围绝经期骨质疏松患者心理状况分析及护理干预策略研究

目的 考察围绝经期骨质疏松患者的心理弹性、焦虑和抑郁情绪,并给予相应的护理干预策略。方法 选取2021年1～12月徐州医科大学附属医院收治的101例围绝经期骨质疏松患者作为研究对象。评估患者的焦虑、抑郁情绪和心理弹性,通过多因素Logistic回归分析法评估围绝经期骨质疏松患者焦虑、抑郁情绪的影响因素,通过Spearman相关性分析法评估患者焦虑自评量表(SAS)和抑郁自评量表(SDS)与患者生活质量和心理弹性的相关性。结果 101例围绝经期骨质疏松患者的SAS评分为(55.14±5.94)分,SDS评分为(52.93±5.80)分。单因素分析结果显示,婚姻状况、病程和家庭人均月收入均与围绝经期骨质疏松患者的焦虑、抑郁情绪有关(P均<0.05)。多因素Logistic分析结果显示,离异或丧偶、病程≥1年和家庭人均月收入<5 000元均是围绝经期骨质疏松患者焦虑、抑郁情绪的影响因素(P均<0.05)。Spearman相关性分析结果显示,围绝经期骨质疏松患者的心理弹性量表(CD-RISC)总分与SDS评分呈负相关(r=-6.142,P=0.005),与SAS评分呈负相关(...     

健康教育干预对围绝经期骨质疏松症的临床观察

目的探讨健康教育对围绝经期骨质疏松症干预的作用。方法选取72例经确诊的围绝经期骨质疏松症患者按入院顺序随机分为两组,观察组36例,对照组36例;观察组予以为期6个月的健康教育干预并定期门诊复查,干预内容主要包括围绝经期骨质疏松疾病认知及防治保健知识,对照组实施普通护理。评价治疗前后两组生活方式的变化并收集治疗前后两组的骨密度值。结果观察组健康教育干预后建立合理饮食习惯、合理运动的人数多于对照组(P0.05);两组养成正确用药习惯的人数无明显差异(P0.05);观察组与对照组治疗前后骨密度值均有改善,差异有统计学意义(P0.05);组间对比,观察组治疗后骨密度值改善优于对照组(P0.05)。结论健康教育干预能全方位地干预和管理围绝经期骨质疏松患者,提高患者认知行为,使患者积极配合、参与围绝经期骨质疏松症的防治过程,增加临床疗效。     

护理干预对围绝经期妇女亚健康状态的影响

目的探讨护理干预对围绝经期妇女亚健康状态的影响,以积极预防该人群亚健康相关疾病的发生。方法采用方便抽样法选取45～55岁围绝经期妇女70例为研究对象,构建个人、家庭、单位/社区共同参与式保健模式,采取群体干预及个体指导相结合的教育方式,实施有氧运动、饮水及饮食调节等措施。干预前后分别对研究对象进行亚健康指标测试。结果干预后3个月与干预前亚健康相关指标参数比较,被测人群的体质量、脂肪、体质指数、肥胖度、腰臀比明显降低(P<0.01);肌肉含量、蛋白总量、骨总量、体内细胞质量、细胞内液、细胞外液、水分总量以及基础代谢率明显升高(P<0.01)。结论该干预措施能有效改善围绝经期妇女亚健康状态;减少体质量及体脂量,改善腹部脂肪堆积;增强肌力,增加骨量,改善体内水分含量,促进机体新陈代谢,降低围绝经期妇女罹患骨质疏松症及心血管等疾病的风险。     

综合护理干预对围绝经期妇女效果研究

目的:探讨护理干预对改善围绝经期妇女健康的效果,以帮助她们顺利度过这一特殊的时期。方法:通过采用电话随访、健康教育讲座、宣传栏、门诊随访及健康知识小册子等形式,对130例围绝经期妇女实施健康教育、饮食运动指导、心理干预及用药指导等综合护理干预。6个月后应用WHO生存质量测定量表、症状自评量表等评估干预效果。结果:6个月后,130例围绝经期妇女主要临床症状改善,心理状态改善,生活质量明显提高,与干预前相比有统计学意义(P<0.05)。结论:对围绝经期妇女实施综合护理干预后,其心理状态明显改善,症状显著减轻,生活质量得到提高。     

老年骨质疏松性髋部骨折患者术后互联网+技术联络服务模式的应用研究

目的探讨互联网+技术联络服务模式对老年骨质疏松性髋部骨折患者术后延续护理的效果。方法选取苏州大学附属第一医院骨科2018年7月至2019年12月收治的老年骨质疏松性髋部骨折患者92例, 采用随机数字表法分为干预组和对照组各46例, 出院后对照组给予常规院外随访, 干预组由骨科专科护士基于互联网+技术居家骨科护理平台为主导实施延续管理。所有患者随访至术后6个月, 比较2组患者术后1、3、6个月的髋关节功能(Harris)评分、疼痛数字评分量表(NRS)、Barthel指数、生命质量评分(SF-36)的差异。结果干预组患者术后1、3、6个月的Harris评分分别为(49.74 ± 4.28)、(76.59 ± 4.33)、(90.78 ± 2.61)分, 对照组患者分别为(46.17 ± 3.85)、(74.26 ± 4.24)、(88.65 ± 2.17)分, 2组比较差异有统计学意义(t=-4.20、-2.60、-4.26, 均P<0.05);干预组患者术后1、3、6个月的NRS评分分别为(1.33 ± 0.47)、(0.83 ± 0.38)、(0.76 ± 0.43)分, 对照...     

积极心理暗示联合协同护理对围绝经期睡眠障碍患者睡眠质量及心理状态的影响

目的：探讨积极心理暗示联合协同护理对围绝经期睡眠障碍患者睡眠质量及心理状态的影响。方法：选取2017年3月至2019年3月厦门大学附属第一医院杏林分院收治的围绝经期睡眠障碍患者74例作为研究对象,按照随机数字表法分为对照组和观察组,每组37例。对照组患者给予常规护理干预,观察组患者予以积极心理暗示联合协同护理,2组均持续护理3个月。比较2组患者护理前、护理3个月后的睡眠质量、心理状态变化,并分析2组护理期间依从性。结果：观察组的总依从率为94.59%(35/37),高于对照组的70.27%(26/37),差异有统计学意义(P<0.05),护理前,比较2组匹兹堡睡眠质量指数(PSQI)量表中各维度评分及总分、抑郁自评量表(SDS)、焦虑自评量表(SAS),差异无统计学意义(P>0.05);护理后,观察组的睡眠时间评分(0.98±0.54)分、睡眠障碍评分(0.82±0.37)分、睡眠质量评分(0.95±0.31)分、入睡时间评分(0.67±0.36)分、催眠药物评分(0.89±0.18)分、睡眠效率评分(0.88±0.34)分、日间功能障碍评分(0.73±0.22)分、总评分...     

河南省城乡围绝经期妇女亚健康状态调查及健康教育对策1）

[目的]探索河南省城乡围绝经期妇女亚健康状态,分析影响因素,为提出健康促进干预模式提供理论依据。[方法]采用统一的围绝经期妇女亚健康状态及影响因素调查问卷,对河南省城市、农村地区各140名围绝经期妇女进行问卷调查。[结果]心理总体自我评价、生理总体自我评价、总体健康水平评价在城乡围绝经期妇女间的差别有统计学意义(t=2.799,2.293,4.221,P=0.005,0.023,0.001)；不同因素对城市围绝经期妇女亚健康状态影响单因素分析显示：文化程度(H=24.244,P=0.019),平时心情(H=41.305,P <0.001),是否为家庭、子女担心(H=15.858,P <0.001),婚姻生活状况(H=19.181,P=0.024),是否绝经(H=8.125,P=0.043),是否痛经(H=12.654,P=0.005)；农村围绝经期妇女亚健康状态的影响因素为每周参加活动次数、是否痛经。不同因素对农村围绝经期妇女亚健康状态影响单因素分析显示：每周参加活动次数(H=25.242,P=0.047),平时心情(H=28.929,P<0.001),是否痛经(H=9.113,P=0.028)。[结论]通过影响因素的分析提出健康促进干预模式,为预防和减少围绝经期妇女亚健康状态的发生,提高其生活质量提供了理论依据。     

耳穴压豆结合心理护理缓解围绝经期综合征效果观察

目的:探讨耳穴压豆结合心理护理缓解围绝经期综合征的临床疗效.方法:将206例围绝经期综合征患者随机分为实验组108例与对照组98例.对照组应用耳穴压豆法治疗,实验组采用耳穴压豆与心理护理结合的方法治疗.观察两组临床疗效及治疗3、6个月后的SCL～90评分变化.结果:实验组临床治疗总有效率为90.74%,对照组为73.47%.两组比较有极显著性差异(P<0.01).治疗3个月后,实验组SCL～90评分为(22.13±5.84)分,对照组为(41.83±5.26)分,两组比较有显著性差异(P<0.05).治疗6个月后,实验组SCL～90评分为(15.75±3.81)分,对照组为(40.76±6.35)分,两组比较有极显著性差异(P<0.01).结论:与单纯进行耳穴压豆治疗相比,耳穴压豆结合心理护理治疗围绝经期综合征可缓解或减轻患者不良心理状态,有利于临床治疗顺利进行.     

社区综合护理干预对围绝经期妇女心理状态和生活质量的影响

目的探讨社区综合护理干预对围绝经期妇女心理状态和生活质量的影响。方法采用上门访视、电话随访、门诊随访、健康教育讲座、宣传栏、健康知识小册子等多种形式,对60名社区围绝经期妇女实施心理干预、健康教育、饮食运动指导、用药指导等综合干预措施。采用症状自评量表、WHO生存质量测定表、自制围绝经期妇女临床症状调查表评估干预效果。结果实施社区综合护理干预后6个月,社区围绝经期妇女心理状态改善,主要临床症状减轻,生活质量提高,与干预前比较差异具有统计学意义（P〈0．05）。结论社区综合护理干预明显改善社区围绝经期妇女的心理状态,生活质量明显提高。     

以患者为中心的系统化健康教育在围绝经期及绝经后骨质疏松症患者中的运用

目的:探讨以患者为中心的系统化健康教育对围绝经期及绝经后骨质疏松症(osteoporosis,OP)患者骨质疏松知识、自我效能及骨密度的影响。方法:将156名围绝经期及绝经后OP患者按照计算机产生的随机数字分为观察组和对照组,对照组实施常规的健康教育,观察组以患者为中心的系统化健康教育方案,收集并比较两组在干预前及干预6个月后的骨质疏松知识(osteoporosis knowledge tests,OKT)、骨质疏松自我效能(osteoporosis self-efficac y scale,OSES)及骨密度的变化情况。结果:干预后两组在骨质疏松知识总分及各维度得分、骨质疏松自我效能总分及各维度得分、L1~L4及左股骨的骨密度均较干预前明显提升,且观察组在上述各项目的数值均明显高于对照组,差异具有统计学意义(P0.05)。结论:实施以患者为中心的系统化健康教育可明显提升围绝经期及绝经后OP患者对疾病的认识水平、应对疾病的自我效能以及骨密度水平,对于预防骨折及改善生命质量具有积极的促进意义。     

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.