化疗期妇科肿瘤患者主要照顾者负荷现状及其影响因素研究

目的调查化疗期妇科肿瘤患者的主要照顾者负荷现状,并探讨其影响因素。方法采用照顾者负荷问卷对168例化疗期妇科肿瘤患者的主要照顾者进行问卷调查。结果化疗期妇科肿瘤患者主要照顾者负荷总得分为(52.79±11.05)分,处于中度负荷。各维度按得分高低排序依次为时间依赖性负荷、发展受限性负荷、身体性负荷、社交性负荷、情感性负荷;多因素分析结果显示,主要照顾者的性别、与患者关系、每日照顾时间、患慢性疾病、患者病程是照顾负荷的主要影响因素(P0.01或P0.05)。结论化疗期妇科肿瘤患者的主要照顾者处于中度照顾负荷,应采取综合护理措施降低主要照顾者的负荷水平,持续提高主要照顾者和患者的生存质量。     

肺癌化疗患者配偶照顾负担与社会支持的相关性研究

目的了解肺癌化疗患者配偶的照顾负担与社会支持的现状,并探讨两者之间是否具有相关性。方法采用Zarit护理负担量表及社会支持量表对175例肺癌化疗患者的配偶进行调查。结果肺癌化疗患者配偶的照顾负担平均得分为(37.15±11.30);社会支持平均得分为(59.12±11.16);负担总分和个人负担维度得分均与社会支持总分及其信息支持、物质支持、社交支持三个维度呈显著负相关(P0.01)。结论肺癌化疗患者配偶照顾负担以中重度为主,与社会支持呈显著负相关。医务工作者应采取综合措施以提高其社会支持水平,减轻肺癌化疗患者配偶的照顾负担。     

照顾者负荷对化疗期妇科恶性肿瘤病人生活质量的影响

[目的]探讨照顾者负荷对化疗期妇科恶性肿瘤病人生活质量的影响。[方法]采用自制的一般情况调查表、主要照顾者负荷量表、世界卫生组织生活质量测定简式量表对201例化疗期妇科恶性肿瘤病人及其照顾者进行调查。[结果]化疗期妇科恶性肿瘤病人生活质量得分为86.25分±10.54分,处于较低范围;照顾者负荷以身体性负荷得分(14.07分±2.31分)最高;不同照顾负荷病人的生活质量得分不同(P0.01)。[结论]应建立多种渠道的信息支持,提高社会支持度,同时给予照顾者更多的情感和精神支持,以降低照顾者负荷、提高病人生活质量。     

老年痴呆患者照顾者照顾感受与自我效能及社会支持的关系研究

目的分析老年痴呆患者照顾者照顾感受与自我效能及社会支持的关系,为改善照顾者照顾感受提供参考依据。方法选取2017年5月—2018年5月200例老年痴呆患者的主要照顾者作为研究对象,通过一般资料调查量表、照顾者积极感受表(PAC)、Zarit照顾者负担量表(ZBI)、一般自我效能感量表(GSES)及社会支持评定量表(SSRS)进行调查,通过Pearson相关分析法分析主要照顾者的照顾感受与自我效能、社会支持的关系。结果 200例老年痴呆患者主要照顾者中,ZBI、PAC、GSES、SSRS总分分别为(34.58±12.29)分、(28.43±5.38)分、(2.45±0.67)分和(31.26±6.24)分;Pearson相关分析结果显示,PAC各维度及PAC总分与社会支持各维度、GSES总分均呈显著正相关性(r0,P0.05),ZBI各维度及ZBI总分与社会支持各维度、GSES总分均呈显著负相关性(r0,P0.05)。结论老年痴呆患者主要照顾者自我效能感水平整体较低,积极感受、社会支持、照顾负担处于中等水平,积极感受、照顾负担与社会支持、自我效能感存在密切关系;应采取针对性的护理干预措施提高老年痴呆患者主要照顾者的自我效能感和社会支持水平,提高积极感受及减轻照顾负担。     

乳腺癌患者配偶社会支持与照顾者负担的相关性研究

目的了解乳腺癌患者配偶的社会支持和照顾者负担情况,探讨其相关性。方法 2013年7月至2014年7月,便利抽样选择湖北省襄阳市中心医院肿瘤科收治的116例乳腺癌患者及其配偶为研究对象,采用一般情况调查表、社会支持评定量表和Zarit照顾者负担量表进行调查。结果乳腺癌患者配偶的社会支持总分为(29.14±3.42)分,照顾者负担总分为(37.52±13.85)分,处于中度负担水平;社会支持总分与照顾负担总分及其各维度呈负相关,其中主观社会支持与照顾负担各维度呈负相关,社会支持利用度与个人负担呈负相关(均P0.05),客观社会支持与照顾负担各维度均无相关性(均P0.05)。结论乳腺癌患者配偶的社会支持与照顾者负担具有显著相关性,作为乳腺癌患者的主要照顾者,其配偶的社会支持应给予重视,临床医护人员应了解并关注乳腺癌患者配偶主观社会支持,并提高其对社会支持的利用度,以缓解其照顾者负担,减轻其在照顾过程中产生的不良体验,使患者及配偶能积极应对疾病及后续治疗。     

首发缺血性脑卒中病人照顾者家庭适应现状及影响因素

目的:调查首发缺血性脑卒中病人照顾者家庭适应现状及影响因素,为开展干预性研究提供参考。方法:采用一般资料调查表、家庭适应性量表、照顾负担量表、简易应对方式问卷和领悟社会支持量表对253名首发缺血性脑卒中病人的照顾者进行调查。结果:首发缺血性脑卒中病人照顾者家庭适应得分为（49.25±7.63）分,照顾负担得分为（26.79±12.76）分,应对方式得分为（29.06±8.09）分,领悟社会支持得分为（63.25±8.57）分。首发缺血性脑卒中病人照顾者家庭适应总分与照顾负担总分和责任负担维度得分呈负相关（P<0.05）,与积极应对总分、社会支持总分及各维度得分呈正相关（P<0.05）。多元线性回归分析表明,积极应对、社会支持和照顾者文化程度是首发缺血性脑卒中病人照顾者家庭适应的影响因素（P<0.05）。结论:首发缺血性脑卒中病人照顾者家庭适应处于较低水平,医护人员应关注文化程度低、社会支持水平低及采取消极应对方式的病人照顾者,针对性地实施个性化干预。     

痴呆症病人家庭照顾者社会支持及相关因素研究

[目的]探讨居家痴呆症病人家庭照顾者社会支持及其相关因素。[方法]采用多点横断面研究设计,应用一般资料问卷、社会支持评定量表和照顾者负担量表对152位痴呆症病人的家庭照顾者进行测评,分析照顾者社会支持情况,探讨其相关因素及其对照顾者负担的影响。[结果]本组研究对象社会支持得分为(32. 26±5. 51)分,显著低于我国常模(t=-5. 158,P=0. 000);单因素分析显示配偶照顾者、不在业的照顾者、教育程度较低的照顾者以及与病人同住的照顾者社会支持总分或分维度得分较低(P0. 05),且照顾者年龄及每周照顾时间与社会支持总分或分维度得分呈负相关(P0. 05);除生理性负担和情感性负担两个维度外,照顾者负担总分及其他维度得分与不同维度的社会支持得分呈负相关(P0. 05)。[结论]本组居家痴呆症病人家庭照顾者社会支持情况不容乐观,针对社会支持的弱势群体、构建符合照顾者需求与特点的支持性干预措施意义重大,以期改善照顾者身心状况与照顾质量,提高照顾者与痴呆症病人双方的生活质量。     

肺癌住院患者主要照顾者的负担与社会支持的相关性

目的了解肺癌住院患者主要照顾者的负担与社会支持状况,探讨两者的相关性。方法 2012年2-4月,便利抽样法抽取西安市3所三级甲等医院病理诊断确诊为肺癌的住院患者的主要照顾者150名,采用照顾者负担量表(Zarit burden interview,ZBI)、社会支持评定量表(social support rating scale,SSRS)进行问卷调查。结果肺癌患者主要照顾者的负担处于轻度水平,社会支持处于中等水平;负担总得分为(31.51±10.24)分;社会支持总分为(31.25±6.15)分,低于全国常模。主要照顾者负担各维度与主观支持、客观支持、社会支持利用度均呈负相关(P<0.01)。结论肺癌患者主要照顾者普遍存在不同程度的照顾负担;其获得的社会支持越高,则负担越轻。     

慢性阻塞性肺疾病住院患者主要照顾者的负担与社会支持相关性探讨

目的 了解慢性阻塞性肺疾病住院患者主要照顾者的负担与社会支持状况及两者的相关性。方法 选取2013年1-6月南宁市2所三级甲等医院慢性阻塞性肺疾病患者的主要照顾者120名,采用照顾者负担量表（ZBI）、社会支持评定量表（SSRS）进行问卷调查和评估。结果 慢性阻塞性肺疾病患者主要照顾者的负担处于轻度负荷,社会支持处于中等水平;负担总得分为（34.52±12.20）分;社会支持总分为（30.62±4.59）分,低于全国常模。主要照顾者负担各维度与主观支持度、客观支持度、支持利用度均呈负相关,差异有显著意义（P〈0.01）。结论慢性阻塞性肺疾病患者主要照顾者普遍存在不同程度的照顾负担,应该采取措施,使照顾者获得更高的社会支持度,进而减轻他们的照顾负担。     

系统性红斑狼疮患儿家庭照顾负担水平及其影响因素

目的:探讨系统性红斑狼疮(SLE)患儿家庭照顾负担水平及其影响因素。方法:应用一般资料调查问卷、Zarit护理负担量表及社会支持评定量表对2020年7月—2021年7月就诊于医院风湿科的165例SLE患儿家庭照顾者进行调查。结果:SEL患儿家庭照顾负担得分为(32.45±14.28)分,社会支持得分为(37.59±8.24)分,均处于中等水平。相关分析显示,Pearson相关分析显示,SLE患儿家庭照顾者照顾负担总分与社会支持总分及主观支持、客观支持以及社会支持利用度维度得分呈负相关(r值分别为-0.155,-0.195,-0.032,-0.039,均P<0.01)。多元逐步回归分析显示,SLE患儿家庭照顾者照护负担的主要影响因素是患儿半年住院次数、家庭月收入及居住地。结论:SLE患儿家庭照顾者照顾负担较重,尤其对于患儿家属的家庭月收入低、非城市居住地及住院次数较多的患儿,医护人员应给予更多的情感支持与关怀,同时多渠道提高患儿及其照顾者的居家护理知识,减少相关并发症的发生和再次住院次数从而缓解其照顾负担。     

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.     

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.     

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.     

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.