无创伤止痛措施用于普外科术后患者的护理体会

疼痛是个体在对一个有害刺激的反应中所经受的不舒适感，是外科患者常见护理问题之一。尤其术后由于手术切口及内脏牵拉引起的疼痛，使患者感到焦虑、恐惧，限制咳嗽、肢体活动，

创伤失血性休克的观察与护理

休克是机体受到突然打击，有效循环血量锐减以致全身各脏器中的微循环血量灌注不足和细胞严重缺血、缺氧所产生的一种危急的临床症状。常表现出烦躁或淡漠、面色苍白、皮肤湿冷、呼吸浅快、血压下降、尿量减少并伴酸中毒等症状。严重的创伤常涉及病人的心、肺、脑、肝、脾等重要器官，危及病人生命。故抢救过程应迅速、及时、准确、果断、有效。

严重复合伤1576例急救护理

随着现代工业、交通业的飞速发展，意外事故导致创伤的发生逐渐增多，由此而造成的死亡率也逐渐增高。如何降低死亡率和伤残率，是一项社会性课题。急救水平高低、护理措施及时有效是影响创伤患者救治结果的关键因素，并为伤后康复打下良好基础。笔者回顾性分析了2005—01至2009—06有护理记录的1576例严重复合型创伤患者资料，护理体会总结如下。

Computer-based simulative training system--a new approach to teaching pre-hospital trauma care

Objective:A computer-based STS(simulative training system) in providing pre-hospital trauma care at a disaster site was applied to teaching nursing students in the Second Military Medical University,China.This article reports on the teaching effectiveness of this system.Methods:Among 92 participants,46 were in the study group and 46 were in the 'control' group. Each student completed a multiple-choice quiz after completing 18 hours(six three-hour sessions) of the study module,and a score was recorded.The simulative training module was completed only by the study group;the 'control' group was assigned in-class discussions for the same amount of time covering the same content as the study group.The final course scores,which included both comprehensive and group task-based tests were compared between these two groups.The study used a descriptive and comparative approach for quantitative data analysis.Tests of independency between the multiple choice scores and the simulation scores were also performed.Finally,anonymous surveys were conducted.Results:The study group performed better than the 'control' group with a significantly higher average score for the group scenario task-based test score,and consequently the study group's final course score was significantly higher than the 'control' group.As per chi-square tests,no significant associations were found between the multiple choice scores and the simulated training scores.The final surveys showed students overwhelmingly agreed that STS training improved their knowledge and skills,their ability to recognize a potential critical event, and their initial response for trauma care at pre-hospital settings.The survey responses of the study group were noteworthy as they indicated that students recognized the importance of simulative training,appreciated the realism of the simulation,and were able to fight/adjust to the stressful feelings in order to focus on the task.Conclusion:Computer-based STS may be an effective teaching model to help students improve their capability in providing pre-hospital trauma care,and in their effectiveness in disaster response.

Trauma care system in Iran

Objective： The high burden of injuries in Iran necessitates the establishment of a comprehensive trauma care system. The purpose of this paper is to describe the current status of trauma system regarding the components and function. Methods： The current status of trauma system in all components of a trauma system was described through expert panels and semi-structured interviews with trauma specialists and policy makers. Results： Currently, various organizations are involved in prevention, management and rehabilitation of injuries, but an integrative system approach to trauma is rather deficient. There has been ongoing progress in areas of public education through media, traffic regulation reinforcement, hospital care and prehospital services. Meanwhile, there are gaps regarding financing, legislations and education of high risk groups. The issues on education and training standards of the front line medical team and continuing education and evaluation are yet to be addressed. Trauma registry has been piloted in some provinces, but as it needs the well-developed infrastructure （regarding staff, maintenance, financial resources）, it is not yet established in our system of trauma care. Conclusions： It seems that one of the problems with trauma care in Iran is lack of coordination among trauma system organizations. Although the clinical management of trauma patients has improved in our country in the recent decade, decreasing the burden of injuries necessitates an organized approach to prevention and management of trauma in the context of a trauma system.

Percutaneous dilatational tracheostomy for ICU patients with severe brain injury

Objective： To sum up our experience in percutaneous dilatational tracheostomy （PDT） in ICU patient with severe brain injury. Methods： Between November 2011 and April 2014, PDTs were performed on 32 severe brain injury patients in ICU by a team of physicians and intensivists. The success rate, efficacy, safety, and complications including stomal infection and bleeding, paratracheal insertion, pneumothorax, pneumomediastinum, tracheal laceration, as well as clinically significant tracheal stenosis were carefully monitored and recorded respectively. Results： The operations took 4-15 minutes （mean 9.1 minutes±4.2 minutes）. Totally 4 cases suffered from complications in the operations： 3 cases of stomal bleeding, and 1 case of intratracheal bloody secretion, but none required intervention. Paratracheal insertion,pneumothorax, pneumomediastinum, tracheal laceration, or clinically significant tracheal stenosis were not found in PDT patients. There was no procedure-related death occurring during or after PDT. Conclusion： Our study demonstrats that PDT is a safe, highly effective, and minimally invasive procedure. The appropriate sedation and airway management perioperatively help to reduce complication rates. PDT should be performed or supervised by a team of physicians with extensive experience in this procedure, and also an intensivist with experience in difficult airway management.

Comparison of severe trauma care effect before and after advanced trauma life support training

Objective： To study the emergency care effect of in-hospital severe trauma patients with the injury severity score （ISS）≥ 16 after medical staff received advanced trauma life support （ATLS） training.Methods： ATLS training was implemented by lectures,scenarios, field practices, and examinations. The clinical effect of in-hospital severe trauma care was compared 2 years before and after ATLS training.Results： During 2 years （from January 1, 2004, to December 31, 2005） before ATLS training, 438 cases of severe trauma were admitted and treated emergently in our department. Among them, ISS score was 28.6±7.8 on average, and 87 cases died with the mortality of 19.9%. The duration in emergency department and from admission to operation were 69.5 min±l 1.5 min and 89.6 min±9.3 min respectively. Two years （from January 1,2007, to December 31, 2008） after ATLS training, 382 cases of severe trauma were admitted and treated. The ISS was 25.3 ±6.1 on average and 62 cases died with the mortality of 15.1%. The duration in emergency department and from admission to operation were 47.8 min±10.7 min and 61.5 min±9.9 min respectively. The ISS score showed no significant difference between the two groups （P＞0.05）, but the mortality, the duration in emergency department and from admission to operation were markedly decreased after ATLS training and showed significant difference between the two groups （P＜0.05）.Conclusion： ATLS course training can improve the emergency care effect of in-hospital severe trauma patients,and should be put into practice as soon as possible in China.