希望理论干预对晚期肝癌患者焦虑和抑郁心理的影响

目的探讨希望理论干预对晚期肝癌患者焦虑和抑郁心理的影响。方法以2013-01—2014-09自贡市第四人民医院肝胆外科住院的180例晚期肝癌患者为研究对象,随机分为观察组(n=90)和对照组(n=90),对照组采用常规护理,观察组实施常规护理加希望理论干预护理,比较两组患者焦虑自评量表(SAS)、抑郁自评量表(SDS)、焦虑和抑郁发生率。结果观察组和对照组干预前SAS和SDS评分差异无统计学意义(P0.05),干预后SAS和SDS差异有统计学意义(P0.05)。观察组干预后SAS和SDS评分显著低于干预前(P0.05),对照组干预后SAS评分和SDS与干预前比较,差异无统计学意义(P0.05)。干预前观察组和对照组焦虑和抑郁发生率差异均无统计学意义(P0.05);干预后观察组焦虑和抑郁发生率显著低于对照组(P0.05)。结论希望理论干预护理可有效缓解晚期肝癌患者焦虑和抑郁心理。     

早期心理护理干预对脑卒中后抑郁病人的疗效分析

[目的]探讨早期心理护理干预对脑卒中后抑郁(PSD)的疗效分析。[方法]将住院的112例PSD病人随机分为观察组和对照组各56例,对照组进行常规治疗和常规护理,观察组在此基础上实施早期心理护理干预。两组病人干预前后进行汉密尔顿抑郁量表(HAMD)评分、日常生活自理能力(MBI)评分、肢体运动功能(FMA)评分和临床疗效比较。[结果]两组病人进行早期心理护理干预前HAMD、MBI、FMA评分差异无统计学意义(P0.05)。干预4周后,HAMD评分观察组低于对照组,差异有统计学意义(P0.05);MBI评分观察组高于对照组,差异有统计学意义(P0.05);FMA评分观察组高于对照组,差异有统计学意义(P0.05)。观察组总有效率为91.1%,对照组为69.6%,差异有统计学意义(χ2=5.76,P0.05)。[结论]早期心理护理干预措施可以改善PSD病人的抑郁情绪,促进病人肢体运动功能和生活自理能力的恢复。     

心理护理对慢性乙型病毒性肝炎患者焦虑与抑郁情绪的影响

目的探讨心理护理对慢性乙型病毒性肝炎患者焦虑与抑郁情绪的影响。方法选取62例慢性乙型病毒性肝炎患者按将数字表法分为对照组和观察组,各31例。对照组采用一般的基础护理方法,观察组在对照组基础上再实施心理干预,对比2组患者干预前后焦虑与抑郁的发生率、SAS与SDS评分情况以及干预后患者用药依从性情况。结果护理干预前,2组患者焦虑和抑郁的发生率差异无统计学意义(P0.05);护理干预后,观察组焦虑发生率12.90%、抑郁发生率16.13%,显著低于对照组焦虑发生率48.39%、抑郁发生率51.61%,差异有统计学意义(P0.05)。护理干预前,2组患者SAS和SDS评分差异无统计学意义(P0.05);护理干预后,观察组SAS和SDS显著低于对照组,差异有统计学意义(P0.05)。观察组护理干预后用药依从性显著高于对照组,差异有统计学意义(P0.05)。结论对慢性乙型病毒性肝炎患者实施心理干预的效果显著,可有效减轻患者焦虑及抑郁情绪,促进患者康复。     

心理干预对泌尿结石钬激光碎石术患者负性情绪的影响

目的探讨心理干预对泌尿结石钬激光碎石术患者负性情绪的影响。方法选取2016年2~9月于本院行钬激光碎石术治疗的泌尿系结石患者84例,按随机数字法分为观察组和对照组,各42例。对照组采用常规护理措施,观察组在对照组的基础上实施心理干预,采用抑郁自评量表(SDS)和焦虑自评量表(SAS)评估两组患者的焦虑抑郁情况,观察比较两组患者SDS评分、SAS评分及护理满意度。结果观察组护理满意度为95.24%优于对照组(80.95%),差异有统计学意义(P0.05);干预前,两组患者SDS评分及SAS评分未见显著性差异(P0.05);干预后,观察组SDS评分(41.36±7.69)分低于对照组(52.47±9.33)分,差异有统计学意义(P0.05);观察组SAS评分(42.34±8.11)分低于对照组(51.76±10.35)分,差异有统计学意义(P0.05)。结论心理干预能有效地改善钬激光碎石治疗的泌尿系结石患者的抑郁焦虑状态,同时提高护理质量,促使患者早日康复。     

认知行为干预对类风湿性关节炎患者焦虑抑郁症状的影响

目的观察认知行为干预对改善类风湿性关节炎(RA)住院患者焦虑抑郁症状的效果。方法将80例RA患者按入院顺序分为对照组和干预组各40例。对照组进行常规的临床治疗及护理,干预组在常规治疗及护理的基础上采用认知行为干预方法进行2周干预。比较干预前后两组的焦虑自评量表(SAS)和抑郁自评量表(SDS)评分。结果干预前两组SAS和SDS评分比较,差异无统计学意义(P0.05);对照组干预后SAS和SDS评分均较干预前评分有所降低,但差异无统计学意义(P0.05);干预组干预后SAS和SDS评分均较干预前评分显著降低,差异有统计学意义(P0.05)。结论认知行为干预可有效改善RA住院患者的焦虑抑郁症状,提高患者的治疗效果和满意度。     

人文关怀护理对脑卒中后抑郁患者的康复效果观察

目的观察人文关怀护理对脑卒中后抑郁(PSD)患者的康复效果。方法选取本院康复医学科2015年1月~2017年5月收治的120例PSD患者,根据数字表法分为对照组和观察组各60例。对照组给予常规治疗及护理措施,观察组在对照组基础上给予人文关怀护理。采用汉密尔顿抑郁量表(HAMD)、Fugl-Meyer运动功能评分量表、Barthel指数评估两组患者护理前后抑郁状态、肢体运动能力及生活质量变化,采用住院患者满意度问卷调查两组患者护理满意度。结果两组患者护理前HAMD评分、Fugl-Meyer评分、Barthel指数比较无显著差异性(P0.05);两组患者护理后HAMD评分明显降低,而Fugl-Meyer评分、Barthel指数明显升高,差异有统计学意义(P0.05);观察组改善情况显著优于对照组,差异有统计学意义(P0.05);观察组护理满意度为91.7%,明显高于对照组的63.3%,差异有统计学意义(P0.05)。结论人文关怀护理可明显改善脑卒中后抑郁患者抑郁状态和肢体运动能力,可显著性提高患者生活质量和护理满意度。     

品管圈护理管理在不孕不育症患者中的应用评价

目的:研究品管圈护理管理在不孕不育症患者中的应用效果。方法:选取我院2016年2月至2017年5月收诊的不孕不育症患者124例,按随机数字表法分组,各62例。对照组给予常规护理干预,观察组在对照组基础上给予品管圈护理管理干预。比较两组干预前后汉密尔顿抑郁(HAMD)量表评分、护理满意度。结果:观察组护理满意度93.55%高于对照组74.19%,差异有统计学意义(P0.05);干预前,两组HAMD评分比较,差异无统计学意义(P0.05);观察组干预后HAMD评分低于对照组,差异有统计学意义(P0.05)。结论:品管圈护理管理应用于不孕不育症患者可有效缓解抑郁情绪,提高护理满意度。     

精细护理干预在血液透析患者中的应用效果

目的探讨精细护理干预对血液透析患者焦虑抑郁、院感并发症及护理满意度的影响。方法选取本院2016年1月~2017年1月80例行血液透析治疗的患者,根据患者护理方案的不同,将80例患者分为对照组及观察组,每组患者40例。对照组行常规基础护理,观察组在对照组基础上行精细护理干预。比较2组患者护理前后焦虑抑郁状态改善情况、院感并发症发生率及护理满意度。结果 2组院感并发症发生情况主要以呼吸道感染、泌尿系统感染、中心静脉导管感染、皮肤感染为主,观察组并发症发生率(10.0%)明显低于对照组(42.50%),差异具有统计意义(P0.05);观察组患者护理总满意率明显优于对照组,差异具有统计学意义(P0.05);2组患者护理后抑郁评分(HAMD)、焦虑评分(HAMA)较护理前明显下降,差异具有统计学意义(P0.05);观察组护理后HAMD、HAMA评分明显低于对照组,差异具有统计学意义(P0.05)。结论精细护理干预可有效改善血液透析患者焦虑抑郁状态并降低院感并发症发生率,提高患者满意度。     

整体护理干预对甲状腺囊肿手术患者手术效果及预后的相关性研究

目的探讨整体护理干预对甲状腺囊肿手术患者手术效果及预后的相关性。方法选择到本院接受甲状腺囊肿手术治疗的90例患者,按照随机数表法将其分为观察组和对照组,每组45例。观察组采用整体护理干预,对照组采用常规护理干预。比较2组患者护理前后焦虑抑郁评分、术后疼痛情况、术后并发症情况、手术时间以及住院时间。结果观察组疼痛率显著低于对照组,2组比较差异具有统计学意义(P0.05);与治疗前对比,2组患者治疗后SAS、SDS评分均显著下降,其中观察组明显低于对照组,2组比较差异具有统计学意义(P0.05);观察组手术时间和住院时间均短于对照组,术后并发症率显著低于对照组,2组比较差异具有统计学意义(P0.05)。结论整体护理干预能够缩短甲状腺囊肿手术患者的手术时间和住院时间,缓解焦虑抑郁情绪,减轻患者疼痛,减少术后并发症,对患者手术效果和预后具有较好的影响。     

综合护理干预对中风后抑郁患者生活质量的影响

目的观察综合护理干预对中风后抑郁患者生活质量的影响。方法选取我院2015年10月～2016年10月收治的中风后抑郁患者90例,随机数字表法分为观察组和对照组各45例。对照组给予常规护理干预,观察组在对照组基础上给予综合护理干预。采用汉密尔顿抑郁量表HAMD评分量表及WHOQOL-100评分量表,评估两组患者生活质量及抑郁情绪变化情况。结果干预前,两组生活质量评分比较差异无统计学意义(P0.05),治疗后,两组评分均明显升高,且观察组生理健康、心理状态、独立能力、社会关系、个人信仰和周围环境等方面评分明显高于对照组,差异有统计学意义(P0.05);干预前,两组HAMD评分比较差异无统计学意义(P0.05),干预后,两组HAMD评分均明显降低,且观察组低于对照组,差异有统计学意义(P0.05)。结论综合护理干预应用于中风后抑郁患者,能显著改善患者抑郁情绪,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.