递进式护理目标在老年股骨颈骨折患者术后康复训练中的应用

目的:探讨递进式护理目标在老年股骨颈骨折患者术后康复训练中的应用效果。方法:将2016年5月1日~2018年5月31日收治的82例老年股骨颈骨折患者按随机数字表法分为对照组和实验组各41例,对照组采用常规康复训练,实验组在对照组基础上采用递进式护理目标管理,比较两组干预效果。结果:干预后实验组自我效能期望评分、结果期望评分及总分均高于对照组(P<0.05);术后8、12周实验组Harris评分、改良Barthel指数(MBI)评分均高于对照组(P<0.05);实验组住院天数短于对照组(P<0.05);实验组髋关节功能优良率高于对照组(P<0.05)。结论:对老年股骨颈骨折患者术后采用递进式护理目标管理,可有效提高患者康复训练的自我效能和训练效果,促进患者关节功能恢复。     

递进式目标护理对股骨颈骨折患者术后关节功能及自我效能的影响

目的探究递进式目标护理对于改善股骨颈骨折患者关节功能及自我效能的影响。方法选取2018年1月—2019年1月间来院接受治疗的股骨颈骨折患者为研究对象,梳理分析病例资料,共纳入90例患者进行本研究。采用随机数字表法将90例患者分为对照组和观察组,每组各45例。对照组实施常规护理干预方式,观察组在对照组基础上采用递进式目标护理。采用自我效能量表(CBSEI-C32)对患者的自我效能进行量化评估,采用髋关节功能评分量表(Harris)及Barthel指数(MBI)评分法对患者关节功能状况进行评估,比较两组患者术后并发症发生情况。结果采用递进式目标护理干预后,观察组患者的结果期望评分、自我效能期望评分均明显高于对照组(P0.05);观察组患者的Harris评分、MBI评分明显高于对照组(P0.05);观察组并发症发生率(6.67%)明显低于对照组(24.44%)(P0.05)。结论递进式目标护理可有效改善股骨颈骨折患者的关节功能状况,对于提升患者的自我效能,降低术后并发症发生率均具有积极作用。     

递进式目标护理配合康复训练对股骨骨折内固定术后功能恢复的影响

目的:探讨递进式目标护理配合康复训练对股骨骨折内固定术后功能恢复的影响。方法:选取我院收治的拟行股骨骨折内固定术患者60例作为研究对象,按照随机数字表法等分为观察组和对照组。对照组给予常规康复训练,观察组在对照组基础上联合递进式目标护理。观察两组患者髋关节功能、自我效能感及日常生活活动能力。结果:护理后两组患者疼痛程度、活动度、关节功能、关节畸形评分显著高于护理前(P0.05),且观察组显著高于对照组(P0.05)。护理后两组患者结果期望评分、自我效能期望评分以及总评分显著高于护理前(P0.05),且观察组显著高于对照组(P0.05)。护理后两组患者日常生活活动能力评分显著高于护理前(P0.05),且观察组显著高于对照组(P0.05)。结论:递进式目标护理配合康复训练能够有效促进股骨骨折内固定术后患者功能恢复,提高自我效能感和日常生活活动能力。     

增强自我效能干预对股骨颈骨折患者功能恢复的影响

目的探讨增强自我效能干预在股骨颈骨折患者中的应用效果。方法采用便利抽样法, 选取2019年1月—2021年3月杭州市萧山区中医院收治的80例股骨颈骨折患者为研究对象, 按照入院时间分组, 将2019年1—12月入院的40例患者作为对照组, 2020年1月—2021年3月入院的40例患者作为观察组。对照组采用常规护理干预, 观察组采用增强自我效能干预。比较两组患者不同时间点自我效能(SER)、功能锻炼依从性、髋关节功能(HHS)得分差异。结果出院时、术后1个月、术后3个月观察组SER评分高于对照组(P<0.05);出院时、术后1个月、术后3个月观察组功能锻炼依从性评分高于对照组(P<0.05);出院时、术后1个月、术后3个月观察组HHS评分高于对照组(P<0.05)。结论增强自我效能干预能提高股骨颈骨折患者的自我效能, 提高患者功能锻炼依从性, 促进髋关节功能恢复。     

软包装冰袋冰敷法结合递进式目标护理对足踝骨折患者疼痛、肿胀程度及康复积极性的影响

目的 探讨软包装冰袋冰敷法结合递进式目标护理对足踝骨折患者疼痛、肿胀程度及康复积极性的影响。方法采用随机数字表法将100例足踝骨折患者分为对照组与观察组,各50例。对照组采用常规护理,观察组在对照组基础上实施软包装冰袋冰敷法结合递进式目标护理。比较两组的干预效果。结果 干预后4周,观察组的血清P物质（SP）、前列腺素E2(PGE2)及多巴胺（DA）水平均明显低于对照组（P<0.05）。干预后1周,观察组的视觉模拟评分法（VAS）与肿胀评分低于对照组（P<0.05）。干预后4周,观察组的积极举动、康复护理配合度评分高于对照组,放弃举动评分低于对照组（P<0.05）。结论 软包装冰袋冰敷法结合递进式目标护理应用于足踝骨折患者中可降低炎性介质水平,减轻疼痛、肿胀程度,提升患者的康复积极性。     

循证护理对股骨颈骨折患者术后自护能力及关节功能恢复的影响

目的探讨循证护理在提高股骨颈骨折患者术后自护能力及关节功能恢复中的应用效果。方法将80例股骨颈骨折的患者随机分组,对照组给予常规护理,观察组在对照组的基础上采用循证护理,比较2组术后的自护能力、住院时间、关节恢复能力以及自理能力。结果出院前观察组在疾病认知能力、自我决策能力和自我锻炼能力等方面的评分均高于对照组,差异有统计学意义(P0.05);观察组的住院时间短于对照组,术后8周以及12周的Harris评分、MBI评分高于对照组,髋关节功能优良率高于对照组,差异均有统计学意义(P0.05)。结论循证护理使护理更加科学、规范,能够提高股骨颈骨折患者术后的自理能力,改善关节功能恢复情况。     

FLS模式护理对老年股骨颈骨折手术患者肢体功能康复的影响

目的探讨在老年股骨颈骨折手术患者中开展骨折联络服务(FLS)模式护理的临床效果。方法选择2021年1月—2022年5月医院收治的95例老年股骨颈骨折手术患者,按照组间基线资料可比的原则分为对照组47例和观察组48例,对照组给予常规护理,观察组在对照组基础上给予FLS模式护理干预,对比两组临床效果。结果与干预前相比,干预后两组髋关节功能评分表(Harris)各项评分、一般自我效能感量表(GSES)评分均升高,且观察组评分较对照组高,差异有统计学意义(P<0.05);干预后两组自我感受负担量表(SPB)评分较干预前均下降,且观察组分值较对照组低,差异有统计学意义(P<0.05);较之对照组,观察组首次下床时间及住院时间更短,差异有统计学意义(P<0.05)。术后随访1年,观察组骨折再发率为2.08%,低于对照组的14.89%,但组间差异无统计学意义(P<0.05)。结论FLS模式护理干预可促进老年股骨颈骨折手术患者自我效能感及肢体功能改善,有助于缓解患者自我感受负担,能够缩短患者康复进程。     

术后早期康复锻炼处方对股骨颈骨折患者髋关节功能康复的影响

目的探讨术后早期康复锻炼处方在股骨颈骨折患者术后髋关节功能康复中的应用。方法将采用术后早期康复锻炼处方的40例股骨颈骨折患者设为观察组,将采用术后常规护理的40例股骨颈骨折患者设为对照组,比较2组术后的疼痛情况、康复积极性以及恢复情况。结果观察组术后1 d、3 d、5 d、7 d的疼痛评分低于对照组,术后康复积极性高于对照组,差异有统计学意义(P<0.05)。观察组的住院时间短于对照组,术后髋关节功能评分、生活能力评分以及髋关节功能优良率高于对照组,差异有统计学意义(P<0.05)。结论术后早期康复锻炼处方能够提高股骨颈骨折患者术后康复锻炼的积极性,促进髋关节功能的恢复。     

“3H”模式结合“五步法”护理在踝关节骨折手术患者中的应用

目的:探讨“3H”模式结合“五步法”护理在踝关节骨折手术患者中的应用效果。方法:将81例踝关节骨折手术患者按照随机化分组法分为对照组40例和观察组41例;对照组实施常规护理及踝关节功能训练,观察组在对照组基础上实施“3H”模式结合“五步法”护理;干预8周后,比较两组自我效能[采用自我效能量表(GSES)]、应对方式[采用简易应对方式问卷(SCSQ)]、术后疼痛[采用视觉模拟评分法(VAS)]、关节肿胀消退率、踝关节功能、护理满意度及并发症发生率。结果:干预后,两组自我效能评分、应对方式中积极应对维度评分均高于干预前(P<0.05),且观察组高于对照组(P<0.05),消极应对维度评分均低于干预前(P<0.05),且观察组低于对照组(P<0.05);两组术后疼痛评分均逐渐降低(P<0.05),且观察组低于对照组同期(P<0.05);两组术后关节肿胀消退率、踝关节足功能评分逐渐提高(P<0.05),且观察组高于对照组同期(P<0.05);观察组护理满意度高于对照组(P<0.05);两组并发症发生率比较差异无统计学意义(P>0.05)。结论:“3H”模式结合“五步法”护理可有效提高患者自我效能,改善应对方式,减轻术后疼痛,促进关节肿胀消退,提高护理满意度。     

早期康复护理联合按摩在股骨颈骨折患者中的应用效果

目的探讨早期康复护理联合按摩在股骨颈骨折患者中的应用效果。方法将武警黑龙江总队医院2013-10—2014-04收治的80例股骨颈骨折的患者随机分为观察组和对照组,对照组采用常规护理,观察组在对照组的基础上采用早期康复护理联合按摩,比较两组患者的术后康复情况。结果观察组术后48 h和72 h的疼痛、并发症少于对照组,切口甲级愈合率高于对照组,住院时间短于对照组,术后第8周、第12周的髋关节功能评分高于对照组,差异有统计学意义(P0.05)。结论术后早期康复护理联合按摩有利于减少股骨颈骨折患者的术后并发症,促进关节功能的康复。     

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.