群体双乙烯酮中毒的急救治疗与护理

目的探讨应急预案急救治疗护理流程图在应对突发公共卫生事件中的作用,为提高应对突发事件的组织管理、抢救治疗能力提供思路。方法对群体双乙烯酮中毒进行回顾性分析。以《突发公共卫生事件应急条例》为标准,制定应急预案和急救治疗护理流程图,成立应急指挥小组,建立、培训应急救治队伍。对该批中毒事件启动应急预案,实行流程化的急救治疗护理。结果210例中毒患者中208例治愈、1例好转出院,1例转上级医院,随访半年未出现其他系统后遗症。结论制订科学可行的应急预案,采用规范的急救治疗护理流程,进行针对性的治疗护理,同时做好事后患方的稳定协调工作,可提高突发事件患者的抢救成功率,降低病死率和伤残率,使救治质量得到保证,减少对社会的负面影响。     

应急预案急救护理流程在抢救成批爆震烧伤患者中的应用

目的将突发事件应急预案急救护理流程应用到突发成批爆震烧伤患者的急救护理中,避免成批烧伤抢救中出现忙乱现象,使患者得到快速有效的救治。方法对该批突发爆震烧伤的14名患者的抢救启动突发灾害事件应急预案,实行流程化的急救护理。结果14例患者的整个抢救过程紧张有序,未出现以往突发大批伤员抢救中的忙乱现象。运回急诊科的伤员在20~60 m in内均得到了妥善安置,10名患者行早期气管切开术,无一例患者因气道梗阻致死。14名患者全部脱离危险。结论对于突发意外灾害事故爆震烧伤的患者,制订可行的应急预案,采用规范的急救护理流程,进行专科化的治疗护理,可提高伤员的抢救成功率,降低死亡伤残率。     

护理人员应对突发事件知识与技能培训效果的探讨

目的 探讨护士应对突发事件应急知识与技能培训的效果.方法 2008年1月～2009年12月以<突发公共卫生事件应急条例>为标准,护理部制订应急预案,建立医院护理应急救治队伍,成立应急指挥专家小组,采用集中突发公共事件理论知识教育培训、模拟训练、突发事件应急演练等方法对护士进行系统化应急培训.在参与突发公共卫生事件时按照预案规定程序,组织人员做好院前急救、消毒隔离及安全防护.结果 实施培训以来,全院各级护理人员应对突发事件的能力有了较大提高,全院护理人员应对突发事件应急知识培训合格率达97.73%,应急流程掌握率达98.31%,急救操作技能掌握率达98.34%,各项考核成绩较培训前有明显提高(p＜0.01).结论 对护理人员进行系统化突发事件应急知识教育培训,并将其考核纳入护理质量管理体系是提高其应对突发事件能力的有效方法.     

护理部在应对突发卫生事件中的作用

目的探讨护理部在应对突发公共卫生事件中的作用,为提高护理部应对突发事件的组织管理能力提供思路。方法以《突发公共卫生事件应急条例》为标准,制定护理部应急预案,建立医院护理应急救治队伍,成立应急指挥领导小组。在发生突发公共卫生事件时按照预案规定程序,组织人员做好各项救治工作。结果在一次突发险情时我院在90min内成功完成475名内科住院病人的安全迁移和安置工作,此事件对病人造成的人身损害为零。结论充分发挥护理部组织、协调和控制的职能作用,有效地实施护理风险预案,能把突发事件造成的损失降到最低点。     

医院突发公共卫生事件应急预案的制定及应用

目的探讨医院突发公共卫生事件应急预案的制定及应用效果。方法根据《中华人民共和国传染病防治法》、《突发公共卫生事件应急条例》和《全国突发公共卫生事件应急预案》等法律、法规,制定医院应对突发公共卫生事件应急预案。对所制定的应急预案进行培训、演练及实战应用。结果医院应对突发公共卫生事件的能力明显提高,突发事件抢救成功率≥98%。结论医院一系列完善的突发公共卫生事件应急预案在多起突发公共事件的救援中取得了很好的社会效益和经济效益。     

护理应急预案在突发公共卫生事件中的应用

[目的]探讨护理应急预案在突发公共卫生事件中的应用.[方法]应用护理应急预案对5批突发公共卫生事件共119例病人进行救治.[结果]经抢救后,食物中毒事件病人无一例死亡,重大交通事故和房屋倒塌事故死亡8例,整个抢救过程紧张有序.[结论]突发公共卫生事件后,迅速启动护理应急预案,科学化、规范化、程序化实施抢救,可使抢救工作行之有效,从而提高抢救的成功率,降低病人的病死率和致残率.     

突发公共事件中批量伤员的组织与救护

目的 探讨突发公共事件中批量伤员的紧急救援与护理管理方法,优化急救流程,提高抢救成功率。 方法 通过迅速启动突发事件应急预案;分流患者,集中救治,合理调配人力资源等,对169起962例批量伤员进行救护。 结果 962例伤员均得到及时有效的治疗与护理,全部治愈出院。 结论 完善的突发事件应急救护预案是救治成功的前提,熟练的组织实施急救流程是成功救治的关键,实施过程中合理调配人力、物力,做好各部门间组织协调,可确保救治流程的畅通,提高批量伤员救治成功率。     

护理应急预案在突发公共卫生事件中的应用

[目的]探讨护理应急预案在突发公共卫生事件中的应用。[方法]应用护理应急预案对5批突发公共卫生事件共119例病人进行救治。[结果]经抢救后,食物中毒事件病人无一例死亡,重大交通事故和房屋倒塌事故死亡8例,整个抢救过程紧张有序。[结论]突发公共卫生事件后,迅速启动护理应急预案,科学化、规范化、程序化实施抢救,可使抢救工作行之有效,从而提高抢救的成功率,降低病人的病死率和致残率。     

急诊科应对突发公共卫生事件的护理组织与管理

【目的】讨论急诊科应对突发公共卫生事件的护理组织与管理。【方法】依照医院突发事件应急预案,按伤（病）员数量分为三个级别,采取相应有效的护理对策。【结果】全面提高了护士对急救知识和技能的掌握。【结论】完善急诊突发公共卫生时间应急预案、过硬的急救护理技术和沉着的应急能力、快速准确的检伤分类这三者是成功救治伤（病）员必不可少的重要因素。     

一起群体儿童亚硝酸盐中毒的抢救及体会

目的 探讨在应对突发公共卫生事件时的组织管理工作。方法 迅速启动应急预案，合理调配人力资源，实施有效的急救措施等。结果 13例患儿除1例入院时已呼吸心跳停止死亡外，其余12例全部抢救成功。结论 对突发公共卫生事件具有高度的敏感性和正确的判断力，并在日常工作中注重对各项应急预案及关键流程的培训及演练，在抢救过程中合理调配人力、物力，做好组织协调工作，是成功应对突发事件的根本保证。     

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.