两种心理干预对多发肋骨骨折患者的影响

目的 探讨两种不同心理干预方法对多发肋骨骨折患者术后恢复的影响.方法 随机将174例多发肋骨骨折手术患者分为两组:实验组(87例)予以术后个体化心理干预和对照组(87例)予以常规心里干预,并比较两组患者预后情况及满意度.结果 实验组患者术日晨及入手术室的心率均低于对照组,且差异有统计学意义(P＜0.05);干预后实验组及对照组焦虑评分分别为(44.46士8.79)和(51.67±9.83),差异有统计学意义(P＜0.05);实验组及对照组患者住院满意度分别为96.6％和69.0％,差异有统计学意义(P＜0.05).结论 个体化心理护理干预方法在加速患者身体恢复降低患者焦虑情绪,提高住院满意度等方面优于常规心理干预.     

精细化护理干预在剖宫产手术产妇中的应用

目的 探讨精细化护理干预在剖宫产产妇中的应用效果.方法 将90例行剖宫产手术的患者随机分为对照组和实验组,每组45例.对照组采用常规护理干预,实验组采用精细化护理干预.比较2组术后不同时期疼痛评分、胃肠功能恢复及乳房泌乳情况和护理满意率.结果 2组患者术后24、48 h疼痛评分均低于术后30 min,差异有统计学意义(P＜0.05);2组患者术后48 h疼痛评分均低于术后24 h,差异有统计学意义(P＜0.05).实验组患者术后24、48 h疼痛评分低于对照组,差异有统计学意义(P＜0.05).实验组肠鸣音、排气、排便恢复时间均短于对照组,差异有统计学意义(P＜0.05).实验组泌乳始动时间、乳房胀痛发生率均低于对照组,48 h内泌乳充足率高于对照组,差异有统计学意义(P＜0.05);实验组护理满意率为97.78％,高于对照组的86.67％,差异有统计学意义(P＜0.05).结论 精细护理干预措施可更有效缓解剖宫产患者术后疼痛,促进胃肠功能功能恢复及产后泌乳,提高患者满意度.     

护理干预对心脑血管疾病患者健康行为及院外依从性的影响

目的 探讨护理干预对心脑血管疾病患者健康行为及院外依从性的影响.方法 将112例心脑血管病患者随机分为实验组和对照组各56例,对照组针对患者病情进行康复治疗,实验组在此基础上根据患者文化水平、性格特点、心理状态及理解能力实施护理干预.比较两组干预前后健康行为及院外依从性情况.结果 实验组干预后健康行为优于干预前(P＜0.05),与对照组比较差异有统计学意义(P＜0.05),院外依从与对照组比较差异有统计学意义(P＜0.05).结论 有效护理干预能改善心脑血管疾病患者的健康行为,提高其自我保健意识及院外依从性.     

心理干预对预防膀胱癌术后复发的作用

目的 探讨心理干预对预防膀胱癌术后复发的作用.方法 选取住院治疗的膀胱癌患者86例,随机分为实验组和对照组,每组43例.两组均行手术及常规护理,实验组同时给予心理护理干预,2年后观察肿瘤的复发率,并采用抑郁自评量表和焦虑自评量表对两组患者的心理状况进行评价.结果 1年后的复发率两组差异无统计学意义;2年后的复发率差异有统计学意义(P＜0.05).焦虑自评量表和抑郁自评量表评分术前实验组和对照组差异无统计学意义,术后2年两组比较差异有统计学意义(P＜0.05).结论 积极的护理干预可以增强患者的信心,消除患者焦虑和抑郁等不良心理障碍,达到预防肿瘤复发和提高患者生活质量的目的.     

胸外科手术患者术后疼痛59例护理干预

目的:探讨胸外科手术患者术后疼痛的护理干预效果.方法:将109例胸外科手术患者随机分为实验组59例和对照组50例,对照组患者实施常规护理,实验组在对照组基础上采取针对性心理干预、健康教育等护理措施.对两组患者术后疼痛、焦虑及治疗情况进行比较.结果:实验组患者SDS、SAS评分及NRS分级比较均优于对照组(P＜0.05);两组患者治疗效果比较差异有统计学意义(P＜0.05).结论:对接受胸外科手术的患者实施护理干预,可有效改善患者术后疼痛程度,提高患者预后.     

全髋关节置换术前综合性干预对术后康复的影响

目的 探讨全髋关节置换术前综合性干预对术后康复效果的影响.方法 选择择期行全髋关节置换手术的患者80例,用抽签法随机分为实验组和对照组(各40例).实验组术前接受心理干预、并掌握排尿功能及肢体功能康复训练方法,对照组术前只了解常规指导,2组术后的康复训练程序完全一致.比较术后心理状态、第一次排尿情况及术后第1、3个月末临床康复效果评价.结果 实验组术后心理状态明显优于对照组,差异有统计学意义(P＜0.05);患者第1次能自行排尿的情况明显优于对照组,差异有统计学意义(P＜0.01);实验组第4周末康复训练计划完成量多于对照组,差异有统计学意义(P＜0.05).术后第1,3个月时,实验组的置换髋关节功能评分分别显著高于对照组,2组间差异有统计学意义(P＜0.05). 结论术前综合干预,可提高术后肢体早期功能训练的效率,减少术后并发症,早日恢复肢体功能.     

临床路径心理干预对肛瘘患者抑郁和焦虑的作用

目的 探讨临床路径心理干预对肛瘘患者抑郁和焦虑的作用.方法 选取住院治治疗的肛瘘患者30例,随机分为实验组和对照组,每组15例.对照组实施常规路径心理干预,实验组实施临床路径心理干预.术后随访1～2个月,观察肛瘘患者心理干预效果,评估采用抑郁状态量表(SDS)评分标准和焦虑自评量表(SAS)评分标准进行评定.结果 实验组SDS和SAS评分均优于对照组,差异有统计学意义(P＜0.05).实验组干预后总有效率(包括显效和有效)为92.8％优于对照组(80.0％),差异有统计学意义(P＜0.05).结论 早期实施临床路径心理干预可减少肛瘘患者抑郁和焦虑心理的发生,避免肛瘘患者产生不稳定心理,但应注意正确的临床路径心理干预经验及相应规范的术后功能康复锻炼.     

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.     

术前护理干预对乳腺癌手术患者焦虑程度的影响分析

目的:探讨乳腺癌患者术前有效的护理干预措施,提高其护理质量.方法:将60例乳腺癌化疗患者随机分为实验组和对照组,各30例.对照组进行常规术前护理,实验组在实施常规术前护理的基础上还对患者和家属实施个性化的术前护理干预,包括心理沟通、心理疏导和生活指导.观察并比较两组患者的焦虑值.结果:两组患者干预前焦虑值比较无统计学意义(P＞0.05),干预后焦虑值比较有统计学意义(P＜0.05);实验组患者干预前后焦虑值比较有显著性差异(P＜0.01),而对照组患者干预前后焦虑值比较仅有统计学意义(P＜0.05).结论:乳腺癌手术患者存在着不同程度的焦虑,术前护理干预在缓解患者术前焦虑上效果优于一般常规护理,这对降低或解除患者的术前焦虑有着积极意义.     

规范化心理护理干预模式在妇科肿瘤患者中的应用效果观察

目的:探讨规范化心理护理干预模式在妇科肿瘤患者中的应用效果.方法:将240例妇科肿瘤患者随机分为实验组和对照组各120例,对照组患者给予一般心理护理干预措施,实验组患者采用我院规范化的心理护理干预措施.比较两组患者的睡眠质量、焦虑抑郁情绪和患者对护理工作的满意度.结果:实验组患者焦虑、抑郁状态明显降低,睡眠质量提高,各指标与对照组比较,差异有统计学意义(P＜0.05);实验组患者对护理工作满意度明显提高,两组比较差异有统计学意义(P＜0.05).结论:对妇科肿瘤患者采用规范的心理护理干预模式能够有效提高患者的生活质量,值得临床推广应用.     

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.