病毒性心肌炎患儿心肌损害早期的临床诊治及护理

目的:探讨病毒性心肌炎(VMC)心肌损害的早期检测和护理方法。方法:对62例VMC患儿进行血清心脏型脂肪酸结合蛋白(h-FABP)和肌酸磷酸激酶同功酶(CK-MB)检测,普通心电图(ECG)和动态心电图(ACG)测定,X线胸透。住院系统治疗与护理2～3个月。结果:治疗前后患儿h-FABP、CK-MB水平有显著性差异(P<0.05),治疗与护理后,痊愈46例(74.2%),好转16例(25.8%),无1例死亡。结论:血清h-FABP联合ACG或ECG检测,对早期诊断VMC和提高检出率,同时对VMC患儿的预后和临床用药及护理具有重要价值。     

支气管肺炎急性期患儿心肌损害的早期诊治与护理

目的通过观察支气管肺炎急性期患儿治疗前后检测指标的变化,探讨早期诊治支气管肺炎心肌损害的检测指标及其护理对策。方法同期选择支气管肺炎急性期患儿97例及健康儿童30例,患儿住院进行综合治疗与护理,对比分析患儿治疗前、后与健康儿童血清心脏型脂肪酸结合蛋白(h-FABP)水平差异。结果治疗前(急性期)患儿h-FABP、肌酸磷酸激酶同功酶(CK-MB)水平均显著性升高(p<0.01);治疗后与治疗前相比均显著下降(p<0.01),治疗后h-FABP、CK-MB水平较对照组高,但差别无统计学意义(p>0.05)。治疗前血清h-FABP的阳性率(84.5%)显著高于血清CK-MB的阳性率(62.9%),也显著高于动态心电图(ACG)(52.6%)和普通心电图(ECG)(39.2%)的异常率。经系统治疗与护理后,患儿均痊愈出院,无1例死亡。结论支气管肺炎患儿大多存在心肌损害,血清h-FABP定量测定是早期诊断支气管肺炎患儿心肌损害的一项指标。同时对支气管肺炎患儿的预后、临床用药及护理具有重要价值。     

病毒性心肌炎患儿心肌损害早期诊治的临床研究

目的；通过观察病毒性心肌炎患儿治疗前后检测指标的变化，探讨早期诊治病毒性心肌炎心肌损害的检测指标。方法：对62例病毒性心肌炎住院患儿进行血清心脏型脂肪酸结合蛋白（h-FABP）和肌酸磷酸激酶同功酶（CK-MB）检测，普通心电图（ECG）和动态心电图（ACG）测定，X线胸透。结果：①治疗前（急性期）患儿h-FABP、CK-MB水平均显著性升高（P〈0．01）；治疗后（恢复期）与治疗前相比均显著下降（P〈0．01），治疗后h-FABP、CK-MB水平较对照组高，但无显著差别（P〉0．05）。②治疗前血清h-FABP的阳性率（96．8％）显著高于血清CK-MB的阳性率（53．2％），也显著高于ACG（62．9％）和ECG（40．3％）的异常率。③系统治疗2～3个月后，痊愈46例（74．2％），好转16例（25．8％）。无1例死亡。结论：血清h-FABP定量测定是早期诊断病毒性心肌炎心肌损害的一项指标，比CK-MB、ACG和ECG具有更高的敏感性。血清hFABP联合ACG或ECG检测，对早期诊断病毒性，心肌炎和提高检出率，同时对病毒性心肌炎患儿的预后和临床用药具有重要价值。     

病毒性心肌炎患儿心肌损害早期的临床诊治及护理

目的：探讨病毒性心肌炎（VMC）心肌损害的早期检测和护理方法。方法：对62例VMC患儿进行血清心脏型脂肪酸结合蛋白（h—FABP）和肌酸磷酸激酶同功酶（CK—MB）检测，普通心电图（ECG）和动态心电图（ACG）测定，X线胸透。住院系统治疗与护理2～3个月。结果：治疗前后患儿h—FABP、CK—MB水平有显著性差异（P〈0．05），治疗与护理后，痊愈46例（74．2％），好转16例（25．8％），无1例死亡。结论：血清h—FABP联合ACG或ECG检测，对早期诊断VMC和提高检出率，同时对VMC患儿的预后和临床用药及护理具有重要价值。     

心电图、心肌酶谱和心肌肌钙蛋白Ⅰ在病毒性心肌炎诊断中的价值

目的 探讨心电图(ECG)、心肌酶谱与心肌肌钙蛋白I (cTnI)在病毒性心肌炎(VMC)中的诊断价值.方法 检测104例病毒性心肌炎患者的ECG、心肌激酶(CK)及其同工酶(CK-MB)与cTnI指标.结果 心电图异常者占89.4%,其中过早搏动所占比例最多.VMC患者中,cTnI的检出率明显高于CK和CK-MB,而且病程越长,差异越明显.结论 与CK和CK-MB相比,cTnI特异性高,诊断窗口时间长,可作为诊断VMC的重要指标.     

急性高血压脑出血患者血清h-FABP水平变化及其临床应用价值

目的 通过观察急性高血压脑出血患者血清心脏型脂肪酸结合蛋白(h-FABP)水平变化,探讨其临床检测价值.方法 血清h-FABP采用双抗体夹心酶联免疫一步法定量检测;cTnI采用固相酶联免疫吸附实验(ELISA);CK-MB采用免疫抑制法测定HT5"H〗结果 急性高血压脑出血患者组血清h-FABP水平显著高于对照组(P<0.01),大量出血者及意识不清者血清h-FABP水平分别显著高于小量出血者及意识清醒者(P<0.01);血清h-FABP阳性率显著高于血清cTnI、CK-MB及心电图的阳性率(P<0.01);死亡率为25.5%(28/110),血清h-FABP、cTnI、CK-MB及心电图异常组的死亡率显著高于正常组(P<0.01);血清h-FABP预测发生死亡具有高的敏感性和阴性预测值,特异性和准确度较低,但心电图具有较高的特异性(64.5%)和准确度(69.1%).结论 血清h-FABP定量测定可作为判断急性高血压脑出血病情轻重及评价发生意外的1项客观指标,联合心电图监测临床价值更高.     

四指标联合检测在儿童手足口病合并心肌损害的早期诊断价值

目的探讨血清心型脂肪酸结合蛋白(h-FABP)、肌钙蛋白(cTnI)、肌红蛋白(Mb)及肌酸激酶同工酶MB(CK-MB)联合检测对儿童手足口病(HFMD)合并心肌损害的早期临床诊断价值。方法收取2015年3~12月本院儿科门诊和住院就诊并确诊为手足口病患儿L276例,最终确诊合并心肌炎57例,同时选择同期健康儿童40例为对照组。采集患者入院后不同时刻的静脉血分别测定患儿血清中h-FABP、cTnI、Mb和CK-MB含量,与对照组比较各指标水平的差异性,并分析其含量在不同时间内的动态变化。结果 276例HFMD患儿中确诊合并心肌炎5 7例,心肌炎并发率为20.65%(57/276),于0~3 h内检测276例HFMD患儿血清中h-FABP、cTnI、Mb和CK-MB的异常率分别为20.29%(56/276)、1.81%(6/276)、14.86%(41/276)和2.90%(8/276),h-FABP和Mb的异常率明显高于cTnI和CK-MB,差异有统计学意义(x~2=35.1 3~37.06,P0.01),h-FABP异常率也高于CK-MB,差异有统计学意义(x~2=3.1 8,P0.05);HFDM合并心肌炎患儿血清中h-FABP、cTnI、Mb和CK-MB浓度均明显高于对照组,各指标之间差异均有统计学意义(t=1 7.26~37.63,P0.01);HFMD合并心肌炎发生后0~3 h h-FABP和Mb浓度开始上升,4~9 h达到峰值,12 h后开始下降,20~36 h基本降至正常:cTnI和CK-MB浓度在HFDM合并心肌炎发生后4~9 h才开始上升,10~1 2 h达到峰值,12~72 h内一直处于较高水平,72 h后开始下降,7 d基本降至正常。结论 HFMD患儿合并心肌炎有较高的发病率,h-FABP是早期诊断最敏感的指标,可作为早期诊断HFMD患儿合并心肌炎的理想标志物,其次为Mb;cTnI和CK-MB是HFMD患儿合并心肌炎中晚期诊断敏感指标。联合检测h-FABP、cTnI、Mb和CK-MB对HFMD患儿合并心肌炎的早期诊断、提高诊断率和减少漏检率等方面均具有重要的临床价值。     

手足口病患儿血清心型脂肪酸结合蛋白的变化及临床意义

目的观察手足口病(HFMD)患儿血清心型脂肪酸结合蛋白(h-FABP)的水平变化,探讨h-FABP在HFMD患儿心肌损害中的诊断价值。方法以44例HFMD患病儿童为研究对象,同时选择40例健康体检儿童作为对照组,在不同时段进行血清肌酸磷酸激酶同功酶(CK-MB)、h-FABP和肌钙蛋白I(cTnI)水平的检测。结果 HFMD组患儿h-FABP、cTnI及CK-MB的最高值分别为(18.42±6.20)ng/mL、(0.20±0.06)ng/mL、(35.2±11.2)U/L,均高于对照组相应指标的最高值(P<0.01),h-FABP增高时间比cTnI和CK-MB早,在6～8h达到峰值。结论血清h-FABP可作为HFMD患儿早期心肌损害的临床生化检验标志物。     

急性酒精中毒心肌损害的早期诊治与护理

目的通过观察急性酒精中毒患者血清心脏型脂肪酸结合蛋白(h-FABP)水平变化,探讨其心肌损害的早期诊断以及治疗与护理措施。方法血清h-FABP采用双抗体夹心酶联免疫一步法定量检测;心肌肌钙蛋白Ⅰ(cTnI)采用固相酶联免疫吸附试验(ELISA);肌酸激酶同工酶(CK-MB)采用免疫抑制法。结果①急性酒精中毒组患者血清h-FABP水平显著高于健康组(P<0.01);随着病情程度的加重,轻、中及重度组患者血清h-FABP水平也依次升高,且差异显著(P<0.01);轻、中及重度组患者血清h-FABP异常阳性率也依次升高,且差异显著(P<0.01)。血清h-FABP阳性率显著高于血清cTnI、CK-MB及心电图的阳性率(P<0.01)。②心肌损害者出院时血清h-FABP浓度均达正常,心脏功能均得到恢复,无1例恶性心律失常与猝死的发生。结论血清h-FABP定量测定可作为早期判断急性酒精中毒心肌损害的一项客观指标,早期心肌损害者经有效的临床治疗与护理,心脏功能均可得到恢复。     

血清心肌肌钙蛋白I对小儿病毒性心肌炎的早期诊断价值——附21例检测分析

目的探讨血清心肌肌钙蛋白I对小儿病毒性心肌炎(viral myocarditis,VMC)心肌损害的早期诊断价值及对心功能的判断价值.方法对VMC组21例,疑似VMC组24例及非心脏疾病患儿的对照组23例测定血清心肌肌钙蛋白I和肌酸激酶及其同工酶(creatine kinase isoenzyme-MB,CK-MB),并将3组结果进行比较,同时对前二组中39例患儿测定左心功能指标(射血分数、缩短分数),比较心肌肌钙蛋白I与左心功能的关系.结果VMC组心肌肌钙蛋白I、肌酸激酶、CK-MB值均明显高于疑似VMC组.对照组心肌肌钙蛋白I值均正常.VMC组及疑似VMC组心肌肌钙蛋白I阳性率均高于肌酸激酶、CK-MB阳性率.39例测定左心功能,VMC组射血分数异常率为57%(12/21),缩短分数异常率为48%(10/21),明显高于疑似VMC组[6%(1/18)、11%(2/18)],两组比较差异统计学意义(P<0.01).结论血清心肌肌钙蛋白I早期诊断小儿VMC优于肌酸激酶、CK-MB,且可提示心肌受累的程度及判断心功能.     

Visiting rights only: the diplomas in nursing in the UK in the interwar period

The aim of this article is to explore the institution and organisation of the diplomas in nursing at the universities of Leeds and London, which were established in 1921 and 1926, respectively. It will be argued that the success of these courses for the individuals who undertook them, and the profession as a whole was ultimately limited. It is accepted that the purpose of the diplomas was at least in part for the nursing elite to maintain their grip on the leadership. Nevertheless, the institution of the courses, when few women in general attended university, identifies a 'radicalness' within the profession, which has rarely been considered. Moreover, that there was a body of nurses capable of university level education challenges previous assumptions.     

Pitfalls in the Care of the Psychiatric Patient in the Emergency Department

Background

Care of the psychiatric patient in the Emergency Department (ED) is evolving. As with other disease states, there are a number of pitfalls that complicate the care of the psychiatric patient.

Objective

The purpose of this article is to update Emergency Physicians concerning the pitfalls in caring for the psychiatric patient, and possible solutions to deal with these pitfalls.

Discussion

The article will address the burden of the psychiatric patient, staff attitudes, medical clearance process, treatment of the agitated patient, suicidal patients, and admission decisions.

Conclusions

Alternative care resources, collaboration with Psychiatry, staff education, improvement in the medical clearance process, proper use of restraint and seclusion, and appropriate choice of medication for agitated patients can help avoid some of the top pitfalls in the care of the psychiatric patient in the ED.     

Changes in the parameters of the rhythms of the electrolyte-excreting function of the kidneys in women in relation to the seasons of the year

The characteristics (period, mesor, amplitude) of the rhythms of urinary excretion of sodium, potassium, chlorine, calcium, magnesium, and phosphorus were examined in normal women during various seasons. The urine was collected for 5 days with 4-hour intervals. The rhythms were detected and their parameters established with the use of mathematical methods for the assessment of the tested curve fragments repetitions and by the least squares nonlinear method. The rhythms of renal urinary and electrolyte excretion were found very smooth, particularly so in the fall and winter. The circadian rhythms have been found the most stable during all the seasons. Examinations of individual electrolyte excretion have shown that Na and K excretion is more stable all the year round and therefore this parameter is the most informative for the detection of disorders in renal electrolyte excretion.     

Choosing the choices in the USA: examples in the maternity area

The concept of choice has featured prominently in both the recent united Kingdom (UK) health care reforms and in the debate relating to the care of childbearing women. An invitation to the USA facilitated contemplation of the health care system on which the recent UK reforms have been modeled. The impact of the health system on mother's choices was a source of particular interest. The implications for midwives, their practice and their relationships with their clients and colleagues emerge clearly. It may be that the United States' model of health care does not answer the needs of the UK.     

Change in the drug-metabolizing function of the liver in patients in the postoperative period in relation to the type of anesthesia]

Anesthesia-dependent changes in pharmaco-metabolic liver function have been studied in patients operated on for cosmetic facial defects. It has been established that the postoperative period in patients subjected intraoperatively to general combined anesthesia and controlled lung ventilation was characterized by inhibited drug metabolism in the liver, which required correction of the drug doses to reduce the risk of side and toxic effects of pharmacotherapy. Patients operated on under local procaine anesthesia had no considerable changes in pharmaco-metabolic liver function in the postoperative period.