ICU患者疼痛评估工具研究进展

疼痛是ICU患者的常见问题,有效的评估是疼痛管理的基础。由于镇静或其他原因,ICU患者的疼痛评估往往比较复杂。能获得患者主诉时可以使用主观疼痛评估工具,不能获得患者主诉时宜使用客观疼痛评估工具。本文就ICU患者常用的主观和客观疼痛评估工具进行综述,为完善ICU患者的疼痛评估和疼痛管理流程提供科学的依据。     

阿尔茨海默病患者疼痛评估和管理的研究进展

疼痛评估和管理对阿尔茨海默病患者的生活质量有着重要的意义。本文从阿尔茨海默病患者疼痛评估工具及疼痛的管理两个方面进行综述:疼痛评估工具主要包括自我描述性评估工具和观察者疼痛评估工具;疼痛的管理主要是正确评估、药物止痛、更新护理模式、家庭护理以及非药物止痛。本综述旨在为进一步对阿尔茨海默病患者疼痛评估和管理提供参考。     

疼痛评估工具在临床中的研究应用进展

本文通过阐述疼痛评估工具的研究进展,包括目前使用的单维度评估工具及多维度评估工具,认为应根据不同的患者合理选择疼痛评估工具,可更好地进行疼痛评估,指导临床疼痛治疗护理工作。     

两种非语言疼痛评估工具的应用现状分析

目的：通过对两种非语言疼痛评估工具相关研究进行文献分析,为我国非语言疼痛评估工具的选择提供参考。方法运用疼痛评估工具性能评分系统对计算机检索获取的相关文献进行分析。结果共纳入29篇文献,疼痛行为量表( BPS)与重症监护疼痛观察工具( CPOT)平均得分分别为9.20分、9.32分。结论疼痛行为量表( BPS)与重症监护疼痛观察工具( CPOT)逐渐被广泛应用于非语言疼痛患者的疼痛评估,但在不同人群中两者的信效度都存在差异,仍需进一步被验证。     

疼痛评估工具在重症监护病房住院患者中的应用与选择

正疼痛是重症监护病房(ICU)危重症患者常见的临床症状~([1])。近年,如何加强对ICU危重症患者的疼痛评估和治疗引起了大量学者的高度关注,并有学者针对ICU危重症患者疼痛评估工具的选择进行了深入研究~([2-3])。本研究复习近年国内外有关疼痛评估工具在ICU危重症患者中的应用现状,现综述如下。1 ICU住院患者疼痛管理的意义疼痛是危重症患者较为显著的临床症状,也是影响其机体代谢应激反应的主要因素~([4])。由于ICU     

疼痛评估工具选择的研究进展

疼痛是一种常见的不舒适形式.鉴于未缓解的疼痛会给患者造成多方面的损害,国际上已将疼痛定义为继体温、脉搏、呼吸、血压四大生命体征之后的第五生命体征.但最近的研究表明,医务人员对疼痛的管理较为薄弱,疼痛仍是困扰病人的一个常见问题[1-2].准确的疼痛评估是疼痛管理的第一步,也是关键的一步.但许多研究表明,在临床上缺少疼痛评估工具,并且医务人员很少使用它们去评估病人的疼痛[3-4].同时,在一些特殊群体中,如新生儿和婴幼儿、认知障碍者以及危重症患者中,疼痛的评估对医护人员来说显得尤为困难,并经常被忽视.针对上述问题,笔者对疼痛评估的原则和方法及疼痛评估工具在不同人群中选择的新进展做一综述,旨在对临床选择疼痛评估工具提供参考.     

智力障碍患者疼痛评估的研究进展

综述智力障碍患者疼痛评估的研究进展,从智力障碍患者疼痛评估不足的原因和疼痛评估方法两方面进行介绍。疼痛评估方法包括自我报告、行为观察法、生理指标测量法,重点介绍了行为观察法中的观察性疼痛评估工具,并提出建议和展望,以期为智力障碍患者临床疼痛管理提供科学的依据。     

危重症患者疼痛观察工具的研究进展

1995年,全美保健机构评审联合委员会(JCAHO)正式将疼痛确定为继体温、脉搏、呼吸、血压之后的第5生命体征[1].由于各种创伤、手术以及许多内科疾病的病理状况的影响[2],以及治疗、护理的直接结果[3-4],疼痛是许多危重症患者的重要压力之一.据研究报道,约有50％的患者经历着中度至重度的疼痛[5-6].因为疼痛是一种主观体验,患者疼痛最有效的信息来源就是患者自身[5],1979年国际疼痛研究协会指出患者自述疼痛评估疼痛的金标准[7].目前很多有效评估疼痛程度的工具都需要和患者交流,和患者交流可以保证给予的干预是对症治疗.然而许多原因导致患者交流障碍,如昏迷的患者.如何评判昏迷患者的疼痛程度对于护理人员是一个挑战.2002-2003年,学者通过参考已存在评估量表和工作经验,发展完善了危重症患者疼痛观察工具(CPOT).至今CPOT已作为研究工具和临床实践工具在北美各种健康护理机构应用[8],并且逐渐被各国学者引进应用.本文将对该工具的特点及实用价值进行探讨,以期CPOT在我国危重症护理中合理运用,提高对ICU昏迷患者疼痛的控制.现综述如下.     

ICU护士对危重患者疼痛护理相关知识与实践现状的分析

为了了解ICU护士对危重患者疼痛相关知识的掌握与实践现状,对某三级甲等医院129名ICU护士进行了调查。结果显示,ICU护士疼痛知识与态度调查平均正确率为35.2%;参加过疼痛学习班、有疼痛处理经验者回答正确率较高(P<0.05)。大多数ICU护士(76.7%)使用过疼痛强度评估量表,但无人使用过行为观察疼痛评估工具。ICU护士选择最能代表危重患者存在疼痛的行为是痛苦表情(66.7%)、皱眉(48.8%)和握紧拳头(46.5%)等。ICU护士认为积极的ICU团队、标准化疼痛评估工具及持续疼痛教育等是危重患者疼痛护理的重要促进因素,患者不能交流、缺少疼痛指南及评估工具、工作量大等是主要障碍因素。应强化对ICU护士的疼痛教育,鼓励应用行为指征对危重患者进行疼痛评估,营造良好的疼痛治疗护理环境,持续改进疼痛护理质量。     

新生儿疼痛管理认知评估工具的范围综述

目的系统综述了国内外新生儿疼痛管理认知评估工具, 以期为未来相关研究提供参考。方法计算机检索中国知网、万方数据库、中国生物医学文献数据库、维普网、Web of Science核心合集、PubMed、Embase中有关新生儿疼痛管理认知评估工具编制的研究, 检索时限为建库至2022年8月30日。对符合纳入标准的文献进行汇总和分析。结果共提取到8个认知评估工具, 工具内容出现频率最高的是镇痛药物、非药物的护理措施和疼痛强度评估的认知与实施情况, 还涉及教育培训、家长参与等内容。结论国内新生儿疼痛相关研究与国外存在较大差距, 新生儿疼痛管理认知评估工具多为国外汉化版, 有必要在综合了解国内外已有相关评估工具的基础上, 结合新生儿疼痛管理最新指南, 编制适合我国医疗文化背景的新生儿疼痛管理认知评估工具, 提高医护人员对新生儿疼痛管理的意识水平和质量。     

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.     

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.     

Molecular characterization of virulence and antimicrobial resistance profile of Shigella species isolated from children with moderate to severe diarrhea in northeastern Brazil

Molecular characterization of virulence and antimicrobial resistance profiles were determined for Shigella species isolated from children with diarrhea in Fortaleza, Brazil. Fecal specimens were collected along with socioeconomic and clinical data from children with moderate to severe diarrhea requiring emergency care. Shigella spp. were isolated by standard microbiological techniques, and we developed 4 multiplex polymerase chain reaction assays to detect 16 virulence-related genes (VRGs). Antimicrobial susceptibility tests were performed using disk diffusion assays. S. flexneri and S. sonnei were the predominant serogroups. S. flexneri was associated with low monthly incomes; more severe disease; higher number of VRGs; and presence of pic, set, and sepA genes. The SepA gene was associated with more intense abdominal pain. S. flexneri was correlated with resistance to ampicillin and chloramphenicol, whereas S. sonnei was associated with resistance to azithromycin. Strains harboring higher numbers of VRGs were associated with resistance to more antimicrobials. We highlight the correlation between presence of S. flexneri and sepA, and increased virulence and suggest a link to socioeconomic change in northeastern Brazil. Additionally, antimicrobial resistance was associated with serogroup specificity in Shigella spp. and increased bacterial VRGs.     

护理干预对面部中重度寻常型痤疮的临床疗效影响分析

目的研究护理干预对面部中重度寻常型痤疮的临床疗效影响。方法选取本院在2014年4月~2016年7月诊治的136例面部中重度寻常型痤疮患者,随机分为研究组与对照组,每组68例;所有患者均依据其情况给予对应的治疗,其中对照组在治疗期间给予常规护理,研究组在对照组的基础上再给予综合性护理干预,比较两组的治疗效果及护理满意度情况等。结果患者在接受治疗和护理后,研究组中度与重度患者的治疗效果较对照组均明显提高(P0.05),研究组护理满意度较对照组明显增高(P0.05)。结论对面部中重度寻常型痤疮患者在其治疗期间给予综合性护理干预,具有良好的效果。