PDCA护理对胸伤性血气胸患者负性情绪的影响探究

胸部损伤诱发的创伤性血气胸病症是比较普遍的,发生率达到70%左右,它对患者的呼吸、循环等工作有着严重的损害,甚至会增加患者死亡风险,所以,应该早期发现,早治疗干预,并配合优质的护理服务,促进患者病情的早期康复。本次研究就以胸伤性血气胸疾病,实施PDCA护理方面的效果进行了综合调研分析。方法 医院近几年接收的胸伤性血气胸病例持续增多,为攻克此类临床护理难题,本次就从科室选入部分典型病例进行了调研,符合此次研究指标病例有40例,以此次实施的护理方案进行分组处理,其中20例患者主要开展常规护理,确定是对照组,还有剩余相同病例患者主要展开PDCA护理,归为观察组,对此次护理过程中患者的焦虑、抑郁程度进行了对比分析,评估此类护理质量程度,以问题形式进行匿名护理满意度调研,对此次出现并发症的病例进行了详细统计。结果 由于患者护理前有较重的焦虑、抑郁情况,不利于患者病情的恢复,通过对症护理后,患者此类状况有所减轻,但小组对比表示,对照组还有部分患者情况改善不显著;护理质量以多维度进行评估,结果为观察组评分更优;对统计后的护理满意度表做对比,其中观察组满意率更高;对记录出现并发症的病例进行统计,其中对照组发生率偏高(P<0.05)。结论 此次主要针对患有胸伤性血气胸的患者在治疗期间并临床护理服务,主要评估不同护理方法的效果,结果为PDCA护理能够帮助患者从心理、生理等多方面进行针对性的干预,能够帮助患者减轻负性情绪,促进患者病情的迅速恢复,保证患者生活质量。

PDCA护理对胸伤性血气胸患者负性情绪的影响探讨

进一步探索与研究PDCA护理对胸伤性血气胸患者负性情绪的影响。方法:自2018年开始到2019年年末时,在我院救治的相关病人病例高达40余例,对其开展了针对性的研究调查以后,进行了临床研究。以PDCA护理形式为主的病人作为实验组,常规护理的病人作为对照组进行实验,经过一段时间以后,查看病人情况的差异,是否存在很大不同,着重从病人的满意度、身体健康状况中进行分析,结果:显示PDCA护理的病人,整体满意度较高,比常规护理形式护理的病人满意度高一成,其他的情况也都均高于对照组,比如说护理质量和满意度、焦虑得分以及抑郁得分等等;结论:临床PDCA护理和胸伤性血气胸患者的负性情绪密切相关。充分发挥PDCA护理的作用,落实护理管理措施,对改善胸伤性血气胸患者负性情绪具有深远的意义,可在临床上予以普及和应用。

外伤性胸主动脉断裂伤的诊断与治疗进展

外伤性胸主动脉断裂伤（traumatic aortic transection，TAT）是胸部钝性外伤导致死亡的主要原因之一，发生率占胸部钝性外伤的13％～20％，死亡率高达90％。美国每年有7500～8000人死于TAT，约85％的患者当场死亡，仅有10％～15％的患者入院时仍存活，而住院期间又有30％患者死亡，其中1／3手术前死亡。因此，寻找快速诊断和及时有效的治疗方法，

外伤性胸主动脉断裂伤的治疗进展

外伤性胸主动脉断裂伤(TAT)由于病情尤为凶险,且死亡率高,因而是临床救治研究的重要内容。此病在临床中较为多见,且在各种交通事故致死原因中,位居第2位。因此,做好此病诊、治工作。尤为关键。本文围绕TAT的病因,就其当前诊、治进展作一综述。

Mechanism of thoracolumbar burst fractures：a biomechanical study

OBJECTIVE: To investigate the mechanism associated with thoracolumbar burst fractures. METHODS: Stress distribution of the spine in the upright, flexion and extension positions was analyzed using a three-dimensional finite element model of the spinal motion segment. RESULTS: Stress concentration was noted at the pedicle and posterosuperior part of the vertebral body near the pedicle. CONCLUSION: Stress concentration of the spine may be implicated in the biomechanical mechanism underlying thoracolumbar burst fractures.

Management of multiple trauma with mainly thoracic and abdominal injuries： a report of 1166 cases

Objective： To discuss the diagnosis and treatment of multiple trauma with mainly thoracic and abdominal injuries. Methods： A retrospective analysis was performed on data of multiple trauma cases with mainly thoracic and/or abdominal injuries. Results： Of 1166 cases, 72.3% were found with shock. The operation rates of thoracic and abdominal injuries were 14.8% （119/804） and 83.5% （710/850） respectively （ x^2=780.683, P 〈0.01）. The operation rates of blunt and penetrating thoracic injuries was 6.8% （42/617） and 40.6% （76/187） respectively （ x^2=131.701, P〈0.01）. The operation rates of blunt and penetrating abdominal injuries were 77.1% （434/563） and 96.1% （276/287） respectively （ x^2=50.302, P〈0.01）. The operation rates of blunt thoracio-abdominal injuries were 6.8% （42/617） in thoracic region and 77.1% （434/563） in abdomen respectively （x^2=544.043, P〈0.01 ）. Among the cases of abdominal injuries, 41 received arteriography embolism, with the efficacy of 95.1% （39/41）. Total mortality rate was 6.1%. The mortality rates of blunt and penetrating injuries were 7.3% （62/854） and 2.9% （9/312） （ x^2=6.51, P〈0.005）. The deaths were mainly due to large volume of blood loss. Conclusions： When both thoracic and abdominal injuries exist, laparotomy is frequently required rather than thoracotomy. Laparotomy is seldomly used for blunt thoracic injuries, but usually used for penetrating thoracic and abdominal injuries. Mortality rate of penetrating thoracic and abdominal injuries is markedly lower than that of blunt injuries. Surgical operation is still important for those patients with penetrating thoracic or abdominal injuries.

Management of traumatic hemothorax by closed thoracic drainage using a central venous catheter

Objective:To evaluate the efficacy and safety of the treatment of traumatic hemothorax by closed pleural drainage using a central venous catheter(CVC),compared with using a conventional chest tube.Methods:A prospective controlled study with the Ethics Committee approval was undertaken.A total of 407 patients with traumatic hemothorax were involved and they were randomly assigned to undergo closed pleural drainage with CVCs(n=214) or conventional chest tubes(n=193).The Seldinger technique was used for drainage by CVC,and the conventional technique for drainage by chest tube.If the residual volume of the hemothorax was less than 200 ml after the daily volume of drainage decreased to below 100 ml for two consecutive days,the treatment was considered successful.The correlative data of efficacy and safety between the two groups were analyzed using t or chi-squared tests with SPSS 13.0.A P value of less than 0.05 was taken as indicating statistical significance.Results:Compared with the chest tube group,the operation time,fraction of analgesic treatment,time of surgical wound healing,and infection rate of surgical wounds were significantly decreased(P<0.05) in the CVC group.There were no significant differences between the two groups in the success rate of treatment and the incidence of serious complications(P>0.05),or in the mean catheter/tube indwelling time and mean medical costs of patients treated successfully(P>0.05).Conclusions:Management of medium or large traumatic hemothoraxes by closed thoracic drainage using CVC is minimally invasive and as effective as using a conventional large-bore chest tube.Its complications can be prevented and it has the potential to replace the large-bore chest tube.

Effect of seawater immersion on plasma osmotic pressure and electrolyte balance following open chest trauma

Objective: To explore the effect of seawater immersion on serum osmotic pressure and electrolytes balance following chest trauma in dogs. Methods: Twenty five healthy adult dogs were used in the experiment. A canine model of right open pneumothorax was established by chest puncturing on all animals. Animals were divided into three groups: a control group (n=10) with chest trauma without any immersion; a seawater group (n=10) immersed in seawater after chest trauma and a normal saline group (n=5) immersed in normal saline solution following chest trauma. Blood samples were taken at different time intervals to determine plasma osmotic pressure and electrolytes. The hemodynamic changes were also recorded. Results: Mortality in the seawater group was much higher than that of the control group and the normal saline group. The mean survival time in the seawater group lasted only 45 minutes, while in the control group and the normal saline group the average survival time was more than 4 hours (P< 0.01 ). One of the most important causes of death was hypernatremia and high osmolality. Severe electrolytes imbalance was observed in seawater group. Hypernatremia and high osmolality were the most significant factors of high mortality in the seawater group. Conclusions: Seawater immersion after chest trauma appears to be associated with severe electrolyte imbalance as well as high osmotic pressure. These may be the risk factors leading to fatal outcome.

Thoracic spinal trauma associated with closed thoraco-abdominal injury

Objective: To explore the management of thoracic spinal trauma (TST) associated with closed thoraco abdominal injuries (CTAI). Methods: A retrospective study was made on 259 patients with TST admitted to our department as an emergency treatment from January 1996 to June 2001. We summarized the clinical features of TST associated with CTAI. Results: Among 259 patients with thoracic spinal trauma, 112 were associated with CTAI. Traffic accident was the most common cause. The force causing upper TST was more violent than that causing the lower. Pulmonary complications were the leading cause of death in this group. Surgery could not improve neurological function for completely paraplegic patients. Conclusions: The reason that upper TST has the tendency to be associated with CTAI is its special anatomical feature. Routine ultrasonic examination can avoid misdiagnosis of latent closed abdominal injuries associated with spinal injury. The presence of potential injuries, especially CTAI, should be considered when deciding whether or not to perform surgery early.

Assessment of internal mammary artery injury after blunt chest trauma: a literature review

The occurrence, bleeding, and treatment of internal mammary artery（IMA） injury after blunt chest trauma have not been well described in the literature. We reviewed articles published from July 1977 to February 2014 describing IMA injury after blunt chest trauma in 49 patients. There was a predominant incidence in males and on the left side. Blunt trauma to the IMA can cause anterior mediastinal hematoma, hemothorax, pseudoaneurysm, arteriovenous fistula, and extra-pleural hematoma. Of the 49 patients studied, 20 underwent embolization, 22 underwent surgical operation, 4 were managed by clinical observation, and 3 had undescribed treatment. Different parts and extents of IMA injury, adjacent vein injury, as well as the integrity of the pleura determined differences in bleeding modality. Prompt diagnosis, complete hemostasis, aggressive resuscitation, and multidisciplinary teams are recommended for patients with IMA injury.