58名骨科护士康复护理知识掌握情况的调查分析

目的调查本市58名骨科护士康复护理知识的掌握情况,为加强骨科康复护理的培训提供理论依据。方法采用上海第二军医大学护理系李娟和徐燕设计的"骨科康复护理知识问卷"对本市两所三级甲等医院58名骨科护士进行问卷调查,了解骨科护士对康复护理知识的掌握情况。结果 58名骨科护士对康复护理知识掌握较差,康复护理总论平均得分(35.21±8.97)分,临床康复护理知识平均得分(52.29±7.45)分;大专学历、7～10年工作年限和专科工作年限的护士康复护理知识得分高于其他学历和工作年限的护士(均P<0.05),而不同职称的护士对康复护理知识掌握情况比较,P>0.05,差异无统计学意义。结论 58名骨科护士康复护理知识欠缺,应加强教育与培训,对不同学历和工作年限的护士采用针对性的培训措施,使其熟练掌握康复护理知识,才能对患者实施早期的康复护理,这对提高患者的护理质量以及治疗效果具有重要意义。     

慢性阻塞性肺疾病患者抑郁和焦虑发生的危险因素分析

目的:探讨慢性阻塞性肺疾病(COPD)患者抑郁症发生的危险因素。方法:收集200例COPD患者的一般信息、肺功能、呼吸困难、生活质量和运动能力评估、HAD和BCKQ信息,进行偏相关分析及多变量模型检测焦虑和抑郁的危险因素,并构建BCKQ的13项疾病知识评估的多变量模型。结果:焦虑和/抑郁组受试者有更少的COPD认识。偏相关分析表明:HAD得分与BCKQ评分呈负相关(r=-0.148,P=0.002);在焦虑和抑郁危险因素的多变量模型中,BCKQ得分(P=0.002,OR=0.890)显著。流行病学(P0.001,OR=0.660)和感染(P0.001,OR=0.695)在评估13个疾病知识项目的多变量模型中显著。结论 :COPD患者的疾病知识水平是其焦虑和抑郁发病的一个显著危险因素,其中流行病学和感染是影响COPD知识水平的重要项目。     

莱芜市社区居民心肺复苏知信行情况调查分析

目的:调查莱芜市社区居民心肺复苏术知信行(KAP)的掌握情况。方法:采用自设莱芜市社区居民关于心肺复苏的KAP调查表,对723名莱芜市社区居民进行问卷调查。结果:莱芜市社区居民关于心肺复苏干预的知识水平较低,居民知识平均得分为(8.3±6.4)分,态度平均得分为(14.3±4.2)分,行为平均得分为(8.2±9.4)分;Spearman相关分析显示,莱芜市社区居民的知识与态度之间、态度与行为之间、知识与行为之间均存在正相关。结论:莱芜市社区居民心肺复苏知晓率低,缺乏心肺复苏理论知识和急救技能;居民心肺复苏知识来源缺乏专业指导,同时其对专业人员进行莱芜市社区心肺复苏知识讲座和培训有很大需求。     

健康教育在慢性阻塞性肺疾病社区康复中的意义

目的探讨健康教育对稳定期慢性阻塞性肺疾病(COPD)患者社区康复的意义。方法对前期研究的46例社区稳定期COPD患者(干预组和对照组各23例),于2013年10月及2014年1月进行两次电话随访,采用Bristol COPD知识问卷(BCKQ)、改良Borg评分、焦虑自评量表(SAS)、抑郁自评量表(SDS)、COPD评估测试(CAT)进行调查。第1轮随访时给予健康教育。结果第1次随访时,干预组各项评分均恶化(P0.05),除SAS、SDS外,与对照组已无显著性差异(P0.05);其中文化程度较高者,评分无显著性恶化(P0.05)。第2次随访时,干预组各项评分明显改善(P0.01),对照组也有改善(P0.05),两组间BCKQ、改良Borg评分、CAT评分有显著性差异(P0.05)。结论稳定期COPD患者社区康复效果可逆。电话随访式健康教育能提高COPD患者的疾病认知,减轻呼吸困难,改善心理和生活质量。     

慢性阻塞性肺疾病患者呼吸功能锻炼依从性的影响因素分析

目的了解慢性阻塞性肺疾病(COPD)患者呼吸功能锻炼的依从性,并探讨其影响因素,为开展临床护理干预提供依据。方法选择COPD住院患者236例,采用自行设计及BCKQ设计的问卷调查表对患者进行调查和评估,应用卡方检验和相关性分析等方法,探讨影响呼吸功能锻炼的因素。结果 236例COPD患者中,进行呼吸功能锻炼者80例(33. 9%),其影响因素主要与年龄、文化程度和家庭个人收入有关,同时COPD知识掌握情况与呼吸功能锻炼依从性呈正相关(r=0. 847,P 0. 001)。结论 COPD患者呼吸功能锻炼依从性整体较差,应加强COPD相关知识和呼吸功能锻炼方法的健康教育,同时定期对患者进行督促和鼓励,调动其锻炼积极性。     

体验式教学在失智老人照护者培训中的应用研究

[目的]探讨体验式教学在失智老人照护者培训中的应用效果。[方法]应用体验式教学法对2016年1月—6月入院治疗的52名失智老人照护者进行培训,采用老年人态度量表(KAOP)、自行研制的失智老人照护知识调查问卷分别于培训前后调查照护者对老年人的态度、照护知识的掌握情况。[结果]KAOP量表培训前评分为(150.92±18.91)分,培训后评分为(164.00±20.35)分,培训前后比较差异有统计学意义(P0.05);培训后专业照护相关知识(3.59分±0.60分)、痴呆的精神行为症状(BPSD)照护相关知识(3.62分±0.60分)、康复活动相关知识(3.62±0.64分)评分高于培训前(2.97分±0.68分、3.02分±0.78分、2.44分±0.71分),培训前后比较差异有统计学意义(P0.01)。[结论]体验式教学可有效改善照护者对老年人的态度,提高照护者的照护知识水平和能力,改善失智老人生活质量。     

德州市骨科康复训练的护理现状

目的 探讨德州市骨科康复护理训练的现状和相关性因素,提高和规范骨科医护人员对康复护理的认识.方法 设计"骨科康复护理训练现状调查问卷",通过分层整群抽样法对德州市公立医院2014年8~12月的500名护理人员进行群体性调查,通过方差分析和描述性统计分析德州市骨科康复的护理现状.结果 共发放调查问卷383份,其中有效问卷359份,有效率93.73%.康复护理活动现状调查中,护理态度良好,平均(43.65±15.32)分;医护合作情况较差,平均(18.21±4.35)分;康复护理知识掌握情况低于基础知识掌握情况,平均(57.34±15.32)分.结论 骨科康复训练的护理工作还存在很大问题,有待于进一步提高. 应该从加强护理人员的康复相关专业知识普及、医护合作、康复训练护理活动等方面进行改进,为骨科患者的康复提供护理基础.     

广州市康复医疗人员培训效果调查

目的调查康复专业技术人员培训效果。方法以广州市10家三级综合性医院为基地,对二级医院康复医学科、一级医院及社区康复医疗服务人员进行训练。调查2013年6~9月(105人)、2014年6~9月(69人)两届培训班学员的知识和技能考核结果。结果两届培训学员的实践考核成绩(82.01±8.91)分,高于理论考核成绩(71.08±10.05)分(P0.01);第二届理论成绩较第一届提高(P0.05),实践成绩考核无显著性差异。结论培训有助于提高二级医院康复医学科、一级医院及社区康复医疗站服务能力。     

综合康复护理对慢性阻塞性肺疾病干预效果及影响因素

目的 探讨综合康复护理对老年慢性阻塞性肺疾病(COPD)患者的干预效果,分析其影响因素.方法 选取60例在我科治疗的老年COPD患者,随机分为观察组和对照组各30例,对照组采取常规护理模式,观察组采取综合康复护理模式,比较两组患者肺功能的变化,评估其对COPD疾病知识的掌握情况.结果 观察组经综合康复护理呼吸训练后,FEV1、FEV1/FVC,6min步行距离均显著高于对照组(P ＜0.05);COPD的概念、症状、痰液的量和颜色、深呼吸和咳痰的方法、持续低流量吸氧的意义、吸入性气雾剂的应用方法等COPD相关知识掌握情况,观察组均明显高于对照组(P＜0.05).结论 综合康复护理改善了患者的肺功能及运动耐受能力.     

医护人员心血管急救知识现状的调查

目的了解医护人员对心血管急救知识的掌握情况。方法应用自编医护人员心血管急救知识现状调查问卷,采取分层随机抽样法对10家医疗机构739名医护人员进行调查。结果 739名医护人员心血管急救知识平均得分(7.23±1.464)分,对基础生命支持知识点的掌握优于进一步生命支持知识点;不同科室、岗位、工作年限、是否参加过AHA培训的医护人员对心血管急救知识的掌握情况存在差异,并有统计学意义(P0.05)。结论医护人员心血管急救知识掌握情况处于中等水平,低于理想水平。     

Endovascular treatment for chronic pulmonary hypertension: a focus on angioplasty for chronic thromboembolic pulmonary hypertension

Introduction: Percutaneous transluminal pulmonary angioplasty (PTPA) was introduced for the treatment of chronic thromboembolic pulmonary hypertension (CTEPH) in the late 20^th century, and first attempts in collective patients were made in 2001 with beneficial effects but a moderate amount of complications. It was refined around 2010, and has been recently established as an effective and safe treatment.

Areas covered: The indication was originally inoperable CTEPH with peripheral lesions, but has now widened to symptomatic or hypoxic patients. The lesion is typically a meshwork-like structure of organized thrombi and is sometimes not seen as a stenosis angiographically, necessitating other means of investigation such as measurement of distal pressure. The technique to treat lesions is the same as for coronary angioplasty except in several ways.

Expert commentary: The effects of PTPA are comparable to those of surgical endarterectomy, and the complications of reperfusion pulmonary edema and vascular injury are now controlled by several strategies and based on experience.     

肺转移瘤的外科治疗

目的 :探讨肺转移性肿瘤外科治疗的手术指征、手术方式、手术疗效。方法 :对 36例肺转移性肿瘤的相关临床资料进行回顾性分析。结果 :对 36例肺转移性肿瘤行肺切除术 39次 ,随访 1年～ 15年 ,术后 1年、3年、5年、10年生存率分别为 77.8%、48.2 %、2 1.7%、7.7%。无手术死亡。结论 :对原发肿瘤已控制、肺转移瘤可以切除、无他处转移及肺功能可承受手术者作为手术指征     

Transthoracic Echocardiographic Evaluation of Pulmonary Valve Anomalies in Pediatric Patients

The pulmonary valve normally consists of 3 leaflets supported in a semilunar fashion within the sinuses of the pulmonary trunk. Pulmonary leaflet malformations, such as congenital single pulmonary cusp absence, bicuspid pulmonary valve, and quadricuspid pulmonary valve anomalies, as well as pulmonary valve commissural fusion, are seldom identified preoperatively on echocardiography. In this study, we report on 5 children with different types of pulmonary valve malformations diagnosed by transthoracic echocardiography.     

成人经皮球囊肺动脉瓣成形术的临床应用

目的：评价成人经皮球囊肺动脉瓣成形术（ＰＢＰＶ）临床应用的疗效。方法：采用 ＰＢＰＶ对 ３７例成人先天性肺动脉瓣狭窄患者进行治疗。结果：ＰＢＰＶ后即刻肺动脉瓣跨瓣压差（△Ｐ）由术前８１±２６ｍｍＨｇ降至３６±１７ｍｍＨｇ（Ｐ＜０．０１）,３２例随访１～９年,平均４．３±２．１年,△Ｐ进一步降为２５±７ｍｍＨｇ。术中及术后无严重并发症。结论：ＰＢＰＶ治疗成人肺动脉瓣狭窄安全、有效,即刻与中远期效果均良好。     

About mechanisms of prostaglandin E1 induced deterioration of pulmonary gas exchange in COPD patients

Summary. Prostaglandin E₁ (PGE₁) has been reported to attenuate COPD-related pulmonary hypertension and to slightly lower the arterial oxygen tension (PaO₂). In order to infer the involved mechanisms, the effects of intravenous infusion of PGE₁ on pulmonary haemodynamics, diffusing lung capacity for CO (DLCO), membrane diffusing capacity (Dm), pulmonary capillary blood volume (Vc), physiological shunt (Q_ps/Q_t), arterial blood gases and other lung functional indices were evaluated in 20 COPD patients with pulmonary hypertension and, excluding right catheterization, in 14 control subjects. The examines were studied at baseline and during infusion of 20–30 ng kg^-1min PGE₁ or placebo. In control subjects PGE₁ only caused systemic arterial pressure decrease (-17.8%). In COPD patients, as expected, PGE₁ increased cardiac index (16-2%), but decreased systemic arterial pressure (-21.2%), pulmonary arterial pressure (-27.9%), pulmonary vascular resistance (-45.4%) and PaO₂ (-10.4%), worsening their hypoxaemia. However, the effect of PGE₁ on DLCO was an increase (11.9%), due to an increase in Vc (15.2%) and less markedly in Dm (4.9%). Physiological and anatomical shunts were increased with PGE₁ (20.2% and 14.8%) and the overall ventilation/perfusion ratio decreased from 0.89 to 0.79. Decrements in PaO₂ correlated with increments in Q_ps/Q_t (r= 0.86). In conclusion, in COPD patients studied, PGE₁ increased DLCO, which compensated for the deleterious effect of increased cardiac output on alveolar-capillary gas equilibration. Therefore, worsening of hypoxaemia during PGE₁ infusion was related with increased right-to-left shunt and deterioration of ventilation-perfusion relationship.,     

Flash Pulmonary Edema in Multiple Sclerosis

Background

Neurogenic pulmonary edema (NPE) occurs in the setting of an acute neurological insult and in the absence of a primary cardiopulmonary cause. No unifying theory on NPE pathogenesis exists. NPE triggered by a discrete neurological lesion is rare, but such cases offer valuable insight into NPE pathogenesis.

Objective

To describe an unusual and instructive case of NPE in multiple sclerosis.

Case Report

A young woman with multiple sclerosis presented to the Emergency Department in acute respiratory failure. She was cyanotic centrally, hypertensive, and tachycardic. The chest X-ray study suggested pulmonary edema. She required non-invasive mechanical ventilation for 12 h. Echocardiography revealed left ventricular hypokinesis. The asymmetrical pulmonary infiltrate raised the suspicion of pneumonia; she was given intravenous antibiotics. By 36 h, she had persistent dyspnea, paroxysmal tachycardia, nausea, and facial flushing; carcinoid syndrome was excluded. By 48 h, she had facial numbness and ataxia. Magnetic resonance imaging (MRI) revealed a demyelinating lesion at the rostromedial medulla. Her symptoms promptly resolved with intravenous steroids, as did the perilesional edema on follow-up MRI.

Conclusion

Life-threatening pulmonary edema can complicate medullary demyelination. Lack of awareness of this diagnostic possibility and an asymmetrical pulmonary infiltrate culminated in diagnostic delay in this case. The case provides clinico-radiological evidence of the pathogenic link between medullary lesions and NPE. The pathogenesis is likely to rely on lesion involvement of the nucleus tractus solitarius or its immediate pathways. Non-uniform vasoconstriction of the pulmonary arterial bed might account for the other peculiarity of this case: the asymmetrical pulmonary infiltrate. Timely diagnosis of NPE is essential because the condition is best managed by nullifying the “neurogenic” trigger.     

Pathogenesis and clinical features of chronic pulmonary aspergillosis – Is it possible to distinguish CNPA and CCPA clinically?

BackgroundThe pathogenesis of chronic pulmonary aspergillosis (CPA) including chronic necrotizing pulmonary aspergillosis (CNPA), chronic cavitary pulmonary aspergillosis (CCPA), and simple aspergilloma (SA) has been poorly investigated. We examined all types of CPA cases with histopathological evidence to clarify the differences in pathogenesis and clinical features.MethodWe searched for cases diagnosed as pulmonary aspergillosis by histopathological examination in Nagasaki University Hospital between 1964 and September 2010. All available clinical information including radiological findings were collected and analyzed.ResultWe found 7, 5, 8, and 7 cases of proven CNPA, probable CNPA, CCPA, and SA, respectively. The radiograph of proven and probable CNPA was initially infiltrates or nodules that progress to form cavities with or without aspergilloma, whereas the radiograph of CCPA showed pre-existed cavities and peri-cavitary infiltrates with or without aspergilloma. The patients with proven and probable CNPA exhibited not only respiratory symptoms but also systemic symptoms and malnutrition. Aspergillus fumigatus was the most frequently isolated Aspergillus species (n = 14), however, Aspergillus niger was the predominant isolated species in proven CNPA cases (n = 4).ConclusionOur data indicate that the cases with chronic infiltration, progressive cavitation, and subsequent aspergilloma formation should be diagnosed as CNPA, and the cases with pre-existed cavities showing peri-cavitary infiltrates with or without aspergilloma would mean CCPA. However, it may be difficult to distinguish the two subtypes if a series of adequate radiography films are not available. We propose the term “chronic progressive pulmonary aspergillosis (CPPA)” for the clinical syndrome including both CNPA and CCPA.     

造血干细胞移植后侵袭性肺曲霉病患者12例的肺功能改变

目的观察12例造血干细胞移植(HSCT)后并发侵袭性肺曲霉病(IPA)对患者肺功能参数及动脉血气的影响。方法 2007年2月~2009年10月本院接受HSCT后并发IPA患者12例,男8例,女4例,中位年龄34岁(26~67岁)。移植前后均行肺功能测试、动脉血气分析以及影像学检查。结果中位随访时间为132 d(97~432 d),无1例发生Ⅲ、Ⅳ度急性移植物抗宿主病(GVHD)。2例在移植1年后发生慢性GVHD。12例均为病理确诊或临床诊断IPA者,移植前肺功能测定仅有弥散功能轻度减退。抗真菌治疗8周后肺功能测试发现所有患者均存在不同程度的阻塞性通气障碍,其中8例患者呈小气道病变[FEF50和FEF75分别为(55.9±3.4)%和(41.9±4.1)%],4例患者则出现混合性通气障碍,总弥散量(DLCO)也显著降低[(47.4±2.9)%预计值],动脉血氧分压(PaO2)仅为(68.7±4.1)mmHg,但弥散常数(DLCO/VA)尚正常,与移植前无显著差异(P0.05)。结论 HSCT后并发IPA可对患者的肺功能造成不同程度的损害,肺内多部位感染或反复发生IPA的患者可出现较严重的混合性通气障碍,弥散也显著减退。     

CT肺动脉造影对肺动脉栓塞的诊断价值

目的探讨CT肺动脉造影对肺动脉栓塞（PE）的诊断价值。方法20例PE患者均行CT肺动脉造影（CTPA）检查。结果Ⅰ型12例,其中4例位于左肺动脉,3例位于右肺动脉,5例左、右肺动脉及肺叶肺动脉皆有;Ⅱ型2例,其中右下叶肺动脉1例,左上叶肺动脉1例;Ⅲ型3例,其中右下叶肺动脉1例,左上叶肺动脉1例,2个以上肺叶肺动脉1例;Ⅳ型3例,均位于双下肺肺段、亚段肺动脉。左、右肺动脉、叶肺动脉、段肺动脉、亚段肺动脉栓塞率分别为77．78％、66．67％、60．00％、12．50％。结论CTPA对肺动脉栓塞有重要的诊断价值。