综合护理干预在提高尿结石患者疾病认知及降低碎石术后复发率中的作用

目的探讨综合护理干预在提高尿结石患者疾病认知及降低碎石术后复发率中的作用。方法将2015年7月—2017年7月我院收治的83例尿结石患者,按就诊顺序分为研究组(42例)和参照组(41例)。参照组给予常规护理干预,研究组在常规护理的基础上给予综合护理干预。比较两组干预前后疾病认知和遵医行为评分、术后复发率、1次成功碎石率和护理满意度。结果干预后,两组疾病认知和遵医行为评分均有所升高,且研究组的升高幅度大于参照组(P0.05)。两组术后3个月和术后6个月的复发率、1次成功碎石率比较无明显差异(P0.05);研究组术后12个月复发率明显低于参照组,护理满意度明显高于参照组(P0.05)。结论将综合护理干预应用于尿结石患者可以提高其疾病认知和护理满意度,降低碎石术后复发率。     

认知行为干预联合系统护理对原发性闭角型青光眼患者术后遵医行为及生活质量的影响

目的:探讨认知行为干预联合系统护理对原发性闭角型青光眼患者术后遵医行为及生活质量的影响。方法:选取2013年6月~2017年6月于我院行小梁切除术治疗的原发性闭角型青光眼患者82例,建档顺序分组,各41例。对照组展开常规护理,观察组于常规护理基础上展开认知行为干预联合系统护理,比较两组干预后遵医行为率及干预前后生活质量评分(SF-36)。结果:干预后观察组遵医行为率92.68%(38/41)高于对照组70.73%(29/41),差异有统计学意义(P0.05);干预前两组SF-36评分对比,差异无统计学意义(P0.05),干预后观察组SF-36评分较对照组提高,差异有统计学意义(P0.05)。结论:对行小梁切除术治疗的原发性闭角型青光眼患者予以认知行为干预联合系统护理可明显改善患者术后遵医行为,提高其生活质量。     

延续性护理对社区精神分裂症患者遵医行为及生活质量的影响

目的探讨延续性护理对社区精神分裂症患者遵医行为及生活质量的影响。方法 80例精神分裂症患者随机分为观察组和对照组,各40例。对照组出院时给予出院指导,观察组在对照组的基础上进行延续性护理,比较2组的遵医行为、生活质量和随访期间复发情况。结果干预12周后,观察组在饮食、情绪管理、适量运动、用药依从性、定期复诊方面的遵医行为评分高于对照组,差异有统计学意义(P<0.01);观察组心理因子、社会关系因子、环境因子评分及总分较干预前均获改善,差异有统计学意义(P<0.01),对照组除心理因子评分升高外,其余评分均无改善,观察组生活质量各因子评分及总分均优于对照组,差异有统计学意义(P<0.01)。观察组随访期间复发率低于对照组,差异有统计学意义(P<0.05)。结论延续性护理有利于提高社区精神分裂症患者出院后的遵医行为,改善生活质量,降低复发率。     

集中护理干预对输尿管软镜钬激光碎石术患者健康知识及术后复发的影响

目的探讨集中护理干预对输尿管软镜钬激光碎石术患者健康知识及术后复发的影响。方法选取92例输尿管软镜钬激光碎石术患者为研究对象,采用随机数字法均分为观察组与对照组。对照组给予常规护理措施,观察组给予集中护理干预,比较2组患者入院时及入院1个月后的健康知识认知水平、满意度及术后复发率。结果入院时,2组患者健康知识认知水平差异无统计学意义(P0.05);入院1个月后,2组患者健康知识认知水平均显著升高,且观察组患者认知水平优于对照组,差异有统计学意义(P0.05);观察组满意度为97.83%(45/46),显著高于对照组的78.26%(36/46),差异有统计学意义(P0.05);观察组复发率为4.35%(2/46),显著低于对照组的23.91%(11/46),差异有统计学意义(P0.05)。结论集中护理干预能够提高患者健康知识认知水平,降低复发率,值得推广应用。     

针对性护理干预对慢性乙型肝炎遵医行为及生活质量的影响

目的:观察针对性护理干预对慢性乙型肝炎(CHB)患者遵医行为及生活质量(WHOQOL-100)的影响。方法:选取我院CHB患者116例,随机数字表法分为研究组和对照组,每组58例。两组均给予对症药物治疗,对照组采用常规护理干预,研究组采用针对性护理干预。观察两组治疗过程中遵医行为及护理后WHOQOL-100评分变化情况。结果:研究组遵医率96.55%(56/58)高于对照组81.03%(47/58),差异有统计学意义(P0.05);护理后研究组WHOQOL-100评分(88.63±7.49)分高于对照组(79.35±8.52)分,差异有统计学意义(P0.05)。结论:针对性护理干预可显著提高CHB患者遵医率,改善患者生活质量。     

延续性护理对溃疡性结肠炎患者生活质量、遵医行为及营养状态的影响分析

目的探讨延续性护理对溃疡性结肠炎(UC)患者生活质量、遵医行为及营养状态的影响。方法选取2012年1月~2016年12月我院收治的220例UC患者。随机分为观察组和对照组各110例。对照组患者实施出院指导后常规定期随访,观察组在对照组基础上予以延续性护理干预。比较两组患者出院前及出院3个月后IBDQ、PG-SGA评分情况,对比两组出院3个月内遵医依从性、UC复发情况。结果出院3个月后,观察组IBDQ各项评分均较出院前有显著提升,且明显高于对照组,差异有统计学意义(P0.05);两组患者PG-SGA评级良好率均较治疗前有显著提升,且观察组明显高于对照组,差异有统计学意义(P0.05);观察组患者遵医依从率明显高于对照组,而UC复发率则明显低于对照组,差异有统计学意义(P0.05)。结论延续性护理能有效改善UC患者院外生活质量、遵医行为及营养状态,对肠道复旧有利。     

早期护理干预对热性惊厥复发患儿遵医依从性的影响

目的 探讨早期护理干预对热性惊厥复发患儿遵医依从性的影响,寻求增强遵医依从性的途径,减轻患儿的痛苦,降低复发率,提高生活质量.方法 随机对94例热性惊厥复发患儿及家长进行分组,观察组44例,对照组50例.两组同样治疗,观察组给予早期护理干预,引用遵医依从性划分标准进行调查,观察干预前后两组患儿遵医依从性的效果.结果 两组患儿干预前无差异.观察组患儿经干预后.遵医依从性差异有统计学意义(P<0.05).结论 经过早期护理干预,可以提高热性惊厥复发患儿遵医依从性,降低复发率,提高患儿生活质量.     

延续性护理干预对腹膜透析患者护理效果及营养状况的研究

目的分析延续性护理干预在腹膜透析患者中的护理效果及营养状况的影响。方法选取2015年1月~2016年12月100例持续性腹膜透析患者作为研究对象,按照数字表法随机分为观察组与对照组,各50例。对照组采取常规护理措施;观察组在对照组的基础上加入延续护理。评估两组患者护理干预前后的生活质量评分、疾病认知评分、遵医行为评分变化以及营养状况(总蛋白、白蛋白、前白蛋白及血红蛋白),并调查患者对护理服务的满意度。结果两组患者护理干预前后生活质量评分、疾病认知评分、遵医行为评分以及各营养指标比较差异有统计学意义(P0.05),但观察组改善幅度显著优于对照组(P0.05);观察组与对照组的护理满意率为90.0%和80.0%,两组间的比较差异有统计学意义(P0.05)。结论延续护理在腹膜透析患者中具有较好的应用效果,能够有效提高患者对疾病的认知,同时提高遵医行为,有助于改善预后情况和营养状况、提升生活质量,值得临床推广使用。     

构建卒中健康管理新模式的干预效果研究

目的构建卒中健康管理新模式,并探讨其对提高脑卒中患者出院居家遵医率及降低再次卒中发生率的作用。方法随机抽取2017年10月—12月3个月卒中高危住院患者130例作为对照组,进行回顾性分析;选取2018年1月—3月本区住院卒中患者130例作为观察组,在以往整体护理的基础上给予卒中健康管理新模式,主要包括成立卒中健康管理小组、建立电子化信息档案、动态随访和个体化干预、微信平台健康宣教和卒中讲堂健康教育。比较两组干预6个月后的平均遵医率及再次卒中的发生率。结果观察组遵医较好的共123例,平均遵医率为94.62%,而对照组遵医较好的72例,平均遵医率为70.77%,观察组明显低于对照组,差异有统计学意义(P 0.05);观察组卒中复发住院1例,复发率为0.77%,对照组复发6例,复发率为4.62%,观察组低于对照组,差异有统计学意义(P 0.05)。结论构建卒中健康管理新模式可明显提高患者出院居家遵医率,降低再次卒中的发生率,值得借鉴推广。     

延续护理干预对腰椎间盘突出症患者遵医行为的影响

目的：探讨延续护理干预对腰椎间盘突出症患者遵医行为的影响。方法将108例腰椎间盘突出症患者按入院时间顺序随机分为观察组和对照组各54例。对照组在出院时给予常规出院指导及健康教育,观察组在此基础上给予为期12个月的延续护理干预。比较两组患者干预前后的遵医行为及干预后12个月内的疾病复发率。结果观察组患者的遵医行为明显高于对照组,差异有统计学意义（P＜0．01）;观察组的复发率为12％,显著低于对照组的32％,差异有统计学意义（P＜0．05）。结论延续护理干预能够提高腰椎间盘突出症患者的遵医行为,降低疾病的复发率。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.