院前急救护理干预在重度颅脑外伤患者中的应用

目的:探讨院前急救护理干预在重度颅脑外伤患者中的应用效果。方法:将60例重度颅脑外伤患者根据急救护理方案不同分为对照组和观察组各30例,对照组采用常规急救护理干预,观察组采用院前急救护理干预,比较两组护理效果。结果:观察组转运时间、急救前评估时间、昏迷时间及住院时间、院前院内死亡及并发症发生率显著低于对照组(P0.05);观察组存活率显著高于对照组(P0.05)。结论:对重度颅脑外伤患者实施院前急救护理干预效果理想,能降低临床病死率,缩短转运时间及住院时间。     

时间目标管理联合外伤急救护理在重症颅脑外伤患者中的应用效果

目的:探讨时间目标管理联合外伤急救护理在重症颅脑外伤患者中的应用效果。方法:选取2019年1月至2019年12月该院收治的重症颅脑外伤患者169例,将2019年1月至2019年6月采取常规管理及外伤急救护理的患者设为对照组(84例),将2019年7月至2019年12月实施时间目标管理模式配合外伤急救护理的患者设为研究组(85例)。比较两组患者急救结局、抢救费用、抢救时间、入院至CT检查时间差异,干预前后神经功能〔格拉斯哥昏迷评分(GCS)〕差异,住院期间并发症发生情况。结果:两组患者院前死亡、院内死亡差异均无统计学意义;研究组患者存活率高于对照组,抢救费用、抢救时间、入院至CT检查时间均低于对照组,差异有统计学意义(P均<0.05);干预后,两组患者GCS各维度得分均较干预前上升,且研究组GCS量表E、M维度得分高于对照组,差异有统计学意义(P<0.05);两组患者V维度得分差异不显著;住院期间两组患者肢体功能障碍、吞咽功能障碍、肺部感染、高热发生率差异不显著,研究组患者电解质紊乱发生率低于对照组,差异有统计学意义(P<0.05)。结论:时间目标管理模式配合外伤急救护理能提升重症颅脑外伤存活率,降低患者抢救费用、抢救时间、入院至CT检查时间,促进患者神经功能恢复,在一定程度上降低患者住院期间并发症发生率。     

临床护理路径在重型脑卒中急救中的应用

目的:探讨临床护理路径在重型脑卒中患者急救中的应用效果。方法:将2016年12月～2017年5月收治的重型脑卒中患者51例作为对照组,接受医院护理常规给予急救;将2017年6月～2018年1月收治的重型脑卒中患者49例作为观察组,按临床护理路径实施急救。比较两组抢救时间、抢救费用、住院时间、病情恢复情况、入院时及住院1周后格拉斯哥昏迷指数(GCS)评分、生活能力指数评分,评价患者对护理的满意度。结果:观察组抢救时间、住院时间较对照组明显缩短(P0.05),抢救费用低于对照组低(P0.05),生活能力指数评分高于对照组(P0.05);住院1周后,两组GCS评分均高于入院时(P0.05);观察组对护理满意度明显高于对照组(P0.05)。结论:对重型脑卒中患者在急救中采用临床护理路径,可以为患者争取更多时间,提高护理质量,改善护患关系,提高患者满意度。     

严重胸部外伤患者院前急救与控制性手术急救护理的研究

目的探析严重胸部外伤患者开展院前急救与控制性手术急救护理措施进行干预的效果。方法随机选择2016年12月—2017年12月到本院接受急救治疗的严重胸部外伤患者84例作为研究对象,分为对照组与观察组,每组各42例。对照组开展院前急救与常规护理措施干预,观察组开展院前急救与控制性手术急救护理措施干预,对比两组患者的护理效果。结果观察组出血量、乳酸清除时间、凝血功能恢复时间、体温恢复时间、VAS评分、住院时间分别为(105.32±18.22)ml、(12.32±2.32)h、(2.88±1.02)h、(4.21±1.25)h、(2.11±1.25)分、(9.12±2.92)d,各项指标与对照组相比,有统计学意义(P0.05);观察组患者护理满意率95.23%高于对照组的80.95%,有统计学意义(P0.05);观察组、对照组抢救成功率分别为97.62%、92.86%,两组患者抢救成功率比较无统计学意义(P0.05)。结论院前急救与控制性手术急救护理措施用于严重胸部外伤患者中,不仅能够提升患者急救效果,还可改善患者治疗预后,对提升患者的整体生存质量有着促进的作用。     

基于风险管控的院前急救护理对妇科急腹症患者的影响研究

目的:探讨基于风险管控的院前急救护理对妇科急腹症患者抢救成功率及护理满意度等的影响。方法:选取我院收治的妇科急腹症患者128例作为研究对象,按照随机数字表法将其等分为观察组和对照组,对照组采用常规院前急救护理,观察组采用基于风险管控的院前急救护理,比较两组患者心理状况、平均出车反应时间、平均急救时间、抢救成功率、术后感染率、护理满意度。结果:护理后两组SAS,SDS评分显著低于护理前,且观察组显著低于对照组(P0.05);观察组平均出车反应时间、平均急救时间显著短于对照组(P0.05);观察组抢救成功率显著高于对照组(P0.05);观察组术后感染率显著低于对照组(P0.05);观察组沟通技巧、理论知识、专业技能、服务质量、入院安排评分显著高于对照组(P0.05)。结论:基于风险管控的院前急救护理可有效改善妇科急腹症患者心理状况,提高抢救成功率和护理满意度。     

快捷护理路径对重型颅脑外伤患者急救效果的影响

目的探究快捷护理路径对重型颅脑外伤患者急救的临床效果,为在临床中开展快捷护理路径提供实践意义。方法选取本科2015年6月-2015年12月收治的30例重型颅脑外伤患者作为常规组,2016年1月-2016年6月收治的30例重型颅脑外伤患者作为观察组。常规组采用临床常规护理急救和治疗,观察组采用快捷护理路径急救和治疗,观察并记录两组急救时间、急救费用及住院时间、住院费用,比较两组住院前后GCS评分及各项并发症发生率。结果观察组急救时间短于常规组(P0.05)、急救费用低于常规组(P0.05);两组转入神经外科病房后,观察组的住院时间也显著少于常规组(P0.05),但两组住院费用、住院前后的GCS评分差异无统计学意义(P0.05),住院期间,两组并发症发生率方面,除尿路感染和肺部感染两组间差异有统计学意义(P0.05),其它项并发症两组间均差异无统计学意义(P0.05)。结论应用快捷护理路径对重型颅脑外伤患者进行急救,能明确抢救步骤与分工,有效提高急救效率与效果,值得临床推广应用。     

严重外伤患者院前急救护理对患者预后的影响研究

选取我院收治的100例严重外伤患者,根据入院方式的不同分为观察组和对照组,对照组患者由家属送入,无有效院前急救护理措施,观察组由120送入,进行院前急救护理,比较两组患者的抢救成功率。结果观察组抢救成功率明显高于对照组,差异具有统计学意义(P<0.05);观察组抢救时间明显低于对照组,差异具有统计学意义(P<0.05)。严重外伤患者的伤情复杂且存在多变性,院前急救护理能够提高患者的生存率,减少死亡,改善患者的预后情况,值得推应用广。     

预见性护理在急性有机磷中毒院前急救中的应用

目的:探讨预见性护理在急性有机磷中毒患者院前急救中的应用。方法:按照入院年份分别抽取34例急性有机磷农药中毒患者作为观察组和对照组,对照组给予常规护理,观察组在院前急救时进行预见性护理措施,观察两组患者的开始抢救时间、开始洗胃时间、抢救成功率、住院天数和并发症发生率。结果:观察组患者的抢救成功率、开始抢救时间、住院天数和并发症发生率均显著优于对照组(P0.01,P0.05)。结论:在急性有机磷农药中毒的院前急救中应用预见性护理措施能有效提高抢救成功率。     

临床护理路径在脑卒中患者院前急救护理中的应用

目的：探讨临床护理路径在脑卒中患者院前急救护理中的应用效果。方法：将我院2010年1月～2011年12月抢救转运的554例脑卒中患者作为研究对象,随机分为观察组和对照组各277例。对照组患者使用脑卒中院前急救常规护理,观察组使用临床护理路径进行院前急救,比较两组患者的存活率、住院时间及满意度。结果：观察组患者入院治疗后的存活率明显高于对照组（P〈0.001）;从接诊到抢救时间、接诊到专业治疗时间、住院时间、住院费用均明显低于对照组（P〈0.05）;观察组患者的满意度明显高于对照组（P〈0.001）。结论：临床护理路径在脑卒中患者院前急救护理中的应用可显著增加脑卒中患者的治疗存活率,缩短其住院时间,值得在临床推广。     

院前急救护理路径在脑卒中患者中的应用效果

目的探讨院前急救护理路径在脑卒中患者院前急救中的应用效果。方法收集本院2014年5—12月入院的40例脑卒中患者作为对照组,2015年1—9月入院的40例作为实验组。对照组患者给予常规护理,实验组患者加施院前急救护理路径干预,比较2组患者相关临床指标、不良事件、医生与护士长满意度与幸存患者满意度。结果实验组患者呼救至院前急救间隔、呼救至入院治疗间隔、住院时间与医疗费用显著低于对照组(P0.05);实验组患者致残率与投诉发生率显著低于对照组(P0.05);实验组患者实施后医生与护士长满意评分组间比较显著高于对照组(P0.05);实验组患者护理满意度显著优于对照组(P0.05)。结论院前急救护理路径在脑卒中患者院前急救中的应用效果显著,可提高满意度。     

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.