个性化护理在剖宫产产妇母乳分泌及新生儿喂养中的应用

目的:探讨个性化护理在剖宫产产妇母乳喂养及新生儿喂养中的临床应用效果。方法:将120例剖宫产产妇按照就诊顺序随机分为观察组和对照组各60例,观察组行个性化护理,对照组行常规护理,比较两组术后疼痛发生率、母乳喂养率、并发症发生率及产妇对护理的满意度,出院时采用抑郁自评量表(SDS)与焦虑自评量表(SAS)对产妇进行心理抑郁和焦虑评价,在产妇出院6个月后回访并详细记录母乳喂养情况。结果:观察组术后疼痛发生率及并发症发生率显著低于对照组(P0.05);观察组出院后母乳喂养率显著高于对照组(P0.05),对照组出院后母乳喂养率明显低于出院前(P0.05);观察组出院时满意度显著高于对照组(P0.05),SDS、SAS评分显著低于对照组(P0.05)。结论:个性化护理可降低产妇术后疼痛程度,提高母乳喂养率,并且有助于产妇心理健康及生理健康的恢复。     

互联网+护理服务促进纯母乳喂养的护理实践

目的：运用互联网+护理服务提高纯母乳喂养率,关注人类全生命周期之生命起始1000天的营养供给,促进纯母乳喂养。方法：随机原则选取在我院产科住院分娩的200 例产妇为研究对象,按住院顺序分为对照组100 例,观察组100 例。向对照组实施母乳喂养常规宣教,对观察组应用互联网+护理服务,我院HIMMS6信息系统, “317护”、“ 云随访”健康教育软件,实施面对面、一对一的哺乳知识与技能指导,出院后随访。开设围产期护理门诊、微信群远程指导延伸护理服务。比较两组产妇在产后42天、6个月时的纯母乳喂养率。结果：产后42天、6 个月观察组纯母乳喂养率高于对照组(P <0.05)。结论：关注人类全生命周期生命起始1000天的营养供给,应用互联网+护理服务,围产期护理门诊、微信群延伸护理服务能够提高产妇的纯母乳喂养率,促进纯母乳喂养成功。     

探讨微信群在产后访视工作中的应用

目的 探讨产后访视中建立微信群对提高母乳喂养率及促进母婴健康的影响。方法 选取南京市鼓楼区凤凰社区卫生服务中心管辖区2016年180例产妇为研究对象,按接诊顺序分为对照组和观察组,每组各90例。对照组产后访视采取定期入户访视方式,观察组产后访视中增加建立微信群方式。对比两种访视方式对提高母乳喂养率、母乳喂养知识知晓率,降低新生儿红臀发生率及乳头皲裂发生率中的作用差异。结果 观察组产妇产后母乳喂养知晓率达86%、纯母乳喂养率67%,均高于对照组;观察组乳头皲裂发生率10%及新生儿红臀发生率4%均低于对照组。结论 在传统产后访视再建立微信群方式显著提高母乳喂养率和母乳喂养知识认知度,能有效降低乳头皲裂和新生儿红臀发生率,有效促进母婴健康。     

路径化健康教育对提高乳头凹陷产妇母乳喂养率的效果观察

[目的]探讨路径化健康教育模式对提高乳头凹陷产妇母乳喂养率的效果。[方法]选择86例乳头凹陷产妇按入院顺位奇偶数分为常规组和路径组各43例。常规组采用传统的健康教育方法,路径组采用路径化健康教育,比较两组产妇母乳喂养相关知识掌握程度及两组出院前和出院后1个月、4个月、6个月的母乳喂养情况。[结果]出院时路径组产妇母乳喂养知识掌握程度高于对照组,出院前和出院后1个月、4个月、6个月母乳喂养率(95.35%,72.09%,65.12%,53.49%)均明显高于对照组(74.42%,51.16%,39.53%,25.58%),两组比较差异均有统计学意义(P0.05)。[结论]实施路径化健康教育可提高乳头凹陷产妇的母乳喂养知识掌握程度和母乳喂养率。     

家庭访视对提高母乳喂养率的效果观察

[目的]探讨家庭访视对提高母乳喂养率的效果.[方法]将160例产妇随机分为观察组和对照组,观察组和对照组在住院期间均按常规进行母乳喂养知识宣教和指导,出院后由护理人员对观察组产妇进行家庭访视,对照组产妇仅进行电话访视1次.比较两组产妇母乳喂养率及观察组在家庭访视前后的母乳喂养率.[结果]观察组母乳喂养率高于对照组母乳喂养率,且家庭访视后母乳喂养率高于访视前母乳喂养.[结论]出院后对产妇进行家庭访视能提高母乳喂养率.     

基于微信平台的延续性护理对产妇产后恢复情况、睡眠质量及母乳喂养行为的影响

目的探讨基于微信平台的延续性护理对产妇产后恢复情况、睡眠质量及母乳喂养行为的影响。方法选取2017年2—6月我院出院产妇200例,采用随机数字表法将其等分为观察组和对照组,对照组产妇实施常规产后护理,观察组给予基于微信平台的延续性护理干预。观察两组产妇的产后恢复情况、睡眠质量改善情况、母乳喂养行为及焦虑情况。结果观察组产妇产后恢复情况明显优于对照组(P0.05);两组产妇干预前PSQI各项指标评分及PSQI总分经比较无统计学意义(P0.05),观察组干预后PSQI各项指标评分及PSQI总分均较干预前有所降低(P0.05),对照组干预后PSQI评分中睡眠质量及睡眠效率两项指标较干预前有所降低(P0.05),干预后观察组PSQI各项指标及PSQI总分均明显低于对照组(P0.05);两组产妇哺乳3个月内坚持母乳喂养例数比较无统计学意义(P0.05),两组产妇哺乳6,9个月时母乳喂养例数比较有统计学意义(P0.05);观察组产妇干预后SAS评分低于对照组(P0.05)。结论在产后护理中开展基于微信平台的延续性护理不仅能够促进产妇产后恢复,改善睡眠质量,同时对改善母乳喂养行为及负面情绪方面具有积极作用,是一种切实可行的院外干预手段。     

电话访视对出院产妇实施延续性健康教育的效果分析

目的探讨电话访视对出院产妇实施延续性健康教育的效果。方法 2007年10月-2008年3月将本院出院的706例产妇随机分为观察组与对照组各353例,对照组在出院时进行系统的出院指导,观察组在出院指导基础上,在出院后28d内实施电话访视3次,加强产妇母婴保健知识的健康教育。比较两组产妇产后42d母婴保健知识掌握率、纯母乳喂养率及产妇对出院后护理服务满意度。结果两组产妇产后第42d母婴保健知识掌握率、纯母乳喂养率及产妇对出院后护理服务满意率比较,均P〈0.01,差异具有统计学意义,观察组健康教育效果优于对照组。结论电话访视有利于健康教育工作的延续性开展,增强了产妇健康保健知识,从而改善了医患关系,对提高医院服务质量起到积极的作用。     

延续性护理对出院产妇提高母乳喂养率的效果观察

目的探讨延续性护理在产科出院患者提高母乳喂养率中的应用效果。方法将220例产妇随机分为对照组与观察组各110例,对照组产前及产后给予母乳喂养知识宣教和哺乳技能指导,观察组在对照组基础上,实施出院后延续性护理,有针对性地给予母乳喂养指导。观察两组的母乳喂养、乳房肿胀、乳腺炎、母乳喂养率。结果两组产妇产后1个月、2个月、3个月、4个月、5个月、6个月纯母乳喂养率比较,均差异具有统计学意义(P0.05),观察组母乳喂养率明显高于对照组。结论延续性护理提高了产科出院产妇的母乳喂养率,降低了乳房肿胀和乳腺炎的发生率。     

动机性访谈在促进乳头凹陷初产妇母乳喂养中的应用

[目的]探讨动机性访谈在促进乳头凹陷初产妇母乳喂养中的应用效果。[方法]将90例乳头凹陷初产妇随机分为对照组和观察组,每组45例。对照组按常规进行母乳喂养指导,观察组以动机性访谈形式进行母乳喂养指导,在干预前、出院时、产后6周回院复查时采用母乳喂养自我效能简式量表(BSES)评估两组产妇的母乳喂养自我效能,对两组产妇的母乳喂养自我效能水平和母乳喂养率进行比较。[结果]观察组产妇出院前、产后6周的母乳喂养自我效能得分和母乳喂养率均高于对照组(P0.05)。[结论]动机性访谈可以明显提高乳头凹陷初产妇的母乳喂养自我效能和母乳喂养率。     

电视影像在产科病房健康宣教中应用

[目的]了解电视影像在产科病房健康宣教中的应用效果。[方法]选取2014年1月—2014年10月我院足月分娩的产妇100例,随机分为对照组和观察组各50例,产后观察组产妇在"一对一"健康宣教的同时进行电视影像宣教,对照组产妇常规进行"一对一"健康宣教。于产妇出院时比较两组产妇对母乳喂养和新生儿护理的掌握程度和产妇的满意程度。[结果]观察组产妇新生儿沐浴、新生儿抚触、脐部护理方法和母乳喂养方法等知识的完全掌握率明显高于对照组,且总满意率(96.0%)明显高于对照组(70.0%)。[结论]产科病房应用电视影像健康宣教法,产妇及其家属的满意程度较高,同时减轻了护理人员工作量。     

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.