影响麻风康复者高血压患者服药依从性的影响因素及护理干预

目的 探讨麻风康复者高血压患者服药依从性的影响因素及护理干预的影响. 方法 纳入我院2013年1月至2014年11月确诊为麻风康复者高血压患者200例,进行问卷调查,对调查的结果进行分析汇总,采用单因素及多因素的Logistic回归进行服药依从性的影响因素的分析;并将纳入调查研究的200例患者随机平均分为两组,其中对照组100例,给予常规的基础治疗;护理干预组100例,在对照组的基础上给予个体化对策的护理干预,分别比较两组患者的服药依从性及血压控制情况. 结果 根据Logistic回归分析依从性危险因素为年龄大、医患关系一般、高血压知识知晓度差、经济收入低;护理干预组在服药依从性及血压控制情况均优于对照组( P<0. 05 ). 结论 麻风康复者高血压患者药物治疗依从性较差与年龄、高血压知识知晓程度、医患关系不良、经济收入低有关,实施相应的护理干预以可以明显提高患者服药依从性并改善血压控制情况.     

老年高血压122例血压波动相关因素调查

目的:探讨老年高血压患者血压波动相关因素及对策.方法:对122例家庭病床的老年高血压患者的一般情况及血压波动相关因素进行问卷调查.结果:老年高血压患者血压波动因素与季节、诱发因素、测量血压方法不正确、监测血压不及时、高血压病知识了解不够、服药依从性差有关.结论:对患者加强健康教育,加强监管力度,提高服药依从性,以减少血压波动,提高血压控制率.     

高血压患者的教育

目的：通过对高血压患者的相关教育，使患者明白高血压对人体危害的严重性，使之日常生活活动更有目的地有利于控制血压。方法：通过与就诊患者交流，了解患者对高血压疾病知识的了解程度，根据患者的不同情况予以相关的高血压知识讲授。结果：高血压患者不同程度地存在对高血压知识的缺乏和片面了解，经过对其进行相关知识讲授后，患者在其日常生活中按有利于防治高血压的方法进行，其血压控制有明显进步。结论：通过对高血压患者讲授高血压防治相关知识，有利于患者血压的控制。     

高血压患者的健康体检管理及整合干预研究

目的探讨健康体检管理对高血压患者的血压控制效果及其并发症的控制情况。方法选取本院健康管理中心体检的高血压患者142例为研究对象,随机分为研究组和对照组各71例,对照组采取常规健康体检管理,研究组在此基础上进行健康指导和临床用药指导干预管理研究,观察2组患者干预1年后健康管理和血压控制情况。结果研究组对高血压疾病控制知识知晓、合理饮食、适度运动和按时服药依从性显著好于对照组(P 0. 05);研究组血压控制效果显著优于对照组(P 0. 05);研究组患者1年后新出现并发症发生率显著低于对照组(P 0. 05)。结论系统规范化的健康体检管理可以提高患者对高血压病的认识程度,合理饮食、适量运动、规范服药,能有效地控制血压,减少并发症。     

维持性透析高血压患者的居家自我管理血压能力调查

目的通过调查分析维持性血液透析高血压患者在家血压的自我管理能力,为有效控制高血压,降低心脑血管并发症的发生率,提高其生存质量提供依据。方法对本院血透中心透析3个月以上,口服1种或以上降压药者的高血压透析患者进行问卷调查。结果根据有无自测血压进行分组,有自测血压组142例占82％,未自测血压组32例占18％,2组的性别、年龄及婚姻状况无统计学差异（P〉0．05）,自测血压组的文化程度、知晓血压控制范围、服药的医从性及知晓高血压危害率较未自测血压组高（P〈0．05）。结论维持性血液透析患者中高血压相关知识掌握较全面的者,文化程度高自我管理能力强,遵医嘱服药依从性高,血压控制较理想。因此,医护人员在采取健康宣教时,重点放在疾病相关知识,让患者了解高血压的发生原因、机理、转归和并发症,可提高其用药依从性,规范测量血压健康行为,减少并发症发生,提高患者的生存质量。     

全程健康教育对农村高血压患者服药依从性的影响调查

目的 改善患者服药的依从性,控制血压,降低脑血管发病率.方法 对80例农村高血压患者服药依从性的影响因素进行分析.针对个体特点进行疾病知识、饮食、运动、服药、血压监测等全程健康宣教.结果 患者对高血压有了全面、正确的了解,掌握了基本用药和自我保健知识,血压得到有效控制.结论 全程健康教育可帮助患者建立健康的生活方式,提高患者的服药依从性,减少并发症发生,提高患者的生存质量.     

社区干预对农村老年高血压患者服药依从性的影响

目的 探讨社区干预对农村老年高血压患者服药依从性及治疗效果的影响。方法选择63例符合条件的农村老年高血压患者，对患者及家属实施知识、管理和家庭支持干预，并对患者进行实施前后服药依从性调查，评估其血压控制情况。结果实施社区干预后患者服药依从性明显好转。治疗主动性增强，血压控制理想。结论实施社区干预对提高农村老年高血压患者服药依从性，控制患者的血压水平有积极作用。     

高血压患者药物治疗依从性调查

目的:了解高血压患者的服药依从性及其影响因素。方法:采用现场测量和问卷相结合对348名高血压患者进行调查。结果:平均依从性为36.21%,经干预措施后提高到45.69%,不同年龄间依从性有差别(P<0.001)。药物依从性主要与高血压防治知识、服药习惯、药物不良反应、经济状况、给药方式和服药种类以及医患关系有关,而与性别、职业、文化程度无明显关系。依从性好的患者血压控制佳,波动幅度小;依从性差者血压控制不佳,波动幅度大。结论:高血压患者药物治疗依从性的影响因素较多,应加大力度,综合干预。     

社区契约式管理对老年高血压患者服药依从性的影响

目的:探讨社区契约式管理对城市老年高血压患者服药依从性及治疗效果的影响。方法:选择本辖区管理的193例符合条件的城市老年高血压患者,对患者及家属实施知识、契约式管理和家庭支持干预,并对患者进行实施前后服药性调查,评估其血压控制情况。结果:实施社区契约式管理后患者服药依从性明显好转。治疗主动性增高,血压控制理想。结论:实施社区契约式管理能提高城市老年高血压患者服药的依从性,对控制患者的血压水平有积极作用。     

高血压患者348例服用福辛普利的依从性调查

目的 了解服用福辛普利治疗高血压患者的服药依从性及其影响因素。方法 选择2004-10／2005-12在中国医科大学附属第四医院内科就诊的高血压患者348例，部分患者行动态血压监测。①于就诊两三个月进行第1次调查．经干预措施（发放宣传材料、科普讲座、电话咨询随访每月一两次等）后两三个月进行第2次调查。调查内容包括年龄、性别、职业、文化程度、高血压防治知识、经济状况、伴随疾病、用药情况、药物不良反应、经治医生情况等。②依从性判定：采用MORISKY推荐的评价高血压患者服药依从性的4个问题，4个问题回答均为“否”为服药依从性好，否则为依从性差。结果 ①第1次调查平均依从性为36．2％，第2次调查为45．7％，随着年龄的增长服药依从性也在提高（P〈0．001）。②福辛普利治疗高血压的依从性主要与高血压防治知识、服药习惯、药物不良反应、经济状况以及医患关系有关，而与性别、职业、文化程度无明显关系。③依从性好的患者血压较依从性差者控制得好、波动幅度小。结论 影响高血压患者服药依从性的因素众多。     

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.     

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.