认知行为干预对微创胆囊切除术患者术前心理及术后躯体恢复的影响

目的:探讨认知行为干预对慢性胆囊炎患者微创胆囊切除术术前焦虑、希望水平及术后躯体恢复的影响。方法:选取2016年3月至2018年9月在西安交通大学第二附属医院接受微创胆囊切除术治疗的108例慢性胆囊炎患者,经随机数表法将其分为对照组与干预组,每组各54例。对照组接受术前常规干预,干预组在常规干预基础上进行认知行为干预。分别采用焦虑自评量表(Self-rating Anxiety Scale,SAS)、Herth希望量表(Hertz Hope Index,HHI)检测两组患者入院即刻、术前 12 h焦虑评分、希望水平评分,并记录术后躯体康复时间。结果:入院即刻,两组患者的SAS评分值、HHI总分及各个维度评分值差异均无统计学意义(P0.05)。术前12 h,干预组SAS评分值低于术前及对照组(P0.05);HHI总分及各个维度评分值均高于术前及对照组(P0.05)。干预组肠道排气时间、术后下床活动时间、术后住院时间均短于对照组患者(P0.05)。结论:微创胆囊切除术患者接受认知行为干预,可有效缓解其术前焦虑并增加希望水平、加速术后躯体康复。     

SDS和SAS评分在腹腔镜胆囊切除术患者心理护理干预中的应用观察

目的探讨心理护理干预对腹腔镜胆囊切除术的患者的焦虑和抑郁程度、术后恢复的影响及应用效果。方法选取2010年11月~2012年9月在本院肝胆外科行腹腔镜胆囊切除术的住院患者101例,采用随机法将其分为对试验组51例和对照组50例。对照组行普外科常规护理干预,试验组在对照组护理的基础上增加心理护理干预,比较两组患者的术前和术后及1个月的焦虑自评量表(SAS)及抑郁自评量表(SDS)的评分、术后恢复情况和患者生活质量情况。结果试验组和对照组在护理干预后的SAS和SDS评分相比,差异均具有统计学意义(P0.05),试验组术后肠鸣音恢复的时间和肛门排气时间均短于对照组(P0.05)。护理干预前两组患者的焦虑自评量表(SAS)评分和抑郁自评量表(SDS)评分,差异均无统计学意义(P0.05)。结论心理护理干预在腹腔镜胆囊切除术后患者中的应用效果比较显著,患者心理状况有明显改善,能有效降低腹腔镜术后患者的抑郁和焦虑程度,促进患者术后的恢复,对提高患者的术后生活质量有一定的临床意义。     

快速康复外科护理对腹腔镜胆囊切除术病人术前焦虑与术后康复的影响

[目的]探讨快速康复外科(FTS)护理对腹腔镜胆囊切除术(LC)病人术前焦虑与术后康复的影响。[方法]将76例腹腔镜胆囊切除术病人随机分为对照组和试验组,每组38例。对照组采用常规护理,试验组实施FTS护理,比较两组病人术前晚收缩压、脉搏、焦虑自评量表(SAS)评分,术后肠鸣音恢复时间、肛门排气时间、输液时间、住院时间、并发症发生率及切口疼痛程度的差异。[结果]试验组术前收缩压、脉搏及SAS评分均低于对照组(P0.05);试验组术后肠鸣音恢复时间、肛门排气时间、输液时间、住院时间均优于对照组(P0.05),恶心、呕吐的发生率及切口疼痛程度均低于对照组(P0.05)。[结论]FTS护理有利于减轻腹腔镜胆囊切除术病人术前焦虑,并促进其术后康复。     

快速康复护理对腹腔镜胆囊切除术术后康复中的效果研究

目的探讨快速康复护理的应用对腹腔镜胆囊切除术(LC)患者术后恢复的影响。方法选取腹腔镜胆囊切除术患者122例为研究对象,按照入院日期分为观察组和对照组,各61例,对照组应用常规护理,观察组依照快速康复外科理念进行护理,比较两组患者术后康复效果。结果观察组下床活动时间、肛门首次排气时间及住院时间均短于对照组[(9.52±0.37)vs.(16.15±0.28),(22.91±0.62)vs.(33.93±0.79),(3.02±1.54)vs.(4.67±1.30)],差异有统计学意义(P0.05);观察组在治疗结束时的焦虑自评量表(SAS)评分和抑郁自评量表(SDS)评分明显较对照组低[(22.53±8.75)vs.(29.46±7.76),(36.73±8.52)vs.(40.07±10.82)](P0.05);观察组术后疼痛程度及并发症发生率低于对照组(P0.05)。结论快速康复护理应用于腹腔镜胆囊切除术围术期护理中,能够加速患者的康复速度,改善患者不良情绪,减轻疼痛,降低并发症。     

全程护理干预对介入治疗的糖尿病患者焦虑与疼痛的影响

目的探讨全程护理干预对糖尿病（DM）患者术前焦虑和术后疼痛的影响。方法46例糖尿病患者分为干预组和对照组各23例,对照组给予常规术前准备和告知同意,干预组在对照组基础上给予术前认知干预、心理干预、行为干预。应用焦虑自评量表于入院时和术前1 d进行效果评价分析;应用视觉模拟评分法对患者术后疼痛进行评价。结果干预组入院时焦虑自评量表评分高于术前1 d（P〈0.01）;对照组术前焦虑自评量表评分高于入院时（P〈0.05）;干预组术前1 d焦虑自评量表评分明显低于对照组（P〈0.01）;干预组术后疼痛明显低于对照组（P〈0.01）。结论全程护理干预可以减轻患者术前焦虑程度及术后疼痛程度,有利于患者手术进行及术后康复。     

线上密室逃脱游戏教学对腹腔镜胆囊切除术病人疾病认知、术前焦虑及满意度的影响

目的:探讨线上密室逃脱游戏教学对腹腔镜胆囊切除术病人疾病认知、术前焦虑及满意度的影响。方法:采用整群抽样法抽取医院2021年8月—2022年8月收治的198例腹腔镜胆囊切除术病人为研究对象,按照随机数字表法分为对照组和观察组,各99例,对照组采用传统教育模式,观察组在对照组基础上采用线上密室逃脱游戏进行健康教育,采用自行设计的腹腔镜胆囊切除术病人疾病认知问卷、焦虑自评量表(SAS)、满意度调查问卷测评两组病人干预后疾病认知、术前焦虑及护理满意度情况。结果:两组病人干预后疾病认知评分、焦虑自评量表(SAS)评分及护理满意度比较,差异均有统计学意义(P<0.05)。结论:线上密室逃脱游戏教育有助于提高腹腔镜胆囊切除术病人疾病认知水平,降低术前焦虑水平,提升护理满意度。     

基于叙事护理理论的心理干预在择期腹腔镜胆囊切除术患者中的应用

目的:探讨基于叙事护理理论的心理干预在择期腹腔镜胆囊切除术患者中的应用效果。方法:将160例择期腹腔镜胆囊切除术患者随机分为干预组和对照组各80例,对照组给予常规护理健康教育,干预组在此基础上实施基于叙事护理理论的心理干预,比较两组干预效果。结果:干预后干预组焦虑自评量表(SAS)、抑郁自评量表(SDS)得分低于对照组(P0.05),干预组患者术前睡眠质量总分低于对照组(P0.05);干预组术后下床时间、首次肛门排气时间及术后住院时间短于对照组(P0.05);干预组治疗依从率高于对照组(P0.05);干预组并发症发生率低于对照组(P0.05)。结论:对择期腹腔镜胆囊切除术患者实施基于叙事护理理论的心理干预能改善患者术前焦虑、抑郁状况,提高患者治疗依从性,改善术后康复效果。     

无缝隙护理模式在腹腔镜下子宫肌瘤切除术患者中的应用

目的:探讨无缝隙护理模式在腹腔镜下子宫肌瘤切除术患者中的应用效果。方法:将2018年1月1日～6月30日实施腹腔镜手术治疗的89例子宫肌瘤切除术患者作为对照组,采用常规围术期护理措施;将2018年7月1日～12月31日实施腹腔镜手术治疗的90例患者作为观察组,在常规护理基础上实施无缝隙护理模式。比较两组干预效果。结果:干预后两组焦虑自评量表(SAS)、抑郁自评量表(SDS)评分均低于干预前(P0.05),且干预后观察组SAS、SDS评分低于对照组(P0.05);观察组患者术后恢复时间和术后住院时间均短于对照组(P0.05);观察组患者护理满意度为97.78%,对照组为87.64%,两组比较差异有统计学意义(P0.05)。结论:无缝隙护理模式应用于腹腔镜下子宫肌瘤切除术患者,可缓解患者焦虑、抑郁情绪,缩短患者术后康复时间,效果满意。     

人性化护理模式对腹腔镜胆囊切除术患者心理状态及生活质量的影响

目的：探讨人性化护理模式对腹腔镜胆囊切除术患者心理状态及生活质量的影响。方法：将110例腹腔镜胆囊切除术患者随机分为观察组和对照组各55例,对照组采用常规护理措施,观察组在常规护理基础上实施人性化护理模式。结果：术后两周时,观察组患者焦虑自评量表（SAS）和抑郁自评量表（SDS）评分均低于对照组（P ＜0.01）;生活质量评分明显高于对照组（P＜0.01）。结论：将人性化护理模式应用于腹腔镜胆囊切除术患者,可有效改善患者心理状态,提高患者整体生活质量。     

宫外孕患者腹腔镜手术治疗的围术期护理

目的探讨宫外孕患者腹腔镜手术治疗的围术期护理效果。方法选取本院行腹腔镜手术治疗的宫外孕患者92例,按随机对照、双盲法分为对照组和观察组,各46例,对照组行围术期常规护理,观察组实施综合护理干预,比较2组术后胃肠功能恢复时间、下床活动时间、住院时间,记录2组术后并发症发生情况,同时采用焦虑自评量表(SAS)、抑郁自评量表(SDS)对患者心理状态进行评定。结果观察组术后胃肠功能恢复时间、下床活动时间及住院时间均短于对照组(P0.05),观察组术后并发症发生率低于对照组(P0.05),观察组术后SAS、SDS评分均低于对照组(P0.05),2组术后SAS、SDS评分较术前均降低(P0.05)。结论宫外孕患者腹腔镜围术期实施综合护理干预,改善患者心理状态,促进患者术后恢复,且降低术后并发症发生率。     

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.     

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.