希望理论干预对晚期肝癌患者焦虑和抑郁心理的影响

目的探讨希望理论干预对晚期肝癌患者焦虑和抑郁心理的影响。方法以2013-01—2014-09自贡市第四人民医院肝胆外科住院的180例晚期肝癌患者为研究对象,随机分为观察组(n=90)和对照组(n=90),对照组采用常规护理,观察组实施常规护理加希望理论干预护理,比较两组患者焦虑自评量表(SAS)、抑郁自评量表(SDS)、焦虑和抑郁发生率。结果观察组和对照组干预前SAS和SDS评分差异无统计学意义(P0.05),干预后SAS和SDS差异有统计学意义(P0.05)。观察组干预后SAS和SDS评分显著低于干预前(P0.05),对照组干预后SAS评分和SDS与干预前比较,差异无统计学意义(P0.05)。干预前观察组和对照组焦虑和抑郁发生率差异均无统计学意义(P0.05);干预后观察组焦虑和抑郁发生率显著低于对照组(P0.05)。结论希望理论干预护理可有效缓解晚期肝癌患者焦虑和抑郁心理。     

认知行为干预对慢性乙型病毒性肝炎患者心理焦虑及睡眠障碍的影响

目的:探讨认知行为干预对慢性乙型病毒性肝炎患者心理焦虑及睡觉障碍的影响。方法:将80例慢性乙型病毒性肝炎患者随机分为研究组和对照组各40例,对照组给予健康心理教育和常规基础治疗及护理,研究组在此基础上给予认知行为干预;比较两组心理焦虑情况、睡眠及依从性。结果:干预后研究组抑郁自评量表(SDS)和焦虑自评量表(SAS)评分低于干预前(P0.05),且研究组均低于对照组(P0.05);研究组出现睡眠障碍情况明显低于对照组,且用药依从性明显高于对照组(P0.05)。结论:对慢性乙型病毒性肝炎患者实施认知行为干预,能够明显减轻患者的心理焦虑情况,克服患者的睡眠障碍,提高睡眠质量,缓解患者因心情焦虑、睡眠状况不佳导致的身体机能下降。     

护理干预对慢性肾功能衰竭患者焦虑抑郁情绪的影响

目的 评价综合护理干预对慢性肾功能衰竭患者焦虑抑郁情绪的影响.方法 将80例慢性肾功能衰竭患者,随机分为对照组和观察组.对照组采用常规护理,观察组采用综合护理干预.结果 观察组患者的依从性优于对照组,差异有显著意义(P＜0.05).治疗后,两组SAS和SDS评分均明显改善,差异有显著意义(P＜0.01)；治疗后,观察组SAS和SDS评分均少于对照组,差异有显著意义(P＜0.01).结论 综合护理干预可以明显改善慢性肾功能衰竭患者的焦虑抑郁心理,而且患者主观评价高,依从性好.     

一对一心理疏导及健康教育对老年功能性消化不良焦虑抑郁症状的效果

目的探讨一对一心理疏导及健康教育对老年功能性消化不良焦虑抑郁症状的影响。方法选取住院100例老年功能性消化不良伴焦虑抑郁患者为研究对象,将患者分为观察组和对照组,各50例,2组患者在常规治疗的基础上实施不同护理措施,对照组给予常规消化内科护理,观察组给予一对一心理疏导及健康教育,观察比较2组干预前后服药依从性、消化系统症状评分、SAS与SDS评分,及生活质量评分。结果观察组护理干预后服药总依从率为96.00%,对照组为80.00%,差异具有统计学意义(P0.05);干预后观察组SAS、SDS及生活质量评分均显著优于对照组,差异具有统计学意义(P0.05)。结论一对一心理疏导及健康教育有利于减轻老年功能性消化不良伴焦虑抑郁症状,提高患者的服药依从性,改善患者的生活质量。     

早期心理支持护理在高血压性脑溢血患者中的应用及对其负性情绪的影响分析

目的探讨早期心理支持护理在高血压性脑溢血患者中的应用及对患者负性情绪的影响。方法选取2016年1月～2018年1月期间本院收治的高血压性脑溢血68例,根据随机数字表法随机分为观察组和对照组各34例。对照组患者给予生命体征检测、健康教育、饮食指导、用药指导等常规护理干预。观察组患者在对照组基础上给予早期心理支持护理。比较两组护理干预前后焦虑自评量表(SAS)、抑郁自评量表(SDS)评分,护理干预后两组患者依从性优良率及护理满意度。结果干预后,观察组SAS评分、SDS评分均低于对照组,差异均有统计学意义(P0.05);干预后,观察组血压监测、按时服药、合理饮食、适当运动依从性优良率均高于对照组,差异均有统计学意义(P0.05);观察组护理满意度为94.12%,高于对照组的73.53%,差异有统计学意义(P0.05)。结论高血压性脑溢血患者应用早期心理支持护理,能有效缓解患者焦虑、抑郁等负性情绪,提高依从性及护理满意度。     

聚焦解决模式在肝癌患者术前心理干预中的应用效果

目的探讨聚焦解决模式在肝癌患者术前心理干预中的应用效果。方法将2017年1~11月90例行肝癌切除术患者随机分为对照组和观察组,每组各45例,对照组采用常规心理护理,观察组在对照组的基础上采用聚焦解决模式进行心理干预,采用焦虑自评量表(SAS)、抑郁自评量表(SDS),分别于入院当日即术前1d对患者的心理状况进行调查,比较2组患者SAS、SDS评分。结果干预前2组患者的SAS、SDS评分比较差异无统计学意义(P0.05);实施聚焦解决模式心理干预后观察组的SAS、SDS评分明显低于对照组,差异有统计学意义(P0.05)。结论采用聚焦解决模式在肝癌患者中进行心理干预,可明显缓解患者术前的焦虑、抑郁情绪,提高患者治疗依从性。     

认知行为干预对急诊消化道出血病人心理及依从性的影响

[目的]探讨认知行为干预对急诊消化道出血病人心理及依从性的影响。[方法]收集我院2016年1月—2017年6月收治的150例急诊消化道出血病人,将病人排序后按照双盲法抽签,将150例病人分为观察组和对照组各75例,病人均常规护理干预,观察组在常规护理基础上给予认知行为干预,采用自行设计的评价标准评价依从性,采用Myin-Germeys情绪问卷评价病人干预前后负面情绪及采用焦虑自评量表(SAS)和抑郁情绪自评量表(SDS)对病人干预前后焦虑、抑郁情绪进行评价。[结果]干预前观察组依从率为49.3%,对照组为46.7%,组间比较差异无统计学意义(P0.05);干预后观察组依从率为97.3%,高于对照组的62.7%(P0.05);干预前负面情绪评分组间比较差异无统计学(P0.05),干预后两组评分均降低,干预后观察组评分低于对照组(P0.05);干预前SAS和SDS比较差异无统计学意义(P0.05),干预后观察组SAS和SDS评分低于对照组(P0.05)。[结论]认知行为干预可以明显提高病人依从性,改善病人的负面情绪,纠正焦虑、抑郁等不良心理反应。     

治疗性沟通系统护理在急性脑卒中患者中的应用

目的:研究治疗性沟通系统对急性脑卒中患者焦虑抑郁情绪和治疗依从性的干预效果。方法:选取急性脑卒中患者150例,按照随机数字表法分为观察组和对照组各75例,对照组给予常规护理,观察组在此基础上给予治疗性沟通系统护理,应用焦虑自评量表(SAS)评价患者的焦虑情况,应用抑郁自评量表(SDS)评价患者抑郁情况,并比较两组治疗依从性。结果:治疗前两组SAS评分和SDS评分比较无统计学意义(P0.05),治疗后两组SAS评分和SDS评分均显著降低,且观察组低于对照组,比较差异具有统计学意义(P0.05);观察组治疗依从性高于对照组(P0.05)。结论:治疗性沟通系统应用于急性脑卒中护理效果显著,能显著改善患者焦虑和抑郁情况,提高治疗依从性。     

特定护理干预对39例妊娠期高血压疾病患者母婴结局的影响

目的:研究以心理干预为主的特定护理干预对妊娠期高血压(PIH)疾病患者母婴结局的影响。方法:选取2015年5月至2017年6月我院78例PIH患者作为研究对象,按入院顺序分组,各39例。对照组实施常规护理,观察组在此基础上实施以心理干预为主的特定护理干预,对比两组母婴结局、护理前后焦虑抑郁(SAS、SDS)评分。结果:观察组不良妊娠结局发生率为10.26%,低于对照组38.46%,差异有统计学意义(P0.05);两组护理前SAS、SDS评分比较无明显差异(P0.05);观察组护理后SAS、SDS评分低于对照组,差异有统计学意义(P0.05)。结论:PIH疾病患者接受以心理干预为主的特定护理干预,可改善母婴结局,缓解患者负性情绪。     

对应用IABP治疗急性心肌梗死患者的心理评估及护理干预研究

目的评估应用IABP治疗的急性心肌梗死患者的心理状态,探讨心理干预的效果。方法选取2018年1月—12月本院收治的AMI并行IABP治疗的60例患者为研究对象。按照随机数字表法将其分为观察组与对照组,每组各30例。对照组采用常规护理,观察组在常规护理的基础上给予有针对性的心理护理。应用焦虑自评量表(SAS)及抑郁自评量表(SDS)评估两组患者的情绪状态,比较两组患者的并发症发生率、住院时间及护理满意度。结果实施有针对性的心理评估及护理干预后,观察组并发症发生率(3.33%)明显少于对照组(20.00%)(P0.05);置管当天两组患者SAS、SDS评分比较,差异无统计学意义(P0.05),干预1周后及拔管时观察组的SAS、SDS评分均低于对照组,差异有统计学意义(P0.001);观察组平均住院时间明显短于对照组,护理满意度明显高于对照组,差异有统计学意义(P0.05)。结论有效的心理评估及护理干预,可改善患者的心理状况,提高患者的依从性;同时能减少并降低患者置机并发症的发生率,缩短患者住院时间,提升护理满意度。     

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.