自制发音气管切开导管在机械通气患者中的应用

气管切开是目前机械通气患者人工气道建立方法之一。但同时使患者丧失了发音功能及语言交流能力，从而对患者心理、生理产生不良影响。目前虽有可发音气管切开导管产品，但价格较为昂贵。2002年10月以来，我们将自制发音气管切开导管应用于12例机械通气患者，成功重建患者的语言交流能力，效果满意，现报告如下。     

非语言交流在使用机械通气病人中的应用

非语言交流是以人体语言（非语言行为）作为载体，即通过人的目光、表情、动作和空间距离等来进行人与人之间的信息交往。使用机械通气的病人，由于气管切开或气管插管引起暂时失声，导致语言沟通障碍，护患交流只能用非语言交流方式进行。用非语言方式与病人进行交流思想、传递表情，满足病人的心理需要，使其能主动配合治疗和护理，提高护理质量。现将非语言交流在机械通气病人中的应用浅述如下。     

ICU气管切开患者非语言交流干预效果的研究

目的探讨为ICU气管切开患者选择一种行之有效的非语言交流方式。方法选取本院ICU 2013年1月~12月的60例气管切开患者,随机分为实验组和对照组各30例,对照组实施传统书面和肢体语言沟通的方法;实验组在此基础上结合音像、图文的方式进行非语言交流干预。结果实验组患者因语言沟通障碍引起的焦虑显著低于对照组(P0.05)。结论对ICU气管切开患者采取多方式的沟通,有利于护患之间的信息交流,可以减少因语言沟通障碍引起的焦虑,从而提高护理质量。     

气管切开患者呼吸道的护理

做好气管切开患的呼吸道管理是保证安全有效的进行机械通气，改善预后的关键。1998年1月至2002年5月我科共收治气管切开应用机械通气的患105例，经精心护理，效果良好，现将护理体会报告如下。     

高压氧治疗气管切开的护理

2002年2月-2005年2月，我院应用高压氧治疗各种麻醉意外、电击伤、脑外伤、一氧化碳中毒等气管切开患23例，治疗中其舱内气管切开的护理是关系到患能否转危为安的一个重要因素。现将护理体会报告如下。     

气管切开术后病人家庭健康教育需求调查分析

对于各种原因引起的呼吸衰竭患，及时识别并积极行气管切开机械通气是提高抢救成功率的关键。气管切开对患家属是一个重大应激事件，家属在应激状态下的表现不仅影响其自身的身心健康，更重要的还会影响患的救治和康复。为此我们对32例气管切开病人家属进行健康教育需求调查分析，现报告如下。     

护患沟通提示卡的制作与应用

目的：促进与气管插管或切开患者的沟通,增进护患关系,及时满足患者生理和心理的需求。方法通过非语言交流方式,获得此类患者常见的需求,制作成表格的形式。结果通过这种沟通方式,消除了护患沟通障碍,提高了护理工作效率。结论护患沟通提示卡的制作和使用,有助于建立和谐护患关系,提高整体护理质量,可以明显减少护患纠纷的发生。     

气管切开后长期带管的老年患者并发肺部感染的分析与护理对策

目的 探讨气管切开后长期带管的老年患呼吸道感染的相关因素及其特点。方法对气管切开后带管125～1860d的21例老年患发生院内下呼吸道感染进行回顾性分析。结果气管切开后带管时间长、平均住院时间长的老年患，其患下呼吸道感染的发病率高，痰培养以Gˉ杆菌为主，铜绿假单胞菌居首。结论 气管切开后长期带管是医院内下呼吸道感染的主要原因之一，因此加强院内感染控制合理使用抗生素、是预防感染的重要措施。     

ICU护士与建立人工气道病人交流的体会

语言是人们表达情感和需求的重要途径，气管插管和气管切开导致病人暂时性失语，不能用语言表达自己的不适和需求，使护患沟通障碍，ICU病房环境的特殊性，导致病人相继出现一系列心理问题，采取不同的交流措施，减少消极心理因素的影响，有利于恢复病人康复的自信心。     

气管切开患者94例的气道护理

气管切开术在抢救危重患的过程中，往往起到起死回生的作用。气管切开后呼吸道直接和外界相通，失去了自然的空气滤过和清除作用．极易引起肺部感染等并发症。作就94例气管切开患的气道护理体会总结如下。     

综合护理干预对传染病患者心理应激因素的影响

目的探讨综合护理干预对传染病患者心理应激因素的影响。方法 2010年10月～2011年6月自行设计调查问卷,对320例传染病住院患者心理应激因素进行调查,根据患者心理应激因素进行护理干预。比较干预前后患者心理应激因素改善情况。结果护理干预后,患者对所患疾病恐惧与焦虑、担心疾病传染给自己家人、担心被别人知道自己患传染病而被疏远、为所处的环境改变感到担忧、担心医护人员的技术水平和服务态度、住院期间担心被传染其他疾病、活动范围受限制等方面,干预前后比较,差异具有统计学意义(均P<0.05),干预后患者心理应激因素明显改善。结论有针对性的综合护理干预,能使传染病住院患者心理应激得到有效的缓解。     

腹腔镜胆囊切除术患者心理痛苦及其影响因素研究

目的探讨腹腔镜胆囊切除术患者的心理痛苦状况及其影响因素,以期更好地指导临床护理。方法采用心理痛苦管理筛查工具对215例腹腔镜胆囊切除术患者进行问卷调查。结果腹腔镜胆囊切除术患者心理痛苦温度计得分中位数为2分,≥4分者占30.23%。心理痛苦具体体现在疼痛、饮食改变、紧张、担忧、消化不良、睡眠问题和经济问题等方面。多元回归结果显示,病程长短、锻炼频率是心理痛苦的负相关因素,其他慢性病、饮食改变则是正相关因素。结论医护人员应早期采用心理护理帮助患者尽快接纳现状,鼓励患者每天适度锻炼,帮助其正确理解饮食改变的作用,同时积极治疗患者的其他慢性病。     

护理干预对门急诊输液患者心理状况的影响

目的探讨护理干预对门急诊输液患者心理状况的影响。方法采用症状自评量表（SCL-90）对600例门急诊输液患者进行问卷调查,了解其存在的心理状态后,进行输液前、中、后的心理护理,于输液治疗的最后1d再次用SCL-90进行问卷调查,采用x^2检验比较2次评定的结果。结果心理护理后本组患者的躯体化,人际关系,焦虑,抑郁,敌对,恐怖,其他项目的阳性分布情况均较干预前有显著改善。结论掌握患者的心理状况,做好静脉输液患者的心理护理,可有效减轻患者不良心理反应,提高护理安全质量,有利于疾病的治疗与康复。     

重症肝病患者自杀心理障碍分析及疏导方法探讨

Background:Suicide is an much severe public hygiene problem. It was reported that suicidal rate in our country was 22.2 per hundred thousand each year(1993).One third of which was caused by their own diseases.Patients of severe hepatitis B suffer severe conditions of the disease with protracted course. It is easy for the patients to have severe psychonosema and suicide occurs.If the abnormal mood of the patients could be found early, the suicide might be avoided,and the patient might get rehabilitation earlier. Objective:To analyze the suicidal causes of the patients of hepatitis B and to study the method of treatment or persuation. Unit:Dept.of Hepatitis,the Sixth People's Hospital of Hangzhou Subjects:9 suicidal cases by falling from high place at the Dept. of Hepatitis B of the Sixth People's Hospital from 1991 to 2000 include 6 men and 3 women, with mean age of (36.7± 10.27) years(23～ 56 years) who were all diagnosed as chronic severe hepatitis with mean protracting course of (5.6± 4.2) years(2～ 11 years).The shortest inpatient time was 1 day,the longest was 228 days.7 of them were married.Their included 4 workers ,4 peasantsand individual trader.Their educational levels included 5 graduates from high school,4 from junior middle school.They all fell from the ward building for suicide. Intervention:The psychonosema were analysed by analyzing the patients'words,letters and their behavior before their suicides.Psychological therapy against these psychonosema were studied in order to avoid more suicide happen. Results:(1)Causes of suicides:One patient had symptoms of psychosis such as hallucination and delusional thinking disturbance.8 patients felt hopeless in curing the disease.4 cases had stress in family relationship. 3 cases could not endure body pain. 6 cases could not endure the heavy economic burden.Love relationship stopped because of the disease in 1 case.(2) Manifestations before their suicides 6 patients had insomnia, emotional lability,anxiety,pessimism and worldweariness in their words.They used to cry secretly.2 cases showed excessive care about their family with special exceted emotion.3 cases used to refered to psychological persuation.(3)Methods of psychological persuation:Physicians should have strong responsibility for their patients.They should understand patients' psychological state besides manage the primary diseases.Once psychological disorder occurred,psychological intervention should be administered immediately.If necessary,family members should participated the intervention.To let patients realize the impact of diseases.Physicians should help patients to clear anxiety and courage them to overcome the condition.Physicians should discuss the management project with patients.For patients with depression,monitoring should be focused.Consultation should be performed on severe patients.Environment surrounding patients should be improved.24-hour care should be carried out by family members. Conclusion:Delayed recovery of somatic diseases and drastic affliction will make patients loss the confidence,and hence exaggerate economical condition.Paradox within family will result severely psychological disorder and suicide.So,necessary psychological intervention is feasible.     

护理干预对门急诊输液患者心理状况的影响

目的 探讨护理干预对门急诊输液患者心理状况的影响.方法 采用症状自评量表(SCL-90)对600例门急诊输液患者进行问卷调查,了解其存在的心理状态后,进行输液前、中、后的心理护理,于输液治疗的最后1 d再次用SCL-90进行问卷调查,采用χ2检验比较2次评定的结果 .结果 心理护理后本组患者的躯体化,人际关系,焦虑,抑郁,敌对,恐怖,其他项目的 阳性分布情况均较干预前.有显著改善.结论 掌握患者的心理状况,做好静脉输液患者的心理护理,可有效减轻患者不良心理反应,提高护理安全质量,有利于疾病的治疗与康复.     

住院老年患者心理需求的调查与分析

目的 了解住院老年患者心理需求状况，为医院老年心理护理的完善提供科学依据。方法 应用自制调查表对扬浦区1所老年医院134例住院老年患者进行问卷调查。结果 61．2％的患者对所惠疾病有紧张、怨恨情绪，75．4％的患者不愿长期住院，55．2％的患者住院最大烦恼是病情不了解。认为住院最大安慰是亲人探望的患者占85．8％。认为住院接触最多的是护工的占53．7％；希望居家养老的占52．2％，希望有护士与其聊天的占87．31％，希望有志愿者聊天的占95．5％。结论 住院老年患者在住院期间存在不同程度的身心健康问题和各种心理需求，护理工作者应根据患者的不同文化程度及其病情恰当而适时地做好心理护理。     

从患者心理呵护的角度看床边交接班的局限性

目的从患者心理呵护的角度,探讨床边交接班的局限性。方法分析和总结患者心理需求,探讨床边交接班的局限性。结果床边交接班的局限性包括忽视患者心理需要、保护患者心理感受的意识薄弱、使用不规范的语言和行为、患者心理得不到连续性的护理和护士缺乏对病情的充分了解等。结论在床边交接班过程中,护士必须掌握患者的心理需要和心理特征,以确保交接班制度实施的全面性,从呵护患者心理的角度而不仅仅从病情的角度来对待患者。     

脑血管病人心理状态调查及心理护理效果评价

目的：探讨脑血管病后心理状态及适宜的心理护理措施。方法：对80例脑血管病后病人进行症状自评量表（SCL-90），抑郁自评量表（SDS），焦虑自评量表（SAS）评定，同时用年龄、性别等相匹配的80例健康人为对照，并且对有明显心理行为改变的脑血管病人进行心理护理和必要的药物干预。结果：脑血管病后病人常有抑郁、焦虑、躯体化等心理行为改变。3种量表总分均明显高于对照罂（P〈0.01）。31例有明显抑郁情绪的病人经心理护理及药物治疗后3种量表总分均明显下降（P〈0．01）。结论：脑血管病后心理行为改变较为明显，迫切需要良好的心理护理和心理干预。     

住院老年慢性病患者抑郁与应对方式的相关性研究

目的了解住院老年慢性病患者抑郁情绪的发生与应对方式的相关性。方法采用老年抑郁量表对300名住院老年慢性病患者的抑郁状况及其应对方式进行调查。结果31．00％的调查对象处于不同程度的抑郁状态;住院老年慢性病患者多采用自责、幻想、退避等消极的应对方式,较少使用解决问题、求助等积极的应对方式。抑郁与解决问题及求助因子呈负相关,与自责、幻想、退避因子呈正相关。结论住院老年慢性病患者存在不同程度的抑郁情绪,与其应对方式有一定相关性,护士应根据患者的具体情况给予其相应的心理支持,以减轻或消除患者的抑郁情绪对健康的不利影响。     

Therapy goal setting in patients with psychological stress in orthopaedic and cardiac rehabilitation

OBJECTIVES: To study goal-setting for patients with psychological stress in orthopaedic and cardiac rehabilitation centres. DESIGN: A questionnaire assessing patients' somatic, functional and psychosocial status ("IRES"-questionnaire) was administered to 3109 patients with musculoskeletal diseases and 1670 patients with cardiovascular diseases from a total of 26 rehabilitation centres at their admission and discharge. For all patients, physicians filled in the "Physician's Sheet" ("Arztbogen") that assesses patient-specific goals of therapy. RESULTS: Nearly 50 % of the patients suffered from psychological stress at their admission. Of the patients with high psychological stress (higher than in 90 % of the general population) only 11.1 % (musculoskeletal diseases) and 3.4 % (cardiovascular diseases) were diagnosed as having a mental disorder (ICD-10 diagnosis in the range of F00 - F99). High psychological stress reported by patients themselves is associated with only a small increase of goal setting in psychological therapy documented in the "Physician's Sheet". The most important factors that influence the predefinition of psychological goals of therapy are high multimorbidity, an ICD-10 diagnosis in the range of F00 - F99, low age, high motivation for rehabilitation and being a woman. However, statistically significant differences between rehabilitation centres in the predefinition of psychological goals of therapy were detected. It can be assumed that differences in concepts of therapy are responsible for this finding. CONCLUSION: The results show that physicians use the patient's self-assessments of their psychological stress only to a small extent while planning psychosocial interventions and care. The predefinition of goals in a context of "forced" consideration of patients self-assessments leads to a higher degree of consistency between patients' judgements and goal settings. It also shows a slightly higher predictive power for rehabilitation effects than the predefinition of goals of therapy without noticing patients' self-assessments. This demonstrates the usefulness of a patient-centred screening instrument for psychological stress in orthopaedic and cardiac rehabilitation.