia or intensive care unit beds were modeled. We found that applying Student's two-sample t-test to the transformation of the numbers of cases and canceled cases from each of six 4-wk periods was valid for most conditions. We recommend that clinicians and managers use this method in their quality monitoring reports. The other methods gave inaccurate results. For example, using chi(2) or Fisher's exact test, hospitals may erroneously determine that cancellation rates have increased when they really are unchanged. Conversely, if inappropriate statistical methods are used, administrators may claim success at reducing cancellation rates when, in fact, the problem remains unresolved, affecting patients and clinicians. IMPLICATIONS: Operating room cancellation rates can be monitored statistically by considering the number of canceled and performed cases during each 4-week period, performing a transformation of each period's cancellation rate, and then applying Student's t-test. Methods such as the Fisher's exact test and {chi}2 test should be avoided for this application because they can give erroneous results.     

Parental satisfaction with pediatric day case surgery

BACKGROUND AND AIMS: Children make excellent candidates for day case surgery. Satisfaction is an important measure of the outcome. The aim of this study was to establish the degree of parental satisfaction with day-case surgery for their children. MATERIALS AND METHODS: Parents of one hundred children were questioned. They were asked to answer questions on their level of satisfaction in several areas; communication with doctors (surgeon and anesthesiologist), physical conditions, staff's care, patients' problems and 2 open ended questions. RESULTS: Parents were most satisfied with nursing care and most dissatisfied with physical conditions. Ninetyseven per-cent of parents stated that, if given a choice they would opt for day case surgery for their child again. CONCLUSIONS: There is a high rate of satisfaction with day case surgery, however, considerable effort is needed to prepare better physical conditions, better time schedule organizations, more anesthesia outpatient clinic consultations.     

Analysis of the efficacy of pediatric day surgery.

OBJECTIVES: To assess the efficacy and safety of a pediatric day surgery program and its benefits to the child and family. DESIGN: A review and analysis of prospectively gathered data. SETTING: The Children's Hospital of Eastern Ontario (CHEO), a university-affiliated pediatric centre with a referral base of 2.5 million people. PATIENTS: All children undergoing day surgery at CHEO during the 5 years between 1992 and 1997. INTERVENTIONS: All surgical procedures performed on a day surgery basis. MAIN OUTCOME MEASURES: Procedures performed, complications and unexpected admissions. RESULTS: An average of 4,899 children per year underwent surgical procedures in the ambulatory day surgery program. The 4 commonest procedures performed were myringotomy, tonsillectomy and adenoidectomy, dental procedures, and inguinal hernia repair. The majority of children were between 2 and 7 years of age. Complications were few, averaging 1.6% per year, with postoperative bleeding, primarily secondary to tonsillectomy and adenoidectomy, being the most common. None resulted in permanent disability and there were no deaths. CONCLUSIONS: Pediatric day surgery is a safe and cost-effective program that benefits the child, the family and the pediatric surgical program.     

氯胺酮复合布托啡诺静脉麻醉在小儿日间手术中的应用

目的 研究氯胺酮复合布托啡诺静脉麻醉在小儿日间手术中应用的临床效果.方法 选择美国麻醉医师协会（ASA）分级Ⅰ或Ⅱ级行腹股沟疝修补术、包皮环切术的患儿（1岁～6岁）200例,按随机数字表法分为2组（每组100例）：氯胺酮复合生理盐水组（KS组）和氯胺酮复合布托啡诺组（KB组）.KS组患儿静脉给予氯胺酮2 mg/kg复合生理盐水2 ml行麻醉诱导,KB组患儿则给予氯胺酮2 mg/kg复合2 ml含有30 μg/kg的布托啡诺,若患儿术中出现明显的体动反应,则静脉追加氯胺酮1 mg/kg.记录呼吸、血流动力学变化、苏醒时间、术后CHEOPS疼痛评分（术后即刻、术后1、2、4、8、12、24 h）和镇静评分（术后15、30、60 min）及氯胺酮用量.结果 KB组的氯胺酮用量（42.2±12.9） mg较KS组（75.0±25.3） mg明显减少;且术后平均CHEOPS评分显著降低、术后镇静评分显著较高;麻醉后复苏室内苏醒时间显著延长（P ＜0.05）,但并不延长出室时间.两组患儿的呼吸与血流动力指标差异无统计学意义.结论 氯胺酮复合布托啡诺静脉麻醉能够安全应用于小儿日间手术,减少大剂量氯胺酮所致的副作用,又可以提供较为完善的镇痛与镇静作用,减少小儿苏醒期躁动的发生.     

Parents’ understanding of and compliance with fasting instruction for pediatric day case surgery

Objective: To determine whether parents understand and adhere to preoperative fasting instructions. Aim: To identify how we may reduce perioperative morbidity relating to failure to fast. Background: Children are routinely fasted preoperatively with the aim of reducing the risk of aspiration of gastric contents and its sequelae. Methods: Parents of children on the day case ward following elective surgery completed a survey asking: (i) For how long was your child asked to fast? (ii) How long did you ensure your child was fasted of food and clear fluids? (iii) What do you think is the purpose of fasting? We also asked the parents to complete a checklist of items they thought acceptable to consume when fasting. Results: Despite affirming fasting status in the preoperative check, 13.5% were not fasted. Parents reported advised fasting times of 1–24 h (median 6) for solids and 0.5–24 h (median 3) for fluids. Children were fasted of solids for 3–40 h (median 9.5) and of fluids for 0.5–24 h (median 5). Regarding the understanding of fasting, 9 referred to aspiration and 53 to the prevention of nausea or vomiting. Thirteen believed that fasting status altered the efficacy of anesthesia. During the fasting period, 4.9% would allow French fries, 22.3% toast/crackers, 17.5% cereal, 14.7% a sweet, 14.9% gum, and 12.6% tea with milk. Conclusions: Children we believe to be fasted may not be. Parents may deliberately misrepresent the actual fasting status of their child. Adherence to fasting advice may be affected by parents’ recall and understanding of fasting advice.     

腹腔镜腹股沟疝修补术日间手术模式的临床效益评价

目的比较日间手术模式和住院手术模式在腹腔镜腹股沟疝修补术的临床效益。方法选取2017年1~12月昆明医科大学第二附属医院就诊的120例单侧腹股沟疝患者作为研究对象。将所有患者按照随机数字表法随机分成日间手术模式组和住院手术模式组,各60例。观察2组患者的手术时间、术中出血量、术后下床活动时间、尿潴留发生率、阴囊积液发生率、异物感发生率、总并发症发生率、医疗费用及满意度。结果所有患者均顺利完成手术,半年随访期内无复发。日间手术模式组与住院手术模式组患者的手术时间、术中出血量、术后下床活动时间、尿潴留发生率、阴囊积液发生率、异物感发生率、总并发症发生率比较,差异均无统计学意义(P>0.05)。日间手术组患者住院时间要明显比住院手术组患者短,日间手术组患者总住院费比住院手术组患者低,日间手术组患者对治疗过程满意程度明显高于对照组患者,差异均有统计学意义(P<0.05)。结论日间手术模式下行腹腔镜腹股沟疝修补术安全有效,且可降低总费用,加快周转率,提高了医疗资源的利用率,提高了患者的满意度。     

儿科静脉输液不良事件原因分析及护理对策

目的分析小儿静脉输液不良事件发生的相关因素,制定防范措施,提高患儿输液安全。方法回顾我院儿科40例次静脉输液不良事件的类别、时间及护理人员情况,分析其发生原因,并提出护理对策。结果 40例次静脉输液不良事件发生原因依次为护理人员查对不严、责任心不强、业务素质差、环境嘈杂;发生时间主要为白天治疗比较集中时和中夜班时段;多发生于实习生、新入科护士及工作5年内人员中。结论严格执行查对和临床教学制度,对实习生、低年资护士进行个性化、规范化培训,是降低不良事件发生的根本措施;科室改革排班模式,按照患者需求进行弹性排班是降低不良事件发生的有效途径。     

Economics and policy of day surgery

With advances in technology, day surgery has become more efficient and has expanded remarkably due to the policies and economic incentives in some countries. In addition, day surgery could potentially serve as a model of explicit accountability for quality assurance and institutional processes for continuous improvement. It is recommended that Japan adapt its policies and systems to facilitate day surgery after a thorough analysis of the health effects and cost structure. Cost shifts to other services and parties should be considered carefully from a long-term, comprehensive perspective. It could be socially beneficial to subsidize start-up costs for the establishment of day surgery units, since significant capital and human resources are required for quality assurance. The encouragement of day surgery could be a driving force for the improvement of clinical technology and patient quality of life. It would foster collaboration between health service providers, including during preparation and follow-up, and allow patients to participate as partners in clinical processes and decisions. To ensure constant readiness, day surgery environments should be equipped with multisite, standardized databases on clinical and economic performance. An expansion of day surgery facilities could lead to the development of a new mechanism of professional quality improvement and to a new health insurance reimbursement system based on clinical achievements and resources.