ICU压疮发病特征及氧合作用和血流灌注指标与压疮发生的相关性研究

【目的】分析 ICU压疮发病特征及氧合作用和血流灌注指标与压疮发生的相关性。【方法】113例ICU患者分为压疮组（26例）与非压疮组（87例）。比较两组患者入院时的一般情况、氧合作用与血流灌注指标,并对有意义的指标进行进一步的 Logistic回归分析。【结果】压疮的多发部位为骶尾部、臀部及肩胛部,大多数压疮患者的分期为Ⅰ期或Ⅱ期;压疮组平均年龄及入院诊断为呼吸系统疾病与外伤患者的比例明显高于非压疮组（P＜0．05）;压疮组与非压疮组动脉血酸碱度（pH）、动脉二氧化碳分压（PaCO2）、收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）及Braden评分比较有统计学意义（P ＜0．05）;多因素分析结果显示高龄（β＝1．637,OR＝5．140）、呼吸系统疾病（β＝1．592,OR＝4．914）、外伤（β＝1．748,OR＝5．743）是 ICU患者发生压疮的危险因素,而高 MAP（β＝-1．528,OR＝0．217）、高Braden评分（β＝-1．705,OR＝0．182）是保护因素。【结论】高龄、呼吸系统疾病、外伤是 ICU患者发生压疮的危险因素,而高 MAP、高 Braden评分是保护因素。     

血流灌注指标与Braden量表预测在ICU患者压力性损伤预防中的应用

目的:探讨血流灌注指标与Braden量表预测在ICU患者压力性损伤预防中的应用效果。方法:选取2018年3月1日～2019年5月31日收治的120例ICU患者,分为压力性损伤组和无压力性损伤组各60例,采用自拟ICU患者压力性损伤因素调查问卷对两组一般资料、血流灌注指标、具体症状进行调查,采用Braden量表评估两组压力性损伤发生风险;比较两组血流灌注指标[包括心率(HR)、平均动脉压(MAP)、舒张压(DBP)、收缩压(SBP)]与Braden量表评分情况。结果:压力性损伤组MAP、DBP、SBP指标水平均低于无压力性损伤组(P0.01),压力性损伤发生的轻度风险、中度风险、重度风险评分均低于无压力性损伤组(P0.01),Braden量表风险性平均分低于无压力性损伤组(P0.01)。结论:ICU相关护理人员,可通过监测血流灌注指标水平的变化及Braden量表评分结果,对ICU患者压力性损伤的发生起到预防作用,可相应地采取有效措施,降低压力性损伤的发生,具有较高的应用价值。     

ICU患者压疮发生危险因素分析

目的：探讨导致ICU患者压疮发生的危险因素。方法：采用自行设计的“ICU患者压疮风险因素调查表”记录735例ICU患者的患病情况、主要治疗情况等资料。结果：性别、糖尿病、脑卒中、入ICU时间、是否持续进行动脉血压监测、水肿、平均动脉压、乳酸Lac、心率、Apachell评分是ICU患者发生压疮的影响因素。结论：ICU患者压疮发生是多因素共同参与的病理生理过程,护理人员应充分认识各种危险因素对ICU患者发生压疮的影响,对存在或可能存在危险因素的ICU患者实施重点防护以减少压疮的发生。     

ICU住院患者发生院内获得性压疮的危险因素分析

目的 :分析ICU住院患者发生院内获得性压疮的危险因素。方法 :采用自制的ICU压疮发生情况资料收集表与ICU压疮预警相关因素资料收集表对2011年10月至2013年10月在广州市某三级甲等医院ICU(MICU、CCU)住院的468例患者资料进行回顾,采用Logistic回归分析ICU压疮的危险因素。结果 :多因素Logistic回归分析显示,高龄、ICU住院日延长、舒张压偏低、清蛋白偏低、有机械通气、有大便失禁为ICU压疮的独立危险因素,Braden总分为保护因素(P0.05)。结论 :应针对ICU压疮高危人群和危险因素采取针对性预防措施,警惕高龄、ICU住院日延长、舒张压偏低、清蛋白偏低、机械通气及伴有大便失禁的患者,重视Braden评分的准确性与规范化。     

Braden评估量表在预测ICU患者发生压疮中的应用及研究进展

综述了Braden评估量表的评估内容、评估价值比较、评分临界值、预测指标、新危险因素等。认为对于ICU危重患者的Braden评估量表的临界值评分为14分,此值兼顾了敏感度与特异度,可以提高ICU患者的压疮预测效果。     

外科重症病人压疮高危因素分析及护理对策

[目的]探讨外科重症病人压疮相关危险因素及护理对策。[方法]采用前瞻性队列研究设计,应用Braden量表筛选出105例Braden评分≤12分的病人为研究对象,分为压疮高度风险组(Braden评分10分～12分)和极度风险组(Braden评分6分～9分)。应用APACHEⅡ评分量表收集19项指标,比较两组独立样本间各项指标的差异,找到可能的危险因素;通过Logistic回归分析筛选出有意义的高危因素。[结果]单因素分析显示,极度风险组病人的平均动脉压、24h尿量低于高度风险组,而APACHEⅡ评分高于高度风险组,差异有统计学意义(P<0.01);多因素Logistic回归分析显示,平均动脉压低是导致压疮风险的高危因素(P<0.01)。[结论]护士应将休克病人视为外科ICU压疮防控的重点关注对象,将低血压作为重点关注的高危因素;树立休克抢救同时防控压疮的意识,积极配合医生尽快恢复有效循环血量,作好休克早期积极的液体复苏,并且在抢救的同时采取多种减压防控措施,有助于提高危重病人防控压疮的护理质量。     

应用Braden量表联合近红外光谱仪评估ICU患者压疮发生的研究

目的探讨局部持续受压对组织血供的影响,评估患者压疮风险,为压疮早期监测提供依据。方法随机选取ICU住院患者117例,应用近红外光谱仪监测患者骶尾部组织氧饱和度,Braden量表进行压疮危险因素评估,采用灵敏度、特异度、阳性及阴性预测值和受试者工具特性曲线(ROC)评价近红外光谱仪对压疮的预测效果。结果有压疮者Braden评分为(12.23±1.67)分,未发生者为(13.14±1.48)分,差异有统计学意义(P0.05)。随ICU住院时间的延长,骶尾部组织氧饱和度(rSO2)持续下降。Braden评分评为中、高度压疮危险组,患者局部rSO2测量显著低于轻度压疮危险组;ROC曲线下面积显示,局部组织rSO2参数对压疮判断优于Braden量表评分,两者结合可提高压疮早期判断的有效性和可靠性。结论应用近红外光谱法结合Braden量表评估有利于临床早期压疮的监测。     

神经外科患者发生压疮的危险因素分析

目的 分析神经外科患者发生压疮的危险因素,为制定预防压疮有效措施提供依据.方法 收集神经外科有压疮发生危险的129例患者的一般资料及相关指标进行多元逐步Logistic同归分析,找出压疮发生的危险因素.结果 意识水平、活动能力、Braden得分是压疮发生的独立危险因素(P<0.05).结论 神经外科压疮预防应该更加关注意识、活动能力方面的评估,根据Braden量表评估结果进行有针对性的预防.     

Braden评分高度风险重症患者的压疮危险因素分析

目的探讨具有压疮高度风险的重症患者压疮相关危险因素。方法应用Braden量表对89例重症患者实施压疮风险评估,对评分≤12分的患者进行分析,评价各项相关指标与压疮高风险的关系。结果89例患者Braden评分平均（9．42±2．01）分,其中Braden评分≤9分的极高危患者占47．19％。与压疮高度风险相关因素有患者无法活动（压力、摩擦力、剪切力并存）、皮肤潮湿、营养不良、以及体温的改变、循环不稳定,肾功能不全、代谢性酸中毒、电解质紊乱、高APACHEⅡ评分等。结论应针对导致重症患者压疮高度风险的危险因素作好积极的预防和护理措施,提高危重患者的护理质量。     

Braden评分预测神经科患者压疮的准确性及影响准确性因素的分析

目的探讨Braden评估表对神经科患者压疮发生危险预测的有效性,并分析在Braden评估表评估危险程度相同的情况下,其他相关因素对压疮发生的影响,以提高预防压疮的有效性。方法对135例神经科压疮患者应用Braden评估表进行评分,并收集包括年龄、意识状态、血清白蛋白、活动方式、体位等13个相关因素以及压疮分期状况。分析该评估表对预测压疮的准确性,及影响准确性的因素。结果135例患者中,Braden评分为极高危或高危者94例占69.63%,中危者31例占22.96%,低危者10例占7.41%,无危者无。相关性分析提示:血清白蛋白值与Braden评分成正相关(r=0.25,P<0.05),意识状态与Braden评分为显著负相关(r=-0.61,P<0.01),压疮严重程度与Braden评分成负相关(r=-0.210,P<0.05)。其他因素与Braden评分无显著相关性(P>0.05)。结论Braden评估表能有效地预测神经科患者发生压疮的危险性;对Braden评分具有相同危险者,血清白蛋白水平越低、意识障碍越重,其发生压疮的危险性越高。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Structure and function of "metalloantibiotics"

Although most antibiotics do not need metal ions for their biological activities, there are a number of antibiotics that require metal ions to function properly, such as bleomycin (BLM), streptonigrin (SN), and bacitracin. The coordinated metal ions in these antibiotics play an important role in maintaining proper structure and/or function of these antibiotics. Removal of the metal ions from these antibiotics can cause changes in structure and/or function of these antibiotics. Similar to the case of "metalloproteins," these antibiotics are dubbed "metalloantibiotics" which are the title subjects of this review. Metalloantibiotics can interact with several different kinds of biomolecules, including DNA, RNA, proteins, receptors, and lipids, rendering their unique and specific bioactivities. In addition to the microbial-originated metalloantibiotics, many metalloantibiotic derivatives and metal complexes of synthetic ligands also show antibacterial, antiviral, and anti-neoplastic activities which are also briefly discussed to provide a broad sense of the term "metalloantibiotics."