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Application of Clinical Nursing Path Improvement for Day Surgery of Laparoscopic Cholecystectomy

Objective To investigate the efficacy of improved clinical nursing path for day surgery of laparoscopic cholecystectomy (LC). Methods The clinical data of 3 274 patients who underwent day surgery of LC following the clinical pathway between January 2011 and December 2015 were collected. The rate of adverse events including pain, postoperative nausea and vomiting (PONV), retention of urine and staxis before and after the improvement of clinical nursing path was analyzed and compared. Results For adverse event rate before and after the improvement of clinical nursing path, the difference in the incidence of pain and PONV was statistically significant (P < 0.05), while the difference in retention of urine and staxis was not statistically significant (P > 0.05). Conclusions Through the improvement of clinical nursing path for LC during day time, the procedure of nursing becomes more standardized. It is more feasible for clinical work and postoperative adverse reactio n rate becomes lower. It can also help shorten postoperative rehabilitation time and ensure perioperative medical quality and safety.

极重度横纹肌溶解合并急性肾损伤供者肾移植一例

在护理本科生操作实习中开展拇指教育的探索

目的:对在护理本科生的操作实习中开展拇指教育的探索。方法：在护理本科生开展关于拇指教育的调查,对调查结果进行分析。结果：护理本科生普遍认为拇指教育更有利于自我的成长。结论：在临床带习老师中定期开展拇指教育的学习非常有必要。

经皮肾镜取石术围手术期护理

摘要:目的: 探讨经皮肾镜取石术(percutaneou nephro lithotomy,PCNL)治疗肾结石的护理措施,总结护理经验。 方法 :回顾分析2006年8月至2009年3月我科172例肾结石患者的临床资料,均采用经皮肾镜取石术治疗,同时做好术前、术后护理、出院指导。 结果 :172例患者均顺利拔管,痊愈出院。其中并发症2例严重出血,1例发生感染性休克,3例出现肾周围血肿,3例水中毒及低钠血症。 结论 :保持患者良好的心理状态、充分的术前准备、术后严密的观察和管道的护理、具体的出院指导等,则是手术成功、患者顺利康复的重要保证。

泌尿专科建立日间病房模式及效果探讨

目的　探讨新医改形势下在三甲医院开设泌尿专科日间病房的可行性和具体措施。 方法　通过制定专科临床路径，住院流程与管理细则、随访方案，对2010年10月－2011年3月泌尿科238例行中小手术患者采用日间住院模式进行治疗与护理。结果　231例患者顺利完成手术，7例因术后并发症或因需行第二次手术等直接转为普通住院。经出院随访，日间住院管理模式下患者各地医保成功报销率达90.48%，满意度达97.88%。 结论　在三甲医院中开设泌尿日间病房，安全性高，可创造较好的社会效益，有利于医改目标的实现。

Influence of dexmedetomidine on early postoperative cognitive dysfunction and inflammatory factors in elderly patients: a meta-analysis

ObjectiveTo systematically review the influence of dexmedetomidine on early postoperative cognitive dysfunction (POCD) and serum inflammatory factors in elderly patients.MethodsWe searched PubMed, EMbase, The Cochrane Library, CBM, CNKI, WanFang Data and VIP databases from inception to April 2017, to collect randomized controlled trials (RCTs) about dexmedetomidine for early POCD in elderly patients. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then, meta-analysis was performed by RevMan 5.3 software.ResultsA total of 23 RCTs, including 2 026 patients were enrolled. The results of meta-analysis showed that, the incidence of POCD in the dexmedetomidine group was lower than that in the control group (the first day: RR=0.40, 95%CI 0.30 to 0.53, P<0.000 01; the third day: RR=0.33, 95%CI 0.23 to 0.48,P<0.000 01; the seventh day: RR=0.42, 95%CI 0.22 to 0.78,P=0.006). Meanwhile, compared with the control group, the dexmedetomidine group significantly decreased the serum levels of TNF-α (immediately after operation: MD=–5.43, 95%CI –7.44 to –3.42, P<0.000 01; 1 h after operation: MD=–4.64, 95%CI –6.92 to –2.36,P<0.000 1; 24 h after operation: MD=–3.27, 95%CI –4.92 to –1.63,P<0.000 1) and IL-6 (immediately after operation: MD=–30.69, 95%CI –41.39 to –20.00,P<0.000 01; 1h after operation: MD=–20.84, 95%CI –28.87 to –12.80,P<0.000 01; 24 h after operation: MD=–13.42, 95%CI –19.90 to –6.94,P<0.000 1).ConclusionCurrent evidence indicates that dexmedetomidine could relief early POCD in elderly patients, in which the reduction of serum inflammatory factors alleviate inflammation response may play a vital role. Due to the limited quality and quantity of included studies, more high quality RCTs are required to verify the above conclusion.

The Nursing of Septic Shock after Percutaneous Nephrolithotomy

目的　探讨孤立肾肾结石经皮肾镜取石（PCNL）术并发感染性休克的护理。 方法　回顾性分析2010年3月－2012年10月5例孤立肾肾结石患者行PCNL术后并发感染性休克的临床资料，对患者术后出现的休克及时补足血容量，使用有效的抗生素，早期足量应用激素、血管活性药物，同时加强心理疏导、健康教育等护理措施。 结果　5例患者体温均在3 d内降至正常；血管活性药物平均使用时间为1.8 d （2～4 d）；1例因血氧饱和度＜80%，血压＜85/50 mm Hg（1 mm Hg=0.133 kPa）转往重症监护病房行呼吸机辅助呼吸2 d后呼吸循环功能改善；另1例同时出现少尿无尿，及时行血液透析，第4天尿量逐渐恢复；5例患者均痊愈出院。 结论　感染性休克是PCNL术后最危险的并发症之一，对其采取积极预防、及早发现、及时有效的治疗和护理等措施，可有效促进患者康复。

优质护理在泌尿外科术后感染性休克中的应用

目的总结应用优质护理服务护理术后感染性休克患者的方法及经验。 方法选择2009年6月－2013年8月行手术治疗后发生感染性休克的患者14例。其中，男13例，女1例，平均年龄（50.8±2.5）岁。应用“以患者为中心”的护理理念，为患者提供全程、全面、连续、专业化的优质护理服务，为患者提供优质的基础护理、生活护理、心理护理及用药指导、健康教育等，并严密观察患者病情变化，早期发现问题，早期诊断，早期处理。 结果14例患者均在72 h内恢复正常体温，神志清楚，精神状态良好，生命体征及氧饱和度正常，白细胞计数从（18.114±8.926）×109/L降至（4.178±0.958）×109/L，最终14例患者均痊愈出院。 结论优质护理应用于术后感染性休克的患者，能取得患者的信赖，增进护患沟通，减轻患者的心理负担，提高患者对护理工作的满意度。通过提高护理服务质量，保证患者的治疗效果，促进患者身心健康恢复，提高患者的生活质量。

综合医院开展医护一体化合作模式的调查

目的　了解综合医院医护一体化合作模式开展以来的医生满意度，为医护合作模式的推广提供依据。 方法　2011年11月采用分层抽样的方法，对370名临床医生以问卷调查方式，验证医护一体化合作模式的运用效果。 结果　96.8%的医生重视医护一体化工作的开展，96.5%的医生认为在医护一体化合作中与护士的合作程度好，93.5%的对这一合作模式的应用现状表示满意，97.3%的对其持支持态度。 结论　医护一体化合作模式已被广大医生认可和支持，是未来发展的方向。

The Diagnostic Value of Multi-slice Spiral CT for Gastrointestinal Stromal Tumors

【摘要】　目的　分析胃肠道间质瘤（gastrointestinal stromal tumors，GIST）的螺旋CT（multi-detector row spiral computeel Tomography，MSCT）表现，评价其对该病的诊断价值。　方法　回顾性分析2000年3月—2010年10月经手术病理证实的32例GIST的MSCT表现，并将其与病理的生物学危险性进行对比研究。　结果　病理高、中、低及极低危险性GIST依次为15、6、7、4例。GIST主要CT表现，肿块腔外生长为主，大部分病灶边界清楚，呈类圆形或分叶状，密度均匀或不均匀，3例可见钙化，GIST增强静脉期强化较动脉期更明显，局部均无淋巴结转移，转移到肝脏的4例，同时伴前腹壁转移1例。15例肿块长径≥5 cm，密度多不均匀，可有囊变、坏死、出血等，增强不均匀强化，其中11例病理为高风险性；17例肿块长径lt;5 cm的病灶中，大多中度均匀强化，其中13例为中度及以下危险性。　结论　GIST患者的MSCT表现具有一定的特征性，MSCT对准确定位、术前估计肿瘤的风险级别、术后随访有重要价值。【Abstract】　Objective　To investigate the imaging features of multi-slice spiral CT (MSCT) for gastrointestinal stromal tumors (GIST) and its diagnostic value. 　Methods　We retrospectively analyzed the MSCT manifestations of 32 cases of GIST confirmed by operation and pathology between March 2000 and October 2010. Comparative study was then carried out between MSCT manifestations and patho-physiological risks. 　Results　Of the 32 GIST lesions, 15 presented with high biological risks, six moderate risks, seven low risks and four very low risks. The MSCT results manifested the following main features. Exophytic growth was predominating; Most lesions were with well-defined margins, and were rotund or lobular in shape with homogeneous or heterogeneous density. Three lesions manifested calcification. The enhancement degree of GIST in portal vein phase was more obvious than in arterial phase. There was no metastasis to local lymph nodes. Hepatic metastasis occurred in four cases, one of which was accompanied with anterior abdominal wall metastasis. Of the 15 lesions with maximal diameter longer than 5 cm, MSCT showed obvious cystic changes, necrosis or hemorrhage within the mass most of which was in heterogeneous density, and heterogeneous enhancement; Eleven out of the 15 lesions were at high risk. Among the 17 lesions with maximal diameter shorter than 5 cm, MSCT showed homogeneous enhancement, and 13 of them were at moderate risk or below. 　Conclusion　The MSCT imaging of GIST manifests some certain characteristics. It is valuable in locating the lesion precisely, estimating the risk level of the tumor, and postoperative follow-up for patients with GIST.