NICU 8例留置尿管患者非计划性拔管的原因分析及对策

目的通过回顾性分析神经外科重症监护室患者留置尿管发生非计划性拔管的特征,分析危险因素,提出针对性的护理对策,减少尿管非计划性拔管的发生。方法收集2012年1月至2014年12月本科重症监护室留置尿管发生非计划性拔管8例患者的病历资料,统计其年龄、性别、诊断、患者的意识状态、拔管的方式、责任护士的资历、有无有效约束、镇静情况、发生意外拔管的时间、拔管后尿道的情况等,计算构成比。结果临床特征中男性患者、意识障碍者、脑出血患者拔管率高;医源性特征中,低年资护士当班、因约束无效、未进行有效镇静处理时发生拔管率高。结论神经外科重症监护室患者留置尿管非计划性拔管的发生率高,危害性大。医护人员应注重有效的护患沟通,有效地加强导管固定,及时有效地评估约束的有效性,正确合理地应用镇静镇痛药物,加强重点人群及高危时段的管理,切实有效地降低尿管非计划性拔管事件发生率,减少对患者的二次伤害。     

新生儿留置胃管非计划性拔管的相关危险因素分析

目的:对新生儿留置胃管非计划性拔管的相关危险因素进行分析,为降低新生儿非计划性拔管发生率提供依据。方法:使用自行设计的非计划拔管登记表,对2017年11月～2018年11月收治的150例留置胃管新生儿进行调查。结果:150例留置胃管新生儿中,发生非计划性拔管30例,未发生非计划性拔管120例,非计划性拔管的发生率为20.00%;普通导管固定、未使用镇静剂、无肢体约束、护士未接受相关知识培训、护士工作年限5年是新生儿发生留置胃管非计划性拔管的影响因素,P0.05。结论:新生儿留置胃管非计划性拔管的发生因素主要包括普通导管固定、未使用镇静剂、无肢体约束、护士未接受相关知识培训、护士工作年限5年,所以,应加强护士相关知识的培训,规范导管固定方式,并予以必要的肢体约束,合理地使用镇静剂等,从而有效预防新生儿留置胃管非计划性拔管的发生。     

外科病人非计划性拔管的原因和防范措施

[目的]分析肝胆胰外科置管病人非计划性拔管的原因,提出有效的防范措施。[方法]对12例肝胆胰外科病人非计划性拔管的临床资料进行回顾性分析。[结果]发生非计划性拔管与病人、医护人员、导管因素有关。[结论]非计划性拔管的发生多因病人舒适度改变、护理安全风险评估和护理措施不到位、健康宣教缺乏而造成,故应提高病人的舒适度,加强对护士的培训,提高护士的风险预见能力,做好心理护理,妥善固定。     

预防新生儿气管插管非计划性拔管的护理进展

综述新生儿非计划性拔管的具体原因,包括约束不当、气管导管固定不牢固、医护间缺乏沟通、镇静目标不明确、操作不规范、医护人员工作时间和人力配置安排不合理等。认为采取合理、有效的约束措施、选择适当有效的固定方法、合理使用镇静剂、健全新生儿气管插管的护理常规、实施预见性护理、加强护士风险意识教育及采用综合护理方法可降低非计划性拔管不良事件的发生率,保证患儿生命安全,提高患儿生活质量。     

心血管外科ICU患者非计划性拔管的因素分析与防范

目的:分析心血管外科ICU非计划性拔管的相关因素,提出防范措施,以确保ICU患者的生命安全。方法:回顾性分析心脏外科手术后患者发生非计划性拔管的护理资料。结果:非计划性拔管的发生与患者的年龄、镇静及导管的种类、固定、约束等因素有关。结论:非计划性拔管的发生存在着主客观多方面的因素,其危害性很大。护理人员应充分了解导致非计划性拔管的相关因素,寻求有效的防范措施,才能保障患者的生命安全。     

成人气管插管患者发生非计划性拔管危险因素的系统评价

目的系统评价成人气管插管患者发生非计划性拔管的危险因素,为临床非计划性拔管的评估和干预提供依据。方法计算机检索Cochrane、PubMed、CBM、中国知网(CNKI)、万方等数据库。纳入关于成人气管插管患者发生非计划性拔管的危险因素研究的中英文文献,采用美国约翰霍普金斯证据等级与质量评价标准对相关文献等级与质量进行评价。结果共纳入49篇有关成人气管插管患者发生非计划性拔管的危险因素文献,其中IB级1篇、ⅡA级1篇、ⅡB级6篇、ⅢA级30篇、ⅢB级7篇、IVA级4篇。危险因素:患者相关的危险因素有躁动/谵妄、意识水平、疾病种类和严重程度、其他因素(急性生理与慢性健康评分、男性)等;护理相关的危险因素有气管导管的固定方法、床边监测减少、护理操作程序、护患比例及护士经验;镇静相关的危险因素有镇静不充分、镇静药物;身体约束具的使用和发生非计划性拔管的高危时间段。结论通过系统评价形成的成人气管插管患者发生非计划性拔管的危险因素具有一定科学性和合理性,但需要进一步完善。     

胃管非计划性拔管的相关因素及护理对策

分析汇总了胃管非计划性拔管的相关因素,包括患者舒适度改变,谵妄、躁动,胃管固定不牢固,未正确约束以及护士年资低,缺乏专业培训等方面。通过有效评估、镇静、约束、固定,加强护理人员培训等措施可预防和减少非计划性拔管的发生。     

ICU患者非计划拔管的高危因素及预见性护理

目的探讨ICU患者产生非计划拔管的高危因素,做好预见性护理措施,减少非计划性拔管的发生,保障患者生命安全.方法通过回顾性分析本院2008年4月~2010年6月期间36例患者发生非计划性拔管的临床资料,分析导致非计划性拔管的原因,评估非计划性拔管的风险,并采取有效的干预措施,保证患者置管安全.结果36例非计划性拔管的发生与患者自身身体状况、医护人员因素、导管因素、药物因素等诸多因素有关.结论通过对护理人员相关知识的培训,有效固定导管,对患者行必要的肢体约束、合理使用镇静剂等措施能够有效地降低非计划性拔管的发生.     

儿童重症监护室非计划性拔管现状调查及分析

目的描述非计划性拔管在儿童重症监护室的现状及原因。方法2008年1—12月上海某三级甲等儿科医院中3个重症监护室发生非计划性拔管的患儿共21例,根据意外事件报告单,对发生非计划性拔管的原因进行系统分析。结果患儿的年龄、患儿身体约束不当、镇静不足、胶布固定无效和护理人力不足是造成患儿非计划性拔管的高危因素。结论非计划性拔管率是重症监护质量的重要指标,建立一套有效的预防非计划性拔管标准包括有效约束、有效胶布固定、有效的镇静,合理护理人力配置以及提高护士的评估能力将有助于降低非计划性拔管发生率,提升重症监护室的护理品质。     

经口气管插管患者非计划性拔管4例原因分析及护理对策

目的探讨呼吸重症监护病房（RICU）经口气管插管患者非计划性拔管的原因,总结护理对策,预防非计划性拔管的发生。方法分析4例RICU患者非计划性拔管的原因。结果经口气管插管患者非计划性拔管的发生与未充分使用镇静剂、缺乏有效的固定、未采用适当的肢体约束措施及医疗护理操作不当等有关。结论加强呼吸机专业技能培训、对清醒患者进行健康宣教、适当应用镇静剂、合理使用约束带等有效措施可使非计划性拔管的发生率降至最低。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.