重症、冠心病监护病房菌群分布特点及耐药性分析

目的了解我院2000年1月～2002年5月重症(ICU)、冠心病监护病房(CCU)菌群分布及不同菌的耐药性,以利于临床合理选用抗生素及预防医院感染. 方法选用浙江省军区细菌生化管手工进行细菌鉴定及用K-B法进行药敏试验,用双纸片协同法测定超广谱β-内酰胺酶(ESBLs). 结果共分离出233株菌,这些标本为下呼吸道标本(多数为痰,少数为气管切开分泌物),其中不动杆菌属60株占25.7%,酵母样真菌54株占23.2%,肺炎克雷伯菌42株占18.0%,金黄色葡萄球菌20株占8.6%,铜绿假单胞菌18株占7.7%,产ESBLs肺炎克雷伯菌6株占14.3%,产ESBLs大肠埃希菌3株占18.8%,MRSA检出4株占20.0%. 结论 ICU、CCU为免疫力低下患者,极易感染病原菌或多种菌混合感染,且分离的菌易呈多重耐药,临床治疗较棘手,所以应在抗生素敏感试验指导下进行治疗.     

护理干预手段对冠心病监护病房患者家属需求的评价

应用护理干预手段对冠心病监护病房(CCU)患者家属需求进行评估,把以患者家属为中心的理念融入CCU以患者为中心的医护服务模式中去.救治重患者的过程中,医护人员应充分考虑患者家属的心理动态,给予全面与足够的照顾,尽力满足患者家属的各种需求,为患者带来更有益的正性支持,达到最大的康复机会.     

CCU限制陪护制度认知与需求调查分析

目的 了解CCU患者、家属及医护人员对家属限制陪护制度认知的差异,以探讨最佳探视模式,达到既有利于患者康复又有利于治疗的目的。方法 选取符合入选标准的患者200人、家属200人、医护人员80人,在患者入院48小时后采用自制设计调查表进行调查。结果 调查从患者产生不良情绪的最主要因素、患者家属对患者的担忧程度及原因、患者及家属认为CCU最令人不满意的方面、患者和家属以及医护人员对限制陪护的认知及满意度和需求等四个方面进行比较。结果显示在限制陪护对病情的利弊、患者及家属和医护人员对限制陪护制度的认知和需求上存在差异（P＜0.01）。结论 尽管患者病因不同。但患者及家属的需求是相同的,应高度重视CCU住院患者、家属对限制陪护的反应性及需求,开展以家庭为中心的全程精细化关护模式,实施分阶段探视制度,制定新型探视模式,寻找制度和人情的平衡点,提高患者的应对能力,更好地配合治疗。     

舒适护理在CCU病房护理中的应用

目的探讨舒适护理对CCU病人心理状态的影响。方法采取语言交流,减轻病人心理负担;改善环境,建立规律的作息制度;增加病人舒适感的方法对病人进行护理。结论对CCU病人实行舒适护理能改善病人的心理状态。使其能积极、主动配合治疗计划,减少疾病的复发。     

运用生物反馈疗法对CCU监护患者实施心理干预

目的:探讨生物反馈疗法对CCU监护患者的心理影响.方法:将30例患者随机分为干预组和对照组各15例,干预组给予常规心理护理和生物反馈训练,对照组给予常规心理护理,1周后应用症状自评量表(SCL-90)评定两组症状差异性.结果:干预组恐惧、焦虑、抑郁、人际关系四个项目的因子分均明显低于对照组(P＜0.05).结论:对CCU监护患者实施生物反馈训练,能有效的降低患者负性情绪,对CCU监护患者的心理护理具有实践意义.     

Diurnal variation of soluble CD40 ligand in patients with acute coronary syndrome. Soluble CD40 ligand and diurnal variation

Introduction

We sought to investigate whether day-night variations occur in the concentration of circulating soluble CD40 ligand in patients with acute coronary syndrome, as this may have practical implications.

Materials and Methods

We assessed 70 consecutive ST-segment elevation myocardial infarction patients admitted into the Coronary Care Unit and 50 control subjects. Each subject was studied under strictly controlled light/dark conditions. Blood samples were drawn at 09:00 h (light phase) and 02:00 h (dark phase). Nocturnal blood samples were drawn by a trained nurse, with the help of a minute torch with a dim red light in order to avoid any direct lighting on the patient during sleep. The soluble CD40 ligand was measured using a commercially available ELISA.

Results

Soluble CD40 ligand levels showed no diurnal variations in control subjects. In the ST-segment elevation myocardial infarction group, however, soluble CD40 ligand concentration (pg/mL) in the light phase was significantly higher than that in the dark phase (167.3 ± 63.2 vs 118.9 ± 48.3 pg/mL, p < 0.001).

Conclusions

The study shows for the first time the existence of diurnal variations in soluble CD40 ligand levels in ST-segment elevation myocardial infarction patients, which indicates the need for standardizing the time of blood sampling for the assessment of this molecule, at least in studies involving ST-segment elevation myocardial infarction patients.     

Acute pulmonary embolism is an independent predictor of adverse events in severe decompensated heart failure patients

BACKGROUND: Congestive heart failure (CHF) is a well-recognized risk factor for venous thromboembolism (VTE) and is associated with higher mortality in patients with an acute pulmonary embolism (PE). There are very few data on how acute PE affects the clinical course of patients with heart failure. The purpose of this study was to determine the impact of an acute PE on the short-term prognosis of patients hospitalized for decompensated CHF. METHODS: This was a prospective cohort study of 198 patients admitted to a coronary care unit between July 2001 and March 2003 with severe decompensated CHF. The primary outcome measure was death or rehospitalization at 3 months. RESULTS: PE was confirmed in 18 of 198 patients enrolled (9.1%). The groups with and without PE were comparable with regards to demographics, the prevalence of comorbid conditions, and severity of CHF (p > 0.05). The prevalence of cancer (p = 0.0001), previous VTE (p = 0.003), and right ventricular overload (p = 0.006) was higher in the PE group. The presence of PE was also associated with a longer hospital stay (37.5 +/- 71.6 days vs 15.4 +/- 15.0 days, p = 0.001) [mean +/- SD] and a higher incidence of death or rehospitalization at 3 months (72.2% vs 43.9%, p = 0.02). In a multiple logistic regression analysis, PE remained an independent predictor of death or rehospitalization at 3 months (odds ratio, 4.0; 95% confidence interval, 1.1 to 15.1; p = 0.038). CONCLUSIONS: Acute PE commonly complicates the hospital course of patients with severe CHF, increasing the length of hospital stay and the chance of death or rehospitalization at 3 months.     

心肌梗塞病人在CCU中的护理要点

冠心病监护室(CCU)能使心肌梗塞患者得到24小时持续护理,及时有效地对其进行治疗及体能恢复,有利于其病情的好转和体能的恢复。1临床资料1997年~1999年我院CCU收住的心肌梗塞病人70例,年龄为35~87岁。2护理要点2.1紧急监护急性期病人及陈旧性心肌梗死病人进入CCU时均要给予特级护理,立即给予心电、血压及呼吸监测,一般至少监护3~5d。病初2~3d,每半小时测血压1次;病情平稳后改为每1h测量1次;24h后,每2~4h测量1次,并认真记录。2.2缓解心前区疼痛病人心前区疼痛可使交感神经兴奋,使心肌缺氧加重,加大梗塞面积,诱发心律失常,因此止痛极为重…     

CCU患者的心理护理

CCU专门收治冠心病特备是心肌梗死患者,对其进行持续病情监护.由于所收治患者病情较重,病情进展较快,再加上陌生的环境,紧张的气氛以及CCU特殊的无陪人管理制度,患者容易出现各种心理问题.本文分析了临床中常见的各种心理问题的原因及症状,并提出了对应的护理措施.     

CCU心肌梗死患者护理流程再造的实证研究

目的 对CCU心肌梗死患者护理流程进行再造,以提高心肌梗死患者救治效率,改进CCU医护人员的自我效能感。方法 通过成立流程再造团队、分析现有流程缺陷、文献分析、头脑风暴、医护大讨论等措施对CCU心肌梗死患者护理流程进行再造,形成流程图,并对CCU医护人员进行相关培训。实施流程再造前,选取2015年1月～3月由于急性心肌梗死入住我院CCU的患者作为对照组,实施流程再造措施后选取2016年1月～3月由于急性心肌梗死入住我院CCU的患者作为观察组,观察两组患者救治效率,CCU护士的自我效能感。结果 对CCU心肌梗死患者护理流程实施再造后,在心电图操作、建立静脉通路及采血、药物应用、询问病史完成各项记录、医嘱审核、医患术前沟通等6个项目的操作时间达标率方面比较差异有统计学意义,p<0.05。实施流程再造后CCU护士自我效能感有所提高,p<0.05,差异有统计学意义。结论 对CCU心肌梗死患者实行急救流程再造,可以提高心肌梗死患者救治效率,改进CCU护士的自我效能感。