对鼻咽镜检查患者的认知情况调查分析与护理

目的 对行多功能纤维鼻咽镜检查的患者进行有关喉镜检查的认知情况调查,并给以护理干预,使患者更好的配合检查,减轻患者的恐惧紧张心理.方法 对592例行多功能纤维鼻咽镜检查的门诊患者进行有关喉镜知识的问卷调查.结果 592例患者中对此项检查感到紧张占87.5%,对喉镜知识完全不了解占66.55%,男性患者与女性患者的紧张程度无明显差异.结论 在行多功能纤维鼻咽镜检查时,根据患者的个体情况有的放矢的给予心理护理和护理干预可以缓解患者的紧张心理,使患者更好的配合该项检查.     

儿童纤维鼻咽喉镜检查的心理护理

对患儿进行纤维鼻咽喉镜检查往往会使患儿产生不同程度的恐惧和紧张心理,通过对50例患儿进行检查前、检查中及检查后的心理护理,有效地消除了患儿的恐惧和紧张情绪,得到了患儿的积极配合,使检查获得顺利成功。     

护理干预在非麻醉下纤维喉镜检查中的应用

目的探讨在非麻醉下纤维喉镜检查中护理干预的应用效果。方法选取1000例纤维喉镜检查患者,随机分成实验组和对照组各500例,对照组执行常规操作程序,实验组检查前不进行鼻咽喉部麻醉,把心理暗示、音乐护理、触摸应用于纤维喉镜检查的整体护理中,观察护理干预在非麻醉下纤维喉镜检查中的作用效果。结果实验组在纤维喉镜检查过程中,舒张压和心率的改变明显轻于对照组,差异有统计学意义（t=-2．164,-2．282,P〈0．05）,紧张恐惧感和恶心呕吐程度也显著轻于对照组,差异有统计学意义（x2=9．06,24．9,P〈0．01）,实验组检查失败病例数明显少于对照组。结论护理干预能帮助纤维喉镜检查患者全面提高适应能力,在非麻醉下顺利完成检查,避免了麻醉后躯体产生的各种不适反应,在提供人性化的服务,建立和谐护患关系,提高患者满意度方面具有重要意义。     

电子鼻咽喉镜检查患者的护理体会

电子鼻咽喉镜检查是目前诊断鼻咽喉疾病最有效、最可靠的方法之一,在临床上发挥着巨大的作用。行电子鼻咽喉镜检查的患者常伴紧张、焦虑、恐惧情绪,许多患者往往拒绝检查,以致延误了诊断和治疗。若要做好患者全面的身心护理,临床护理工作者必须全面了解患者的心理需要、心理状态及心理问题,使患者在心理、生理及精神上处于满足的状态,减少或降低患者的不适程度,可使患者对将要进行的检查取得配合,使检查顺利进行。我科对300例行电子鼻咽喉镜检查的患者进行耐心、精心的护理,取得了较满意的效果。现将护理体会报告如下。     

全程护理干预对电子喉镜检查实施的效果评价

电子喉镜是继间接喉镜、直接喉镜、纤维鼻咽喉镜、硬管喉镜后出现的又一新型鼻咽喉部疾病诊断工具,是目前鼻咽喉部疾病诊断和治疗的一种可靠手段.但由于其属于侵入性技术操作,患者在接受检查时会出现不同程度的不良反应.全程护理干预注重了患者的认知行为、心理和环境因素,达到了减轻焦虑的目的,使患者呼吸平稳,心率、血压稳定,机体处于高度节能状态,可降低机体对应激的高反应性.我科尝试通过实施全程护理干预方法对电子喉镜检查进行效果研究,现报道如下.     

纤维喉镜检查患者心理状态调查及护理对策

目的了解纤维喉镜检查患者的心理状况,分析患者紧张焦虑的原因,提出有针对性的护理措施,为今后对行纤维喉镜检查患者实施人性化护理提供依据。方法100例行纤维喉镜检查患者检查前填写状态焦虑量表(S-AI),对其得分情况进行统计学分析。结果100例患者得分均值与常模进行独立样本t检验,有统计学意义,提示在行纤维喉镜检查前大部分患者有紧张焦虑心理。结论实施人性化护理,保持良好的检查环境及实施健康教育,可减轻患者紧张,增加安全感。     

纤维喉镜检查患者心理状态调查及护理对策

目的 了解纤维喉镜检查患者的心理状况,分析患者紧张焦虑的原因,提出有针对性的护理措施,为今后对行纤维喉镜检查患者实施人性化护理提供依据.方法 100例行纤维喉镜检查患者检查前填写状态焦虑量表(S-AI),对其得分情况进行统计学分析.结果 100例患者得分均值与常模进行独立样本t检验,有统计学意义,提示在行纤维喉镜检查前大部分患者有紧张焦虑心理.结论 实施人性化护理,保持良好的检查环境及实施健康教育,可减轻患者紧张,增加安全感.     

电视监视下纤维鼻咽喉镜诊治120例综合护理干预

目的:探讨电视监视下纤维鼻咽喉镜诊治的护理配合方法。方法:将240例电视监视下纤维鼻咽喉镜诊治患者随机分为实验组和对照组各120例,对照组实施常规护理干预,实验组在常规护理基础上实施围术期综合护理干预。比较两组内镜插入时间和对护理服务的满意率。结果:实验组内镜插入时间(3.12±1.43)min,明显低于对照组(5.46±2.05)min(P0.05);实验组患者对护理服务的满意率为96.7%,明显高于对照组92.5%(P0.05)。结论:在电视监视下纤维鼻咽喉镜诊治的护理配合中实施综合护理干预,可明显缩短手术时间,提高患者满意度。     

术前干预对支气管镜检查前患者焦虑情绪的影响

目的探讨支气管镜检查患者对其术前进行心理护理、人文关怀,可使患者消除紧张及恐惧心理,以提高其检查耐受性。方法由专人针对性地对60例纤维支气管镜检查前患者实施护理干预,通过护理干预观察受试对象干预前后焦虑、血压以及心率变化的情况。结果干预后患者焦虑情绪明显低于对照组(P<0.05),患者的焦虑情绪与护理干预呈正相关。结论在患者进行支气管镜检查前进行护理干预,可使之主动而有效配合纤支镜检查,从而提高检查及肺部疾病诊断的成功率。     

术前干预对支气管镜检查前患者焦虑情绪的影响

目的 探讨支气管镜检查患者对其术前进行心理护理、人文关怀,可使患者消除紧张及恐惧心理,以提高其检查耐受性.方法 由专人针对性地对60例纤维支气管镜检查前患者实施护理干预,通过护理干预观察受试对象干预前后焦虑、血压以及心率变化的情况.结果 干预后患者焦虑情绪明显低于对照组(P＜0.05),患者的焦虑情绪与护理干预呈正相关.结论 在患者进行支气管镜检查前进行护理干预,可使之主动而有效配合纤支镜检查,从而提高检查及肺部疾病诊断的成功率.     

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.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.