手术室护理路径在老年髋关节置换术患者中的应用价值

目的探讨手术室护理路径在老年髋关节置换术患者中的应用价值。方法选取86例老年髋关节置换术患者按照随机数字表法平均分为2组,对照组采用常规护理管理,观察组采用手术室护理路径管理,护理持续时间为术前1周至术后2周,共3周,比较术后2组患者并发症发生情况、手术时间及术中出血量、髋关节功能评分、护理满意度。结果观察组发生术后感染2例(4.65%)、假体松动1例(2.33%),对照组发生术后感染9例(20.93%)、关节脱位6例(13.95%)、假体松动8例(18.60%),2组并发症发生率差异有统计学意义(P0.05);观察组手术时间(4.41±0.72)h、术中出血(269.39±56.55)m L,对照组手术时间(6.21±0.95)h、术中出血(391.58±61.19)m L,差异有统计学意义(P0.05);手术前2组患者髋关节评分差异无统计学意义(P0.05),术后观察组髋关节评分高于对照组(P0.05);观察组患者护理满意度高于对照组(P0.05)。结论手术室护理路径对老年髋关节置换术患者缩短手术时间、减少术中出血量以及改善术后恢复具有重要价值。     

护理干预对髋关节置换术患者心理状态及术后并发症的影响

目的探讨护理干预对髋关节置换术患者心理状态及术后并发症的影响。方法选取78例髋关节置换术患者,根据随机数字法分为对照组(常规护理)和观察组(护理干预),各39例,采用焦虑自评量表(SAS)、抑郁自评量表(SDS)评估2组患者护理前后心理状态,并比较2组髋关节功能、术后并发症以及生活质量、满意度。结果观察组护理后SAS及SDS评分均显著低于对照组(P0.05);观察组术后Harris髋关节功能评分、生活质量评分均显著高于对照组(P0.05);观察组并发症发生率显著低于对照组,且护理服务满意度显著高于对照组(P0.05)。结论护理干预能够明显改善髋关节置换术患者的负面情绪,降低术后并发症发生率,提升患者术后生活质量。     

健康教育护理干预与常规护理对全髋关节置换术患者并发症的影响

目的探讨健康教育护理干预与常规护理对全髋关节置换术患者并发症的影响。方法选取苏州市立医院本部2013年5月~2015年5月的108例全髋关节置换术患者为研究对象,随机分为干预组和对照组各54例,对照组采用常规护理,干预组在对照组的基础上进行健康教育护理干预,干预后随访3个月,采用采用视觉模拟评分(visual analogue scale,VAS)疼痛评分对疼痛进行评价,采用日常生活活动(Activities Of Daily Living,ADL)量表评分评价患者日常生活活动能力,采用髋关节(Harris)评分对患者关节的功能、畸形与活动度进行评价。观察2组患者护理前后并发症发生率、护理前后VAS评分、Harris评分及ADL评分、患者满意度。结果干预组的并发症发生率(7.4%)明显低于对照组(29.6%),差异具有统计学意义(P0.05);干预组的VAS评分、ADL评分和Harris评分与对照组存在明显差异(P0.05);干预组的满意度(100%)明显高于对照组(79.6%),差异具有统计学意义(P0.05)。结论对全髋关节置换术患者术后的并发症进行健康教育护理干预可以有效的改善患者的并发症,减少疼痛,患者的满意度比较高。     

综合护理在老年全髋关节置换术患者术后恢复中的应用

目的:探讨综合护理在老年全髋关节置换术患者术后恢复中的应用。方法:将2010年1月~2014年12月收治的168例行全髋关节置换术治疗的老年髋部骨折患者随机分为对照组和观察组各84例,对照组给予常规护理,观察组在此基础上给予综合护理。比较两组患者髋关节功能、日常生活能力、抑郁症状和并发症情况。结果:干预后两组Harris评分、Barthel指数显著升高(P0.05),且观察组Harris评分、Barthel指数显著高于对照组(P0.05)。干预后两组GDS抑郁评分显著降低(P0.05),且观察组GDS抑郁评分显著低于对照组(P0.05)。观察组并发症发生率为6.0%,显著低于对照组34.5%(P0.05)。结论:综合护理可有效提高老年全髋关节置换术患者术后关节功能、日常生活能力,降低抑郁症状和并发症发生率。     

快速康复护理联合中医护理干预在老年髋关节置换病人围术期的应用效果

目的:探讨快速康复护理联合中医护理干预在老年髋关节置换术围术期的应用效果.方法:选取2019年9月—2020年8月于医院行髋关节置换术的132例老年病人为研究对象,据不同护理方案分为观察组与对照组各66例.对照组实施骨科常规护理与治疗(围术期护理、基本术后康复护理),观察组则采用快速康复护理联合中医护理干预.比较两组病人疼痛评分、日常生活能力(ADL)评分及髋关节功能Harris评分、术后并发症发生率.结果:护理后观察组病人视觉模拟疼痛量表(VAS)评分、并发症发生率低于对照组(P<0.05);护理后观察组病人ADL评分、髋关节功能Harris评分高于对照组(P<0.05).结论:老年髋关节置换病人采用快速康复护理联合中医护理干预,可显著降低疼痛,改善术后日常生活能力及髋关节功能.     

系统化护理干预对人工全髋关节置换术患者的影响

目的探讨系统化护理干预对人工全髋关节置换术患者护理质量的影响。方法选取我院2016年7月至2017年7月关节外科住院行全髋关节置换术患者60例为研究对象,将其随机等分为观察组和对照组,对照组给予常规护理,观察组在此基础上给予系统化护理干预,比较两组患者的护理满意度。结果对照组护理满意度平均得分为(82.44±4.78)分,观察组护理满意度平均得分为(90.11±5.93)分,观察组评分明显高于对照组,差异有统计学意义(P0.05)。结论系统化护理干预应用于全髋关节置换术,能够明显提高护理质量和护理满意度,值得临床推广应用。     

以Orem自护理论为核心的护理干预在全髋关节置换术老年患者中的应用

目的:探讨以Orem自护理论为核心的护理干预在全髋关节置换术老年患者中的应用方法及效果。方法:将92例行全髋关节置换术老年患者随机分为对照组和观察组各46例,对照组行常规骨科护理,观察组在此基础上实施以Orem自护理论为核心的护理干预,比较两组护理干预效果。结果:观察组患者Harris、自理能力(ADL)评分优于对照组(P0.05),术后并发症发生率低于对照组(P0.05),护理满意度高于对照组(P0.05)。结论:以Orem自护理论为核心的护理干预可改善全髋关节置换术老年患者的髋关节功能,提高自理能力,减少术后并发症,提高护理满意度。     

基于手术室护理关注点拓展的全方位舒适护理对老年髋关节置换术患者的影响

目的观察基于手术室护理关注点拓展的全方位舒适护理在老年人工髋关节置换术患者中的应用效果。方法选择2016年1~12月于本院手术室接受人工全髋关节置换术干预的110例老年患者为研究对象,随机等量分为对照组和观察组,每组各55例,对照组接受常规手术室护理,观察组接受基于手术室护理关注点拓展的全方位舒适护理干预,对干预后两组病例在各相关观察指标方面的差异性做出比较。结果观察组老年受术者干预后焦虑评分、心率波动幅度均显著低于对照组,舒适度评分与手术室护理满意度评分显著高于对照组同类老年受术者(P0.05)。结论采用基于手术室护理关注点拓展的全方位舒适护理对老年髋关节置换术患者实施干预,能够显著改善该类受术者手术焦虑情绪,避免手术应激性心率剧烈波动,提高术中舒适度与手术室护理满意度。     

手术室护理干预对促进髋关节置换患者手术切口甲级愈合及预防感染的应用效果分析

目的探讨手术室护理干预对髋关节置换患者手术切口甲级愈合及预防感染的应用效果。方法选取行髌关节置换术患者120例为研究对象,随机分成观察组和对照组各60例。对照组行髋关节置换术手术室常规护理,观察组在常规护理基础上行手术室护理干预,观察两组术后切口甲级愈合率、感染率及患者对护理满意度。结果观察组甲级愈合率93.33%(56例)、感染率3.33%(2例)、护理满意度98.33%(59例),对照组分别为80.00%(48例)、、13.33%(8例和86.67%,两组比较,观察组术后切口甲级愈合率和护理满意度明显高于对照组,感染率明显低于对照组,差异有统计学意义(P<0.05)。结论手术室护理干预能明显提高髋关节置换术患者甲级愈合率,减少感染,提高患者对护理的满意度,改善医患关系,加速康复进程。     

综合疼痛护理干预对全膝关节置换术后患者康复效果的影响

目的 探讨围手术期综合疼痛护理干预对全膝关节置换术后患者的康复效果的影响.方法 选择行全膝关节置换手术的患者100例,采用随机分组法将患者分为对照组和干预组各50例,对照组实施常规的术后护理,干预组在常规护理的基础上,施行综合疼痛护理干预措施,观察并记录两组患者术后的康复训练情况.结果 干预组术后4,8,12,24,48,72 h的疼痛评分分别为(3.12±0.13),(2.35±0.92),(2.42±1.23),(1.92±0.17),(1.65±1.17),(1.73±0.63)分;对照组分别为(4.80±0.30),(6.12±1.65),(7.42±2.09),(3.70±0.22),(3.80±1.67),(3.48±1.67)分;两组比较,差异有统计学意义(f分别为4.72,13.77,14.73,14.09,8.23,7.69;P＜0.01).术后干预组患者的主动直腿抬高时间、膝关节主动屈膝活动达90.时间均显著低于对照组[分别为(14.50±1.90)比(24.73±3.04)h,(3.27±0.73)比(4.10±1.05)d],差异有统计学意义(t分别为24.24,5.75;P＜0.01).干预组出院时膝关节主动活动度显著大于对照组[(106.46±11.65)比(98.60±11.36)°],差异有统计学意义(t=2.57,P＜0.05).干预组的出院满意度显著高于对照组(x2=63.25,P＜0.01).结论 综合疼痛护理干预可以减轻膝关节置换术患者的术后疼痛,增加患者的舒适度,有助于患者尽早进行功能锻炼,促进患者的早期康复,提高护理质量,提高患者满意度.     

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.