食管癌术后患者自我管理积极度现状及影响因素分析

目的了解食管癌术后患者自我管理积极度现状, 并分析其影响因素。方法 2022年8月至2023年9月, 采用便利抽样法, 选取中山大学肿瘤防治中心158例食管癌术后患者为研究对象, 使用一般资料调查问卷、患者积极度量表、恐惧疾病进展简化量表、家庭关怀度指数量表进行横断面调查, 采用多重线性回归分析食管癌术后患者自我管理积极度的影响因素。结果有效回收问卷144份, 其中男106例, 女38例, 年龄18～39岁22例, 40～59岁55例, ≥60岁67例。食管癌术后患者积极度量表得分为(59.61 ± 16.07)分、恐惧疾病进展量表得分为(40.45 ± 9.76)分、家庭关怀度指数得分为(11.41 ± 2.36)分。多重线性回归分析结果显示, 文化程度、恐惧疾病进展、家庭关怀度指数是食管癌术后患者自我管理积极度的影响因素(t=2.54、-13.49、2.45, 均P<0.05)。结论食管癌术后患者自我管理积极度总体有待提高, 临床护理工作者应密切关注食管癌术后患者自我管理积极度现状, 制订系统、科学、有效的自我管理积极度干预策略。     

肝癌患者术后正念水平与家庭关怀度的相关性研究

目的 探讨肝癌患者术后正念水平与家庭关怀度的相关性.方法 选取96例肝癌患者作为研究对象,均实施肝癌根治术治疗,均于术后采用简式五因素正念量表(FFMQ-SF)中文版评估正念水平,采用家庭关怀度指数问卷(APGAR)修订版评估患者家庭关怀度.分析肝癌患者术后正念水平与家庭关怀度的相关性.结果 肝癌患者正念水平处于低等水平,家庭关怀度中等缺乏;相关性分析结果显示,肝癌患者术后FFMQ-SF评分与APGAR评分呈正相关(r=0.824,P＜0.05);96例肝癌患者中,有80例低等正念水平,有16例中高等正念水平;初步比较低等正念水平组、中高等正念水平组APGAR评分后,经回归分析检验结果显示,肝癌患者APGAR各条目评分及总分降低会增加低等正念水平发生风险(OR =6.814、12.054、59.614、61.869、1.412、1.512,P＜0.05).结论 肝癌患者术后正念水平较低,与家庭关怀度密切相关,随家庭关怀度降低,患者正念水平降低,家庭关怀度是肝癌患者术后正念水平的影响因素.     

稳定期慢性阻塞性肺疾病患者希望水平及影响因素

目的 探讨稳定期慢性阻塞性肺疾病(COPD)患者的希望水平及其影响因素.方法 采用Herth希望量表、家庭关怀度量表、社会支持量表、医学应对方式问卷等,对91例18～65岁的住院稳定期COPD患者进行研究.结果 本组患者希望水平得分(35.52±3.18)分.患者的性别、肺功能情况会影响其希望水平,患者的希望水平与其家庭关怀度、社会支持及医学应对方式中的屈服的相关性有统计学意义.结论 稳定期COPD患者的希望水平处于中高水平.应采取有效措施,提高患者的家庭关怀度、社会支持,帮助患者有效应对,以提高患者希望水平.     

癌症病人希望水平与领悟社会支持及家庭关怀度的相关性研究

[目的]探讨癌症病人希望水平与领悟社会支持、家庭关怀度的相关性,并分析其影响因素。[方法]采用Herth希望量表、领悟社会支持量表、家庭关怀度量表进行横断面调查。[结果]癌症病人总体希望水平得分为(36.13±3.39)分;年龄、住院次数、家庭人均月收入、文化程度、费用支付方式、居住地等对癌症病人希望水平有影响(P0.05);病人希望水平与领悟社会支持总分和各维度均呈正相关(P0.01);希望水平与家庭关怀度部分维度之间呈正相关(P0.01)。[结论]领悟社会支持与家庭关怀度是影响癌症病人希望水平的重要因素,医护人员应采取针对性的措施,提升病人的希望水平,提高病人的生活质量。     

肾移植患者希望水平与家庭关怀度的相关性研究

了解肾移植患者希望水平与家庭关怀度的现状,并探讨两者之间的关系,为制订肾移植患者干预方案提供参考.方法采用便利抽样法,选取2018年4月—2019年4月在烟台毓璜顶医院器官移植科行术后随访的肾移植患者200例作为研究对象.采用一般资料问卷、Herth希望量表、家庭关怀度指数量表进行调查.结果肾移植患者希望水平得分为(3...     

女性不孕症患者焦虑抑郁状况及其影响因素的调查研究

目的观察女性不孕症患者焦虑抑郁状况,并对其影响因素进行调查研究。方法本研究为横断面研究,抽取杭州市两所三级甲等医院符合纳入标准的女性不孕症患者为研究对象,共计206例,分别采用自制人口学资料和疾病相关情况调查表、焦虑自评量表、抑郁自评量表、社会支持评定量表和家庭关怀度指数问卷对研究对象进行调查,并使用SPSS 20.0统计软件对数据进行处理分析。结果 206例女性不孕症患者的焦虑得分为(44.61±10.29)分,显著高于国内正常人群常模水平(29.28±10.07)分,经比较,t=27.794,P0.001;抑郁得分为(51.49±9.87)分,显著高于国内正常人群常模水平(33.46±8.55)分,经比较,t=29.746,P0.001。Pearson相关分析显示:焦虑得分与家庭关怀度得分(r=-0.276,P0.01)、社会支持得分(r=-0.284,P0.01)均显著相关;抑郁得分与家庭关怀度得分(r=-0.278,P0.01)、社会支持得分(r=-0.329,P0.01)均显著相关。经多因素逐步回归分析显示,女性不孕症患者的焦虑、抑郁与年龄及丈夫是否为独生子显著相关。结论女性不孕症患者的焦虑抑郁得分均高于国内常模,其影响因素有家庭关怀度、社会支持、年龄、丈夫为独生子等。     

肺癌患者自我效能、家庭关怀度与术后康复的相关性分析

目的了解肺癌患者自我效能、家庭关怀度与术后康复的关系,为临床治疗及护理提供相应的依据和指导。方法方便性抽样选取2011年6-9月山东大学附属省立医院胸外科收治的原发性肺癌患者共100例,采用一般资料问卷、健康促进策略量表及家庭关怀度指数问卷对其进行测评,评价患者术后康复情况并分析患者自我效能、家庭关怀度与术后康复的相关性。结果肺癌患者的自我效能平均得分为(92.01±25.02)分;家庭关怀度平均得分为(7.23±2.35)分。分析显示,患者自我效能水平越高,术后康复越好;家庭关怀度水平越高,术后康复越好。结论自我效能和家庭关怀是促进肺癌患者术后康复的重要因素。医护人员应通过心理疏导与支持、设置合理目标、选择示范对象等增强患者的自我效能;通过对家属进行有效的健康教育,强调家庭关怀对康复护理的重要性等提高家庭关怀度,从而促进患者的顺利康复。     

脑外伤患者希望水平及其家庭关怀度的关系研究

目的探讨脑外伤患者希望水平及与其家庭关怀度的关系。方法采用Herth希望量表和家庭关怀度指数问卷对212例脑外伤患者进行问卷调查,采用分层回归分析探讨脑外伤患者希望水平的影响因素。结果 1脑外伤患者的希望水平总分为(28.55±4.30)分,其中希望水平较低者占18.87%,希望水平中等者占60.38%,希望水平较高者占20.75%;2脑外伤患者家庭关怀度总分为(7.47±1.56)分;3住院时间、家庭收入、亲密度、情感度和适应度是脑外伤患者希望水平的影响因素。结论脑外伤患者希望水平处于中等水平,家庭关怀度为脑外伤患者希望水平的影响因素,提高家庭关怀度,有利于改善其希望水平。     

慢性心力衰竭患者希望水平及其影响因素研究

目的探讨慢性心力衰竭患者希望水平及其影响因素,为提高患者的希望水平及生活质量提供参考。方法采用一般资料调查问卷、Herth希望量表、家庭关怀度指数问卷、医学应对方式问卷对171例慢性心力衰竭患者进行调查。结果慢性心力衰竭患者希望水平总分为(33.68±4.29)分,其中采取积极的行动维度得分为(12.20±1.64)分,与他人保持亲密的关系维度得分为(11.06±1.52)分,对现实和未来的积极态度维度得分为(10.43±1.91)分。工作状况、心功能分级、家庭关怀度、面对和屈服应对是慢性心力衰竭患者希望水平的主要影响因素。结论慢性心力衰竭患者处于中等希望水平,医护人员应从影响患者希望水平因素的角度出发,针对性地对患者进行心理干预,以有效提高患者的希望水平。     

老年高血压患者家庭功能与依从行为的研究

目的 了解老年高血压患者家庭功能对依从行为的影响,为实施老年高血压患者家庭支持干预提供依据.方法 选择2009年1月～6月在内科住院的老年高血压患者186例,采用自制一般情况调查表、家庭关怀度指数问卷、中文版高血压患者依从性行为量表对患者进行调查.结果 老年高血压患者家庭关怀度指数问卷平均得分(5.24±2.31),依从性行为量表的平均得分(34.04±7.41),不同家庭功能状况患者的依从行为量表总分、意向、生活方式、态度、服药维度的得分比较,差异有统计学意义(P均<0.001),而责任和吸烟维度得分比较,差异无统计学意义(p均>0.05).结论 老年高血压患者家庭功能越差,依从行为越差.     

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.