认知护理对甲状腺瘤手术患者应激反应的影响

目的探讨认知护理对甲状腺瘤手术患者应激反应的影响。方法将128例甲状腺瘤手术患者随机分为干预组66例和对照组62例。干预组在术前给予认知护理措施干预,对照组术前只给予常规护理,术前1d采用焦虑自评量表（SAS）和抑郁自评量表（SDS）评定两组患者的心理状况,分别于手术麻醉前30min测量两组患者血压、脉搏的变化,测定两组患者皮质醇及血管紧张素Ⅱ的水平变化,并进行比较。结果干预组焦虑值和抑郁值均明显低于对照组,干预组手术麻醉前30min血压明显较对照组低,脉搏也明显慢于对照组,干预组手术麻醉前30min皮质醇及血管紧张素Ⅱ也明显较对照组低,两组比较,差异均有统计学意义（P均〈0．01）。结论认知护理可明显消除甲状腺瘤手术患者不良心理状态,减轻患者的应激反应程度,增强患者治疗的信心,从而促进康复。     

认知护理对甲状腺瘤手术患者应激反应的干预价值评析

收集2013年1月~2015年1月,我院择期行甲状腺瘤手术患者104例,随机分为观察组与对照组,每组52例。对照组实施常规护理,观察组在对照组的基础上加行认知护理干预,对比两组的手术应激指标变化。结果干预后观察组的心理应激(SAS、SDS)评分显著低于对照组,血压(SBP、DBP)、心率(HR)、皮质醇及血管紧张素Ⅱ(ATⅡ)水平均显著低于对照组(P0.05)。对甲状腺瘤手术患者开展认知护理干预有利于降低患者的心理和生理应激反应,提高手术安全性,值得推广应用。     

快速康复外科护理对下肢骨折患者的影响

目的探讨快速康复外科(FTS)护理对下肢骨折患者应激反应、心理状态、生活质量的影响。方法选取该院2016年1月至2018年12月收治的108例下肢骨折患者为研究对象,按照入院单双号分为对照组和观察组,每组54例,对照组给予常规护理干预,观察组给予FTS护理干预,比较两组应激反应指标[血管紧张素Ⅱ(AngⅡ)、C反应蛋白(CRP)、皮质醇(Cor)]、心理状态[汉密顿焦虑量表(HAMA)、汉密顿抑郁量表(HAMD)]及生活质量(SF-36)评分的变化。结果干预后观察组AngⅡ、CRP及Cor水平低于对照组,干预后观察组HAMA、HAMD评分低于对照组,干预后观察组生活质量评分高于对照组,差异均有统计学意义(P<0.05)。结论FTS护理能够降低下肢骨折患者的应激反应,改善其不良心理状态,提高生活质量。     

共情护理在甲状腺腺瘤手术患者中的应用

目的探讨共情护理在甲状腺腺瘤手术患者术前心理干预中的应用效果。方法选取2018年4月—2021年4月本院接收的87例甲状腺腺瘤切除术患者作为研究对象,根据随机数字表法将其分为对照组(n=44,给予常规术前心理护理)与观察组(n=43,给予共情护理干预),比较两组的心理应激反应及护理满意度。结果干预后,观察组的心理应激反应(焦虑自评量表评分和抑郁自评量表评分)低于对照组,且观察组的护理满意度高于对照组(P<0.05)。结论将共情护理应用于甲状腺腺瘤手术患者,能够有效改善患者的心理状况,提高患者的护理满意度。     

心理护理对妇科肿瘤患者围术期心理状况及生理应激的影响

目的探讨心理护理对妇科肿瘤患者围术期心理状况及生理应激的影响。方法选择接受手术治疗的妇科肿瘤患者93例,随机分为干预组47例和对照组46例。对照组给予妇科手术前后常规护理,干预组在此基础上开展心理护理。观察2组焦虑自评量表(SAS)和抑郁自评量表(SDS)评分和心率、血压的变化。结果入院时、术前1 d、术后干预组SAS和SDS评分呈递减趋势(P0.01);对照组在术后SAS和SDS评分降低(P0.01);术前1 d和术后,干预组SAS和SDS评分均低于对照组(P0.01);干预组术前5 min心率、血压明显低于对照组(P0.01)。结论心理护理能够改善患者围术期心理状况,降低生理应激反应。     

甲状腺围手术期的心理干预

目的探讨心理护理对甲状腺手术患者的影响。方法将780例需手术治疗的甲状腺疾病患者随机分为2组，观察组给予心理干预，对照组患者只简单的告知手术注意事项，分别于入院时和手术前用SAS焦虑自评量表进行评分，对比2组患者焦虑、血压、心率、术后头痛等指标差异。结果2组患者焦虑、手术中血压、血率变化、术后头痛有显著性差异（p〈0．01）。结论围手术期心理干预对甲状腺手术患者血压、心率的稳定性起到积极的作用，减轻术前焦虑、减少术后头痛等不良反应。     

术前心理干预对手术室患者手术耐受性及心理状态的影响

目的 探讨术前心理干预对手术室患者耐受性及心理状态的影响.方法 将我院2009年6月至2010年6月收治的择期手术治疗的104例患者,随机分为观察组和对照组各52例,对照组术前采用常规护理,观察组在对照组的基础上采用心理护理干预,主要方法有:心理疏导、情绪转移法、身心松弛法.采用医院焦虑自评量表(SAS)及抑郁自评量表(SDS)评定患者术前的心理状态,并比较2组患者术前1d、麻醉前的心率和血压变化.结果 2组患者均存在不同程度的焦虑、抑郁现象,焦虑、抑郁评分均高于国内常模.护理后观察组焦虑、抑郁的改善程度显著优于对照组;且观察组麻醉前心率、血压波动情况较对照组更加平稳,手术耐受性较好.结论 术前心理干预有利于患者的负面情绪,提高手术耐受性,确保手术的安全和疗效.     

手术室连续性护理对剖宫产产妇心理及生理应激的影响

目的:探讨手术室连续性护理对剖宫产产妇心理及生理应激的影响。方法:将2018年1月1日～11月30日行剖宫产手术的105例产妇随机分为干预组53例和常规组52例,常规组采用传统手术护理流程,干预组采用手术室连续性护理。比较两组干预效果。结果:干预后,干预组产妇焦虑自评量表(SAS)、抑郁自评量表(SDS)评分均低于常规组(P 0. 05);干预组产妇心率、收缩压、舒张压、肾上腺素、皮质醇等指标值均低于常规组(P 0. 05);干预组产妇护理满意度高于常规组(P 0. 05);干预组产妇术后泌乳时间、术后排气时间短于常规组(P 0. 05)。结论:手术室连续性护理可有效改善剖宫产产妇心理、生理应激反应,缓解患者焦虑、抑郁情绪,改善产妇生理指标,提高产妇对护理服务的满意度。     

心理护理对耳鼻喉科全身麻醉患者的干预效果

目的 探讨心理护理对耳鼻喉科全身麻醉患者的干预效果.方法 将86例耳鼻喉科全身麻醉病人随机分为对照组(40例)与观察组(46例).对照组病人常规护理,观察组病人在常规护理基础上强化心理护理.在病人干预前后采用抑郁自评量表(SDS)评分及焦虑自评量表(SAS)评估负性情绪,并对病人术前血压、心率及苏醒期躁动程度进行评估.结果 观察组病人手术前SDS评分及SAS评分显著低于对照组(P＜0.05),术前血压及心率显著优于对照组(P＜0.05);苏醒期躁动程度显著低于对照组(P＜0.05).结论 对耳鼻喉科全身麻醉患者强化心理护理可显著改善病人焦虑抑郁情绪,血流动力学平稳,有助于手术顺利进行并减少术后病人躁动.     

心理干预对患者手术应激反应的影响

目的 将心理干预用于手术麻醉中，了解其对患者手术应激反应的影响。方法 随机将56例ASAⅠ～Ⅱ级的腹部手术患者分为认知组和对照组。术终统计心率（HR）、收缩压（SBP）及变化幅度，用放免法测不同时间的血皮质醇（Cor）、胰岛索（Ins）、血管紧张素浓度Ⅰ（AⅠ）和Ⅱ（AⅡ），为避免昼夜节律性的影响，统一于术前1日16时、切皮后30min、术日当天16时和次日16时采备血样。结果（1）对照组的HR和SBP均高于认知组，差异有显著性（P〈0．05）。（2）监测血皮质醇（Cor）、胰岛素（Ins）、血管紧张素Ⅰ（AⅠ）和Ⅱ（AⅡ），对照组与认知组相比均有不同程度的升高（P〈0．05）。结论 试验证明通过手术麻醉前的心理干预，可以正确调整患者术前的恐惧及焦虑程度，建立正确的心理防御机制，减轻患者手术中的应激反应。     

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.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

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.