心理护理干预对消化性溃疡患者不良情绪及溃疡疼痛的影响

目的 探讨心理护理干预对消化性溃疡患者不良情绪及溃疡疼痛的影响.方法 将本院100例消化性溃疡住院患者分为观察组和对照组,对照组采用常规护理,观察组在对照组的基础上加强心理护理干预,比较两组患者护理前后的不良情绪及溃疡疼痛的变化.结果 观察组护理后的SDS、SAS评分显著低于对照组(P＜0.05).观察组治疗的依从性、疼痛缓解率、复发率均显著优于对照组(P＜0.05).结论 心理护理干预有利于缓解消化性溃疡患者的不良情绪,减轻疼痛.     

系统护理干预对消化性溃疡患者治疗依从性及疗效的影响

目的:探讨系统护理干预对消化性溃疡患者治疗依从性、疗效及复发的影响。方法:将128例消化性溃疡患者随机分为观察组和对照组各64例,对照组采用常规护理,观察组在此基础上采取系统护理干预;比较两组治疗依从性、疗效和复发情况。结果:观察组总依从性、总有效率均明显优于对照组(P0.05),复发率明显低于对照组(P0.05)。结论:系统护理干预能明显提高消化性溃疡患者的治疗依从性,有助于提高其治疗效果,减少疾病复发。     

护理干预对消化性溃疡患者医嘱依从性及疗效的影响

目的:探讨护理干预对消化性溃疡患者医嘱依从性及疗效的影响.方法:将80例消化性溃疡患者随机分为干预组45例和对照组35例,对照组给予常规治疗及护理,干预组在此基础上对患者实施护理干预,出院后采用电话、随访方式调查两组的医嘱依从性、溃疡病复发情况及不遵医的原因.结果:干预组对医嘱依从率高于对照组(P＜0.05),复发率明显低于对照组(P＜0.01),经济问题成为不遵医的主要原因.结论:护理干预能提高消化性溃疡患者的医嘱依从性,减少溃疡的复发.     

护理干预对胃炎及消化性溃疡患者治疗依从性及疗效的影响

目的探讨护理干预对胃炎及消化性溃疡患者治疗依从性及疗效的影响。方法选择近期在长沙市第三医院住院治疗的诊断为慢性胃炎和消化性溃疡的46例患者作为观察组,与以往在长沙市第三医院住院治疗的46例对照组患者进行对比分析,给予对照组患者院内常规治疗措施以及常规护理方法,观察组患者在对照组基础上实施护理干预措施,对两组患者医嘱依从性及溃疡复发等临床疗效进行统计分析。结果观察组患者院后医嘱依从性为73．9％,显著高于对照组的39．1％,两组比较差异有统计学意义（P〈0．05）;观察组出院后溃疡复发率15．2％,明显低于对照组的32．6％,两组比较差异有统计学意义（P〈0．05）。对依从性差的患者开展相关调查结果显示,对疾病认识不足是导致其依从性差的最主要原因。结论对胃炎及消化性溃疡患者进行护理干预措施,可以明显提高患者的遵医依从性,降低溃疡复发率,提高临床疗效,值得在临床中进一步推广应用。     

中医治疗及辨证施护对消化性溃疡患者负性情绪及疗效影响

目的 探讨中医治疗及辨证施护对消化性溃疡患者不良情绪以及疗效的影响.方法 80例消化性溃疡的患者随机分为观察组和对照组,对照组采用常规治疗+常规护理,观察组采用中医治疗,并进行辨证施护,比较两组的焦虑、抑郁情况以及治疗效果.结果 观察组的总有效率为95.0％显著高于对照组的92.5％ (P ＜0.05).但观察组护理后的焦虑、抑郁评分显著低于对照组(P＜0.05),复发率显著低于对照组(P＜0.05).结论 中医治疗可显著提高消化性溃疡的疗效,辨证施护可显著减少患者的不良情绪,降低复发率.     

综合护理干预在根治消化性溃疡伴Hp感染患者中的应用

目的：探讨综合护理干预在根治消化性溃疡伴幽门螺旋杆菌( Hp )感染患者中的应用效果。方法选取140例消化性溃疡患者为研究对象,按照随机数字表法将其随机分为观察组和对照组各70例。在常规治疗基础上,给予对照组患者常规护理,给予观察组患者综合护理干预。治疗1个月后,比较两组患者的临床疗效和消化道症状。患者出院后随访1个月,比较两组患者的溃疡复发率、并发症发生率、患者满意率。结果观察组的临床总有效率(92.86％)显著高于对照组(72.86％)(χ2=8.49, P=0.00);观察组的反酸、嗳气、恶心呕吐、消化道出血及Hp阳性发生率均显著低于对照组( P<0.01);随访显示观察组的溃疡复发率和并发症发生率均显著低于对照组( P<0.05);观察组的护理满意度明显高于对照组( P<0.05)。结论综合护理干预可以明显提高消化性溃疡伴Hp感染患者的临床疗效,改善临床症状和预后,提高患者的满意度,值得在临床推广。     

心理护理及健康教育对消化性溃疡患者的影响

目的 探讨心理护理及健康教育对消化性溃疡患者的心理状况及疼痛缓解情况的影响.方法 将我院2010年8月至2011年2月90例消化性溃疡患者采用多中心、随机、双盲双模拟、平行对照的方法,分为观察组和对照组各45例,对照组采用常规护理,观察组在对照组的基础上加强心理护理和健康宣教,比较两组患者护理前后的心理状况、症状缓解情况及溃疡复发率.结果 观察组护理后的SAS、SDS评分的改善显著优于对照组(P＜0.05);观察组痊愈35例,好转8例,症状缓解率为95.6％,显著高于对照组的80.0％(P＜0.05);观察组2年内的复发率为0,显著低于对照组的13.2％ (P＜0.05).结论 心理护理及健康教育有利于提高患者对自身疾病的认知,缓解不良心理,减轻疼痛,降低疾病复发率.     

护理干预对消化性溃疡患者医嘱依从性及复发率的影响

目的探讨护理干预对消化性溃疡患者医嘱依从性及复发率的影响。方法选取本院2014年10月~2015年10月收治入院的消化性溃疡出院治愈患者160例,将其随机分为两组,对照组和干预组各80例。对照组给予一般溃疡病知识宣教及常规护理;干预组在对照组基础上给予患者出院后健康教育、生活方式指导、服药指导和心理护理等方面的维持一年以上的全程护理干预措施。结果干预组较对照组在出院后2、4、8周末的医嘱依从性明显提高,半年及一年复发率明显降低,差异有统计学意义(P0.05)。结论实施全程护理干预可有效地改变消化性溃疡患者的健康观念和生活方式,提高治疗依从性,降低溃疡的复发率,明显改善患者的生活质量。     

护理干预对预防消化性溃疡复发的效果评价

目的了解护理干预对预防消化性溃疡复发的临床效果。方法将2013年5月~2013年11月份收治的80例消化性溃疡患者随机分为观察组40例和对照组40例。对照组患者按一般常规护理模式进行护理;观察组患者在常规护理的基础上进行护理干预。比较2组消化性溃疡患者护理干预后医嘱依从性及复发情况。结果 2组医嘱依从性比较,观察组优于对照组,差异具有统计学意义(P0.01)。复发情况比较,观察组复发率低于对照组,差异具有统计学意义(P0.05)。结论在常规护理基础上行护理干预能有效提高患者的医嘱依从性,进而利于去除消化性溃疡复发的诱发因素,减少了消化性溃疡的复发。     

护理干预对消化性溃疡患者生活方式及服药依从性的影响

目的探讨护理干预对消化性溃疡患者生活方式及服药依从性的影响。方法将本院80例消化性溃疡患者随机分为观察组和对照组,对照组给予常规护理,观察组加强护理干预,比较2组的生活方式、服药依从性以及临床症状的变化。结果观察组在情绪调节、自我监测、合理饮食等生活方式上的掌握率高于对照组(P0.05)。观察组用药依从性好于对照组,随访时的反酸、嗳气、腹痛、腹胀等临床症状计分低于对照组(P0.05)。结论加强护理干预能够促进消化性溃疡患者形成健康的生活方式,提高用药的依从性,显著改善临床症状。     

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.