人性化护理在无痛胃镜检查中的应用

目的：探讨人性化护理在无痛胃镜检查中的应用。方法回顾性分析我院内镜中心2016年3月做无痛胃镜检查的3518名患者资料,对其实施人性化护理进行了总结。结果对3518名做无痛胃镜检查的患者进行人性化的护理,所有患者顺利完成检查,检查结束后无痛苦性回忆,满意度高。结论在内镜中心的护理中,人性化护理可以在很大程度上减轻患者所承受的痛苦,具有很大的实用价值。     

五常法管理方案在经内镜逆行性胰胆管造影术患者中的应用

目的：探讨五常法管理方案在经内镜逆行性胰胆管造影术患者中的应用效果。方法选取我院内镜中心收治的胆道梗阻患者238例，随机分为实验组和对照组，每组119例。对照组患者实施普通护理管理，实验组患者采取五常法管理方案。结果实验组术后护理准备时间、操作完成善后时间均少于对照组（P＜0．05），术前准备时间、术后清理时间均少于对照组（P＜0．05），及时运送患者人数明显多于对照组（P＜0．05），患者及医务人员满意度均高于对照组（P＜0．05）。结论五常法管理对ER－CP手术患者预后情况有很大改观，临床应用价值较大。     

人性化管理应用于护理管理中的效果评价

目的：观察评价人性化管理应用于护理管理中的效果。方法采用随机数字表法将我院60名护士分为两组,其中对照组采用常规护理管理模式,实验组采用人性化护理管理模式,通过不同模式管理,比较两组护士护理质量评分情况、护理差错发生情况、基础护理合格率和护理操作合格率,比较患者对护理的满意情况。结果经对比观察,实验组患者对护理的满意度（100.0％）明显高于对照组满意度（70.00％）,经过人性化护理管理模式的实验组护士护理质量评分明显高于对照组护士所得分数,实验组护士护理差错发生率（3.33％）明显低于对照组护士（33.33％）。实验组护士基础护理合格率（96.67％）和护理操作合格率（93.33％）都明显高于对照组实验组护士基础护理合格率（70.00％）和护理操作合格率（66.67％）,差异有统计学意义（P＜0.05）。结论将人性化管理应用于护理管理中,可提高护理质量,提高护理人员的工作热情,提高患者对护理的满意程度,应该在临床上推广应用。     

护理访视在眼科局麻手术患者中的应用研究

【摘要】目的研究护理访视是否有助于患者应对手术。方法眼部局麻手术患者194例，随机分为两组，实验组由巡回护士进行访视和回访，对照组不进行访视，只做简单的术前解释。结果实验组患者心理状态优于对照组（P〈0．05），两组患者生理指标比较差异有显著性（P〈0．01，P〈0．05），两组患者配合程度比较，实验组高于对照组（P〈0．05）。结论护理访视可消除或减轻患者恐惧心理，使患者以恰当的应激水平去应对手术，提高了手术配合程度，从而提高了手术成功率，减少了术后并发症。     

老年患者静脉滴注拔针后按压针口新方法的观察

目的探讨更适合老年静脉滴注患者拔针后按压针口的新方法，以提高护理质量，最大限度减轻患者的损伤。方法将400例老年静脉滴注患背随机分成两组，拔针后采用新方法按压针口为实验组；采用传统方法按压针口为对照组。15min后对比两组方法所得结果及患者对新方法的满意程度。结果将实验组与对照组的有效率及满意度进行比较，实验组有效率达到99．0％，明显高于对照组的94．1％（P〈0．01）；实验组患者满意度也超过对照组。结论实验组的护理质量远超过对照组，新方法有临床应用及推广价值。     

心理护理对择期手术患者焦虑的影响

目的探讨心理护理对择期手术患者焦虑程度的影响。方法选择择期手术患者63例,将患者分为实验组和对照组。对照组30例患者实施常规手术室护理,观察组33例患者实施心理护理,分别对2组患者进行术前、术中、术后焦虑评分,评估术中配合程度,测量血压、心率,并进行比较。结果实验组患者焦虑值、生理指标明显低于对照组,差异有统计学意义（P〈0．05）;术中配合程度明显高于对照组,差异有统计学意义（P〈0．05）。结论心理护理有助于改善患者的焦虑情绪,维持血压、心率稳定,提高患者手术配合程度,保证手术顺利进行。     

内镜下行微创保胆取石（息肉）手术的临床护理体会

目的：探讨内镜下行微创保胆取石手术的临床护理方法与护理效果。方法选取我院2010年1月至2014年1月收治的124例内镜下行微创保胆取石（息肉）手术的患者进行分析研究,随机分为2组,每组62例,对照组患者采用常规护理方式,观察组患者采用人性化护理方式,观察两组患者临床护理效果以及患者后期治愈效果。结果观察组患者护理总有效率达到96．77％,护理效果明显优于对照组;两组患者在护理后,其疼痛、抑郁、焦虑指数都较护理前有明显改善;观察组患者的改善情况明显优于对照组;两组患者护理后的生活质量都较护理前有很大提高,差异均有统计学意义（ P＜0．05）。结论人性化护理方式对内镜下行微创保胆取石手术的患者进行护理,能有效提高临床护理效果,减轻患者痛苦,提高患者生活质量,值得临床推广应用。     

优质护理对恶性肿瘤患者癌痛及生活质量的影响

目的研究优质护理对恶性肿瘤患者癌痛及生活质量的影响。方法选取本院恶性肿瘤患者80例，随机分为实验组和对照组。对照组患者实施常规护理，实验组患者实施优质护理，观察两组患者的护理效果。结果实验组患者护理后生活有效质量达到92．7％，对照组生活有效质量为74．3％，实验组明显高于对照组，差异有统计学意义（P〈0．05）。结论优质护理可以有效提高恶性肿瘤患者的生活质量，降低患者疼痛程度。     

循证护理在重症手足口病合并脑炎患儿中的应用效果

目的：探讨循证护理在重症手足口病合并脑炎患儿中的应用效果。方法选取在我科接受治疗的重症手足口病合并脑炎患儿200例,随机分为实验组和对照组各100例,对照组患儿给予常规护理,实验组患儿在常规护理措施的基础上采用循证护理,对比分析两组患儿的临床效果以及满意程度。结果对两组患儿分别进行护理后,实验组患儿总有效率91．00％,明显高于对照组患儿的总有效率55．00％,且实验组患儿及其家属的满意程度95．00％,明显高于对照组患儿及其家属的满意程度61．00％,差异有统计学意义（P＜0．05）。结论循证护理在重症手足口病合并脑炎患儿中的应用效果显著,明显改善患儿的临床症状,使患儿及其家属更为满意,可以在临床上广泛应用。     

分析探讨疼痛护理管理模式在创伤骨科病房中的应用效果

目的：研究分析疼痛护理管理模式在创伤骨科患者中的应用效果。方法选取在本院骨科治疗的股骨颈骨骨折的88例患者,将患者随机分成实验组和对照组,平均每组44例患者。实验组的患者采用疼痛护理管理模式给予护理,对照组的患者采用常规的护理模式给予护理,观察两组患者的疼痛程度、睡眠情况及满意程度。结果实验组的患者的疼痛程度明显低于对照组的患者的疼痛程度,差异具有统计学意义（ P＜0．05）;观察组的患者睡眠质量较差的人数明显少于对照组,实验组对于护理管理模式的总满意率明显高于对照组,差异具有统计学意义（ P＜0．05）。结论将疼痛护理管理模式应用于创伤骨科可有效减轻患者的疼痛,在临床上值得推广。     

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.