目的 探讨快速康复外科理念在手术室护理中应用效果。方法 选取2012年2月—2014年10月我院手术室普外科择期手术治疗140例患者随机分为康复组和常规组,分别采用快速康复外科理念护理和常规护理,比较两组患者胃肠功能恢复时间、下床活动时间、住院时间及并发症发生情况。结果 康复组胃肠功能恢复时间、下床活动时间及住院时间均短于常规组,两组间各值比较有统计学意义(P＜0.05);康复组并发症总发生率为4.29%,低于常规组20.00%发生率,两组比较差异有统计学差异(P＜0.05)。结论 快速康复外科理念应用于手术室护理可缩短患者康复时间,降低并发症发生,有较高应用价值,值得在临床中推广应用。
当前公立医院面临的内外部环境十分复杂，各种不确定因素影响公立医院健康运营。引入内部控制理念，建立健全采购与付款环节是必要的。文章对目前公立医院采购与付款业务管理中存在的问题进行分析，从改善内部环境建设、建立起有效的风险评估体系、加强采购与付款业务控制活动、巩固监督检查体系、加强信息沟通建设五个方面提出相应策略，优化公立医院采购与付款环节内部控制，从而减少风险带来的不确定性，保障医院运行的效率效益，助力医院高质量持续发展。
Public hospitals are currently navigating a complex internal and external environment，where various uncertainties can impact their effective operation．The introduction of internal control concepts and the establishment of robust procurement and payment processes are essential．This paper analyzes the issues present in the management of procurement and payment operations within public hospitals．It proposes strategies across five key areas：enhancing the internal environment，establishing an effective risk assessment framework，strengthening control activities in procurement and payment processes，reinforcing the supervision and inspection system，and improving information communication．These strategies aim to optimize internal controls，reduce uncertainty associated with risks，ensure operational efficiency，and support the sustainable，high-quality development of public hospitals．
目的 对比分析钝性分离扩皮法与常规扩皮法对乳腺癌术后患者经外周静脉置入中心静脉导管（PICC）置管应用效果。方法 选取2022年4月—2024年4月在天津肿瘤医院空港医院接受治疗的120例乳腺癌术后PICC置管患者，依据随机数字表法进行分组处理。对照组60例给予常规扩皮法，观察组60例给予钝性分离扩皮法，对比两组患者扩皮结果。结果 观察组患者满意度为96.67%，对照组患者满意度为86.67%（χ 2 =3.927，P=0.048）；观察组患者的穿刺点血液浸湿面积分别为穿刺后即刻（0.87±0.14）cm2 、1 d后（4.89±0.94）cm2 以及3 d后（0.21±0.05）cm2 ，均低于对照组的（2.74±0.63）（9.89±2.04）（0.44±0.12）cm2 ，对比差异有统计学意义（t=22.444、17.243、13.704，P＜0.05）；观察组患者一次性送鞘成功率为98.33%，对照组患者一次性送鞘成功率为88.33%，观察组高于对照组（χ 2 =4.821，P=0.028）；扩皮前两组患者的VAS评分无差异（P＞0.05），扩皮后两组患者的VAS评分均降低，且观察组（1.75±0.54）分低于对照组（3.89±1.22）分，对比差异有统计学意义（t=12.425，P＜0.001）；观察组患者不良事件发生率为5.00%，对照组患者不良事件发生率为16.67%，观察组患者不良事件发生率低于对照组（χ 2 =4.227，P＜0.05）。结论 钝性分离扩皮法能够降低穿刺点血液浸湿面积及不良事件发生率，提高一次性送鞘成功率，减轻患者疼痛感，提高患者满意度。
Objective To analyze the effect of blunt separating skin expansion and conventional skin expansion in PICC catheterization of patients after breast cancer surgery．Methods From April 2022 to April 2024，120 patients with postoperative PICC catheterization for breast cancer were selected and grouped according to the random number table method．Sixty patients in the control group received conventional skin expansion，and 60 patients in the observation group received blunt separation skin expansion，which the results of the two groups were compared．Results The patient satisfaction was 96.67% in the observation group，86.67% in the control group（χ 2 =3.927，P=0.048，P＜0.05）．In the observation group，the blood immersion area after catheterization，after 1 d and 3 d were（0.87±0.14），（4.89±0.94），（0.21±0.05）cm2 ，lower than those of the control group ［（2.74±0.63）（9.89±2.04）（0.44±0.12）cm2 ］，the comparative difference was statistically significant（t=22.444，17.243，13.704，P＜0.05）．The success rate of disposable sheath delivery in the observation group was 98.33%，which was higher than 88.33% in the control group（χ 2 =4.821，P=0.028＜0.05）．There was no difference in VAS scores between the two groups before the intervention（P＞0.05），VAS scores decreased in both groups after the intervention，the score of the observation group（1.75±0.54）was lower than that of the control group（3.89±1.22），the difference was statistically significant（t=12.425，P＜0.001）．The incidence of adverse events in the observation group was 5.00%，and in the control group was 16.67%，which difference was significant（χ 2 =4.227，P＜0.05）．Conclusions Blunt separating skin expansion can reduce the area of blood immersion and the incidence of adverse events，improve the success rate of disposable sheath delivery，reduce patient pain，improve patient satisfaction，and have significant clinical application value．
