失禁患者发生失禁相关性皮炎危险因素的Logistic回归分析

目的探讨失禁患者发生失禁相关性皮炎（incontinence-associated derrnatitis,IAD）的危险因素。方法选取一段时间内某院普通病区和监护病区的失禁患者121例,记录性别、年龄、是否存在慢性病、失禁类型、失禁次数、有无进行机械通气、营养支持方式、白蛋白水平、抗生素种数、供氧方式、是否使用镇静剂、Braden评分、体温等13个指标,对可能影响失禁相关性皮炎发生的因素作单因素分析与Logistic多元回归分析。结果单因素分析共筛选出白蛋白水平、供氧方式、有无进行机械通气、是否使用镇静剂、体温、失禁次数、是否存在慢性病、抗菌药物种数、Braden评分9方面因素有统计学意义（均P〈O．05）;以有失禁相关性皮炎发生为应变量,其他因素为自变量赋值后进行非条件多因素回归分析,最终显示抗菌药物种数和Braden评分2方面因素是失禁患者发生失禁相关性皮炎的危险因素。结论合理使用抗菌药物,科学地使用Braden量表,能有效预防失禁相关性皮炎的发生。     

卒中患者排便失禁性皮炎的影响因素

目的探讨卒中患者排便失禁性皮炎的影响因素。方法选取2018年3月—2020年4月医院收治的卒中患者180例为研究对象,将发生排便失禁性皮炎56例患者作为病例组,未发生排便失禁性皮炎124例患者作为对照组,采用单因素及多因素分析卒中发生排便失禁性皮炎相关影响因素,并设计结构化皮肤护理措施。结果调查结果显示,在180例卒中患者排便失禁患者中发生失禁性皮炎患者为56例(31.11%),其中1级失禁性皮炎患者为31例(17.22%),2级失禁性皮炎患者为25例(13.89%);单因素分析结果显示,意识状态、进食方式、Braden评分、Barthel评分、失禁频次、肠道菌群失调、糖尿病、使用抗生素时间均为卒中患者排便失禁性皮炎发生的相关影响因素(P<0.05);多因素分析显示,肠内营养、抗生素使用时间、糖尿病为卒中患者排便失禁性皮炎发生的独立危险因素(P<0.05)。结论肠内营养、抗生素使用时间、糖尿病为卒中患者排便失禁性皮炎发生的独立危险因素。临床上需结合以上危险因素采取有效的护理对策,以期降低患者失禁性皮炎发生率,提升其临床预后。     

神经内科ICU老年患者失禁相关性皮炎的危险因素分析

目的探讨神经内科ICU老年患者发生失禁相关性皮炎的危险因素。方法将2017年1月至2019年6月河南省人民医院神经内科ICU住院的119例老年患者作为研究对象,收集患者性别、年龄、是否合并糖尿病等一般资料,以及疾病情况、失禁情况、入住ICU时Braden评分(包括感知能力、潮湿程度、活动力、移动力、营养状态及摩擦力/剪切力)等数据,根据ICU入住期间失禁相关性皮炎的发生情况将患者分为失禁相关性皮炎组和非失禁相关性皮炎组,并采用单因素、logistic回归分析失禁相关性皮炎发生的影响因素。结果 119例患者中有33例出现失禁相关性皮炎,发生率为27.73%。单因素分析显示:失禁相关性皮炎组和非失禁相关性皮炎组在是否合并糖尿病、失禁类型、失禁频次、腹泻、低蛋白血症、抗菌药物种类、大便性状、感知能力、潮湿程度及摩擦力/剪切力方面评分比较,差异有统计学意义(P0.05)。logistic回归分析结果显示:大小便失禁、失禁频次6次/d、低蛋白血症、水样便、感知能力低及潮湿程度高是神经内科ICU老年患者发生失禁相关性皮炎的独立危险因素(P0.05)。结论神经内科ICU老年患者发生失禁相关性皮炎与失禁状态、低蛋白血症、排便状态及Braden评分密切相关,临床可针对患者自身特点采取相应的预防措施,以降低失禁相关性皮炎的发生风险。     

重型颅脑损伤患者失禁性皮炎的影响因素与护理干预对策

目的探讨重型颅脑损伤患者失禁性皮炎的影响因素,制定护理干预对策。方法选取我院2013年2月至2018年2月收治的268例重型颅脑损伤患者为研究对象,收集患者年龄、随机血糖、Braden评分、性别、低蛋白血症、痔疮、肠内营养、抗生素使用时间等资料,采用单因素分析及多因素logistic回归分析重型颅脑损伤发生失禁性皮炎的影响因素。结果 268例患者中有94例发生失禁性皮炎,发生率35.07%。单因素分析显示,低蛋白血症、随机血糖、Braden评分、体温、痔疮、肠内营养、抗生素使用时间、失禁频率、失禁类型、大便性状是重型颅脑损伤患者发生失禁性皮炎的相关因素(P0.05)。多因素logistic回归分析显示,Braden评分、有低蛋白血症、失禁频率(每天6次)、失禁类型(大小便失禁)、大便性状(水样便)、抗生素使用时间(≥14 d)是影响重型颅脑损伤患者发生失禁性皮炎的独立危险因素(P0.05)。结论重型颅脑损伤患者失禁性皮炎发生率较高,影响因素较多,在临床工作中应早期识别高危风险因素,制定预见性护理干预措施,以预防失禁性皮炎的发生。     

某三级甲等医院失禁相关性皮炎现状调查分析

目的了解住院患者失禁相关性皮炎患病率及相关因素。方法采用横断面观察法,以某时点某所三级甲等医院1375名住院患者为观察对象。结果失禁现患率为13.81%,失禁相关性皮炎现患率为13.15%,IAD合并压疮46.2%,合并皮肤撕裂伤11.5%。IAD现患率前三位科室为重症监护室42.9%,神经内科22.2%,普通内科12.9%。80岁以上患者占65.4%,住院7 d患者占80.8%,卧床患者占96.2%。失禁患者使用与皮肤p H值相近清洁溶液及皮肤保护剂比例只有3.14%和9.9%。结论卧床患者,年龄80岁、住院时间7 d、频繁失禁患者需要重点预防IAD发生。护理人员对IAD发生预见性不足,失禁患者皮肤保护性预防措施有待加强。     

皮肤保护剂在失禁患者中的应用效果及相关因素分析

目的 探讨皮肤保护剂在失禁患者中的应用效果,并分析IAD发生的危险因素和保护因素,为临床提供有效的防范依据.方法 将2013年5月至2014年1月入住南通市某三级甲等医院4个监护病区（神经外科ICU、神经内科ICU、急诊ICU、综合ICU）的174例高危失禁患者随机分成3组（A组造口护肤粉,B组鞣酸软膏,C组皮肤保护膜）,予以皮肤保护剂预防性地干预,比较IAD的发生率、发生时间,并对可能引起IAD的相关因素进行多因素Logistic回归分析.结果 发生IAD者32例占18.4％.A组、B组和C组IAD发生率依次为30.4％、10.3％和15.0％,B组lAD的发生率最低,其次为C组和A组,经比较,3组间差异有统计学意义.经两两比较发现,A组与B组之间、A组与C组之间,IAD发生率的差异有统计学意义,B组与C组之间差异无统计学意义.IAD平均发生时间为（7.00±3.91）d,3组患者IAD发生时间比较差异无统计学意义.多因素Logistic回归分析显示,大便性状和失禁频率是高危失禁患者发生IAD的危险因素,使用预防效果较好的皮肤保护剂是其发生的保护因素.结论 在失禁护理过程中,应尽早给予清洁肛周皮肤并使用预防效果较好的皮肤保护剂.     

某三级甲等医院失禁相关性皮炎的现状分析

[目的]了解住院期间失禁病人的失禁相关性皮炎发生率、护理用具的使用及所采取的皮肤护理措施。[方法]横断面调查2013年1月13日某院住院病人失禁性皮炎发生率。[结果]当日有76例失禁病人,其中26例发生失禁性皮炎,大小便均失禁导致失禁性皮炎发生率高且程度严重;失禁性皮炎的发生与病种、自理能力、意识、年龄、住院时间有关(P0.05);失禁病人的护理用具选择主要是尿管和尿片(P0.05),部分采取综合性护理措施。[结论]大小便均失禁病人、老年病人、神经系统疾病、无自理能力及住院14d内的病人应给予特别关注;失禁病人的护理器具选择和使用应加强培训,并采取综合性皮肤护理措施预防失禁性皮炎的发生。     

某三级甲等医院失禁相关性皮炎的现状分析

[目的]了解住院期间失禁病人的失禁相关性皮炎发生率、护理用具的使用及所采取的皮肤护理措施.[方法]横断面调查2013年1月13日某院住院病人失禁性皮炎发生率.[结果]当日有76例失禁病人,其中26例发生失禁性皮炎,大小便均失禁导致失禁性皮炎发生率高且程度严重;失禁性皮炎的发生与病种、自理能力、意识、年龄、住院时间有关（P〈0.05）;失禁病人的护理用具选择主要是尿管和尿片（P〈0.05）,部分采取综合性护理措施.[结论]大小便均失禁病人、老年病人、神经系统疾病、无自理能力及住院14d内的病人应给予特别关注;失禁病人的护理器具选择和使用应加强培训,并采取综合性皮肤护理措施预防失禁性皮炎的发生.     

全国52所医院老年住院患者失禁相关性皮炎发生现况及影响因素分析

目的探讨全国52所医院老年住院患者失禁相关性皮炎的发生现况及影响因素, 并分析老年住院失禁患者的护理现况, 为临床干预提供参考依据。方法采用便利抽样法, 于2021年3月31日, 选取全国52所医院的14 675例老年住院患者为研究对象, 采用自制的老年住院患者失禁相关性皮炎调查问卷进行调查, 收集患者的一般人口学资料、健康状况、失禁情况和皮肤护理措施相关情况。采用二项Logistic回归分析探讨老年住院患者失禁相关性皮炎的影响因素。结果 14 675例老年住院患者中, 皮肤干燥症的现患率为38.78%(5 691/14 675), 失禁现患率为11.06%(1 623/14 675), 失禁相关性皮炎的现患率为1.91%(280/14 675);轻度、中度和重度失禁相关性皮炎的现患率分别为1.27%(186/14 675)、0.55%(81/14 675)、0.09%(13/14 675)。1 623例老年住院失禁患者护理现况中, 落实率较低的项目为:使用中性洗剂清洁皮肤(14.17%, 230/1 623)、润肤后使用皮肤保护剂(17.68%, 287/1 623)、每次清洗皮肤后...     

失禁性皮炎的护理进展

阐述失禁性皮炎的定义、流行病学、护士认知,从皮肤评估、皮肤清洗、皮肤滋润、皮肤保护剂的使用、收集器具的使用综述失禁性皮炎的护理进展,指出护士对失禁性皮炎的认知度及重视度、评估工具选择、护理干预方法等方面有待进一步研究,同时期待有更多大样本、多中心的研究,为失禁性皮炎规范化预防和治疗提供循证依据。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.