生活行为指导对高血压患者血压控制和生活质量的影响

目的:探讨生活行为指导对高血压患者血压控制和生活质量的影响。方法:将100例高血压患者采用随机对照的方法分为观察组和对照组各50例,两组治疗方法相同,对照组采用常规护理,观察组在对照组基础上采用生活行为指导;比较两组患者血压控制和生活质量。结果:随访时,观察组压舒张压(DBP)、收缩压(SBP)显著低于对照组(P0.05),血压控制总有效率显著高于对照组(P0.05),生理、心理、社会等生活质量方面评分显著高于对照组(P0.05)。结论:生活行为指导有助于帮助高血压患者建立健康的生活方式,有效控制血压,改善生活质量。     

社区健康管理在控制老年患者高血压中的应用

目的探讨社区健康管理在控制老年患者高血压中的应用效果。方法选择2016年1—6月在我院出院的高血压患者60例,分为观察组和对照组各30例。两组患者均给予一般常规护理措施,观察组患者则在此基础之上加用社区健康管理,包括有氧运动指导、生活方式指导、高血压的预防知识指导及药物指导。观察两组患者6个月中血压控制情况,再次入院情况及不良反应发生情况。结果 6个月后,观察组与对照组患者在收缩压控制方面比较差异有统计学意义(P0.05);再次住院率比较差异有统计学意义(P0.05);头痛呕吐发生率比较差异有统计学意义(P0.05)。结论加强社区健康管理能稳定老年患者的血压状况,降低再次住院率,减少不良反应的发生,有助于提高高血压患者的生活质量。     

对高血压患者实施社区健康教育的效果评价

目的观察对高血压患者实施社区健康教育的效果,探讨应用价值。方法选择2008年1月至2009年12月建湖县沿河镇卫生院两社区各80例正在药物治疗的高血压分别作为观察组及对照组,对照组在进行一般性高血压教育,自行锻炼和饮食控制;观察组建立健康档案进行个体评估,实施相应的健康教育:高血压知识、心理、生活方式、服药、患者家属、自我监测。结果两组开始治疗依从性、血压参数比较无统计学差异(P>0.05),实施健康教育1年后观察组依从性好73.75%,健康教育内容掌握90.00%,高于对照组的52.50%、52.50%(P<0.05);收缩压(16.32±0.98)kPa、舒张压(10.31±0.78)kPa低于对照组的(17.49±0.97)kPa、(11.22±0.87)kPa(P<0.05)。结论在社区中规范化地开展健康教育工作,进行合理管理、跟踪随访可以提高高血压治疗依从性,有效控制血压血压水平,应把健康教育工作纳入社区高血压的目标管理当中。     

以行为改变整合理论为基础的护理随访对高血压患者生活质量的影响

目的:探讨以行为改变整合理论为基础的护理随访对高血压患者生活质量的影响。方法:将就诊的150例高血压患者根据随机数字表分为观察组和对照组各75例,对照组应用常规性健康教育,观察组以行为改变整合理论为基础实施护理随访,干预时间为6个月;比较两组干预前后血压变化情况、生活方式改变情况及生活质量情况。结果:干预后观察组收缩压(SBP)、舒张压(DBP)水平均低于对照组(P0.01),血压管理能力、饮食管理能力、运动锻炼管理能力、用药管理能力、并发症管理能力评分均高于对照组(P0.01),社会领域、心理领域、生理领域、环境领域及生活质量总评分均高于对照组(P0.01)。结论:以行为改变整合理论为基础的护理随访能有助于高血压患者建立健康的生活方式,控制患者血压水平,提高患者生活质量。     

慢病管理模式对某社区老年高血压患者的影响

目的探讨规范的慢病管理模式对高血压患者治疗的影响。方法 160例高血压患者随机分为慢病综合管理组80例和常规治疗组80例,两组均采用常规药物治疗,综合管理组在此基础上实施慢病规范管理模式。观察患者生活方式,对高血压的认识、血压控制情况,进行6个月的随访。结果综合管理组患者的高血压知晓率和血压控制率明显提高,生活方式改善。两组统计学比较,综合管理组优于常规治疗组(P<0.01)。结论社区开展高血压患者的规范管理有利于提高患者对高血压的知晓率和控制率,有利于高血压的达标。     

互动式护理对社区高血压病患者血压控制作用与相关影响因素分析

目的:探讨互动式护理对社区高血压病患者血压控制作用并分析相关影响因素。方法:选取2015年2月~2016年1月我社区高血压病患者300例,统计并分析患者血压控制及治疗基本情况,分析相关影响因素。同时,以随机数字法将其等分为观察组及对照组,对照组给予常规社区护理干预,观察组行互动式护理干预,对比两组患者高血压预防知识认知率、治疗依从性、护理前后血压控制,并分析影响血压控制效果的相关因素。结果:经多因素Logistic回归分析可知,血压监测认知、血压监测依从性、服药依从性、生活方式依从性以及服药认知均为影响社区高血压患者血压控制的危险因素。护理后观察组高血压预防知识认知率及治疗依从性均显著高于对照组,差异均有统计学意义(P0.05)。两组护理后血压控制及治疗依从性均显著高于护理前,而观察组又显著高于对照组,差异均有统计学意义(P0.05)。结论:影响社区高血压病患者血压控制效果的危险因素包括血压监测认知、血压监测依从性、服药依从性、生活方式依从性以及服药认知,通过互动式护理干预,可有效改善患者高血压病预防知识认知及治疗依从性,进一步提高血压控制情况。     

中老年高血压患者的社区综合健康管理模式探索

目的 探索中老年高血压患者的社区综合健康管理模式.方法 选取中老年高血压120例,以调查对象的入院顺序进行编号,根据随机数字表分成两组.对照组按照普通管理,观察组按照社区健康管理模式管理.在饮食、运动及心理、中医等一系列健康的生活方式予以详细指导.1年后比较两组患者血压变化情况.结果 两组患者血压均较前有下降,其中社区...     

对社区高血压患者实施综合干预管理的效果观察

目的 观察对社区高血压实施综合干预管理的效果,探讨价值.方法 随机选择正在药物治疗的社区高血压患者180例分为观察组及对照组各90例.对照组在进行一般血压监测,自行锻炼和饮食控制;观察组建立健康档案进行个体评估,实施相应干预管理:健康教育及认知干预;心理干预;行为引导生活干预;服药管理;定期体格检查.结果 两组实施管理前药物治疗依从性、疗效评价、高血压病知识知晓率、自我管理行为比较无统计学差异(P>0.05),实施综合管理1年后观察组依从性好(71.11%)、血压达标(86.67%)、知晓率(93.33%)、自我管理(86.67%)均高于对照组(38.89%、51.22%、72.22%、58.89%)(P<0.05).结论 综合管理有利于社区高血压依从性的提高,改善治疗,是提高社区高血压人群健康水平和生活质量的切实可行方法.     

高血压社区规范化管理对患者相关防治知识及行为的影响

【目的】分析高血压社区规范化管理对患者相关防治知识及行为的影响,为完善社区高血压规范化管理体系提供依据。【方法】选取分别就诊于社区接受规范化管理（管理组）及心内科门诊随访（对照组）的两组高血压患者,每组各300例。对选定人群采用问卷调查及查阅患者病历,获取相关信息,分析高血压规范化管理对患者相关知识及行为的影响。【结果】社区规范化管理组的高血压防治知识知晓率,生活方式改善率均高于对照组,且两组相比较差异有显著性（P＜0．05）。【结论】高血压社区规范化管理可提高患者对高血压防治知识的知晓率,改善其生活方式。     

健康档案在高血压社区管理中的应用价值评析

选取2014年我社区常住的高血压患者50例设为对照组,选取2014年我社区常住的高血压患者50例设为观察组。对照组阶段实施常规的高血压社区管理,未采取电子健康档案管理模式,观察组阶段在高血压的社区管理中应用电子健康档案管理模式。比较两组患者的血压控制效果、健康行为评分以及生活质量评分。观察组的血压控制总有效率为94%,较对照组的78%明显更高(P0.05)。与对照组相比,观察组的健康行为评分以及生活质量评分均明显更高(P0.05)。在高血压的社区管理中实施电子健康档案管理,可更加有效地控制患者的血压水平,改善患者的健康行为以及生活质量。     

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.