舒适护理模式在住院患者中的应用及效果评价

目的 探讨对住院患者实施舒适护理的效果和可行性,为舒适护理的全面开展提供依据.方法 收集符合标准的住院患者300例并随机分为对照组和干预组,各150例,以问卷调查形式了解患者的舒适需求,对干预组实施舒适护理,对照组给予常规护理.比较2组患者的舒适度和住院满意度.结果 干预组患者入院与出院时舒适度增加量大于对照组,比较差异均具有统计学意义（P〈0.05）.干预组患者的住院满意度高于对照组,比较差异有统计学意义（P〈0.05）.结论 在病房实施舒适护理可最大程度满足患者的需求及舒适度,提高患者的满意度,并取得良好的社会效益.     

对住院患者实施舒适护理的效果及可行性分析

目的 探讨对住院患者实施舒适护理的效果和可行性,为舒适护理的全面开展提供依据.方法 收集符合标准的住院患者300例,随机分为对照组和干预组各150例,以问卷调查的形式了解患者的舒适需求,对干预组实施舒适护理,对照组实施常规护理.通过舒适度自我评分表对2组患者的舒适度和住院满意度进行比较.结果 对照组和干预组的患者人院与出院时舒适度比较差异均有统计学意义(P＜0.05).出院时2组患者舒适度比较差异有统计学意义(P＜0.05),出院时2组患者的满意度比较差异有统计学意义(P＜0.05).结论 在病房实施舒适护理可最大程度满足患者的需求及舒适度,提高患者的满意度,并取得良好的社会效益.     

舒适护理在血液护理中的应用探讨

目的探讨在血液护理中实施舒适护理的临床应用价值。方法将我院治疗的白血病患者85例随机分为干预组40例与对照组45例,对照组采用常规护理,干预组实施有针对性的舒适护理。结果两组患者在护理后的舒适度评分均显著高于护理前,两组比较,差异有统计学意义（P〈0．05）,干预组护理后舒适度评分高于对照组,两组比较,差异有统计学意义（P〈0．05）。结论血液护理中实施舒适护理,可以有效提高医院护理服务的质量,大大提高了患者的舒适程度,值得临床推广应用。     

舒适护理对乳腺癌化疗患者生活质量的影响

目的探讨舒适护理对乳腺癌化疗患者生活质量的影响。方法采用方便抽样法选取乳腺癌改良根治术后住院化疗患者80例作为研究对象，将其随机分为干预组与对照组各40例。对照组采用常规护理，干预组在此基础上给予化疗全程的舒适护理。采用欧洲癌症研究和治疗组织癌症患者生活质量问卷调查表（QLQ—C30）、医院焦虑和抑郁量表（HADS）和自编护理工作满意度调查表定期对2组患者进行评定。结果干预前2组患者的生活质量比较差异无统计学意义（P〉0．05），干预后差异有统计学意义（P〈0．05）。干预组的抑郁和焦虑的发生率明显低于对照组（P〈0．05），对护理工作的满意度明显高于对照组（P〈0．05）。结论舒适护理能够提高护理服务质量，减少焦虑、抑郁状态的发生，提高乳腺癌化疗患者的生活质量。     

SFA综合干预预防急性冠状动脉综合征患者便秘的效果

目的探讨SFA干预法预防急性冠状动脉综合征（ACS）患者便秘的效果。方法将93例ACS患者随机分为干预组44例和对照组49例。对照组实施常规预防便秘的护理措施,干预组在此基础上加入SFA干预法。比较两组患者便秘情况、住院期间在排便过程中发生并发症的例数以及排便后的舒适满意度。结果干预组患者便秘发生率、缓泻剂和开塞露的使用率分别为27．27％,25．00％,2．27％,均低于对照组的48．92％,51．02％,26．53％,差异均有统计学意义（X2分别为4．604,6．616,10．668;P〈0．05）;两组患者首次排便时间比较,差异无统计学意义（P〉0．05）;两组患者排便用力、大便干结、腹泻发生率比较,差异均无统计学意义（P〉0．05）;干预组排便时排便不尽感和肛门直肠阻塞感发生情况均低于对照组,差异均有统计学意义（）（2分别为6．578,7．454;P〈0．05）;干预组患者排便后舒适满意度高于对照组,差异有统计学意义（x2=0．455,P〈0．05）;干预组患者住院期间排便过程中并发症的发生率低于对照组,差异有统计学意义（X2=4．247,P〈0．05）。结论SFA干预法有效地预防了ACS患者的便秘,提高了患者便后的舒适满意度。它是一种符合自然疗法的有效绿色护理方法,安全可靠,无副作用。     

认知行为干预对首次支气管镜检查患者舒适度的影响

目的探讨认知行为干预对首次电子支气管镜检查患者舒适度的影响。方法128例患者随机分为干预组和对照组各64例,干预组在常规护理基础上进行认知行为干预,对照组仅实施常规护理,比较两组患者检查中血压、心率、血氧饱和度变化及并发症、舒适度、满意度。结果两组检查中血压、心率、血氧饱和度变化差异有统计学意义（P〈0．01）,干预组舒适度、满意度明显高于对照组（P〈0．01）,并发症发生率明显低于对照组（P〈0．01）。结论认知行为干预能最大程度满足首次电子支气管镜检查患者的舒适需求,提高满意度。     

连续护理模式对缺血性卒中患者的临床效果分析

目的探讨连续护理模式对缺血性脑卒中患者临床效果,为日后护理干预提供理论指导和实践依据。方法采用随机数字分组法将2010年5月～2013年5月入住本院神经内科缺血性卒中住院患者67倒分为连续性护理组35例和对照组32例,对照组患者仅给予神经内科常规治疗和护理,连续性护理组患者在实施常规护理的基础上增加连续性护理措施,分别在出院前3d和出院后3月进行资料收集,包括血TC、TG、Hcy指标;采用Barthel指数进行日常生活能力的测评;比较2组患者的PSHC和PSDC。结果连续性护理组出院后3月的BI指数较对照组比较差异有统计学意义（P〈0．05）,而出院前3d及提高幅度比较差异无统计学意义（P〉0．05）;出院后3月连续性护理组患者血TC、TG、Hcy指标的测量值均下降,并且具有统计学意义（P值均〈0．05）,而出院前3d2组患者相关指标的比较与对照组出院前3d与出院后3月的比较差异无统计学意义（P值均〉0．05）;连续性护理组患者的PSHC和PSDC均高于对照组（P〈0．05）。结论连续康复护理干预能够有效地降低脑卒中患者的血Tc、’rG、Hcy,提高脑卒中偏瘫患者的日常生活能力,提高患者出院后的满意度,值得在临床护理工作中进一步推广。     

临床护理路径对脑梗死患者康复效果及护理满意度的影响

目的探讨临床护理路径对脑梗死患者康复效果及护理满意度影响。方法选取我院收治的脑梗死患者164例,随机分为观察组和对照组各82例,观察组采用临床护理路径管理,对照组一般常规护理,比较两组rusl—Meyer运动功能评分、ADL日常生活活动能力评分,并于出院时进行护理满意度评价。结果出院时两组患者Fugl—Meyer评分和ADL评分均有好转,且观察组好转程度大于对照组,差异有统计学意义（P〈0．05）;观察组住院时间、住院费用低于对照组,差异有统计学意义（P〈0．05）,出院时观察组满意度87．43％,对照组满意度76．56％,两组满意度差异有统计学意义（P〈0．05）,观察组满意度高于对照组。结论对脑梗死患者应用临床护理路径管理可以提高护理人员护理主动性,促进患者康复,提高临床护理满意度。     

护理干预在卵巢癌患者化疗期舒适度变化中应用研究

目的探讨护理干预对卵巢癌患者化疗期舒适度的影响。方法选取2010年6月至2013年6月我院收治的40例卵巢癌患者为研究对象,随机分为观察组和对照组各20例,对照组给予常规护理,观察组在常规护理基础上采用心理、生理、药物不良反应等综合护理干预措施,比较两组舒适度变化及护理满意度。结果观察组舒适度评价明显高于对照组,差异有统计学意义（P〈0．05）;观察组护理满意度为95．00％,明显高于对照组65．00％,差异有统计学意义（P〈0．05）。结论卵巢癌患者心理与生理均承受着重大的压力,临床综合护理干预措施能有效缓解患者疼痛,提高化疗期舒适度,促进康复。     

疼痛护理干预对妇科腹腔镜手术患者术后肩痛及护理满意度的影响

目的：探讨疼痛护理干预在妇科腹腔镜患者术后护理中的应用效果。方法将本院2013年8月至2014年3月收治的80例妇科腹腔镜患者随机分为观察组和对照组,每组40例,对照组术后采用常规护理,观察组在对照组的基础上术后加强疼痛护理干预,比较两组术后肩痛情况、护理满意度及住院时间。结果两组患者术后6 h的肩痛评分差异无统计学意义（P＞0．05）。观察组术后24、48、72小时的肩痛评分均低于对照组,镇痛剂使用剂量少于对照组,出院前在生理、心理、社会环境、文化方面的舒适度评分均高于对照组,差异有统计学意义（ P＜0．05）。观察组的住院时间短于对照组,在服务态度、护理过程、护理结果等方面的护理满意度均高于对照组,差异有统计学意义（ P＜0．05）。结论疼痛护理干预有利于减少妇科腹腔镜患者术后肩痛程度,提高患者的舒适度和护理满意度,促进患者术后康复。     

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.