脑卒中偏瘫病人居家日常生活护理指导

[目的]探讨居家护理指导对脑卒中偏瘫病人日常生活活动能力(ADL)的影响。[方法]将44例脑卒中偏瘫病人出院时随机分成指导组和对照组,指导组由护士入户对照顾者及病人进行ADL能力训练指导每周1次;对照组由照顾者对病人进行ADL能力训练。6个月后采用Barthel指数(BI)评分法评定ADL能力,比较居家护理指导的效果。[结果]两组病人在出院时ADL能力无明显差异(P>0.05),而在出院后6个月两组病人ADL能力有明显差异(P<0.05),即指导组ADL能力明显高于对照组。[结论]经居家护理指导明显提高了脑卒中偏瘫病人的居家ADL能力,从而改善了病人的生存质量。     

三级康复护理对脑卒中偏瘫病人日常生活能力影响的研究

[目的]探讨三级康复护理对脑卒中偏瘫病人日常生活能力（ADL）的影响。[方法]将70例脑卒中偏瘫病人随机分为两组,每组35例,均予以神经内科常规治疗和护理,康复组同时给予三级康复护理。入组时及6个月末比较两组ADL情况。[结果]两组病人在入组时ADL评分差异无统计学意义（P〉0．05）,6个月末康复组ADL评分高于对照组（P〈0．01）。[结论]三级康复护理可以明显提高脑卒中偏瘫病人ADL。     

以时机理论为基础的居家护理对中青年脑卒中病人自我护理及家庭照顾者照顾能力的影响

[目的]探讨基于时机理论(TIR)的居家护理对中青年脑卒中病人自我护理及其家庭照顾者照顾能力的影响。[方法]将109例中青年脑卒中病人及其家庭照顾者随机分为试验组55例和对照组54例,试验组在常规护理与随访的基础上采取以时机理论为基础的居家护理;对照组接受神经内科常规护理与随访,分别于病人干预前、出院时、出院3个月及6个月应用自我护理能力测定量表(ESCA)和家属照顾者照顾能力测量表(FCTI)评价两组病人的自我护理能力及其家庭照顾者的照顾能力。[结果]干预后试验组病人自我护理能力在各测量点均高于对照组(P0.05或P0.01),试验组家庭照顾者照顾能力在各测量点均低于对照组(P0.05或P0.01)。[结论]以时机理论为基础的居家护理,能更有效地提高中青年脑卒中病人的自我护理能力及其家庭照顾者的照顾能力。     

阿尔茨海默病病人认知训练与照顾者支持平行干预的效果评价研究

[目的]评价阿尔茨海默病（AD）病人认知训练与家庭照顾者支持相结合平行干预的效果。[方法]将26例居家AD病人及照顾者分为干预组与对照组。干预组病人及照顾者在益智训练室同步接受病人认知训练及照顾者支持的干预方案；照顾者指导AD病人在家每天固定时间训练及活动；开设专门电话热线，解答干预组AD病人及照顾者的相关问题；每周固定时问研究人员主动了解照顾者及病人在家训练情况。时间持续1年。对照组不进行干预。两组分别于3个月、6个月、12个月进行AD病人的简易智力状态检查量表（MMSE）、日常生活能力量表（ADL）、激越行为量表（CMAI）、功能活动调查表（FAQ）等功能状态和照顾者的Zung抑郁自评量表（sDs）、Zung焦虑自评量表（SAS）、家庭关怀度指数问卷（APGAR）及照顾者负担等评定指标随访评价。[结果]除CMAI得分，两组病人除6个月、12个月比较有统计学意义外，3个月、6个月、12个月，病人及照顾者的其余评定指标的差异均无统计学意义（P〉0．05）。[结论]AD病人认知训练与家庭照顾者支持相结合的平行干预方案，尚缺乏延缓AD病情进展及减轻照顾者负担的正向结果；有必要进行多中心大样本的深入研究加以证实。     

长期护理保险制度下应用微信平台改善老年脑卒中病人家庭照顾者照护能力的效果

[目的]研究长期护理保险制度联合应用微信平台实施对老年脑卒中病人家庭照顾者照护能力和压力的影响。[方法]将处于恢复期急性缺血性脑卒中老年病人的主要家庭照顾者223人随机分为观察组112人和对照组111人,两组照顾者在住院期间接受相同的常规护理和健康教育,出院后对照组采用传统方法进行出院宣教,发放宣传手册,每周电话随访。观察组在此基础上先征得病人及其照顾者同意并自愿参加长期护理保险,研究团队成员与定点服务机构工作人员及家庭照顾者一起制定居家服务项目并组织实施;再建立微信群向照顾者发送康复锻炼技能视频、疾病相关知识、饮食用药指导、提供心理疏导、预约复诊时间和医生等。比较两组病人出院后3个月、6个月照顾者照护压力,病人出院后6个月照顾者照护能力、病人生存质量差异。[结果]出院3个月、6个月后观察组照护压力得分低于对照组(P0.05)。观察组照护能力显著好于对照组(P0.05)。观察组病人日常生活活动能力评定得分高于对照组(P0.05)。[结论]脑卒中恢复期病人参加长期护理保险,医务人员通过微信平台对照顾者进行健康教育,可以有效提高脑卒中病人家庭照顾者的照护能力,降低照顾者的压力,减轻照顾者的负担。     

骨盆控制训练对脑卒中偏瘫病人步行能力及日常生活活动能力影响的研究

[目的]探讨骨盆控制训练对脑卒中偏瘫病人步行能力及日常生活活动能力（ADL）的影响。[方法]随机将60例脑卒中偏瘫病人分为观察组与对照组,对照组采用常规康复训练,观察组在常规康复训练基础上加骨盆控制训练,8周后观察病人步行能力和ADL。病人步行能力评定采用限时步行功能检查法,ADL评定采用Barthel指数评定。[结果]观察组步行能力和ADL明显优于对照组（P〈0.05）。[结论]骨盆控制训练对改善脑卒中偏瘫病人步行能力和ADL有促进作用。     

出院康复指导对脑卒中患者日常生活活动能力恢复的影响

目的探讨出院指导对脑卒中偏瘫患者日常生活活动能力 (ADL)恢复的影响。方法 60例住院的脑卒中偏瘫患者在出院前随机分成指导组与对照组 ,出院后前者除对症服药治疗外 ,还给予出院后的康复训练指导 ,后者只给予对症服药治疗。在出院前 2— 3d及出院 3个月后对两组患者进行ADL评定。结果指导组患者的ADL评分高于对照组 (P <0 0 5 )。结论出院康复指导对脑卒中偏瘫患者ADL的恢复有良好作用。     

远程康复护理干预对急性脑卒中偏瘫病人日常生活能力及照顾者压力指数的影响

[目的]探讨远程康复护理干预对急性脑卒中偏瘫病人日常生活能力及照顾者压力指数的影响。[方法]将100例急性脑梗死偏瘫病人随机分为两组,分别为常规护理组和远程护理组。常规护理组病人出院后给予常规护理,远程护理组病人出院后给予远程康复护理干预。[结果]远程护理组病人日常生活能力评分优于常规护理组,照顾者压力指数改善大于常规护理组(P0.05)。[结论]远程康复护理干预有助于提高脑卒中偏瘫病人日常生活能力、缓解照顾者压力,提高照顾者对脑卒中偏瘫病人的康复锻炼质量。     

病人照顾者综合康复护理培训联合延续护理对缺血性脑卒中病人居家生活质量及日常生活能力的影响

[目的]探讨照顾者接受综合康复护理培训联合延续护理对缺血性脑卒中病人居家生活质量及日常生活能力(ADL)的影响。[方法]选择我院2015年6月—2016年1月收治的缺血性脑卒中病人96例作为研究对象,采用随机数字表法分为干预组与对照组,各48例。干预组出院前对病人及照顾者进行常规出院宣教,同时对照顾者进行综合康复护理培训,出院后给予延续护理;对照组出院前对病人及照顾者进行常规出院宣教,出院后定期电话随访。于出院前3d及出院3个月后分别采用脑卒中专用生活质量量表(SS-QOL)、Barthel指数评价病人生活质量和日常生活能力。[结果]两组出院前3d SS-QOL、Barthel评分比较差异无统计学意义,干预后3个月干预组SS-QOL总分(155.02分±16.85分)高于干预前(123.46分±13.23分)和对照组干预后(125.71分±20.17分);与对照组干预后比较,除思维、视力、工作生产能力3个维度外,其余维度得分比较差异均有统计学意义(P0.01);干预组病人Barthel评分(62.71分±6.76分)高于干预前(48.65分±5.03分)及对照组干预后(52.60分±4.61分)。[结论]对照顾者进行综合康复护理培训联合出院后延续护理可改善缺血性脑卒中病人居家生活质量。     

社区护理干预对缺血性脑卒中病人血脂水平和卒中复发的影响

[目的]探讨社区护理干预对伴高脂血症的缺血性脑卒中病人血脂水平的影响。[方法]将社区65例伴高脂血症的缺血性脑卒中病人随机分为干预组和对照组,干预组病人由经过培训的社区护士结合病人病情,定期给予健康指导,如饮食指导、调整药物;对照组采用传统的出院指导。于干预前及干预3个月、6个月和12个月时评价干预效果。[结果]干预组病人总胆固醇（TC）、三酰甘油（TG）和低密度脂蛋白胆固醇（LDL—C）水平明显下降,与对照组比较均有统计学意义（P〈0．001）;高密度脂蛋白胆固醇（HDL—C）水平升高,在6个月和12个月时与对照组比较差异有统计学意义（P〈0．05）。且干预组脑卒中复发率明显低于对照组（P〈0．05）。[结论]社区护理干预能有效降低伴高脂血症的缺血性脑卒中病人的血脂水平,减少脑卒中的复发。     

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.