认知行为干预对高血压患者服药依从性的影响

目的 探讨认知行为干预对高血压患者服药依从性的影响.方法 选择86例符合条件的住院高血压患者,随机分为对照组和实验组各43例.对照组按照内科护理常规进行护理,实验组在此基础上实施认知行为干预,对2组服药依从性及血压值进行比较.结果 实施干预3个月、6个月后2组患者的服药依从性和降压效果比较有显著差异.结论认知行为干预可提高高血压患者的服药依从性,有利于血压的控制.     

肾移植后患者服药依从性现状及干预研究进展

目的总结归纳肾移植后患者服药依从性现状、测评方法及提高患者服药依从性的干预措施,为医护人员采取措施提高患者服药依从性提供参考。方法检索国内外有关提高肾移植后患者服药依从性的干预性研究文献,从现状、干预对象、测评方法、干预策略、干预效果等角度进行综述。结果肾移植后患者服药不依从发生率超过35%,服药依从性测评方法有直接法和间接法2种。提高服药依从性的干预措施包括针对未按次数服药、未按时服药、未按剂量服药及未连续服药4方面。结论肾移植后服药不依从现象普遍存在,医护人员应根据患者不依从的类型,选择合适的一种或几种干预措施,帮助患者提高服药依从性。     

延续性护理在肾移植术后出院患者自我管理中的应用对提升患者用药依从性的价值

目的 探讨针对肾移植术后出院患者自我管理中开展延续性护理所予以的临床价值分析.方法 抽取我院2019年1月至11月收治的肾移植患者138例为研究对象,予以分组,各69例.对照组用常规护理,观察组结合延续性护理,展开出院时、出院3个月后的用药依从性评测值、生活质量评测值比较.结果 干预前两组出院时服药依从性评分对比无差异(P＞0.05);经干预后出院3个月后服药依从性经评测,观察组评分明显高于对照组(P＜0.05);经干预后观察组各方面生活质量明显高于对照组(P＜0.05).结论 对肾移植术后出院的患者在自我管理中开展延续性护理干预,能有效提高患者的服药依从性,提升生活质量.     

全程护理干预对脊柱结核患者服药依从性的影响

目的探讨全程护理干预对脊柱结核患者服药依从性的影响。方法对脊柱结核患者在住院期间及出院后的服药依从性实施全程护理干预,采用问卷调查收集资料对患者进行效果评价。结果实施全程护理干预后患者服药依从性较实施前显著提高;患者对疾病的认知程度较实施前显著提高,差异有统计学意义（P〈0．01）;患者出院后服药依从性、疾病认知程度较前期调查结果显著提高（P〈0．01）,差异有统计学意义。结论全程护理干预能有效提高患者对疾病的认知程度和患者的服药依从性,从而提高对疾病的治疗效果。     

认知行为干预对精神分裂症缓解期患者治疗依从性和生活质量的影响

目的探讨认知行为干预对精神分裂症缓解期患者治疗依从性和生活质量的影响。方法将160例住院精神分裂症缓解期患者随机分为对照组和研究组各80例。对照组接受常规的治疗和护理,研究组在对照组基础上进行个体认知行为干预。评价2组患者干预前、出院时、出院3个月后的生活质量、服药依从性、自知力与治疗态度。结果 2组患者生存质量评分、自知力与治疗态度评分均显著提高,且研究组提高更显著。出院3个月后,研究组服药依从性高于对照组(Z=-2.468,P=0.014)。结论认知行为干预能改变精神分裂症缓解期患者对客观事物的不良认知情绪及行为反应,有效改善其生活质量,提高其服药依从性,对患者的病情康复及生活能力和社会功能改善有很好的促进作用。     

出院后延续性护理干预对肾移植患者心理素质及免疫抑制剂治疗依从性的影响

目的 探讨出院后随访式延续性护理干预对肾移植术后患者心理素质和免疫抑制剂治疗依从性的影响.方法 将157例肾移植术后出院患者随机分为对照组76例和研究组81例.对照组给予常规出院护理和免疫抑制药物治疗,研究组在常规护理、免疫抑制药物治疗的同时,在出院后实施延续性护理干预方案.出院6个月后应用情感量表分别对2组患者的心理素质进行测评,采用Morisky服药依从性量表评价2组患者的药物治疗依从性.结果 治疗6个月后,研究组患者心理素质各项评分明显优于对照组,2组比较差异有统计学意义;研究组免疫抑制剂治疗依从性高者占45.7％,而对照组免疫抑制剂治疗依从性高者占22.4％,2组比较差异有统计学意义.结论 出院后随访式延续性护理干预可明显提高肾移植术后患者的心理素质和免疫抑制剂治疗依从性,从而达到提高患者生活质量的目的.     

健康教育对肾移植术后患者服药依从性的作用

目的:肾移植患者对免疫抑制药物的依从性与排斥反应的发生及移植肾的存活等临床结果有关,调查健康教育对提高肾移植术后患者服药依从性的影响。方法:选择2005-01/2006-12在解放军总医院接受肾移植手术患者124例,患者对治疗方案均知情同意。按随机数字表法分为健康教育组和对照组,每组各62例。对照组进行常规护理,健康教育组在常规护理基础上实施健康教育干预措施,然后进行包括一般情况、肾病、肾移植和服药依从性在内的问卷调查,比较两组患者得分情况,得分越高,表明对肾移植相关知识掌握越多,服药依从性越好。结果:124例肾移植患者全部进入结果分析。①服药依从性在不同年龄组之间差异无显著性意义(P>0.05);女性患者的依从性较男性好(P<0.01);不同文化程度、婚姻状况、医疗费支付方式的患者依从性差异无显著性意义(P>0.05);干部较其他职业者依从性好(P<0.05);服用的主要免疫抑制剂为进口药物者较国产者依从性好(P<0.01);有提醒服药者较无提醒服药者依从性好(P<0.01)。②健康教育组患者实施健康教育干预后对肾移植术基本知识的掌握和认识程度及服药依从性的得分均显著高于对照组(P<0.05)。结论:系统规范的健康教育可使患者掌握肾移植的基本知识,增强患者的服药依从性,有助于提高其生活质量。     

基于微信的多媒体健康教育联合回授法对院外肾移植受者服药依从性的干预研究

目的探讨多媒体健康教育联合回授法对院外肾移植受者服药依从性的干预效果。方法将入组肾移植受者按照随机数字表法分为对照组及干预组,对照组30例实施常规门诊护理,干预组30例在常规门诊护理的基础上联合回授法进行基于微信的多媒体健康教育。采用免疫抑制剂依从性Basel评估量表对两组研究对象进行干预前、后服药依从性的测评比较。结果干预前两组服药依从性评价比较,差异无统计学意义(P0.05);干预后,干预组服药依从性得分(23.47±2.61)高于对照组(20.12±4.37),服药依从性好者(83.33%)多于对照组(60.00%),差异均有统计学意义(P0.05)。结论多媒体健康教育联合回授法能在一定程度上提升院外肾移植受者的服药依从性,值得推广应用。     

基于微信平台的延续护理在冠心病介入术后患者中的应用

目的探讨基于微信平台的延续护理在冠心病PCI术后患者中的应用效果。方法选择2014年12月至2015年10月204例冠心病PCI术后患者,分为干预组和对照组。对照组进行常规出院宣教及出院后电话随访。干预组基于微信平台针对疾病认知、术后康复指导、家庭保健3大主题进行延续护理。比较两组患者出院时及出院后3个月服药依从性与生活质量方面的差异。结果出院3个月后,干预组服药依从性和生活质量比同期对照组明显提高,差异有统计学意义(P0.05)。结论基于微信平台的延续护理可以有效提高PCI术后患者服药依从性和生活质量。     

认知行为干预对子宫内膜异位症患者术后服药依从性及负性情绪的影响

目的探究认知行为干预对子宫内膜异位症患者术后服药依从性及负性情绪的影响。方法选取我院收治的子宫内膜异位症患者100例,随机分为对照组和研究组各50例。对照组接受常规护理干预,在此基础上,研究组给予认知行为干预。观察对比两组干预前后生活质量和负性情绪,同时比较两组术后服药依从性和满意度。结果干预后,两组社会和环境维度的评分比较,无显著差异(P0.05),而研究组生理及心理维度均明显高于对照组(P0.05);研究组HAMD、SAS评分均明显低于对照组(P0.05);研究组服药依从性明显高于对照组(P0.05)。结论对MEs患者开展认知行为干预可缓解患者负性情绪,改善生活质量,有利于提高服药依从性,值得推广应用。     

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.