人工全髋关节置换术的手术护理

回顾性总结了80例人工全髋置换术患者的术前、术中、术后护理特点与方法,主要措施为手术室护理人员做好术前访视,了解患者的生理和心理特点,加强术中护理,术后正确搬动与转运.认为围手术期的有效护理能保证手术顺利与安全.     

人工髋关节置换术18例的护理体会

目的:探讨全髋关节置换术患者的护理.方法:对18例人工髋关节置换术患者给予实施系统有效的护理干预.结果:术后均治愈出院.结论:通过对人工髋关节置换术患者实施系统有效的护理,能有效减少并发症的发生,术后病人能早期下床活动和早期康复出院.     

人工髋关节置换术的围手术期护理

人工髋关节置换术目前已成为治疗股骨颈骨折,股骨头坏死患者的标准术式.它能有效缓解疼痛,改善肢体的功能状态,术后患者可早期活动,避免了长期卧床导致的并发症.而且能在短时间恢复一个无痛的髋关节.对于提高患者的生存质量具有重要意义.做好围手术期护理,是保证患者康复,避免发生并发症的重要环节.现将护理体会介绍如下.     

康复路径应用于老年股骨颈骨折行髋关节置换术后的效果评价

目的 探讨康复路径在老年股骨颈骨折行髋关节置换术后的应用效果.方法 选取本院骨科股骨颈骨折行髋关节置换患者62例,分为对照组和观察组,对照组给予常规功能锻炼指导,观察组则依据康复路径给予指导,观察和比较2组康复效果.结果 达到标准住院天数,观察组(27例)优于对照组(20例),χ2=6.38,P<0.05;在第10天能够下地行走的例数,观察组(27例)优于对照组(18例),χ2=8.86,P<0.01;关节僵硬的发生率,观察组(0例)优于对照组(6例),χ2=4.89,P<0.05.结论 股骨颈骨折行髋关节置换术后,按照康复路径给予正确、科学、有效的康复训练,可促进患者康复,降低并发症的发生率.     

人工全膝关节置换术后关节肿胀预防性护理

目的:探讨促进全膝关节置换患者术后关节肿胀的预防性护理.方法:对42例行人工全膝关节置换术患者,在围术期进行系统预防性护理,术前帮助患者树立手术成功信心,进行必要功能锻炼指导;术后早期即进行分阶段的详细功能锻炼指导,并做好心理护理.结果:本组术后10-15天出院,出院后均能自行拄双拐行走;均未发生关节肿胀;术后2周关节活动度为80°-100°,膝关节HSS评分为60-82分;术后随访6个月,关节活动度为85°-120°,膝关节HSS评分为82-90分,结论:系统化功能锻炼指导有利于人工全膝关节置换术后患者关节功能恢复,减少关节肿胀发生率.     

全髋关节置换术后早期并发症分析及防治

目的:探讨分析全髋置换术后早期并发症的原因和防治策略.方法:回顾性分析我院53例全髋置换术的临床资料.结果:术后早期并发症共8例中低钾血症3例,脱位2例,肺部感染1例,急性肾功能不全1例,髋部浅表感染l例.8例均为围手术期管理不当所致,经及时治疗均未导致严重后果.结论:围手术期管理不当是全髋关节置换术后早期并发症发生的主要原因,早期治疗,预后良好.     

老年患者人工髋关节置换术的护理体会

目的:探讨老年人工髋关节置换术的护理方法.方法:对32例髋关节置换术患者加强生命体征监测和患肢护理,预防并发症,并指导合理的功能锻炼.结果:术后发生电解质紊乱1例,脱位1例,经积极治疗均痊愈出院.结论:对老年患者的正确护理和康复训练,可促进病情康复,提高生活质量.     

15例高龄髋关节置换术后并发肺部感染的护理

总结了高龄髋关节置换术后并发肺部感染的护理方法,包括:在全身性应用抗茵药物的同时加强心理护理,体位护理,呼吸道及口腔护理,配合营养支持疗法及用药的护理,观察治疗护理效果.认为做好院内卫生监测,强化无菌观念,对患者进行有效的心理护理干预,加强呼吸道及口腔护理,及时观察病情及用药效果,能够提高患者的治愈率和生活质量.     

预防性护理干预对人工关节置换术后下肢深静脉血栓形成的影响

报告了对69例人工关节置换术后患者进行预防性护理干预的效果,本组只有1例术后出现患肢肿胀、疼痛加剧,进行抬高患肢,抗凝治疗后症状缓解.认为对人工关节置换术后患者进行预防性护理干预,加强早期功能锻炼,并进行预防性的抗凝治疗,可增加治疗效果,防止并发症及减少术后下肢深静脉血栓的发生.     

股骨颈骨折髋关节置换术的护理和康复训练

目的:总结髋关节置换术病人的围手术期护理.方法:回顾对23位髋关节置换书病人的护理过程和总结,得出经验和不足,以更好的护理病人.结论:通过多病人的为手术期护理和术后的一系列护理康复训练,病人的预后叫好,都顺利的通过了手术期.     

早期康复治疗对脊髓损伤后痉挛性神经源性膀胱功能的影响

目的:探讨早期康复治疗对脊髓损伤后痉挛性神经源性膀胱功能的影响.方法:将60例外伤性脊髓损伤患者按康复介入开始时间分为早期康复组(术后1个月内)和对照组(术后3个月)各30例,分别在治疗前和治疗3个月后进行膀胱容量、残余尿量、尿路感染发生率进行测定,比较两组数据.结果:早期康复组患者膀胱容量增加、残余尿量减少、尿路感染发生率降低,且均优好于对照组(P<0.05).结论:早期康复治疗能有效改善脊髓损伤后痉挛性神经源性膀胱的排尿功能.     

人工干预对妇科腹腔镜术后患者肠功能恢复的影响

目的:观察不同人工干预方法对妇科腹腔镜手术后患者肠道功能恢复的影响.方法:随机观察90例患者,分为三组,每组30人,年龄从20岁至66岁.对照组30例患者,年龄20岁至66岁,观察组①采用开塞露20ml于术后第二天9时入肛,观察组②对无肠道损伤者采用酚酞片2片手术后第二天9时口服,观察组③采用新斯的明0.5mg于手术后第二天9时肌注.结果:经人工干预后,观察组患者不同程度缩短了排气、排便的时间.结论:人工干预对妇科腹腔镜术后患者肠功能恢复有很好的促进作用.     

Temporal factors influence recovery of function after embryonic brain tissue transplants in adult rats with frontal cortex lesions.

Adult rats with lesions of the medial frontal cortex received implants of frontal cortex taken from embryos on the 19th day of gestation and placed directly into the zone of injury at 7, 14, 30, or 60 days after initial surgery. Another group was given bilateral frontal lesions, followed 20 days later by a second small lesion to enhance the release of putative neurotrophic factors. They then received transplants 7 days after this second operation. All rats began postoperative training on a spatial alternation learning task within 4 days after the implants of fetal tissue. The brain-damaged rats with transplants at 7 or 14 days after surgery significantly improved postoperative acquisition of spatial alternation. Transplants made 30 or 60 days postoperatively had no effect; these groups were as impaired as those with lesions alone. The animals given a second, "priming" lesion after a 20-day delay, followed by implants of fetal brain tissue, performed as poorly as the group with frontal cortex lesions alone. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Bilateral hemispheric activation in the early recovery of motor function after stroke

BACKGROUND AND PURPOSE: Functional recovery after cerebral infarction is a complex phenomenon that depends on various factors. The aim of this study was to investigate changes in cerebral perfusion during motor activity in stroke patients with very early recovery of motor function. METHODS: We included 9 consecutive patients hospitalized for acute-onset hemiparesis who showed complete functional recovery within 24 hours. CT of the brain showed an ischemic or hemorrhagic cerebral lesion in areas compatible with the symptomatology. Within 36 hours (range, 28 to 36) all patients were examined for the effects of a thumb-to-finger opposition task on cerebral blood flow in the middle cerebral arteries, evaluated by means of bilateral transcranial Doppler ultrasonography. Data were compared with those of 9 healthy subjects matched for age and sex. In patients, the evaluation was repeated 2 to 4 months later. RESULTS: A comparable increase in flow velocity (% mean+/-SD) was observed with respect to baseline in the contralateral middle cerebral artery during motor activity with patients' normal (8.8+/-2.0%) and recovered hand (9.7+/-4.1%) and with both hands of control subjects (10.6+/-1.4%). In the middle cerebral artery ipsilateral to the hand performing the motor task, the increase in flow velocity was significantly higher (P<0.0001) during movement of the recovered hand in patients (8.6+/-2.7%) than during movement of the normal hand in both patients (2.6+/-1.6%) and control subjects (1.4+/-0.7%). In patients, pattern of changes in flow velocity during motor performance remained the same in the second evaluation. CONCLUSIONS: These observations suggest that areas of the healthy hemisphere can be activated soon after a focal injury and contribute to the positive evolution of a functional deficit in some patients. This phenomenon of ipsilateral activation cannot be considered transient because it is evident months after stroke onset.     

Extent of recovery of function after early sensory deprivation in the rat.

Compared the performances of 400 90- and 150-day-old light-reared and dark-reared Long-Evans rats on rigorous tests of depth and form discriminative abilities in 2 experiments. Significant differences due to rearing and age were found. Exposure to a normal light environment for 60 days was found to partially alter the effects of an early 90-day period of visual deprivation in the case of depth discrimination but to have little impact in the case of form discrimination. It is theorized that the initial deficits in the performance of the dark-reared rats and the extent of recovery of function after exposure to a normal environment are related to the kind of perceptual ability being measured and to the sensitivity of the test. (33 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Methods to assess the development and recovery of locomotor function after spinal cord injury in rats

Recovery of comprehension and total language in 22 Wernicke's aphasics was correlated with lesion size and extent of involvement of certain structures on CT. Recovery rates and outcomes were separately examined using 0-3 months and 0-12 months poststroke language data. Quantitative measures of structural damage were regressed on total aphasia and comprehension outcome measures. Supramarginal and angular gyri appeared to be the most significant structures in recovery in addition to initial severity and lesion size. This was confirmed by using ANOVA to compare the extent of involvement in each postcentral structure among the poor, moderate, and good recovery groups. The superior temporal and middle temporal gyri are less involved in the good recovery group. Structures posteriorly adjacent to Wernicke's area are important for compensation in Wernicke's aphasia and in the accompanying comprehension deficit. Persisting Wernicke's aphasia usually involves the supramarginal and angular gyri in addition to the superior temporal area.     

Factors that influence the further survival of patients who survive for five years after the diagnosis of cancer in childhood or adolescence

Acute confusional states and agitated delirium are among the most common psychopathologic disorders in the elderly. However, they are rarely reported in the course of infarcts in the territory of the posterior cerebral artery. This study involving thirteen patients aged more than 65 years suggests that acute confusional states from posterior cerebral artery infarcts are less rare than usually thought, although the diagnosis may be difficult during the acute phase. The risk factors are no different from those observed for infarcts in other cortical areas, suggesting that this syndrome is due to structural damage of the brain rather than the other, usual causes of confusion in the elderly (intoxications, dysmetabolic diseases or dementia). The recognition of acute confusional states from posterior cerebral artery infarcts and its distinction from other causes of confusion is important in elderly patients because of the different diagnostic, prognostic and therapeutic implications involved.     

The function of the quadriceps muscle after a fracture of the femur in patients who are less than seventeen years old

Thirty-three patients who had been managed for an isolated, closed fracture of the femoral shaft when they were less than seventeen years old were examined at an average of thirty-three months (range, eighteen to fifty-six months) after the injury. Thirteen patients (39 per cent) had a persistent deficit in the strength of the quadriceps of the fractured limb, as identified on testing with a Cybex-II isokinetic dynamometer. Six patients (18 per cent) had a deficit according to the one-leg-hop for distance test, fourteen (42 per cent) had an average loss of ten millimeters in the circumference of the thigh, and sixteen (48 per cent) had an average loss of 10 degrees of flexion of the knee. The etiological factors that were thought to possibly be responsible for the weakness of the quadriceps were evaluated. The amount of maximum displacement of the fracture, as seen on the initial radiographs, was the only factor that was significant for the prediction of weakness of the quadriceps (p = 0.006) at both test speeds of the Cybex dynamometer and in all statistical analyses. Despite the persistent weakness of the quadriceps, none of the patients had a clinical problem at the latest follow-up examination. A subclinical deficit in the strength of the quadriceps may be related to damage sustained by the muscle at the time of the fracture. On the basis of the results of this study, we do not recommend a change from the traditional methods of treatment, which involve early application of a spica cast or use of traction followed by application of a spica cast.     

Early and late post-ischaemic recovery of contractile function is affected to different degrees by isoflurane and halothane in the anaesthetized rabbit model

We took advantage of the partial protection exerted by suitable dosages of nicotinamide against the beta-cytotoxic effect of streptozotocin (STZ) to create a new experimental diabetic syndrome in adult rats that appears closer to NIDDM than other available animal models with regard to insulin responsiveness to glucose and sulfonylureas. Among the various dosages of nicotinamide tested in 3-month-old Wistar rats (100-350 mg/kg body wt), the dosage of 230 mg/kg, given intraperitoneally 15 min before STZ administration (65 mg/kg i.v.) yielded a maximum of animals with moderate and stable nonfasting hyperglycemia (155 +/- 3 vs. 121 +/- 3 mg/dl in controls; P < 0.05) and 40% preservation of pancreatic insulin stores. We also evaluated beta-cell function both in vitro and in vivo 4-9 weeks after inducing diabetes. In the isolated perfused pancreas, insulin response to glucose elevation (5-11 mmol/l) was clearly present, although significantly reduced with respect to controls (P < 0.01). Moreover, the insulin response to tolbutamide (0.19 mmol/l) was similar to that observed in normal pancreases. Perfused pancreases from diabetic animals also exhibited a striking hypersensitivity to arginine infusion (7 mmol/l). In rats administered STZ plus nicotinamide, intravenous glucose tolerance tests revealed clear abnormalities in glucose tolerance and insulin responsiveness, which were interestingly reversed by tolbutamide administration (40 mg/kg i.v.). In conclusion, this novel NIDDM syndrome with reduced pancreatic insulin stores, which is similar to human NIDDM in that it has a significant response to glucose (although abnormal in kinetics) and preserved sensitivity to tolbutamide, may provide a particularly advantageous tool for pharmacological investigations of new insulinotropic agents.