目的 探讨自我效能干预对于手术室护士的压力能够起到的调节效果。方法 通过对66名手术室护士的压力来源进行总结,并根据压力来源渠道分别进行自我效能护理干预一个月,并进行自我效能感以及工作倦怠方面对比评定,应用自我效能量表(USES量表)、工作倦怠量表( MBI量表)进行测算,将结果进行归纳总结。结果 经过自我效能护理干预的手术室护士的自我效能感评分显著提高,经过自我效能护理干预的手术室护士的MBI量表评分显著提高,干预前:手术室护士自我效能感以非常低的为主,占54.55%;干预后以非常高的为主,所占比例为48.48%;经过自我效能护理干预的手术室护士的MBI量表评分显著提高,干预前主要以中重度的工作倦怠护士为主,重度43例、中度21例;干预后主要以轻度和无倦怠的护士为主(P＜0.05)。结论 通过自我效能护理干预可以显著提高手术室护士的自我效能感、减少工作倦怠情绪,提高工作效率。

目的 探讨胸部良性疾病非计划二次手术的原因,降低非计划二次手术率,研究防止措施。方法 回顾性分析2006年5月—2016年5月间胸部良性疾病患者行外科手术治疗的临床资料574例,其中16例术后因各种原因行非计划二次手术,总结胸部良性疾病外科治疗后非计划二次手术的临床特点、治疗经过及原因,对可能的影响因素进行单因素分析和多因素分析。结果 本组患者行非计划二次手术,无死亡病例,二次手术手术时间为30～215(135.6±47.4) min。术中出血量50～650 (313.6±93.1)mL。术后住院时间7～30(15.7±6.8)d。二次手术原因包括术后出血 (10例)、术后肺持续漏气(4例)、切口感染(2例)。单因素分析首次手术疾病分类,首次手术时间,首次手术方式与胸部良性疾病非计划二次手术相关性有统计学意义(P<0.05),多因素分析结果显示首次手术疾病分类,首次手术时间,首次手术方式是胸部良性疾病非计划二次手术的独立危险因素(P<0.05)。结论 根据胸部良性疾病的不同疾病类别来估计和预防可能出现的并发症,特别是胸部炎症性病变,术前充分准备、术中仔细操作、术后并发症的早期积极处理,能降低胸部良性疾病非计划二次手术的发生率。

Objective To investigate the causes of benign thoracic disease unplanned reoperation,improve the level of diagnosis and treatment and reduce the rate of unplanned reoperation. Methods From May 2006 to May 2016,594 cases of benign thoracic disease were performed thoracic surgery,including 16 patients underwent the unplanned reoperation due to various reasons. The clinical characteristics, therapy course and results of benign thoracic disease unplanned reoperation were analyzed retrospectively. Results The patients underwent the unplanned reoperation were no deaths. The operative time 30～215(135.6±47.4)min, intraoperative blood loss 50～650 (313.6±93.1)mL,postoperation hospitalization duration 7～30(15.7±6.8)d. The causes of benign thoracic disease unplanned reoperation were as follows: postoperative bleeding (10 cases), prolonged air leaks (4 cases),incision infection (2 cases). Univariate analysis showed first-time classification of diseases, operative time and operation method were statistically significant (P<0.05), Multivariate Logistic regression analysis revealed first-time classification of diseases, operative time and operation method were independent factors associated with benign thoracic disease unplanned reoperation. Conclusion According to the different classification of benign thoracic disease to estimate and prevent possible complications, we need to have sufficient preoperative preparation, intraoperative careful operation. Early active processing can be taken in postoperative complications.It can reduce the incidence of unplanned reoperation in benign thoracic disease,especially the chest inflammatory diseases.

目的 探讨脉管炎围手术期出现焦虑症状及影响因素和护理以提高在围手术期的生活质量。方法 通过对脉管炎患者进行问卷调查焦虑发生及影响因素。结果 脉管炎围手术期患者出现焦虑是十分常见的,生活质量下降直接或间接影响手术的成功率。结论 有效的护理干预能改善各方面的焦虑因素,使患者在围手术期保持心情舒畅,从而适应截肢形象的改变,提高生活质量。

目的 探讨双侧声带麻痹治疗方式的选择与疗效。方法 回顾分析本院自2000年1月—2007年12月收治的双侧声带麻痹患者16例手术治疗资料与术后随访情况。结果 16例双侧声带麻痹的患者总共接受了29次手术治疗。4例鼻咽癌放疗后患者接受1次气管切开术,其他12例患者总共接受了25次手术治疗,平均每人2.1次。术式包括:气管切开术、神经肌蒂移植术、喉声带外移术、支撑喉镜CO₂激光声带手术及喉裂开单侧声带切除。结论 目前针对双侧声带麻痹的手术治疗有多种术式可供选择,临床医生应结合患者具体情况为患者提供个性化的治疗方案。

Objective To investigate the choice of surgical treatments for patients with bilateral vocal cord paralysis. Methods A retrospective analysis the operation and postoperative treatments in patients with bilateral vocal cord paralysis,from Jannuary 2000 to December 2007 in our hospital. Results A total of 29 operations were applied in 16 cases patients with bilateral vocal cord paralysis.Four cases of patients with nasopharyngeal carcinoma were received one time tracheotomy after radiotherapy.The others were received operation therapy for a total of 25 times.The average operation times in these groups was 2.1.Among them:Two patients were received one time operation,accounted for 16.7%(2/12);Five patients were received two times operation,accounted for 41.7%(5/12);Three patients were received three times operation,accounted for 25%(3/12);One patient was received four times operation,accounted for 6.3%(1/12).The surgical treatments included of tracheotomy,neuromuscular pedicle transplantation,lateral cordopexy,the laryngoscope vocal cord operation by CO₂ laser and laryngofissure unilateral vocal cord resection. Conclusion There have a variety of surgical options for bilateral vocal cord paralysis.Clinicians should provide individualized treatment plans for patients combined with their specific circumstances.

目的 探寻改良内眦赘皮、重睑组合手术并观察美学效果。方法 选取40例有内眦赘皮、重睑手术需求的患者,分为对照组和观察组,对照组采用传统内眦赘皮、重睑组合手术,观察组采用改良内眦赘皮、重睑组合手术,比较两组患者满意度、美学效果。结果 对照组患者满意度为60. 0%,观察组患者满意度为95. 0%,观察组患者满意度高于对照组(P<0. 05)。观察组美学效果优于对照组(P<0. 05)。结论 改良内眦赘皮、重睑组合手术能够充分矫正内眦赘皮的异常结构,更好暴露泪阜, 能成形鼻眶窝,使鼻根部具有起伏协调之曲线美感,具有较好美学效果的手术方法之一。

目的 探讨优质护理对于提高白内障手术患者术后恢复的影响。方法 选取本院自2014年1月—2014年6月收治的56例实施白内障手术的患者,将患者平均分配为对照组和实验组,对照组实行常规护理服务,观察组实施优质护理服务,建立完善的护理人员工作机制,提高护理人员素质;加强对患者的健康教育和心理护理,及时给患者进行检查。统计两组患者的治疗效果,分析优质护理服务的效果。结果 在术后接受优质护理服务的实验组患者的恢复效果好于对照组患者,术后的不良事件发生率较对照组低,患者的疼痛程度低,二组数据差异具有统计学意义。结论 给白内障术后的患者以优质护理服务能提高护理质量,缩短患者恢复时间,提高患者恢复效果。

目的 研究探讨适合基层医院开展白内障复明手术的手术方式。方法 随机抽取我院2010年4月—2014年4月收治的白内障患者1560例为研究对象。所有患者的患眼有2460只。并将其随机分成观察组和对照组,每组患者患眼分别有1230只。对照组采用大切口(巩膜隧道)有缝线白内障(囊外)摘除并人工晶状体植入手术,观察组患者采用小切口(巩膜隧道) 无缝线白内障(囊外)摘除并人工晶状体植入手术治疗的方法,并对两组的疗效进行分析。观察患者手术后的视力、术中以及术后并发症、住院费用等。结果 治疗结果显示,观察组患者的视力术后7天在0.4以上的患者占有89.7%,对照组患者视力在0.4以上的患者占有87.3%。差异无统计学意义(P＞0.05)。手术时间对照组长于观察组,手术费用对照组略高于观察组,差异有统计学意义(P<0.05)。两组在术中后囊膜破裂的发生率、前房型人工晶体植入的比例、上袢缝合固定后房型人工晶体植入比例比较,差异有统计学意义(P<0.05),观察组上述情况少于对照组。结论 在基层医院进行白内障复明活动,采用小切口(巩膜隧道) 无缝线白内障(囊外)摘除并人工晶状体植入手术治疗的方法疗效可靠,并发症少,手术时间短,住院总费用较低,有利于我们在资金、设备有限的情况下在限定的时间内完成较多的白内障复明手术。因此,在基层医院开展的白内障扶贫复明活动中小切口白内障(囊外)摘除并人工晶状体植入手术方法值得推广。

目的 探讨生长抑素对腹部手术后早期肠内营养支持顺应性的影响。方法 选择在本院接受中等以上腹部手术的住院病人60例,随机分成实验组和对照组各30例,手术后12 h开始给予早期肠内营养支持,连续5 d,实验组按常规使用生长抑素5 d,而对照组未使用生长抑素;比较两组在术后5 d内胃肠道不适的发生与否,胃肠减压的引流量,肠蠕动功能恢复情况,以及术后7 d的血液常规、肝、肾功能及血糖等血液生化指标。结果 与对照组比较,实验组在手术后胃肠道不适的发生,鼻胃管(胃肠减压)引流量,肠蠕动功能恢复时间等差异有统计学意义;术后7 d的血液常规、肝、肾功能及血糖等指标比较差异无统计学意义。结论 生长抑素有助于机体对腹部手术后肠内营养支持的顺应性,并安全可行。

Objective To study the clinical effects of somatostatin on compliance of early enteral nutrition after abdominal surgery. Methods 60 cases who accepted above medium abdominal operations were randomized into two groups including 30 cases of treatment group with somatostatin on the bases of early enteral nutrition and 30 cases of control group with early enteral nutrition, continued for 5 days after abdominal surgery. The promotion of clinical manifestations and signs, gastrointestinal decompression, blood routine examination, liver and renal function, blood glucose and so on were compared between the two groups. Results As for clinical manifestations and signs promotion, there were statistically significance in the alleviation of pain and distension of the abdominal and the average volume gastrointestinal decompression and the time of recovering peristalsis and passing flatus (P<0.05).As for blood routine examination, liver and renal function, blood glucose there were no statistically significance between the two groups. Conclusion Somatostatin can effected on compliance of early enteral nutrition after abdominal surgery.

目的 探讨体外循环手术前后患者血清HMGB₁、CK、CK-MB、LDH、LD₁、AST水平变化及意义。方法 采用ELISA法检测57例体外循环患者手术前后血清HMGB₁表达水平,采用临床常规方法检测血清中CK、CK-MB、LDH、LD₁、AST水平。对体外循环手术前后血清HMGB1表达水平与CK、CK-MB、LDH、LD₁、AST的水平进行比较与相关分析。结果 体外循环手术患者HMGB₁、CK、CK-MB、LDH、LD₁、AST水平在手术后0.5小时、24小时、48小时、72小时均高于手术前(P<0.05);HMGB₁、CK、CK-MB、LD₁、AST水平在手术后24小时达高峰,LDH水平高峰出现于手术后48小时,其他各指标渐渐下降。体外循环手术阻断时间延长,则HMGB₁、CK、CK-MB、LDH、LD₁、AST水平升高。体外循环手术后患者血清中HMGB₁表达水平与CK、CK-MB、LDH、AST指标呈正相关关系(P<0.05)。结论 体外循环手术后患者血清HMGB₁、CK、CK-MB、LDH、LD₁、AST水平升高,HMGB1参与了心肌的缺血再灌注损伤过程。

Objective To investigate before extracorporeal circulation and after HMGB₁, CK, CK-MB, LDH, LD₁, AST levels and significance in serum of patients. Methods 57 cases before extracorporeal circulation surgery and after, the levels of HMGB₁ were detected by ELISA,while the levels of CK and CK-MB and LDH and LD₁ and AST were detected by using conventional methods of clinical. Difference of HMGB₁ and CK, CK-MB, LDH, LD₁ and AST levels were compared. The relationship were been analyzed on the patients before extracorporeal circulation surgery and after. Results In extracorporeal circulation surgery, HMGB₁, CK, CK-MB, LDH, LD₁, AST levels after surgery in 0.5 hours, 24 hours, 48 hours,72 hours were higher than before surgery (P<0.05); HMGB₁, CK, CK-MB, LD₁, AST levels peaked at 24 hours aftersurgery, LDH levels was peaked at 48 hours after surgery, and then gradually declined. Extracorporeal circulation blocking was prolonged, the levels of HMGB₁ and CK and CK-MB and LDH and LD₁ and AST were elevated. After extracorporeal circulation surgery in serum the levels of HMGB₁ expression and CK,CK-MB,LDH, AST indicators showed a positive correlation(P<0.05). Conclusion The levels of HMGB₁, CK, CK-MB, LDH, LD₁ and AST were elevated after extracorporeal circulation surgery. HMGB₁ was involved in myocardial ischemia and reperfusion injury.

目的 探讨个体化术前访视在手术室临床护理路径的作用。方法 将167例进入手术室临床护理路径的子宫肌瘤截石位阴式全子宫切除手术患者随机分为实验组和对照组,分别予以或不予个体化术前访视,其他手术室临床护理路径相同,比较两组的护理效果。结果 两组均未出现手术体位并发症,实验组的术中心理应激变化小于对照组,实验组术后首次肛门排气时间、下床活动时间均早于对照组,实验组患者满意度高于对照组(P均<0.05)。结论 手术室临床护理路径应从个体化术前访视开始。