压疮高危患者居家护理相关因素的调查分析

目的：调查压疮高危患者居家主要照顾者对压疮预防知识、态度及行为的现状,分析家庭护理不当的相关因素。方法采用问卷调查法对抽取的108例压疮高危患者主要照顾者进行调查（一般资料调查、采用自行设计的压疮知信行评估问卷进行测评）。结果压疮高危患者居家主要照顾者对压疮的相关知识的认知程度不高,且缺乏正规的学习渠道。在压疮相关知识认知方面：大专及以上者优于大专以下者、护工优于亲属、接受过培训的人员优于未接受过培训人员、有护理经历的人员优于没有护理经历的人员（均P＜0.05）。在防护压疮的态度和行为方面：大专以下主要照顾者优于大专及以上者、护工优于亲属、接受过培训的人员优于未接受过培训人员、有护理经历的人员优于没有护理经历的人员（均P＜0.05）。结论压疮高危患者居家主要照顾者预防压疮的意识薄弱,应加强压疮防护知识的健康教育,广泛开展多种形式的健康宣教,降低压疮高危患者压疮的发生率,提高其生活质量。     

压疮患者居家换药护理管理模式探索

目的：探讨压疮患者居家换药护理模式,解决居家压疮患者行动不便、就医困难、家属及照顾者处理方法落后的局面．为居家压疮患者家属提供简单实用的换药操作流程和压疮预防指南,减少居家压疮患者压疮相关医疗费用支出,改善居家压疮患者及居家压疮高危人群的生存质量。方法：总结247例居家压疮患者换药模式,遴选成功案例与失败案例相关因素进行比对分析,讨论居家压疮患者换药成功与失败的相关因素,探讨居家压疮患者照顾者评估、教育、培训、指导的要点与方法,制定科学合理的居家换药操作流程和通俗易懂的居家压疮高危人群压疮预防指南。结果：大多数居家压疮患者的照顾者在培训后可以掌握简单的换药操作流程,但是要达到较好的换药效果,需要1～5次的教育、演示、考核,并提供书面的换药操作流程和压疮高危人群居家护理指南,确认居家照顾者掌握基本换药方法,方可提供1—5次的换药物品,并通过电话随访、网络沟通等方式保持联络与支持。结论：经过积极的院内清创处理和换药,评估遴选适合居家换药的压疮患者,并对居家压疮患者的照顾者进行培训,提供书面的换药操作流程和压疮高危人群居家护理指南,保持联络与支持,是护理居家压疮患者的可行方法。     

压疮分级防治管理实践与效果

目的:根据住院患者发生压疮危险程度结合护士人力资源的分层,探讨压疮防治分级管理的方法及效果。方法:建立压疮管理组织,明确各层级组织的职责;制定标准,实施全员培训;运用Braden评估表对住院患者进行评估,预测发生压疮的危险程度,实施分级预防、全程监控。结果:实施压疮防治分级管理模式与传统的管理方法相比,难免压疮高危患者的压疮发生率和带入压疮的治愈率明显降低(P<0.05)。结论:运用Braden评分预测压疮发生风险,对不同危险程度的人群,按照护士的能级实施分级防治并实时监控压疮,有效地减少难免压疮发生率,提高带入压疮的治愈率。     

对老年高危压疮患者居家照护者的护理干预及效果评价

目的:对老年高危压疮患者居家照护者进行护理干预,降低高危压疮居家患者的压疮发生率。方法:成立压疮管理小组,通过填写调查问卷筛选出有效的照护者及Braden评分14分的高危压疮危险人群,经过系统化的培训、指导、随访,让照护者掌握压疮的预防护理知识。结果:观察组患者压疮发生率低于对照组(P0.05),满意度高于对照组(P0.05)。结论:通过对老年高危压疮居家照护者进行护理干预可有效地降低患者压疮发生率,提高患者对护理工作的满意程度。     

智能手机软件在院外压疮高危患者护理中的应用效果评价

目的：探讨基于智能手机软件的院外护理在长期卧床患者压疮预防中的应用效果。方法：将100例压疮高危患者随机分为观察组和对照组各50例。对照组按照传统的门诊随访模式管理。观察组在对照组的基础上应用手机远程护理软件进行定期随访和管理。分析两组患者压疮发生率、住院率,居家及住院发生压疮相关费用情况。结果：观察组患者压疮发生率、住院率,居家及住院发生压疮相关费用低于对照组,差异有统计学意义（P＜0.05）。结论：使用智能手机软件对长期卧床患者压疮进行院外管理,可增进医护人员与患者的有效沟通,减少患者压疮发生和经济负担。     

住院患者压疮预见性管理

目的 探讨住院患者压疮预见性管理的实践效果.方法 重视发挥临床护士的力量,将压疮质量控制主权前移到临床护士:培训准入压疮专责护士,由造口及慢性伤口小组、压疮专责组长、压疮专责护士形成三级压疮质量管理网络,为临床护士提供明确的压疮护理指引;实行无惩罚呈报及层级管理制度;不断实践PDCA循环,建立压疮护理效果跟踪表,对护理措施进行持续改进等.结果 实施预见性压疮管理前(2008年)后(2009年)住院患者压疮发生情况比较差异有统计学意义(χ2=69.95,P＜0.01),实施预见性压疮管理后较之前压疮发生率明显降低.结论 进行压疮预见性管理能使住院患者得到及时的、安全的、专业的压疮护理,降低压疮发生率.     

肿瘤患者压疮高危人群的风险管理

目的探讨风险管理对肿瘤患者压疮高危人群的实施效果。方法对照组患者按压疮护理常规进行护理;观察组患者在此基础上实施压疮风险管理,即：对护理人员进行压疮相关知识培训,对患者压疮风险因素进行评估与筛查,制订个体化压疮预防护理方案,分层次动态管理。结果观察组患者的压疮发生率低于对照组（P〈0．05）,压疮护理质量高于对照组（P〈0．01）。结论对肿瘤患者压疮高危人群实施风险管理可以降低压疮的发生率和提高压疮护理质量。     

基层压疮高危人群居家照顾现状及策略

总结了我国压疮高危人群居家照顾现状,主要包括基层压疮高危人群居家现状、照顾者技能培训现状。认为通过对基层压疮高危人群居家照顾者的培训,可以有效改善照顾者照顾行为,降低压疮高危人群压疮发生率及压疮再发生率。     

手术患者发生压疮相关因素分析及护理对策

目的:探讨手术患者发生压疮的相关因素及护理对策。方法:对176例行手术治疗的患者术前应用Braden量表进行压疮风险因素评估、术中采取针对性预防措施,制定压疮预防管理方法。结果:本组发生压疮16例,单因素分析结果显示,不同年龄、血清白蛋白、禁食时间的患者压疮的发生率差异有统计学意义(P<0.05);Logistic回归分析显示,年龄(β=3.42,P<0.01)、血清白蛋白水平(β=3.27,P<0.01)及禁食时间(β=2.71,P<0.05)是导致压疮发生的危险因素。结论:年龄、血清白蛋白水平、禁食时间3个因素与术后压疮的发生率密切相关,对于手术患者中压疮高危人群应给予重视,注意预防危险因素是减少压疮发生的关键。     

护理随访对居家卧床老年患者压疮发生的影响

目的：观察护理随访对居家卧床老年患者压疮发生率的影响。方法将72例具有压疮风险的居家卧床老年患者随机分为干预组和对照组,对照组患者出院时予常规出院指导,而干预组患者在此基础上由护士定期进行电话回访和家庭访视,时间为6个月,6个月后观察并比较两组患者压疮发生情况。结果干预组患者发生压疮3例（8.33%）,对照组患者发生压疮11例（30.56%）,两组比较差异有统计学意义（字2=4.345,P<0.05）。结论护理随访可提高患者照护者的认知度和依从性,有效预防具有压疮风险的居家卧床老年患者压疮的发生。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.     

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.