阶段性康复护理干预在心脏瓣膜置换术后患者中的应用

目的:探讨阶段性康复护理干预在心脏瓣膜置换术后患者中的应用方法及效果。方法:将231例心脏瓣膜置换术后患者随机分为观察组115例和对照组116例,对照组采用常规护理干预,观察组在对照组护理基础上实施阶段性康复护理干预。比较两组患者术后住院天数、卧床时间及应用抗凝药依从性,患者护理满意率及预后。结果:观察组ICU住院时间、卧床时间、住院天数均短于对照组(P<0.05),用药依从性评分高于对照组(P<0.05);观察组患者护理满意率高于对照组,患者预后情况优于对照组(P<0.05)。结论:阶段性康复护理干预应用于心脏瓣膜置换术后患者,可缩短患者住院天数,提升患者治疗依从性,加快患者术后康复。     

心脏瓣膜置换术后抗凝治疗依从性综合护理干预

目的 通过护理干预,减少心脏瓣膜置换术后患者抗凝治疗不当并发症.方法 将140例心脏瓣膜置换术后抗凝治疗患者,按入院先后时间将前60例设为对照组,后80例为观察组,对照组采用传统健康教育方法,观察组由责任护士负责健康指导,强调患者家属参与,护理组长阶段性评估与补充,出院后随访等综合护理干预.结果 观察组抗凝治疗不当并发症明显低于对照组,抗凝知识掌握和治疗依从性、患者满意度均显著高于对照组.结论 心脏瓣膜置换术后系统科学的综合护理干预,能提高心脏瓣膜置换术后患者抗凝药物治疗依从性及自我管理,减少抗凝不当并发症的发生.     

HtoH连续护理对心脏瓣膜置换术患者的影响

目的:探讨医院到家庭(HtoH)连续护理对心脏瓣膜置换术患者的影响。方法:将130例心脏瓣膜置换术患者随机分为实验组和对照组各65例,实验组实施从入院到出院后1年的HtoH连续护理,对照组实施常规护理,比较两组生活质量(SF-36)量表评分、汉密尔顿焦虑(HAMA)量表评分和1年内心血管抗凝不良事件发生率。结果:实验组SF-36量表评分高于对照组,其中生理职能比较差异无统计学意义(P0.05),其他项目比较差异均有统计学意义(P0.05,P0.01);实验组术前、出院前、出院1年HAMA量表评分均低于对照组(P0.05);出院后1年内实验组心血管抗凝不良事件发生率低于对照组(P0.05)。结论:HtoH连续护理可以提高心脏瓣膜置换术患者的生活质量,缓解负性情绪,降低并发症发生率。     

心脏瓣膜病患者瓣膜置换术后ICU综合护理的效果及对睡眠质量的影响分析

目的：探讨心脏瓣膜病患者瓣膜置换术后在重症监护室(ICU)综合护理的效果及对睡眠质量的影响。方法：选取2022年1月至2022年12月福建医科大学附属协和医院接受瓣膜置换术治疗的心脏瓣膜病患者90例作为研究对象,按照随机数字表法随机分为对照组和观察组,每组45例。在瓣膜置换术后ICU监护期间,对照组实施常规护理,观察组实施综合护理,对比组间各项指标如治疗依从性、护理满意度,并在组间和组内对比各项指标如舒适度评分、心理评分、睡眠质量评分、生命质量评分。结果：关于治疗总依从率、护理总满意率的数据显示,观察组均比对照组更高(P<0.05)。护理后,与对照组的舒适度评分、生命质量评分比较,观察组数值均更高,而与对照组的焦虑、抑郁、睡眠质量各项评分比较,观察组数值均更低(P<0.05)。结论：在心脏瓣膜病患者瓣膜置换术后ICU治疗期间,综合护理干预可增强患者的治疗依从性,有利于消除患者躯体不适感和不良情绪,使其睡眠质量和生命质量得到提升,进一步提高其对于护理服务的评价。     

延续性护理在膀胱癌术后灌注化疗患者中的应用效果

目的探讨应用延续性护理对膀胱癌术后膀胱灌注化疗患者依从性、护理满意度及生活质量的影响。方法选取2017年8月—2018年8月本院收治的80例膀胱癌术后膀胱灌注化疗的患者,采用数字表法随机将其分为对照组(n=40)和观察组(n=40),对照组采用常规护理,观察组在对照组常规护理基础上实施延续性护理;比较两组患者干预前后的治疗依从性、SF-36评分及治疗后护理满意度情况。结果干预前两组SF-36评分无显著性差异(P 0. 05),干预后两组SF-36得分均得到显著改善(P 0. 05),但观察组SF-36改善显著高于对照组(P 0. 05);观察组治疗依从性高于对照组(P 0. 05),观察组治疗满意度显著高于对照组(P 0. 05)。结论延续性护理能够提高膀胱癌患者的治疗依从性及护理的满意度,并改善化疗后患者的生活质量。     

护理干预对雄性激素缺乏致Ⅲb型前列腺炎患者的影响

目的:探讨护理干预对雄性激素缺乏导致Ⅲb型前列腺炎患者治疗依从性及生活质量的影响。方法:将85例患者随机分为观察组43例和对照组42例,两组均接受激素药物治疗,对照组给予常规性护理,观察组在此基础上给予护理干预,观察比较两组干预前后治疗依从性及生活质量评分情况。结果:干预后观察组治疗依从性明显高于干预前(P0.05),治疗依从性高于对照组(P0.05),SF-36总评分及各维度评分显著高于对照组(P0.05)。结论:对雄性激素缺乏导致Ⅲb型前列腺炎患者实施有效的护理干预,可有效提高患者治疗依从性,改善其生活质量,值得推广应用。     

护理干预对慢性乙型肝炎病人治疗依从性及生活质量的影响

[目的]探讨护理干预对慢性乙型肝炎病人治疗依从性及生活质量的影响。[方法]将260例慢性乙型肝炎病人随机分为观察组和对照组各130例,对照组给予常规护理干预,观察组实施有针对性的护理干预。采用健康状况评估量表(SF-36)、抑郁自评量表(SDS)评定两组病人干预前后生活质量、抑郁情况,比较两组治疗依从性情况。[结果]观察组病人干预后SF-36评分优于对照组(P0.05);观察组干预后抑郁发生率降低且低于对照组(P0.05),SDS评分低于对照组(P0.05);观察组干预后治疗依从性高于对照组(P0.05)。[结论]护理干预可提高慢性乙型肝炎病人治疗依从性及生活质量,有利于病人保持良好心态。     

基于知信行评价的再循环教育在心脏瓣膜置换病人抗凝治疗管理中的应用研究

目的 观察基于知信行评价的再循环教育在心脏瓣膜置换术病人抗凝治疗管理中的应用效果。方法　选择2018年1月至2019年3月于我院行心脏瓣膜置换术患者90例为观察样本,以随机数字表法分为对照试验两组各计45例,对照组接受心脏瓣膜置换术后抗凝用药常规教育,试验组在此基础上加用基于知信行评价的再循环教育,对两组干预后的各观察指标进行比较。结果　试验组心脏瓣膜置换术病例干预后抗凝知识掌握度评分与抗凝用药依从性评分显著高于对照组,抗凝用药相关并发症发生率显著低于对照组,(P＜0.05)。结论　采用基于知信行评价的再循环教育对心脏瓣膜置换术后抗凝治疗病人实施干预,可显著提高其抗凝知识掌握度与抗凝用药依从性,提高抗凝用药安全性。     

护理干预对心脏瓣膜置换术后抗凝治疗患者依从性的影响

目的:探讨护理干预对心脏瓣膜置换术后抗凝治疗患者依从性的影响.方法:将实施抗凝治疗的300例心脏瓣膜置换术后患者随机分为实验组和对照组各150例,实验组给予健康教育和预见性不良反应预防措施,对照组给予常规护理措施.结果:实验组患者对心脏瓣膜置换术、抗凝治疗的认识程度和使用药物的依从性显著高于对照组(P<0.05);实验组不良反应出血和血栓发生率均低于对照组(P<0.05).结论:对心脏瓣膜置换术后抗凝治疗患者给予相应的护理干预可提高患者对心脏瓣膜置换术和抗凝治疗的认知程度和用药依从性,减少不良反应的发生.     

“一病一品”对提高直肠癌患者护理质量的效果

目的探讨"一病一品"对提高直肠癌患者护理质量的效果。方法选择本院2017年12月至2018年11月收治的96例直肠癌患者作为研究对象,随机将其等分为对照组与试验组,对照组实施常规护理,试验组实施"一病一品"护理。比较两组造口周围皮肤评估表(DET)、健康状况调查简表(SF-36)评分。结果对照组DET各维度评分及总分高于试验组,差异有统计学意义(P0.05);对照组SF-36各维度评分低于试验组,差异有统计学意义(P0.05)。结论 "一病一品"可显著改善直肠癌患者术后造口周围皮肤情况,提高患者生活质量。     

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.