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自制一种简易的金属气管套管堵管塞

Perioperative Nursing Care of Recurrent Laryngeal Never Reconstruction

目的:总结喉返神经修复重建术围手术期的护理配合。方法：我科2007年10～11月手术治疗双侧喉返神经麻痹患者3例，手术前加强患者的心理护理、密切观察病情变化，及时处理声带麻痹引起的喉梗阻、误吸、呛咳等症状。术后重视体位护理、呼吸道的管理、保证药物及时准确使用，协助患者进行正确的吞咽进食训练、声带协调运动训练等康复护理。结果：3例患者术后均获完整随访，3月后均顺利拔除气管套管，无吸气性呼吸困难，无发音困难，嗓音质量较术前明显改善。结论：良好的围手术期护理有助于手术的成功。

品质管理圈在择期手术患者术前禁食禁饮管理中的应用

目的　讨论品质管理圈（QCC）活动在改进择期接台手术患者术前禁食禁饮管理中的应用与效果。 方法　2011年12月起开展品QCC活动，对择期手术患者术前禁食禁饮管理中存在的口渴、饥饿、烦躁、焦虑等问题进行分析，拟定管理对策，并将活动前后的结果进行分析比较。 结果　开展QCC活动后，患者口渴、饥饿不适感、烦躁、焦虑情绪明显减轻，与活动前相比差异具有统计学意义（P＜0.01）。 结论　QCC活动提高了护士的责任心，增强了团队凝聚力，使临床护理更有计划性，择期接台手术患者术前禁食禁饮问题得到一定程度的改进，提高了患者舒适度。

自护技能指导前移对提高喉癌术后患者自护效果的影响

目的　讨论自护技能指导前移对提高喉癌术后患者出院后自护能力的效果，寻求切实有效的健康教育方法。 方法　将2010年6月－2011年3月接受喉癌手术的113例患者按病床序号分为对照组54例和观察组59例，对照组按常规在患者出院前2～3 d开始进行自护技能指导，观察组则将指导时间提前至术后第5天，两组自护技能指导内容相同。并于患者出院前1 d和出院后15 d对其自护技能及家庭护理效果进行评价。 结果　观察组患者自护技能得分水平出院前后都明显高于对照组（P＜0.05）；出院后在套管垫安置正确、能自行排痰、掌握保护气道方法3个方面家庭护理效果优于对照组（P＜0.05）。 结论　自护技能指导前移更能提高喉癌术后患者出院后的自护能力水平，减轻患者及家属对出院的焦虑感，促进家庭护理效果。

喉癌合并2型糖尿病患者的围手术期护理

【摘要】　目的　总结喉癌合并2型糖尿病患者的围手术期护理经验。　方法　2005年7月-2010年6月，对62例喉癌合并2型糖尿病患者围手术期护理的临床资料进行归纳总结。　结果　25例行喉全切除术、20例行垂直半喉切除术、17例行水平半喉切除术。经过精心护理和专科处理，患者均顺利度过围手术期康复出院。　结论　对喉癌合并2型糖尿病患者，其术前术后的饮食指导和血糖控制及感染预防，是患者获得手术成功和疾病治愈的关键。

纳吸棉在慢性中耳炎术后填塞中的临床观察

目的探讨纳吸棉在慢性中耳炎术后填塞中的效果，为临床耳科手术填塞物的选择提供依据。 方法将 2012年 4月－2013年 1月住院接受同一医疗组医生手术治疗的 200 例慢性中耳炎患者，根据入院时间分为对照组和试验组，对照组采用碘仿纱条材料填塞术耳腔，试验组采用纳吸棉材料填塞术耳腔，观察两组患者术后 48 h内术耳疼痛、渗血量，首次抽取填塞物时术腔出血及疼痛情况。 结果试验组患者术后 48 h 内术耳疼痛、首次抽取填塞物时的疼痛及出血情况均低于对照组，两组比较差异均有统计学意义（P＜0.05）；两组患者术后 48 h内术耳渗血情况差异无统计学意义（P＞0.05）。 结论慢性中耳炎术后应用纳吸棉填塞术腔能提高患者舒适度，减少抽取填塞物时对术耳的损伤，促进术耳康复。

Related Factors and Nursing Countermeasures for Psychonosema in Postoperative Laryngeal Cancer Patients

ObjectiveTo explore the related factors and nursing countermeasures for psychonosema in postoperative laryngeal cancer patients. MethodsWe retrospectively analyzed the clinical data of eight patients who accepted laryngectomy and developed psychonosema from January 2008 to April 2013. The related factors for psychonosema in these patients were analyzed and nursing countermeasures were summarized. ResultsEight patients had different degree of psychonosema, and it was correlated with psychological factors, various channels of undesirable stimulation, sleep disorders, drug and other factors. After treatment and careful nursing, within three to seven days, all patients' abnormal mental symptoms were alleviated, and all of them were discharged. ConclusionThere are many factors which can cause psychonosema after laryngectomy for laryngeal carcinoma. Medical staff should try to reduce or avoid inducing factors. Once it happens, medical staff should carry out psychiatric treatment in time to avoid accidents and promote the rehabilitation of patients.

Experiences of the Diagnosis and Treatment of Symmetric Lipomatosis in the Neck

【摘要】　目的　探讨颈部对称性脂肪瘤的诊断和治疗。　方法　对2004年3月-2010年10月收治的5例颈项部脂肪瘤患者，其临床症状、体征、术前术后处理及结果等临床资料进行回顾。　结果　5例均为男性，以颈、项部大量皮下脂肪堆积为主要临床表现，其中1例伴有胸部上分皮下脂肪堆积，呈对称性隆起。3例患者伴阻塞性睡眠呼吸暂停低通气综合征，2例患者有睡眠打鼾但无明显呼吸暂停。4例患者有脂肪肝和长期酗酒史，但肝功能无异常改变，其中1例（1/4）有多次乙醇中毒史。1例患者无酗酒史，但诉经常作颈部刮痧治疗。5例均行外科手术切除，术中见肿瘤为白色无包膜脂肪组织。术后随访3个月~2年，1例术后1年复发，未行再次治疗，其余未见明显复发。　结论　颈部对称性脂肪瘤是脂肪组织弥漫性、对称性沉积于颈胸部皮下浅筋膜间隙和（或）深筋膜间隙的良性疾病。患者以中年男性居多，长期的酗酒史及典型的临床表现对于该病的诊断有一定帮助，但酗酒可能并非唯一病因。对于影响美观及功能的患者，其手术疗效较理想。【Abstract】　Objective　To explore the diagnosis and treatment of symmetric lipomatosis in the neck.　Methods　We retrospectively analyzed the clinical manifestations, signs, preoperative and postoperative management, and the treatment outcome of five patients with symmetric lipomatosis hospitalized in the Department of Otolaryngology-Head and Neck Surgery of West China Hospital between March 2004 and October 2010.　Results　All the five patients are male with a large quantity of subcutaneous fat deposit in and around the neck. Among them, one patient demonstrated extending upper thorax mass in the form of symmetrical apophysis; three experienced obstructive sleep apnea hypoventilation syndrome, and two had the symptom of snoring without apnea. Four patients had a long history of alcohol abuse with fatty liver, but had no liver dysfunction. In these four patients, one had alcoholism for many times. One out of the five patients had no history of alcohol abuse, but said to have been treated by a traditional Chinese medical technique GUASHA. All the patients underwent resection surgery, during which a large amount of noncapsulated white adipose tissue was confronted. The duration of follow-up lasted from three months to two years. There was one case of recurrence one year after the surgery and the patient refused re-operation. No obvious recurrence was found in the rest of the group.　Conclusions　Symmetric lipomatosis is a benign lesion characterized by diffused and symmetric accumulation of adipose tissue in the superficial or deep fascia space in the cervico-thoracic region. It mainly takes place in the middle-aged people. Long history of alcohol abuse and typical clinical manifestations can help to reach the diagnosis, but alcoholism may not be the only cause in etiology. Surgery may be the feasible therapeutic modality up to now.