全人照护管理在重症肺炎患儿临床护理中的应用

目的 探讨全人照护管理在重症肺炎患儿临床护理中的应用效果。方法 将96例重症肺炎患儿按随机数字表法分为观察组和对照组,各48例。对照组实施常规护理干预,观察组在对照组基础上实施全人照护管理,观察住院全程,出院后随访1个月。于干预前及干预后(出院当天),采用儿童医疗恐惧调查表调查患儿的医疗恐惧情况,采用Frankl依从量表、Houpt行为量表评估患儿的治疗配合度,采用儿童生活质量测定量表评估患儿的生活质量,统计患儿住院时间以及发热、喘息、咳嗽、肺啰音等临床症状持续时间。结果 干预后两组儿童医疗恐惧调查表的医疗环境恐惧、医疗操作恐惧、人际关系恐惧和自我恐惧维度评分均较干预前显著降低(P<0.01),观察组显著低于对照组(P<0.01)。干预后两组Frankl依从量表、Houpt行为量表评分较干预前显著升高(P<0.05),观察组显著高于对照组(P<0.05或0.01)。观察组发热、喘息、咳嗽、肺啰音持续时间及住院时间均显著短于对照组(P<0.01)。干预后两组儿童生活质量测定量表的生理功能、情感功能、社会功能、角色功能维度评分均较干预前显著升高(P<0....     

循证护理干预对口腔正畸患儿治疗效果的影响研究

目的探讨循证护理对儿童口腔正畸治疗依从性及口腔健康状况的影响。方法选取2016年9月—2017年12月于本院接受口腔正畸治疗的120例患儿为研究对象,采用随机数字表法将其分为对照组与观察组,每组各60例。对照组实施常规护理,观察组采取循证护理。比较两组患儿的治疗依从性、口腔健康评分及随访情况。结果观察组的治疗依从性各项评分及总评分均明显高于对照组,差异有统计学意义(P 0.001);护理前,两组患儿口腔健康评分比较,差异无统计学意义(P 0.05);护理后,两组口腔健康评分均高于护理前,且观察组高于对照组,差异均有统计学意义(P 0.05);观察组随访期间各项指标均明显优于对照组,差异有统计学意义(P 0.05)。结论对口腔正畸治疗患儿实施循证护理,有助于提高患儿的治疗依从性和治疗配合度,改善其口腔健康状况,值得临床推广应用。     

笑气-氧气吸入镇静结合计算机程控给药系统对儿童牙科畏惧症患者的治疗效果观察

目的观察笑气-氧气吸入镇静结合口腔无痛局麻仪对儿童牙科畏惧症患者的治疗效果。方法选取128例无法配合常规治疗的儿童牙科恐惧症患者,以笑气-氧气吸入镇静结合计算机程控给药系统对其进行儿童牙科治疗,手术过程中监测患者的血压(BP)心率(HR)及血氧饱和度(Sp O2),进行改良中文版儿童牙科畏惧调查表(CFSS-DS)评分、Frankl治疗依从性和Houpt行为量表评分。结果在操作过程中,BP、HR、Sp O2无明显变化(P0.05)。治疗前后CFSS-DS评分差异无统计学意义,Frankl治疗依从性和Houpt行为量表评分有显著性提高,差异有统计学意义(P0.05)。结论笑气-氧气吸入镇静结合计算机程控给药系统对儿童牙科畏惧症患者,具有良好的镇静、镇痛、抗焦虑作用,无严重不良反应。     

PRECEDE模式健康教育对固定正畸患者治疗效果的影响

目的:探讨PRECEDE模式健康教育对固定正畸患者治疗效果的影响。方法:将153例正畸初诊患者根据就诊日期(单、双日)随机分为观察组68例和对照组85例,对照组采用常规口腔卫生指导,观察组在此基础上进行针对性的PRECEDE模式健康教育;对两组的效果进行比较。结果:两组第一次托槽脱落率、牙面脱矿率及患者的复诊依从性比较差异有统计学意义(P0.05)。结论:实施PRECEDE模式健康教育的患者有助于改善口腔卫生状况,降低患者托槽脱落率和牙釉质脱矿率,提高患者的依从性。     

趣味游戏干预对牙科龋齿充填患儿配合程度的影响

目的 评价趣味游戏干预对牙科龋齿充填患儿配合程度的影响。 方法 将2017年10月-2018年3月口腔科门诊行乳牙龋齿充填治疗的63例患儿作为对照组,采用传统口腔科护理;2018年4-9月口腔科门诊行乳牙龋齿充填治疗的66例患儿设为观察组,在传统护理的基础上联合趣味游戏干预,采用Frankl临床行为分级评定量表、改良儿童畏惧调查表-牙科分量表(children fear survey schedule-dental subscale,CFSS-DS)、笑脸评分法及FLACC(face, legs, activity, crying, consolability)量表对患儿进行评价。 结果 观察组患儿配合程度明显高于对照组(Z=-4.146,P<0.001),CFSS-DS评分明显低于对照组(t=28.297,P＜0.001)。观察组患儿治疗中主观察疼痛评分与客观疼痛评分均低于对照组(t=-13.276,P<0.001; t=-8.294,P＜0.001)。 结论 趣味游戏干预可缓解牙科龋齿充填患儿紧张、畏惧情绪,减轻疼痛并提高其配合程度。     

成人佩戴固定矫治器对牙龈健康的影响--附48例报告

目的:探讨正畸固定矫治器对牙龈健康的影响。方法:正畸患者48例为观察组,在佩戴固定矫治器1周、2周和4周时检查牙龈,进行牙龈指数测定和菌斑指数测定。并与随机选取的45名在校大学生(对照组)作同期对照。结果:戴固定矫治器者的牙龈指数和菌斑指数均明显高于对照组(P<0.05),且随时间的推移,观察组的牙龈指数和菌斑指数自身比较有明显增加(P<0.05);戴固定矫治器者牙龈炎的发生率明显高于对照组(P<0.01),且有随时间延长而上升的趋势(P<0.05)。结论:正畸固定矫治器对牙龈健康有负面影响。     

护理干预对手足口病患儿态度行为及依从性的影响

目的:探讨护理干预对手足口病患儿态度行为及依从性的影响。方法:将186例手足口病患儿按就诊顺序随机分为对照组88例和观察组98例,对照组实施常规护理,观察组在此基础上加强护理干预。采用Achenbach儿童行为量表和中国儿童气质量表(CPTS)对两组患儿干预前后态度、行为评分及治疗依从性进行评估并比较。结果:两组患儿干预后态度、行为评分优于干预前(P<0.05,P<0.01),观察组干预后态度、行为评分及治疗依从性均优于对照组(P<0.05)。结论:有效的护理干预可明显改善手足口病患儿的态度行为并提高其依从性,有助于促进患儿的身心健康。     

青少年口腔正畸的依从性分析与干预效果研究

目的探讨青少年口腔正畸的依从性与干预效果。方法选择接受正畸治疗的青少年患者118例为研究组,接受正畸治疗的成年患者55例为对照组,对两组进行依从性评估。将研究组以1∶1随机配比分为干预组和非干预组,每组各59例,对非干预组采用常规的口腔健康宣教;对干预组则进行认知、行为、心理3方面进行个体化的干预,评价干预效果。结果青少年口腔正畸患者依从性不如成年患者,研究组按时预约复诊比率、配合使用口外装置(口外弓、橡皮圈)的比率显著低于对照组,正畸过程中断治疗比率高于对照组(P均0.05)。从干预效果看,干预组托槽脱落率、带环脱落损坏率和弓丝折断率显著低于非干预组,总疗程长度短于非干预组,口腔卫生良好率显著高于非干预组(P均0.05)。结论青少年口腔正畸的依从性较成年人差,个体化干预能提高青少年患者的行为依从性,并提高治疗效果。     

护理干预对牙科焦虑症固定正畸患者治疗依从性的影响

目的：探讨护理干预对牙科焦虑症固定正畸患者治疗依从性的影响。方法将100例牙科焦虑症固定正畸患者随机分为干预组和对照组各50例,对照组给予常规护理,干预组在常规护理的基础上加强心理护理、饮食护理、口腔卫生保健的护理干预。观察比较两组患者在整个治疗过程中软垢指数、按时复诊及托槽脱落情况有无差别。结果治疗期间,干预组软垢指数、按时复诊、托槽脱落情况均显著优于对照组,两组比较差异均具有统计学意义（均P＜0．05）。结论护理干预能有效提高固定正畸患者的治疗依从性,从而减少因治疗依从性不佳、不配合导致的矫治并发症的发生。     

基于健康信念模式的健康教育在糖尿病合并牙周炎病人口腔基础治疗中的应用

[目的]探讨口腔卫生健康教育在糖尿病合并牙周炎病人口腔基础治疗中的应用效果。[方法]将我院2016年1月—2016年12月收治的60例糖尿病合并牙周炎的病人随机分为观察组和对照组,每组30例。对照组给予常规健康教育,观察组给予健康信念模式的健康教育。比较两组治疗依从性、复诊率、口腔卫生健康知识掌握情况及治疗效果等。[结果]观察组治疗依从性、复诊率高于对照组,口腔卫生健康知识掌握情况好于对照组,差异均有统计学意义(P0.05)。观察组治疗后的菌斑指数、牙龈出血指数、牙周袋深度均小于对照组,差异均有统计学意义(P0.05)。[结论]基于健康信念模式的健康教育能够增加糖尿病合并牙周炎病人的口腔卫生知识,提高治疗依从性,改善治疗效果。     

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.