【摘要】 目的 探讨吸入性损伤气管切开置管，导管脱出的原因及正确的护理方法，提高护士对患者的预见性护理能力。 方法 对2005年1月-2011年3月收治的158例吸入性损伤气管切开患者，其中9例术后发生导管脱出的原因及护理对策进行回顾性总结。 结果 9例患者发生导管脱出的主要原因有导管选用不当、剧烈咳嗽、系带过松、气囊充气不足或气囊破裂、切口过大，以及自行拔出。9例发生脱管时间不一，最短于气管切开术后第1天，最长于术后15 d，8例经予以紧急处理而尚未影响后续治疗，1例因缺氧时间太长而死亡。 结论 充分认识吸入性损伤患者气管切开脱管原因，并采取预见性的观察及护理措施，可减少脱管发生，确保患者安全。【Abstract】 Objective To explore the reasons and correct nursing methods of placing endotracheal tubes and tubes prolapsing after incision of trachea for inhalation injury. Methods The clinical data of nine patients with endotracheal tubes prolapse after incision of trachea out of 158 patients suffering from incision of trachea for inhalation injury from January 2005 to March 2011 were retrospectively analyzed. Results The reasons of nine patients suffering from endotracheal tubes prolapse included tubes incongruity, severe cough, too slack bridles, insufficiency and break of aerocysts, too large incision and extraction by themselves. The prolapse time of nine patients was different. The shortest time was postoperative one day, the longest one was postoperative 15 days. Eight patients were treated emergently and healed normally. One patient died of long oxygen deficiency. Conclusions The reasons of endotracheal tubes prolapse after incision of trachea are sufficiently recognized. Predictable observing and nursing methods may decrease the incidence rate of tubes prolapse.
目的 对烧伤层流病房多重耐药菌感染的相关因素进行分析，通过护理干预来预防和减少烧伤病房多重耐药菌感染的发生。 方法 回顾性分析2011年1月－12月收治的629例烧伤患者，其中发生多重耐药菌感染74例，感染率为11.8%。 结果 感染部位：创面分泌物培养感染占70.2%，痰液标本培养感染占9.4%，血液标本培养感染占16.2%，其他占4.2%。感染病原菌：以金黄色葡萄球菌为主，占77.0%；鲍曼不动杆菌占4.2%，铜绿假单胞菌占10.8%，肺炎克雷伯菌占6.7%，真菌感染占1.3%。 结论 对发生医院内多重耐药菌感染的原因进行分析并及时采取相应的护理干预措施，及可行的医院感染管理控制措施，对烧伤患者预后有重要的意义，可有效降低院内感染率的发生。
ObjectiveTo explore the effects of burn ward cleaning methods on multi-drug resistant bacteria infection, in order to improve and optimize the cleaning process and method. MethodsFrom November 2012 to October 2013, the cleaning and disinfection methods in our burn wards were regarded as the traditional cleaning methods, and from November 2013 to October 2014, the cleaning and disinfection methods were called the improved cleaning methods (new system cleaning methods). By retrospective analysis, we compared the infection rates of multi-drug resistant bacteria before and after the implementation of the new system cleaning methods. ResultsNew system methods were used in the ward environment cleaning and disinfection. The infection rate of multi-drug resistant bacteria before and after the implementation of the new system cleaning methods were 12.414‰ and 5.922‰ respectively. The methicillin resistant Staphylococcus aureus infection rate was 7.286‰ and 3.718‰, and the carbon-resistant Pseudomonas aeruginosa infection rate was 2.699‰ and 0.689‰. Both differences were significant (P < 0.05). The carbon-resistant Acinetobacter baumanii infection rate was 2.429‰ and 1.515‰ before and after the implementation of the new methods with no significant difference (P > 0.05). ConclusionAdopting new system to carry out cleaning can effectively reduce the infection rate of multi-drug resistant bacteria in the burn ward, and it is worthy of clinical popularization and application.
ObjectiveTo investigate the management methods of drug repercussion and its intervention measures in the Burn and Plastic Surgery Department by analyzing the reasons for drug repercussion. MethodBased on the drug repercussion data provided by the computer information center, we analyzed the common reasons and the status quo of drug repercussion. Active intervention measures were carried out, and real-time supervision and feedback of drug repercussion management were also performed. We compared such repercussion indexes before intervention (between May and September 2013) and after intervention (between October 2013 and February 2014):number of drug repercussion patients, times of drug repercussion, amount of money involved in drug repercussion, ratio of drug repercussion and dispensing and comprehensive ranking of the drug repercussion in the whole hospital. ResultsAfter intervention, the ranking of the causes of drug repercussion changed obviously. Changing orders casually dropped to the 3rd of the rank, and changing the department based on necessity rose from the 4th to the 2nd. All the indexes (including the times, number, and amount of money of drug of repercussion, and the ratio of repercussion and dispensing and compreheasive rank) reduced significantly (P<0.05). ConclusionsActualizing active intervention measures redounds to reducing drug repercussion, standardizing clinical use of drugs, insuring safety, and advancing the satisfaction of patients and quality of medical nursing.
ObjectiveTo explore the causes and prevention measures of the cracking of skin tissue expander applied for ear deformity surgery. MethodsWe retrospectively analyzed the clinical data of the patients who underwent ear reconstruction surgery with skin tissue expander which cracked during water injection after surgery between January 2013 and March 2015. And then we analyzed the causes and summarized the preventive measures, such as strengthening health education, protective ear cap application, and correct water injection. ResultsWe collected a total of 149 patients including 153 deformity ears, and 151 skin tissue expanders were used. Skin tissue expander cracking occurred in 7 ears during water injection after surgery with an incidence of 4.64%. Among the seven cases, 5 cases of cracking occurred in the late water injection period when the skin flap size was almost close to expectations; these 5 patients underwent stage-two surgery after the expanders were taken out, and the results were satisfactory. The other 2 ears had expander cracking in the early water injection period, so we took out the skin tissue expander and implanted it again, and the second phase surgery was also satisfactory. The third-stage surgery for the seven cases was all successful. After the third-stage surgery, all patients were followed up for 3 to 6 months, and the outcomes were satisfying without any complications. ConclusionTo reduce or avoid skin tissue expander cracking, we should master strict terms of water injection and take effective health education and preventive measures.
【摘要】 目的 探讨肢体深度烧伤后，影响功能康复的相关因素。 方法 采用美国日常生活自理量表和功能性日常生活量表，对2009年4月-2010年7月来门诊复诊的101例肢体深度烧伤患者的功能康复情况进行问卷调查和统计学分析。 结果 接受专业康复的患者得分明显低于自我康复患者得分，差异有统计学意义（Plt;0.01）；不同性别、不同文化程度之间的比较差异有统计学意义（Plt;0.001）；年龄14～50岁的患者对是否接受专业康复的比较，差异有统计学意义（Plt;0.001）；年龄lt;14岁、gt;50岁及婚姻状况，在是否接受专业康复的比较差异无统计学意义（Pgt;0.01）。 结论 肢体深度烧伤后患者在专业医师的指导下进行专业功能康复比自我康复的患者效果更好，使得烧伤患者社会期日常生活自理能力得到提高。【Abstract】 Objective to explore the related factors affecting the function recovery of deeply burned limps. Methods Adopting ADL body independent living scale and functional daily life scale, the questionnaire survey of the function recovery situation and statistical analysis were performed on the patients from the 101 outpatient appointment patients whose limbs were deeply burned from April 2009 to July 2010. Results The score of patients who accepted professional rehabilitation was significantly lower than that of the self healing patients, and the difference was significant (Plt;0.01); the difference of sex and the comparison between different literate degree were statistically significant (Plt;0.001); the difference in whether to accept the comparison of the professional rehabilitation among the patients with age oflt;14 years old, gt;50 years old and different marital status was not statistically significant (Pgt;0.01). Conclusion patients with deeply burned limbs recover better under the professional function recovery direction of professional doctor than the patients who have self recovery.