高压氧治疗新生儿缺氧缺血性脑病观察

新生儿缺氧缺血性脑病（HIE）是造成围产儿死亡及小儿智力低下、脑瘫等后遗症的重要原因，近年来运用高压氧治疗HIE有不少成功经验报道，遂宁市红十字医院在常规治疗基础上开展高压氧治疗HIE取得了明显的效果，现报告如下。     

高压氧治疗新生儿缺氧缺血性脑病78例

新生儿缺氧缺血性脑病 (ＨＩＥ)是新生儿早期死亡的常见原因。而且存活者很大部分留有癫痫、脑性瘫痪等严重的神经系统后遗症。我科于 1990年 7月～ 1998年 7月在常规治疗基础上加用高压氧治疗 ,取得良好的效果。现总结如下。1　资料和方法1.1　一般资料　本组缺氧缺血性脑病14 8例均为我院儿科病房住院患儿。其诊断标准和分度按 1989年济南新生儿专题会议标准。我们把ＨＩＥ的常规药物治疗组定为对照组共 70例 ,男 40例 ,女 3 0例 ,胎龄 (3 8.4± 2 .3 )周 ,日龄 (41± 18.8)小时。其中轻度 2 8例 ,中度 2 5例 ,重度 17例。把常规药物加高…     

新生儿缺氧缺血性脑病应用高压氧治疗智能追踪随访报告

新生儿缺氧缺血性脑病(ＨＩＥ)可致中枢神经细胞不可逆损伤,常有程度不同的中枢神经系统后遗症,智能低下。迄今,对减轻和避免ＨＴＥ所致永久性神经功能缺陷的后遗症,国内外尚缺少有效治疗方法。我院于1996年4月～10月对41例ＨＩＥ患儿应用高压氧(ｈｙｐｅｒｂａｒｉｃｏｘｙｇｅｎ,ＨＢＯ)治疗,并对多数患儿进行智能追踪随访,取得显著效果。现报告如下。1　对象和方法1.1　对象　采用随机抽样(单住院号为治疗组,双住院号为对照组)方法,将ＨＩＥ患儿分为两组。高压氧(ＨＢＯ)治疗组(简称治疗组):41例均为我院新生儿病区ＨＩＥ患儿,男23例、女…     

高压氧佐治重度新生儿缺氧缺血性脑病临床疗效评价

目的 探讨高压氧佐治重度新生儿缺氧缺血性脑病（HIE）临床疗效.方法 将重度HIE新生儿分高压氧治疗组20例,对照组18例,比较两组近期临床症状、体征消失的时间及新生儿行为神经评分（20项NBNA）的变化,同时观察远期有无后遗症的发生.结果 高压氧治疗组治疗后呼吸衰竭消失天数较对照组明显缩短（P＜0.01）,循环不良与消化道紊乱消失天数与对照组无显著性差异（P＞0.05）,治疗后20项NBNA评分在高压氧组明显高于对照组（P＜0.05）.远期疗效观察后遗症的发生率,高压氧组明显低于对照组.结论高压氧佐治新生儿重度HIE临床疗效较对照组好,未发现明显副作用.     

高压氧治疗新生儿缺氧缺血性脑病临床分析

<正>新生儿缺氧缺血性脑病(hypoxic-ischemic encephalopathy,HIE)是一种围产期、新生儿期常见的中枢神经系统疾病,是由多种原因造成缺氧缺血而导致的脑损害。HIE的发生主要与围产期窒息、缺氧、宫内窘迫及分娩过程有密切关系。由于新生儿期的发育相当活跃,所需氧气及糖分相对较多,故缺血对脑组织损害相对明显。为了探讨高压氧疗法对HIE     

高压氧治疗新生儿缺氧缺血性脑病的临床观察

围产期缺氧缺血引起的脑损害 ,临床称为缺氧缺血性脑病(Hypoxic- ischemic encephalopathy,HIE)。我们搜集 2 0 0 0年 3月～ 2 0 0 1年 4月我科应用高压氧治疗新生儿缺氧缺血性脑病(HIE)患儿 36例 ,取得满意的疗效。现报道如下 :1　临床资料1.1　观察对象　 2 0 0 0年 3月～ 2 0 0 1年 4月我科收住的 HIE患儿 6 8例。诊断依据及临床分度均根据 1996年杭州会议制度的标准 ,根据治疗方法不同随机分为两组。治疗组 36例 ,常规治疗 (支持疗法、对症治疗 ,脑细胞代谢药物自由基清除剂等 )加高压氧组治疗 ,其中男 2 6例女 10例 ,入院日龄均 <2…     

高压氧治疗新生儿缺氧缺血性脑病临床疗效分析

目的:探讨高压氧治疗新生儿缺氧缺血性脑病的近期和远期疗效。方法:将2004年6月～2006年6月在吉安市妇幼保健院新生儿科就诊的75例中、重度新生儿缺氧缺血性脑病患儿随机分为高压氧治疗组(40例)和对照组(35例),高压氧组在生后76～96h内给予高压氧治疗,两组在急性期和恢复期其余治疗措施相同。两组患儿在生后4天、14天进行新生儿神经行为测定,3个月、6个月、12个月进行CDCC婴幼儿智能运动发育检查测定。结果:①两组患儿生后4天NBNA测定值比较,差异无显著性意义(t=0.26,P>0.05),生后14天NBNA测定值高压氧组与对照组比较,差异具有显著性意义(t=2.48,P<0.05)。②3个月、6个月、12个月时,高压氧组智力发育指数(MDI)和运动发育指数(PDI)均高于对照组,两组比较差异具有显著意义(P<0.05)。结论:高压氧治疗新生儿缺氧缺血性脑病有明显的近期和远期神经保护作用。     

高压氧治疗新生儿缺氧缺血性脑病的观察与护理

新生儿缺氧缺血性脑病(以下简称HIE)是新生儿窒息后严重并发症。我院1995年8月～1996年8月用高压氧舱辅佐治疗HIE36例,现将观察与护理报告如下。1 临床资料 36例HIE均符合1989年济南会议诊断标准,男21例,女15例。生后24小时以内就诊31例,3天以内就诊5例。临床分度:轻度12例,中度11例,重度13例。主要临床表现有激惹15例,反应差2例,肌张力增高5例,有惊厥12例,前囱饱满或紧张2例。全部病例均有明确宫内窘迫史或产时窒息史,其中自然分娩21例,胎吸助产9例,产钳4例,剖宫产2例。     

白蛋白联合呋塞米治疗中重度新生儿缺氧缺血性脑病的临床探讨

目的:探讨白蛋白联合呋塞米治疗中重度新生儿缺氧缺血性脑病(HIE)的临床价值。方法:50例中重度HIE患儿随机分为两组,对照组20例,按照HIE治疗方案(试行稿)标准治疗;治疗组30例,将方案中"降低颅内压"措施改用白蛋白(0.5~1 g/kg,2次/d)联合呋塞米(0.5~1 mg/kg,4次/d),疗程3天,其他治疗措施同对照组。观察患儿神经学症状(意识改变、肌张力改变、原始反射改变、惊厥、脑干症状)消失时间与血钠变化。结果:两组患儿神经学症状的消失时间有显著性差异;治疗组明显优于对照组,且血钠的恢复较对照组更满意。结论:白蛋白联合呋塞米治疗中重度HIE优于HIE治疗方案中"降低颅内压"措施,值得临床参考应用。     

新生儿缺氧缺血性脑病患儿不同时间开始干预的预后对比

目的:探讨不同时间开始干预新生儿缺氧缺血性脑病对预后的影响。方法:将110例缺氧缺血性脑病患儿随机分为3组,A组满月后开始干预,B组满6个月起开始干预,C组满1岁起开始干预,3组小儿每月随访1次,对照组为正常足月儿,未行干预常规抚养,每月随访1次。观察脑瘫早期症状出现情况,在6、12、18、24个月时用0~6岁儿童神经心理量表评估发育商。结果:A组DQ明显优于B、C组。A组无1例脑瘫后遗症,C组后遗症发生率明显高于A组B组。结论:出生后6个月内开始早期干预是减少脑瘫后遗症发生的有效方法。     

高压氧合并针刺治疗职业人员颈源性椎-基动脉血流动力学紊乱疗效研究

目的评价高压氧(HBO)并针刺治疗不同职业人员颈性椎-基动脉血流动力学紊乱的临床疗效。方法80例患者依来诊的先后顺序分为高压氧并针刺组(治疗组)及单纯高压氧组(对照组)各40例,观察治疗前后颈性眩晕症状与功能评分及经颅多普勒(TCD)检测椎基动脉(VBA)血流情况等的变化。结果(1)两组治疗后颈性眩晕症状与功能评分增加,且差异有统计学意义(P<0.05)。(2)治疗后两组VBA血流动力学紊乱得到显著改善,差异有统计学意义(P<0.05)。(3)治疗组愈显率为60.75%,总有效率为90.00%;对照组愈显率为40.00%,总有效率为82.50%,前者明显高于后者,差异有统计学意义(P<0.01,P<0.05)。结论高压氧并针刺治疗各种职业人员颈性椎-基动脉血流动力学紊乱的临床疗效明显优于单纯高压氧疗法。     

Good practice in social care: the views of people with severe and complex needs and those who support them

This paper reports findings drawn from a study of good practice in English social care for adults with disability and older people with severe and complex needs. People with severe and complex needs are a relatively small proportion of adult social care service users, but they are growing in numbers and have resource‐intensive needs. The study involved qualitative research with adults with disability and older people with severe and complex needs, family carers and members of specialist organisations (n = 67), focusing on the features of social care services they considered to be good practice. Data were collected between August 2010 and June 2011. The approach to data collection was flexible, to accommodate participants' communication needs and preferences, including face‐to‐face and telephone interviews, Talking Mats^© sessions and a focus group. Data were managed using Framework and analysed thematically. Features of good practice were considered at three levels: (i) everyday support; (ii) service organisation; and (iii) commissioning. Findings relating to the first two of these are presented here. Participants emphasised the importance of person‐centred ways of working at all levels. Personalisation, as currently implemented in English social care, aims to shift power from professionals to service users through the allocation of personal budgets. This approach focuses very much on the role of the individual in directing his/her own support arrangements. However, participants in this study also stressed the importance of ongoing professional support, for example, from a specialist key worker or case manager to co‐ordinate diverse services and ensure good practice at an organisational level. The paper argues that, despite the recent move to shift power from professionals to service users, people with the most complex needs still value support from professionals and appropriate organisational support. Without these, they risk being excluded from the benefits that personalisation, properly supported, could yield.     

对危急重患者实施院前急救与不实施院前急救的效果分析与对比

目的探讨对危急重患者实施院前急救所采取的各种措施，从而给病人带来的各种好处。方法回顾我院实施院前急救的危急重患者100例，与未实施院前急救的危急重患者100例进行疗效及费用等分析比较。结果实施院前急救组的病人从致残率、死亡率、住院天数及费用均优于不实施院前急救组。结论对危急重患者实施院前急救是必要的、有效的。     

农村地区重度子痫前期/子痫病例产前检查服务质量现状分析

目的:探讨农村地区重度子痫前期/子痫产前检查服务质量,针对存在的问题提出改进措施。方法:收集孕产妇死亡率较高的河南省某县2005年7月～2007年8月所有开展助产技术服务的医疗保健机构中重度子痫前期/子痫住院病例,对其病历资料进行调查研究,评价其产前检查服务质量,分析产前检查与妊娠结局及并发症的关系。结果:257例研究对象中,有168例(65.37%)做过产前检查。记录产前检查次数的69例中,最少的1次,最多的6次,≥5次的只有8例(11.59%)。做过产前检查的患者其并发症的发生率(12.50%)要低于未做产前检查的患者(27.27%),差异有统计学意义(P<0.05)。结论:该地区产前检查服务质量有待进一步提高,以促进母婴健康。     

An investigation of factors related to the use of respite care services for children with severe motor and intellectual disabilities (SMID) living at home in Japan

Limited time away from the child is cited as the main factor that increases the burden for the primary caregiver of severely disabled children. The aim of this study was to quantitatively elucidate the factors related to the desire to use social services and the actual use of respite care services by the primary caregivers of severely disabled children in Japan. In this study, we investigated the use of respite care services in accordance with the primary caregivers’ wishes by examining inhibiting or promoting factors associated with respite care service use only among those who wished to use social services. A total of 169 Japanese mothers participated and answered the questionnaires. We conducted a logistic regression analysis and a multiple regression analysis to investigate the factors related to respite care service use. The most important factors affecting a primary caregiver's desire to use social services were the belief that the child would enjoy using social services and the family's approval of the social service use. The most important factors affecting respite care service use were the family's approval of the use and a large care burden on the primary caregiver. Respite care services should be sought out before the care burden becomes too great to enable the primary caregiver to more easily contribute to the continuation of home care. A background of mother–child separation anxiety disrupted the use of respite care. However, believing that the child enjoys using social services may reduce primary caregivers’ psychological resistance to being separated from their child, which is supported by tradition. Thus, it is also important for respite care service providers to provide information about the children to their primary caregivers and families while they are using respite care services.     

Temporal changes in bacterial resistance in German intensive care units, 2001-2003: data from the SARI (surveillance of antimicrobial use and antimicrobial resistance in intensive care units) project

Conservative testing revealed a stable antibiotic resistance situation for Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae and Enterobacter cloacae in 32 German intensive care units (ICUs) actively participating in the SARI (surveillance of antimicrobial use and antimicrobial resistance in ICUs) project over a three-year period (2001--2003). No significant changes were shown for methicillin-resistant S. aureus (MRSA) (P=0.501; the MRSA rate increased in 18 ICUs and decreased in 14 ICUs). The only exception was an increase in ciprofloxacin-resistant E. coli.     

The feasibility,reliability and validity of the McGill Quality of Life Questionnaire-Cardiff Short Form (MQOL-CSF) in palliative care population

In terminally-ill patients, effective measurement of health-related quality of life (HRQoL) needs to be done while imposing minimal burden. In an attempt to ensure that routine HRQoL assessment is simple but capable of eliciting adequate information, the McGill Quality of Life Questionnaire-Cardiff Short Form (MQOL-CSF: 8 items) was developed from its original version, the McGill Quality of Life Questionnaire (MQOL: 17 items). Psychometric properties of the MQOL-CSF were then tested in palliative care patients consisting of 55 out-patients, 48 hospice patients and 86 in-patients. The MQOL-CSF had little respondent burden (mean completion time=3.3 min) and was evaluated as ‘very clear’ or ‘clear’ (98.2%), comprehensive (74.5%) and acceptable (96.4%). The internal consistency reliability was moderate to high (Cronbach’s α=0.462–0.858) and test-retest reliability (Spearman’s r_s) ranged from 0.512–0.861. Correlation was moderate to strong (0.478–0.725) between items in the short form and their analogous domains in the MQOL. Most MQOL-CSF items showed strong associations with their own domain (r_s ≥ 0.40). Scores from MQOL-CSF significantly differentiated between patients with differing haemoglobin levels (p < 0.05). Construct validity was overall supported by principal component analysis. It is concluded that the MQOL-CSF is a feasible tool with favourable psychometric properties for routine HRQoL assessment in the palliative care population.     

The involvement of volunteers in palliative care and their collaboration with healthcare professionals: A cross‐sectional volunteer survey across the Flemish healthcare system (Belgium)

Volunteers occupy a specific space in the delivery of palliative care (PC), addressing specific aspects of care and providing a link between professional healthcare providers and informal care. Engaging and empowering these volunteers can be an important strategy to deliver more integrated and comprehensive PC. Insights into current actual volunteer involvement and collaboration across different healthcare services providing generalist and specialist PC is lacking. This study aims to describe volunteers’ involvement in the organisation of PC, collaboration with professionals and how they evaluate this. A cross‐sectional postal survey of volunteers was conducted between June and November 2018 using a written questionnaire. A two‐step disproportionately stratified cluster randomised sample of 2,273 registered volunteers was taken from different strata of healthcare organisations providing care for people with serious illnesses in the Flemish healthcare system (Belgium). Overall response was 35% (15%–60% for individual strata). About 67% of volunteers were often to always informed about the organisation of patient care and 48% felt the organisation often to always takes their opinion into account, while a minority report having decision rights (18%) or autonomy (24%). For some, their organisation failed to inform (17%), consult (27%), take into account their opinion (21%), give them decision rights (20%) or autonomy (16%) over certain aspects of patient care provision often enough. Overall, volunteer–professional collaboration was low, and mostly limited to information sharing. Dedicated PC volunteers collaborated extensively with nurses, often involving task coordination (46%). Ambiguity regarding tasks, agreements and/or rules (15%) and lack of information exchange (14%) were the most cited barriers to volunteer–professional collaboration. Many volunteers were open to stronger involvement in the organisation of care in PC services. Collaboration with professionals seemed lacking in width and depth. Particularly, nursing home volunteers indicated a desire and large potential for more involved and collaborative roles in PC provision.