冠脉介入术患者拔除鞘管时发生迷走神经反射的抢救与护理

目的探讨冠脉介入术患者拔除鞘管时发生迷走神经反射的抢救与护理。方法选择本院接受治疗的736例冠状动脉介入术患者,按照随机数字法分为实验组和对照组,每组各368例,术后拔除鞘管时发生迷走神经反射共44例。对照组术后予以常规的护理模式,实验组则在对照组的基础上予以优质护理,比较2组患者护理后SDS、S-AI、T-AI评分、并发症发生情况及护理满意度情况。结果实验组DS、S-AI、T-AI评分、并发症发生率及护理满意度均显著优于对照组(P<0.05)。结论优质护理模式不仅能够降低患者抑郁、焦虑状态及迷走神经反射等并发症发生率,还能提高患者对护理的满意度以及抢救效果。     

家庭综合干预对妇科肿瘤术后化疗患者生活质量和性功能的影响

目的:探讨家庭综合干预对妇科肿瘤术后化疗患者生活质量和性功能的影响。方法:将60例妇科恶性肿瘤术后化疗患者随机分为干预组和对照组各30例,对照组住院期间给予常规护理,包括出入院宣教、围术期护理、围术期健康教育、化疗并发症预防等,干预组由护理团队对患者及家属进行家庭综合干预。分别在手术后1周、化疗3次后、术后6个月时进行生命质量核心量表EORTC(QLQ-C30)和女性功能量表(FSFI)调查。结果:干预组QLQ-C30功能量表、症状量表、整体生活质量评分均高于对照组(P0.05),症状量表中的恶心、呕吐和单项测量项目失眠评分低于对照组(P0.05),术后6个月时干预组在性功能评分方面高于对照组,而且术后6个月干预组性功能评分高于术后1周,比较差异有统计学意义(P0.05)。结论:对妇科肿瘤术后患者给予家庭综合干预,能提高患者的整体生活质量和性功能。     

“阳光护理服务”对乳腺癌术后化疗期间负性情绪及生活质量的影响

目的探讨"阳光护理服务"对乳腺癌术后化疗期间负性情绪及生活质量的影响。方法选取2015年1月~12月我科收治的行乳腺癌根治手术患者120例,根据分层抽样法分为观察组和对照组,各60例。对照组围手术期间行常规护理。观察组围手术期间实施"阳光护理服务"。比较两组化疗期间负性情绪及生活质量的差异。结果观察组引流时间、总引流量、平均住院时间少于对照组(P0.05),满意度评分高于对照组(P0.05)。观察组干预后抑郁自评量表(SDS)、焦虑自评量表(SAS)评分低于对照组,生活质量评分高于对照组(P0.05)。结论 "阳光护理服务"可提高乳腺癌患者术后护理质量,减轻患者围手术期焦虑、抑郁情绪,提高其术后生活质量。     

围术期心理护理在乳腺癌手术患者中的应用

目的:探讨围术期心理护理在乳腺癌手术患者中的应用方法及效果。方法:将105例乳腺癌手术患者随机分为干预组66例与对照组39例,对照组给予常规围术期护理,干预组在此基础上给予围术期心理护理。采用世界卫生组织推荐的健康调查简易量表(SF-36)进行评分,比较两组术后健康状况及生活质量各指标评分情况。结果:干预组术后健康状况及生活质量各指标评分情况与对照组比较有显著性差异(P<0.05)。结论:围术期心理护理应用于乳腺癌手术患者,可提高患者生活质量,有利于术后康复。     

缩短围术期禁饮食时间对乳腺癌术后患者的影响

目的:探讨缩短围术期禁饮食时间对乳腺癌术后患者的影响。方法:选取某三级甲等肿瘤专科医院乳腺癌择期手术患者198例,随机分为对照组和干预组各99例;对照组接受乳腺癌围术期常规护理,干预组在对照组基础上基于加速康复外科理念缩短乳腺癌患者围术期禁饮食时间;比较两组术前饥饿、口渴及术后恶心、呕吐情况。结果:干预组术前饥饿、口渴分级低于对照组(P0.05),术后恶心、呕吐分级低于对照组(P0.05)。结论:缩短围术期禁饮食时间能缓解乳腺癌患者术前饥饿、口渴及术后恶心、呕吐程度。     

舒适护理在乳腺癌术后化疗患者中的应用

目的:探讨舒适护理在乳腺癌术后化疗患者中的应用方法及效果.方法:将436例乳腺癌术后化疗患者按入院时间随机分为对照组192例和实验组244例,对照组给予常规护理,实验组在此基础上给予舒适护理.比较两组恶心、呕吐发生情况.结果:实验组恶心、呕吐发生率明显低于对照组(P＜0.01).结论:舒适护理应用于乳腺癌术后化疗患者,可有效减少恶心、呕吐等不良反应的发生率.     

优质护理理念对乳腺癌行乳腺全切术患者围手术期心理情绪及生活质量的影响

目的 分析优质护理理念对乳腺癌行乳腺全切术患者围术期心理情绪及生活质量的影响。方法 来源于我院 2020 年 4 月 至 2021 年 6 月的 86 例行乳腺癌全切术患者作为研究对象。患者按随机数字表法将其分为对照组和实验组,每组各 43 例。对 照组实施常规护理,实验组予以优质护理理念。分析两组患者围术期心理情绪,生活质量和护理满意度。结果 护理后实验组 生活质量评分明显高于对照组（P＜0.05）。护理后实验组抑郁自评量评分表与焦虑自评量表评分明显低于对照组（P＜0.05）。 实验组和对照组护理满意度分别为 96.67%和 66.67%,实验组满意度明显高于对照组（P＜0.05）。结论 行 BC 全切术患者实施 优质护理理念可获得显著价值,能够有效提高其 QLR,改善心理情绪,且提高患者满意度。     

渐进性肌肉放松训练对乳腺癌患者围术期心理状态、生活质量的影响

目的探讨渐进性肌肉放松训练对乳腺癌患者围术期心理状态、生活质量的影响。方法选取2014年1月—12月本院收治的103例乳腺癌患者为研究对象,根据入院时间顺序分为对照组(n=52)和观察组(n=51),对照组实施常规护理,观察组在常规护理基础上实施渐进性肌肉放松训练。比较两组患者干预前、干预6周后焦虑、抑郁情绪、生活质量及睡眠质量变化情况。结果干预6周后,两组患者SAS评分、SDS评分及PSQI指数均较干预前降低(P0.05),FACT-B评分较干预前升高(P0.05);干预6周后,观察组的SAS评分、SDS评分及PSQI指数均低于对照组(P0.05),FACT-B评分高于对照组(P0.05)。结论将渐进性肌肉放松训练运用到乳腺癌患者围术期护理中,能有效缓解患者的心理状态,提高生活质量,改善睡眠质量。     

集束化护理策略对乳腺癌术后化疗患者不良反应的影响

目的探讨集束化护理策略对乳腺癌术后化疗患者不良反应的影响。方法选取本院2016年2月~2017年3月收治的30例乳腺癌术后化疗患者为观察组,给予集束化护理策略。选取同期收治的20例乳腺癌术后化疗患者为对照组采用常规护理。比较两组患者化疗的不良反应及生活质量。结果观察组出现静脉炎、口腔炎、恶心呕吐、食欲不振等不良反应评分均低于对照组,差异有统计学意义(P0.05);观察组在生理状况、情感状况、功能状况、附加关注等生活质量方面的评分高于对照组,差异有统计学意义(P0.05);观察组的护理满意度高于对照组,差异有统计学意义(P0.05)。结论集束化护理策略能够减少乳腺癌术后化疗患者的不良反应,提高患者的生活质量。     

健康宣教路径在乳腺癌患者围术期护理中的应用

目的研究健康宣教路径在乳腺癌患者围术期护理中的应用对患者康复的指导意义。方法试验组和对照组患者分别采用健康宣教路径法和传统方法进行乳腺癌患者围术期护理指导,观察患者及家属对健康知识掌握情况、患者满意度。结果试验组对健康知识的掌握情况和患者满意度显著优于对照组（P〈0.05）。结论采用健康宣教路径法进行乳腺癌患者围术期护理指导,提高了患者及家属对健康宣教知识的掌握程度,提高了患者满意度,值得在更多的疾病中推广使用。     

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.