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Hospitalized adult patients with sleep disturbance, Factor Analysis and Countermeasures

Single vertebral fracture in 8 cases, 2 cases of double vertebral fractures, compression type in 6 cases, 4 cases of burst. 2 except for general items for open reduction of vertebral fractures and spinal canal exploration equipment, its special equipment for the SF set of pedicle screw fixation device,[link widoczny dla zalogowanych], 3.5mm Kirschner wire 4 to 6, pliers 1, mobile x-ray radiography machine (two in 8 patients with intraoperative use of C-arm x ray monitoring), high frequency electric knife, suction and so on. Circuit ① 3 patients with a nurse who, after the operating room, nurses must first warm reception circuit and comfort encourage patients to lift the ideological concerns, and establish the confidence of a successful operation. ② check the patients and the project, the use of intravenous catheter in 18 patients with upper limb to establish good intravenous access, to help anesthetists epidural anesthesia or general anesthesia. ⑧ The onset spinal surgery will be required by patients prone on the operating table,[link widoczny dla zalogowanych], with a long soft pillow on the chest and abdomen in patients with good left and right pad, belly to be vacant, knee, head of the pad of a soft pillow head during general anesthesia Circle and note pad first slip off the endotracheal tube. Limbs can be placed comfortably under pressure. ④ connected electric knife, suction, regulate the lighting, and nurses wash their hands with physical inventory of the stage. Close observation of changes in condition, ready to adjust the infusion rate. 4 nurses with the equipment drape ① incision routine disinfection, to the patients as the center back of the vertebral midline incision, the length of the exposed bottom of a spinous process and lamina. Skin incision, both sides of the spinous process and lamina line subperiosteal dissection, gauze to stop bleeding, automatic distraction device into the sides of both sides of the sacral spine muscle to expose the facet joints between the pedicle and transverse process. ② Location: In the disease and one each in the upper and lower vertebral segment, both sides of the pedicle to determine the entrance point, that is fixed on the joint lateral longitudinal vertebral transverse midpoint of the horizontal line and the intersection. Up and down both sides of the vertebral fractures were 4, spondylolisthesis of 6. The entrance point is located on the articular process, where there is a ridge, with the needle nose rongeur bite a little ridge than cortical bone, with a positioning device positioning,[link widoczny dla zalogowanych], and then use the awl larvae L, depth of 3.5mm, Kirschner wire probe L larvae around the bone wall, larvae L Kirschner wire was inserted inside. ③ decompression: Delivery rongeur bite Chubing vertebral spinous process, lamina, articular process, the removal of herniated disc, protruding posterior than biting edge, lift the vertebral compression, respectively, with the catheter 8, the upper and lower spinal canal exploration unobstructed. Spinal canal stenosis, removal of part of the bone with a bone knife; those of nerve root adhesion, release nerve root. ④ RESET: Nurse shake the operating table so that the spine hyperextension or against the traction, so that spine extension. When necessary, with Harrington distraction device reset. ⑤ Verification: Tour nurses to assist with the mobile x-ray machine bed is taken lateral x films, confirmed good reduction and Kirschner wire through the pedicle screw into the central location. ⑥ fixed: the correct positioning Kirschner wire after pull out with pliers, screw plate pedicle screw screwed into each hand. Placement of longitudinal rods, vertebral distraction to restore disc height, placement of horizontal rods. Vertical bar spondylolisthesis were loaded, the first two central pedicle screws tightened to enhance the complex vertebral body spondylolisthesis, and then tighten the remaining four screws from the fixation. ⑦ grafting: patients who take iliac bone block, trimmed to the bone H, intercalation between the spinous process. Check no bleeding,[link widoczny dla zalogowanych], the nurse count gauze, equipment items is complete, wash the wound, placement of silicone tube drainage, leads from the lower incision next to the skin, layer by layer close the wound. 5 ① good psychological care experience. Follow-up of patients before surgery, because patients are spinal disease, and some paralysis, surgical fixation to put psychological pressure. To explain patiently to do the work in plain language description of the operation to the patient and long-term effects need to enhance their confidence to overcome the disease. And to moderate their language describes the process of surgery and postoperative conditions, so that patients have the necessary psychological preparation for surgery in the normal emotional state. Stool and urine allowed to learn to lying, lying solutions are not used to prevent postoperative stool and urine and abdominal distention, constipation, bladder over-filling. ② gracefully the most critical position, prone position on respiratory and venous reflux surgery has an impact. In the lower abdominal pressure can cause compression of the inferior vena cava, the operative field bleeding, change thy blood less, blood pressure, especially against a large body fat. Must use booster cushion the shoulders, anterior superior iliac spine and other dual-pivot, so that a certain breathing room for chest and abdomen. Patients with head and ring head pad eye injury should be noted, non-slip pad to pad plugged dynamic stability. To coordinate action when turning, not turning too fast. Surgery should observe the condition changes. ③ ready to use material should be complete, take notice after surgery should be based on disease situation and the CT slice of vertebral pedicle screw choose SF. The 4 models: F-type is used for thoracolumbar fractures, F-type for the double fracture or fractures of the lower lumbar, st for the L-type slip, sz for the L-type slip. ④ equipment nurses should be familiar with surgical procedures, and concentrate on co-delivery devices should be steady, accurate, light, fast. SF internal fixation separated from ordinary instruments for access. SF has not stepped forward to place pedicle screw bending plate installed to prevent loss and is conducive to
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