康复护理在脑梗死康复期患者中的应用

目的:探讨康复护理在脑梗死康复期患者中的应用效果。方法:将98例康复期脑梗死患者随机分为观察组和对照组各49例,对照组实施常规护理,观察组在常规护理的基础上实施康复护理,干预2个月后比较两组Barthel指数、焦虑自评量表(SAS)和抑郁自评量表(SDS)评分。结果:干预后观察组Barthel指数评分高于对照组(P0.05),SAS和SDS评分低于对照组(P0.05)。结论:对脑梗死康复期患者实施康复护理可以有效改善患者的日常生活自理能力和心理状态。     

整体护理干预在老年脑梗死患者中的应用

目的:探讨整体护理干预在老年脑梗死患者中的应用方法及临床效果。方法:将100例老年脑梗死患者随机分为干预组和对照组各50例,对照组给予神经内科常规治疗、康复运动训练及护理干预,干预组在此基础上给予整体护理干预,比较两组干预前后焦虑自评量表(SAS)、抑郁自评量表(SDS)及Barthel指数评分情况。结果:干预组干预后SAS、SDS评分低于干预前(P<0.05),两组干预后SAS、SDS及Barthel指数评分比较差异均有统计学意义(P<0.05)。结论:整体护理干预可明显改善老年脑梗死患者的焦虑、抑郁状态,提高其生活质量,值得临床推广。     

护理干预对脑梗死后遗症患者负面情绪及生活质量的影响

目的探讨护理干预对脑梗死后遗症患者负面情绪及生活质量的影响。方法选取400例脑梗死后遗症患者,根据随机数字法分为对照组(常规护理)和观察组(护理干预)各200例,采用焦虑自评量表(SAS)、抑郁自评量表(SDS)、生活质量测定量表(EORTC QLQ-C30)进行测定,比较2组护理前后SAS、SDS、生活质量各维度及总分变化情况以及护理满意度。结果观察组护理后SAS、SDS评分显著低于对照组(P0.05);观察组护理后生活质量各维度及总分显著高于对照组(P0.05);观察组护理满意度显著高于对照组(P0.05)。结论对于脑梗死后遗症患者,护理干预能够明显改善患者的负面情绪,提升患者的生活质量及护理满意度。     

复合护理在脑出血后遗症患者中的应用价值分析

目的分析在脑出血后遗症患者临床护理中,实施复合护理模式干预的临床效果。方法选取2020年4月至2021年4月我院收治的60例脑出血后遗症患者为研究对象,随机分为对照组和观察组各30例。对照组实施常规护理干预,观察组则实施复合护理模式干预,对比两组康复效果、心理状态(SAS/SDS)、护理满意度、神经功能缺损程度(NIHSS)、日常生活活动能力(Bathel)、独立生活能力(FIM)。结果(1)观察组康复效果(96.67%)高于对照组(76.67%,P<0.05);(2)观察组SAS、SDS评分均低于对照组(P<0.05);(3)观察组护理满意度(96.67%)显著高于对照组(73.33%,P<0.05);(4)观察组NIHSS评分明显低于对照组、Barthel、FIM评分高于对照组(P<0.05)。结论在脑出血后遗症患者临床护理中,实施复合护理模式干预具有显著效果,可有效改善患者心理状态,减轻其神经功能缺损程度,提升独立生活能力、日常生活活动能力及护理满意度,值得推广应用。     

老年脑梗死后遗症患者的心理状态及护理对策110例

将本院急诊住院部2011年3月²014年2月收治的老年脑梗死后遗症患者110例纳入本研究,入院时采用焦虑自评量表(SAS)和抑郁自评量表(SDS)评价患者心理状态。针对患者心理状态实施相应的护理对策,对比患者护理干预前后SAS评分、SDS评分的变化。入院时所有患者SAS评分、SDS评分均高于临界值。与护理干预前对比,我们发现护理干预后患者SAS评分、SDS评分均明显下降,差异经统计学分析后认为有意义(P<0.05)。老年脑梗死后遗症患者多存在着焦虑、抑郁等不良心理状态。通过护理干预可有效改善这一现象,促进患者康复。     

以微信平台实施延续性护理对脑外伤术后偏瘫患者康复的影响

【摘要】目的 探讨以微信平台实施延续性护理对脑外伤术后偏瘫患者康复、自理能力及心理状态的影响。方法 纳入脑外伤术后偏瘫患者98例，根据实施延续性护理前后顺序，分为对照组48例（2016年1月～2016年12月），观察组50例（2017年1月～2018年1月）。患者出院后对照组给予常规护理指导，观察组以微信平台实施延续性护理。观察6个月，应用神经功能缺损量表(NIHSS)评分、日常生活能力(Barthel指数)、临床神经功能缺损程度评分量表（CSS）、焦虑自评量表(SAS)、抑郁自评量表(SDS)对2组患者进行康复、自理能力及心理状态进行评价。结果 出院6个月时，观察组与对照组比较，NIHSS、临床神经功能缺损程度CSS、SAS及SDS评分分值均下降，Barthel指数分值升高，两组差异均有统计学意义（P＜0.05）。结论 对脑外伤术后偏瘫患者实施基于微信平台的延续性护理可促进患者神经功能的康复、提高日常生活能力、改善心理状态，值得临床推广使用。     

身心护理对老年急性脑梗死患者认知功能及预后改善的影响

目的探讨身心护理对老年急性脑梗死患者认知功能的影响及对预后改善的干预作用。方法选取本科2016年1月-2016年12月收治的90例老年急性脑梗死患者作为研究对象,其中将2016年7月前收治的45例患者作为对照组,给予临床常规护理;2016年7月及后收治的45例患者作为观察组,在对照组的基础上给予身心护理干预。分别采用焦虑和抑郁自评量表(SAS、SDS)、简易智能状态检查量表(MMSE)评价两组护理干预前后的心理状态、认知功能;采用ADL评分法中的巴氏指数(Barthel指数)、美国波士顿健康研究所研制的简明健康测量量表(SF-36)中文版评定护理干预6个月后两组的生活自理能力和生活质量水平。结果两组护理干预后的SAS、SDS评分、MMSE评分均较干预前明显改善,且干预后观察组均明显好于对照组(P0.05)。护理干预后6个月随访,观察组的Barthel指数评分(65.3±5.1)分显著高于对照组的(44.7±3.9)分,SF-36各项评分均明显优于对照组,差异均有统计学意义(P0.05)。结论对于老年急性脑梗死患者给予身心护理干预,能明显降低患者的焦虑及抑郁心理,有效改善患者的认知功能,显著提高患者预后生活自理能力和生活质量水平,可在临床中推广应用。     

中医情志康复护理对老年缺血性脑卒中患者情志状态的影响

目的：探讨中医情志康复护理对老年缺血性脑卒中患者情志状态的影响。方法：将2020年11月1日～2021年11月1日收治的200例老年缺血性脑卒中患者,按照随机数字表法分为观察组和对照组各100例,对照组实施常规护理,观察组在常规护理基础上实施中医情志康复护理;比较两组护理前后心理状态[采用抑郁自评量表(SDS)、焦虑自评量表(SAS)]、护理满意度、神经功能、住院时间、护理依从性及后遗症发生情况。结果：护理后,观察组SDS、SAS评分低于对照组(P<0.01);观察组护理满意度、住院时间、护理依从性及后遗症并发症均优于对照组(P<0.05);护理后,两组神经功能评分优于护理前(P<0.01),且观察组优于对照组(P<0.01)。结论：将中医情志康复护理运用在老年缺血性脑卒中患者中,能够帮助患者改善抑郁、焦虑等心理状态及神经功能,缩短住院时间,提高康复护理依从性,减少后遗症的发生,从而提高护理满意度。     

细节化优质护理对脑梗死患者心理状态及护理依从性的影响

目的:探讨细节化优质护理对脑梗死患者心理状态及护理依从性的影响。方法:将108例脑梗死患者随机分为观察组和对照组各54例,对照组给予脑梗死常规护理干预,观察组给予细节化优质护理,比较两组护理效果。结果:护理干预后,观察组日常生活能力(ADL)、神经功能缺损评分(NIHSS)、焦虑自评量表(SAS)及抑郁自评量表(SDS)评分均优于对照组(P0.05),观察组护理依从率高于对照组(P0.05)。结论:细节化优质护理干预可改善脑梗死患者ADL、CSS及护理依从性,对于缓解患者不良心理情绪具有重要影响。     

时效性激励护理联合血栓通对脑梗死患者的影响

目的:探讨时效性激励护理联合血栓通对脑梗死患者自我护理、不良情绪、神经系统的影响。方法:选取2019年1月1日～2020年7月31日收治的脑梗死患者80例为研究对象,根据住院尾号奇偶分为对照组和观察组各40例,对照组采用血栓通联合常规的康复护理,观察组在对照组基础上采用时效性激励护理;比较两组护理后3个月的自我护理能力[采用自我护理能力量表(ESCA)]、神经功能[采用美国国立卫生研究院卒中量表(NIHSS)、Barthel指数],比较两组护理前后的不良情绪[采用焦虑自评量表(SAS)、抑郁自评量表(SDS)]。结果:护理后3个月,观察组整体自护能力优于对照组(P0.05),SAS、SDS评分低于对照组(P0.01),NIHSS评分和Barthel指数优于对照组(P0.01)。结论:将时效性激励护理联合血栓通应用于脑梗死患者中,可促进患者自护能力的提升,有效提高患者的心理状态和神经功能,有利于预后。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.