心理干预对糖尿病患者焦虑抑郁状态的影响

目的：探讨心理干预对糖尿病患者焦虑抑郁状态的影响。方法将72例糖尿病患者随机分成干预组和对照组各36例。对照组采用常规护理方法,干预组在对照组的基础上给予个体化和集体化的心理干预,分别在入院、出院时采用焦虑自评量表( SAS )和抑郁自评量表( SDS )对72名患者进行问卷调查,评估心理干预后两组患者焦虑抑郁状态的改变情况,同时在出院时调查对护理工作的满意度。结果两组患者入院时焦虑和抑郁评分比较差异无统计学意义(P＞0.05),经心理干预治疗后,干预组焦虑评分为(40.12±8.25)分,低于对照组(46.08±9.02)分,差异有统计学意义(P＜0.05),干预组抑郁评分为(39.02±8.21)分,低于对照组(45.72±8.69)分,差异有统计学意义(P＜0.05)。结论心理干预可以明显缓解糖尿病患者的焦虑和抑郁,改善患者生活质量,同时提高患者对护理工作的满意度。     

护理干预对慢性心力衰竭患者负性情绪、遵医行为和生活质量的影响

目的 探讨护理干预对慢性心力衰竭患者负性情绪、遵医行为和生活质量的影响. 方法 选择100例慢性心力衰竭患者作为研究对象,随机分为观察组和对照组各50例.对照组仅接受常规的基础护理、生活护理与治疗处置,观察组在此基础上进行包括健康教育、舒适环境、体力活动、遵医行为、饮食和心理指导.观察组在患者入院第3天实施干预,并分别在患者入院第3天和出院时对2组患者进行焦虑、抑郁、遵医行为和明尼苏达心力衰竭生活质量调查表的测试.采用χ2检验和t检验对数据进行分析. 结果 干预前,观察组与对照组的抑郁、焦虑评分,遵医行为各项构成比,以及生活质量各因子评分比较差异无统计学意义.干预后,2组抑郁、焦虑评分,按时服药、定期复查、合理膳食、戒烟限酒、体力活动等遵医行为,体力限制、情绪、症状、社会限制等生活质量评分比较,观察组均显著优于对照组. 结论 护理干预有利于改善患者焦虑、抑郁负性情绪,促进患者的遵医行为,提高生活质量.     

糖尿病肾病早期微量白蛋白尿病人的综合护理干预

[目的]探讨综合护理干预对门诊糖尿病肾病早期微量白蛋白尿病人的应用效果。[方法]将门诊糖尿病肾病早期微量白蛋白尿病人随机分为观察组和对照组各46例。对照组接受门诊专科护士常规建档管理,观察组在对照组干预措施基础上实施综合护理干预。比较两组病人干预前和干预1年后遵医行为,激惹、抑郁和焦虑评分,以及糖尿病肾病危险因素控制率及生活质量的变化。[结果]干预1年后,观察组激惹、抑郁和焦虑总分[(22. 56±2. 89)分]、生存质量总分[(37. 55±8. 69)分]低于对照组[(24. 07±3. 85)分、(70. 12±7. 85)分],遵医行为、糖尿病肾病危险因素控制率高于对照组,差异均有统计学意义(P0. 05)。[结论]综合护理干预有助于提高糖尿病肾病早期微量白蛋白尿病人的治疗依从性,改善负性情绪,提高生活质量。     

护理干预对慢性心力衰竭患者负性情绪、遵医行为和生活质量的影响

目的探讨护理干预对慢性心力衰竭患者负性情绪、遵医行为和生活质量的影响。方法选择100例慢性心力衰竭患者作为研究对象,随机分为观察组和对照组各50例。对照组仅接受常规的基础护理、生活护理与治疗处置,观察组在此基础上进行包括健康教育、舒适环境、体力活动、遵医行为、饮食和心理指导。观察组在患者入院第3天实施干预,并分别在患者入院第3天和出院时对2组患者进行焦虑、抑郁、遵医行为和明尼苏达心力衰竭生活质量调查表的测试。采用r检验和t检验对数据进行分析。结果干预前,观察组与对照组的抑郁、焦虑评分,遵医行为各项构成比,以及生活质量各因子评分比较差异无统计学意义。干预后,2组抑郁、焦虑评分,按时服药、定期复查、合理膳食、戒烟限酒、体力活动等遵医行为,体力限制、情绪、症状、社会限制等生活质量评分比较,观察组均显著优于对照组。结论护理干预有利于改善患者焦虑、抑郁负性情绪,促进患者的遵医行为,提高生活质量。     

综合性心理护理对肝硬化患者负性情绪、遵医行为及生活质量的影响

目的:探讨综合性心理护理对肝硬化患者负性情绪、遵医行为及生活质量的影响。方法:选取2018年6月~2019年2月收治的80例肝硬化患者作为研究对象,随机分为对照组和观察组,各40例。对照组实施常规护理,观察组在对照组的基础上实施综合性心理护理,比较两组患者负性情绪、遵医行为及生活质量。结果:护理后,观察组焦虑自评量表及抑郁自评量表评分均低于对照组,差异均有统计学意义(P<0.05);观察组遵医率高于对照组,差异有统计学意义(P<0.05);观察组生活质量高于对照组,差异有统计学意义(P<0.05)。结论:实施综合性心理护理可有效减少肝硬化患者的负性情绪,显著提升其遵医行为及生活质量。     

护理干预对糖尿病患者出院后遵医行为及血糖的影响

目的 探讨护理干预对糖尿病患者出院后遵医行为的影响.方法 将190例糖尿病患者按出院顺序随机分为干预组和对照组各95例,两组患者出院后均接受系统的饮食疗法、药物疗法、运动疗法等,干预组在此基础上给予护理干预.于患者出院时及出院6 mo末采用自行设计的遵医行为问卷评定遵医行为,同时测定血糖并进行对比分析.结果 遵医行为问卷评分护理干预前两组各因子分比较均无显著性差异(P＞0.05),护理干预6 mo末干预组按时检查、饮食控制、药物疗法、自我监测因子分均显著高于对照组(P均＜0.01),日费用及血糖水平显著低于对照组(P均＜0.01).结论 护理干预对提高糖尿病患者出院后遵医行为效果显著,对控制血糖水平具有重要作用.     

AIDET沟通联合延续性护理干预在输尿管结石术后携带双“J”管出院患者中的应用

目的：探究AIDET沟通联合延续性护理干预在输尿管结石术后携带双“J”管出院患者中的应用。方法：选取2017年1月~2019年1月收治的92例输尿管结石术后携带双“J”管出院患者为研究对象,根据入院顺序分为对照组和实验组各46例,对照组给予常规干预,在此基础上实验组给予延续性护理干预联合AIDET沟通。观察两组患者遵医行为、生活质量及焦虑、抑郁程度。结果：实验组遵医率为93.48%,高于对照组的71.74%（P＜0.05）;干预后实验组焦虑、抑郁评分低于对照组,生活质量评分高于对照组（P＜0.05）。结论：AIDET沟通联合延续性护理干预应用于输尿管结石术后携带双“J”管出院患者,有助于减轻患者焦虑、抑郁程度,促进遵医行为,改善生活质量。     

个性化健康教育对糖尿病患者生活质量及遵医行为的影响

目的探讨个性化健康教育对糖尿病患者生活质量及遵医行为的影响。方法将70例糖尿病患者随机分为观察组35例和对照组35例。对照组采用传统的健康教育方法,观察组采用个性化的健康教育方法。分别在两组患者入院时、出院时、出院后2w运用生活质量评定量表和遵医行为调查问卷进行调查,观察比较两组患者生活质量和遵医行为情况。结果入院时两组患者生活质量及遵医行为评分比较,差异无统计学意义(P0.05);出院时和出院后2w两组患者生活质量及遵医行为评分较入院时均有提高,而观察组明显高于对照组,差异具有统计学意义(P0.05,P0.01)。结论实施个性化健康教育可提高糖尿病患者的生活质量和遵医行为。     

“双心”干预对中青年急性心肌梗死患者心脏康复的影响

目的:探讨"双心"干预对中青年急性心肌梗死(AMI)患者心脏康复的影响。方法:将60例中青年AMI患者随机分为观察组和对照组各30例,对照组给予常规治疗和健康指导,观察组在对照基础上实施"双心"护理干预。比较两组心脏事件发生率及遵义行为,分别采用生活质量综合评定问卷(GQOI-74)、焦虑自评量表(SAS)、抑郁自评量表(SDS)评价患者生活质量、焦虑及抑郁情况。结果:干预后观察组躯体健康度、心理健康度、社会功能维系度均好于对照组,焦虑、抑郁心理评估分数明显降低(P0.05),遵医行为显著改善(P0.05)。结论:"双心"干预能显著改善中青年AMI患者心脏康复期的心理状态,提高遵医行为,提高生活质量。     

基于“微信平台”的延续性管理对冠心病搭桥术后患者希望水平及遵医行为的影响

目的探讨基于“微信平台”的延续性管理对冠心病搭桥术后患者希望水平及遵医行为的影响。方法收集我院心脏外科收治的160例首次行冠状动脉搭桥手术治疗的冠心病患者作为观察对象,在开通微信平台前(2017年4-10月)选取80例患者作为对照组,出院后给予常规延续性护理,在开通微信平台后(2018年5-11月)选取80例患者作为观察组,出院后给予基于“微信平台”的延续性护理。出院前及干预1、3、6个月后,采用调查量表评估患者遵医行为,出院前及干预6个月后,运用Herth希望量表评估患者希望水平、采取WHO生存质量测定量表(WHO QOL-BREF)评价患者生存质量。结果干预1个月、3个月、6个月后,观察组的遵医行为评分为(68.84±3.02)分、(75.69±3.45)分、(93.38±5.54)分,均高于对照组的(60.28±2.93)分、(68.70±3.10)分、(80.13±4.34)分(P<0.05);干预后6个月,观察组Herth希望量表总评分为(39.50±4.01)分,高于对照组的(31.57±3.84)分(P<0.05);观察组生理领域评分为(16.05±2.20)分、心理领域评分为(18.05±2.84)分、社会领域评分为(15.34±2.06)分、环境领域评分为(18.02±2.89)分,均高于对照组的(13.08±1.96)分、(14.43±2.16)分、(13.48±1.92)分、(13.59±2.40)分,差异均有统计学意义(P<0.05)。结论基于“微信平台”的延续性管理能够有效增强冠心病搭桥术后患者遵医行为,提高希望水平及生活质量水平。     

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.