强化护理健康教育对上皮瓣下角膜磨镶术近视患者的效果

目的探讨强化护理健康教育对行准分子激光上皮瓣下角膜磨镶术近视患者的效果。方法选择2015年3月—2016年3月于江苏省无锡市中医医院行准分子激光上皮瓣下角膜磨镶术近视患者90例,以2015年10月—2016年3月收治的45例为观察组,接受强化护理健康教育;以2015年3—9月收治的45例为对照组,接受常规健康教育。比较两组患者术后用药依从性和视觉满意度。结果两组患者术后用药依从性和视觉满意度比较,观察组均高于对照组,差异有统计学意义(P0.05)。结论强化护理健康教育应用于行准分子激光上皮瓣下角膜磨镶术近视患者中,能够提高患者的用药依从性,增强患者的视觉满意度,值得临床推广应用。     

强化护理健康教育对行准分子激光上皮瓣下角膜磨镶术近视患者的效果分析

[摘要]目的 分析强化护理健康教育对接受准分子激光上皮瓣下角膜磨镶术的近视患者的术后用药依从性和视觉满意度的影响。方法 选择2015年3月-2015年9月在我院45例接受常规健康教育的行准分子激光上皮瓣下角膜磨镶术近视患者,将其作为对照组;再选取2015年10月-2016年3月接受强化护理健康教育的行准分子激光上皮瓣下角膜磨镶术近视患者作为观察组。对比两组患者术后用药的依从性情况,同时比较两组患者术后的视觉满意度。结果 观察组患者的用药依从率为91.1%,对照组患者的用药依从率为68.9%,差异有统计学意义(P＜0.05)。观察组患者的视觉满意度为100.0%,对照组患者的视觉满意度为84.4%,差异有统计学意义(P＜0.05)。结论 强化护理健康教育应用于行准分子激光上皮瓣下角膜磨镶术的近视患者中,能够提高患者的用药依从性,增强患者的视觉满意度,值得临床进一步推广应用。     

准分子激光原位角膜磨镶术中患者头位变化对手术疗效的影响

目的 :通过对准分子激光原位角膜磨镶术术中患者头位改变的观察 ,探讨术中患者头位对手术疗效的影响。方法 :选择接受准分子激光原位角膜磨镶术治疗的近视患者 40 0例 (80 0眼 ) ,分为实验组和对照组 ,实验组在完成准分子激光原位角膜磨镶术角膜瓣后 ,观察记录患者头位 ,在继续进行手术前 ,对头位改变的患者予以调整 ,对照组给予常规护理 ,不予调整头位。对两组手术疗效予以对比分析。结果 :完成角膜瓣后明显改变头位的有 11.2 5 %;术后 6个月裸眼视力实验组优于对照组 ;对照组激光切削偏离中心及散光轴位矫正偏移发生率均大于实验组。结论 :准分子激光原位角膜磨镶术术中患者头位有不同程度的改变 ,头位的改变对手术疗效有一定程度的影响 ,进一步做好准分子激光原位角膜磨镶术术中患者的心理护理、协助手术医师发现及纠正患者术中头位变化是十分必要的。     

准分子激光角膜上皮瓣下磨镶术中角膜上皮瓣的活性

背景：保证角膜上皮瓣活性的最佳乙醇浸润时间是准分子激光角膜上皮瓣下磨镶术研究的热点。目的：观察准分子激光角膜上皮瓣下磨镶术后影响角膜上皮瓣活性的相关因素。方法：应用前瞻性研究方法选取50例（100眼）行准分子激光角膜上皮瓣下磨镶术患者,术眼按度数分为轻度近视（〈-3.00m-1）40眼和中度近视（-3.00～-6.00m-1）60眼。术中乙醇作用时间分别为15,25s。结果与结论：术后1周、1,6,12个月时,相同近视度数下,与乙醇作用25s比较,术中乙醇作用15s眼的裸眼视力明显提高,角膜上皮愈合时间加快（P〈0.01）,角膜荧光素染色评分降低,雾状角膜混浊程度降低（P〈0.05或P〈0.01）。相关性分析显示,角膜荧光素染色评分与雾状角膜混浊程度呈正相关（P〈0.01）。说明准分子激光角膜上皮瓣下磨镶术中切削深度相当情况下,乙醇浸润时间越短,角膜上皮瓣制作质量越高,术后角膜上皮瓣活性越好,愈合较快、视力易恢复。     

高度近视患者行准分子激光上皮下角膜磨镶术角膜上皮瓣去留对术后视觉质量的影响

目的探讨高度近视患者经准分子激光上皮下角膜磨镶术治疗过程中去除、保留角膜上皮瓣对患者术后视觉质量的影响情况。方法选取2017年1月至2018年1月高度近视患者28例,按照随机数表法其分为研究组与对照组,每组14例。研究组行去除角膜上皮瓣准分子激光上皮下角膜磨镶术,对照组行保留角膜上皮瓣准分子激光上皮下角膜磨镶术。结果两组术前裸眼视力(UCVA)比较,差异未见统计学意义(P0.05),术后5 d研究组UCVA显著高于对照组(P0.05),术后随访6个月两组UCVA比较,差异未见统计学意义(P0.05);研究组术后角膜上皮愈合时间、术后5 d VAS评分均显著少于对照组(P0.05);研究组术后角膜上皮下雾状混浊总发生率与对照组比较,差异未见统计学意义(P0.05)。结论应用去除角膜上皮瓣准分子激光上皮下角膜磨镶术治疗高度近视有效性、安全性均较优,有利于保障患者术后视觉质量及预后。     

准分子激光上皮瓣下角膜磨镶术的手术配合

[目的]总结准分子激光上皮瓣下角膜磨镶术(LASEK)的手术配合措施.[方法]回顾性分析2 350例(4 638眼)准分子激光上皮瓣下角膜磨镶术病人的临床资料.[结果]本组病人术后随访3个月～6个月,术后90%病人轻度不适,无一例感染,均达到预期效果.[结论]加强准分子激光上皮瓣下角膜磨镶术病人的手术配合是手术成功的保证.     

基于心理干预的综合护理在准分子激光原位角膜磨镶术患者中的应用效果

目的：探讨基于心理干预的综合护理在准分子激光原位角膜磨镶术患者中的应用效果。方法：将2012年2月~2014年3月在我院激光近视治疗中心行准分子激光原位角膜磨镶术治疗屈光不正的240例患者随机分为综合干预组和常规护理组各120例,常规护理组采取常规护理措施,综合干预组在常规护理基础上给予基于心理干预的综合护理措施,比较两组患者干预前后血压和心率变化情况,利用 Zung 焦虑自评量表（SAS）对患者焦虑水平进行评估,对患者对护理过程满意度进行调查。结果：常规护理组干预后收缩压、舒张压和心率均较干预前升高（P ＜0.05）,综合干预组仅心率出现升高（P ＜0.05）。综合干预组干预后收缩压、舒张压和心率均低于常规护理组（P ＜0.05）;干预后 SAS 评分低于常规护理组（P ＜0.05）;患者对护理过程的满意度高于常规护理组（P ＜0.05）。结论：基于心理干预的综合护理措施应用于准分子激光原位角膜磨镶术中有助于减轻患者心血管反应和焦虑情绪,提高患者对护理过程的满意度。     

准分子激光原位角膜磨镶术患者的护理干预

目的：促使患者积极配合手术治疗和术后护理，提高准分子激光原位角膜磨镶术（LASIK）的治疗效果。方法：通过对1518例LASIK手术患者实施护理干预，术前让其了解手术过程，解除心理顾虑；术中指导患者正确配合，采取准确体位和眼位；术后加强用药、护跟指导。结果：1518例患者中，1516例积极配合手术治疗与护理，1例因术中眼球固视不良而暂停手术，1例术后术眼意外受伤导致角膜瓣移位。结论：适时、有效的护理干预是提高准分子激光原位角膜磨镶术治疗效果、减少并发症的重要护理手段。     

准分子激光原位角膜磨镶术护理安全问题与管理对策

目的探讨如何提高准分子激光原位角膜磨镶术的护理质量管理。方法分析234例准分子激光原位角膜磨镶术患者术前、术中、术后易出现的护理问题,提出针对性管理措施。结果通过行使有效的护理管理措施,准分子激光原位角膜磨镶术护理达到满意效果,97.8%的患者达到术前的预期矫正视力,护理问题得到解决。结论提高护士对准分子激光原位角膜磨镶术护理安全的认识,采取针对性护理管理措施,是保证准分子激光原位角膜磨镶术安全开展的基础。     

优化全程护理在准分子激光上皮瓣下磨镶术中的应用效果

目的探讨优化全程护理在准分子激光上皮瓣下磨镶术中的应用效果。方法选取2017年7月至2019年7月本院收治的200例准分子激光上皮瓣下磨镶术患者作为研究对象,按照随机数字表法将其分为研究组与对照组,各100例。研究组实施优化全程护理,对照组实施常规护理。比较两组的护理效果。结果护理后,两组的SAS、SDS评分均低于护理前,且研究组低于对照组(P<0.05)。研究组的并发症总发生率低于对照组(P<0.05)。术后1、3个月,两组的视力水平均高于护理前,且研究组高于对照组(P<0.05)。研究组的护理满意度明显高于对照组(P<0.05)。结论优化全程护理应用于准分子激光上皮瓣下磨镶术中可调节患者心理状态,减少术后并发症的发生,促进视力恢复,提升护理满意度,值得临床推广应用。     

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.