正念减压干预对结直肠癌术后化疗患者的护理效果

目的 探讨正念减压护理干预对结直肠癌术后化疗患者癌因性疲乏、自我效能及睡眠质量的影响。方法 选取医院2020年12月—2021年5月收治的82例结直肠癌术后化疗患者为研究对象。按组间基本资料匹配原则将其分为观察组和对照组,各41例。对照组采用常规护理干预,观察组在对照组基础上采用正念减压标准化干预。比较两组患者的癌因性疲乏、自我效能、睡眠质量。结果 正念减压护理干预后,观察组癌因性疲乏程度低于对照组,差异有统计学意义（P<0.05）;观察组自我效能高于对照组,差异有统计学意义（P<0.05）;观察组睡眠质量高于对照组,差异有统计学意义（P<0.05）。结论 正念减压疗法标准化干预可以降低结直肠癌术后化疗患者的癌因性疲乏程度,提高患者的自我效能及睡眠质量。     

自我效能干预对乳腺癌术后化疗癌因性疲乏的影响

目的探讨自我效能干预对乳腺癌患者术后化疗癌因性疲乏的影响。方法将52例乳腺癌术后化疗患者随机分为实验组和对照组各26例。对照组采用一般护理常规实施护理,实验组在此基础上增加癌因性疲乏的自我效能干预。利用修订的Piper疲乏量表（RPFS）评价2组患者的CRF程度。结果干预前2组疲乏值比较差异无统计学意义,干预后实验组疲乏值低于对照组（P〈0．05）。结论自我效能干预可有效缓解乳腺癌术后化疗患者的CRF,提高患者的生活质量。     

以问题为导向护理干预对胃癌术后患者癌因性疲乏及自我效能的影响

目的:探讨以问题为导向护理干预对胃癌术后癌因性疲乏及自我效能的影响。方法:选择我院2016年3月~2017年6月收治的100例胃癌术后患者为研究对象,随机等分为观察组与对照组,对照组接受常规护理,观察组接受以问题为导向护理干预,对两组患者干预前后癌因性疲乏及自我效能情况进行观察。结果:干预前两组患者癌因性疲乏总评分无明显差异(P0.05),干预后观察组患者癌因性疲乏总分明显低于对照组(P0.05)。干预前两组患者自我效能感评分无明显差异(P0.05),干预后观察组自护效能感评分明显高于对照组(P0.05)。两组患者干预前自护能力各维度评分无明显差异(P0.05),干预后观察组自我能力各维度评分高于对照组,差异有统计学意义(P0.05)。结论:以问题为导向护理干预可降低胃癌术后患者癌因性疲乏,提高自我效能感与自护能力,值得临床推广。     

疲乏护理干预对乳腺癌化疗患者生活质量的影响

目的探讨疲乏护理干预对乳腺癌化疗患者生活质量的影响。方法选取2015年1月~12月我科收治的40例乳腺癌化疗患者为观察组,在常规护理的基础上采用疲乏护理干预。选取同期收治的40例乳腺癌化疗患者为对照组,采用常规护理。比较两组干预后疲乏程度及生活质量的差异。结果观察组干预后疲乏程度轻于对照组,差异有统计学意义(P0.05)。观察组功能状况、情感状况、生理状况、社会/家庭状况、附加关注评分高于对照组,差异有统计学意义(P0.05)。结论疲乏护理干预能够显著缓解乳腺癌化疗患者的疲乏程度,提高患者治疗期间的生活质量。     

激励干预在直肠癌术后永久结肠造口患者围术期护理中的应用效果分析

目的 探讨直肠癌术后永久结肠造口患者围术期采用激励干预的应用效果。方法 选取2017年4月～2018年10月我院收治的行常规护理的35例行手术治疗的直肠癌患者纳入对照组,将同期于我院接受激励干预的35例行手术治疗的直肠癌患者纳入观察组,对比两组患者负性情绪、自我效能及生活质量。结果 出院时,观察组SDS、SAS评分均低于对照组,差异有统计学意义(P0.05);干预后,观察组自我效能评分、生活质量评分均高于对照组,差异均有统计学意义(P0.05)。结论 对直肠癌术后永久结肠造口患者围术期护理采用激励干预有助于降低焦虑、抑郁情绪,提高患者造口自我护理能力。     

天有多高,云有多淡（上）

目的 探讨乳腺癌患者癌因性疲乏的护理干预效果.方法 将80例乳腺癌术后出现癌因性疲乏的患者随机分为观察组和对照组,各40例.对照组根据医嘱行乳腺癌患者术后护理常规;观察组除接受常规护理外,由专职主管护师进行系统的癌因性疲乏护理干预.比较2组患者的癌因性疲乏状况、生存质量、自我护理能力.结果 干预前2组患者疲乏程度比较,差别无统计学意义(p>0.05);干预后,观察组疲乏程度低于对照组(p<0.05),生存质量高于对照组(p<0.05),差别有统计学意义;2组患者的自我护理能力比较,除自我责任感外,观察组均优于对照组(P均<0.05).结论 认知干预、有氧运动、心理疏导、健康教育等护理干预,有利于消除或缓解乳腺癌患者的疲乏程度,提高患者的生存质量.     

综合护理干预在乳腺癌护理中的应用价值

目的 探讨病发乳腺癌后综合护理对发病对象生活质量的影响.方法 选取2021年6月至2022年6月期间本院收诊的200例乳腺癌患者作为研究对象.随机将患者分为对照组与观察组,每组各100例.对照组采用常规护理干预,观察组实施综合护理实施干预.分析对比两组的癌因性疲乏程度、心理状态、化疗依从性、自我效能感、生活质量以及自我负担感.结果 干预前,两组的PFS评分无显著差异(P＞0.05).干预后,两组的PFS评分均显著降低,且观察组下降的幅度高于对照组(P＜0.05).干预前,两组的心理状态评分无显著性差异(P＞0.05);干预后,观察组心理状态评分显著低于对照组(P＜0.05).观察组的化疗依从性显著高于对照组(P＜0.05).护理前,两组的自我效能感、生活质量评分均无显著差异(P＞0.05);护理后,两组的自我效能感、生活质量评分均显著提高,且观察组的自我效能感、生活质量评分显著高于对照组(P＜0.05).护理前,两组自我感受负担评分无显著差异(P＞0.05);护理后,观察组的自我感受负担评分显著低于对照组(P＜0.05).结论 综合护理用于乳腺癌患者的干预中,能降低癌因性疲乏程度,改善患者的心理状态,提高化疗依从性、自我效能感、生活质量,降低自我负担感.     

系统化认知干预对乳腺癌化疗患者自我效能的影响

目的探讨系统化认知干预对乳腺癌化疗患者自我效能的影响。方法选择2017年1—12月本院收治的260例乳腺癌患者,随机等分为对照组和研究组,对照组采用常规护理干预,研究组在对照组基础上应用系统化认知干预,比较两组患者干预前后生活质量、自我效能等相关指标。结果两组患者干预前癌因性疲乏状况比较,差异无统计学意义(P 0. 05),研究组干预后改善情况显著优于对照组(P 0. 05);研究组患者干预后生活质量显著优于对照组(P 0. 05);两组患者干预前自我效能评分无差异(P 0. 05),研究组患者干预后自我效能评分显著高于对照组(P 0. 05)。结论在乳腺癌患者化疗期间,应用系统化认知干预效果显著,能有效提高患者自我效能,提高患者生活质量,值得推广应用。     

康复志愿者人文关怀支持对乳腺癌手术患者自我感受负担及生活质量的影响

目的：观察康复志愿者人文关怀支持对乳腺癌手术患者自我感受负担及生活质量的影响。方法：选择72例行手术治疗的乳腺癌患者,以随机数字表法分为观察组和对照组各36例。对照组给予常规护理干预,观察组给予康复志愿者人文关怀支持。干预1年后观察两组患者自我感受负担、生活质量、心理状态、疾病知识知晓率情况。结果：干预前,两组患者自我感受负担、生活质量各维度得分、心理状态（SAS、SDS）评分比较差异无统计学意义（P＞0.05）。干预1年后,两组患者自我感受负担各维度评分及总分、心理状态各项评分均低于干预前,生活质量各维度评分均高于干预前,且观察组优于对照组,差异有统计学意义（P＜0.05）;观察组疾病各方面知识知晓率高于对照组,差异有统计学意义（P＜0.05）。结论：康复志愿者人文关怀支持可有效减轻乳腺癌患者术后康复治疗中的自我感受负担,提高患者生活质量,改善其心理状态,提高患者疾病知识知晓率。     

系统化护理干预对乳腺癌化疗患者癌性疲乏与生活质量的影响

目的:研究系统化护理干预对乳腺癌化疗患者癌性疲乏与生活质量的影响。方法:选取2015年9月~2016年7月我院收治乳腺癌化疗患者86例,依照入院顺序分组,各43例。对照组予以常规护理,观察组在对照组基础上予以系统化护理干预。统计两组干预前后癌性疲乏状况和生活质量。结果:护理前两组癌性疲乏、生活质量评分对比差异无统计学意义(P0.05);护理后观察组癌性疲乏评分低于对照组,生活质量评分高于对照组,差异有统计学意义(P0.05)。结论:乳腺癌化疗患者施以系统化护理干预可改善其癌性疲乏状态,提高生活质量。     

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.     

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.