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Application of Clinical Nursing Path Improvement for Day Surgery of Laparoscopic Cholecystectomy

Objective To investigate the efficacy of improved clinical nursing path for day surgery of laparoscopic cholecystectomy (LC). Methods The clinical data of 3 274 patients who underwent day surgery of LC following the clinical pathway between January 2011 and December 2015 were collected. The rate of adverse events including pain, postoperative nausea and vomiting (PONV), retention of urine and staxis before and after the improvement of clinical nursing path was analyzed and compared. Results For adverse event rate before and after the improvement of clinical nursing path, the difference in the incidence of pain and PONV was statistically significant (P < 0.05), while the difference in retention of urine and staxis was not statistically significant (P > 0.05). Conclusions Through the improvement of clinical nursing path for LC during day time, the procedure of nursing becomes more standardized. It is more feasible for clinical work and postoperative adverse reactio n rate becomes lower. It can also help shorten postoperative rehabilitation time and ensure perioperative medical quality and safety.

在护理本科生操作实习中开展拇指教育的探索

目的:对在护理本科生的操作实习中开展拇指教育的探索。方法：在护理本科生开展关于拇指教育的调查,对调查结果进行分析。结果：护理本科生普遍认为拇指教育更有利于自我的成长。结论：在临床带习老师中定期开展拇指教育的学习非常有必要。

Preoperative Nursing Measures of Patients with Urethral Stricture Treat by Dorsal Onlay Ducal Mucosal Urethroplasty

摘要:目的:探讨口腔颊黏膜尿道背侧镶嵌补片法治疗长段前尿道狭窄围术期的护理措施。 〖方法:术前做好口腔、会阴部及肠道准备,重视患者心理护理;术后重视尿管护理,维持吻合口低压状态,做好口腔及饮食护理,适当限制活动,注重并发症的观察与及时处理。结果:术后2～3月手术成功率达到92.4%,仅7.5%患者复发。结论:保证围手术期护理措施的质量对尿道成形手术的效果起到了重要的作用。 Abstract: Objective: To explore the perioperative nursing measures for the patients who underwent urethroplasty with dorsal onlay autogenetic oral ducal mucosa. Methods: Preoperative preparation includes oral cavity, perinea region,bowel cleansing and psychological nursing. Postoperatively, urinary catheter nursing is crucial to keep the anastomosis tension acceptablely low. Other postoperative care includes oral cleansing, activity restricting, discovering and dealing promptly with the complications. Results: Success rate was 92.4% 23 months after operation .Only 7.5% patients relapsed. Conclusions: Intensive perioperative nursing care was obviously helpful in improving the outcome of urethroplasty.

先天性黄斑缺损一家系二例

The Nursing of Septic Shock after Percutaneous Nephrolithotomy

目的　探讨孤立肾肾结石经皮肾镜取石（PCNL）术并发感染性休克的护理。 方法　回顾性分析2010年3月－2012年10月5例孤立肾肾结石患者行PCNL术后并发感染性休克的临床资料，对患者术后出现的休克及时补足血容量，使用有效的抗生素，早期足量应用激素、血管活性药物，同时加强心理疏导、健康教育等护理措施。 结果　5例患者体温均在3 d内降至正常；血管活性药物平均使用时间为1.8 d （2～4 d）；1例因血氧饱和度＜80%，血压＜85/50 mm Hg（1 mm Hg=0.133 kPa）转往重症监护病房行呼吸机辅助呼吸2 d后呼吸循环功能改善；另1例同时出现少尿无尿，及时行血液透析，第4天尿量逐渐恢复；5例患者均痊愈出院。 结论　感染性休克是PCNL术后最危险的并发症之一，对其采取积极预防、及早发现、及时有效的治疗和护理等措施，可有效促进患者康复。

综合医院开展医护一体化合作模式的调查

目的　了解综合医院医护一体化合作模式开展以来的医生满意度，为医护合作模式的推广提供依据。 方法　2011年11月采用分层抽样的方法，对370名临床医生以问卷调查方式，验证医护一体化合作模式的运用效果。 结果　96.8%的医生重视医护一体化工作的开展，96.5%的医生认为在医护一体化合作中与护士的合作程度好，93.5%的对这一合作模式的应用现状表示满意，97.3%的对其持支持态度。 结论　医护一体化合作模式已被广大医生认可和支持，是未来发展的方向。

泌尿专科建立日间病房模式及效果探讨

目的　探讨新医改形势下在三甲医院开设泌尿专科日间病房的可行性和具体措施。 方法　通过制定专科临床路径，住院流程与管理细则、随访方案，对2010年10月－2011年3月泌尿科238例行中小手术患者采用日间住院模式进行治疗与护理。结果　231例患者顺利完成手术，7例因术后并发症或因需行第二次手术等直接转为普通住院。经出院随访，日间住院管理模式下患者各地医保成功报销率达90.48%，满意度达97.88%。 结论　在三甲医院中开设泌尿日间病房，安全性高，可创造较好的社会效益，有利于医改目标的实现。

The Diagnostic Value of Multi-slice Spiral CT for Gastrointestinal Stromal Tumors

【摘要】　目的　分析胃肠道间质瘤（gastrointestinal stromal tumors，GIST）的螺旋CT（multi-detector row spiral computeel Tomography，MSCT）表现，评价其对该病的诊断价值。　方法　回顾性分析2000年3月—2010年10月经手术病理证实的32例GIST的MSCT表现，并将其与病理的生物学危险性进行对比研究。　结果　病理高、中、低及极低危险性GIST依次为15、6、7、4例。GIST主要CT表现，肿块腔外生长为主，大部分病灶边界清楚，呈类圆形或分叶状，密度均匀或不均匀，3例可见钙化，GIST增强静脉期强化较动脉期更明显，局部均无淋巴结转移，转移到肝脏的4例，同时伴前腹壁转移1例。15例肿块长径≥5 cm，密度多不均匀，可有囊变、坏死、出血等，增强不均匀强化，其中11例病理为高风险性；17例肿块长径lt;5 cm的病灶中，大多中度均匀强化，其中13例为中度及以下危险性。　结论　GIST患者的MSCT表现具有一定的特征性，MSCT对准确定位、术前估计肿瘤的风险级别、术后随访有重要价值。【Abstract】　Objective　To investigate the imaging features of multi-slice spiral CT (MSCT) for gastrointestinal stromal tumors (GIST) and its diagnostic value. 　Methods　We retrospectively analyzed the MSCT manifestations of 32 cases of GIST confirmed by operation and pathology between March 2000 and October 2010. Comparative study was then carried out between MSCT manifestations and patho-physiological risks. 　Results　Of the 32 GIST lesions, 15 presented with high biological risks, six moderate risks, seven low risks and four very low risks. The MSCT results manifested the following main features. Exophytic growth was predominating; Most lesions were with well-defined margins, and were rotund or lobular in shape with homogeneous or heterogeneous density. Three lesions manifested calcification. The enhancement degree of GIST in portal vein phase was more obvious than in arterial phase. There was no metastasis to local lymph nodes. Hepatic metastasis occurred in four cases, one of which was accompanied with anterior abdominal wall metastasis. Of the 15 lesions with maximal diameter longer than 5 cm, MSCT showed obvious cystic changes, necrosis or hemorrhage within the mass most of which was in heterogeneous density, and heterogeneous enhancement; Eleven out of the 15 lesions were at high risk. Among the 17 lesions with maximal diameter shorter than 5 cm, MSCT showed homogeneous enhancement, and 13 of them were at moderate risk or below. 　Conclusion　The MSCT imaging of GIST manifests some certain characteristics. It is valuable in locating the lesion precisely, estimating the risk level of the tumor, and postoperative follow-up for patients with GIST.

经皮肾镜取石术围手术期护理

摘要:目的: 探讨经皮肾镜取石术(percutaneou nephro lithotomy,PCNL)治疗肾结石的护理措施,总结护理经验。 方法 :回顾分析2006年8月至2009年3月我科172例肾结石患者的临床资料,均采用经皮肾镜取石术治疗,同时做好术前、术后护理、出院指导。 结果 :172例患者均顺利拔管,痊愈出院。其中并发症2例严重出血,1例发生感染性休克,3例出现肾周围血肿,3例水中毒及低钠血症。 结论 :保持患者良好的心理状态、充分的术前准备、术后严密的观察和管道的护理、具体的出院指导等,则是手术成功、患者顺利康复的重要保证。

一次性灌肠器在行盆底组织重建术女性患者术前阴道冲洗中的应用

目的探讨一次性灌肠器在行盆底组织重建术女性患者术前阴道冲洗中的应用及效果。 方法对2012年2月－2013年8月收治的88例拟行盆底组织重建术女性患者，术前采用一次性灌肠器进行阴道冲洗的方法及效果进行回顾分析。 结果本组患者采用一次性灌肠器进行阴道冲洗，均无不良反应或意外情况发生，经冲洗各例患者外阴均能保持良好清洁度，符合手术清洁要求。 结论一次性灌肠器用于阴道冲洗，操作简便、省力、省时，患者舒适度高，值得临床推广使用。