综合护理对玻璃酸钠膝关节腔注射治疗膝骨关节炎的疗效影响

目的探讨综合护理对玻璃酸钠膝关节腔注射治疗膝骨关节炎疗效的影响。方法收集本院80例玻璃酸钠膝关节腔注射治疗膝骨关节炎患者按是否愿意接受系统护理分为2组。对照组患者给予常规护理,实验组患者施加综合护理干预,比较2组患者治疗前后Lysholm评分情况、总体治疗效果、出院前知识掌握、健康行为采纳与护理满意度情况。结果治疗后,实验组患者Lysholm评分显著高于对照组(P0.01);实验组患者治疗总有效率明显高于对照组(P0.05);实验组患者基础常识掌握与情绪平稳率、遵医用药与康复运动采纳率显著高于对照组(P0.05);实验组患者出院前护理满意度显著优于对照组(P0.01)。结论综合护理对玻璃酸钠膝关节腔注射治疗膝骨关节炎疗效显著,可提高患者满意度。     

系统化护理干预应用于骨外固定支架治疗四肢长管状骨骨折患者的效果

目的探讨系统化护理干预对骨外固定支架治疗四肢长管状骨骨折患者的应用效果。方法收集入院的100例行骨外固定支架治疗的四肢长管状骨骨折患者按是否愿意接受系统化护理干预分为2组。对照组患者给予常规护理,实验组患者施加系统化护理干预,比较2组患者骨折预后、自我护理意识、并发症发生率与护理满意度。结果实验组患者骨折预后优良率显著高于对照组(P0.01);实验组患者干预后限制行为、管理行为、心理活动与状态管理评分显著高于对照组(P0.01);实验组患者总体并发症发生率显著性低于对照组(P0.01);实验组患者护理满意度显著性优于对照组,(P0.01)。结论系统化护理干预可提高骨外固定支架治疗四肢长管状骨骨折患者的满意度,具有临床借鉴性。     

循证护理对胰岛素泵强化治疗2型糖尿病的效果分析

目的探讨循证护理对胰岛素泵强化治疗2型糖尿病患者的干预效果。方法收集本院50例行胰岛素泵强化治疗的2型糖尿病患者按是否接受循证护理分为2组各25例,对照组患者携泵期间给予常规护理,实验组患者加施循证护理,比较2组患者携泵期间健康行为评分、糖尿病相关参数、意外事件发生与满意度等。结果实验组患者用药治疗、合理饮食、适量运动、自我监测与尊医携泵评分均显著性高于对照组,血糖达标时间与胰岛素用量显著性低于对照组,具有统计学意义(P0.05);低血糖、黎明现象、针头脱落、导管堵塞与感染发生率明显低于对照组,护理满意度明显高于对照组,具有统计学意义(P0.05)。结论循证护理对胰岛素泵强化治疗2型糖尿病患者的干预效果显著,具有借鉴性。     

品管圈活动对危重糖尿病患者行实时动态血糖监测系统护理的影响

目的:探讨品管圈活动对危重糖尿病患者行实时动态血糖监测系统(RT-CGMS)护理的影响。方法:将66例危重、血糖控制不良、佩戴RT-CGMS的糖尿病患者随机分为观察组和对照组各33例,观察组推行品管圈活动,对照组行常规护理。结果:观察组专业知识、解决问题能力、团队精神、护理品质意识4个方面评分明显高于对照组(P0.05),断图次数、故障次数明显低于对照组(P0.05)。结论:主题为RT-CGMS护理的品管圈活动中,以团队精神为目标,对提高护理品质、提高患者对护理的满意度有促进作用。     

护理干预对2型糖尿病患者空腹血糖、餐后2h血糖、糖化血红蛋白的影响研究

目的 评估护理干预在2型糖尿病患者治疗中的重要作用.方法 将94例经住院治疗血糖控制平稳的2型糖尿病患者出院后随机分为2组.对照组46例,只接受普通的门诊药物治疗;实验组48例,在药物治疗基础上,接受系统的护理干预,1次/1周.结果 护理干预后在定期检查、饮食控制、血糖监测方面比较,实验组明显优于对照组,差异非常显著(P<0.01);在运动疗法方面.实验组明显优于对照组,差异显著(P<0.05);FBG、PBG、HbA1c比较,实验组明显优于对照组,FBG、PBG差异显著(P<0.05);HbA1c差异非常显著(P<0.01).结论 系统的护理干预治疗能有效地控制2型糖尿病患者血糖水平,从而延缓并发症的发生、发展.     

康复护理在急性腰扭伤患者中的应用效果

目的探讨康复护理在急性腰扭伤患者中的应用效果。方法选取80例急性腰扭伤患者随机分为2组,对照组给予常规护理,实验组加施康复护理干预,比较2组患者康复效果、疼痛与功能障碍、生活质量与护理满意度。结果实验组患者康复总有效率高于对照组,差异有统计学意义(P0.05);实验组患者干预后VAS与RMDQ评分显著低于对照组,差异有统计学意义(P0.01);实验组患者干预后生理机能、生理职能、躯体疼痛、健康状况、精力、社会功能、情感职能与精神健康评分显著高于对照组,差异有统计学意义(P0.01);实验组患者护理满意度评价优于对照组,差异有统计学意义(P0.05)。结论康复护理在急性腰扭伤患者中的应用效果显著,可提高满意度,具有借鉴性。     

肝癌射频消融术患者的临床护理路径研究

目的探讨临床护理路径在肝癌射频消融术患者中的应用效果。方法 120例行射频消融术的肝癌患者分为2组。对照组给予常规护理,实验组给予临床护理路径干预。比较2组患者干预前后知识知晓与自我护理能力、相关临床指标、并发症与护理满意度。结果实验组患者干预后相关知识掌握与自我护理能力评分显著高于对照组(P0.01);实验组患者卧床时间、住院时间与医疗费用显著低于对照组(P0.01);实验组患者恶心、呕吐、穿刺点异常与呃逆发生率显著低于对照组(P0.05);实验组患者肝区疼痛与尿潴留发生率显著低于对照组(P0.01);实验组患者护理满意情况显著性优于对照组(P0.01)。结论临床护理路径在肝癌射频消融术患者中应用效果显著。     

心理干预对抑郁障碍糖尿病患者抑郁程度及生活质量影响的分析

目的 探讨心理干预对抑郁障碍糖尿病患者生活质量的影响.方法 将40例抑郁障碍糖尿病患者随机分为实验组和对照组各20例,实验组在常规治疗护理基础上进行心理干预,对照组仅执行常规治疗护理.干预前后分别对2组患者用自评抑郁量表(SDS)、生活质量综合评定问卷(GQOLI-74)进行测评.结果 干预后实验组SDS评分指数较对照组显著降低,差异有统计学意义(P＜0.01);干预后实验组GQOLI-74测评躯体功能、心理功能、社会功能3个维度的评分均高于干预前,差异有统计学意义(P＜0.01);干预后实验组GQOLI-74评分较对照组显著升高,差异有统计学意义(P＜0.01).结论 心理干预能有效改善抑郁障碍糖尿病患者的抑郁症状,提高生活质量.     

风湿免疫疾病中肺部并发症的治疗与护理

目的探讨优质护理干预在风湿免疫疾病患者中的辅助治疗与肺部并发症预防效果。方法收集本院80例风湿免疫疾病患者按是否愿意接受优质护理分为2组,对照组患者给予常规护理,实验组患者加施优质护理干预,比较2组患者干预前后护理质量评分、风湿疼痛情况、并发症与护理满意度调查结果等。结果实验组患者干预后护理质量评分显著性上升(P0.01),2组患者干预后NRS评分显著性下降,2组间比较存在显著性差异(P0.01);实验组患者总并发症发生率显著低于对照组(P0.01),护理满意度调查结果显著优于对照组(P0.01)。结论优质护理干预在风湿免疫疾病患者中的辅助治疗与肺部并发症预防效果显著,可提高满意度,具有借鉴性。     

舒适护理对老年腰椎压缩性骨折术后患者疼痛的影响

目的探讨舒适护理对老年腰椎压缩性骨折术后患者疼痛的影响效果。方法收集80例腰椎压缩性骨折老年患者随机分为2组,对照组行常规护理,实验组则加施舒适护理,比较2组患者干预前后总体疼痛、生活质量、并发症与护理满意度。结果实验组患者干预后总体疼痛情况显著优于对照组,差异有统计学意义(P0.01);实验组患者干预后生理机能、生理职能、躯体疼痛、社会功能与一般健康状况评分显著高于对照组,差异有统计学意义(P0.01);实验组患者总体并发症发生率低于对照组,差异有统计学意义(P0.05);实验组患者护理满意度显著优于对照组,差异有统计学意义(P0.01)。结论舒适护理对老年腰椎压缩性骨折术后患者疼痛的影响效果显著,可提高护理满意度。     

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.