血液透析患者护理需求的调查及对策

目的 了解血液透析患者的护理需求.方法 选取维持性血液透析患者102例,采用自行设计的问卷对患者的护理需求进行调查,并提出对策.结果 血液透析患者的护理需求包括透析治疗安全有效无并发症、舒适、健康指导、情感支持等.结论 血液透析患者有护理需求,要进行针对性护理.     

血液透析治疗肾功能不全患者抗生素相关性脑病的护理

目的 探讨血液透析治疗肾功能不全患者抗生素相关性脑病的观察与护理要点.方法 收集5例应用抗生素引起脑病的肾功能不全患者,对维持性血液透析患者加强血液透析治疗,未透析患者予以血液透析治疗,透析过程中做好精心的护理.结果 5例患者意识状态均恢复正常、神经系统症状消失,1例停止血液透析,4例过度到维持性血液透析.结论 血液透析对治疗抗生素相关性脑病效果良好,而精心的护理可以使患者早日康复.     

营养护理对终末期肾病血液透析患者的影响

目的 探讨营养护理对终末期肾病血液透析患者的影响.方法 选取该院医治的66例终末期肾病血液透析患者(2013年10月~2015年10月)作为本次实验的研究对象,对66例终末期肾病血液透析患者实施计算机随机分组方案.常规组33例终末期肾病血液透析患者实施常规护理,实验组33例终末期肾病血液透析患者在常规护理的基础上实施营养护理,分析比较两组终末期肾病血液透析患者护理后的生活质量评分及并发症发生率.结果 实验组和常规组终末期肾病血液透析患者护理后的生活质量评分存在明显差异(P<0.05);且实验组患者的并发症发生率为21.21%,显著低于常规组(48.48%)(P<0.05).结论 对终末期肾病血液透析患者采取营养护理干预,能显著改善患者的营养状况,降低患者出现低血压、恶心呕吐、头痛、出血等并发症的机率,提高患者的生活质量,护理效果明显.     

维持性血液透析患者实施临床护理路径的效果评价

目的 探讨对维持性血液透析患者实施临床护理路径的应用效果.方法 选择2009年1～12月血液透析室120例维持性血液透析患者,随机分为对照组和观察组各60例.对观察组实施临床护理路径进行护理,对照组接受常规护理.比较2组并发症发生情况,遵医行为及对护理质量的满意度.结果 实施临床护理路径后观察组患者较对照组患者并发症减低和护理差错降低,患者遵医行为明显提高,对护理质量的满意度评分显著提高.结论 临床护理路径在维持性血液透析患者中的应用,可以提高整体护理质量以及患者对护理的满意度,对提高患者透析和生存率有重大意义,是全面提高血液透析整体护理质量的有效方法.     

血液透析中透析器及管路凝血的原因分析及护理

总结长期血液透析患者在血液透析过程中透析器及管路凝血的原因及护理.根据血液透析患者临床护理资料、血液透析临床凝血表现,回顾性分析16例(20例次)透析器及管路凝血的原因.血液透析患者在透析过程中血液高凝状态、透析中肝素用量不足、无肝素透析、血流量不足、机器故障停泵等均可造成透析器及管路凝血.血透护理属专科护理,护士应熟练掌握透析原理,精通血液透析操作的程序,增强责任心,加强理论知识学习,掌握患者病情及用药,密切观察,及时处理透析机报警,可有效预防凝血发生,预防患者透析效果下降.     

血液透析患者自我管理能力调查分析

目的 探讨血液透析患者的自我管理能力及影响因素,以期为提高护理质量提供依据.方法 采用自行设计的血液透析患者自我管理调查问卷对95例血液透析患者进行随访调查,了解患者自我管理能力,并探讨影响自我管理的影响因素.结果 43例血液透析患者自我管理能力欠佳,影响血液透析患者自我管理的主要相关因素为原发疾病、文化程度、医疗费支付方式、婚姻状况、家庭支持状况、血液透析时间等.结论 在血液透析患者护理过程中,要注重患者的自我管理能力以及患者家庭、社会等因素对自我管理能力的影响,才能有效提高血液透析患者的生活质量.     

人性化护理在中青年血液透析患者中的应用

目的 探讨中青年血液透析患者人性化护理的临床实践应用分析.了解中青年血液透析患者的心理需求及人性化护理模式下指导的相应护理措施.方法 对66例中青年血液透析患者随机分为实验组(33例)和对照组(33例),均进行常规护理.对实验组针对不同患者的实际情况进行人性化护理.结果 通过对中青年患者进行人性化护理,患者对治疗的满意程度明显高于未接受人性化护理的患者,并在接受治疗过程中能主动配合治疗,精神愉快,情绪稳定.2组比较有显著意义(P＜0.01).结论 进行人性化护理可让中青年血液透析患者树立起战胜疾病的信心,有效的人性关爱能增强中青年血液透析患者应对压力的能力,消除患者焦虑抑郁的心理,促进患者康复.     

血液透析致心血管合并症2212例次临床观察及护理

目的探讨血液透析致心血管合并症治疗护理措施.方法对2212例次血液透析出现的心血管合并症给予相应的治疗护理.结果2212例次血液透析中出现心血管合并症.经治疗护理后94%患者症状明显改善,均能顺利完成血液透析.结论熟悉血液透析中出现心血管合并症的原因,给予相应的治疗护理,可促进血液透析顺利完成.     

舒适护理模式在血液透析患者中的应用

目的:探讨舒适护理模式在血液透析患者中的应用效果.方法:将80例血液透析患者随机分成干预组与对照组各40例,干预组采用舒适护理措施,对照组采用常规护理措施,分别采用患者舒适护理需求调查表、患者舒适度自我评分表于护理前、护理后对患者舒适度的改变进行评价.结果:护理后两组患者舒适度改变比较差异有统计学意义(P<0.05).结论:舒适护理可加强血液透析患者之间、患者与家属之间、患者与医护人员之间的沟通与交流,可明显提高患者生活质量,提高护理服务质量.     

维持性血液透析患者皮肤瘙痒的护理

目的 探讨维持性血液透析患者并发皮肤瘙痒症的护理经验,提高维持性血液透析患者的临床疗效和生活质量.方法 回顾分析2008年10月至2011年1月我科收治的维持性血液透析并发皮肤瘙痒症患者75例,其中轻度瘙痒39例.中度瘙痒13例,重度瘙痒23例.我科护理人员综合运用心理护理、饮食护理、皮肤护理、透析护理等多种措施对上述皮肤瘙痒患者进行护理.结果 经过6～8个月的综合护理治疗,轻度瘙痒患者有37例瘙痒症状消失;中度瘙痒患者有2例瘙痒症状消失,7例转为轻度瘙痒;重度瘙痒患者5例转为轻度瘙痒,11例转为中度瘙痒.结论 我科护理人员使用的护理干预措施能有效地防治维持性血液透析患者并发的皮肤瘙痒症.     

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.     

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.