综合护理干预对冠心病心绞痛患者临床疗效及心理状态影响

【目的】探讨综合护理干预措施对冠心病心绞痛患者的生活质量与心理状态的影响。【方法】将本院2011年3月至2013年3月收治的120例冠心病心绞痛患者随机分为观察组和对照组,观察组60例患者采用综合护理干预措施,而对照组60例患者采取常规护理措施,比较两组患者的护理效果。【结果】护理后,观察组患者的总有效率为96．67％,明显高于对照组患者,组间差异具有明显统计学意义（ P ＜0．05）,观察组患者的生活质量各因子评分及心理状态SAS、SDS评分均较对照组患者出现了明显改善,组间差异具有统计学意义（ P ＜0．05）。【结论】综合护理干预措施对冠心病心绞痛患者具有显著的效果,有利于改善患者的生活质量和负性情绪,有利于患者的预后恢复。     

优质护理在肿瘤晚期疼痛护理中的应用效果

目的探讨优质护理在肿瘤晚期患者疼痛护理中的应用效果及临床价值。方法将本院治疗的140例晚期肿瘤患者采用随机数字表法分为观察组和对照组各70例,对照组给予常规护理,观察组给予优质护理,比较2组患者疼痛、焦虑、抑郁、心理情绪、躯体功能等情况。结果观察组干预后疼痛评分、焦虑自评量表评分、抑郁自评量表评分均低于对照组,差异比较有统计学意义(P0.05);观察组干预后自觉症状、心理情绪状态、躯体生理功能状态、日常生活、社会活动评分均高于对照组,差异比较均具有统计学意义(P0.05)。结论优质护理应用在肿瘤晚期患者疼痛护理中能够减轻患者疼痛感以及焦虑和抑郁负性情绪,提升患者生活质量,值得临床推广。     

心理干预对高血压抑郁症患者血压和生活质量的影响

目的:探讨心理干预对高血压抑郁症患者临床治疗效果及生活质量的影响。方法:将150例高血压抑郁症患者按随机数字表法分为干预组和对照组75例,对照组采用常规降压治疗,干预组在此基础上给予心理干预。治疗3个月后,比较观察两组治疗后降压效果、抑郁水平及生活质量。结果:干预组治疗后血压水平、HAMD评分、GQLI-64评分与对照组比较差异有统计学意义(P0.01)。结论:对高血压抑郁症患者给予心理干预,可改善患者血压水平,调节患者抑郁情绪,改善患者生活质量。     

综合护理干预对中风后抑郁患者生活质量的影响

目的观察综合护理干预对中风后抑郁患者生活质量的影响。方法选取我院2015年10月～2016年10月收治的中风后抑郁患者90例,随机数字表法分为观察组和对照组各45例。对照组给予常规护理干预,观察组在对照组基础上给予综合护理干预。采用汉密尔顿抑郁量表HAMD评分量表及WHOQOL-100评分量表,评估两组患者生活质量及抑郁情绪变化情况。结果干预前,两组生活质量评分比较差异无统计学意义(P0.05),治疗后,两组评分均明显升高,且观察组生理健康、心理状态、独立能力、社会关系、个人信仰和周围环境等方面评分明显高于对照组,差异有统计学意义(P0.05);干预前,两组HAMD评分比较差异无统计学意义(P0.05),干预后,两组HAMD评分均明显降低,且观察组低于对照组,差异有统计学意义(P0.05)。结论综合护理干预应用于中风后抑郁患者,能显著改善患者抑郁情绪,提高患者生活质量。     

综合护理干预对老年结直肠癌造口患者焦虑抑郁状态及生活质量的影响

目的：探讨综合护理干预对老年结直肠癌患者焦虑抑郁状态及生活质量的影响。方法选择2012年6月～2013年9月在本院进行手术治疗的156例老年结直肠癌患者为研究对象,并随机分为观察组与对照组各78例,对照组患者给予常规护理和健康宣教,观察组在对照组的基础上给予综合护理干预,包括饮食指导、心理疏导、健康教育、造瘘口的术后护理。利用SCL－90和SF－36健康调查简表对患者综合护理干预前后的生活质量和精神状态进行评价。结果干预后观察组和对照组SCL－90各因子评分比较,观察组均低于对照组,差异均具有统计学意义（均P＜0．05）;干预后观察组和对照组SF－36各因子评分比较,观察组均高于对照组,差异均具有统计学意义（均P＜0．05）。结论对老年结直肠癌患者实施综合护理干预可有效缓解患者的负性情绪,提高患者术后的生活质量。     

综合护理干预在子宫肌瘤并发高血压患者围术期的效果探讨

目的：探讨综合护理干预在子宫肌瘤并发高血压患者围术期的效果。方法选择2010～2013年100例子宫肌瘤并发高血压患者临床资料,2010～2011年收治的50例为对照组,2012～2013年收治的50例为观察组,对照组单纯给予常规护理,观察组在常规护理基础上,给予有针对性的围术期综合护理干预,比较两组患者的血压控制情况、并发症发生率、住院时间、患者满意度及两组患者的生活质量评分。结果（1）观察组术前、术后24 h、3 d舒张压和收缩压控制稳定情况优于对照组,两组比较差异有统计学意义（P＜0．05）。（2）观察组并发症低发生率低、住院时间短、患者满意度高,与对照组比较,差异有统计学意义（P＜0．05）。（3）观察组患者的生活质量评分高,与对照组比较有统计学意义（P＜0．05）。结论综合护理干预子宫肌瘤并发高血压患者围术期能够有效稳定血压,降低并发症,缩短住院时间,提高患者满意度和生活质量。     

综合护理干预对慢性前列腺炎患者生存质量的影响

目的 探讨综合护理干预措施对慢性前列腺炎(CP)患者生存质量的影响.方法 将100例确诊为CP的患者,随机分为对照组与治疗组,对照组给予常规护理,治疗组除给予常规护理外,给予综合护理干预措施.观察比较干预前后2组生存质量、心理健康及治疗有效率.结果 综合护理干预后3个月,治疗组的生活质量评分QOL明显高于对照组,差异有统计学意义(P<0.05);症状自评量表SCL-90评分、国际前列腺炎症状评分指数NIH-CPSI明显低于对照组,差异均有统计学意义(P<0.05).结论 综合护理干预可明显提高CP治疗的有效率,改善CP患者精神心理状态,提高CP患者的生存质量.     

心理护理干预对老年患者全膝关节置换术围手术期的负性情绪及生活质量的影响

目的探讨心理护理干预对老年患者全膝关节置换术围手术期的负性情绪及生活质量的影响。方法选取我院收治的老年全膝关节置换术患者40例,随机分为对照组和观察组,每组20例。对照组给予常规护理干预,观察组在常规护理干预基础上给予心理护理干预。观察两组患者术后4、12、24、48h疼痛情况,比较SAS、SDS评分情况,并对患者的生活质量进行评定。结果观察组患者术后4、12、24、48h的VAS疼痛评分明显低于对照组（P〈0．05）;两组患者SDS、SAS评分均明显低于干预前（均P〈0．05）,观察组患者SDS、SAS评分明显低于对照组（均P〈0．05）;观察组患者角色功能评分、心理功能评分、躯体功能评分、社会功能评分及GQOL-74总评分均明显高于对照组（均P〈0．05）。结论实施有效的心理护理干预,能够有效地改善老年患者全膝关节置换术围手术期的疼痛症状,缓解患者的焦虑抑郁的心理状态,提高患者的生活质量。     

思维导图配合心理护理对乳腺癌患者术后心理状态与生活质量的影响

目的探讨思维导图配合心理干预对乳腺癌患者术后心理状态及生活质量的影响。方法选取2016年3月至2017年12月我院治疗的乳腺癌患者78例作为研究对象,随机将其等分为对照组和观察组,对照组给予常规护理,观察组在常规护理的基础上实施思维导图结合心理干预;比较两组患者护理干预前后心理状态、生活质量情况。结果护理干预前,两组患者SAS,SDS及生活质量评分比较差异无统计学意义(P 0. 05);护理干预后,观察组患者SAS,SDS评分低于对照组,生活质量各维度评分均高于对照组,差异有统计学意义(P 0. 05)。结论思维导图配合心理干预有助于改善乳腺癌患者术后心理状态,提高生活质量,减少术后并发症,值得推广应用。     

综合护理在妊娠高血压综合征患者产后护理中的应用观察

目的 观察综合护理在妊娠高血压综合征患者产后护理中的应用效果。方法 选取我院妊娠高血压综合征患者 68 例（2021 年 1 月至 2021 年 11 月）,随机分为对照组组（34 例）和观察组（34 例）。对照组采用常规护理,观察组实施综合护理。观察患 者血压水平、不良事件发生率、心理状态、生活质量。结果 与对照组相比,观察组血压水平低,不良事件发生率低,SAS、SDS 评分低,生活质量评分较高（P＜0.05）。结论 妊娠高血压综合征患者给予综合护理,能降低血压水平,且不良事件发生率低, 改善不良心理状态\提升生活质量。     

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.     

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.