慢性心力衰竭患者远程监护的应用现状

远程监护是近年来针对慢性疾病管理的研究热点。相关研究发现,对慢性心力衰竭(CHF)患者实施远程监护能改善其临床结局、生活质量和优化医疗资源,但CHF患者远程监护的临床应用和监护系统的设计仍处于探索阶段。本文就CHF远程监护的必要性及远程监护模式两方面进行阐述,以期为CHF患者远程监护的设计、管理及系统优化提供参考。     

慢性心力衰竭患者远程监护临床应用及影响因素研究进展

目的了解慢性心力衰竭患者远程监护的临床应用及相关影响因素。方法检索国内外数据库的相关文献,重点分析远程监护的临床应用效果、使用依从性和相关影响因素。结果远程监护能有效改善慢性心力衰竭患者出院后的院外疾病管理,使用依从性较高,但随着时间的推移其使用依从性有所下降。影响因素包括:患者年龄、监护设备、监测指标、测量频率、干预速度。结论远程监护能早期发现慢性心力衰竭患者的病情变化,帮助其在院外进行医疗求助,延缓疾病的发展和改善患者后期生活质量。今后的研究需重视远程监护相关因素对其应用效果的影响,今后对测量指标和技术参数的设定等有待深入研究。     

远程家庭监护的建立对慢性心力衰竭患者再入院率的影响

目的 探讨远程家庭监护的建立对慢性心力衰竭（chronic heart failure,CHF）患者再入院率的影响。方法 将89例CHF患者随机分为观察组45例和对照组44例。对照组按常规方法处理,住院期间由床位护士进行CHF健康教育,出院前予以出院宣教。观察组在常规护理基础上,建立远程家庭监护,按时电话随访,每周一次,连续三个月;并要求患者每日应用一次家庭监护系统,将体重及对症状的描述传输至心脏护士监控中心。通过远程家庭监护,及时发现心衰加重先兆,并提醒患者及时就医。比较两组患者三个月内再入院率。结果 三个月内观察组再入院率44.4%,对照组再入院率86.4%,观察组明显低于对照组（P<0.01）。结论 家庭监护的建立可降低CHF患者的再入院率。     

慢性心力衰竭患者远程照护护理问题评估指标的构建

目的 构建慢性心力衰竭（chronic heart failure,CHF）患者远程照护护理问题评估指标,为CHF患者的远程照护实施提供参考,以促进和完善CHF患者健康支持体系。方法基于文献分析、半结构式访谈提取CHF患者远程照护相关护理问题,通过奥马哈问题分类系统使问题的表达规范化,于2021年5月—9月应用德尔菲法确定CHF患者远程照护护理问题评估指标。结果 共开展2轮专家函询,专家权威系数为0.923,2轮函询专家的积极系数分别为73.33%和100%,肯德尔和谐系数分别为0.219、0.247（均P<0.01）。最终确定的CHF患者远程照护护理问题评估指标包含4个一级指标,24个二级指标,58个三级指标。结论 构建的CHF患者远程照护护理问题评估指标科学性、实用性较强,可为CHF患者远程照护的实施及健康支持体系的构建提供参考。     

远程重症监护系统的应用研究进展

介绍远程重症监护系统的概述及分类、优势、应用现状及影响因素,以促进远程重症监护系统的临床应用,鼓励临床医护人员参与远程重症监护相关知识的学习和精准管理,为改善病人预后提供参考。     

不同心脏远程实时监护技术对心肌缺血患者的临床应用价值

目的探讨不同心脏远程实时监护技术对心肌缺血患者护理的临床应用价值。方法选取我院2018年3月至2019年3月收治的88例心肌缺血患者为研究对象,采用心脏远程实时监护技术进行实时监护,另采用24 h动态心电图监测,比较不同监测手段的心肌缺血检出率,并据此完善护理措施。结果心脏远程实时监护和24 h动态心电图均未监测出室性心动过速;在窦性心动过速、窦性心动过缓、房性期前收缩、室性期前收缩方面,心脏远程实时监护的检出例数均高于24 h动态心电图监测;心脏远程实时监护心律失常和ST-T改变例数均高于24 h动态心电图监测(P 0.05);佩戴心脏远程实时监护仪的时间越久,心肌缺血的检出率越高。结论心脏远程实时监护技术对心肌缺血有良好的临床应用价值,其心肌缺血检出率较高。医院心脏远程监护中心人员应详细准确的记录患者联系方式,指导其正确佩戴及使用监护仪,24 h时刻监测心电图的动态变化,发现心电信息异常时,应及时打电话指导患者开展处理措施,以降低心肌缺血的致残率和病死率。     

基于移动互联网的远程睡眠管理对慢性失眠治疗的价值

目的 探讨采用移动互联网的远程睡眠管理对慢性失眠患者的治疗效果.方法 针对失眠患者设计专用软件,建立线上睡眠管理平台,对失眠患者远程管理,以2020年4月1日—2020年7月1日在某院诊断为慢性失眠并接受治疗的114例失眠患者为研究对象,所有受试者焦虑和抑郁自评均在轻度以内,按来诊时间先后顺序随机分为研究组和对照组,各57例,观察两组治疗效果及患者睡眠质量.结果 移动互联网的远程睡眠管理治疗疗效显著高于常规治疗,差异有统计学意义(P<0.05).结论 基于移动互联网技术的远程线上睡眠管理系统可用于慢性失眠治疗,易于操作,治疗依从性好,具有很好的临床推广应用价值.     

强化管理干预对慢性心力衰竭患者负性情绪、心功能及生活质量的影响

<正>慢性心力衰竭(CHF)是由患者慢性心肌病损、心室长期压力、容量负荷多导致的慢性心排出量降低、静脉淤血及动脉供血不足[1]。CHF患者临床表现为呼吸困难、失眠、疲劳等症状,患者心理与生理上的压力容易产生抑郁、焦躁、烦闷等负性情绪,严重影响临床治疗效果[2]。对CHF患者行强化管理干预可缓解紧张、焦虑、悲观等不良情绪,增强药物治疗依从性[3-4]。同时,规范用药、定期随访均能改善患者心功能、生活质量,进而促     

应客观对待他汀类药物在慢性心力衰竭中的治疗作用

慢性心力衰竭（CHF）是各种心脏疾患的终末阶段，并随着人口的老龄化及医疗水平的不断发展，CHF发病率、死亡率逐年上升，因此CHF已成为当代临床心脏病学者关注和研究的热点。近些年来人们研究发现他汀类药物除有显著降血脂作用外，还有阻止CHF的发生和发展的作用，并能改善CHF患者的预后。     

低钠血症对中、重度心力衰竭患者心脏功能和预后的影响

低钠血症是慢性充血性心力衰竭（CHF）过程中常见的并发症，低钠血症在心力衰竭患者短期预后的判断中起重要作用[1]，对CHF患者长期预后影响的研究较少。本研究对近年来收治的中、重度CHF住院病例资料进行分析并进行了3年随访，观察低钠血症患者的临床特点及远期预后，为CHF患者进行危险分层、指导治疗和预后判断提供依据。     

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.     

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.