目的 为老年股骨颈骨折的患者制定合理的循证护理方案。 方法 在充分了解老年股骨颈患者病情的基础上,根据PICO原则,提出临床问题并转化为易于检索的形式,于2012年5月检索了Cochrane系统评价数据库(CDSR)、Cochrane对照试验注册中心(CCTR)、效果评论摘要数据库(DARE)、Medline、国家指南网(NGC)、PubMed 网站、中国生物医学文献数据库(CBM)以及复旦大学JBI循证护理中心,获取并评价相关的系统评价、随机对照试验以及临床指南。 结果 共检索到3篇系统评价、2篇临床随机对照试验和1篇临床实践指南。根据检索的结果,与患者及家属沟通后,选用Braden量表对患者进行压疮评估;指导患者每2小时翻身;进行腰背肌的锻炼,2~4 h/次,第1天5遍/次,之后逐渐递增为10~20遍/次;指导摄入高能量、高蛋白食物。1周后,患者机体状况良好,顺利接受手术治疗。 结论 采取循证护理的方法可以为患者提供科学、个性化的护理。
目的 分析胃肠外科手术切口感染的影响因素,为医院感染的防治提供理论依据。 方法 回顾性分析2010年12月-2012年12月764例行胃肠外科手术患者的临床资料,并用单因素χ2检验统计分析患者医院感染的危险因素。 结果 共有65例患者发生手术切口感染,其感染率为8.5%,且分离培养出合格菌株48株,阳性率73.8%,其中G−菌32株,占66.7%,G+菌16株,占33.3%。G−菌主要以大肠杆菌、变形杆菌、克雷伯杆菌和肠杆菌为主,分别占29.2%、18.8%、12.5%和6.2%;G+菌以肠球菌和表皮葡萄球菌为主,分别占22.9%和10.4%。单因素χ2检验显示年龄>60岁、手术时间>120 min、术中有输血、且有肿瘤病变的患者具有较高的切口感染发生率(P<0.05)。 结论 胃肠外科手术切口感染的主要致病菌是G−杆菌,患者的年龄、手术时间、术中输血情况和疾病良恶性质是术后切口感染的高危因素,积极采取相应的预防措施有望减低其感染的发生率。
目的 探讨临床护理差错产生的原因及其预防措施,以提高护理质量。 方法 回顾性分析2011年7月-2012年6月临床护理工作中发生的护理差错案例,对其进行统计分析,并提出防范护理差错的对策与措施。 结果 该期间医院发生临床护理差错23例,其中医嘱执行不当或错误13例(占56.52%),违反操作常规4例(占17.39%),未严格执行查对制度3例(占13.04%)及业务技术水平不足3例(占13.04%),其发生的原因既有个人因素也有管理因素,个人因素主要为粗心大意、责任心不强、技术操作不当等;管理因素主要为护理人员数量不足、护理管理制度特别是对护理差错的处理方式不够科学及人文社会环境因素所致等。 结论 临床护理差错的发生是由多方面因素造成的,需采取相关对策综合防制。
ObjectiveTo summarize the research progress of relationship between distal landing zone geometric and outcomes of endovascular aortic aneurysm repair (EVAR) for abdominal aortic aneurysm. MethodsThe domestic and foreign literature on the accumulation of the impact of proximal and distal landing zone geometric morphology on clinical outcomes, the evaluation methods for related complications of proximal and distal landing zones, preventive measures for adverse outcomes related to the geometric morphology of the distal landing zone, and the pathophysiological mechanisms of complications related to the distal landing zone were retrieved to make an review. ResultsThe irregular geometric morphology of the proximal landing zone was closely associated with adverse events following EVAR. The morphology of the distal landing zone was actually more complex than that of the proximal zone, and the measurement methods for its parameters were also more complicated. Common methods used in the literature for studying landing zones included the centerline distance method, the minimum distance method, and the landing area method. Primary preventive measures for adverse outcomes related to the geometry of the distal landing zone included increasing radial support force and contact area, using endostaples, and extending the landing zone. In addition to anatomical factors, the distal landing zone was also influenced by various pathophysiological factors. ConclusionsThe morphology and related pathological changes of the distal landing zone significantly impact the clinical outcomes following EVAR for abdominal aortic aneurysm. However, current research on the distal landing zone is limited. Future studies should focus on developing new technologies and methods to improve the evaluation and management of the distal landing zone, thereby reducing the complications after EVAR, enhancing the success rate of the surgery, and improving patient survival quality.