激励式护理对留置T管患者的影响

目的探究激励式护理对留置T管患者心境状态、自我护理能力及生活质量的影响。方法选择胆道探查术后留置T管的110例患者作为研究对象,随机分为试验组(54例)和对照组(56例),对照组采取常规护理,试验组在常规护理的基础上加以激励式护理,比较两组干预前后心境状态、自我护理能力及生活质量。结果实施激励术护理干预前两组患者的心境状态量表评分、自我护理能力差异均无统计学意义(P0.05)。试验组通过实施激励式护理后,其心境状态量表评分、自我护理能力及生活质量较对照组均升高,差异均有统计学意义(P0.05)。结论激励式护理能明显改善胆道探查术后留置T管的患者的心境状态,提高患者自我护理能力并改善其生活质量。     

延续性护理干预对携T型管出院患者自我护理能力 及术后康复的影响

目的 探讨延续性护理干预对携T型管出院患者自我护理能力及术后康复的影响.方法 选择2014年6月至2016年3月携带T型管出院患者152例为研究对象,采用随机数字表法分为观察组和对照组,各76例.对照组给予常规出院指导和健康宣教,观察组实施延续性护理干预,比较两组患者自我护理能力、自我护理行为依从性、胃肠生存质量、并发症等指标.结果 携T管出院后拔管当天,观察组患者健康知识水平、自我概念、自护责任感、自我护理技能评分均明显高于对照组(t=4.366, 3.865, 3.257, 6.425,P<0.05),正确观察胆汁量及颜色、正确夹闭和开放T管等自我护理行为依从性均明显高于对照组(x2=3.958, 4.489, 4.378, 4.385, 4.930, 4.489, 4.209,P<0.05),自觉症状、躯体生理功能、日常与社会活动、心理情绪状态、总分评分均明显高于对照组(t=6.171, 5.931, 9.926, 8.115, 5.594, P<0.05);携管期间并发症发生率7.89%明显低于对照组19.74%(x2=4.475, P<0.05).结论 延续性护理可以提高带T 管出院患者的自我护理能力,提高患者自我护理行为依从性,减少并发症,改善胃肠生存质量.     

延续护理对提高带T管出院患者自我护理能力的效果研究

目的:探讨延续护理对提高带T管出院患者自我护理能力的效果。方法:将2014年4~8月出院的45例胆总管切开探查或取石术后带T管患者作为对照组,采取常规出院宣教;将2014年9~12月出院的50例胆总管切开探查或取石术后带T管患者作为观察组,实施延续护理服务。比较两组患者出院时、出院后1个月和出院后2个月的各项自我护理能力评分,以及带管期间的护理不良事件发生率。结果:出院后1,2个月观察组患者自我护理能力评分高于对照组患者(P0.05),带管期间护理不良事件发生率低于对照组患者(P0.05)。结论:延续护理能明显提高带T管患者的自我护理能力,减少护理不良事件的发生率,对临床护理工作有一定的延伸意义。     

团队随访在带T管出院患者随访护理中的应用

目的:探讨团队随访在带T管出院患者随访护理中的应用。方法:选取2017年3月1日～2020年1月1日接受胆道相关探查手术后带T管出院患者186例,随机分为观察组和对照组各93例;对照组给予常规院外护理干预,观察组在对照组基础上给予团队随访;比较两组自我护理能力实施量表(ESCA)得分、护理不良事件发生情况及自我护理项目掌握情况。结果:两组返院拔管时ESCA评分均高于出院时(P0.01),且观察组高于对照组(P0.01);观察组不良事件发生率低于对照组(P0.05);观察组自我护理各项目掌握率高于对照组(P0.05)。结论:团队随访方案能提高患者自我护理能力,减少不良事件的发生,提高患者自我护理能力各项目掌握率。     

人工肛门袋在T管引流患者家庭延伸护理中的应用

胆总管探查或切开取石术后放置T管引流,有利于解除梗阻,引流胆汁及残余结石,支撑胆道,控制感染。T管一般在术后3—4周拔除。为缩短患者的住院时间,减轻患者的心理压力及经济负担,往往准许术后恢复良好的患者于术后6～10d带管出院。但对于医学知识缺乏又没有经过引流管护理知识培训的患者,带T管出院存在一定的护理隐患。     

延续性护理在带"T"管出院患者中的应用效果

目的探讨延续性护理对带"T"管出院患者自我护理能力、遵医行为及满意度的影响。方法选取2016年2月—2017年6月于本院行胆总管切开探查取石术后带T管出院的73名患者,随机分为对照组和实验组。取其中37例作为对照组,样本流失2例,采用常规出院宣教;实验组36例,无样本流失,实施延续性护理服务。比较两组患者出院后自我护理能力、遵医行为及满意度情况以及带管期间不良事件的发生率。结果实验组患者"T"管护理、遵医行为及满意情况均优于对照组,差异具有统计学意义(P0.05),两组不良事件的发生率比较无统计学差异(P0.05)。结论延续性护理能显著提高带"T"管患者的自我护理能力、遵医行为及满意度。     

胆道术后带T管出院病人自我护理指导

胆道手术留置T管,往往作为常规,其中大部分病人拔管出院,但由于多种原因,仍有一部分病人需带管出院。带管病人出院后,若护理不当,将会发生T管脱出、胆道感染、胆道出血等严重并发症,大大增加了病人痛苦和经济损失。因此,出院后,病人的自我护理就显得尤为重要。我们对本院48例胆道术后带T管出院病人均给予了自我护理指导,获得较好的效果。     

基于微信平台的延续护理在行胆道术后带T管出院患者中的应用效果

目的探讨基于微信平台的延续护理在行胆道术后带T管出院患者中的实施效果。方法回顾性分析福建省浦城县医院2020年1月至2022年6月收治的199例行胆道术后带T管出院患者的临床资料,按护理方法的不同将患者分入对照组和观察组。100例对照组患者给予常规延续护理,99例观察组患者应用基于微信平台的延续护理。比较2组患者的不良事件发生率、T管维护知识水平、自我管理能力和肝肾指标水平。结果观察组的胆瘘、T管滑脱或堵塞等不良事件总发生率为4.04%,低于对照组的12.00%(P<0.05)。出院2周后及T管拔除时,2组的T管维护知识水平和自我管理能力评分均较出院时提高(P均<0.05),且观察组均较同期对照组更高(P均<0.05)。出院2周后及T管拔除时,2组的碱性磷酸酶、γ-谷氨酰转肽酶、直接胆红素水平均较出院时降低(P均<0.05),且观察组均较同期对照组更低(P均<0.05)。结论基于微信平台的延续护理可提高行胆道术后带T管出院患者的T管维护知识水平和自我管理能力,促进其肝肾指标水平恢复,减少不良事件的发生。     

胆总管探查术后留置T管的护理

目的：探讨胆总管探查术后T管的护理。方法：收集我院2009年1月～2012年1月行胆总管探查术病人74争例临床资料。总结胆总管探查术后T管的护理体会。结果：胆总管探查术后T管拔除时间延长至术后6周，给予正确的T管护理和出院指导．胆漏发生率低，病人恢复顺利，满意度提高。结论：正确的护理是术后病人顺利恢复的重要保证，出院指导是术后护理的延续，对病人的最终康复具有重要意义。     

胆道手术后带T管出院患者院外护理需求及移动健康教育作用分析

目的探讨胆道手术后带T管出院患者院外护理需求及移动健康教育的作用效果。方法选取2019年8月1-31日我院行胆道手术后带T管出院的116例患者作为研究对象。出院前调查患者对T管护理知识的掌握程度与院外护理需求。出院后实施移动健康教育,借助微信渠道实施健康宣教、在线咨询与指导等院外护理。回院复查时再次调查患者院外护理知识掌握程度。随访患者在此期间并发症发生情况及对移动健康教育的满意度情况。结果移动健康教育干预前患者对护理知识的掌握程度评分为(31.35±5.06)分,干预后患者对护理知识的掌握程度评分为(50.81±6.42)分,评分较干预前显著升高(P0.05)。116例患者中出现5例管道移位或脱落、3例腹部不适、1例皮肤刺激,未出现胆道感染;总的并发症发生率为7.76%,总满意度为98.28%。结论胆道手术后带T管出院患者对院外护理需求较高,院外T管护理知识掌握水平低,需要加强出院后的健康教育。采用移动健康教育能改善其院外护理知识的掌握程度,减少并发症的发生,提升患者的满意度。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.