护理人员对静脉输液速度控制态度与行为分析

目的 了解临床护理人员对控制静脉输液速度的态度与行为.方法 采用问卷调查法,研究对象为某综合医院的护理人员,共回收有效问卷134份.结果 所有被调查者均认为控制输液速度很重要,其中需要严格控制速度的患者主要包括心脏病患者、老人、儿童等;护士长遇见关于输液速度不当导致不良后果的比例较高;护士选择输液工具的根据主要是执行医嘱;调节不同类型输液器以恒速调节器需要时间最短.结论 护理人员需进一步强化输液速度控制的意识,加强对输液速度监控,选择合适的输液工具,为患者提供一个安全的治疗护理环境.     

临床医生对控制静脉输液速度态度的调查与分析

目的了解临床医生对控制输液速度的态度,为临床护理人员提供信息。方法采用自行设计问卷,对某所综合性医院的53名医生进行调查。结果所有被调查者均认为控制静脉输液速度很重要;需要严格控制输液速度的患者主要包括心脏病患者、老年人与休克患者等;30.2%的医生每次书写医嘱注明静脉输液速度。结论应进一步强化医护人员对静脉输液速度的控制意识,在工作中规范医嘱书写,加强对输液速度的监控,为患者提供安全的治疗和护理。     

护士合理选择输液工具的现状调查及分析

目的了解护理人员对静脉输液工具的认识程度和选择态度及患者对输液工具的认知情况,分析存在的问题,探讨正确合理的输液工具选择方案。方法以问卷调查的方式,对该院195名护理人员和183例住院患者进行调查分析。结果 (1)74.87%的护理人员认为合理选择输液工具非常重要,52.31%的护理人员在工作中依据临床护理经验选择输液工具,75.38%的护理人员知道静脉输液常见并发症,52.82%的护理人员知道常见并发症的处置。(2)护理人员主要通过医院培训进行输液知识学习,仅38.46%的护理人员经常进行相关知识学习。(3)绝大多数住院患者不了解输液穿刺、穿刺工具和输液方法相关知识。结论护理人员应该进一步加强关于输液工具选择相关知识的全面、系统、多方式学习,同时应加强护患沟通,向患者普及输液工具选择的相关知识。     

某传染病医院护理人员对输液工具选择认知状况调查分析

目的:了解传染病医院护理人员对输液工具选择的认知状况,分析影响因素,提出对策。方法:采用自行设计的调查表,对昆明市某三甲传染病医院114名护士发放调查表,对调查结果进行统计分析。结果:在参与调查的114名护理人员中,能够全面掌握输液前评估内容的护士仅占24.56%,70.18%的护士部分掌握,5.26%的护士对相关内容不掌握;大部分护士能够全面掌握静脉留置针(69.30%)和CVC(57.89%)的护理,但PICC(7.02%)的护理掌握情况差;调查对象中66.67%的护理人员认为,传染病患者和非传染病患者在输液工具的选择上没有区别;73.68%的调查对象的输液工具选择相关知识获知途径来源于专科书籍,而根据指南学习获取知识的护士仅占28.95%。结论:调查对象对输液工具选择认知的状况不理想,医院在针对性开展培训的基础上,应逐步建立静脉治疗质控体系,保障输液治疗安全,提高输液治疗质量。     

静疗手册在静脉输液中的应用与效果评价

目的:探讨静疗手册在静脉输液治疗前后的应用效果。方法:选择2014年10月~2015年1月273患者作为对照组,2015年2~5月251例患者作为观察组,对照组采用常规输液步骤输液;观察组建立静疗手册,对护士进行培训学习,以分层级管理方式落实静疗手册的应用,比较两组患者的输液工具选择、并发症发生率及满意度。结果:观察组患者留置针使用率高于对照组(P0.05),输液肿胀率低于对照组(P0.05),患者的满意度高于对照组(P0.05)。结论:静疗手册在输液前后的应用,改变了患者对传统输液工具的认识,选择合适的输液工具,降低了输液肿胀率,减轻患者的痛苦,提高了患者对护理人员的满意度。     

护士合理选择静脉输液工具的现状及影响因素分析

目的:调查临床护士对静脉输液工具的认知和使用情况,探讨影响护士合理选择静脉输液工具的主要因素,并针对静脉输液工具实际使用过程中存在的问题提出相应对策。方法:采用自行设计的调查问卷,对医院血液科27名在职护士进行问卷调查,分析临床护士对静脉输液工具认知和选择情况。结果:血液科护士对头皮钢针、静脉留置针、经外周静脉置入中心静脉导管(PICC)相关知识掌握情况较好,而对中心静脉导管(CVC)、输液港相关知识掌握不足;血液科护士对PICC使用较多,而头皮钢针使用率较低;对选择合适的静脉输液工具较为重视;患者要求,药物因素是影响护士合理选择静脉输液工具的主要因素。结论:低年资护士仍需加强对各类型静脉输液工具相关知识和技能的学习,从专业角度选择适宜患者实际情况的输液工具,以提高血液科静脉输液治疗管理质量。     

三级甲等综合医院住院患者静脉治疗横断面调查分析

目的:调查三级甲等综合医院住院患者静脉治疗现状,对存在问题进行分析,持续改进并提升静脉治疗质量。方法:按照静脉治疗小组设计的《静脉治疗技术操作规范横断面调查表》调查内容,对某三级甲等综合医院2017年11月23日全天所有住院患者静脉治疗情况进行横断面调查,采用SPSS 17.0软件对数据进行分析。结果:住院患者输液率60.92%,重症医学科输液率100.00%;静脉治疗使用工具以外周静脉导管为主,使用率54.69%,钢针使用率34.16%,同时存在经外周静脉置入中心静脉导管、中心静脉导管等多种输液装置;在进行静脉治疗的住院患者中,在日常维护、输液工具选择、并发症等方面存在387项问题,发生率为29.98%,在存在的问题中日常维护占73.13%,输液工具选择不合理占24.03%,发生并发症占2.84%。结论:三级甲等综合医院住院患者输液率低于全国平均水平,但部分科室输液率仍需进一步控制;临床静脉治疗输液工具选择相对合理,但钢针的使用率还要控制收紧;静脉治疗在日常维护、输液工具选择、并发症等质量改进方面还有待改进提升。护理管理者要加强静脉治疗输液工具选择、置管、维护、并发症预防等各环节的质量控制,持续改进提升静脉治疗质量,确保患者输液安全,促进《规范》的贯彻落实。     

静脉输液前馈控制现状

静脉输液是临床治疗过程中最常见的给药途径及护理技术操作,是临床护理工作中必须掌握的一门技术［1］,文献［2］报道90％～95％的住院患者需要静脉输液治疗。输液治疗的疗效很确定,但因输液导致的静脉炎、渗出等静脉损伤也并不少见。临床输液治疗的患者多数是从使用头皮针开始［3］,在短期输液治疗里,大部分护理人员易忽略患者的治疗方案、疗程以及个体血管条件等因素去选择输液的工具与途径,在静脉治疗发生困难时或出现输液并发症时才开始慎重评估,给患者造成了痛苦及经济损失。笔者查阅了大量文献资料,对近几年来中国国内静脉输液前馈控制现状进行了汇总,现报告如下。     

陕西地区部分医院静脉输液工具使用及维护的调查与对策

[目的]了解陕西地区医院静脉输液工具使用及维护现状,为进一步规范静脉输液工具使用及维护提供依据。[方法]运用中华护理学会静脉治疗护理专业委员会统一编制的静脉输液工具使用及维护调查问卷,对陕西地区18所医院的468个科室护理人员进行调查。[结果]静脉输液工具选择:陕西地区医院静脉输液主要途径是外周静脉(96.48%),静脉穿刺工具中头皮钢针占58.36%,外周静脉留置针占38.12%,经外周静脉置入中心静脉导管(PICC)占2.19%,中心静脉导管(CVC)占1.33%。静脉输液工具使用及维护:在输液接头的选择、敷料应用和更换、封管方法、相关的穿刺记录等方面做得较好。但在穿刺部位的选择方面,存在留置针选择手背静脉占39.10%,CVC首选锁骨下静脉仅占56.20%;PICC、CVC置管成功后拍片确定导管尖端的位置均低于70%,存在安全隐患。科室内使用PICC、CVC和外周留置针过程中最常见的并发症是导管阻塞,反映导管维护存在问题。[结论]陕西地区部分医院静脉输液工具选择不够合理,护理人员维护知识掌握欠佳。     

警示牌在心内科患者控制静脉输液速度中的应用

目的探讨安全警示牌在心内科患者控制静脉输液速度中的作用。方法选择需控制静脉输液速度的心内科患者305例,随机分为观察组155例和对照组150例,对照组采用口头宣教方法告知患者及陪医控制输液速度的要求及重要性,观察组在对照组的基础上应用自制的安全警示牌。观察两组患者输液速度、不良反应或主诉不适、因输液速度导致的医护矛盾情况。结果观察组患者出现输液速度过快情况明显少于对照组,因输液过快出现不良反应或不适的患者明显少于对照组,因速度过快引发医护矛盾明显少于对照组,两组比较,均P<0.05,差异具有统计学意义。结论安全警示牌能增强告知及警示作用,有效提高患者对输液速度的依从性,避免差错事故发生,值得临床推广应用。     

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.