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优质护理服务在泌尿专科日间病房的开展与成效

目的　深化“以病人为中心”的服务理念，提升泌尿专科日间病房护理服务工作质量。 方法　对 2012年7月－11月入住日间病房的230例患者，实行责任制整体护理，包括加强基础护理，密切观察患者病情，协助医生实施诊疗，参与医生查房，积极与患者沟通，提供健康指导等护理工作，为患者提供全程、连续的优质护理服务。 结果　护理工作质量和患者满意度明显提高，整体满意度达到99.1%。优质护理服务开展前后各项指标满意度评分比较，差异有统计学意义(P＜0.05)。 结论　转变护理服务理念与模式，能全面提升对患者的服务品质，有效提高整体护理质量，提高患者满意度。

Application effect of triple therapy of “washing, blowing, and plugging” in wound treatment after PPH operation

ObjectiveTo explore the effect of " washing, blowing and plugging” triple therapy on wound treatment after procedure for prolapse and hemorrhoids (PPH) operation.MethodsTwo hundreds and four patients with moderate to severe hemorrhoids treated by PPH from June 2017 to September 2018 in the Fifth Hospital of Zhangjiakou City of Hebei province were selected as study subjects and divided into two groups according to the random number table, the control group received saline fumigation followed by sitz bath and conventional wound dressing change on the second day after operation, the observation group were treated with " washing, blowing and plugging” triple therapy and routine wound dressing change on the 2nd day after operation. The clinical efficacy, wound pain, wound exudation, skin margin edema, hemorrhage, granulation tissue filling time and complete wound healing time were compared between the two groups.ResultsThere was no significant difference in the effective rate between the observation group and the control group in degree Ⅱ hemorrhoids (P>0.05), while the effective rates of patients with degree Ⅲ and Ⅳ hemorrhoids were higher than those of the control group (P<0.05). The visual analogue scale (VAS), wound exudation, skin margin edema and hemorrhage scores of the two groups decreased gradually with time (P<0.05), meanwhile, the scores of VAS, wound exudation, skin margin edema and hemorrhage at each time point in the observation group were lower than those in the control group (P<0.05). The granulation tissue filling time and complete wound healing time in the observation group were shorter than those in the control group (P<0.05).ConclusionsAfter PPH operation, the " washing, blowing and plugging” triple therapy has definite clinical effect, can significantly improve wound pain, wound exudation, skin margin edema and hemorrhage, and effectively shorten the wound healing time.

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。

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。

开放性尿道手术术前会阴部泡洗方法探讨

目的探索3种不同泡洗溶液在开放性尿道手术术前会阴部泡洗中的效果。 方法将2012年4月-12月行开放性尿道手术的36例患者随机分为A、B、C组，每组各12例，术前会阴部泡洗分别采取：A组应用0.1%聚维酮碘进行泡洗，B组应用0.1%聚维酮碘+1.6%食盐水进行泡洗，C组应用1.6%的食盐水进行泡洗。比较3种泡洗方法的安全性、有效性及差异。 结果36例患者中A、B组各有1例仅在首次泡洗过程中的前2 min稍感瘙痒、皮肤发红等不适，尔后症状逐渐消失，顺利完成相应泡洗方案，3种泡洗方案均为安全。A、B、C组共34例完成手术，其中B、C组各1例出现感染，3组患者伤口感染率差异无统计学意义（P＞0.05）；3组患者伤口痊愈时间差异无统计学意义（P＞0.05）。 结论A、B、C 3种泡洗方法运用于开放性尿道手术术前准备时是安全的，患者耐受性较好；仅从预防感染的效果上来说，A组泡洗溶液更优，但三者在预防感染和促进伤口痊愈时效果无明显差异。

Traditional Chinese Medicine for Essential Hypertension: An Overview of Systematic Reviews

ObjectiveTo evaluate the methodological bias and the reliability of the conclusions of systematic reviews (SRs) about traditional Chinese medicine for essential hypertension. MethodsWe comprehensively searched PubMed, EMbase, The Cochrane library (Issue 4, 2014), CBM, CNKI and WanFang Data to collect SRs of traditional Chinese medicine for essential hypertension from the establishment time of databases to April 30th, 2014. The AMSTAR tool was applied for methodological quality assessment of included studies, and the GRADE system was applied for evidence quality assessment of included outcomes of SRs. ResultsA total of 12 SRs involving 31 outcomes were included, of which 11 SRs focused on the comparison of therapeutic effects between traditional Chinese medicine combined with western medicine and western medicine alone. Nine SRs adopted Jadad tool to assess methodological quality of included original studies. The results of assessment using AMSTAR showed that, among 11 items, there were the most problems concerning Item 1 "Was an 'a prior' design provided?" (none of the 12 SRs provided it); followed by Item 11 "Were potential conflict of interest included?" (nine SRs didn't described it), and Item 6 "Were the characteristics of included studies provided" (six SRs didn't provided it). The results of grading showed that, 29 outcomes were graded as "low" or "very low" quality. The main factors contributed to downgrading evidence quality were limitations (31 outcomes), followed by imprecision (12 outcomes), and inconsistency (13 outcomes). ConclusionCurrently, the methodological quality of SRs about traditional Chinese medicine for essential hypertension was poor on the whole, with low quality of evidence as well as lack of enough attention to the end outcomes of patients with essential hypertension. Thus, physicians should apply the evidence to make decision about traditional Chinese medicine for essential hypertension with caution in clinical practice.

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。

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。

经鼻高流量氧疗在慢性阻塞性肺疾病急性加重期的研究进展

一次性灌肠器在行盆底组织重建术女性患者术前阴道冲洗中的应用

目的探讨一次性灌肠器在行盆底组织重建术女性患者术前阴道冲洗中的应用及效果。 方法对2012年2月－2013年8月收治的88例拟行盆底组织重建术女性患者，术前采用一次性灌肠器进行阴道冲洗的方法及效果进行回顾分析。 结果本组患者采用一次性灌肠器进行阴道冲洗，均无不良反应或意外情况发生，经冲洗各例患者外阴均能保持良好清洁度，符合手术清洁要求。 结论一次性灌肠器用于阴道冲洗，操作简便、省力、省时，患者舒适度高，值得临床推广使用。