互联网+电话随访早产儿延续护理的应用效果

目的 探讨互联网+电话随访早产儿延续护理的临床效果。方法 选取 2020 年 1 月至 2021 年 1 月期间达出院标准的早产 儿 60 例,按入院时顺序编号,随机分为对照组和观察组,每组各 30 例。对照组实施早产儿常规护理,观察组通过电话随访、 微信公众号及微信群实施早产儿延续护理。比较两组的体重、掌握延续护理知识,护理满意度和随访依从率。结果 观察组不 同时间段体重高于对照组（P<0.05）。观察组家长掌握护理知识优于对照组（P<0.05）。观察组家长随访依从率和护理满意度高 于对照组（P<0.05）。结论 互联网+电话随访早产儿延续护理,能够促进早产儿生长发育,增加家长护理知识,提高护理满意度, 提升随诊依从性。     

早期护理干预对早产儿发育的影响

目的探讨早期护理干预对早产儿行为智能发育的影响。方法将164例早产儿分为干预组(86例)和对照组(78例)。干预组早产儿出生后即提供发育支持护理,同时对家长进行健康教育,出院时给予家庭护理指导。对照组给予常规的育儿指导及常见病预防指导。在3个月、6个月、12个月时对两组早产儿进行智能测试。结果干预组随访率明显高于对照组,差异有极显著性意义(P<0.001);干预组脑瘫发生率低于对照组,差异有显著性意义(P<0.01);且在适应性、大运动、精细运动、语言和社会交往5个方面与对照组相比,差异有显著性意义(P<0.01或P<0.05)。结论早期护理干预可明显提高早产儿随访率,促进其行为智能发育。     

应用微信平台对早产儿出院后母亲护理水平的影响

目的探讨应用微信平台的护理宣教法对早产儿出院后母亲护理水平的影响。方法选取2015年7月—2017年7月中山大学附属第三医院岭南医院儿科NICU出院的100例早产儿作为研究对象,将100例早产儿母亲随机分为观察组和对照组,每组各50例;对照组进行常规宣教及电话随访,观察组在此基础上应用微信平台进行宣教干预;对两组早产儿母亲护理知识掌握情况、对护理服务满意度等评价指标进行分析比较。结果微信平台宣教干预后的观察组早产儿母亲对护理知识掌握合格率91.1%(41例)高于对照组72.3%(34例),差异有统计学意义(P0.05)。观察组护理服务满意度93.3%(42例)高于对照组的68.1%(32例),差异有统计学意义(P0.05)。结论微信平台护理干预能有效提高早产儿母亲的护理水平,提高护理服务满意度,具有临床使用价值。     

家长参与式护理模式对早产儿生长发育及家属护理技能的影响

[目的]探讨家长参与式护理模式对早产儿生长发育及家属护理技能的影响。[方法]将426例早产儿随机分为对照组和观察组,每组213例。对照组给予系统性发育支持常规护理,观察组给予家长参与式护理。干预后比较两组患儿住院相关情况、患儿体重变化情况、患儿母乳情况及家长的紧张焦虑感、自护能力情况。[结果]两组患儿出院后体重均不断增长,观察组出院时、出院后15 d、30 d的体重增长均高于对照组(P<0.05),且观察组患儿体重增长速度高于对照组(P<0.05);观察组纯母乳喂养率及患儿喂养耐受率均高于对照组(P<0.05);观察组家长出院时紧张焦虑感评分低于对照组(P<0.05),自护能力评分高于对照组(P<0.05)。[结论]家长参与式护理模式应用在早产儿护理中,可促进早产儿生长发育,提高早产儿体重增长速度及母乳喂养率,缓解早产儿家长紧张、焦虑感,提高家长的护理技能,改善早产儿生存质量。     

基于微信主导的延续性护理干预对出院后早产儿及母亲的影响

目的:探讨基于微信主导的延续性护理干预对出院后早产儿及母亲的影响。方法:选择2017年1月1日~2018年12月31日医院出生的92例早产儿为研究对象,根据住院时间分为观察组(2018年1月1日~12月31日)48例和对照组(2017年1月1日~12月31日)44例。对照组给予包括出院指导、门诊随访、电话随访等常规延续性护理干预,观察组采用基于微信主导的延续性护理干预。随访12个月,比较两组早产儿母亲角色适应能力、早产儿体格发育、神经行为[采用中国20项新生儿行为神经评分法(NBNA)]。结果:随访12个月,两组早产儿母亲角色认同、照顾行为、亲子依附得分及总分高于出院时(P<0.05),且观察组高于对照组(P<0.05);随访12个月,两组早产儿身高、体重、头围优于出院时(P<0.01),且观察组优于对照组(P<0.01);随访12个月,两组NBNA各维度得分高于出院时(P<0.05,P<0.01),且观察组NBNA中行为能力、主动肌张力、原始反射、一般评估得分高于对照组(P<0.05,P<0.01)。结论:基于微信主导的延续性护理干预有助于增强早产儿母亲角色适应能力,促进早产儿体格与智力发育。     

基于微信平台延续性护理对难治性癫痫患儿的影响

目的 探讨儿童难治性癫痫（RE）给予基于微信平台延续性护理对生酮饮食（KD）依从性、家长接受程度和满意度的影响。方法 选取2020年1月—2022年4月医院收治的RE患儿141例为研究对象,按照组间资料均衡可比的原则分为观察组70例和对照组71例。所有患儿均接受KD,对照组给予常规延续性护理,观察组给予基于微信平台延续性护理。比较两组KD保留情况、KD依从性、癫痫发作控制情况、智能发育情况、家长接受程度及满意度。结果 观察组干预后3、6个月KD保留率较对照组高（P<0.05）;观察组干预6个月后Frankie依从性量表评分高于对照组（P<0.05）;观察组癫痫发作控制率高于对照组（P<0.05）;观察组干预6个月后Gesell发育诊断量表评分高于对照组（P<0.05）;观察组干预6个月后患儿家长接受程度高于对照组（P<0.05）;观察组患儿家长护理满意度评分高于对照组（P<0.05）。结论RE患儿给予基于微信平台延续性护理,能够改善KD保留情况和依从性,控制患儿癫痫发作,促进智能发育,提高家长接受程度、满意度。     

早期床旁一对一指导对极低出生体重儿出院后生长发育及智能发育的影响

目的:探讨早期床旁一对一指导对极低出生体重儿出院后生长发育及智能发育的影响。方法:根据随机数字表法将2018年3月—2019年3月新生儿科收治的110例极低出生体重儿分为观察组及对照组各55例,对照组行早产儿常规性护理,观察组在对照组基础上实施早期床旁一对一指导。对两组患儿随访6个月,比较两组产妇护理技能、患儿生长发育及智能发育情况。结果:观察组患儿干预后口腔运动干预、抚触、床旁智护指导方面评分高于对照组(P<0.05)。观察组患儿出生42 d时体重、身高、头围指标较对照组明显改善(P<0.05)。观察组患儿干预3个月、6个月后智力发育指数(MDI)评分、心理运动发育指数(PDI)评分高于对照组(P<0.05)。结论:早期床旁一对一指导可提高产妇早产儿护理技能,从而促进极低出生体重儿出院后生长发育及智能发育。     

电话随访式与微信随访式延续护理在出院后早产儿中的应用研究

[目的]探讨电话随访式与微信随访式延续护理在出院后早产儿中的应用效果。[方法]将2016年7月—2018年6月儿科出院的72例早产儿随机分为电话随访式延续护理组(TEL组)或微信随访式延续护理组(WeChat组)各36例,对两组患儿分别进行电话随访式或微信随访式的延续护理。比较两组早产儿3月龄、6月龄及12月龄时的生长发育情况、再入院率及其家长对早产儿生长发育、家庭护理及常见病预防的相关知识了解度、对医疗服务的满意度。[结果]WeChat组患儿智能发育的各能区、身高、体重及其家长对相关知识了解度均优于TEL组,再入院率低于TEL组(P0.05);两组早产儿头围及其家长对医疗服务的满意度评分比较,差异均无统计学意义(P0.05)。[结论]微信随访式延续护理能更有效促进早产儿出院后的智能及体格生长发育,有利于提高患儿家长对相关知识的了解度和有利于减少早产儿的再入院率,效果优于电话随访式延续护理。     

新生儿早期基本保健对早产儿6个月内生长发育的影响

目的 探讨实施新生儿早期基本保健技术对早产儿体格及智能发育的影响。方法选取2017年6月—2018年6月在宁夏医科大学总医院新生儿重症监护室住院的36例早产儿为观察组,按照组间基本特征均衡可比的原则选择同期在宁夏医科大学第二附属医院的35例早产儿为对照组。对照组在分娩后实施常规产后处理和早产儿发育支持护理,观察组在分娩后实施“新生儿早期基本保健”中的核心干预内容(包括充分彻底擦干、立即母婴皮肤接触、延迟断脐、母乳喂养及袋鼠式护理)和早产儿发育支持护理。出院后对两组早产儿进行出院随访和早期教育训练指导至矫正6月龄;比较两组早产儿生后第7天、第14天、第42天、矫正3月龄和矫正6月龄的体格及智能发育情况。结果 观察组早产儿在矫正3月龄、6月龄的体质量、身长和头围均高于对照组（P<0.05）;在生后第42天,观察组新生儿神经行为测定总分及各维度得分均高于对照组（P<0.05）;在矫正3月龄和矫正6月龄,观察组早产儿各维度发育商得分均高于对照组（P<0.05）。结论 新生儿早期基本保健有益于早产儿生后42 d、矫正3月龄和矫正6月龄体格及智能的发育。     

早期护理干预对改善早产儿预后的临床观察

目的探讨早期护理干预对早产儿体格、智能、运动发育的影响。方法将97例早产儿分成观察组52例与对照组45例进行观察,观察组从纠正胎龄40周后开始在家庭接受护士指导的早期干预,以后每月定期到儿童保健科接受体格发育和神经系统的监测和评估,并根据评估结果指导家长进行干预,直至系统跟踪随访2周岁,并采用中国儿童发展中心(CDCC)量表进行智力和运动能力测定判断智能发育是否正常。结果观察组在1、2岁时智能发育与运动发育指数明显优于对照组(p<0.05),观察组智能异常发生率明显低于对照组(p<0.05),但2组在一般发育状况方面比较,差异不明显(p<0.05)。结论早期护理干预可以促进早产儿智能发育,降低伤残率,提高患儿远期生存质量。     

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.