华西骨科会议心得课件.ppt

Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,会议内容,骨科压疮预防循证研究进展,骨科患者静脉血栓栓塞症的预防,骨科疼痛病房管理,骨科护理新进展与骨科用具指南,骨科围手术期患者心肺功能评估及护理管理,四肢创伤修复护理,骨科压疮新进展,压疮预警管理模式,危险评估工具评估压疮发生的危险,发现危险者作为重点干预对象,采取措施,定期评价干预效果,分析原因，修正不良措施,效果评价,影响压疮预防因素,预防措施不当,（凭经验差异大,）,器械使用不当,压疮预测、评估结果不准,临床研究方法不完善,（缺乏临床对照研究）,护士知识落后,（缺乏相关知识或知识陈旧,）,影响因素,全球压疮最新指南,针对以下六点,体位更换,营养,皮肤评估,危险评估,压疮病原学,减压垫,2007-,英国对,期压疮独立危险因素的研究,术后体重下降,术前白蛋白低,术中低血压,长时间的压迫发红,小结,识别和降低压疮的危险,规范压疮的预防措施,提高压疮的预防效果,促进伤口护理学科的发展,创伤的类型,碾压伤,撕脱伤,挤压伤,多发伤,创伤的特点,1,复杂混合型损伤,骨折,广泛软组织损伤,严重污染,2,病情紧急、严重处理困难,3,.,并发症多,残疾率高,死亡率高,治疗原则,康复,预防并发症,保全肢体,抢救生命,出血量的估计,500ML,1000ML,1000ML,1000ML,1000ML,上肢,/,小腿,大腿,骨盆,腹部,胸部,护理,体位护理,肢体血运观察,创面护理,营养支持,疼痛、并发症护理,术后护理,脂肪栓塞综合症护理,胸片,生化检查,出血点,神经系统症状,生命体征,呼吸困难、发热,38.5,度，脉搏,120,次,/,分,.,意识障碍,颈、肩、前胸、眼睑结膜与眼底,I,血小板减少、血红蛋白降低、血沉加快，血尿中有脂肪滴,斑片状阴影，“暴风雪”样表现,临床表现,严密观察病情：意识、生命体征、出血点,患肢安全有效制动,保持呼吸道通畅,准确及时采集化验标本,护理措施,正确使用抗脂栓药物，低脂饮食，禁止脂肪餐,危险因素得分分,Caprini VTE,风险评分,年龄岁,小手术,/,下肢水肿,严重肺部疾病包括肺炎（一个月内）,妊娠期或产后,不能解释或二次自然流产病史,需要卧床休息的患者,败血症,静脉曲张,肺功能异常,急性心肌梗塞,充血性心力衰竭（一个月内）,肠炎病史,口服避孕药物或激素替代治疗,危险因素得分分,年龄,岁,关节镜手术,开放式手术（大于分钟）,腹腔镜手术（大于分钟）,危险因素得分分,年龄岁,病史,家族史,恶性肿瘤,卧床（大于小时）,石膏固定,中央静脉通路,狼疮抗凝物阳性,抗心磷脂抗体阳性,血清同型半胱氨酸升高,因子,elden,阳性,凝血酶原阳性,危险因素得分分,脑卒中,择期关节置换术,肝素诱导的血小板减少症,其他先天性或获得性血栓症,髋关节、骨盆或下肢骨折,急性脊髓损伤（一个月内）,简易肺功能评估,登楼梯实验,正常速度一口气上层楼梯，心肺功能储备良好,低于层楼梯，术后并发症可能性增加，手术应谨慎,低于一层楼梯，手术风险极高,屏气实验,正常人，屏气时间大于,.,屏气时间小于，提示心肺储备功能下降，但能耐受一般麻醉,屏气时间小于，提示心肺储备功能明显下降，往往不能耐受手术,总结,虽有佳肴,弗食不知其旨也；虽有至道,弗学不知其善也,.,是故学然后知不足,教然后知困,.,知不足然后能自反也,知困然后能自强也,.,故曰：教学相长也,.,