“和谐使命-2011”病房护理工作的实践

目的 根据医疗服务期间病房护理工作的特点,总结在“和谐使命-2011”任务中,医院船病房的护理工作经验和体会,为提高医院船对外医疗服务水平提供参考.方法 医院船住院病房7名护士,根据医院船特点,对医院船收治的来自牙买加、特立尼达和多巴哥、哥斯达黎加等拉美三国的96名不同专科手术患者制定合理护理计划.结果 96名患者无一例出现并发症,治愈率为100％,非常圆满地完成了对外医疗服务工作.结论 海上医院病房护理工作的组织管理及优质的护理是为医疗服务的圆满完成提供了有力保障.     

影响海外医疗服务病房护患沟通的相关因素及护理对策

目的:提高医院船海外医疗服务中病房护患沟通能力。方法:通过本次"和平方舟"号医院船出访拉美四国,在医疗服务实践中发现病房护患沟通存在的问题并对成功及不足之处进行分析总结。结果:在真诚、自然、耐心、细致的前提下,灵活运用多元化的沟通方式可以在很大程度上克服与海外患者的沟通障碍。结论:继续强化语言培训,加强非语言沟通,结合书面形式的沟通,并善于综合运用语言及非语言交流技巧可进一步提高海外医疗服务中病房护患沟通的能力。     

医院船赴拉美三国开展白内障手术护理配合的体会

目的总结医院船赴拉美三国开展白内障手术护理配合的经验体会。方法对31例白内障患者手术护理配合情况从术前、术中、术后三方面进行分析探讨。结果31例手术均安全顺利，术中患者生命体征平稳，术后视力恢复理想，无一例眼心反射等意外事故发生。结论语言的有效沟通、手术仪器设备的针对性准备、术中对患者生命体征的严密监护是医院船在海外开展白内障手术护理配合中的三个重要环节。     

海上医院船满负荷训练中的护理管理

目的保障医院船满负荷训练中的护理工作有序开展,伤员救治及时无延误。方法改变护理模式、科学优化护理流程,在首次海上医院船满负荷训练中对护理人员、伤员、病历和物品实施管理。结果训练中护理工作快捷有效,顺利完成训练任务,得到了领导和专家的一致认可。结论统一的组织、制订切实可行的流程并进行有效的管理是医院船满负荷训练的有力保障。     

医院船医疗废物管理的探讨

目的加强医院船医疗废物管理。方法以法律、法规为准则。对医院船医务人员进行培训,建立严格医疗废物处置流程及监管制度。结果通过对医疗废物及时、彻底和无害化处理,达到规范化管理的目的。结论医院船全体医务人员要将医疗废物管理融人医疗护理行为中,对预防医院感染、保护伤病员及医务人员安全,保护舰船环境、防止海洋环境的破坏具有重大意义。     

在9·29突发海难搜救中医院船的护理管理

目的探讨海难搜救中医院船的护理管理方法。方法严密组织、合理分组,充分的物品准备及护理人员的心理准备,实施海上搜救、检伤分类、严密消毒隔离等。结果通过直升机和医院船搜救,打捞落水遗体10具。医院船内人员未发生交叉感染;护理人员心理状况稳定,1个月后随访未发生心理应激反应。结论通过参加海上搜救的护理管理工作,为今后的海难搜救积累了经验。     

医院船医疗队护理人员训练中存在的问题及对策

海上伤病员的护理是海上伤病员医疗后送工作的主要工作之一,其工作质量的好坏直接影响整个伤员救护工作的质量与效率。由于海上环境的特殊性,伤员护理工作与陆地有很大的差别。近期,医院船医疗队通过海上卫勤训练,锻炼了队伍,积累了经验,对提高战伤护理的工作质量起到了积极的作用。但个别医疗队在护理训练的组织和实施中仍存在不足,使训练无法达到预期的效果。笔者结合参加医院船医疗队训练的实际,就医院船医疗队护理人员训练中存在的问题进行讨论,并提出相应的对策。     

海军医院船手术室护理流程及职责初探

目的寻求海军医院船手术室适用的护理流程及职责。方法通过2次海上医院船卫勤演习训练,分析医院船手术室的战时特点和人员状况,将手术室的护理岗位进行合理分配,对各级护士的护理工作流程及职责进行描述性分析研究。结果根据海战战伤特点及医院船上手术的实施救护要点,制定出适合海战伤需要的手术室护理职责及流程。结论明确海战伤的手术救护特点和各级护理职责,提高护士在海战中的手术室救护技术,是提高海战伤手术救护质量的关键。     

文职护士参与医院船护理任务的组织培训与管理

目的探讨文职护士参与医院船护理任务的培训与管理方式。方法通过强化文职护士的职责意识,重视岗位培训,采取专科护理技术与战时救护能力相结合、"三基"训练与军事技能培训相结合等培训方法,加强训练的组织管理。结果通过多层面的强化训练,文职护士明确了担负卫勤保障任务的职责,成为海上卫勤保障的一支生力军。结论对文职护士进行有目的、有计划、有组织的培训,可显著提高文职护士的军政素质和卫勤保障能力,是保证医院船履行职责、完成使命的有效途径。     

香港护理管理见闻及启示

2004年9月4日～18日,我院赴港进行了为期两周的学术交流,对香港目前医疗卫生系统运行模式、护理管理现状有了较为全面的了解.现将体会报告如下.     

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.     

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.     

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.     

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.