ICU住院患者意外拔管的原因分析与护理对策

目的研究分析重症病房住院患者的意外拔管原因及护理对策。方法观察组64例通过原因分析，采用有效沟通、妥善固定、合理镇静、适当约束、正确装置的护理对策；对照组51例采用传统的护理方法。结果与对照组比较，观察组意外拔管发生率明显降低（P〈O．01）。结论强化有效沟通、妥善固定、合理镇静、适当约束、正确装置能有效降低患者意外拔管，达到提高患者抢救成功率、减轻患者痛苦的目的。     

Association of Parkinson's disease with hospitalization for traumatic brain injury

Purpose: The goal of our study was to determine if patients with Parkinson's disease (PD) are more susceptible to hospitalization for traumatic brain injury (TBI). Methods: The US Nationwide Inpatient Sample database was queried (2004–2011) to identify cohorts of patients with PD (N = 1?047?656) and without PD (N = 115?95?173). The age range of the study population was 60–89 years. The incidence of TBI among patients with PD was compared to the incidence of TBI in patients without PD. A multivariate logistic regression model, adjusted for all covariates that significantly differed in the bivariate analyses, was used to determine if PD was an independent predictor of TBI hospitalization. Results: The incidence of TBI hospitalization was significantly higher (relative risk: 1.76, 95% CI: 1.73–1.80) in the PD cohort. The PD cohort with TBI had fewer comorbidities and risk factors for falls/TBI compared to the non-PD cohort with TBI. The multivariable analysis, adjusting for other TBI risk factors, revealed that PD status increased the likelihood of TBI hospitalization (odds ratio: 2.99, 95% CI: 2.93–3.05). Conclusion: Our study shows that patients with PD are more susceptible to hospitalization for TBI. A greater proportion of fall-related TBI occurs in patients with PD compared to patients without PD. Further research is needed to prevent falls in PD patients to avoid TBI.     

金山区老年人意外伤害死因及分析

[目的]了解上海市金山区老年人意外伤害致死情况,探讨伤害预防控制对策。[方法]对金山区2000～2004年60岁及以上老年人的全部报告资料进行意外伤害死亡率、标化死亡率分析。[结果]意外伤害在老年人全死因顺位中居第4位,意外伤害标化死亡率为112.13/10万。机动车交通事故、意外跌落、淹死、其他事故有害效应和自杀是意外伤害死亡的主要原因。[结论]意外伤害是威胁老年人生命的主要危险因素之一,家庭和社会都应重视老年人意外伤害的防治工作,采取以社区为基础的干预对策控制伤害的发生。     

河南省某幼儿园1992～2003年在园幼儿意外伤害调查

[目的]找出幼儿园儿童意外伤害的规律及原因,提出相应的干预措施.[方法]对河南省某幼儿园1992～2003年12年的所有儿童意外伤害记录进行收集整理.[结果]某园1992～2003年各学期伤害事故发生频率大致在0.32%～1.63%之间;伤害事故多发生在上午的10：00～11：30及下午的2：30～4：50两个时间段;事故发生地点,室外发生占69.00%,室内发生占31.00%;男性发生占64.29%,女性占35.71%;且随着幼儿年龄的增长伤害的发生率越高,各类伤害事件中尤以皮肤创伤为主,占64.28%.[结论]幼儿年龄与伤害事故的发生率存在正相关关系.提示我们,幼儿年龄不同,因其活动能力及活动范围不同,应对意外伤害采取不同的预防和教育措施.     

5岁以下儿童意外伤害相关因素分析及干预建议

[目的]探讨5岁以下儿童意外伤害的相关因素及其有效的干预措施。[方法]对2002年1月～2006年8月我院收治的562例5岁以下意外伤害病例的临床资料进行统计分析。[结果]5岁以下小儿意外伤害集中在2～5岁之间,占全部病例的70.64%。男童比女童发生率较高,分别为51.96%、48.04%。排在前3位的致伤原因依次是烧（烫）伤、跌（摔）伤和锐器伤,分别占19.04%、16.55%和14.41,且3种致伤类型发生率均随年龄增长逐渐下降;而溺水、交通意外和爆炸伤发生率均在2岁以后随年龄增长越来越高。区域比较,农村乡镇略高于市县城区,分别为52.14%、47.86%。[结论]5岁以下儿童意外伤害与小儿自身生理心理特点有关,家庭是意外伤害最易发生的场所,加强看护及其他预防、处理措施可以减少发生率,降低致残致死率。     

7～13岁儿童意外伤害干预研究

目的探讨儿童意外伤害的干预措施和效果。方法选择4所小学的学生,随机分为干预组和对照组。干预组在2年内采取一系列预防意外伤害的安全教育和防范措施,并统计意外伤害发生情况。结果第1年干预组发生意外伤害262例,发生率8.26%,对照组234例,发生率8.67%,两组比较差异无显著性意义。第2年干预组发生伤害211例,发生率6.54%,对照组229例,发生率8.63%,两组比较差异有显著性意义(P<0.01)。结论强化学校、家庭对儿童安全的教育及防范措施,能有效减少儿童意外伤害的发生。     

2001~2004年上海市中小学生伤害死亡流行病学分析

[目的]　了解上海市中小学生伤害死亡流行状况及相关特征,为政府部门制定预防控制措施提供依据。　[方法]　对上海市2001~2004年中小学生伤害死亡者入户询问调查,对资料进行统计分析。　[结果]　2001~2004年上海市中小学生伤害年均死亡率为8. 68 /10万,伤害致死占总死亡38. 71%,是中小学生第一位死因;伤害死亡主要原因为交通事故、中毒、意外跌落、淹死和自杀;不同性别年龄中小学生的伤害死亡构成不同。　[结论]　上海市中小学生伤害死亡有明显的年龄性别特征,应采取针对性措施预防控制伤害发生。     

Pilot study comparing the influence of different types of exercise intervention on the fear of falling in older adults

Background: Individuals who fear falling may restrict themselves from performing certain activities and may increase their risk of falling. Such fear, reflected in the form of falls efficacy, has been measured in only a small number of studies measuring the effectiveness of exercise interventions in the elderly. This may be due to the various types of exercise that can be performed. Hence the effectiveness of exercise on falls efficacy is relatively understudied. Therefore, there is a need to measure falls efficacy as an outcome variable when conducting exercise interventions in the elderly. Methods: A total of 43 elderly community‐dwelling volunteers were recruited and randomly allocated to a conventional exercise intervention, a holistic exercise intervention, or a control group. The interventions were performed 2 days per week for 10 weeks. Falls efficacy was measured at baseline and at the completion of the interventions using the Modified Falls Efficacy Scale (MFES). Results: Within group comparisons between baseline and follow‐up indicated no significant improvements in falls efficacy, however, the difference for the conventional exercise group approached statistical significance (baseline 8.9 to follow‐up 9.3; P = 0.058). Within group comparisons of mean difference MFES scores showed a significant difference between the conventional exercise group and the control group (conventional exercise group 0.4 vs control group ?0.6; P < 0.05). Conclusion: Given the lack of significant improvements in falls efficacy found for any of the groups, it cannot be concluded whether a conventional or a holistic exercise intervention is the best approach for improving falls efficacy. It is possible that the characteristics of the exercise interventions including specificity, intensity, frequency and duration need to be manipulated if the purpose is to bring about improvements in falls efficacy.     

Inadvertent intrathecal injection of labetalol in a patient undergoing post-partum tubal ligation

After receiving a continuous spinal anesthetic for labor following an inadvertent dural puncture with a 17-gauge epidural needle, a morbidly obese parturient underwent post-partum tubal ligation 12 h after vaginal delivery. The patient received a total of 2 mL of 0.75% hyperbaric bupivacaine for the surgery. In response to moderate hypertension the patient received intravenous labetalol hydrochloride 20 mg. She subsequently was inadvertently administered approximately 15 mg of labetalol through the spinal catheter. The spinal catheter was removed immediately after the procedure. She suffered no apparent adverse neurologic effects.     

Reliability of traditional and fractal dimension measures of quiet stance center of pressure in young, healthy people

OBJECTIVES: To assess reliability of traditional and fractal dimension measures of quiet stance center of pressure (COP). DESIGN: Cross-sectional study. SETTING: University laboratory. PARTICIPANTS: Thirty young healthy men (n=20) and women (n=10) (mean age, 23 y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: COP was recorded for 3 trials across 4 conditions: eyes open and eyes closed standing on firm and foam surfaces. Traditional COP variables--peak sway velocity and range of sway, both in the anteroposterior (AP) and mediolateral (ML) directions, and total excursion area, and fractal dimension of the COP in the AP and ML directions--were calculated. Reliability statistics were calculated. RESULTS: Range of sway (AP) was the most reliable traditional variable (intraclass correlation coefficient model 2,1 [ICC(2,1)] range -.28 to .72.). Peak sway velocity (AP) had poorest reliability (ICC(2,1) range, .05-.29). Only 1 of the traditional variables had excellent reliability; total excursion area (firm, eyes closed) (ICC(2,1)=.95). All bar 1 fractal dimension measures had excellent ICCs. Relative technical error of measurement ranged from 4% to 7% for the fractal dimension measures. Coefficients of variation were also very good, ranging from 1.8% to 6.7%. CONCLUSIONS: Fractal dimension measures were more reliable than traditional measures of COP. Although traditional measures are used extensively to assess COP, their reliability is questionable. Fractal dimension measures show promise to reliably quantify COP and warrant further investigation.