集束化综合干预对危重症机械通气患者预后的影响

目的:探讨集束化综合干预对危重症无创机械通气慢性阻塞性肺病患者预后效果影响。方法:将入选患者80例随机等分为观察组与对照组,观察组给予集束化综合护理干预;对照组仅实施常规化护理。利用护理服务满意度、患者住院费用、平均住院时间,患者出院后1年内疾病复发情况以及患者饮食、睡眠、生活自理能力以及生活期望值四个方面为主要指标进行评价。结果:观察组患者治疗后各项指标与对照组比较均有明显改善,且差异具有统计学意义(P0.05)。结论:集束化干预能够有效提髙患者护理满意度,降低出院后复发率,改善患者预后生活质量。     

临床护理路径在治疗慢性阻塞性肺疾病急性发作患者中的应用

目的探讨临床护理路径在中西医结合治疗慢性阻塞性肺疾病急性发作患者中的应用效果。方法将128例慢性阻塞性肺疾病急性发作患者随机分为观察组和对照组,每组各64例,观察组按制定的临床路径实施护理,对照组采用常规整体护理模式进行护理。对2组患者的平均住院天数、住院费用、护理满意度、临床疗效进行比较。结果观察组患者平均住院天数、住院费用低于对照组,差异有统计学意义(P0.01);护理满意度、临床疗效好于对照组,差异有统计学意义(P0.05)。结论针对慢性阻塞性肺疾病急性发作期患者按临床路径实施护理,在保证护理质量的前提下,可以缩短住院天数,降低住院费用,提高患者满意度,增强临床治疗效果。     

集束化护理干预对慢性阻塞性肺疾病患者自我效能及依从性的影响

目的：了解集束化延续护理干预对慢性阻塞性肺疾病（cCOPD）稳定期患者自我效能以及患者依从性的影响。方法选择本院呼吸内科连续收治的COPD稳定期患者。干预组接受集束化护理干预,对照组接收常规康复指导。观察指标包括：COPD自我效能量表、患者对肺康复锻炼的依从性、住院费用、住院天数、出院后30天内再住院率。两组均随访6个月,比较各项指标组间差异。结果入组患者包括干预组29例,年龄66．34±7．54岁;对照组30例,年龄（58．24±20．58）岁。集束化护理干预能显著减少COPD患者的住院天数（P＜0．05）、平均住院费用（P＜0．05）、提高COPD患者的自我效能,并且患者对康复锻炼的依从性显著高于对照组。结论集束化延续护理干预能显著提升COPD稳定期患者的自我效能;同时,患者对集束化康复策略的依从性较高,可用于进一步的临床实践。     

社区团队护理干预模式对老年慢性阻塞性肺疾病患者生活质量的影响

目的：探讨社区团队护理干预对慢性阻塞性肺疾病(chronic obstructive pulmonary diseases)患者生存质量的影响。方法：将80例慢性阻塞性肺疾病患者随机分为观察组与对照组各40例。对照组采用常规护理方法,观察组在对照组的基础上采用社区团队护理干预的方法,观察两组患者的复发率,住院率及生活质量评价。结果：观察组患者COPD复发率、住院率较对照组低,生活质量较对照组高,两者差异有统计学意义（P<0.05)。结论： 社区团队护理干预对慢性阻塞性肺疾病患者的康复及生活质量提高有较好的辅助作用。     

结构化教育在COPD患者中的应用

目的评价构化教育对慢性阻塞性肺疾病患者的护理效果。方法选取2012年3月至2014年3月住院的慢性阻塞性肺疾病患者220例,分为干预组和对照组,对照组采用常规护理措施,干预组采用结构化教育。采用COPD评估测试量表中文版和COPD自我效能感量表评估患者生命质量和自我效能感,并测量患者遵医行为和护理工作满意度。结果干预组COPD评估测试得分较对照组降低(P0.01),自我效能感、遵医行为和护理工作满意度均较对照组提高(P0.01)。结论结构化教育能提高COPD患者自我效能感,尽最大程度改善患者生活质量,并提高患者遵医行为和护理满意度,值得推广。     

临床护理路径在慢性阻塞性肺疾病患者中的应用

目的探讨临床护理路径在慢性阴塞性肺疾病患者中的应用效果。方法应用·临床护理路径对慢性阻塞性肺疾病患者进行康复护理,将2011年1月～2011年12月慢性阻塞性肺疾病患者110例随机分成观察组和对照组各55例,观察组采用新法进行康复护理,对照组采用传统方法进行护理,并以2组患者对健康知识掌握情况、满意度调查及住院天数进行比较。结果观察组的健康知识掌握情况及患者满意度明显高于对照组,住院天数则低于对照组,差异均有统计学意义（P〈0．05）。结论应用临床护理路径开展整体护理工作是一种行之有效的工作方式,可有效促进患者康复,缩短患者住院天数,减少住院费用,提高患者满意度和健康教育知识掌握程度,亦规范了医疗护理行为,提高了医院的社会和经济效益。     

延续性护理对COPD稳定期患者生活质量的影响

目的探讨延续性护理对慢性阻塞性肺疾病稳定期患者生活质量的影响。方法将64例患者随机分为研究组和对照组,各32例,两组均接受常规的治疗、护理和健康教育。对研究组患者额外接受延续性护理干预,并对比干预后两组患者肺功能、生活质量、住院天数和前后住院时间间隔。结果研究组肺功能及生活质量改善程度明显优于对照组,住院天数明显少于对照组,两次住院间隔时间明显长于对照组,两组比较差异有统计学意义(P0.05)。结论延续性护理能改善慢性阻塞性肺疾病稳定期患者的生活质量,减少住院次数及缩短住院天数,值得临床推广。     

集束化护理在腕管综合征住院患者中的效果评价

目的探讨集束化护理在腕管综合征住院患者中的应用。方法选取2013年1月-2014年12月在我科住院的200例腕管综合征患者。将2013年未开展集束化护理的100例患者设为对照组,2014年开展集束化护理的100例患者设为观察组。对照组采用用常规护理模式,观察组运用集束化护理模式。结果两组患者在住院期间的平均住院天数、平均住院费用、健康知识掌握程度、住院满意、自理能力等方面比较差异均具有统计学意义(P0.05)。结论采取集束化护理可节约住院成本,提高患者住院满意度。     

集束化肺康复护理对慢性阻塞性肺疾病病人肺功能及生活质量的影响

[目的]探讨集束化肺康复护理对慢性阻塞性肺疾病病人肺功能及生活质量的影响。[方法]选取2017年6月—2018年11月在医院呼吸内科接受治疗并出院的52例慢性阻塞性肺疾病病人为研究对象,随机将其分为对照组和观察组各26例。对照组病人采用常规护理,观察组病人在常规护理的基础上联合集束化肺康复护理。两组病人均干预6个月,比较两组病人干预前后肺功能、生活质量。[结果]干预6个月后观察组病人的FEV_1、FEV_1/FVC均高于对照组(P0.05);干预后观察组病人症状、活动能力及疾病对日常生活的影响得分均低于对照组(P0.05)。[结论]将集束化肺康复护理应用于慢性阻塞性肺疾病病人的护理干预中,能有效促进病人的肺功能康复,提升病人的生活质量。     

集束化护理干预在腹膜透析患者中的应用

目的:探讨集束化护理干预在腹膜透析患者中的应用效果。方法:将行腹膜透析的60例住院患者随机分为观察组和对照组各30例,对照组实施常规护理,观察组实施集束化护理干预;比较两组住院天数、住院费用、腹膜炎发生率、生活质量[采用健康调查简表(SF-36)]。结果:观察组住院天数明显短于对照组(P 0. 01),住院费用明显低于对照组(P 0. 01),SF-36各维度评分显著高于对照组(P 0. 01,P 0. 05)。结论:集束化护理干预能够有效缩短腹膜透析置管住院患者的住院日,降低住院费用,降低腹膜透析患者腹膜炎的发生率,并提高其生活质量,值得临床推广应用。     

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.