急性心肌梗死的急诊护理方案分析

选取就诊我科的急性心肌梗死患者共132例,患者入院后护理人员尽快建立静脉通路、吸氧、监测生命体征,并严格遵照医嘱给予药物治疗,将患者随机分成两组:对照组与观察组,对照组62例采用常规的护理,观察组70例在对照组的护理基础上采用更积极的全方面护理,包括急救护理、心理护理以及病情监测等,对两组患者抢救的成功率和护理的满意度进行调查统计并比较。结果观察组抢救的成功率明显高于对照组,其中观察组抢救率达87.1%,对照组67.74%,观察组护理满意度94.2%也高于对照组的82.2%,两组对比有统计学意义,P0.05,71例被转到内科继续接受治疗,18例转到ICU接受治疗,40例转到CCU治疗,3例病情危急抢救无效死亡。患者在治疗过程中未出现并发症。两组对比差异有统计学意义,P0.05。给予急性心肌梗死患者积极迅速全面的急诊护理对挽回患者的生命、提高抢救成功率有着举足轻重的作用,并有利于医患关系的改善。     

个性化护理对急性心肌梗死院前抢救患者急救诊断率、转运成功率及病死率的影响

目的探讨个性化护理对急性心肌梗死院前抢救患者急救诊断率、转运成功率及病死率的影响。方法采用随机抽样方式,选取2015年2月—2016年1月于本院接受急性心肌梗死院前抢救的患者35例作为对照组,实施常规院前护理,选取2016年2月—2017年1月于本院接受急性心肌梗死院前抢救的患者35例作为观察组,在对照组基础上行个性化护理干预,对比两组的急救诊断率、转运成功率及病死率。结果观察组的出诊反应时间为(49.38±18.26)s、急救时间为(19.37±5.36)min、入院时间为(2.57±0.31)h,对照组的出诊反应时间为(93.51±32.40)s、急救时间为(41.39±6.28)min、入院时间为(3.14±0.42)h,观察组的出诊反应时间、急救时间和入院时间均明显短于对照组,差异均有统计学意义(P0.05)。观察组的急救诊断率(97.14%)明显高于对照组的82.86%;转运成功率(100.00%)明显高于对照组的88.57%;病死率(2.86%)明显低于对照组的17.14%,两组差异均具有统计学意义(P0.05)。结论对急性心肌梗死患者实施院前抢救时,在常规护理的基础上对患者实施个性化护理,能够取得更好的护理效果,患者的出诊反应时间、入院时间和急救时间能够得到有效缩短,患者的急诊诊断率以及转运成功率能够获得较大提升,病死率显著降低,个性化护理对急性心肌梗死院前抢救具有较高的临床应用价值。     

急性心肌梗死的院前急诊护理分析

根据我院收治的急性心肌梗死患者护理情况分为观察组52例患者接受过院前急诊护理,另一组为对照组50例患者未接受过院前急诊护理,两组患者采取相同治疗方法及常规护理,,对比两组患者护理效果。观察组死亡率、护理纠纷发生率明显低于对照组,护理满意度及护理质量明显高于对照组,急救时间及入院时间短于对照组(P0.05)。在急性心肌梗死患者中采取院前急诊护理,可稳定患者病情,降低死亡率,提高患者治疗效果,应用价值显著。     

个性化护理在急性心肌梗死患者院前急诊护理中的应用

目的:探讨个性化护理在急性心肌梗死患者院前急诊护理中的应用效果。方法:选择2011年9月~2012年9月我院接诊的92例急性心肌梗死患者作为观察组,院前急诊护理中采取个性化护理;选择2010年9月~2011年8月接诊的92例急性心肌梗死患者作为对照组,院前急诊护理中采取常规护理。观察比较两组的临床护理效果。结果:观察组出诊反应时间、急救时间和入院时间短于对照组(P0.05),观察组急救诊断率、转运成功率和急救成功率高于对照组(P0.05)。结论:个性化护理在急性心肌梗死患者院前急诊护理中应用效果明显,可降低病死率。     

针对性护理在心肌梗死院前急诊护理中的应用

目的:评价针对性护理在心肌梗死院前急诊护理中的应用效果。方法:选取2017年1月～2018年9月接诊的84例急性心肌梗死患者,根据急诊护理的不同分为对照组(n=42)与观察组(n=42)。对照组采用常规护理,观察组采用针对性护理,比较两组急诊抢救情况。结果:观察组院前急救用时短于对照组,转运及急救成功率、血管再通率高于对照组,并发症发生率低于对照组,差异有统计学意义(P0.05)。结论:在心肌梗死患者院前急诊护理中运用针对性护理,能使患者尽快得到救治,提高转运、急救成功率及血管在通率,降低并发症发生率。     

院前急诊护理对急性心肌梗死患者抢救成功率的影响

目的探讨院前急诊护理对急性心肌梗死患者抢救成功率的影响。方法选取本院2013年1月~2015年1月收治的168例急性心肌梗死患者,按照随机数字表法分为观察组和对照组,对应随机数字为偶数者为观察组,奇数者为对照组,每组84例。观察组院前急救护理之后进行常规救治,对照组给予常规救治。比较两组的出诊时间、入院时间、急救时间、抢救成功率、急救诊断率、转运成功率以及接诊3周后随访复发率和并发症发生率。结果对照组的出诊反应时间(93.8±31.2)s,急救时间(39.7±7.1)min,入院时间(2.95±0.38)h,均长于观察组,差异有统计学意义(P0.05);观察组的抢救成功率98.81%,急救诊断率97.62%,转运成功率100%均优于对照组,差异有统计学意义(P0.05);观察组3周后的复发率4.76%和并发症发生率10.71%均小于对照组,差异有统计学意义(P0.05)。结论急性心肌梗死患者接受院前护理可以稳定患者病情,提高治疗效果和抢救成功率。     

急性心肌梗死的院前急诊护理

目的探讨急性心肌梗死的院前急诊护理措施。方法回顾性分析48例急性心肌梗死患者的临床资料。院前急诊护理包括现场急救护理、转运护理及院前溶栓处理。结果经及时有效的救治和护理干预,患者均安全转送至急诊科或心血管内科给予静脉溶栓或介入治疗,治疗结束后5例死亡(10.42%)。结论对急性心肌梗死患者进行有效的院前急诊护理,能够使患者安全、及时的到达医院进行就诊,提高抢救成功率。     

急性心肌梗死患者应用优化急诊护理流程的救治效果及抢救成功率分析

目的 探讨优化急诊护理流程对急性心肌梗死患者救治效果及抢救成功率的效果。方法 选取 2018 年 1 月份至 2021 年 12 月份在我国接受治疗的 597 例急性心肌梗死患者作为研究对象。依据随机分组法将患者分成对照组和观察组,对照组 298 例, 观察组 299 例。对照组采取常规护理方法,观察组采取优化急诊护理流程。比较两组患者的接诊后时间窗、抢救成功率、早期 再灌注治疗率及复发率。结果 接诊后时间窗指标观察组均低于对照组（P<0.05）。抢救成功率观察组高于对照组（P<0.05）。 早期再灌注治疗率及复发率观察组低于对照组（P<0.05）。结论 优化急诊护理流程用于急性心肌梗死疾病护理中,有助于优 化护理流程,抢救成功率高,救治效果显著,建议在临床上大力应用。     

急诊绿色通道在急性心肌梗死患者抢救中的应用

目的探讨急诊绿色通道在急性心肌梗死患者抢救中的应用效果。方法便利选取2013年12月至2014年12月温州医科大学附属第一医院急诊科收治的急性心肌梗死患者,其中2013年12月至2014年5月的80例患者为对照组(经常规流程接受治疗),2014年6-12月的98例患者为观察组(经急诊绿色通道接受治疗),比较两组患者入院至首次球囊扩张的时间、并发症发生情况及抢救成功率。结果观察组和对照组入院至首次球囊扩张的平均时间分别为(58.91±12.75)和(90.17±29.53)min,差异有统计学意义(t=9.88,P0.01);观察组抢救成功率(100%)高于对照组(95%),总并发症发生率及尿潴留发生率明显低于对照组,差异均有统计学意义(P0.05)。结论经急诊绿色通道对急性心肌梗死患者进行抢救,能够有效缩短入院至首次球囊扩张的时间,为患者的治疗及预后提供了保障。     

院前急诊护理干预对创伤性休克病人抢救效果的影响

目的:探讨院前急诊护理干预对创伤性休克病人抢救成功率的影响。方法:回顾性分析总结2011年2月～2013年5月在我院就诊的273例创伤性休克病人病历资料,其中169例病人由"120"急救车送入院,均接受院前急诊护理,设为观察组;另104例病人由家属或者他人送入医院救治,均未接受院前急诊护理,设为对照组。结果:观察组住院抢救成功157例,对照组为82例,差异具有统计学意义(P0.05),此外,观察组抢救介入时间、术前准备时间均明显优于对照组,差异有统计学意义(P0.05)。结论:院前急诊护理干预能够切实提高创伤性休克病人的抢救成功率,需要加强宣教并引起民众高度重视。     

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.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.