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经皮肾镜碎石取石术后感染性休克抢救与护理一例

肝移植手术静脉通道的建立及其用药

手术室优质护理服务模式探讨

目的　总结手术室开展优质护理服务的模式及特点。 方法　术前访视做到用语规范化、内容常规化、指导个性化；术中护理实行服务人性化、安全核查常态化、抗生素使用及时化、手术用物清点严格化、手术配合流程化、临床护理工作创新化等，同时加强对患者皮肤、体温的护理，强化安全转运及回访。 结果　开展优质护理服务后，患者和手术医生对护理服务的满意度明显提高。 结论　只要坚持以患者为中心，不断改进工作方法，优化工作流程，创新护理服务理念与手段，就可实现让患者满意、社会满意、政府满意的优质护理服务目标。

泌尿外科腔内钬激光手术的护理体会

【摘要】　目的　分析总结泌尿外科腔内钬激光手术的护理要点，以指导护理。　方法　2009年6月－2010年12月，对400例行腔内钬激光手术患者在术前术中认真做好仪器参数设置及检查、体位摆放、病情观察、并发症预防等各项护理工作。　结果　400例手术均成功，手术配合效果满意，无因术中护理不当造成患者意外损伤、设备光纤意外损坏等情况发生。　结论　泌尿外科腔内钬激光手术配合专业性强，护理人员应熟知钬激光工作原理、正确设置钬激光参数，以确保患者安全。

经尿道高功率钬激光前列腺汽化术护理

【摘要】　目的　加强经尿道高功率钬激光前列腺汽化术各环节的护理配合，防止发生电切综合征。　方法　通过对2007年10月-2009年1月36例行经尿道高功率钬激光前列腺汽化术患者资料回顾，总结该手术护理配合要点及体会。　结果　36例均顺利完成手术，术中患者生命体征平稳，无一例出现电切综合征。　结论　经尿道高功率钬激光前列腺汽化术是一种安全可靠的治疗前列腺增生的微创手术方法，护理在各个环节的密切配合是保证手术成功的必要条件。

控制特殊手术器械包翻蒸的管理实践与效果

目的探讨控制手术室特殊器械包翻蒸的有效措施，以减少翻蒸量、优化手术资源使用并延长器械使用寿命。 方法统计手术室普外科2009年12月－2010年5月翻蒸器械类别及数量，分析各类器械翻蒸原因，并从2010年6月起通过整改器械配置、改变器械储存/消毒方法、调整器械备用数量等干预措施降低器械翻蒸量。 结果手术器械翻蒸包从干预前的平均每月38包减少到干预后的平均每月15包，翻蒸比例由0.63%降低到0.25%，器械翻蒸得到有效控制。 结论使用科学、动态的管理方法，器械包的翻蒸量是可以控制的。

Retrospective analysis of 240 surgery-related near misses

Objective To summarize the characteristics of surgery-related near misses including events composition, cause of incident, specialty category, personnel allocation etc, and to provide experience of feedforward control for the nurses in operating room and a clinical basis of safety standards for the management of operating rooms. Method The 240 surgery-related near misses occurred between July 2014 and July 2016 were retrospectively analyzed, using frequencies and percentiles to describe the count data. Results The 240 surgery-related near misses were mainly associated with surgical stitches (91 cases, 37.9%), surgical dressings (52 cases, 21.7%) and surgical instruments (45 cases, 18.8%). The main features of the 91 cases of surgical stitching included loss of suture needles (40.7%, 37/91) and fracture events (37.4%, 34/91). Among the 52 cases of surgical dressings, the most commonly were gauze dressing events (43 cases, 82.7%), in which 19 were with unclear numbers of retained gauzes in the reoperation patient’s body, and 15 were postoperative counting anomalies. Among the 45 cases of surgical instruments, the fracture and defect were the most common (21 cases, 46.7%). Conclusion The operation nurses should focus on the prevention of suture needle loss, the surgical dressings loss and the fracture and defect of surgical instruments, etc, to reduce or avoid the surgery-related near misses.

Chlorhexidine versus povidone iodine for preventing surgical site infections: a meta-analysis

Objective To systematically review the efficacy of chlorhexidine versus povidone iodine in the prevention of wound infections after surgeries by meta-analysis. Methods All randomized controlled trials comparing these two disinfectants were searched from databases of PubMed, The Cochrane Library (Issue 3, 2016), EMbase, WanFang Data, VIP and CNKI from inception to August 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.2 software. Results A total of 14 randomized controlled trials were included. The results of meta-analysis showed that the chlorhexidine group had significantly lower rates in any surgical site infection (RR=0.71, 95% CI 0.58 to 0.88,P=0.001) and superficial incisional infection (RR=0.66, 95% CI 0.48 to 0.91,P=0.01) when compared with povidone iodine group. However, there were no significant differences in deep incisional infection (RR=0.51, 95% CI 0.23 to 1.11,P=0.09) and organ-space infection (RR=0.97, 95% CI 0.53 to 1.76,P=0.92) between the two groups. Furthermore, subgroup analysis revealed differences in any surgical site infection and superficial incisional infection could only be found in surgeries possibly contaminated. Conclusion Chlorhexidine may be superior in decreasing the incidence of infection in probably contaminated surgery.