新生儿腕踝标识带脱落原因分析及改进方法

目的分析新生儿腕踝标识带脱落的影响因素，并探讨改进措施。方法选择60例新生儿，测量其手腕、足踝相关部位的数据和标识带周长，观察其与标识带脱落的关系。结果共有26．67％（32／120）的标识带脱落；标识带实际系戴周长均大于邻近部位的最粗周长，脱落组脚踝标识带周长与脚周长的差值大于未脱落组（P〈0．01），新生儿采用的手腕标识带周长数据标准差较大。结论标识带脱落与标识带本身（宽度、材质）、护理人员系戴方式等因素有关，建议采取改进措施防止其脱落。     

不同标识腕带对新生儿身份核查准确性的影响

目的:探讨不同标识腕带对新生儿身份核查准确性的影响。方法:208例新生儿按入院单双号顺序分为两组各104例,单号为实验组,佩戴改良的脚踝标识腕带作为新生儿身份识别的依据;双号为对照组,佩戴传统的手腕标识带作为新生儿身份识别的依据。观察并记录护理人员对两组新生儿使用标识带进行身份核查的依从性,两组新生儿发生标识带脱落及因身份识别错误而发生护理差错情况。结果:护理人员使用脚踝标识带进行身份核查的依从性明显高于传统的手腕标识带(P0.05);实验组患儿住院期间发生标识带脱落及护理差错例数明显低于对照组(P0.05)。结论:脚裸标识带具有信息带直接露在包裹外,方便护理人员操作时查对及固定带系于患儿脚踝不易脱落等优点,能提高新生儿科护理人员使用标识带进行身份核查的依从性和对患儿身份识别的准确性,减少因身份识别错误而导致的护理差错。     

偏执型精神分裂症Stroop实验的fMRI研究

目的研究偏执型精神分裂症完成注意力Stroop实验时的fMRI特点,探讨其脑功能机制。方法偏执型精神分裂症14例,正常对照组16例,按年龄、性别、文化层次进行配对。刺激采用Stroop任务,运用刺激-休息-刺激的模式。分别将两组数据标准化、合并和平均,对两组平均后的脑激活图像的激活区域及激活数目进行比较。结果①偏执型精神分裂症完成有色字和无色字干扰的Stroop实验反应时间长于对照组(P<0.05);完成有色字干扰Stroop实验错误率显著高于对照组(P<0.05);②偏执型精神分裂症在有色字干扰Stroop实验下左侧额中回、右侧前扣带皮质脑区激活计数小于对照组(P<0.05),颞叶、右侧额上回脑区激活计数高于对照组(P<0.05);③偏执型精神分裂症在两种Stroop实验时脑区激活计数无显著性差异(P>0.05),对照组在有色字干扰Stroop实验时右侧额下回、左侧额中回脑区激活计数显著多于无色字干扰的脑区激活计数(P<0.05)。结论Stroop实验激活了左右两侧额中回、额下回以及前扣带皮质;偏执型精神分裂症存在选择性注意障碍,这些障碍可能与左侧额中回、右侧前扣带回皮质以及颞叶脑区功能障碍有关。     

个性化约束在降低重症病人非计划拔管率中的应用效果分析

目的分析使用个性化约束护理对降低ICU病人非计划拔管率的效果。方法研究对象为外科重症监护室因病情需要采用保护性约束护理的患者2688例,采用随机数字表法分为对照组和观察组1344例。对照组行手腕约束或脚腕约束中的一种约束方式,观察组同时行手腕约束和波板手套约束或背心型胸带约束中的两种及两种以上个性化约束,突出约束工具、部位、约束时间等个性化、人性化。结果对照组非计划性拔管为3例,占0.22%;观察组非计划拔管1例,占0.07%。同比观察组下降;观察组约束部位皮肤异常(肿胀、淤青或破损)明显低于对照组。结论使用个性化约束对降低非计划拔管率有积极意义,并可以保护患者约束部位的皮肤。     

啪啪圈式病人身份识别腕带的设计与应用

<正>查对制度是护理工作的核心制度,是临床护理安全管理的重要内容。腕带作为识别病人身份的一种手段,是将标有病人基本信息的标识带系在病人手腕或脚腕上进行贴身标识,能够有效保证对病人进行快速准确的识别。目前使用的纽扣式腕带,病人戴上后不方便取下,若取下就损坏,无法再戴上,皮肤科大部分病人进行药浴治疗后致腕带沾水,出现字迹模糊,不易     

手腕部深度烧伤后的康复治疗

对46例(75只)手腕部深度烧伤患者进行削痂植皮,功能位加压及康复训练,结果表明69只手腕部外形和功能恢复良好。提示烧伤早期对手部、腕部深度创面进行上述方法治疗,对于恢复手的功能及外形至关重要。     

去松果体大鼠学习能力、大脑皮质胆碱能纤维及一氧化氮合酶的变化

目的:探讨松果体功能减退对大鼠学习能力、大脑皮质胆碱能纤维分布以及一氧化氮合酶表达影响。方法:实验于1997-07/2000-06在珠江医院神经内科实验室完成。选择经Y型迷宫测试学习正常的雄性SD大鼠12只,随机分两组,实验组6只,行松果体摘除术,对照组6只行假手术。①学习能力测试:大鼠学习能力测试用三等分Y型迷宫进行,以大鼠学习尝试次数表示。②采用酶组织化学法测乙酰胆碱酯酶表达,采用SABC法检测神经元型一氧化氮合酶表达。③乙酰胆碱酯酶纤维定量分析:采用LeicaDiaplan显微镜及LeicaQuantimet500 图像分析仪,测量单位面积内乙酰胆碱酯酶的密度,定量参数为每374693.656μm2内乙酰胆碱酯酶纤维覆盖面积(μm2)。运动皮质,体感皮质测量第Ⅱ,Ⅲ,Ⅳ层,海马为CA1,CA2,CA3区的辐状层、腔隙层、分子层和齿状回多形细胞层。皮质神经元型一氧化氮合酶表达以每只大鼠随机取相同部位的3张切片,共计6张切片,光镜下分别随机选右侧皮质、内侧隔核-斜角带核、纹状体、海马区各部位相邻4个视野(×400),统计神经元型一氧化氮合酶阳性细胞数。结果:纳入动物12只,均进入结果分析。①大鼠学习能力测试:术前实验组大鼠学习能力(14.67±4.97)次,与对照组(14.33±4.32)次基本一致(P>0.05),松果体摘除40d后大鼠学习能力(28.67±2.42)次,比术前自身对照及术后对照组(13.83±8.33)次明显下降(P<0.01)。②大鼠大脑皮质中乙酰胆碱酯酶纤维密度测定结果:实验组各部位均比对照组明显降低[实验组运动皮质、体感皮质、海马CA1,CA2,CA3区和齿状回多形细胞层纤维密度分别为(15244±1339),(14764±1391),(12991±970),(15077±1020),(19546±1489),(19337±1378)μm2,对照组分别为(21001±1021),(17930±2225),(17260±1342),(18911±1048),(24108±1671),(22917±1909)μm2,P<0.01]。③不同脑区神经元型一氧化氮合酶表达:实验组大鼠大脑皮质含有较多神经元型一氧化氮合酶阳性细胞数,细胞数为(5.90±0.68)个,并以体感皮质稍多于运动皮质,多于对照组(3.68±0.39)个(P<0.05);隔核-斜角带核部神经元型一氧化氮合酶阳性细胞数(16.21±2.03)个,明显多于对照组(9.32±1.05)个(P<0.01);海马部神经元型一氧化氮合酶阳性细胞数(4.27±0.75)个、纹状体区(9.35±2.58)个,与对照组(3.94±0.53)个和(8.96±2.31)个相比差异无显著性(P>0.05)。结论:大鼠松果体摘除可以引起大鼠学习能力障碍,其原因可能与大脑皮质、隔核-斜角带核神经元型一氧化氮合酶过度表达,引起一氧化氮神经毒性致胆碱能神经元受损伤有关。     

思乐扣固定在减少腹腔引流管脱落中的价值分析

探讨思乐扣固定在减少腹腔引流管脱落中的价值。选取诊治的腹腔引流患者200例,依据随机数字表法分为思乐扣组和敷贴组各100例,敷贴组给予传统透明敷贴固定处理,思乐扣组给予思乐扣固定处理,采用自制腹腔引流管舒适量表评估舒适程度,分析两组引流管脱落发生情况和患者引流期间舒适程度。思乐扣组引流管脱落发生率明显低于敷贴组,差异显著(P0.05);思乐扣组患者舒适率和舒适得分明显高于敷贴组,差异显著(P0.05)。思乐扣固定可有效减少腹腔引流管脱落的风险,同时可有效提高患者引流期间的舒适程度,值得临床推广应用。     

类风湿关节炎手腕部骨侵蚀声像图表现浅析

目的分析类风湿关节炎(RA)手腕部骨侵蚀的声像图表现,探讨肌骨超声在其检测中的临床应用价值。方法对76例经2010年美国风湿病协会/欧洲抗风湿病联盟诊断标准确诊的RA患者行手腕部(包括腕关节、掌指关节和近端指间关节)肌骨超声检查,观察有无滑膜炎、腱鞘炎和骨侵蚀,记录骨侵蚀部位和数量;对各关节病变超声表现进行半定量分级并计算总评分,分析骨侵蚀与滑膜炎、腱鞘炎评分的相关性。结果 76例RA患者超声检出49例,共86处发生骨侵蚀病变。手腕部关节骨侵蚀数量与手腕部滑膜炎灰阶超声(GSUS)评分和能量多普勒超声(PDUS)评分均呈正相关(r=0.579、0.765,均P0.01),与腱鞘炎GSUS评分和PDUS评分均无显著相关性。骨侵蚀评分与手腕部滑膜炎GSUS评分和PDUS评分均呈正相关(r=0.634、0.828,均P0.01),与腱鞘炎GSUS评分和PDUS评分均无显著相关。结论肌骨超声能有效检测RA手腕部骨侵蚀病变,且骨侵蚀的发展与关节滑膜炎活动性的发展程度密切相关。     

腕保护器抗冲击载荷的有限元分析

背景：人体防滑倒腕部保护支具对手腕部有明显的保护作用。目的：采用有限元分析验证腕保护器防护腕部骨折的有效性。方法：以中国力学可视人原始资料为依据,应用Abaqus6.51软件构建带软组织的正常手腕和佩带腕保护器手腕的三维有限元模型,对整个手腕模型加载2m/s的速度载荷,经程序运算后对比手腕部三维有限元模型佩带腕保护器前后的应力应变分布云图及腕部尺骨远端掌面最大应力值随时间变化规律图。结果与结论：与未佩带腕保护器比较,佩带腕保护器后在跌倒过程中小鱼际和腕关节背面的软组织等效应力、腕部桡尺骨下段的等效应力均明显变小,力学结构最薄弱的桡尺骨远端应力变小尤为最明显,而第2～4掌骨、食指近节、钩骨等力学结构相对坚强的短管状骨和不规则骨所受应力明显增大,提示腕保护器可分散、吸收一部分桡尺骨远端应力,转移至腕、掌、指骨上一部分,对保护腕关节尤其是防止桡尺骨远端骨折有积极的作用。     

Acustimulation wrist bands are not effective for the control of chemotherapy-induced nausea in women with breast cancer

This experiment examined the efficacy of an acustimulation wrist band for the relief of chemotherapy-induced nausea using a randomized three-arm clinical trial (active acustimulation, sham acustimulation, and no acustimulation) in 96 women with breast cancer who experienced nausea at their first chemotherapy treatment. Five outcomes related to wrist band efficacy (acute nausea, delayed nausea, vomiting, QOL, and total amount of antiemetic medication used) were examined. The five outcomes were examined separately using analysis of covariance controlling for age and severity of past nausea. There were no significant differences in any of these study measures among the three treatment conditions (P>0.1 for all). Study results do not support the hypothesis that acustimulation bands are efficacious as an adjunct to pharmacological antiemetics for control of chemotherapy-related nausea in female breast cancer patients.     

Educating patients after conscious sedation for gastrointestinal procedures.

Medication for conscious sedation during gastrointestinal (GI) diagnostic procedures causes amnesia, thereby preventing patients from recalling postprocedure instructions or follow-up appointments. A serious complication after GI diagnostic procedures is bleeding, which can occur if patients take aspirin or nonsteroidal anti-inflammatory agents after the procedure. Past research revealed that 73% of patients did not remember instructions. The purpose of this randomized controlled trial was: (1) to determine if patients with wrist bands remember to read their postprocedure instructions, and (2) to determine what patient demographics are associated with failure to read postprocedure instructions. Sixty-one GI clinic outpatients participated in this Veterans Affairs Medical Center study, received routine written instructions before and after GI diagnostic procedures, and were randomly assigned to one of two groups: control group (standard care plus next-day phone call) or intervention group (wrist band plus standard care plus next-day phone call). A memory test evaluated patients' knowledge of procedure results, date of follow-up appointment, and medications. Results indicated no significant differences in the memory test between the groups (t = 0.9, p = .36). Patients 65 years of age and older had scores indicating memory problems, regardless of the wrist band (r = 0.19, p = .06). The wrist band was ineffective as a reminder to read instructions; rather, the next-day phone call served as the reminder.     

身份腕带在心血管外科病人安全管理中的应用

目的探讨身份腕带在心血管外科病人安全管理中的应用方法及重要意义。方法对我院10年来心血管外科病人应用身份腕带进行回顾性分析。结果未发生接错病人的护理差错。结论身份腕带可提高医护人员对病人识别的准确性,加强住院病人的安全管理。     

可调式踝足矫形带与动态踝足矫形器对改善脑卒中下肢屈肌协同患者步行能力的比较

目的:比较可调式踝足矫形带与动态踝足矫形器对脑卒中下肢屈肌协同患者步行能力的影响.方法:选择符合标准的脑卒中患者20例,分别在三种状态下(无矫形装置、穿戴DAFO、穿戴可调式踝足矫形带)观测患者步行时踝足位置,不同状态下Berg平衡功能和10m步行速度.结果:在步行状态下,戴DAFO和可调式踝足矫形带均可矫正踝足对位关...     

The Effect of Manual Therapy on Lower Extremity Joint Kinematics during Running: A single-subject case study

BackgroundWhile there is scarcity of current literature to support the effectiveness of muscle energy techniques (MET) with musculoskeletal injuries, the overall impact on gait kinematics necessitates investigation. This case study involved a 48-year-old male runner and aimed to determine the effect of manual therapy, including joint mobilization and MET, on lower extremity (LE) kinematics. The subject had a medical history that included: Achilles tendonitis, low back pain, and iliotibial band syndrome.MethodsA clinical exam and Xsens motion capture were performed on the subject prior to treatment and at the conclusion of the 6 weeks of treatment. Motion capture was used to examine bilateral foot contact time, hip transverse plane motion and ankle sagittal plane motion. Pre-treatment and post-treatment ipsilateral and bilateral differences between groups were analyzed.ResultsChanges were noted between ipsilateral and bilateral pre- and post-treatment contact times; right foot sagittal plane joint angle at foot off; left hip transverse plane joint angle at foot contact and foot off, all bilateral pre- and post-treatment hip angles at foot contact and foot off, all bilateral pre- and post-treatment ankle angles at foot contact and foot off.ConclusionsClinical exams paralleled the change in hip external rotation bringing the hips to a more neutral position. In addition, the final clinical exam noted a decrease in subtalar eversion bilaterally, which may relate to the improved pelvic symmetry and biomechanical compensation pattern. Clinically, these findings may coincide with improving proximal lumbopelvic symmetry assisting with normalizing distal mobility by using manual therapy.     

Sonographic Evaluation of the Peripheral Nerve in Diabetic Patients

Objective. Early detection of nerve dysfunction is important to provide appropriate care for patients with diabetic polyneuropathy. The aim of this study was to assess the echo intensity of the peripheral nerve and to evaluate the relationship between nerve conduction study results and sonographic findings in patients with type 2 diabetes mellitus. Methods. Thirty patients with type 2 diabetes (mean ± SD, 59.8 ± 10.2 years) and 32 healthy volunteers (mean, 53.7 ± 13.9 years) were enrolled in this study. The cross‐sectional area (CSA) and echo intensity of the peripheral nerve were evaluated at the carpal tunnel and proximal to the wrist (wrist) of the median nerve and in the tibial nerve at the ankle. Results. There was a significant increase in the CSA and hypoechoic area of the nerve in diabetic patients compared with controls (wrist, 7.1 ± 2.0 mm², 62.3% ± 3.0%; ankle, 8.9 ± 2.8 mm², 57.6% ± 3.9%; and wrist, 9.8 ± 3.7 mm², 72.3% ± 6.6%; ankle, 15.0 ± 6.1 mm², 61.4% ± 5.3% in controls and diabetic patients, respectively; P < .05). Cross‐sectional areas were negatively correlated with reduced motor nerve conduction velocity and delayed latency. Conclusions. These results suggest that sonographic examinations are useful for the diagnosis of diabetic neuropathy.     

The influence of contractures and variation in measurement stretching velocity on the reliability of the Modified Ashworth Scale in patients with severe brain injury

OBJECTIVE: To determine the influence of contractures and different stretching velocities on the reliability of the Modified Ashworth Scale (MAS) in patients with severe brain injury and impaired consciousness. DESIGN: Cross-section observational study. SETTING: A rehabilitation centre for adult persons with neurological disorders. SUBJECTS: Fifty patients with impaired consciousness due to severe cerebral damage of various aetiologies. MEASUREMENT PROTOCOL: Three experienced and trained medical professionals rated each patient in a randomized order once daily for two consecutive days. Shoulder, elbow, wrist, knee and ankle spasticity were assessed by the use of the MAS with different stretching velocities. The presence of contractures was assessed by a goniometer. MAIN OUTCOME MEASURES: Retest and inter-rater reliability (k(w) = weighted kappa) of the MAS. RESULTS: The retest reliability of the MAS was good (shoulder joints (k(w) 0.74), elbow joints (k(w) 0.74), wrist joints (k(w) 0.72), knee joints (k(w) 0.72), ankle joints (k(w) 0.77)) and the inter-rater reliability was moderate (shoulder joints (k(w) 0.49), elbow joints (k(w) 0.52), wrist joints (k(w) 0.51), knee joints (k(w) 0.54) ankle joints (k(w) 0.49)). The presence of contractures significantly influenced the reliability of MAS in shoulder and wrist joints. No influence of stretching velocity on the reliability of the MAS was found. CONCLUSION: In patients with impaired consciousness due to severe brain injury the MAS has good retest, but only limited inter-rater, reliability. The presence of contractures may influence reliability of the MAS, but stretching velocity does not.     

智能化手腕带在危重病人身份识别中的应用

[目的]探讨智能化手腕带在危重病人身份识别中的应用。[方法]选择重症监护病房住院危重病人316例为对照组采用传统的身份识别手段,354例为观察组应用智能化手腕带进行身份识别。[结果]观察组未发生护理差错,对照组发生8例(2.53%)。[结论]结合医院信息系统平台,应用无线识别技术及智能化手腕带对危重病人进行身份确认,可提高医嘱执行的准确性,提高护理安全。