集束化护理对新生儿肺炎雾化吸入疗效及家属满意度的影响

目的探讨集束化护理对新生儿肺炎雾化吸入疗效及家属满意度的的影响。方法将128例行雾化吸入治疗的新生儿肺炎患儿随机分为观察组及对照组,各64例,对照组治疗期间给予常规性护理,观察组治疗期间行集束化护理,对比分析2组患儿治疗依从性、临床疗效以及家属满意率。结果观察组患儿治疗依从性、总有效率、家属满意率高于对照组(P0.05),而护理意外发生率、护理投诉率低于对照组(P0.05)。观察组呼吸困难消失时间、气喘缓解时间、痰鸣音消失时间、咳嗽缓解时间、总住院时间短于对照组(P0.05),比较差异均有统计学意义。结论集束化护理可提高新生儿肺炎雾化吸入治疗依从性及治疗效果,缩短患儿治疗时间,提高患儿家属满意率,值得临床推广应用。     

集束化护理对支气管肺炎雾化吸入患儿的治疗效果

目的探讨集束化护理对支气管肺炎雾化吸入患儿治疗效果的影响。方法选取我院儿科2018年2月至2019年4月收治的114例雾化吸入治疗的支气管肺炎患儿为研究对象,随机将其等分为对照组和观察组,对照组给予常规护理,观察组在对照组基础上行集束化护理,比较两组咳嗽消失时间、哮喘消失时间、肺部啰音消失时间以及血氧饱和度以及第1秒用力呼气容积(FEV1)、用力肺活量(FVC)以及最大呼气峰速(PEFR)、治疗依从性。结果观察组咳嗽消失时间、哮喘消失时间、肺部啰音消失时间以及血氧饱和度等症状改善均优于对照组(P 0. 05);观察组FEV1,FVC以及PEFR优于对照组(P 0. 05);观察组治疗依从性高于对照组(P 0. 05)。结论集束化护理应用于支气管肺炎雾化吸入患儿的治疗中,可缩短康复进程,改善哮喘、咳嗽等症状,提升肺功能指标水平,提高治疗依从性,值得临床推广。     

集束化护理在新生儿雾化吸入中的应用

目的探讨集束化护理应用于新生儿肺炎雾化吸入护理的策略与效果。方法选择该院儿科2013年6月至2014年6月120例肺炎新生儿为研究对象,将其分为对照组和集束化护理组各60例,对照组采用常规护理方法,集束化护理组采用集束化护理。比较两组患儿心率、呼吸频率、脉搏血氧饱和度,临床症状改善时间及住院时间。结果雾化吸入过程中和雾化吸入后,集束化护理组的心率、呼吸频率和脉搏血氧饱和度水平均较对照组有明显改善,两组间比较差异有统计学意义(P0.01)。集束化护理组患儿中断雾化吸入的发生率为1.7%,明显低于对照组的11.7%,差异具有统计学意义(2χ=4.821,P0.05)。集束化护理组患儿咳嗽明显减轻时间、呼吸困难消失时间、痰鸣音消失时间和住院时间均明显短于对照组,差异有统计学意义(P0.01)。结论集束化护理策略应用于新生儿雾化吸入的临床护理具有较好的应用价值,不仅可快速改善患儿不良症状和体征,还可提高雾化吸入的应用效率,降低中断率,促进药物吸收与药效发挥。     

集束化护理在新生儿肺炎雾化吸入治疗中的应用

目的:探讨集束化护理在新生儿肺炎雾化吸入治疗中的临床效果。方法:选取我院呼吸科2014年2月~2015年2月收治的新生儿肺炎患者140例作为研究对象,随机等分为观察组和对照组,对照组患者给予常规护理;观察组患者给予集束化护理,比较两组患儿的耐受情况、疗效、家属对护理的满意程度。结果:观察组的治疗疗效明显优于对照组;观察组患儿对护理的满意程度明显优于对照组(P0.05)。结论:集束化护理可以有效提高患儿治疗的耐受性以及家属对护理满意度,值得在临床推广。     

循证护理在氧气驱动雾化吸入治疗喘息性肺炎患儿中的应用

目的:探讨循证护理在氧气驱动雾化吸入治疗喘息性肺炎患儿中的应用效果。方法:将60例喘息性肺炎患儿按随机数字表法分为对照组和观察组各30例,两组均给予抗感染、营养支持等常规治疗,并通过氧气驱动雾化吸入布地奈德,共治疗7 d;对照组采用常规护理方式,观察组在常规护理基础上给予循证护理。检测两组治疗前后血氧分压(Pa O2)、血二氧化碳分压(Pa CO2)水平,比较两组患儿临床症状消失时间、治疗依从性、不良反应发生率、家长对护理满意程度。结果:治疗后,观察组Pa O2水平均高于对照组(P0.01),Pa CO2水平低于对照组(P0.01);观察组临床症状消失时间短于对照组(P0.01),治疗依从率、各项护理满意度评分均高于对照组(P0.01,P0.05);观察组治疗期间不良反应发生率均低于对照组(P0.05)。结论:在氧气驱动雾化吸入治疗喘息性肺炎过程中采用循证护理,可缩短患儿临床病症消失时间,提高治疗依从性和家长对护理满意度,并降低不良反应发生率,值得临床推广。     

集束化护理在小儿支气管肺炎雾化吸入治疗过程中的干预效果

目的：探讨集束化护理在小儿支气管肺炎雾化吸入治疗过程中的干预效果。方法：选取2019年8月至2021年9月安徽医科大学附属宿州医院儿科收治的106例支气管肺炎住院患儿,其中2019年8月至2020年7月的患儿实施雾化吸入的常规护理,记为常规组(n=53),2020年8月至2021年9月开始成立集束化护理干预小组,并实施雾化吸入的集束化护理,记为研究组(n=53)。收集两组患儿一般资料,重点比较两组雾化吸入依从性及治疗效果的相关指标。结果：研究组患儿咳嗽、发热、肺啰音消失时间和住院时间短于常规组(P<0.05)。研究组雾化吸入过程中哭闹次数少于常规组,治疗依从率为94.34%,高于常规组的81.13%(P<0.05)。两组干预后用力肺活量(forced vital capacity,FVC)、第1秒用力呼气容积(forced expiratory volume in the first second,FEV1)和呼气流量峰值(peak expiratory flow,PEF)均有明显改善(P<0.05),且研究组上述肺功能指标高于常规组(P<0.05)。结论：集束...     

循证护理在毛细支气管炎氧气驱动雾化吸入患儿依从性中的应用

目的:探讨循证护理在毛细支气管炎氧气驱动雾化吸入患儿依从性中的应用效果。方法:选取收治的毛细支气管炎行氧气驱动雾化吸入患儿180例随机分为对照组和观察组各90例,两组均给予毛细支气管炎一般护理和对症治疗,对照组给予氧气驱动雾化吸入常规护理,观察组在氧气驱动雾化吸入常规护理基础上运用循证护理;比较两组患儿氧气驱动雾化吸入的依从性和治疗效果。结果:观察组氧气驱动雾化吸入依从性明显好于对照组(P0.01);观察组喘憋消失时间、肺部罗音消失时间、咳嗽消失时间、住院时间均少于对照组(P0.01)。结论:循证护理可提高毛细支气管炎氧气驱动雾化吸入患儿依从性,提高治疗效果缩短住院时间,值得临床应用和推广。     

集束化护理与传统护理在肺炎患儿中的应用比较研究

目的探讨与比较集束化护理与传统护理在肺炎患儿中的应用效果。方法将100例肺炎患儿按家属是否接受集束化护理分为2组各50例,对照组患儿采用常规护理,实验组则加施集束化护理,比较2组患儿临床总体辅助治疗效果、依从率、并发症、相关临床指标、家属护理能力与满意度。结果实验组患儿总有效率与依从率显著高于对照组,并发症发生率显著低于对照组,差异有统计学意义(P0.05);实验组患儿退热时间、止咳时间、肺啰音消失时间、X线片正常时间与住院时间均显著低于对照组(P0.05);实验组患儿家属肺炎知识、预防意识、排痰技能、疾病监测、药物管理与预防复发评分组间比较显著高于对照组(P0.05);实验组患儿家属护理满意度显著优于对照组(P0.05)。结论集束化护理在肺炎患儿治疗中辅助效果较好,并可提高家属护理能力与满意度,具有借鉴性。     

循证护理对小儿支气管肺炎雾化吸入治疗效果及预后转归的影响分析

目的 探讨循证护理对小儿支气管肺炎雾化吸入治疗效果及预后转归的影响。方法 选择2018年1月～2019年10月期间于我院行雾化吸入治疗的支气管肺炎患儿80例,根据入院时间分为观察组和对照组各40例。对照组采用常规护理,观察组在常规护理基础上采用循证护理。比较两组临床效果及不良反应发生情况。结果 观察组总有效率高于对照组,差异有统计学意义(P0.05);观察组症状改善时间、住院时间均短于对照组,差异均有统计学意义(P0.05);治疗后,观察组肺功能指标显著高于对照组,差异有统计学意义(P0.05);观察组不良反应发生率显著低于对照组,差异有统计学意义(P0.05)。结论 支气管肺炎患儿雾化吸入治疗期间给予循证护理,可显著提高治疗效果,改善患儿肺功能,有利于尽早恢复。     

集束化护理在小儿支气管肺炎雾化吸入治疗过程中的干预效果

目的 观察且分析小儿支气管肺炎雾化吸入过程中采取集束化护理的效果。方法 选取 2020 年 1 月至 2022 年 10 月本院 收治的病发支气管肺炎患儿 60 例作为研究对象。依据信封法将患儿均分为对照组和观察组,每组各 30 例。对照组接受常规化 护理,观察组接受集束化护理。分析对比两组的症状改善时间、雾化吸入依从性及肺功能。结果 观察组咳嗽、哮喘及肺啰音 消失时间均比对照组显著缩短（P<0.05）。观察组依从性为 96.67%,显著高于对照组的 73.33%（P<0.05）。观察组皮疹、胃 肠反应等并发症发生率显著低于对照组（P<0.05）。干预前,两组 FVC、FEV1 及 PEF 均无显著差异（P>0.05）。干预后,与 对照组比,观察组 FVC、FEV1 及 PEF 均显著提高（P<0.05）。结论 小儿支气管肺炎雾化吸入过程中采取集束化护理,能提 高患儿依从性,促进症状改善,提升肺功能。     

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.     

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.