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Application of PDCA Cycle in Urgent Values Management in Surgical Intensive Care Unit

ObjectiveTo discuss the application and effect of PDCA cycle in urgent values management in surgical intensive care unit. MethodsWe analyzed the quality of 141 cases of urgent value reports in surgical intensive care unit from May to July 2013 before the application of PDCA management. The quality of urgent values were totally controlled by PDCA circle. There were 135 cases of urgent value reports after the use of PDCA cycle. The data including qualify rate of specimens, record specification rate, and handover of urgent values were compared between the two groups of urgent values. ResultsAfter the application of PDCA cycle management, the awareness rate of urgent value content and disposal processes among medical staffs increased from 75% to 95%, with significant improvement in the quality rate of samples, recording and processing of urgent values and the quality rate of recording. ConclusionThe application of PDCA circle management can constantly correct the problems and ensure the policy implementation in the urgent values system in clinical departments, which can promote continuous quality improvement.

外科监护室退药现象分析及对策

目的　通过对外科监护室退药现象的分析，从而寻求控制退药的途径与方法。 方法　收集外科监护室2011年1月－6月发生的退药信息，并对各退药原因进行统计分析。 结果　引起退药的原因依次是患者转出占49.4%、医生调整医嘱25.9%、出院死亡8.6%、医生错开5.1%、医院信息系统不完善3.6%、操作电脑失误2.5%、其他占4.9%。 结论　降低外科监护室退药比例应从控制转出患者退药、医生更改医嘱等方面入手，同时尽量降低因医生错开、电脑系统操作失误和信息系统不完善导致的退药。

盐酸万古霉素与头孢哌酮钠舒巴坦钠使用存在配伍禁忌

目的探讨在临床输液过程中，盐酸万古霉素与头孢哌酮钠舒巴坦钠使用存在配伍禁忌。 方法将头孢哌酮钠舒巴坦钠3 g加入生理盐水50 mL内，将盐酸万古霉素100万U加入生理盐水100 mL内，各抽取2 mL混匀，观察两组药物之间的反应。 结果将混合的液体在常温下放置10 min、1 h、2 h，观察混合液是否变澄清，但发现液体仍为浑浊液体。 结论盐酸万古霉素与头孢哌酮纳舒巴坦纳使用存在配伍禁忌。

两种鼻胃管的压疮发生率比较

目的比较两种不同材质鼻胃管的压疮发生率。 方法选择 2014 年 9 月—2015 年 9 月入住重症监护室符合纳入、排除标准的 180 例患者，根据其住院号尾数奇、偶分为对照组和试验组，每组各 90 例。对照组使用普通硅胶鼻胃管，试验组使用“复尔凯”鼻胃管。两组患者均使用 2.5 cm×7.0 cm 人字形 3M 易撕敷料胶带进行固定，面部采用 3M 透明敷料进行加强固定。观察两组患者鼻部压疮发生时间及发生率。 结果两组患者在带管 10 d 内均无鼻部压疮发生。带管 10～20 d，对照组 7 例患者发生压疮，压疮发生率为 7.8%；试验组无患者发生压疮，差异有统计学意义（P<0.05）。 结论“复尔凯”鼻胃管外径小，材质柔软，对于患者鼻部的刺激及挤压性较小，引起鼻部压疮发生较少，有利于减少患者鼻胃管相关的压疮发生率。

保易定自粘性压力绷带固定桡动脉置管针的效果评价

目的　观察保易定自粘性压力绷带固定桡动脉置管针的应用效果。 方法　将2010年12月－2011年9月100例入住外科重症监护室、需行桡动脉压力监测患者随机均分为观察组和对照组各50例。对照组采用透明敷贴常规固定桡动脉穿刺置管针，观察组则采用透明敷贴+保易定自粘性压力绷带固定置管针，比较两种方法对穿刺部位留置时间的影响和反应。 结果　观察组置管针渗液、针头滑脱、意外拔针发生率明显低于对照组（P＜0.05）；留置时间长于对照组（P＜0.05）。 结论　透明敷贴+保易定自粘性压力绷带固定桡动脉穿刺置管针可有效保护留置动脉导管，延长导管留置时间，降低再次穿刺痛苦，值得在临床应用和推广。

品管圈活动在降低外科重症监护高危患者压疮发生率中的作用

目的　探讨品管圈活动在降低外科重症监护（SICU）高危患者压疮发生率中的作用。 方法　2011年11月起成立品管圈小组，确立以“降低SICU高危患者压疮发生率”为活动主题，通过制定相关制度和改进护理措施，加大对压疮高危患者的护理预防力度，并对活动前后A、B两组共100例患者的压疮发生情况进行对比分析。 结果　高危患者压疮发生率由7.6%下降到2.0%。 结论　品管圈活动在降低SICU高危患者压疮发生率中的效果明显，值得推广。

急性颅内动脉瘤破裂出血术后患者在重症医学科的血压管理

目的 探讨严格的血压管理对急性颅内动脉瘤破裂出血术后患者目标血压的控制效果。 方法 对 2015 年 1 月—9 月 28 例颅内动脉瘤破裂出血术后患者进行严格的血压调控和监护。 结果 28 例患者的血压经专科对症治疗及综合的血压管理，均得到较好控制。21 例单个动脉瘤术后患者平均动脉压控制在 90～110 mm Hg（1 mm Hg=0.133 kPa），收缩压控制在 135～160 mm Hg；7 例多个动脉瘤术后患者平均动脉压控制在 80～100 mm Hg，收缩压控制在 135～150 mm Hg。21 例患者血压在 24 h 内降至理想水平，7 例患者血压在 48 h 内降至理想水平，患者未出现颅内再出血。27 例患者呼吸机辅助呼吸 5～7 d 后顺利停机拔管，转入神经外科病房继续治疗；1 例患者于术后第 2 天自动出院。 结论 对急性颅内动脉瘤破裂出血术后患者采取有效的血压管理，可以减少患者术后并发症。

气管切开术后专用一次性护理包的设计

Effect of Precise Management on Life-saving Equipment Management in Surgical Intensive Care Unit

ObjectiveTo explore the effect of precise management on life-saving equipment management in Surgical Intensive Care Unit (SICU). MethodsWe actualized precise management in the life-saving equipment management process in March 2014, including precise management control system, precise personnel training, and precise process management. ResultsAfter precise management, the knowledgement of life-saving equipment of the nurses increased from 90.2% (May, 2014) to 98.5%. The number of equipments repaired before (March-May, 2014) and after the management (June-August, 2014) was 65 and 47, respectively; the number of nonstandard management times in nurses after the equipments were used was 98 and 10, respectively. ConclusionPrecise management can drastically improve management efficiency, serviceability rate and service efficiency of life-saving equipment, obviously enhancing the degree of familiarity and using skills of clinical nurses, and ensuring quick and smooth emergency work. It plays an active role in securing severe patients' life.

Present Situation of Psychological Pressure in Intensive Care Unit Nurses

ObjectiveTo explore the psychological pressure in Intensive Care Unit (ICU) nurses and the sources of their pressure. MethodWe investigated the ICU nurses in West China Hospital with a self-designed psychological pressure questionnaire from March to September 2013. ResultsThe total stress level of ICU nurses was 2.89±0.86. The top five sources were low salaries and welfare benefits (3.37±0.61), high frequency of night work (3.31±0.88), wide need of knowledge (3.22±0.41), heavy workload (3.20±0.80) and chronic fatigue syndrome (3.19±0.75). ConclusionsGreat psychological pressure exists in ICU nurses. We urgently need effective approaches to relieve the stress of ICU nurses in order to improve the efficiency and quality of nursing service.