急诊科护士睡眠质量和心理健康状况的调查及分析

目的:调查分析急诊科护士的睡眠质量和心理健康状况.方法:采用匹兹堡睡眠质量指数量表(PSQI)和症状自评量表(SCL-90),对本市两所三级甲等医院68名急诊科护士和70名普通内科护士的睡眠质量和心理健康状况进行调查.结果:急诊科护士匹兹堡睡眠质量指数量表总分和各因子得分均高于普通内科护士,差异有显著性(P＜0.05,P＜0.01).症状自评量表中除敌对、偏执因子外,其余因子分及总分均高于普通内科护士,有显著性差异(P＜0.01).急诊科护士除睡眠时间这个成分外,其余匹兹堡睡眠质量指数量表各成分与症状自评量表各因子及总分间呈正相关关系.结论:急诊科护士睡眠质量和心理健康水平值得关注,需采取多种措施改善急诊科护士的睡眠质量和提高其心理健康水平,以保证护理安全和质量.     

抗击新型冠状病毒肺炎一线临床护士睡眠质量与情绪状态、工作疲溃感的相关性

[目的]了解抗击新型冠状病毒肺炎一线护士睡眠质量的现状,探讨情绪状态、工作疲溃感与睡眠质量的相关性。[方法]应用匹兹堡睡眠质量指数量表、症状自评量表和工作疲溃感量表对292名抗击新型冠状病毒肺炎临床一线护士进行问卷调查。[结果]抗击新型冠状病毒肺炎一线护士睡眠质量指数量表总分为(7.57±3.74)分,睡眠质量指数量表、症状自评量表和工作疲溃感量表评分与常模比较差异均有统计学意义(P0.05)。症状自评量表、情绪疲惫感和工作无成就感得分与睡眠质量量表总分、睡眠质量、入睡时间、睡眠时间、睡眠障碍、睡眠药物和日间功能障碍均相关(P0.05);工作冷漠感与睡眠质量量表总分、睡眠质量、睡眠障碍和日间功能障碍呈正相关(P0.05)。[结论]抗击新型冠状病毒肺炎一线护士睡眠质量处于中等水平,情绪状态、工作疲溃感与睡眠质量有关,管理者需建立睡眠管理策略,通过科学人力资源管理,建立独立休息区,强化睡眠改善措施,加强人文关怀等策略来帮助改善一线护士的睡眠质量,保障护理安全和护理质量。     

心外科ICU护士职业紧张及睡眠质量的现状研究

[目的]分析心外科重症监护室(ICU)护士职业紧张及睡眠质量现状,探究职业紧张与睡眠质量的相关性。[方法]将心外科ICU 102名护士纳入研究范围,采用职业紧张指数修订版(QSTR)量表、匹兹堡睡眠质量指数(PQSI)量表对护士进行调查分析,并利用Pearson双变量分析方式分析其相关性。[结果]心外科ICU护士职业任务量表得分为(165.23±23.14)分,个体紧张反应量表得分为(113.23±22.34)分,个体应对资源调查量表为(117.34±23.12)分,与国内常模比较差异有统计学意义(P0.05),心外科ICU护士睡眠质量总分为(6.78±3.21)分,与国内常模比较差异有统计学意义(P0.05),采用PQSI量表分析显示,职业任务与睡眠质量指数、日间功能障碍呈正相关,与睡眠效率呈负相关;个体紧张与日间功能障碍呈正相关,与睡眠时间呈负相关;个体应对资源与睡眠效率、睡眠质量指数呈正相关;与睡眠质量、睡眠时间、入睡时间呈负相关(P0.05)。[结论]职业紧张和睡眠质量问题是心外科ICU护士普遍存在的问题,职业紧张与睡眠质量相关性明显,睡眠质量可通过缓解职业紧张改善。     

睡眠剥夺对夜班护士睡眠质量、情绪状态及自我效能感的影响

目的调查睡眠剥夺对夜班护士睡眠质量、情绪状态及自我效能感的影响。方法存在睡眠剥夺夜班护士14例和无睡眠剥夺非夜班护士12例,分别作为睡眠剥夺组(SDG)和非睡眠剥夺组(NSDG)。采用睡眠日记和匹兹堡睡眠质量指数(PSQI)评定睡眠时间和睡眠质量;用简明心境量表(POMS)评估情绪状态;一般自我效能感量表(GSES)测评自我效能感。结果 SDG护士睡眠时间、PSQI评分低于NSDG护士,SDG护士睡眠障碍率高于NSDG护士,睡眠时间和PSQI评分组间差异均具有统计学意义(P0.05);SDG护士消极情绪分量表评分增加,积极性情绪分量表评分减少,其中愤怒-敌视、疲劳-迟钝、慌乱-迷茫、精力-活力4个分量表评分以及情绪紊乱总分(TMD)组间比较差异具有统计学意义(P0.05);SDG与NSDG护士GSES总分分别为(1.71±1.05)分和(2.67±1.13)分,组间比较差异具有统计学意义(P0.05)。结论相对于非睡眠剥夺组护士,睡眠剥夺组护士出现明显的睡眠质量下降、情绪状态恶化和一般自我效能感减弱。     

护士睡眠质量和情绪状态的相关性研究

[目的]探讨新疆生产建设兵团某三级甲等医院临床护士的睡眠质量与情绪状态的关系,为促进护士个体和医院管理者重视并加强护士睡眠质量和情绪状态管理提供依据。[方法]选取新疆生产建设兵团某三级甲等医院的临床护士496人,采用自制的一般情况调查表、匹兹堡睡眠质量指数量表(PSQI)和简明心境量表(POMS)调查其社会人口学特征、睡眠质量和情绪状态,分析护士睡眠质量和情绪状态的相关性。[结果]52.3%的护士存在不同程度的睡眠问题,有睡眠问题护士的POMS总分及各因子评分均高于无睡眠问题护士(P0.01);护士PSQI评分与POMS总分和消极情绪状态呈正相关,与积极情绪状态呈负相关(P0.05)。[结论]有睡眠问题的护士检出率较高,睡眠质量与情绪状态密切相关,有睡眠问题的护士情绪状态较无睡眠问题护士差,消极情绪影响睡眠质量,积极情绪有利于提高睡眠质量,需重视护士睡眠质量和情绪状态的健康管理,积极采取有效干预措施,改善护士较差的睡眠质量和情绪状态。     

理查兹-坎贝尔睡眠量表护患一致性评价研究

目的验证患者及护士分别使用理查兹-坎贝尔睡眠量表测评睡眠质量的一致性。方法对186例ICU患者采用理查兹-坎贝尔睡眠量表分别由护士对患者和患者对自身进行睡眠质量的评价,采用Bland-Altman plot图法比较一致性。结果 186例患者睡眠质量总体评价,护士评分为(58.2±19.6),患者自评为(56.6±22.8),t=-0.756,P=0.316,各维度均无统计学意义(P0.05)。结论理查兹-坎贝尔睡眠量表评估护患一致性较高,可由护士代替患者进行评分。     

睡眠剥夺对夜班护士睡眠质量、情绪状态及护理差错的影响

目的 探讨睡眠剥夺对夜班护士睡眠质量、情绪状态及护理差错的影响.方法 选取存在睡眠剥夺夜班护士14例和无睡眠剥夺非夜班护士12例,分别作为睡眠剥夺组(SDG)和非睡眠剥夺组(NSDG).采用睡眠日记和匹兹堡睡眠质量指数 (PSQI) 评定睡眠时间和睡眠质量;用简明心境量表(POMS)评估情绪状态;回忆、查找和记录护理差错的发生例数.结果 SDG护士睡眠时间、PSQI评分低于NSDG护士,睡眠障碍率高于NSDG护士,睡眠时间和PSQI评分组间差异均具有统计学意义(均P<0.05);SDG护士消极情绪分量表评分增加,积极性情绪分量表评分减少,其中愤怒-敌视、疲劳-迟钝、慌乱-迷茫、精力-活力4个分量表评分以及情绪紊乱总分(TMD)组间比较差异具有统计学意义(P<0.05);SDG护士护理差错发生例数高于NSDG护士,其中小护理差错(LNE)和人均护理差错(NEPP)发生次数组间比较差异具有统计学意义(P<0.05).结论 相对于非睡眠剥夺组护士,睡眠剥夺组护士出现明显的睡眠质量下降、情绪状态恶化和护理差错发生次数增加.     

理查兹一坎贝尔睡眠量表护患一致性评价研究

目的 验证患者及护士分别使用理查兹-坎贝尔睡眠量表测评睡眠质量的一致性.方法 对186例ICU患者采用理查兹-坎贝尔睡眠量表分别由护士对患者和患者对自身进行睡眠质量的评价,采用Bland-Altman plot图法比较一致性.结果 186例患者睡眠质量总体评价,护士评分为(58.2±19.6),患者自评为(56.6±22.8),t=-0.756,P=0.316,各维度均无统计学意义(P＞0.05).结论 理查兹-坎贝尔睡眠量表评估护患一致性较高,可由护士代替患者进行评分.     

三级甲等医院ICU护士睡眠质量与焦虑情绪的相关性研究

目的探讨ICU护士的睡眠质量、焦虑状况及其两者的相关性。方法采用睡眠状况自评量表和焦虑自评量表对50名ICU护士进行调查。结果睡眠状况得分为(29.94±4.52)分,睡眠障碍发生率为92.00%;焦虑得分为(54.02±7.15)分,82.00%的护士存在焦虑情绪。睡眠质量与焦虑呈正相关(P<0.01)。结论睡眠质量与焦虑情绪之间有密切的关系,且相互影响,建议护理管理者应加以重视,帮助护士保持最佳工作状态,提高护理服务质量。     

新型冠状病毒疫情期间护士睡眠质量与正念水平的影响因素研究

目的 了解新型冠状病毒疫情期间护士睡眠质量与正念水平现状,并探究护士睡眠质量的影响因素.方法 采用一般资料问卷、匹兹堡睡眠质量指数和正念注意觉知量表对1128名护士进行问卷调查.结果 匹兹堡睡眠质量指数总分为(11.47±3.59)分,存在睡眠质量问题护士891名(78.99％),正念注意觉知得分为(61.44±12....     

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.