常用人工肝支持方法的原理、临床应用和展望

我国人工肝技术临床应用尽管只有十多年的历史，但发展很快，正逐渐为成为重型肝炎肝衰竭及其它一些肝病常用和有效的治疗方法。目前有上百家单位开展相关临床治疗，数十家机构进行相关基础研究。由于我国肝病的多发性及肝脏移植尚不普及，因此人工肝发展潜力仍然很大。由于肝脏在人体代谢的中枢地位、复杂性及肝病的多发性和多样性，使得人工肝支持比其它任何人工器官方法更多，困难更大。本文综述了国内外几种主要人工肝技术的原理及临床应用情况，并就人工肝脏治疗存在的困难及发展方向进行初步讨论和展望。     

MARS人工肝治疗仪的临床使用和护理体会

近年人工肝脏技术发展迅速，有望成为重型肝炎肝衰竭及其它一些肝病最常用和最有效的治疗方法之一。分子吸附循环系统(MARS)人工肝治疗仪是新近用于临床的人工肝支持系统，在国内尚未普及。本文着重介绍了MARS人工肝治疗仪的工作原理及使用中的护理体会。     

学会动态

第一次全国人工肝学术会议简讯由中华医学会医学工程学分会、中华医学会传染病寄生虫学分会共同主办 ,首都医科大学北京佑安医院承办的第一次全国人工肝学术会议 ,拟于２００２年６月在北京召开。会议将全面展示和总结我国人工肝治疗研究的经验和成就 ,并就人工肝治疗、护理、设备、细胞及组织工程、高分子材料及相关血液净化技术等多个方面进行专题演讲和讨论。征文内容 :１、人工肝临床研究和应用２、人工肝基础研究 ;３、人工肝临床护理 ;４、人工肝相关设备的购置、管理、使用、维护维修 ;５、人工肝相关高分子材料的研究和应用 ;６、其…     

人工肝设备的发展现状及展望

本文简述了人工肝治疗技术的起源、发展和分类,结合人工肝设备系统组成成分,包括血流动力系统、智能操控系统、安全监测报警系统以及肝脏模拟辅助装置,明确了人工肝设备的发展现状。通过对不同品牌、不同功能治疗设备的临床应用和市场调查,分析了人工肝设备与治疗的相互关系,实验与临床的应用需求。指出人工肝在物理治疗的基础上,组合生物反应治疗将是临床创新突破的研究路线,未来的人工肝设备发展趋向于离线混合型治疗的多功能应用模式。     

非生物型人工肝设备与技术专家共识

肝衰竭是多种因素引起的以黄疸及凝血功能障碍为主要特征的严重肝脏损害症候群。人工肝支持系统(简称人工肝是暂时替代肝脏部分功能的体外生命支持系统,为肝衰竭的主要治疗手段之一,其中非生物型人工肝(NBAL)被证明有效且在临床应用广泛。NBAL治疗因其在临床适用范围与技术操作上的特点,对NBAL设备的性能、管理及操作规范有特殊要求。四川大学华西医院结合多年的人工肝技术与设备应用经验,对常用的NBAL技术与设备参数要求发布“非生物型人工肝设备与技术专家共识”,为计划开展NBAL治疗的医疗机构提供适用设备选择指导,为研发人工肝设备的科研机构与生产企业提供参照依据,促进人工肝技术与设备的发展。     

膜式血浆交换疗法治疗肝功能衰竭的新进展

笔者在十五年前曾对加快我国人工肝研究的必要性发表过一篇调研报告,对人工肝的治疗方法进行过比较分析。但由于种种原因,在我国推行人工肝的治疗,无论是生物型或非生物型,都长期处于缓慢的发展时期,有部份医院虽然在这方面做了不少工作,但由于很多基础研究工作还未能跟上,加上在国内开展的还很不普及,对所取得的疗效究竟是药物的作     

人工肝支持系统应用简介

本文回顾了人工肝的发展及在临床急慢性肝脏功能衰竭中的应用。目前非生物型人工肝仍在临床广泛应用并取得了较好效果。非生物型人工肝目前国内应用最多的方法为血浆置换法，一般血浆置换法设备是由多组泵、阀、管路、传感器以及过滤器（分离器）组合而成，并由计算机控制的系统。因为血浆置换法是侵入性的，设备的特点是安全性必须好，但由于肝脏功能的复杂性，以体外培养活性细胞为中心的生物型或混合型人工肝在肝衰时的支持治疗作用会更加明显和接受自然肝脏的功能。生物型人工肝发展迅速，但还有一系列问题需要解决。     

人工肝设备和技术的进展与临床评价

人工肝脏技术是人体重要的器官支持治疗，有望成为重型肝炎肝衰竭及其它一些肝病最常用和最有效的治疗方法之一。由于肝脏在人体代谢的中枢地位、复杂性及肝病的多发性，使得人工肝支持系统比其它任何人工器官更具发展潜力和挑战性。本文综述了几种主要人工肝技术的进展与临床应用情况，并对人工肝脏治疗存在的困难及发展方向进行了讨论和展望。     

人工肝支持系统的设备及其应用选择

近年来人工肝的临床试用成为新一轮的研究热点，人工肝的设备和技术也得到空前发展，为临床应用提供了条件。详尽地介绍了人工肝支持系统的组成。目前国内的相关设备，并就设备的应用选择发表参考意见。     

新型人工肝——分子吸附再循环系统及其临床应用

到目前为止，急慢性重型肝炎的治疗仍强调基础护理和一般的支持对症处理，缺乏清除肝脏毒素和促进肝细胞再生的有效手段。虽然血液透析、灌流和血浆置换已被用于重型肝炎的治疗，但其临床疗效尚未被公认。与上述血液净化方法不同的是，新型人工肝－－分子吸附再循环系统在有效清除水溶性中小毒素分子的同时，还可以选择性清除亲脂性及与血浆白蛋白相结合的毒素分子，并保留血液中有用的重要营养物质和蛋 白质。本文对这一新型人工肝支持系统的基本原理、使用方法、不良反应及临床应用研究进展作了综述。     

社区常见家庭护理问题的临床路径探索

目的为改善社区管理现状,探索科学的社区护理管理模式,开展了社区常见家庭护理问题的临床护理路径探索。方法社区家庭护理专职护士对社区患者按照规范的临床护理路径实施系统开展护理操作,并与未进入临床护理路径的社区患者进行比较,开展专职护士间的比较,达到探索科学临床护理路径的目标。结果进入社区家庭临床护理路径的患者转归情况与社区接受一般护理治疗无差异,在许多护理学指标方面都显示出管理优势,在护理造作质量的优秀率上进入路径操作高于一般临床护理,进入路径的患者住院天数及费用低于一般护理治疗患者。结论社区临床护理路径这一全新的护理服务模式,正随着我国的改革开放被引入,其高品质、低费用的服务宗旨符合我国目前的卫生体制改革的政策。     

Cooperation in the care of the institutionalized elderly in a rural community

OBJECTIVE: To develop a method of addressing and minimizing the institutional, cultural, and regulatory barriers to the care of nursing facility residents in our community. METHODS: Nurses, administrators, and medical directors from all the nursing facilities in our community plus representatives from the community hospital participated in a monthly meeting where difficult issues in the care of nursing facility residents were discussed. The committee developed responses to these issues that were implemented throughout the community. RESULTS: This committee has provided an opportunity for the whole community to address problems in the care of the institutionalized elderly. Systems have been developed which have improved communication between nurses and physicians and between nursing facilities and the hospital. Community standards for the care of common problems in nursing facility residents have also been developed. Other unexpected benefits have included community discussion of regulatory concerns, nurse assistant education, and care at the end of life, as well as coordination of laboratory services in the nursing facilities. Other rural communities may find a similar approach useful.     

双胎妊娠期急性脂肪肝合并DIC 1例的护理体会

回顾1例双胎妊娠期急性脂肪肝合并弥散性血管内凝血（DIC）的抢救与护理体会。通过对妊娠晚期孕妇急性脂肪肝（AFLP）配合医生迅速终止妊娠,同时做好DIC及产后出血的抢救与护理,加强人工肝治疗（血浆置换）的急救与护理,预后可明显改善。     

基于人工智能干预的临床试验研究进展

随着越来越多的人工智能技术被开发应用于医疗卫生领域,近年来以人工智能为干预的临床试验开始不断出现.本文将介绍以人工智能为干预措施的临床试验的发展现状、方案指南、报告规范和面临的挑战与展望,以便于未来研究者规范地开展此类临床试验,推动人工智能技术在医疗卫生领域的发展与应用.     

Measurement of nursing practice models using multiattribute utility theory: relationship to patient and organizational outcomes

Workforce shortages are challenging administrators in the health care environments to examine existing models of providing care. Although characteristics of nursing care delivery contribute in important ways to the success or failure of hospital care, factors common to all practice models have not been identified nor have measurement strategies been designed that assess the impact of care on patient and organizational outcomes. The purpose of this study was to test a measurement model of nursing practice that was developed using multiattribute utility theory. A total of 24 factors identified by expert nurse administrators as being common to all nursing practice models were mathematically formulated into a multidimensional composite index that represented the degree to which a practice model on a nursing unit approached the professional ideal. The index was tested with 298 registered nurses working on 28 medical surgical nursing units in 3 hospitals. The model was evaluated in 2 ways: first by comparing the composite index scores to a qualitative appraisal of the nursing unit's practice model and patient and organizational outcomes. Secondly, individual factors in the model were evaluated in the same manner. While the composite index was not fully validated, there is strength in the evidence of the relationship between individual factors and outcomes. Specifically, factors that addressed interactions among health care team members were most often related to outcomes.     

护理干预在人工肝联合抗病毒治疗慢加急性肝衰竭中的应用

目的探讨人工肝支持系统联合抗病毒在治疗慢加急性肝衰竭过程中易出现的问题及护理对策。方法对120例慢加急性肝衰竭患者,随机分为护理干预组和非护理干预组（对照组）。观察治疗前、治疗中、治疗后各种不良反应的发生率。结果护理干预组各种不良反应发生率均低于对照组。结论通过护理干预,可以减少各种不良反应的发生率,保证人工肝治疗顺利进行,提高患者使用核苷类抗病毒药物的依从性。     

康乐保保护膜保护法应用于小儿肠造口术后瘘周皮炎的护理分析

目的通过与其他应用于小儿肠造口术后瘘周皮炎护理的方法相比较,讨论康乐保保护膜保护法在小儿肠造口术后发生瘘周皮炎护理上的优点。方法抽出从2011年1月—2012年10月在该院进行肠造口手术发生瘘周皮炎的85例患儿进行分组护理。结果在对42例患儿临床观察中,通过对两种护理方法对比得出:采用康乐保保护膜保护法护理瘘周皮炎患儿效果显著。结论小儿肠造口术后发生瘘周皮炎护理难度大,根据我院临床护理经验,采用康乐保保护膜+造口袋进行小儿肠造口护理,对瘘周皮炎的发生有很好的预防和治疗效果。     

Determinants in the development of advanced nursing practice: a case study of primary-care settings in Hong Kong

Different factors have been shown to influence the development of models of advanced nursing practice (ANP) in primary-care settings. Although ANP is being developed in hospitals in Hong Kong, China, it remains undeveloped in primary care and little is known about the factors determining the development of such a model. The aims of the present study were to investigate the contribution of different models of nursing practice to the care provided in primary-care settings in Hong Kong, and to examine the determinants influencing the development of a model of ANP in such settings. A multiple case study design was selected using both qualitative and quantitative methods of data collection. Sampling methods reflected the population groups and stage of the case study. Sampling included a total population of 41 nurses from whom a secondary volunteer sample was drawn for face-to-face interviews. In each case study, a convenience sample of 70 patients were recruited, from whom 10 were selected purposively for a semi-structured telephone interview. An opportunistic sample of healthcare professionals was also selected. The within-case and cross-case analysis demonstrated four major determinants influencing the development of ANP: (1) current models of nursing practice; (2) the use of skills mix; (3) the perceived contribution of ANP to patient care; and (4) patients' expectations of care. The level of autonomy of individual nurses was considered particularly important. These determinants were used to develop a model of ANP for a primary-care setting. In conclusion, although the findings highlight the complexity determining the development and implementation of ANP in primary care, the proposed model suggests that definitions of advanced practice are appropriate to a range of practice models and cultural settings. However, the findings highlight the importance of assessing the effectiveness of such models in terms of cost and long-term patient outcomes.