预防骨科患者发生Ⅱ期压疮的护理方法及体会

由于骨折的疼痛和治疗的需要，骨科患者多处于被动体位，因此压疮发生的危险也相对增加，压疮的预防成为骨科护理管理的重要组成部分。本科自2003年4月～2006年4月共收治骨折患者1231例，达到了“住院患者Ⅱ期压疮发生率为零”的要求，将护理方法及体位介绍如下。     

老年骨科患者的临床护理体会

目的探讨老年骨科患者的临床护理方法。方法选取本院2014年1月~12月的老年骨科患者100例,对他们采取心理、饮食、并发症预防等全面的护理措施,并总结护理体会。结果对于压疮、呼吸道、泌尿道、心脑血管、骨的延迟愈合等并发症要采取针对性的护理措施。结论实施有效的护理措施,能提高老年骨科患者的治愈率。     

骨科患者发生压疮相关因素分析与护理对策

目的探究骨科患者发生压疮的危险因素与护理对策。方法选择2007年10月至2011年10月本院骨科压疮患者42例,对其危险因素进行调查与分析,并采取相应的护理对策。结果对于骨科压疮的护理重点在于及时掌握患者的危险因素,做好预防工作,通过护理方法改善患者受压处的皮肤情况。结论对于骨科卧床患者压疮危险因素进行评估,可以及时预测早期压疮的出现,以便采取相应的措施进行早期干预,延缓压疮的进展。     

Braden压疮风险评估表在骨科压疮高危患者中的应用

目的探讨Braden压疮风险评估量表应用于骨科压疮高危患者压疮预防的效果。方法将234例骨科住院患者随机分为实验组和对照组,每组各117例,对照组给予常规压疮预防护理,实验组在对照组基础上采用Braden评分量表进行评估,并对评分结果为13—14分的中度危险及得分小于该分的高度危险患者给予针对性预防措施。比较两组患者压疮发生情况。结果对照组117例患者中发生压疮10例,压疮发生率为8．7％,实验组发生压疮2例,压疮发生率为1．7％,组问比较差异有统计学意义（χ2=4．435,P〈0．05）。结论根据Braden评分量表对高危患者进行风险评估并采取针对性的护理措施能有效地降低压疮发生率,值得在临床推广应用。     

巧用小水枕预防压疮

我科从1998年以来将小水枕应用于神经外科危重患者和骨科患者,在防止压疮上取得满意的效果,现报告如下：     

3000ml3％氯化钠溶液在骨科压疮防治中的应用

骨科患者由于疾病的困扰卧床时间长，容易发生压疮，为了有效预防压疮的发生，本科将3000ml3％氯化钠溶液置于患者受压部位，取得了良好的效果。现将具体方法介绍如下。     

品管圈活动对降低骨科患者压疮发生率的效果

目的：探讨品管圈活动在降低骨科患者压疮发生率中的应用效果。方法在开展品管圈活动前,选取2013年6—7月于骨科住院的96例患者为对照组;开展品管圈活动后,选取2013年9—10月于骨科住院的96例患者为观察组。骨科8名护士自愿组成“奔跑圈”,确定活动主题为“降低骨科患者压疮发生率”,分析压疮发生的原因,并对其进行改进。结果观察组压疮发生率明显低于对照组（8.3%比17.7%,P〈0.05）。品管圈每位成员的责任心、发现并解决问题的能力、专业知识、沟通能力、团队协作精神、展示自我这6个方面均得到显著提高。结论品管圈活动不仅大大降低了骨科患者压疮的发生率,同时也提高了每位圈员的质量管理能力和团队协作意识。     

水垫在预防骨科患者局部压疮中的应用

压疮又称压力性溃疡,是骨科患者中最常见的护理问题之一,也是评价护理质量的一项重要内容。骨折患者由于肢体疼痛及活动受限,容易导致压疮的发生。压疮不仅给患者带来身体的痛苦,同时也增加其经济负担,严重时将延迟手术。如臀部、骶尾部的压疮将影响老年髋部骨折患者进行股骨头置换。我科护理人员在长期工作中发现应用水垫可预防骨折患者臀部     

品管圈活动在降低老年骨科手术患者中发生压疮的作用

目的：探讨品管圈活动在降低老年骨科手术患者中发生压疮的作用。方法采用随机抽样法选取2012年10月至2013年10月在我院实施骨科手术的患者100例,将2012年10月至2013年4月的50例患者设为对照组,将2013年5月至2013年10月的50例患者设为观察组。对照组患者给予常规的护理措施;观察组患者按照品管圈活动的要求进行系统的护理。记录并分析两组患者的满意度,并比较两组发生压疮的人数与次数以及圈内人员实施品管圈活动后的各项目平均值。结果品管圈活动后,观察组患者的各项满意度均高于对照组（均P＜0．05）,且观察组压疮人数和压疮次数与对照组相比,均有了明显的改善（均P＜0．05）。品管圈活动后,圈员的各项目的评分均明显高于活动实施前（均P＜0．01）。结论应用品管圈活动在降低骨科手术患者中发生压疮的因素多为外在因素,可通过护理人员加以预防。     

压疮预防快速参考指南应用于骨科围手术期效果评价

目的探讨《压疮预防快速参考指南》运用于骨科围手术期患者预防压疮的临床效果.方法观察2010年7月~2011年6月123例行骨科手术的患者,围手术期按照2009年《压疮预防快速参考指南》对患者实施护理,与往年未执行参考指南时期同类患者压疮发生率进行比较.结果观察组按照《压疮预防快速参考指南》流程实施护理,未出现1例新发压疮患者,远低于往年同类患者压疮发生率3.3%,预防效果显著.结论应用《压疮预防快速参考指南》可有效降低压疮的发生率,提高患者的生活质量.     

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.