痉挛型脑性瘫痪患儿静脉输液方法的研究

目的 探讨对痉挛型脑性瘫痪患儿于姿势控制后行静脉输液穿刺的效果.方法 将接受静脉输液治疗的痉挛型脑瘫患儿158例随机分为常规组77例,按护理基本技术操作规程实施常规输液;干预组81例,在姿势控制后进行输液.比较2组输液时间和一次性穿刺成功率.结果 常规组一次穿刺成功率64.3%,干预组一次穿刺成功率88.3%,2组比较差异有统计学意义(P＜0.05).常规组平均耗时(5.77±3.60)min,干预组平均耗时(4.92±3.21)min,2组比较差异无统计学意义(P＞0.05).结论 对痉挛型脑性瘫痪患儿进行合理的姿势控制后行静脉输液,可有效提高穿刺成功率.     

门诊学龄前患儿静脉输液的安全管理及护理措施

目的：评价学龄前患儿周围静脉输液管理的临床过程和结果,为临床学龄前患儿静脉输液护理提供依据。方法选择门诊静脉输液的学龄前患儿100例,按照随机数字表法分为观察组与对照组各50例,对照组采用常规输液护理措施,观察组采用输液安全预防性护理措施,使用自行设计的学龄前患儿静脉输液风险评估及防范措施表记录患儿输液情况,比较两组首次穿刺成功率、药液外渗情况、呼叫换液和满意度情况。结果观察组患儿静脉输液首次穿刺成功率为94．00％,静脉药液外渗发生率为12．00％,输液呼叫率为43．33％,均优于对照组的68．00％,40．00％,49．21％,差异有统计学意义（χ2／Z值分别为10．981,－3．098,75．614;P＜0．05）。观察组患儿家长对换液及时满意度、巡视维护、解决问题能力得分分别为（4．27＆#177;0．56）,（4．43＆#177;0．38）,（4．48＆#177;0．51）分,均高于对照组的（3．13＆#177;0．42）,（3．16＆#177;0．64）,（3．11＆#177;0．60）分,差异有统计学意义（t值分别为2．828,2．963,2．977;P＜0．05）。结论学龄前患儿静脉输液过程中安全管理能提高首次穿刺成功率,减少不良反应的发生,患儿家长满意度更高,值得临床推广与使用。     

按摩干预在痉挛型脑瘫患儿静脉穿刺前的应用

目的:探讨在痉挛型脑瘫患儿静脉穿刺前进行按摩干预的效果.方法:将186例痉挛型脑瘫患儿随机分为观察组与对照组各93例,观察组于静脉穿刺前进行按摩干预,对照组按常规静脉输液操作流程进行.结果:观察组静脉穿刺成功率高于对照组(P<0.05).结论:痉挛型脑瘫惠儿静脉穿刺前进行按摩干预效果优于常规静脉输液操作流程,此方法值得临床推广应用.     

音乐护理对门诊呼吸道感染患儿静脉输液的影响

目的探讨音乐护理对门诊呼吸道感染患儿静脉输液的影响。方法选取2006-2007年因呼吸道感染于门诊行静脉输液治疗的患儿120例为对照组,2008-2009年接受门诊静脉输液治疗的呼吸道感染患儿120例为观察组,对照组给予心理护理和常规护理,观察组在此基础上加以音乐护理,比较两组一次穿刺成功率、输液穿刺耗时、重新输液患儿数及终止门诊输液转入住院患儿数。结果观察组一次穿刺成功率、输液穿刺耗时均优于对照组,差异均有统计学意义（x2分别为6．712,7．613;P〈0．05）;重新输液患儿数及终止门诊输液转入住院患儿数均低于对照组,差异均有统计学意义（x2分别为8．664,6．414;P〈0．05）。结论实施音乐护理干预可以提高门诊呼吸道感染患儿静脉输液一次穿刺成功率,缩短穿刺耗时,保障输液顺利进行,节约护士人力资源,减轻患儿不良情绪体验,值得在临床推广应用。     

减压穿刺法在患儿头皮静脉输液中的应用

摘要：目的 探讨减压穿刺法在患儿头皮静脉输液中的应用效果。方法 将１２０例患儿按输液单双日分为两组各６０例。对照组采用常规头皮穿刺输液；观察组采用减压穿刺法，即降低输液瓶、升高调节器高度进行患儿头皮静脉输液。结果 两组一次穿刺成功率及穿刺回血时间比较，差异有显著性意义（Ｐ＜０.０５，Ｐ＜０.０１）。结论 采用减压穿刺法进行患儿头皮静脉输液，静脉回血早，可提高一次穿刺成功率，有效保护患儿血管，提高其家属满意度。关键词：儿童；　头皮静脉穿刺；　减压穿刺法；　一次穿刺成功率中图分类号：Ｒ４７２．９　　文献标识码：Ｂ　　文章编号：１００１-４１５２（２００７）０３-００４２-０２     

心理干预对患儿静脉穿刺时疼痛的影响

目的：探讨心理干预对患儿静脉穿刺时疼痛的影响。方法：将300例需静脉输液的患儿随机分为两组，对照组（150例）采用常规穿刺护理，干预组（150例）在此基础上对患儿进行心理干预。比较两组穿刺时患儿的疼痛程度及一次穿刺成功率。结果：干预组与对照组对穿刺时的疼痛比较具有显著差异性（P〈0．01），静脉穿刺的成功率92％，对照组64％（P〈0．01）。结论：心理干预能减轻患儿静脉穿刺时的疼痛，增加护患之间的感情，使静脉穿刺一次成功率得到提高。     

综合心理干预对门诊患儿输液治疗的影响

目的：探讨综合心理干预对门诊患儿输液治疗过程及结果的影响。方法将308例静脉输液患儿作为研究对象,将其随机分为两组,每组各154例。对照组采用常规静脉输液,观察组在行静脉输液前实施综合性的心理干预。观察、比较两组患儿输液配合程度,穿刺一次成功率以及家长满意度。结果观察组患儿静脉输液配合率、一次穿刺成功率及患儿家长满意度（72．73％、86．36％、90．91％）均高于对照组（12．34％、64．93％、63．64％）,差异均有统计学意义（P＜0．05）。结论在静脉输液前对患儿进行综合的积极心理干预,能有效减轻其恐惧、抵触及其他不良情绪,可以提高患儿配合程度,提高静脉穿刺的成功率。     

护理干预对小儿静脉输液顺从性及穿刺成功率的影响

目的：探讨护理干预对提高小儿静脉输液的顺从性、穿刺成功率、满意度的影响。方法收集2012年6-7月于接受静脉输液治疗的患儿1800例,采用随机数字表法分为对照组与观察组,两组各900例,对照组患儿给予常规护理,观察组患儿通过改进小儿静脉输液相关护理工作,提高护理干预技术。比较两组患儿的顺从性、穿刺成功率及满意度。结果观察组患儿静脉输液的顺从性为90．00％,明显高于对照组的62．22％,两组比较差异有统计学意义（χ2＝190．99;P＜0．05）;观察组患儿穿刺成功率为93．33％,明显高于对照组的67．78％,两组比较差异有统计学意义（χ2＝187．54;P＜0．05）。观察组患儿家属满意度为98．89％,明显高于对照组的77．78％,两组比较差异有统计学意义（χ2＝194．61;P＜0．05）。结论积极的护理干预措施可有效提高患儿静脉输液的顺从性、穿刺成功率及家属满意度。     

心理支持在门诊患儿静脉补液中的应用研究

[目的]探讨心理支持在静脉补液中对患儿合作程度的影响，以提高静脉补液穿刺成功率。[方法]将428例患儿随机分为对照组和干预组各214例，根据患儿静脉补液时不同的心理反应类型对干预组进行相应的心理干预，然后对两组患儿补液时合作程度进行比较。[结果]静脉输液合作率对照组为57．9％，干预组为85．0％，两组比较差异有统计学意义（x^2=38．57，P〈O．01）。两组不同心理类型患儿静脉输液合作程度分别为勇敢型（x^2=1．59，P〉O．05），紧张焦虑型（x^2=22．18，P％0．01）和强迫型（x^2=22．33，P〈0．01）。[结论]心理支持可提高静脉补液穿刺成功率。     

探讨门诊静脉输液患儿的护理干预方法

目的：探讨门诊静脉输液患儿的护理干预方法。方法：将284．例门诊静脉输液患儿随机分为观察组及对照组，观察组在静脉输液过程中对患儿家长进行卫生宣教，对患儿进行分散注意力、心理护理、暗示疗法及激励疗法，并给予微笑服务、勤巡视、温馨看护等方法进行护理干预：对照组则只进行常规护理干预。结果：观察组一次静脉穿刺成功率明显高于对照组，差异具有非常显著性意义（P〈0．01），输液过程中因脱针造成的重注率则明显低于对照组，差异也具有非常显著性意义（P〈0．01）。结论：对门诊静脉输液患儿采取护理干预措施，能明显提高一次静脉穿刺成功率，降低输液过程中因脱针造成的重注率。     

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.     

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.     

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.     

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.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.