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     

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。     

腹股沟疝日间手术经验和注意事项

国内外报道腹股沟疝日间手术已经多年[1-3],但是国内目前腹股沟疝日间手术状况与国际先进水平相比,无论是在普及程度,还是运行机制等方面有很大差距.究其原因与对腹股沟疝日间手术理念不了解,日间手术如何运作及应注意什么等问题不清楚有关.下面结合我们多年腹股沟疝日间手术的实践经验介绍一些体会.     

机器人胸外科日间手术的围手术期护理

目的:探索机器人辅助胸外科日间手术模式的临床护理实践。方法:回顾性分析2020年12月—2021年6月中南大学湘雅医院接受机器人辅助胸外科日间手术22例患者的病例资料,统计患者的一般资料、术中出血量、住院时间、胸腔引流管留置时间、术后并发症、住院费用等资料,总结机器人辅助外科部日间手术的护理经验。结果:22例患者中,住院时间为(51.69±16.54)h,术后留院时间为(30.00±11.98)h,术中出血量为(61.05±26.00)ml,胸腔引流管留置时间平均为(1.41±0.59)d,住院期间总费用为(70193.99±7940.05)元,转科1例,非计划性再入院1例。结论:在机器人胸外科日间手术的围手术期中实行全程精细化护理可缩短患者的住院时间,降低医疗费用,且可保障医疗质量及安全。     

Regional techniques for pediatric day surgery

Regional blocks provide effective pain relief in pediatric day surgery, but local anesthetics are part of a concept that also includes nonsteroidal anti-inflammatory drugs. The choice of the regional technique is crucial to avoid unnecessary motor blockade and other side effects leading to prolonged hospital stay. For many interventions simple wound infiltration is therefore the optimal choice. For inguinal incisions, caudal anesthesia with approximately 1 mL/kg of bupivacaine 0.125% with epinephrine or ilioinguinal nerve block is widely used. Although ilioinguinal nerve block is preferable in older children, caudal anesthesia seems preferable for infants and toddlers. For penile surgery, penile block is the gold standard; the subpubic technique is described in detail. For extremity procedures, axillary brachial plexus block or intravenous regional anesthesia can be used in selected children. Copyright © 2000 by W.B. Saunders Company     

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.     

不插管全凭吸入七氟醚麻醉在患儿口腔日间手术的应用

目的观察不插管全凭吸入七氟醚麻醉在患儿口腔日间手术应用的效果。方法需行口腔日间手术治疗的患儿84例,男52例,女32例,年龄2～8岁,ASAⅠ级,采用随机数字表法将患儿分为两组,每组42例。七氟醚麻醉组(S组)术中不插管全凭吸入七氟醚麻醉,气管插管静脉全麻组(C组)行常规气管内插管麻醉。记录麻醉诱导时间、麻醉苏醒时间、治疗时间和达到麻醉后出院评分系统(PADSS) 12分时间;记录手术结束后15 min、30 min、1 h和2 h的离院标准评分,术中发生体动、呛咳及术后不良反应情况。结果所有患儿全部顺利完成手术,麻醉结束后2 h安全离开医院。S组麻醉诱导、苏醒时间和达到PADSS 12分时间均明显短于C组(P0.01)。S组麻醉结束后30 min、1 h和2 h的离院标准评分明显高于C组(P0.05)。无一例患儿术中发生体动或呛咳。但术后C组有13例(31%)患儿发生吞咽不适明显多于S组1例(2%)(P0.01)。结论与常规气管内插管麻醉比较,不插管全凭吸入七氟醚麻醉更适合用于患儿口腔日间手术。     

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。