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小儿烧伤惊厥的原因分析及干预措施

目的　探讨小儿烧伤并发惊厥的原因及护理措施。 方法　回顾性分析2010年3月－2012年2月收治的35例患儿烧伤并发惊厥的临床病历资料。 结果　小儿烧伤惊厥的原因有休克、高热、电解质紊乱、烧伤毒血症、脑缺氧脑水肿，各种原因之间相互影响。本组35例患儿中，惊厥持续时间30 s～5 min不等，34例治愈，1例因多器官功能衰竭死亡，所有患儿随病情而好转。 结论　小儿烧伤后并发惊厥的原因较多，在治疗和护理过程中应随时把握病情变化，正确处理患儿高热、电解质紊乱等，一旦发生惊厥应采取及时有效的救护措施，防止意外发生。

Reasons and Treatment of Endotracheal Tube Prolapse after Inhalation Injury

【摘要】　目的　探讨吸入性损伤气管切开置管，导管脱出的原因及正确的护理方法，提高护士对患者的预见性护理能力。　方法　对2005年1月-2011年3月收治的158例吸入性损伤气管切开患者，其中9例术后发生导管脱出的原因及护理对策进行回顾性总结。　结果　9例患者发生导管脱出的主要原因有导管选用不当、剧烈咳嗽、系带过松、气囊充气不足或气囊破裂、切口过大，以及自行拔出。9例发生脱管时间不一，最短于气管切开术后第1天，最长于术后15 d，8例经予以紧急处理而尚未影响后续治疗，1例因缺氧时间太长而死亡。　结论　充分认识吸入性损伤患者气管切开脱管原因，并采取预见性的观察及护理措施，可减少脱管发生，确保患者安全。【Abstract】　Objective　To explore the reasons and correct nursing methods of placing endotracheal tubes and tubes prolapsing after incision of trachea for inhalation injury.　Methods　The clinical data of nine patients with endotracheal tubes prolapse after incision of trachea out of 158 patients suffering from incision of trachea for inhalation injury from January 2005 to March 2011 were retrospectively analyzed.　Results　The reasons of nine patients suffering from endotracheal tubes prolapse included tubes incongruity, severe cough, too slack bridles, insufficiency and break of aerocysts, too large incision and extraction by themselves. The prolapse time of nine patients was different. The shortest time was postoperative one day, the longest one was postoperative 15 days. Eight patients were treated emergently and healed normally. One patient died of long oxygen deficiency.　 Conclusions　The reasons of endotracheal tubes prolapse after incision of trachea are sufficiently recognized. Predictable observing and nursing methods may decrease the incidence rate of tubes prolapse.

严重雷电击伤合并晚期妊娠护理一例

Factors Related to Multi-drug Resistant Bacteria Infection in Laminar Flow Burn Ward

目的　对烧伤层流病房多重耐药菌感染的相关因素进行分析，通过护理干预来预防和减少烧伤病房多重耐药菌感染的发生。 方法　回顾性分析2011年1月－12月收治的629例烧伤患者，其中发生多重耐药菌感染74例，感染率为11.8%。 结果　感染部位：创面分泌物培养感染占70.2%，痰液标本培养感染占9.4%，血液标本培养感染占16.2%，其他占4.2%。感染病原菌：以金黄色葡萄球菌为主，占77.0%；鲍曼不动杆菌占4.2%，铜绿假单胞菌占10.8%，肺炎克雷伯菌占6.7%，真菌感染占1.3%。 结论　对发生医院内多重耐药菌感染的原因进行分析并及时采取相应的护理干预措施，及可行的医院感染管理控制措施，对烧伤患者预后有重要的意义，可有效降低院内感染率的发生。

烧伤病房陪护管理方法探讨

【摘要】　针对烧伤病房陪护管理问题，通过采用加大宣传教育力度及制定落实陪护管理制度等措施，从多个方面切实加强烧伤层流病房的陪护管理。在大家的努力下，烧伤病房陪护人员数量得到有效控制，感染防控意识明显加强，但在中午以及夜间薄弱时间段对陪护人员的管理还需加强。目前采取的陪护管理方法能够实现较规范的陪护管理，但完善的陪护管理仍有可探讨改进的空间。

改良封闭式负压引流技术用于电击伤创面的护理

【摘要】　目的　总结改良封闭式负压引流（vacuum sealingdr ainage，VSD）技术治疗电击伤创面的护理方法。　方法　对2010年10月-2011年6月收治17例电击伤创面，采用改良VSD技术即在常规封闭引流装置的海绵中埋置留置针导管，并定时进行冲洗治疗的护理方法及特点进行回顾性总结。　结果　本组15例25处电击伤创面于安置改良VSD负压引流7～10 d去除VSD泡沫，其创面清洁、肉芽组织生长良好，行二期植皮手术修交创面。1例1处创面安置改良VSD负压引流第2天出血，予以结扎止血、重新更换贴膜继续负压引流8 d后植皮手术修交创面。1例1处创面采用改良VSD负压引流7 d去除泡沫，仍有部分坏死组织及分泌物，予以再次扩创并重新采用改良VSD 5 d后植皮修复创面。　结论　改良VSD技术治疗电击伤创面能明显降低堵管概率，有效促进坏死组织充分引流，加快肉芽组织生长，缩短治疗时间，降低因引流管堵塞反复更换导致的费用增加。

Related Factors Affecting the Function Recovery of Deeply Burned Limps

【摘要】　目的　探讨肢体深度烧伤后，影响功能康复的相关因素。　方法　采用美国日常生活自理量表和功能性日常生活量表，对2009年4月-2010年7月来门诊复诊的101例肢体深度烧伤患者的功能康复情况进行问卷调查和统计学分析。　结果　接受专业康复的患者得分明显低于自我康复患者得分，差异有统计学意义（Plt;0.01）；不同性别、不同文化程度之间的比较差异有统计学意义（Plt;0.001）；年龄14～50岁的患者对是否接受专业康复的比较，差异有统计学意义（Plt;0.001）；年龄lt;14岁、gt;50岁及婚姻状况，在是否接受专业康复的比较差异无统计学意义（Pgt;0.01）。　结论　肢体深度烧伤后患者在专业医师的指导下进行专业功能康复比自我康复的患者效果更好，使得烧伤患者社会期日常生活自理能力得到提高。【Abstract】　Objective　to explore the related factors affecting the function recovery of deeply burned limps.　Methods　Adopting ADL body independent living scale and functional daily life scale, the questionnaire survey of the function recovery situation and statistical analysis were performed on the patients from the 101 outpatient appointment patients whose limbs were deeply burned from April 2009 to July 2010.　Results　The score of patients who accepted professional rehabilitation was significantly lower than that of the self healing patients, and the difference was significant (Plt;0.01); the difference of sex and the comparison between different literate degree were statistically significant (Plt;0.001); the difference in whether to accept the comparison of the professional rehabilitation among the patients with age oflt;14 years old, gt;50 years old and different marital status was not statistically significant (Pgt;0.01).　Conclusion　patients with deeply burned limbs recover better under the professional function recovery direction of professional doctor than the patients who have self recovery.

Nursing of Skin Expander Plasty of Giant Nevus

【摘要】 目的 总结皮肤扩张器用于巨痣整形的护理措施。 方法 2008年4月-2009年11月对28例皮肤扩张器置入治疗巨痣整形的护理措施进行总结和分析，重点加强了心理护理、健康教育及注水期间的护理。 结果 术后患者皮肤色泽正常，外观满意出院。随诊1年，效果佳。 结论 加强心理护理，有针对性的健康教育，重视注水期间护理措施的实施，对皮肤扩张器置入术用于巨痣整形患者至关重要。【Abstract】Objective To summarize the nursing interventions of skin expander plasty of giant nevus. Methods From April 2008 to November 2009, 28 cases of giant nevus were admitted for skin expander surgery.The nursing interventions，especially the mental nursing, health education and nursing care during the infusion period were summarized and analyzed. Results The results were satisfactory including the color and the appearance by one-year follow-up. Conclusion It is important to emphasize the mental nursing, health education and nursing care during the infusion period for the patient undergoing giant nevus plasty treated with skin expander.

臀会阴及下肢大面积皮肤软组织撕脱伤患者的护理

【摘要】 目的 总结臀会阴及下肢大面积皮肤软组织撕脱伤的护理特点及方法。 方法 2005年1月-2007年6月，对8例臀会阴及下肢大面积皮肤软组织撕脱伤患者进行综合治疗。男女各4例，年龄4～48岁。病程1 ～14 d，平均5 d。撕脱皮肤占体表总面积8%～20%。致伤原因:车祸伤7例，高坠伤1例。分析此类患者的手术要领，心理特点和住院期间及出院后的护理经验。 结果 8例患者经综合治疗及积极护理后伤口均愈合，随访3～6个月皮肤愈合良好。6例行结肠造瘘的患者中3例因骨盆骨折稳定于出院后3个月行结肠造瘘还纳术，恢复肛门排便，脊髓损伤患者终身需行结肠造瘘。 结论 臀会阴及下肢大面积皮肤软组织撕脱伤患者通过上翻身床，必要时行结肠改道，积极的创面处理及对症支持治疗，根据治疗的不同阶段合理调整护理重点，对患者康复起到了积极作用。

Investigation on the Management Methods of Drug Repercussion in Burn and Plastic Surgery Department and Evaluation of the Effect of These Methods

ObjectiveTo investigate the management methods of drug repercussion and its intervention measures in the Burn and Plastic Surgery Department by analyzing the reasons for drug repercussion. MethodBased on the drug repercussion data provided by the computer information center, we analyzed the common reasons and the status quo of drug repercussion. Active intervention measures were carried out, and real-time supervision and feedback of drug repercussion management were also performed. We compared such repercussion indexes before intervention (between May and September 2013) and after intervention (between October 2013 and February 2014):number of drug repercussion patients, times of drug repercussion, amount of money involved in drug repercussion, ratio of drug repercussion and dispensing and comprehensive ranking of the drug repercussion in the whole hospital. ResultsAfter intervention, the ranking of the causes of drug repercussion changed obviously. Changing orders casually dropped to the 3rd of the rank, and changing the department based on necessity rose from the 4th to the 2nd. All the indexes (including the times, number, and amount of money of drug of repercussion, and the ratio of repercussion and dispensing and compreheasive rank) reduced significantly (P<0.05). ConclusionsActualizing active intervention measures redounds to reducing drug repercussion, standardizing clinical use of drugs, insuring safety, and advancing the satisfaction of patients and quality of medical nursing.