临床护理路径对钬激光碎石术患者治疗依从性及术后并发症的影响

【目的】探讨临床护理路径对钬激光碎石术患者治疗依从性及术后并发症的影响。【方法】选取2015年6月至2016年6月本院收治的124例行钬激光碎石术治疗的输尿管结石患者,根据随机数字表将患者分为观察组及对照组,每组各62例。对照组应用常规性护理,观察组应用临床护理路径,比较两组患者治疗期间不良情绪、疾病知识掌握、治疗依从性、术后并发症及治疗满意度情况。【方法】观察组干预后焦虑自评量表（SAS）、抑郁自评量表（SDS）评分显著低于对照组,差异有统计学意义（P〈0．05）。观察组疾病知识掌握率、治疗依从率及满意率高于对照组（P〈0．05）,而并发症发生率低于对照组（P〈0．05）,观察组患者术后住院时间短于对照组（P〈0．05）。【结论】临床护理路径能有效改善钬激光碎石术患者不良情绪,提高患者疾病知识掌握率及治疗依从性,降低患者术后并发症发生率,促进患者尽早康复,提高患者满意度。     

PDCA循环管理在心脏介入术后患者中的应用

目的:探讨PDCA循环管理在心脏介入术后患者中的应用效果。方法:选取本院收治的心脏介入术后患者100例,选取施行PDCA循环管理前行常规护理的50例患者作为对照组,选取施行PDCA循环管理后的50例患者作为观察组。两组均随访为期6个月,比较两组治疗依从性、护理满意度、并发症发生情况等,采用匹茨堡睡眠质量指数量表(PSQI)、抑郁自评量表(SDS)、焦虑自评量表(SAS)评价两组睡眠质量、心理状态。结果:观察组治疗依从性高于对照组(P 0. 05),观察组干预后PSQI评分、SAS评分、SDS评分均低于对照组(P 0. 05),观察组护理满意度高于对照组(P 0. 05),观察组并发症发生率低于对照组(P 0. 05)。结论:PDCA循环管理能有效提高心脏介入术后患者治疗依从性,提高患者睡眠质量,缓解患者心理负担,提高患者满意度,减少并发症,有助于促进患者病情康复。     

个性化护理干预联合准分子 LASIK 治疗难治性近视效果分析

目的：探讨个性化护理干预联合准分子激光原位角膜磨镶术（LASIK ）治疗难治性近视的临床效果。方法采用随机、单盲、多中心的研究方案,将960例（1920眼）行准分子LASIK治疗的难治性近视患者随机分为对照组和观察组,每组各480例（960眼）。对照组给予常规护理。观察组在常规护理基础上,实施个性化护理干预。应用Zung氏焦虑自评量表（SAS量表）评估患者术前焦虑程度;观察患者术中固视情况,计算术后裸眼视力（UCVA）达到术前最佳矫正视力（BCVA）的比例,观察术后并发症发生情况。结果观察组和对照组患者术前SAS量表评分差异无统计学意义（P＞0．05）;观察组术中固视能力优于对照组（P＜0．05）;观察组术后10 d、1个月、3个月时UCVA达到术前BCVA的比例均高于对照组（P＜0．05）;观察组术后干眼症发生率低于对照组（P＜0．05）。结论个性化护理干预措施可增强准分子LASIK治疗难治性近视的效果,也有利于降低术后并发症的发病风险。     

心理干预在老年下肢骨折患者围术期中的护理效果分析

目的：对心理干预在老年下肢骨折患者围术期中的护理效果进行分析。方法选取2013年1～12月我院收治的老年下肢骨折病人60例为研究对象,入选患者按照住院单双号分为试验组和对照组各30例,对照组行常规护理,试验组患者在对照组患者的基础上加用心理护理干预。结果两组患者干预前的SAS、SDS评分差异无统计学意义（ P＞0．05）;两组干预后的SAS、SDS评分差异有统计学意义（P＜0．05）;试验组患者自评焦虑、抑郁得分均低于对照组,差异有统计学意义（P＜0．05）;两组患者干预前的HAMA、HAMD评分差异无统计学意义（P＞0．05）;两组干预后的HAMA、HAMD评分差异有统计学意义;护理人员对试验组患者焦虑、抑郁状态的评分均低于对照组,两组患者干预后对治疗依从性和对护理工作满意度的比较差异有统计学意义,试验组患者的治疗依从性和对护理工作的满意度显著高于对照组,差异有统计学意义（ P＜0．05）。结论对老年下肢骨折病人实施围术期心理护理干预,可以显著改善患者的不良心理,提高其治疗依从性及对护理工作的满意度,具有重要临床推广意义。     

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护理干预

目的：探讨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。方法将62例急性脑卒中患者随机分为对照组30例和干预组32例。对照组采用常规护理方法,干预组在常规护理方法的基础上实施治疗性沟通系统。2组干预前采用焦虑自评量表（SAS）、抑郁自评量表（SDS）进行调查;2组干预后采用SAS、SDS、治疗依从性调查表进行调查。结果干预后2组患者SAS、SDS评分与本组干预前比较均显著下降,差异有统计学意义（P＜0．05）;组间比较,干预组下降程度显著高于对照组（P＜0．05）。干预组患者治疗完全依从性显著高于对照组（P＜0．05）,治疗不依从性显著低于对照组（P＜0．05）。结论治疗性沟通系统能有效改善急性脑卒中患者的焦虑抑郁情绪,提高患者治疗依从性。     

专科护理和心理健康辅导干预对泌尿外科患者术后并发症的影响

目的：临床分析专科护理和心理健康辅导干预对泌尿外科患者术后并发症的影响。方法选取该院2012年3月至2013年3月收治的泌尿外科手术患者90例,按照随机分配的方法,将其分为研究组与对照组,每组45例。对照组给予常规护理,研究组在常规护理基础上,给予专科护理与心理健康辅导干预,选择焦虑自评表（SAS）、抑郁自评量表（SDS）评价两组出入院时的心理变化,评定两组患者出院后3个月和6个月时的依从性情况,分析并发症治疗状况。结果经过治疗后,两组患者出院时的SAS、SDS评分均有所降低,但研究组评分明显低于对照组,差异有统计学意义（P＜0．05）。出院后3个月时,研究组与对照组的服药依从性比较,差异无统计学意义（P＞0．05）,出院后6个月时,研究组与对照组的服药依从性比较,差异有统计学意义（P＜0．05）。经过对症治疗,针对并发症治疗,研究组有效率比对照组明显较高,两组比较差异有统计学意义（P＜0．05）。结论泌尿外科实施外科手术后,采用专科护理模式,给予心理健康辅导干预,可有效防治术后并发症,提高服药依从性,值得临床推广应用。     

护理干预对提高糖尿病性白内障围手术期患者依从性的影响

[目的]探讨护理干预对提高糖尿病性白内障（D C ）围手术期患者依从性及降低并发症的效果。[方法]将85例DC患者按入院的不同时期分为43例个性化护理干预组（观察组）以及42例常规性护理组（对照组）,对比分析两组患者干预前后依从性、心理状况及术后并发症发生率等方面的差异。[结果]与干预前相比,观察组干预后依从率显著提高（P ＜0．05）,而对照组无明显变化（P ＞0．05）。观察组干预后汉密尔顿焦虑量表（HAMA）评分为（9．31±4．82）,汉密尔顿抑郁量表（HAMD）评分为（10．91±2．82）,对照组干预后HAMA评分为（13．26±7．84）,HAMD评分为（16．31±3．81）,两组比较差异有统计学意义（P ＜0．05）。观察组术后伤口感染率、角膜水肿、前房渗出等并发症发生率以及糖化血糖蛋白（HbAlc）、空腹血糖水平显著低于对照组,差异有统计学意义（ P ＜0．05）。[结论]对DC围手术期患者应用护理干预能有效提高患者依从性,改善患者负性情绪,降低患者术后并发症发生率,有利于患者预后。     

优质护理服务应用于重度烧伤患者的护理效果观察

目的：探讨优质护理服务应用于重度烧伤患者的护理效果。方法选取重度烧伤患者58例采用信封法随机分为两组,观察组29例患者采用优质护理服务;对照组29例患者采用重度烧伤常规护理。观察比较两组患者创面恢复、并发症发生情况及住院时间;于患者入院后第1d、第2周、第4周分别进行SAS（抑郁自评量表）和SDS（焦虑自评量表）量表评分,对两组患者评分结果进行比较;对两组患者采用自制问卷调查表调查患者对本次护理的满意度。结果4周后观察组创面愈合率明显高于对照组;创面愈合时间及住院时间观察组明显少于对照组（ P＜0．05）;观察组2例（6．90％）发生并发症,对照组7例（24．14％）发生并发症,观察组并发症发生率低于对照组,但差异不显著（P＞0．05）;两组患者入院第1d时SAS及SDS评分比较无显著差异,但入院后第4周、第8周时,观察组SAS及SDS评分均明显低于对照组,也明显低于治疗前;护理满意度评分观察组评分明显高于对照组（ P＜0．05）。结论对重度烧伤患者采用新的护理模式-优质护理服务,不仅发挥了护理人员的主动服务作用,提高了护理效果,而且可明显促进患者心理健康,同时还提高了患者的满意度。     

情志护理干预调节老年脑梗死患者负性情绪和提高治疗依从性的临床分析

目的：探讨情志护理干预对调节老年脑梗死患者负性情绪和提高治疗依从性的效果。方法选取我院收治的149例老年脑梗死患者为研究对象,采用随机分层法分为对照组74例,采取常规护理,观察组75例,在对照组基础上加入情志护理干预,比较两组护理干预前后抑郁自评量表（ SDS）评分、焦虑自评量表（ SAS）评分、治疗依从性以及神经功能缺损（ NIHSS）评分。结果观察组患者经过精心、细致的情志护理干预后,SDS、SAS评分明显低于对照组,差异有统计学意义（ P＜0．05）;治疗依从性明显高于对照组,差异有统计学意义（P＜0．05）;神经功能缺损（NIHSS）评分降低程度明显优于对照组,差异有统计学意义（P＜0．05）。结论情志护理干预可以减弱或者是消除老年脑梗死患者的不良心理反应,有助于情绪调节,提高患者的治疗依从性,促进患者的康复。     

共情护理在无痛肠镜检查患者中的应用

目的：探讨共情护理在无痛肠镜检查患者中的应用方法及效果。方法：将85例行无痛肠镜检查患者随机分为观察组43例和对照组42例,对照组给予常规护理,观察组在对照组基础上实施共情护理,比较两组护理效果。结果：两组患者护理后焦虑自评量表（SAS）及抑郁自评量表（SDS）评分、满意度、依从性、并发症发生率比较差异有统计学意义（P ＜0.05）。结论：共情护理能有效改善无痛肠镜检查患者的焦虑、抑郁情绪,提高患者依从性及满意度,减少并发症。     

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.     

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.