目的 提高胸心血管外科患者ICU转出交接班质量，避免护理差错和纠纷。 方法 2010年1月－6月，针对患者转运出现的问题，在查阅文献及专家咨询的情况下，设计制定胸心血管外科ICU患者转出交接单，对患者转出ICU时的病情、用药、并发症等信息进行完善，同时规范交接班签字手续。采用调查问卷方式，对交接单运用效果进行评价。 结果 转出交接单的应用，提高了病房护士对ICU护士交接班质量满意度，除“医嘱单正确执行”、“签字和药物交接班清楚”与运用前满意程度无差异外，其余条目满意程度均有所增加，增加率波动在3.7%～33.4%。 结论 转出交接单使用能够提高ICU患者术后转运交接质量，预防护理差错和纠纷，确保证患者安全。
目的 总结胸腔镜下二尖瓣置换术的护理配合要点。 方法 2011年7月－12月利用腔镜技术以肋间开胸方式对5例心脏疾患患者施行二尖瓣置换手术，术前充分准备和术中密切配合，确保了手术的顺利施行和完成。 结果 除1例患者因术中出血改为传统开胸手术外，其余4例均顺利完成手术。患者术中出血量平均约300 mL，术后平均引流量约100 mL，手术平均时间4 h，患者术后在监护室留观1 d后转入病房。 结论 腔镜二尖瓣置换术是一项值得推广的手术方式，护理人员要不断加强知识的学习和更新，以适应新术式发展对护理工作的挑战和要求。
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.
ObjectiveTo investigate the mid-to-long term quality of life (QOL) and influencing factors in the patients after heart valve replacement.MethodsConvenient sampling method was used to recruit 224 patients who had heart valve replacement surgery in our hospital from June 2008 to June 2017. There were 63 males and 161 females, aged 18-83 (51.49±10.60) years. General information questionnaire and MOS SF-36 scale were used to collect data. Univariate analysis and multiple linear regression analysis were used to analyze and determine the influencing factors for the QOL.ResultsThe total score of QOL of 224 patients was 71.78±17.60 points. All these scores of the patients were significantly lower than those of the general population of Chengdu (P<0.05) except the dimension of vitality. The QOL scores differences between sex, marital status, family income, working condition, the occurrence of anticoagulant complications and other complications were significant (P<0.05). Multivariate analysis showed that family income, working condition, the occurrence of anticoagulant complications and other complications could be included in the regression model, explaining 26.8% of total variance. ConclusionThe mid-to-long term QOL is lower in the patients after heart valve replacement. Family income, working condition, anticoagulant complications and other complications are the main influencing factors for mid-to-long term QOL for patients after heart valve replacement.
【摘要】 目的 总结先天性心脏病术后无创通气的监护。 方法 2008年1-12月胸外ICU 36例先天性心脏病术后患儿，在使用无创通气前后监测血压、心率、呼吸及血气变化。 结果 与无创通气前相比，无创通气后30 min、1 h、2 h的指标均恢复到满意水平，循环稳定。 结论 通过采用无创通气，80%的患儿避免了再次插管，缩短有创通气时间，同时避免了相关的呼吸道并发症，缩短了患儿住院时间，节省了医疗费用，提升了先天性心脏病患儿术后成活率。【Abstract】 Objective To summarize the nursing experience of noninvasive ventilation for infants with congenital heart disease after the surgery. Methods A total of 36 patients who underwent noninvasive ventilation from January to December 2008 were enrolled. The blood pressure, heart rate, respiration, and blood gas were recorded and analyzed before and after noninvasive ventilation. Results Compared with the results before noninvasive ventilation, all of the indexes returned to a satisfying level and the circulation kept stable 30 minutes, one hour, and two hours after noninvasive ventilation. Conclusion Noninvasive ventilation may avoid reintubation, shorten the invasive ventilatory time, decrease the respiratory complications, shorten the time of hospitalization, save the medical expenses, and promote the survival rate of infants with congenital heart disease.
Objective To investigate the opinions of operating room nurse (ORN) on enhanced recovery after surgery (ERAS). Methods A questionnaire survey was performed among 215 ORNs in West China Hospital. There were 10 males and 205 females at age of 33.4±8.84 years. Results A total of 154 ORNs (71.6%) thought that we already had very good ERAS theory but we still needed more practice. Thirty-four ORNs(15.8%) thought that the application of ERAS was poor in our clinic comparing to other countries.A percentage of 84.2% (181/215) ORNs thought the criteria to judge whether the ERAS succeed or not should be average days of hospitalization, patients' feeling, and experience and social satisfactions. Besides, 78.1% (168/215) ORNs selected team building as the key point of ERAS success. There were 91.2% (196/215) ORNs who believed expert consensus and ERAS guide should be worked out and propagandized through academic forum or conference in order to popularize the ERAS. Conclusion The theory of ERAS has already been accepted by almost all the clinicians and team building is the best way to make ERAS work well.
ObjectiveTo explore the changes of intraoperative temperature and influencing factors of the short-term prognosis of patients undergoing clipping of posterior communicating artery aneurysms.MethodsThe basic clinic data and intraoperative temperature of patients undergoing elective clipping of posterior communicating artery aneurysms between October 2018 and July 2019 were collected, and the minimum intraoperative temperature was categorized into ≥36.0 and <37.5℃, ≥35.0 and <36.0℃, and <35.0℃. According to the Glasgow outcome scale (GOS) at discharge, the patients were divided into good prognosis group (GOS 4-5) and bad prognosis group (GOS 1-3). Multiple logistic regression analysis was used to obtain the risk factors of short-term prognosis.ResultsA total of 127 cases were involved, and intraoperative hypothermia (<36.0℃) occurred in 64 cases (50.4%). The intraoperative temperature presented classical three-phrase changes, i.e. it dropped rapidly at 1 hour after anesthesia introduction, decreased slowly during 2-3 hours after anesthesia introduction, and then entered the plateau. In the 127 cases, 93 (73.2%) had good prognosis, with an intraoperative hypothermia proportion of 44.1% (41/93); and 34 (26.8%) had bad prognosis, with an intraoperative hypothermia proportion of 67.6% (23/34). Univariate analysis showed that Hunt-Hess grade (χ2=18.999, P<0.001), intraoperative bleeding (χ2=7.074, P=0.008), minimum intraoperative temperature (Z=−3.473, P=0.001), and postoperative complications (χ2=43.060, P<0.001) were related to the short-term prognosis of patients undergoing clipping of posterior communicating artery aneurysms. Multiple logistic regression analysis presented that high Hunt-Hess grade (Ⅳ, Ⅴ) [odds ratio (OR)=6.456, 95% confidence interval (CI) (1.141, 36.532), P=0.035], the minimum intraoperative temperature <35.0℃ [OR=7.552, 95%CI (1.450, 39.345), P=0.016], and postoperative complications [OR=22.866, 95%CI (6.778, 77.142), P<0.001] were independent risk factors of the short-term prognosis. The difference in short-term prognosis between patients with the minimum intraoperative temperature ≥35.0 and <36.0℃ and the ones with the minimum intraoperative temperature ≥36.0 and <37.5℃ was not statistically significant (P>0.05).ConclusionsThe minimum intraoperative temperature<35.0℃ and postoperative complications were changeable factors to effect progonosis of patients undergoing elective clipping of posterior communicating artery aneurysms. Clinical staff should set medical intervention measures based on the individual conditions of patients to improve patients’ quality of life.
ObjectiveTo summarize the research status of intelligent patient monitoring and risk warning, and provide reference and enlightenment for promoting the construction of intelligent monitoring and management platform of clinical patient risk.MethodThe literatures about patient monitoring and risk warning at home and abroad in recent years were reviewed.ResultsAt present, the research at home and abroad mainly focused on the retrospective construction of the prediction model of severe complications of inpatients by using the electronic medical record database. The clinical decision support system based on real-time vital signs and dynamic electronic medical record data was still in the early development stage, and there was no mature product with high market share.ConclusionsThe construction process of structured electronic medical record system should be further strengthened, and the fully integrated clinical decision support system and artificial intelligence self-learning system should be the key research and development direction in the future, so as to promote the deep integration of big data and artificial intelligence technology with clinical scenes.
Objective To study the correlation between the cervical posture in the cervical disc replacement (CDR) and the cervical curve restoration in neutral position after surgery. Methods Between January 2008 and August 2010, 51 patients underwent single segmental PRESTIGE LP replacement, and the clinical data were retrospectively analyzed. During the surgery, the patient was supinely placed and the lordosis of the cervical spine was mantained with a pillow placed beneath the neck. Of them, 28 were male and 23 were female, aged 30-64 years (mean, 45 years); 32 were diagnosed as having cervical spondylotic myelopathy, 7 having radiculopathy, and 12 having myelopathy and radiculopathy. The disease duration was 3-48 months (mean, 15 months). CDR was performed at C4, 5 in 5 cases, at C5, 6 in 42 cases, and at C6, 7 in 4 cases. The Cobb angles of the cervical alignment, targeted functional spinal unit (FSU), and targeted disc were measured by sagittal X-ray film of the cervical spine in neutral position before and after surgery, as well as the intraoperative C-arm fluroscopy of the cervical spine. Linear correlation and regression were performed to analyze the relation between cervical Cobb angle difference at intraoperation and improvement of the Cobb angles at 3 months after operation. Results The cervical Cobb angles at intraoperation and 3 months after operation were larger than those at preoperation (P lt; 0.05). The difference of the Cobb angle between intra- and pre-operation was (6.72 ± 9.13)° on cervical alignment, (2.10 ± 5.12)° on targeted FSU, and (3.33 ± 3.75)° on targeted disc. At 3 months after operation, the Cobb angle improvement of the cervical alignment, targeted FSU, and targeted disc was (6.30 ± 7.28), (3.99 ± 5.37), and (4.29 ± 5.36)°, respectively. There was no significant difference in the Cobb angle improvement between the targeted FSU and the targeted disc (t= — 0.391, P=0.698), and between the targeted disc and the cervical alignment (t= — 1.917, P=0.061), but significant difference was found between the targeted FSU and the cervical alignment (t= — 2.623, P=0.012). The linear correlation between the Cobb angle difference and the Cobb angle improvement of the cervical spine was observed (P lt; 0.05). Conclusion A slightly lordotic cervical posture during CDR is an important factor to maintaining normal physiological lordosis of the cervical spine after surgery.