心理干预模式对手术患者的影响

目的 探讨对手术患者实施心理干预的效果,制订科学合理的心理干预模式.方法 选取我院外科、骨科、妇科手术患者共60例,随机分为干预组和对照组各30例.对干预组患者根据特定的心理干预模式进行心理干预;对照组采取常规心理护理,评估并比较2组患者的心理状态.结果 干预组手术患者焦虑分值、抑郁分值、恐惧分值、孤独分值、负性情绪总分下降幅度与对照组比较,差异有统计学意义(P＜0.05).结论 对手术患者实施心理干预模式可缓解其负性情绪,使患者保持良好的身心状态.     

心理干预对妇科手术患者负性情绪的影响

目的探讨妇科手术患者心理干预及其措施，并验证其效果。方法选取妇科手术患者32例，随机分为干预组和对照组，每组16例。干预组根据制定的心理干预模式实施心理干预；对照组采取常规心理护理，评估并比较两组患者的心理状态。结果干预后，干预组患者焦虑分值、孤独分值、负性情绪总分的降低幅度均较对照组明显，差异有统计学意义（P〈0.05）。结论心理干预可缓解妇科手术患者的负性情绪，帮助其保持较良好的身心状态。     

手术患者心理干预模式及其效果研究

目的探讨手术患者心理干预模式及具体措施,并验证其效果。方法选取某三级甲等医院外科手术患者30例,随机分为干预组和对照组,每组各15例。干预组患者根据制定的心理干预模式实施心理干预;对照组采取常规心理护理,评估并比较两组患者的心理状态。结果干预后,干预组患者焦虑分值、孤独分值、负性情绪总分的降低幅度均较对照组明显,差异有统计学意义(P<0.05)。结论心理干预模式可缓解手术患者的负性情绪,帮助其保持较良好的身心状态。     

术前访视在手术室的应用

目的：探讨心理干预对手术患者心理状态的影响。方法：选取普外科及妇科择期手术患者60例，随机分为干预组和对照组各30例，干预组手术前1d访视患者，对患者进行心理干预，对照组接受常规护理，评估并比较2组患者的心理状态。结果：干预组手术患者焦虑、抑郁等负性情绪总分下降幅度与对照组比较，差异有统计学意义（P〈0．05）。结论：对手术患者实施术前心理干预可缓解其负性情绪，使患者保持良好的身心状态。     

围术期亲情护理的延伸对患者术后心理影响的临床研究

目的 探讨围术期亲情护理干预术前患者心理模式及具体措施，并验证其效果。方法选取三级甲等医院行腹腔镜胆囊切除术的患者120例，随机分为亲情护理干预实验组和对照组各60例，实验组患者根据制定的亲情护理干预模式实施心理干预；对照组未采取心理干预，且术后1年均进行电话随访，评估并比较两组患者的心理状态。结果干预后，实验组患者焦虑分值总分的降低幅度均较对照组明显，差异有统计学意义（P〈0．05）。结论亲情护理心理干预模式可缓解手术患者的负性情绪，帮助其保持较良好的身心状态，有利于术后康复。     

糖尿病胰岛素泵强化治疗患者心理干预效果的研究

目的探讨胰岛素泵强化治疗患者心理干预模式及具体措施。方法选取2005年10月至2007年12月我院内分泌科糖尿病患者120例，分为实验组和对照组，每组60例。对照组采取常规健康教育，实验组在此基础上实施心理干预，评估并比较两组患者的心理状态及血糖控制情况。结果干预后实验组患者焦虑、抑郁分值低于对照组，血糖控制明显好于对照组（P〈0．05）。结论心理干预模式可以缓解胰岛素泉强化治疗患者的负性情绪，提高胰岛素泵的治疗效果。     

基于PERMA模式的积极心理干预在宫颈癌放化疗病人中的应用

目的:探讨基于PERMA模式的积极心理干预对宫颈癌放化疗病人益处发现、心理痛苦及负性情绪的影响。方法:将120例宫颈癌病人按病区分为观察组和对照组，各60例，对照组实施常规护理措施，观察组在其基础上实施基于PERMA模式的积极心理干预。比较两组病人干预前、干预结束时、干预12周后益处发现、心理痛苦及负性情绪评分。结果:两组病人益处发现、心理痛苦及负性情绪评分的干预效应、时间效应、交互效应均有统计学意义（均P<0.05）。结论:基于PERMA模式的积极心理干预能提高宫颈癌病人的益处发现水平，有效降低心理痛苦程度并缓解其负性情绪。     

心理干预对减轻宫颈癌手术患者负性情绪的效果观察

目的 探讨心理干预对减轻宫颈癌手术患者负性情绪的效果.方法 将100例确诊为宫颈癌并需手术治疗的患者随机分为观察组和对照组各50例.对照组给予一般的术前访视,观察组采用健康教育、认知治疗、心理干预等综合干预措施.采用焦虑自评量表(SAS)和抑郁自评量表(SDS)评价2组患者干预前后的焦虑及抑郁状况,并对2组干预前后焦虑恐惧、抑郁的发生率进行比较.结果 综合干预后观察组SDS和SAS评分明显低于对照组,负性情绪发生率明显低于对照组.结论 对宫颈癌手术患者实施综合心理干预,可减轻患者焦虑、抑郁、恐惧等负性情绪,有利于患者配合治疗,增加手术耐受能力,提高手术治疗效果,促进患者早日康复.     

妇科肿瘤患者实施心理护理干预对患者焦虑抑郁心理的影响

目的 探讨心理护理干预对妇科肿瘤患者的护理效果。方法 选取 2020 年 10 月至 2022 年 9 月期间在我院的 80 例妇科肿 瘤患者作为研究对象。依据随机数字表法将患者分成对照组和观察组,每组各 40 例。对照组接受常规护理。观察组实施心理 护理。比较两组的负性情绪、生活质量、依从率。结果 观察组的不良情绪评价分值低于对照组患者（P<0.05）。观察组生活质 量评价分值高于对照组患者（P<0.05）。观察组的依从率（95.00%）高于对照组（72.50%）（P<0.05）。结论 妇科肿瘤实施心理 护理干预,能够改善负性情绪,提高生活质量,增强依从性     

经阴道无张力悬吊术后患者的心理护理

目的 探讨经阴道无张力悬吊术后患者的有效的心理干预模式及具体措施,并验证其效果.方法 选取经阴道无张力悬吊手术后负性情绪评分高于常模的患者30例,随机分为干预组和对照组各15例.干预组患者根据制订的护理干预模式实施心理护理;对照组采取常规心理护理,评估并比较2组患者干预不同时期的心理状态.结果 干预后,干预组患者焦虑、孤独、负性情绪总分较对照组改善更加显著,差异有统计学意义(P＜0.05).结论 合理的护理干预模式可缓解经阴道无张力悬吊术后患者的负性情绪,帮助其保持良好的身心状态.     

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.