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Reasons and Treatment of Endotracheal Tube Prolapse after Inhalation Injury

【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.

严重雷电击伤合并晚期妊娠护理一例

小儿烧伤惊厥的原因分析及干预措施

目的　探讨小儿烧伤并发惊厥的原因及护理措施。 方法　回顾性分析2010年3月－2012年2月收治的35例患儿烧伤并发惊厥的临床病历资料。 结果　小儿烧伤惊厥的原因有休克、高热、电解质紊乱、烧伤毒血症、脑缺氧脑水肿，各种原因之间相互影响。本组35例患儿中，惊厥持续时间30 s～5 min不等，34例治愈，1例因多器官功能衰竭死亡，所有患儿随病情而好转。 结论　小儿烧伤后并发惊厥的原因较多，在治疗和护理过程中应随时把握病情变化，正确处理患儿高热、电解质紊乱等，一旦发生惊厥应采取及时有效的救护措施，防止意外发生。

烧伤病房陪护管理方法探讨

【摘要】　针对烧伤病房陪护管理问题，通过采用加大宣传教育力度及制定落实陪护管理制度等措施，从多个方面切实加强烧伤层流病房的陪护管理。在大家的努力下，烧伤病房陪护人员数量得到有效控制，感染防控意识明显加强，但在中午以及夜间薄弱时间段对陪护人员的管理还需加强。目前采取的陪护管理方法能够实现较规范的陪护管理，但完善的陪护管理仍有可探讨改进的空间。

Factors Related to Multi-drug Resistant Bacteria Infection in Laminar Flow Burn Ward

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。

改良封闭式负压引流技术用于电击伤创面的护理

【摘要】　目的　总结改良封闭式负压引流（vacuum sealingdr ainage，VSD）技术治疗电击伤创面的护理方法。　方法　对2010年10月-2011年6月收治17例电击伤创面，采用改良VSD技术即在常规封闭引流装置的海绵中埋置留置针导管，并定时进行冲洗治疗的护理方法及特点进行回顾性总结。　结果　本组15例25处电击伤创面于安置改良VSD负压引流7～10 d去除VSD泡沫，其创面清洁、肉芽组织生长良好，行二期植皮手术修交创面。1例1处创面安置改良VSD负压引流第2天出血，予以结扎止血、重新更换贴膜继续负压引流8 d后植皮手术修交创面。1例1处创面采用改良VSD负压引流7 d去除泡沫，仍有部分坏死组织及分泌物，予以再次扩创并重新采用改良VSD 5 d后植皮修复创面。　结论　改良VSD技术治疗电击伤创面能明显降低堵管概率，有效促进坏死组织充分引流，加快肉芽组织生长，缩短治疗时间，降低因引流管堵塞反复更换导致的费用增加。

Nursing of Vacuum-assisted Closure Technology for Deficiency of Skin and Soft Tissue Deficiency Damaged in“4·20”Earthquake

ObjectiveTo summarize the nursing experience of vacuum-assisted closure (VAC) technology for deficiency of skin and soft tissue in "4·20" earthquake damage. MethodsWe used VAC to treat 20 patients suffering from deficiency of skin and soft tissue who were injured in "4·20" earthquake (35 wounds) from April 21st to 28th, 2013; and we observed closely the results of nursing for pain and psychological care. ResultsA total of 35 wounds were all cleaned after 5 to 7 days; 20 wounds were healed after VAC treatment; 15 wounds recovered well by covering autogenous split-thickness skin; 20 patients had stable emotion and all left the hospital with the recovery. ConclusionVAC for deficiency of skin and soft tissue caused by "4·20" earthquake damage may obviously decrease the time of wound healing, relieve the pain caused by changing fresh dressing, and reduce the length of stay in the hospital.

Nursing of Skin Expander Plasty of Giant Nevus

【摘要】 目的 总结皮肤扩张器用于巨痣整形的护理措施。 方法 2008年4月-2009年11月对28例皮肤扩张器置入治疗巨痣整形的护理措施进行总结和分析，重点加强了心理护理、健康教育及注水期间的护理。 结果 术后患者皮肤色泽正常，外观满意出院。随诊1年，效果佳。 结论 加强心理护理，有针对性的健康教育，重视注水期间护理措施的实施，对皮肤扩张器置入术用于巨痣整形患者至关重要。【Abstract】Objective To summarize the nursing interventions of skin expander plasty of giant nevus. Methods From April 2008 to November 2009, 28 cases of giant nevus were admitted for skin expander surgery.The nursing interventions，especially the mental nursing, health education and nursing care during the infusion period were summarized and analyzed. Results The results were satisfactory including the color and the appearance by one-year follow-up. Conclusion It is important to emphasize the mental nursing, health education and nursing care during the infusion period for the patient undergoing giant nevus plasty treated with skin expander.

臀会阴及下肢大面积皮肤软组织撕脱伤患者的护理

【摘要】 目的 总结臀会阴及下肢大面积皮肤软组织撕脱伤的护理特点及方法。 方法 2005年1月-2007年6月，对8例臀会阴及下肢大面积皮肤软组织撕脱伤患者进行综合治疗。男女各4例，年龄4～48岁。病程1 ～14 d，平均5 d。撕脱皮肤占体表总面积8%～20%。致伤原因:车祸伤7例，高坠伤1例。分析此类患者的手术要领，心理特点和住院期间及出院后的护理经验。 结果 8例患者经综合治疗及积极护理后伤口均愈合，随访3～6个月皮肤愈合良好。6例行结肠造瘘的患者中3例因骨盆骨折稳定于出院后3个月行结肠造瘘还纳术，恢复肛门排便，脊髓损伤患者终身需行结肠造瘘。 结论 臀会阴及下肢大面积皮肤软组织撕脱伤患者通过上翻身床，必要时行结肠改道，积极的创面处理及对症支持治疗，根据治疗的不同阶段合理调整护理重点，对患者康复起到了积极作用。

The Cause Analysis and Prevention of Cracking of Skin Tissue Expander Applied for Ear Deformity Surgery

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.