PICC置管患者在导管门诊个性化护理的效果分析

选取于我院PICC门诊进行导管维护的肿瘤科患者60例,随机分为对照组和观察组。对照组患者于导管门诊给予PICC置管常规护理措施,观察组患者则在对照组基础上给予个性化护理措施。观察记录两组患者在PICC置管治疗过程中非计划拔管率、堵管发生率,及肿胀、渗血、感染、血管损伤和导管滑出等各种并发症发生情况。另外,对患者进行调查,了解并比较患者护理前后对PICC置管相关知识知晓率,及对治疗的满意率、依从性。观察组患者非计划拔管率与堵管率明显低于对照组患者(P<0.05);观察组患者的肿胀、渗血、感染、血管损伤及导管滑出等各种并发症发生率明显低于对照组患者(P<0.05);观察组患者护理后PICC置管相关知识知晓率、患者满意率及治疗依从性明显高于对照组患者(P<0.05)。个性化护理可降低PICC置管患者的非计划拔管率及各种并发症发生率,临床效果良好,患者满意度和治疗依从性都较高,值得进一步在导管门诊中推广应用。     

艾宾浩斯遗忘理论在癌症PICC携管患者出院随访健康教育中的应用

目的探讨艾宾浩斯遗忘理论在癌症经外周中心静脉置管(peripherally inserted central catheters,PICC)携管患者出院随访健康教育中的应用效果。方法选择2011年1月~2012年1月在本院PICC出院后并到门诊维护的癌症患者127例,设为对照组,选择2012年4月~2013年4月在本院PICC出院后并到门诊维护的癌症患者135例,设为实验组。对照组患者出院前行常规健康教育,实验组患者在对照组基础上进行出院随访,并运用艾宾浩斯遗忘规律曲线理论对患者进行导管维护相关知识健康教育,直到拔管。比较两组患者置管期间并发症发生情况。结果两组患者静脉炎、导管堵管、非计划拔管发生率比较,均P0.05,差异无统计学意义;两组患者导管相关感染、血栓、延期换药发生率比较,均P0.05,差异具有统计学意义,实验组患者发生率明显低于对照组。结论癌症PICC携管患者出院随访中,运用艾宾浩斯遗忘理论对患者进行导管维护相关知识健康教育,可提高患者置管后维护依从性,从而降低患者置管期间并发症的发生。     

PICC护理门诊的建设及管理

目的分析PICC护理门诊的建设及规范化管理措施,以提高PICC置管患者的护理质量。方法选取2013年4月-2015年4月行PICC置管的患者,按就诊时间将其分为对照组270例和实验组430例。对照组按照常规方法进行PICC置管,实验组在PICC护理门诊进行PICC置管。比较2组患者PICC导管留置时间、按时复诊率、相关并发症发生率及患者满意度。结果实验组PICC导管留置时间长于对照组,按时复诊率高于对照组,并发症发生率低于对照组,患者满意度高于对照组。结论 PICC护理门诊实现了PICC置管护理的规范化管理,有效降低了PICC相关并发症的发生率,提高了患者满意度。     

PICC门诊带管患者常见护理问题原因分析与处理

目的 了解出院PICC带管患者常见的护理问题,进行原因分析,提出有效的预防与处理措施.方法 采用回顾性调查的方法进行分析总结.结果 有8.5%的PICC带管患者在治疗间歇期出现堵管、感染、静脉炎、脱管、知识缺乏等问题.结论 及时、有效的护理指导与全程的质量监控,能降低出院PICC带管患者的导管并发症,延长导管使用时间,提高患者的生活质量.     

肿瘤患者化疗间歇期留置PICC的社区护理效果观察

目的 探讨肿瘤患者化疗间歇期留置PICC的社区护理效果及其可行性.方法 将符合入选标准的78例需应用PICC作为静脉通道进行化疗的恶性肿瘤患者,按自愿原则分为两组,对照组42例患者置管后至拔管(含化疗间歇期)均在医院住院,接受常规导管护理.观察组36例患者置管后于化疗间歇期带PICC进入家庭休养,由社区护士或肿瘤科护士到家庭进行导管护理,每周1.2次.观察两组患者留置PICC期间的感染、导管阻塞、导管脱落、导管异位等并发症发生情况.结果 观察组并发症发生率为19%(7/36),其中发生感染2例,导管阻塞1例,导管脱落1例,导管异位2例,机械性静脉炎1例;对照组并发症发生率为17%(7/42),其中发生导管阻塞2例,导管脱落2例,导管异位2例,机械性静脉炎1例.两组并发症发生率比较,χ2=0.10,P>0.05,差异无统计学意义.结论 肿瘤化疗患者在化疗间歇期留置PICC到社区接受导管护理安全可行.     

PICC携管出院患者基于QQ群健康教育的效果观察

目的 探讨QQ群在PICC携管出院患者健康教育的应用效果.方法 将126例PICC携管出院患者根据QQ群建立时间的前后分为观察组和对照组各63例.对照组患者给予常规导管护理指导及电话随访,观察组患者在对照组基础上基于QQ群健康教育.观察比较2组患者PICC维护知识认知情况、导管按时维护依从率、护理服务满意度及PICC并发症的发生率.结果 随访3个月末,观察组患者PICC维护知识回答正确率高于对照组(P<0.05),出院后PICC导管按时维护依从率、护理服务满意度高于对照组(P<0.05);观察组患者携管出院后PICC穿刺点感染、静脉炎、导管移位及堵管并发症的发生率低于对照组(P<0.01).结论 对PICC携管出院患者基于QQ群健康教育,可提高了PICC携管出院患者PICC维护知识认知水平,提高患者导管按时维护的依从率及护理服务满意度,降低了置管后并发症发生.     

延续性护理在肿瘤PICC置管出院患者中的应用

目的探讨延续性护理在肿瘤PICC置管出院患者中的应用效果。方法将100例肿瘤PICC置管出院患者随机分为对照组和观察组各50例,对照组实施常规护理,观察组在对照组基础上实施家庭延续性护理,并予电子系统追踪护理,分析两组导管并发症和非计划性拔管情况。结果观察组并发症发生率、非计划性拔管率均低于对照组(P0.05)。结论对PICC置管出院患者实施延续性护理,可降低导管相关并发症发生率,减少因并发症而导致的非计划性拔管,提升患者满意度。     

电话随访教育对PICC带管出院患者并发症发生率及非正常拔管率的影响

目的:探讨电话随访教育对经外周静脉置入中心静脉导管(PICC)带管出院患者自我维护导管并发症发生率及非正常拔管率的影响。方法:将2013年2~8月在我院留置PICC后带管出院自我维护的102例患者随机分为随访组和对照组各51例,对照组实施常规基本护理,随访组在常规基本护理的基础上实施电话随访教育,统计分析两组患者并发症发生率和非正常拔管率。结果:随访组并发症发生率和非正常拔管率均明显低于对照组(P0.05)。结论:电话随访教育在降低PICC带管出院自我维护患者并发症发生率及非正常拔管率方面效果显著,值得临床推广应用。     

延续性护理在肿瘤PICC置管出院患者中的应用

目的:探讨延续性护理在肿瘤PICC置管出院患者中的应用效果。方法:将108例肿瘤PICC置管出院患者随机分为对照组和观察组各54例,对照组实施常规护理,观察组在此基础上实施延续性护理,分析两组导管相关并发症和非计划性拔管情况。结果:观察组并发症发生率及非计划性拔管率均低于对照组(P0.01,P0.05)。结论:对PICC置管出院患者实施延续性护理,可降低导管相关并发症发生率,减少因并发症而导致的非计划性拔管。     

静脉治疗护理学组在PICC带管出院患者延续护理中的效果

目的 探讨运用静脉治疗护理学组对PICC带管出院患者延续护理的效果.方法 选取该院2015年3月~2016年6月PICC带管出院患者148例.根据患者所接受的延续护理方式为依据分为观察组和对照组各74例.对照组采用常规带管出院维护护理,观察组予以静脉治疗护理学组延续护理.在患者出院时、出院1个月后和出院3个月后使用自我护理能力测定量表对患者导管维护能力进行评价.记录导管按时维护率和各类并发症(导管脱落、静脉炎、感染、导管堵塞、非正常拔管、血栓形成)发生率.结果 观察组出院1个月后、出院3个月后的自护能力评分均显著高于同时期对照组评分(均P<0.05).观察组导管按时维护率显著高于对照组(P<0.05).观察组静脉炎、导管滑脱、感染、导管堵塞、非正常拔管发生率均显著低于对照组(均P<0.05).结论 在PICC带管出院患者延续护理中予以静脉治疗护理学组护理,可以取得更好的效果.     

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.     

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.     

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.     

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.