对临终病人家属的护理

在很大程度上临终患者的亲属比病人更需要护理。综述了护士如何对临终患儿父母及亲友进行护理，以帮助他们渡过失去亲人最悲哀的时期，使护士成为他们真诚的情感支持者。     

对临终病从家属的护理

在很大程度上临终患者的亲属比病人更需要护理，综述了护士如何对临终患儿父母及亲友进行护理，以帮助们渡过失去亲人最悲哀的时期使护士成为他们直诚的情感支持者。     

老年临终病人与家属的需求调查分析

目的 为探讨临终病人与家属的需求，从而做好临终护理。方法 采用问卷的形式调查在我科临终的18名病人及其家属在病人临终期最关心的问题。结果 病人临终期及其家属最关心的问题是病人能舒适、安详、有尊严地离开人世。病人家属最关心的是在做好病人的临终护理的同时能得到心里安慰，2项结果均为100％；同时在病人临终前允许家属陪护的需求率达88％：愿意接受临终关怀的病人和同意病人接受临终关怀的家属各占22％与11％。结论 做好临终护理，让病人舒适、安详、有尊严地离去，同时在丧亲悲哀高峰期能得到心里安慰是所有病人和家属的愿望，鼓励和允许家属陪护病人临终，对临终病人及其家属进行死亡教育很有必要。     

我国临终护理发展现状与前景展望

临终护理是一门新兴的学科,由医学、伦理学、护理学、心理学与行为科学所组成;是向临终病人及家属提供一种全面的照顾,包括生理、心理、社会等方面;使临终病人的生命得到尊重、症状得到控制、生命质量得到提高,家属的身心健康得到维护和增强,使病人在临终时能无痛苦、安宁、舒适地走完人生的最后旅程。本文通过从临终护理的起源、临终护理的意义、我国临终护理的模式、临终护理的内容、临终护理对护理人员的要求、临终护理的教育、我国临终护理所面临的问题及对策、我国临终护理前景展望8个方面综合论述了我国临终护理的发展现状与前景展望。     

临终病人压力性损伤护理的研究进展

从临终病人压力性损伤发生率、分期和诱因、评估量表、干预策略方面综述临终病人压力性损伤护理的研究进展,阐述对临终病人压力性损伤护理质量的思考,为提高临终病人生命质量提供参考。     

临终护理经验与设想

临终护理是为满足晚期患者生理、心理、社会需求的全面照顾。在多年临床护理工作中，面对患者不幸死亡，护理人员也经历由恐惧、悲哀到能以护士高度职业责任感、同情心满足病人使其无憾离开人世的心理历程。为提高尚存生命的质量，维护其人格生命的尊严，切实做到让患者在最后生命历程中，面对死亡，保持安详。［１］本文就临终患者生理心理社会需求及临床中取得较好效果的护理方法作如下介绍。１　临终患者生理需求及护理经验临终患者因其所患疾病不同而表现出不同行为反应。护理人员必须全面掌握病情，主动了解和帮助解决其生理上痛苦，满…     

1288例肿瘤病人临终护理现状调查及护理干预

目的 探讨肿瘤病人临终护理,提高肿瘤病人生命质量.方法 采用问卷调查法,抽取一线城市三所三甲级医院临终护理肿瘤病人1 288例,随机分为两组,一组为接受常规临终护理组,另一组为针对肿瘤病人病情制定护理干预的临终护理组,接受临终护理3个月后比较两组临终护理质量.结果 肿瘤病人常规临终护理质量满意度较低,接受针对肿瘤病人需求制定护理干预的临终护理组的肿瘤病人临终护理质量满意度大大提高.结论 常规的临终护理已不能满足肿瘤病人的需求,改进后的临终护理干预使肿瘤病人临终护理满意度提高,提升了他们的生命质量.     

恶性肿瘤临终病人心理护理的研究进展

综述近年来国内外对恶性肿瘤临终病人进行心理护理的相关研究现状.从心理护理的概念和作用出发,阐明心理护理的必要性;研究肿瘤病人和临终病人的心理反应,阐述肿瘤临终病人心理护理的内容,探讨心理护理效果的影响因素和建议,为临床恶性肿瘤临终病人心理护理工作提供参考依据.     

急症临终病人的护理

目的探讨对急症临终病人的护理。方法针对急症临终病人的需要和护理要点制定相关的护理措施。结果有针对性地护理措施在引导病人和家属正确对待死亡,提高急症临终病人的生活质量方面有积极意义。结论提高护士心理素质和对临终关怀的认识,对做好急症临终关怀非常重要。     

狂犬病病人临终护理干预方法研究

目的:为护理临终狂犬病病人摸索出一系列行之有效的护理措施和方法,并加以贯彻落实,使病人安详、平稳地度过生命的最后阶段。方法:通过对临终狂犬病病人及其家属存在的护理问题进行有针对性地护理方法研究和总结,提出一系列具体措施。结果:病人得到良好的护理和关怀,情绪稳定,生存时间延长,家属平稳接受。结论:良好的临终护理干预,可使狂犬病病人临终时期减轻肉体的痛苦及心理恐惧,能得到医务人员及家属的良好照顾和关怀,最大限度地延长病人的生存时间;加强消毒、隔离防护,预防医院感染及职业暴露的发生,使家属及群众得到狂犬病知识的宣教。     

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.