产后家庭访视质量标准的制订与应用

目的落实产后家庭访视举措,提高访视效果。方法由课题组成员在理论研究与实践调研的基础上初拟产后家庭访视质量标准(下称产后访视标准),采用德尔菲法对15名专家进行2轮咨询、筛选与论证;按出院日将产妇286人单号分为观察组(154人)、双号分为对照组(132人),分别行常规访视和采用产后访视标准访视,连续3次时评价效果。结果形成8个一级条目、45个二级条目的产后访视标准;2轮专家咨询问卷的回收率均为100%,专家的权威系数为0.81,第2轮的协调系数为0.567,一致性检验P<0.01。观察组健康教育、访视前后处理、整体服务效果得分显著高于对照组(均P<0.01)。结论产后访视标准内容合理,评分客观,用于产后家庭访视可提高访视效果。     

996例产后家庭访视护理指导及效果分析

对40例弱视惠儿采用验光配镜后进行遮盖疗法及弱视治疗仪训练等综合治疗及护理。结果总有效率达95．0%。提出心理护理、掌握治疗时机、及时矫正屈光不正性弱视、综合弱视训练、坚持治疗和随访对治疗患儿屈光不正性弱视起着重要作用。     

妊娠高血压综合征病人的护理

妊娠高血压综合征(pregnancy induced hypertension,PIH简称妊高征)是人类妊娠期特有的多器官功能失调性疾病,新近国外报道的发生率占所有妊娠的4％-5％[1].妊高征是妊娠期特有的全身性疾病,发生于妊娠20周以后,临床一般表现为高血压、蛋白尿、水肿,严重时出现抽搐、昏迷,重症患者可出现头晕、头痛、眼花、胸闷、呕吐、视物障碍等一系列自觉症状[2],是迄今孕产妇及围生儿死亡的重要原因.病情进一步发展则可发生心力衰竭、肾衰竭等严重后果,对母婴健康造成极大的威胁.护理工作中,护士应加强孕期健康教育,使孕妇及家属了解妊高征的知识及其对母儿的危害,从而促使孕妇自觉地于妊娠早期开始作产前检查,并坚持定期检查,以便及时发现异常,及时治疗和纠正.现将相关护理报告如下.     

1例重度妊娠高血压综合征并存水痘的护理

总结1例重度妊娠高血压综合征并存水痘患者的护理，提出安定患者情绪，避免抽搐，加强营养及皮肤护理，严格执行消毒隔离制度，预防感染及交叉感染是护理的关键。     

妊娠高血压疾病患者护理体会

目的:探讨护理干预对妊娠高血压疾病患者围产期生活质量的影响。方法:分析2010年11月～2011年11月在我科住院的妊娠高血压疾病产妇产前、后生活质量的变化,并对同期无妊娠高血压疾病剖宫产孕妇产前、后生活质量进行比较。结果:与对照组比较,产前疾病组生活质量较低(P<0.05),而护理后两组无明显差异(P>0.05)。结论:对妊娠高血压疾病产妇实施有效的护理可预防妊娠高血压疾病,有效保证提高母婴安全。     

56例妊娠高血压综合征的护理体会

目的:探讨妊娠高血压综合征的护理方法.方法:对我院2008-2010年56例妊高征患者的护理方法进行回顾性分析和总结.结果:孕产妇全部救治成功,无1例新生儿死亡.结论:妊娠高血压疾病经采取积极有效地护理措施,可降低母婴的并发症和死亡率,促进早日康复,提高治愈率.     

社区高血压患者家庭访视方案的构建

目的构建适合我国国情的社区高血压患者家庭访视方案。方法以奥马哈系统为理论依据,选取17名专家进行德尔菲法咨询和40例患者预试验,构建社区高血压患者家庭访视方案。结果形成的高血压家庭访视方案包括“高血压家庭访视评估表”、“高血压家庭访视干预方式”和“高血压家庭访视问题的效果评分”三部分。“高血压家庭访视评估表”2轮咨询专家积极系数分别为100％和93．75％,专家权威系数分别为0．860和0．852,肯德尔和谐系数分别为0．201和0．498（均P〈0．01）;总的Cronbach’sα系数为0．875,社会心理领域、生理领域、健康相关行为领域的Cronbach＇sα系数分别为0．848、0．680、0．838;总的重测信度r为0．949,社会心理领域、生理领域、健康相关行为领域r分别为0．956、0．799、0．946。内容效度为0．882。结论高血压家庭访视方案设计合理,可用于社区高血压患者家庭访视。     

社区高血压患者家庭访视方案的构建

目的构建适合我国国情的社区高血压患者家庭访视方案。方法以奥马哈系统为理论依据,选取17名专家进行德尔菲法咨询和40例患者预试验,构建社区高血压患者家庭访视方案。结果形成的高血压家庭访视方案包括"高血压家庭访视评估表"、"高血压家庭访视干预方式"和"高血压家庭访视问题的效果评分"三部分。"高血压家庭访视评估表"2轮咨询专家积极系数分别为100%和93.75%,专家权威系数分别为0.860和0.852,肯德尔和谐系数分别为0.201和0.498(均P0.01);总的Cronbach′sα系数为0.875,社会心理领域、生理领域、健康相关行为领域的Cronbach′sα系数分别为0.848、0.680、0.838;总的重测信度r为0.949,社会心理领域、生理领域、健康相关行为领域r分别为0.956、0.799、0.946。内容效度为0.882。结论高血压家庭访视方案设计合理,可用于社区高血压患者家庭访视。     

1例重度妊娠高血压综合征并存水痘的护理

总结1例重度妊娠高血压综合征并存水痘患者的护理,提出安定患者情绪,避免抽搐,加强营养及皮肤护理,严格执行消毒隔离制度,预防感染及交叉感染是护理的关键.     

重度妊娠高血压综合征的预防和护理体会

目的:探讨重度妊娠高血压综合征的预防护理措施.方法:对2007年9月至2010年10月收治的重度妊娠高血压综合征患者32例的护理经验进行总结分析.结果:所有产妇经过精心的病情观察及有效预防护理,均无不适症状发生,全部治愈出院.护理前后密切观察血压、头晕、眼花、蛋白尿、浮肿有显著的疗效.结论:产前、产后严密的病情观察及有效的护理措施,能防止并发症的出现,维护母婴身体的健康.     

The anion gap associated with pregnancy-induced hypertension

OBJECTIVES: To determine if pregnancy-induced hypertension (PIH) is associated with a narrow anion gap. METHODS: Chart review of women with uncomplicated pregnancies and those with PIH and varying degrees of proteinuria. Electrolytes, total protein, albumin, creatinine, uric acid, a qualitative or quantitative measurement of urine protein were required for inclusion into the study. RESULTS: A low anion gap relative to women with normal pregnancies was found only in the group of PIH patients who had the greatest degree of proteinuria. The anion gap correlated directly with the concentration of plasma albumin. Women with PIH, proteinuria, and elevated liver transaminases had the lowest plasma albumin values and the smallest anion gap. CONCLUSION: The degree of hypoalbuminemia determines the magnitude of the anion gap in women with PIH and proteinuria.     

孕妇鼾症与妊娠期高血压病和先兆子痫的相关性分析

目的分析孕妇在不同妊娠期鼾症的发生情况及其与妊娠期高血压病和先兆子痫发病的相关性。方法选择2016年7月至2016年12月我院妊娠的2 000例孕产妇在产后1天进行问卷调查,内容包括一般信息、妊娠期睡眠情况、妊娠期母体结局,单因素分析比较不同妊娠期鼾症组和无鼾症组妊娠期高血压病和先兆子痫的发病率差异,采用多因素logistic回归分析妊娠期高血压病和先兆子痫发病的危险因素。结果 2 000例孕妇中孕前鼾症者129例(6.45%),孕期新发鼾症者340例(17.00%),其中孕早期鼾症者29例(1.45%),孕中期鼾症者200例(10.00%),孕晚期鼾症者111例(5.55%)。2 000例患者随访期间出现妊娠期高血压病者178例(8.9%),其中先兆子痫者98例(4.9%)。在妊娠的不同分期中,鼾症组妊娠期高血压病和先兆子痫的发病率显著增加(P<0.05);多因素分析结果显示年龄(P=0.012,0.034)、孕前体重指数(P=0.008,0.015)、孕中期鼾症(P=0.035,0.016)和孕晚期鼾症(P=0.042,0.028)是妊娠期高血压病和先兆子痫发病的独立危险因素。结论随着妊娠的进展,孕妇鼾症的总发生率逐渐增高,妊娠中、晚期鼾症是妊娠期高血压病和先兆子痫的独立危险因素。     

Cardiorespiratory arrest with laryngeal oedema in pregnancy-induced hypertension

Canadian Journal of Anesthesia/Journal canadien d'anesthésie - A 17-year-old black female with pregnancy-induced hypertension (PIH) suffered cardiorespiratory arrest on arrival in the...     

Impact of geographic location on access to liver transplantation among ethnic minorities

BACKGROUND: Recent reports have documented ethnic disparity in access to health care. This disparity appears to exist in organ transplantation and the contributing factors include lack of insurance as well as poor socioeconomic status. The role of geographic location and ethnic composition on accessibility to liver transplantation (LT) is unclear. Therefore, the aim of this study was to determine ethnic transplantation trends based on United Network for Organ Sharing (UNOS) regions. METHODS: Using the UNOS database, we identified all adults (> or =18 years) that received LT between 2000 and 2005. We excluded multiorgan transplants and living donor transplantation. The data collected included ethnicity, transplantation rate, and UNOS region. Data were analyzed using the chi test. RESULTS: A total of 30,311 patients received a LT during the study period. Of these, 22,673 (74.8%) were white, 3621 (12%) were Hispanic, 2490 (8.2%) were African Americans, and the rest of other ethnic groups (5%). Liver transplantation based on ethnicity was region specific, with the lowest for African Americans in region 6 (2.7%), for Hispanics in region 11 (2.2%), and for whites in region 5 (57.6%), respectively. There was no consistent correlation between the ethnicity of the recipients and the ethnic composition of the geographic location (region). CONCLUSION: Significant variations in access to liver transplantation for ethnic minorities exist across geographic lines. Understanding the interaction between ethnic minorities with end-stage liver disease in a geographic location and a transplant center will be invaluable as a first step in identifying the key nonmedical factors that play a role in this disparity.     

Role of prostaglandins in pregnancy-induced hypertension

Enzymes involved in prostaglandin I2 (PGI2) and thromboxane A2 (TXA2) synthesis were studied in maternal and fetal platelets and venous endothelium from normotensive pregnant controls (n = 70), women with mild preeclampsia (MP, n = 45), and severe preeclampsia (SP, n = 34). Activities of phospholipase A2 (PHA2), cyclooxygenase (PGHS), and PGI2 synthetase (PGIS) or TXA2 synthetase (TXAS) were determined in platelets and in endothelial cells. The PGHS enzyme was studied further by immunoblot methodology. In maternal platelets: Vmax (per 10(-10) mol/mg protein) and Michaelis-Menten constant (Km) (10(-7) mol, mean +/- SEM) of PHA2 were 3.0 +/- 0.8, 3.0 +/- 0.7, and 31.7 +/- 10.9* maximum velocity (Vmax) and 1.8 +/- 0.3, 2.0 +/- 0.8, and 0.8 +/- 0.2 (Km) in normal control (NC), mild preeclampsia (MP), and severe preeclampsia (SP), respectively (*P less than 0.05 against NC). The apparent overall PGHS plus TXAS activity was 10.2 +/- 1.8, 23.8 +/- 7.1, and 68.8 +/- 18.8* (Vmax) and 3.2 +/- 1.3, 5.4 +/- 1.4, and 6.9 +/- 1.2* (Km, *P less than 0.05 against NC). TXA synthesis in fetal platelets demonstrated PHA2 activity of 6.4 +/- 1.4, 12.0 +/- 1.3, and 17.2 +/- 3.2* (Vmax) and 3.5 +/- 0.9, 2.2 +/- 1.5, and 0.7 +/- 0.3* (Km, *P less than 0.05 against NC), respectively, whereas an apparent overall PGHS plus TXAS activity was 18.5 +/- 2.8, 87.5 +/- 12.5*, and 3.6 +/- 0.1* (Vmax) and 4.8 +/- 1.0, 8.8 +/- 1.2, and 0.8 +/- 0.3* (Km, *P less than 0.05 against NC).(ABSTRACT TRUNCATED AT 250 WORDS)     

妊高征血管功能改变及其超声学检测的相关研究进展

妊娠高血压综合征是导致孕产妇和围产期妇女发病、死亡的主要原因之一。研究表明,胎盘滋养层细胞功能障碍及母体血管系统内皮功能障碍是妊高征始发的病理生理学中心环节。本文对高频超声检查对妊高征潜在的预测价值进行综述。     

Nifedipine attenuates the hypertensive response to tracheal intubation in pregnancy-induced hypertension

Thirty women with pregnancy-induced hypertension (PIH) scheduled for Caesarean section under general anaesthesia were studied to evaluate the efficacy of sublingual nifedipine in attenuating the pressor response to laryngoscopy and tracheal intubation. The patients were randomly given either the contents of a nifedipine capsule 10 mg or placebo sublingually 20 min before induction of anaesthesia. Blood pressure and heart rate were recorded at various time intervals. There was a decrease in mean arterial blood pressure (MAP) after pre-treatment with nifedipine (P < 0.01). The increase in MAP during laryngoscopy and intubation was higher in the control group compared with nifedipine pretreatment group (P < 0.01). During laryngoscopy and intubation, MAP decreased by 3 mmHg in the nifedipine pretreatment group, while there was an increase of 14 mmHg in the control group. Heart rate increased in both the groups during the laryngoscopy and tracheal intubation (P < 0.01) but the increase was higher in the nifedipine group than in the control group (P <0.05). Neonatal Apgar scores in both the groups were comparable. These results suggest that sublingual nifedipine is effective in attenuating the hypertensive response to laryngoscopy and intubation but not the tachycardiac response in parturients with PIH.     

Access to and coverage of renal replacement therapy in minorities and ethnic groups in Venezuela

Access to and coverage of renal replacement therapy in minorities and ethnic groups in Venezuela. Numerous studies have documented the presence of racial and minority disparities regarding the impact of renal disease and access to renal replacement therapy (RRT). This problem is less well documented in Latin America. Venezuela, like most countries in the region, is subject to severe constraints in the allocation of resources for high-cost chronic diseases, which limits the access of patients with chronic kidney disease to RRT. Although access to health care is universal, there is both a deficit in coverage and disparity in the access to RRT, largely as a result of socioeconomic limitations and budget constrains. With current rising trends of the incidence of end-stage renal disease (ESRD) and costs of medical technology, the long-term goal of complete RRT coverage will become increasingly out of reach. Current evidence suggests that prevention of progression of renal disease is possible at relatively low cost and broad coverage. Based on this evidence, the Ministry of Health has redesigned its policy with respect to renal disease based on 4 elements: 1. Prevention by means of early detection and referral to multidisciplinary health teams, as well as promotion of health habits in the community. 2. Prevention of progression of renal disease by pharmacologic and nonpharmacologic means. 3. An increase in the rate of coverage and reduction of disparities in the access to dialysis. 4. An increase in the rates of renal transplantation through better organ procurement programs and reinforcement of transplant centers. However, the projected increase in the number of patients with ESKD receiving RRT will represent a serious burden to the health care system. Therefore, implementation of these policies will require the involvement of international agencies as well as an adequate partnership between nephrologists and health care planners, so that meeting the increasing demands of ESKD programs may be balanced with other priorities of our national health system.