循证护理对妊娠期糖尿病产妇血糖控制及妊娠结局的影响

目的探讨循证护理对妊娠期糖尿病产妇血糖控制及妊娠结局的影响。方法选取我院2018年1—12月收治的100例妊娠期糖尿病产妇为研究对象,将其随机等分为观察组和对照组,对照组采用常规护理,观察组采用循证护理。比较两组产妇血糖控制情况及妊娠结局。结果观察组产妇空腹血糖、餐后2 h血糖、糖化血红蛋白均低于对照组(P 0. 05);观察组产妇不良妊娠结局发生率低于对照组(P 0. 05)。结论循证护理在妊娠期糖尿病产妇中应用,可有效控制血糖水平,减少不良妊娠结局。     

个性化护理对妊娠期糖尿病病人血糖控制及妊娠结局的影响

[目的]探讨个性化护理对妊娠期糖尿病病人血糖控制及妊娠结局的影响。[方法]采用随机数字表法将2015年8月—2017年10月收治的174例妊娠期糖尿病病人分为观察组和对照组各87例,对照组给予常规护理干预,观察组在常规护理基础上给予个性化护理。比较两组病人干预前和分娩前(干预后)血糖控制效果,记录产妇妊娠结局(剖宫产、妊娠期高血压、羊水过多、早产和胎膜早破发生率)以及新生儿并发症发生情况(低血糖、新生儿窒息、巨大儿、新生儿黄疸等)。[结果]两组病人干预后空腹血糖(FPG)、餐后2h血糖(2hPG)降低,且观察组低于对照组(P0.05);观察组剖宫产率、妊娠期高血压、羊水过多、早产和胎膜早破发生率均低于对照组(P0.05);观察组新生儿低血糖、新生儿窒息、巨大儿和新生儿黄疸并发症发生率低于对照组(P0.05)。[结论]在常规护理的基础上为妊娠期糖尿病病人提供个性化护理,可以取得更好的血糖控制效果,改善产妇分娩结局,减少新生儿并发症的发生。     

基于微信平台的健康教育对高龄产妇妊娠期糖尿病护理效果研究

目的:探讨基于微信平台的健康教育和饮食指导对高龄产妇妊娠期糖尿病(GDM)护理效果的影响。方法:选取2014年4月~2017年4月我院进行产前检查的GDM的高龄产妇120例,采用随机字母表法分为观察组与对照组,对照组采用常规护理,观察组产妇采用基于微信平台的健康教育和饮食指导,比较两组产妇血糖控制水平、分娩方式、妊娠结局及护理满意度。结果:观察组产妇护理后空腹血糖、餐后2 h血糖及糖化血红蛋白值均显著低于对照组(P0.05);观察组产妇剖宫产及阴道助产率均明显低于对照组(P0.05),顺产率高于对照组(P0.05);观察组产妇不良妊娠发生率明显低于对照组(P0.05),护理满意度高于对照组(P0.05)。结论:基于微信平台的健康教育和饮食指导能够降低高龄产妇GDM血糖指标,提高顺产率,改善妊娠结局,并能够促进护理满意度提升。     

健康教育及心理护理干预对妊娠期糖尿病患者血糖控制及妊娠结局的影响

探讨健康教育及心理护理干预对妊娠期糖尿病患者血糖控制及妊娠结局的影响。选取我院102例妊娠期糖尿病患者,根据入院时间顺序分组,各51例。对照组予以常规护理,观察组采取健康教育及心理干预,统计对比两组护理前后血糖控制效果及妊娠结局。结果护理后观察组空腹血糖(FBG)及午餐后2h血糖(2h PBG)水平明显低于对照组,差异有统计学意义(P0.05);观察组不良妊娠结局发生率为7.84%,低于对照组31.37%,差异具有统计学意义(P0.05)。健康教育及心理护理干预对于降低妊娠期糖尿病患者血糖水平具有显著效果,对于改善不良妊娠结局发生率具有重要意义。     

孕期规范化管理对妊娠期糖尿病(GDM)高危产妇血糖控制及妊娠结局分析

目的探讨孕期规范化管理对妊娠期糖尿病(GDM)高危产妇血糖控制及妊娠结局的影响。方法选择就诊的80例妊娠期糖尿病高危产妇,应用随机数字表法分为对照组和观察组各40例,观察组实施孕期规范化管理,对照组仅实施常规孕期检查,比较两组妊娠期糖尿病发生率、血糖控制、分娩方式、产后出血及产后恢复情况、妊娠不良结局发生率、新生儿Apgar评分。结果观察组妊娠期糖尿病发生率低于对照组(P0.05),其干预后的空腹血糖、餐后2h血糖与干预前相比均无统计学意义(P0.05),而对照组空腹血糖、餐后2h血糖均较干预前增高(P0.05)。观察组剖宫产率低于对照组(P0.05),其阴道自然分娩率高于对照组(P0.05)。观察组产后2h、24h出血量均低于对照组(P0.05),其产后出血发生率也低于对照组(P0.05)。观察组产后子宫复旧时间、恶露消失时间均短于对照组(P0.05)。观察组胎膜早破、早产、巨大儿、新生儿窒息等发生率均低于对照组(P0.05)。观察组新生儿出生后1min、5min Apgar评分高于对照组(P0.05)。结论在妊娠期糖尿病高危产妇中开展孕期规范化管理,可有效减少妊娠期糖尿病发生,有利于控制血糖水平,减少剖宫产、产后出血,改善母婴结局。     

人性化护理干预对妊娠期糖尿病产妇妊娠结局的影响研究

目的探讨人性化护理干预对妊娠期糖尿病产妇妊娠结局的影响。方法选取2013年7月-2017年6月本院收治的妊娠期糖尿病产妇214例为研究对象,随机分为干预组与对照组,每组107例。对照组产妇给予常规的护理干预,干预组产妇在常规护理干预的基础上给予人性化护理干预,比较两组产妇干预前后空腹血糖(FBG)及餐后2 h血糖水平(2 h PBG)水平、妊娠结局、围产儿结局,并统计两组产妇的护理满意度。结果干预前两组产妇的血糖水平无显著差异(P0.05),干预后干预组与对照组产妇的FBG及2 h PBG水平均较干预前显著下降,且干预组干预后的血糖水平低于干预后对照组(P0.05);干预组与对照组的护理满意度分别为96.26%、71.96%,干预组护理满意度显著高于对照组(P0.05);干预组产妇早产、胎膜早破、高血压发生率显著低于对照组(P0.05),两组剖宫产、羊水过多的发生率对比无显著差异(P0.05);干预组围产儿高胆红素症及新生儿窘迫症发生率高于对照组(P0.05),两组围产儿巨大儿及病理性黄疸发生率无显著差异(P0.05)。结论人性化护理干预应用于妊娠期糖尿病产妇可有效控制血糖水平,降低不良妊娠结局的发生率,值得临床推广。     

管理小组干预模式对妊娠期糖尿病孕妇妊娠结局的影响

目的探讨管理小组干预模式对妊娠期糖尿病孕妇妊娠结局的影响。方法将252例妊娠期糖尿病孕妇按产前检查时间分为对照组、观察组各126例,对照组采用常规孕期保健与护理,观察组在常规孕期保健与护理基础上应用管理小组模式实施护理干预至临产前,比较两组孕妇空腹与餐后2h血糖、糖化血红蛋白及妊娠结局。结果观察组空腹与餐后2h血糖、糖化血红蛋白控制状况优于对照组,P0.05;观察组妊娠期高血压、羊水过多、巨大儿、胎儿窘迫、早产的发生率低于对照组,P0.05。结论妊娠期糖尿病实施管理小组干预模式可有效控制孕妇血糖水平,降低围生期母婴并发症,改善妊娠结局。     

阶段性综合护理干预在妊娠合并糖尿病患者中的应用效果

目的:分析阶段性综合护理干预在妊娠合并糖尿病患者中的应用效果。方法:选取2016年8月～2017年8月在我院进行规律产检的78例妊娠合并糖尿病产妇作为研究对象,采用随机数字表法分为对照组和观察组,每组39例。对照组给予常规护理干预,观察组给予阶段性综合护理干预。比较两组产妇血糖变化、负性心理情绪、分娩方式、妊娠期并发症和围产儿结局。结果:干预前,两组血糖水平和负性情绪相比较,差异无统计学意义,P0.05;干预后,观察组的空腹血糖水平、餐后2 h血糖水平、抑郁自评量表(SDS)评分和焦虑自评量表(SAS)评分均明显低于对照组,差异均有统计学意义,P0.05;观察组发生妊娠期高血压综合征、泌尿系感染、羊水过多、早产等并发症的几率明显低于对照组,差异均有统计学意义,P0.05;观察组的自然分娩率高于对照组,差异有统计学意义,P0.05;观察组围产儿不良结局发生率明显低于对照组,差异有统计学意义,P0.05。结论:阶段性综合护理干预可以在不同阶段为妊娠合并糖尿病产妇提供个性化的综合性护理,有助于产妇更好地控制血糖,改善其心理状态,降低围产儿不良结局及产妇的妊娠期并发症发生率,保障母婴安全。     

个体化中医饮食护理结合运动护理对妊娠期糖尿病患者母婴结局的影响

目的考察个体化中医饮食护理结合运动护理对妊娠期糖尿病患者血糖控制及母婴结局的影响。方法选取2020年10月至2021年10月三明市第一医院诊治的120例妊娠期糖尿病患者作为研究对象,并将其根据护理方法的不同分为对照组(60例)和观察组(60例)。对照组给予常规饮食和运动护理,观察组给予个体化中医饮食护理结合运动护理。比较2组的血糖水平、分娩方式以及不良妊娠结局。结果护理3周时和分娩前,2组的糖化血红蛋白(HbA1c)、空腹血糖(FPG)和餐后2h血糖(2hPG)水平均低于入院时(P均<0.05);分娩前,2组的上述血糖水平均低于护理3周时(P均<0.05);观察组的FPG、2hPG和HbA1c水平均较同期对照组更低(P均<0.05)。与对照组相比,观察组的剖宫产率更低(P<0.05)。观察组产妇的不良结局总发生率低于对照组,新生儿的不良结局总发生率低于对照组(P均<0.05)。结论个体化中医饮食护理结合运动护理可有效控制妊娠期糖尿病患者的血糖水平,降低剖宫产率,改善母婴结局。     

综合护理对妊娠期糖尿病患者妊娠结局及围产儿健康状况的影响

目的 探讨妊娠期糖尿病患者应用综合护理干预对其妊娠结局、围产儿健康状况产生的影响。方法 回顾性分析2020年1月至2021年2月盐城市妇幼保健院收治的90例妊娠期糖尿病患者的基本资料,按照护理措施的不同将所有患者分为对照组(46例)和观察组(44例)。对照组实施常规护理,观察组基于常规护理应用综合护理干预。对比2组患者的妊娠结局、血糖控制情况、体重管理情况,以及围产儿的健康状况。结果 护理1周后,2组的空腹血糖、餐后2 h血糖及糖化血红蛋白水平均低于同组护理前(P均<0.05),且观察组的上述指标水平均低于对照组(P均<0.05)。观察组的不良妊娠结局总发生率和围产儿并发症总发生率均低于对照组(P均<0.05)。分娩前和分娩后,观察组的体重均轻于对照组(P均<0.05)。结论 综合护理有助于控制妊娠期糖尿病患者的血糖水平和体重情况,并可改善母婴结局。     

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.     

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.     

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.     

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.