新生儿听力筛查测试时间对结果的影响

2003年12月～2004年3月，我们对新生儿听力筛查测试时间对结果的影响进行了观察，以指导临床工作。现报告如下。     

手术室噪音对患者的心理影响及护理探讨

手术室作为病人接受手术治疗及抢救伤病员的重要场所，环境要求较高，如：清洁、无菌、安静等，但手术室的噪音却常常被忽视。所谓噪音，指不需要、不悦耳、紧张而有害的声音。它有许多测定方法，但大多数以db-A为单位分级，40db～80db属中等声响，80db～lOOdb已经很响。手术室常见的噪音来源有推机器声、推器械车声、脚步声、交谈声、监     

心外科重症监护病房噪声对患者的影响及对策

重症监护病房(intensive care unit,ICU)用于心脏手术后治疗及监护,对环境要求高,应保持清洁、无菌、安静、色彩、光线适宜等.但ICU的噪声却常常被忽视.……     

综合性护理干预对重症监护病房感染性休克患者效果影响

目的:探究给予ICU感染性休克患者展开综合性护理,随后进行效果分析.方法:于2018年1月--2019年11月,选取ICU感染性休克患者60例,均予以随机分组,分2组各30例.控制组应用基础护理,基于此试验组应用综合性护理干预.比较两个组别总有效率.结果:两个组别总有效率对比发现试验组明显高于控制组(P<0.05).通...     

重症监护病房与普通病房细菌分布及耐药性比较

目的：比较呼吸科重症监护病房（RICU）、外科重症监护病房（SICU）以及普通呼吸科病房检出细菌流行病学分布及耐药特点。方法：采用纸片扩散法（K—B法）,对我院RICU、普通呼吸科病房、SICU患者中1523株分离细菌进行药敏试验,并用WHONET软件5-4进行分析。结果：1523株细菌中革兰阴性菌1112株（73．0％）：革兰阳性菌411株（27．0％）。RICU、普通呼吸科病房和SICU分别检出细菌383、441和699株．三大病房金黄色葡萄球菌中耐甲氧西林金黄色葡萄球菌（MRSA）流行率分别占96．7％、64.3％和98．4％,未检出对万古霉素或替考拉宁耐药株．SICU检出耐万古霉素屎肠球菌4株。肺炎克雷伯菌产超广谱B内酰胺酶（ESBLs）菌株在RICU、普通呼吸科病房和SICU的流行率分别为21．6％、10．6％和45．9％;非发酵菌分别占革兰阴性菌的75．0％、53．0％和54．0％。三大病房比较,普通病房各细菌耐药率均较低;RICU和SICU鲍曼不动杆菌仅对头孢哌酮-舒巴坦耐药率低（〈20％）,对其余临床常用抗生素耐药率均高于50．0％;SICU检出铜绿假单胞菌对临床常用抗假单胞菌药物耐药率均高于40．0％。结论：三大病房检出细菌均以革兰阴性菌为主,多重耐药非发酵菌是常见细菌。葡萄球菌属在革兰阳性菌检出中占主导．已发现耐万古霉素屎肠球菌菌株。     

重症监护病房患者睡眠障碍的研究进展

睡眠是人体重要的生理学行为,对疾病康复具有重要的意义.住院患者尤其是重症监护病房(intensive care unit,ICU)患者均存在不同程度的睡眠障碍.甚至在出院3个月后,仍有相当数量患者持续存在睡眠障碍[1].睡眠障碍是导致患者伤口延迟愈合、感知受损、应激反应的常见原因,是预后不良,增加死亡风险,延长住院时间,增加住院费用的一个独立的危险因素[2].本文就住院ICU患者睡眠障碍的现状、影响因素、应对措施作一综述,旨在引起住院医师的更多关注,促使患者早日康复.     

重症监护病房患者不适体验及影响因素的临床调查研究

目的了解危重患者在重症监护病房（ICU）住院期间疼痛、焦虑、睡眠障碍等不适体验发生的比例及严重程度,探讨治疗干预手段、护理操作和病房环境等对患者不适体验的影响。方法2006年6月至2007年12月收住东南大学附属中大医院ICU,且ICU住院时间超过24h的危重患者,患者经积极抢救治疗后病情相对平稳,转至普通病房。转科后3～7d内接受问卷调查。记录患者疼痛、焦虑、口渴、睡眠障碍和自觉环境噪音等不适体验的发生率,分析导致患者不适体验的影响因素。结果142名ICU危重患者纳入观察组,患者疼痛、焦虑、口渴、睡眠障碍和自觉环境噪音等不适的发生率分别为35．2％、51．9％、88．9％、55．8％和47．2％。有78．0％（78／100）的患者可回忆起使用呼吸机的痛苦经历,其中有吸痰痛苦记忆的患者占52．5％（42／80）。吸痰、留置胃管和静脉注射等操作与患者疼痛密切相关;与患者焦虑明显有关的因素有环境噪音、交流困难、机械通气和静脉注射;ICU环境噪音、希望家属陪护、机械通气、经人工气道吸痰、留置胃管及静脉注射等均可能影响患者睡眠,甚至睡眠剥夺。结论ICU患者疼痛、焦虑、睡眠障碍等不适体验发生率高,治疗干预、护理操作及病房环境是导致不适体验发生的主要原因。     

肾脏重症监护病房病原菌分布及耐药性分析

目的:分析肾脏重症监护病房(RICU)分离的病原菌分布及耐药性,为重症肾脏病感染的治疗提供理论依据.方法:回顾性分析2015-01-01至2019-12-31RICU送检的各种组织、体液标本中分离的病原菌分布情况及药敏结果.结果:本研究311例患者培养出559株病原菌,其中革兰阴性菌353株(63.15％),革兰阳性菌...     

新生儿抚触技术对新生儿生长发育的影响探讨

目的探讨并分析新生儿抚触技术对新生儿生长发育的影响。方法资料选自2011年6月-2013年6月于本社区出生的健康足月新生儿186例,随机分为两组,对照组93例新生儿给予常规产科护理,观察组93例新生儿在常规产科护理基础上给予抚触护理技术,再对两组新生儿生长发育的情况作回顾性分析与对照。结果常规产科护理结合抚触护理技术的观察组新生儿睡眠时间、吃奶量、身长、头围及体质量等指标均明显优于单纯给予常规产科护理的对照组,组间比较差异具有统计学意义(P0.05)。结论新生儿抚触技术对增强新生儿睡眠,减少哭闹;促进新生儿头围、身长、体质量增长;提高母乳喂养成功率及吃奶量等方面有着十分明显、积极的作用,建议在新生儿中护理及抚育中多重视对抚触技术的应用。     

重症监护病房病原菌分布及耐药性分析

目的:了解2013年我院重症监护病房(ICU)患者病原菌的分布及对抗菌药物的耐药性。方法:收集我院2013年ICU感染患者临床分离的1379株非重复细菌、并进行分析。结果:分离细菌的标本来源主要是痰液(58%),其次是血液(16%)、引流液(10%)、尿液(7%),以及胸水、腹水等。共分离病原菌1379株,G-菌827株占60%,G+菌461株,占33.4%,真菌91株,占6.6%。最常见的菌种分别为鲍曼不动杆菌(26.4%)、金黄色葡萄球菌(17.8%)、铜绿假单胞菌(11.2%)、凝固酶阴性葡萄球菌(CNS,7.5%)、肺炎克雷伯菌(6%)、大肠埃希菌(5.7%)、嗜麦芽窄食单胞菌(5.5%)和屎肠球菌(3.1%)。其中耐甲氧西林金葡菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的检出率分别为88.4%和88.3%,未发现对万古霉素、替考拉宁和利奈唑胺不敏感的葡萄球菌。粪肠球菌对所测抗菌药物的耐药率均明显低于屎肠球菌。检出2株耐万古霉素的屎肠球菌(VRE)。大肠埃希菌和肺炎克雷伯菌产超广谱β-内酰胺酶(ESBLs)的检出率分别为70%和36%。肠杆菌科细菌中发现1株耐碳青霉烯类的肺炎克雷伯菌。铜绿假单胞菌对亚胺培南和美洛培南的耐药率分别为62.3%和60.4%,对其他测试药物的耐药率也都在42.9%以上。鲍曼不动杆菌对上述2种碳青霉烯类抗菌药物的耐药性分别为93.7%和94.2%,泛耐药鲍曼不动杆菌的检出率达到47.5%。真菌以白色念珠菌为主,对5种抗真菌药物耐药率均小于5.9%。结论:我院ICU分离的细菌耐药现象严重,特别是多耐药革兰阴性杆菌,应加强病原学和耐药性监测,为临床合理应用抗菌药物和预防医院感染提供一定的参考依据。     

预见性护理对ICU糖尿病患者的效果研究

目的分析探究预见性护理对ICU糖尿病患者中的应用效果。方法该次将该院在2018年1月-2019年3月收治的90例糖尿病患者作为研究的对象,随机分为两组,各45例,对照组给予常规护理,观察组给予预见性护理,对比两组血糖指标及ICU相关指标。结果①转出ICU时,在FPG、2 hPG、HbAlc方面,观察组均明显要比对照组低(P<0.05);在ICU入住时间方面,观察组的(10.05±1.26)d明显要比对照组的(14.82±1.50)d低(P<0.05)。②观察组并发症发生率的11.117%,显著要比对照组的26.67%低(P<0.05)。结论预见性护理应用于ICU糖尿病患者中,可优化血糖控制效果,降低并发症发生率,值得推广使用。     

碘缺乏与学龄儿童听力和语言智商的研究

为研究儿童尿碘水平与听力和语言智商的关系。随机拉机昆明春城小学１５０名８～１０岁学童收集其尿液进行尿碘测定。并将其中６０名学童分为两组（低尿碘组和正常尿磺对照组，每组各３０名）进行双耳纯音气导听力测定，用韦克斯勒学龄儿童智力测验量表（ＷＩＳＣ－ＣＲ）测试语言智商，结果表明，尿碘中位数为１７１．４μｇ／Ｌ尿碘值在１００μｇ／Ｌ以下的共４０例，占２６．７％，低尿碘组学童平均听阈显著高于正常尿碘对照组（     

口服伊曲康唑治疗危重患者白色念珠菌肺部感染临床疗效观察

目的评估伊曲康唑口服制剂治疗重症监护病房(ICU)中危重患者白色念珠菌肺部感染的临床疗效。方法将2005年11月至2007年5月天津市第一中心医院ICU住院患者中痰培养为白色念珠菌者71例分为2组:伊曲康唑口服组36例,予伊曲康唑口服液200mg口服,每12h1次,疗程14d;氟康唑静脉制剂组35例,氟康唑静脉制剂首剂400mg静脉滴注,以后200mg静脉滴注,每日1次,疗程14d。结果伊曲康唑口服组完成总疗程者31例,真菌清除率64.52%(20/31),平均清除时间(10.12±2.57)d,有效率58.06%(18/31),痊愈率19.35%(6/31)。氟康唑静脉制剂组完成总疗程者29例,真菌清除率65.52%(19/29),平均清除时间(8.87±1.95)d,有效率62.07%(18/29),痊愈率17.24%(5/29)。伊曲康唑口服组与氟康唑静脉制剂组不良反应发生情况比较,差异无显著性意义,肝功能异常发生率分别为25.81%(8/31)和24.14%(7/29),经治疗无效停药者分别为3.23%(1/31)和6.90%(2/29)。结论伊曲康唑口服制剂治疗ICU白色念珠菌肺部感染疗效确切,且用药方便、安全、副反应低。     

Nerve protective effect of Baicalin on newborn HIBD rats

Objetive:To investigate the nerve protective effect and mechanism of baicalin on newborn rats with hypoxic ischemic brain damage(HIBD).Methods:A total of 64 SD newborn rats were randomlu divided into control group.model group.nerve growth factor group and baicalin group.with 16 in each group.Left carotid artery ligation method was adopted to establish the HIBD model except fou in control group,which was treatde with intraperitoneal injection of salin e10mL/kg for 3 d.After oxygen recovery on hypoxia ischemia rats.intraperitoneal injectionof salin 10mL/kg was adopted in model group for 3 d.Intraperitoneal injection of nerve growth factor injection50μg/kg per day was adopted in nerve growth factor group for 3 d:intraperitoneal injection of radix scutellariae 16mg/kg per day was adopted in baicalin group for 3 d after modeeling.Four rats of each group were sacrificed at Day 1,2,3,7 for microscopic observation of pathological morphological changes in brain tissus aften HE staining,S-P immunohistochemical method was used for observation of Fas and FasL expression in brain cells.Results:Neat structure of cells was observed in control group;edema cells in disordered arrangement was observed in model group,with some cells necrosis and cavity change;tissue injury in nerve growth factor group and baicalin group was significantly lighter than that in model group;Fas and FasL expression in model group,nerve growth factor group and baicalin group were significantiy higher than that in control group at different time points(P0.05):Fas and FasL expression in nerve growth factor group and baicalin group were significantly lower than that in model group at different time points(P0.05):There was no statistical diggerence of Fas,FasL expression at each time point between nerve growth factor group and baicalin group(P0.05).Conclusions:Baicalin can reduce expression of Fas and FasL in HIBD rats,inhibit apoptosis of nerve cells,thus achieve the protective effect on HIBD rat nerves.     

糖尿病酮症酸中毒患者ICU护理效果

目的 对糖尿病酮症酸中毒患者ICU护理效果进行分析.方法 2018年7月—2019年7月之间于该院接受ICU病房治疗的110例糖尿病酮症酸中毒患者为研究对象,根据患者入院接受治疗的时间对患者进行分组处理,实验组中55例患者,对照组中55例患者.两组患者所应用的治疗方法相同,且护理方法不同,实验组患者应用综合护理干预,对...     

人工智能在内分泌代谢领域的应用及展望

人工智能(artificial intelligence,AI)是近年发展最快的科学之一,其在医学领域的发展带来了全新的概念,也对传统医学带来了巨大的冲击,是借势而为还是静观其变是对各学科和医学人的考验。AI在医学影像等领域已经取得了令人瞩目的效果。目前,AI在内分泌代谢领域的应用研发也日趋广泛,包括在糖尿病及其并发症...     

Association between self-reported hearing impairment,use of a hearing aid and performance of instrumental activities of daily living

Background and purposeAge-related hearing loss is a prevalent condition among the growing elderly population, which has been associated with both cognitive decline and decreased daily functioning. Decreased functioning is linked to lower performance, predominantly regarding instrumental activities of daily living (IADLs). The present study aims to explore the association between hearing loss and impairment in IADLs.MethodsThis is a secondary analysis of The Health, Well-Being, and Aging Colombia study, performed in 2015. Participants were classified into three groups: 1) without hearing loss, 2) hearing loss corrected through the use of a hearing aid, and 3) hearing loss without a hearing aid. Bivariate and adjusted multivariate analyses were performed. The measured outcome was IADLs.Results and discussionInformation from a total of 23,694 community-dwelling Colombian older adults (age ≥ 60 years) was used. The prevalence of hearing impairment was 23.4%, 1.8% out of those reported the use of hearing aids. Independent associations were found for having impaired IADLs when comparing participants with hearing loss without a hearing aid and those with normal hearing. However, there was no statistical significance with respect to IADLs when comparing hearing loss corrected by hearing aids versus participants with normal hearing. Participants using hearing aids have better functioning evaluated by IADLs when compared with participants with hearing impairment and no hearing aids.ConclusionThis study evidences a positive association between hearing impairment and performance in the IADLs. This association is not significant in older adults using hearing aids     

Assessment and management of hearing loss in older people in Belgium,Portugal and Turkey

Hearing loss, usually due to presbycusis, is frequent in old age and goes often undetected or untreated. Older subjects with hearing loss have increasing communication problems, reduced quality of life, isolation, depression and also feelings of frustration and discouragement. Hearing loss is also linked to cardiovascular problems, depression and dementia. Despite its relevance, country-level epidemiological data on age-related incidence and prevalence of presbycusis are limited, and no specific data in different geriatric settings are usually available. Population screening programs similar to those in infants are not widely implanted, although both primary care providers and geriatricians have incorporated strategies to detect hearing loss. No guidelines are available on when and how to screen and manage hearing loss in old age. Management of presbycusis is usually directed by ENT specialists, in cooperation with audiologist. These may be hospital-based or work in for profit centres, depending on the country. Funding of hearing aids by health care providers is limited, so some patients do not have access to them due to their high cost. Attitudes towards hearing loss, including considering it an inevitable age-related problem, may also limit access to care. Cochlear implants are still anecdotal in older patients in most countries. There is still a long way to go in the detection and management of hearing loss in older people. Systematic screening, careful assessment and treatment guidelines will have to be developed and implemented, both at country and European level.