865例离退休老年人健康状况调查分析

目的:了解离退休老年人群的健康状况.方法:采用自编调查表对865例>60岁的武汉市离退休老年人进行健康状况调查并与体检相结合,分析老年人生活方式、患病情况及对疾病认知状况等.结果:865例中患有慢性疾病者815例(94%),其中心血管系统疾病占首位,多数老年人患有>2种慢性病;生活习惯与健康状况有密切关系,被调查对自身疾病的认识程度较高(90%).结论:离退休老年人慢性病患病率较高,社区内开展不同层次的卫生健康教育有利于提高老年人健康水平.     

社区老年人慢性病患病状况及其对生活功能的影响

目的研究社区老年人慢性病患病现状及对日常生活功能的影响。方珐应用OARS问卷（中文版）对武汉市城区3个社区卫生服务中心辖区内648名60岁及以上的社区老年人慢性病患病状况及其对日常生活功能的影响进行调查。资料统计方法采用X^2检验和非条件Logistic回归模型分析。结果老年慢性病患病率为85．8％,居前5位的疾病是高血压病、关节炎与风湿疾病、消化系统疾病、慢性肺部疾病、心脏疾病。日常生活功能（activities of daily living,ADL）的受损率为55．1％,生理性日常活动功能（physical activities of daily living,PADL）的受损率为15．6％,工具性日常生活功能（instrumental activities of daily living,IADL）的受损率为54．8％。致老年人ADL功能障碍作用最强的疾病为慢性肺部疾病、消化系统疾病、关节炎及风湿疾病、心脏疾病、中风及青光眼,老年人患慢性病的数量越多,ADL受损率越高。培论慢性病是老年人的重要健康问题,对其日常生活功能有显著影响,应大力开展老年保健工作,提高老年人的生活质量。     

社区老年慢性病病人分层护理模式构建

[目的]了解社区老年人慢性病患病情况和生活方式,构建合适的社区护理模式。[方法]采用老年健康状况和相关因素调查量表对500例社区老年人进行问卷调查。[结果]500例老年人中333例老人患病,其中吸烟51例,饮酒51例,从不吃大蒜20例,食盐口味重97例,独居44例,不常看电视84例,不常下棋310例,不常锻炼127例。患病率较高的6种慢性病依次为高血压、心脏病、偏头痛、高胆固醇血症、慢性支气管炎和糖尿病。[结论]根据本研究得出的老年人患病情况和生活方式,提出构建老年慢性病社区分层护理模式。     

深圳市福田区老年人慢性病患病状况及护理需求情况的调查分析

[目的]了解深圳市福田区老年人慢性病患病状况及护理需求情况。[方法]采用问卷调查法,对福田区8个社区792例老年人进行慢性病患病现状及护理需求调查。[结果]本组老年人慢性病患病率为64.1%,患病率前5位依次为高血压、糖尿病、心血管疾病、颈和腰椎疾病、高血脂;常住、暂住老年病人在文化程度、居住状态、经济来源、个人收入、医疗费来源方面差异具有统计学意义(P<0.05);影响病人家庭护理需求服务的主要因素依次为就医指导、照顾者角色、个人经济状况、医疗费和患病种类(P<0.05)。[结论]老年慢性病病人有较高的家庭护理服务需求,开展老年人家庭护理服务是必然的趋势。     

鄂西北地区农村老年人健康自评与慢性病的关系

[目的]探讨鄂西北地区农村老年人健康自评与慢性病的关系,以期为农村老年人的医疗保健服务工作提供依据。[方法]应用老年健康状况和相关因素调查量表对三个行政村≥60岁的531名老年人进行调查。[结果]老年人健康自评与性别、慢性病患病情况和慢性病患病数量相关。Logistic回归分析显示,负性生活事件、脑卒中或偏瘫、偏头痛、心脏病、经济收入是老年人健康自评状况的影响因素。[结论]应在老年人群中普及医疗卫生保健知识,使老年人对慢性病有一定的了解,进而提高其自我保健意识。     

慢性疾病对老年人生活质量的影响

目的:研究老年人的生活质量现状及常见慢性病对老年人生活质量的影响,为更好地为老年人进行医疗护理服务提供依据。方法:采用简化的健康测量量表,对本市的380名老人(其中老干部305例,占80.2%)进行生活质量评估,调查其同时所患的慢性病情况。结果:慢性支气管炎/肺气肿、高血压及脑血管意外、肿瘤、糖尿病、前列腺疾病等对老年人生活质量有明显影响。结论:在对老年人卫生保健服务实施进程中,有必要充分考虑老年人所患慢性病的情况,有针对性地早期干预其危险因素,重视防治结合,提高老年人的生活质量。     

高原地区60岁以上人群慢性病现状及其影响因素

为了解高原地区老年人慢性病患病现状及其影响因素 ,以改善本地区老年人生活质量及健康状况 ,并为高原地区老年人保健政策提供科学依据 ,我们于 1 997年 4～ 5月对西宁地区老年人慢性病状况进行了调查。共调查 6 0岁以上 1 36 2人 ,其中患慢性病者92 6人 ,患病率为 6 7 99% ;男性 76 9人 ,患病5 5 8人 ,患病率为 72 5 6 % ;女性 5 93人 ,患病36 8人 ,患病率为 6 2 0 6 %。男性患病率明显高于女性 (Ｐ <0 0 1 )。本次调查发现老年病人多患有 1种以上慢性病 ,最多者同时患 7种慢性病。患 1～ 4种病人数分别为 41 2人( 44 49% )、 2 81人 (…     

从老年人生活方式谈社区卫生服务对策

为探索老年人社区服务对策,以广州市诗书街６０岁以上老年人为研究对象,调查１０２７名老年人生活方式与健康状况。结果表明：嗜烟者呼吸系统和心脑血管疾病发病率明显高于无吸烟习惯者;嗜酒者易患消化系统疾病。结果还显示老年人对吸烟、饮酒的危害性尚无深刻的认识,患慢性病者较注重健身运动,闲暇活动越多的老人对个人健康状况的自我评价越好。提出老年人社区卫生服务的重点是改变其不良行为,促进其积极参与健身运动,以预防疾病的发生。     

西安市社区老年人慢性病与抑郁症状关系的研究

[目的]了解西安市社区老年人群慢性病患病情况,探讨其对老年抑郁症状的影响.[方法]采用一般情况调查表、老年抑郁量表(GDS)对1 950名社区老年人进行问卷调查.[结果]社区老年人慢性痛患病率为82.2%,慢性病痛人中存在抑郁症状的为27.0%;Logistic回归结果显示,脑血管疾病、冠心痛、糖尿病、视觉障碍是与老年抑郁症状发生有密切关系的4种主要疾病.[结论]开展慢性病健康教育,提高社区老年人日常生活能力,关注老年人心理健康对社区老年护理工作至关重要.     

北京市城区养老服务机构老年人生活质量调查

目的:调查北京市养老服务机构老年人的生活质量的现状,研究老年人生活质量的影响因素。方法:以健康状况调查问卷SF-36对北京市养老服务机构老人生活质量进行评估,并调查其患病情况。结果:发现该老年人群年龄普遍较高,慢性病的患病率达86.6%。慢性病、自理能力、职业、家庭经济状况等因素对生活质量有显著影响。结论:应针对老年人所患慢性病情况提供有效的养老护理服务,制定具体措施进行有效的护理干预,以全面提高养老服务机构老年人生活质量。     

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.     

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.