家庭护理干预对产后抑郁症发病影响的研究

目的探讨家庭护理干预对改善产后抑郁症的效果。方法选择在我区区域内常住或暂住第一胎顺产的产妇1525人,按住院的先后顺序排号单数为观察组763人,双数为对照组762人。观察组按设计的家庭护理干预措施实施干预,对照组按常规的产后家庭访视进行,分别在产后第42天及第6个月用产后抑郁评分表(EPDS)进行测评,EPDS总分<12分为阴性,≥13分为阳性,即诊断为产后抑郁症。比较2组产妇的产后抑郁情况。结果产后42d抑郁症的发生率观察组和对照组分别为2.36%和10.5%,产后6个月抑郁症发生率观察组和对照组分别为3.15%和12.3%,2组比较差异均有统计学意义,P<0.01。结论通过实施家庭护理干预有效地降低了产后抑郁症的发生,提高了产妇的生活质量。     

围术期三联护理支持在剖宫产产妇产后抑郁症中的应用

[目的]观察围术期三联护理支持在剖宫产产妇产后抑郁症中的应用效果。[方法]将106例接受剖宫产干预的产妇按随机数字表法分为对照组和观察组,每组53例,对照组接受常规剖宫产护理,观察组在对照组基础上针对生理不适、心理问题与信息不足等加用三联护理支持,对两组产妇干预后爱丁堡产后抑郁量表(EPDS)评分、满意度及抑郁症发生率进行比较。[结果]观察组干预后EPDS评分和产后抑郁症发生率低于对照组,护理满意率高于对照组(P0.05)。[结论]采用三联护理支持对剖宫产产妇施以产后抑郁症防治干预,可降低剖宫产产妇产后抑郁发生率与抑郁程度。     

围生期心理护理对产后抑郁的影响

目的探讨围生期心理护理干预对产后抑郁的有效性。方法抽取100例产前抑郁状态孕妇，随机分为干预组54例和对照组46例，干预组产前抑郁孕妇在常规产前教育和分娩护理的基础上，接受系统的心理护理干预，对照组接受常规产前检查，产前教育和产褥期护理，观察2组孕妇产后42天EPDS抑郁评分和产后抑郁症的发生率。结果心理护理干预组与对照组在孕28周基础EPDS评分比较无显著性差异（P〉0．05），而产后6周2组比较差异有显著性（P〈0．05），且干预组心理护理干预前后（孕28周与产后6周）比较有高度显著性差异60〈0．01）。产后6周干预组产后抑郁症的发生率为35．2％（19／54），而对照组产后抑郁症的发生率为63．0％（29／46），2组有显著性差异（P〈0．01）。结论对产前抑郁患者进行围生期的心理护理干预，能有效地减轻其抑郁情绪，降低产后抑郁症的发生。     

产后心理干预对产后抑郁症的影响

目的探讨产后心理干预对产妇产后抑郁症产生的影响。方法将120例产妇随机分为干预组（n=62）和对照组（n=58）,对照组接受传统的产后家庭访视,干预组在常规产后护理基础上,于产妇出院后7d、产后28d上门对产妇进行家庭访视,评估产妇心理问题,有针对性地进行心理干预。比较两组产妇满意度和抑郁症发病率。结果干预组产妇对家庭访视的满意度为100％,对照组为88．3％,差异有统计学意义（x2=12．43,P〈0．05）。两组产妇产后爱丁堡产后抑郁量表（EPDS）得分比较,干预组低于对照组[（7．59±2．40）vs（8．67±2．32）分],差异有统计学意义（t=2．29,P〈0．05）。抑郁症发病率对照组为17．2％,干预组为3．2％,两组比较差异有统计学意义（x2=6．54,P〈0．05）。结论产后心理干预能有效减少产妇产后抑郁症的发生。     

社康家庭护理干预在产后抑郁症产妇中的应用

目的:探讨社康家庭护理干预在产后抑郁症产妇中的应用效果。方法:选择我院2016年1~7月100例产后抑郁症产妇为研究对象,随机将其等分为对照组与观察组,对照组采取常规护理干预,观察组采取社康家庭护理干预,比较两组产妇产后的自身感觉、产妇体验成就感得分、产妇丈夫及家属参与护理婴儿的情况、产妇从哺乳中感受到快乐、产妇的睡眠质量、饮食的评分情况以及产后42 d、产后6个月的抑郁EPDS情况。结果:观察组产妇自身感觉情况、体验成就感得分、产妇从哺乳中感受快乐的评分高于对照组(P0.05),产妇丈夫及家属参与护理婴儿情况的得分、产妇睡眠质量得分、饮食情况得分均高于对照组(P0.05)。产后42 d、产后6个月的抑郁情况,观察组产妇明显优于对照组(P0.05)。结论:给予产后抑郁症产妇实施社康家庭护理干预,有效改善了产后抑郁情况,提高了其生活质量。     

护理干预对初产妇产后抑郁的作用

目的 探讨护理干预对治疗初产妇产后抑郁的作用以及影响初产妇产后抑郁的相关因素.方法 选取2010年1月-2010年6月我院住院的正常足月自然分娩初产妇100例,随机分为观察组和对照组,每组50例.对照组采用常规护理方法,观察组在常规护理方法的基础上应用心理护理等系统的护理干预.采用Edinburgh产后抑郁量表(EPDS)观察两组孕妇产后2 wEPDS评分和产后抑郁症的发生情况.结果观察组产后抑郁的发病率远远低于对照组,观察组发生产后2w抑郁症3例,发生率为6％;对照组发生产后抑郁症8例,发生率为16％,两组比较差异显著具有统计学意义(P＜0.05).结论 对初产妇孕产期进行合理有效的护理干预可有效减轻产妇的抑郁情绪,降低产后抑郁症的患病率,值得在护理实践中推广应用.     

护理干预对预防产后抑郁症的临床效果观察

目的探讨应用护理干预手段预防产后抑郁症的效果。方法选择2007年1-6月300例符合观察条件的产妇作为研究对象,随机分为对照组150例、观察组150例。对照组实行一般产科常现护理,观察组在产科常现护理的基础上实施综合的护理干预,产后6周用爱丁堡产后抑郁量表（EPDS）进行测评。结果观察组和对照组产后抑郁的发生率分别为5.3%和14.6%,2组比较差异有统计学意义（P〈0.01）。结论通过全面的护理干预能有效地降低产后抑郁症的发生率,提高产妇的生活质量。     

产科和新生儿科联合访视对产后抑郁症影响的研究

[目的]探讨产科和新生儿科联合访视对产后抑郁症的影响。[方法]按出院日期单双日分成观察组和对照组,观察组由产科高年资护士和新生儿科医生组成联合访视小组,对照组由产科护士按常规进行产后家庭访视。分别在产后第10天、第28天、第42天进行访视并采用爱丁堡产后抑郁量表(EPDS)进行测试,统计两组抑郁症发生率及其相关因素。[结果]观察组第42天产后抑郁症发生率为3.43%,对照组产后抑郁症发生率为15.45%,两组抑郁症发生率比较,差异有统计学意义(P<0.01)。[结论]联合访视能及时有效解决新生儿健康问题,加强对产妇心理状态的干预,是预防产后抑郁症发生的重要手段。     

产妇分娩期间丈夫的支持干预对其产后抑郁症发病的影响

[目的]探讨分娩时丈夫对妻子的支持干预措施对产后产妇抑郁症发病的影响。[方法]选择在我院分娩的孕妇200例,按1∶1的比例随机分为干预组和对照组各100例。对两组孕妇孕期行焦虑-抑郁情绪自评量表(HAD)测试;产后行艾迪产后抑郁量表(EPDS)测试。干预组采取常规护理及丈夫对妻子的支持干预措施,对照组采取常规护理。观察两组产妇出现产后抑郁症的情况。[结果]对照组产后焦虑-抑郁情绪发生率为43%,干预组发生率为14%;产后对照组抑郁病人13例,干预组6例,两组比较差异有统计学意义(P0.01)。产后抑郁症病人N量表评分、P量表评分明显高于产后无抑郁症者(P0.05);而产后抑郁症病人L量表评分明显低于产后无抑郁症者(P0.05);两者的E量表评分比较,差异无统计学意义(P0.05)。[结论]在常规护理基础上丈夫对妻子的支持干预措施能够显著降低产妇产后抑郁症的发生率。     

产后抑郁因素及护理干预效果分析

目的 分析引起产后抑郁症的相关因素并进行心理治疗评定。 方法 应用爱丁堡产后抑郁量表(EPDS)对2007年1~11月我院收治的432例孕产妇进行调查研究,并将患有抑郁症的产妇分为治疗组和对照组。治疗组全程进行针对性的护理,对照组采用一般护理,于产后42天比较2组抑郁发生情况。 结果 产妇的年龄与产后抑郁有关,高龄产妇产后抑郁发生率高;治疗组的抑郁发生情况好于对照组。结论 全程进行针对性的护理措施,能有效降低产妇产后抑郁症的发生率。     

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.