血清白蛋白联合Braden评分量表在脊髓损伤后压疮患者中的应用价值

目的探讨血清白蛋白(ALB)与Braden评分在脊髓损伤后并发院内压疮患者中的临床应用价值。方法对我院2013年3月—2017年6月住院的248例脊髓损伤患者进行回顾性分析。利用Braden评分量表对入院患者进行压疮风险评估,并监测患者血清白蛋白。利用受试者操作曲线(ROC)对Braden评分、ALB及两者联合预测效能进行分析。结果脊髓损伤患者院内压疮发生率为16.94%,压疮组患者Braden评分及ALB水平均明显低于无压疮组患者(P0.05)。血清ALB和Braden评分单独预测压疮发生的AUC分别为0.791和0.826(P0.01),而ALB联合Braden评分预测脊髓损伤患者压疮发生的ROC曲线下面积大小(AUC)为0.901。结论脊髓损伤患者血清ALB水平及Braden评分低下是患者并发压疮的独立危险因素,ALB联合Braden评分能准确预测脊髓损伤患者院内压疮的发生。     

某县级综合医院压疮现患率和医院内获得性压疮发生率的调查与分析

目的了解县级综合医院住院患者压疮现患率及医院内获得性压疮发生率,为压疮预防和提高护理人员压疮防范意识提供科学依据。方法采取床旁调查、拍照和查阅住院病历相结合的方法,对丽水市青田县人民医院2015年1月1日至3月31日(除产、儿科外)住院且年龄18岁的所有患者进行压疮现患率和医院获得性压疮发生率的调查。结果 2015年1月至3月调查患者共计2 570例次,压疮患病例数为50例(116处),现患率为1.95%。医院获得性压疮患者8例(14处),发生率为0.31%。压疮发生部位前3位分别为尾骶部22处(占18.97%)、髂嵴和股骨大转子21处(占18.10%)、足跟16处(占13.79%)。压疮发生与患者年龄、Braden评分、合并疾病数等有关。结论县级综合医院压疮现患率较国内三级医院高,医护人员应提高压疮防范意识,根据压疮发生的特点积极采取预防措施。     

肝移植患者急性压疮的原因分析及护理体会

目的探讨肝移植患者急性压疮的发生原因和护理措施。方法采用Waterlow's压疮危险评分法对61例肝移植患者进行压疮危险评分,并跟踪观察患者急性压疮的发生情况和采取相应的护理干预。结果压疮评分在10~14分者36例,15~19分18例,20分以上7例;发生急性压疮11例(18.03%),其中Ⅳ期压疮1例,Ⅲ期2例,Ⅱ期6例,Ⅰ期2例;急性压疮的发生主要与患者全身情况差、手术时间长、不合理手术体位及术后护理干预不及时等有关。结论落实术前皮肤评估与护理、严格交接制度、术后评估皮肤损伤并进行早期护理干预、做好患者的心理护理及加强创面护理对肝移植患者急性压疮的防治具有重要意义。     

股骨颈骨折压疮高危患者的护理

选取2016年1~12月70例股骨颈骨折压疮高危患者,总结了其风险评估及护理经验,包括对所有高危患者进行压疮风险评估,结合病情给予基础护理、饮食指导、健康宣教等护理干预,70例患者无院内压疮发生,11例Ⅰ期院外压疮患者痊愈出院,1例Ⅱ期压疮由于住院时间短好转出院。认为对股骨颈骨折压疮高危患者进行压疮风险评估及护理干预效果显著,值得临床推广。     

护理干预对脊髓损伤患者压疮的影响

目的 探讨预防脊髓损伤患者压疮发生的干预方法。方法 将84例经压疮危险因素评估评分≤14分的患者随机分为观察组与对照组各42例。观察组进行护理干预,对照组给予常规护理。观察两组患者实施各护理方案后1周内压疮发生率、发生时间、发生程度等指标。结果 观察组患者压疮发生率、压疮程度均显著低于对照组(P＜0.05),压疮发生时间明显延迟(P＜0.05)。结论 护理干预可有效降低脊髓损伤患者的压疮发生率,延迟难免性压疮的首次发生时间,减轻压疮发生程度,减少患者痛苦,提升基础护理质量。     

院内宣教和家庭护理指导在压疮预防中的应用

目的 探讨院内宣教和家庭护理指导对压疮预防的效果。 方法 选取2012年1~3月院外带入的30例压疮患者为对照组,2012年4~6月院外带入的30例患者作为干预组。对照组在患者住院期间予以常规健康教育和护理,干预组在对照组的基础上对患者和其家属进行培训和进入家庭进行护理指导。根据回访登记记录,评价2组患者出院后压疮再次发生情况。 结果 干预组患者出院后未再发生压疮,而对照组20例再次发生压疮。 结论 院内宣教和家庭护理指导能有效预防院外压疮的发生。     

居家老年慢性病患者压疮相关因素调查分析

目的:调查居家老年慢性病患者压疮发生的相关因素。方法:采用住院患者首次评估单、自行设计的调查表格及Braden量表,对495例居家老年慢性病压疮患者入院24 h内进行调查。结果:压疮发生的部位主要为骶尾部,共337例(68.08%);2处及以上压疮402例(81.21%),Ⅱ～Ⅳ期压疮有344例(69.50%);高度及重高度危险431例(87.07%)。活动度水平、运动能力及感官知觉是居家老年慢性病患者压疮发生的主要危险因素,家庭状况与压疮发生关系密切。结论:居家老年慢性病患者病情复杂、病程长,易发生压疮,应引起全社会及社区护理人员的重视。     

泸州市某三甲综合医院住院患者压疮现状调查分析

目的:调查泸州市某三级甲等综合医院住院患者压疮发生特点和预后效果,为临床压疮管理与预防提供数据支持。方法:收集泸州市某三甲医院2011~2014年压疮上报数据,对压疮发生率、发生时间、患者年龄、分期、部位、科室分布和结局指标等进行回顾性统计分析。结果:2011~2014年共发生压疮1 047例,其中院内131例、院外916例,压疮发生率为0.016%~0.056%;院外压疮患者年龄高于院内(P0.05);40.458%院内压疮患者发生在入院后1~10 d,院外压疮74.454%由家庭带入;压疮高发部位是骶尾部,其次为足部、髋部、臀部等,Ⅱ期是最常见的压疮类型;压疮高发科室为神经内科、神经外科、ICU、心内科等;院内压疮痊愈率和病死率均高于院外(P0.05),Ⅰ期和Ⅱ期压疮痊愈率比较差异有统计学意义(P0.05)。结论:对于老年和危重患者应建立压疮高风险患者的预警评估系统,针对高风险患者建立压疮标准化防护体系;同时成立区域或全国性的压疮管理组织,制定压疮管理标准和指南,利用多学科合作优势,提高压疮治愈率,加强压疮规范管理。     

延续护理对脊髓损伤病人康复效果的影响

[目的]探讨延续护理在脊髓损伤(SCI)病人长期康复中的干预作用,以期改善脊髓损伤病人的生活质量。[方法]选取我院2010年5月—2015年5月收治的180例脊髓损伤病人为研究对象,将180例病人按出院时间分为观察组和对照组,各90例,住院期间均给予常规护理。对照组出院后进行定期门诊复查;观察组实施延续护理,出院后定期进行电话和上门随访,持续跟踪指导其家庭护理。观察并记录两组病人出院时、出院后6个月时膀胱功能恢复与重建,尿路感染、肺部感染、压疮的发生与转归及日常生活能力情况。[结果]出院后6个月时两组病人的尿路感染、肺部感染、压疮的发生与转归率比较,差异有统计学意义(P0.05);日常生活能力程度差异无统计学意义(P0.05)。[结论]对脊髓损伤病人出院后实施系统的延续护理,能有效降低压疮、肺部感染、尿路感染的发生率,减轻病人的痛苦和家庭经济负担,促进病人康复。     

老年人股骨骨折后压疮预防的护理

目的讨论老年股骨骨折患者压疮预防的护理方法。方法对2013年1月-6月收治的33例股骨骨折老年患者,入院后即行压疮预测评估,并根据评估情况采取使用软床垫、及时变换受压部位、保护骨隆突处等预防措施,同时对患者和家属进行个体化的健康教育及加强护士交接班预防措施,积极预防和减少压疮的发生。结果院外带入的1例Ⅲ期压疮患者通过治疗和护理转为Ⅰ期,4例Ⅰ期、2例Ⅱ期压疮患者均治愈,住院期间无新发压疮患者。结论积极的护理措施可预防股骨骨折老年患者压疮的发生,减轻患者的痛苦,提高护理质量和患者的满意度。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.