循证护理在老年白内障患者围手术期的应用

目的:探讨循证护理在老年白内障患者围手术期护理中的临床应用效果.方法:将老年白内障行超声乳化人工晶状体置入患者124例152眼,随机分为常规组(58例66眼)与循证组(66例86眼),常规组采用常规围手术期护理方法;循证组采用循证护理方法,检索有关医学文献,根据循证获得的证据,确定临床实践中的问题,实施最佳的护理,并对比观察其效果.结果:两组老年白内障患者的术后感染、一过性眼压升高、视网膜脱离等问题比较,差异有统计学意义(P＜0.01,P＜0.05).结论:循证护理应用于老年白内障患者的围手术期护理,能显著降低手术并发症的发生.     

玻璃体切割治疗外源性眼内炎围手术期护理

探究玻璃体切割治疗外源性眼内炎围手术期护理效果。按照入院顺序抽取我院2015年2月~2017年2月收治的外源性眼内炎患者30例,分为优质组和常规组各15例。常规组进行围术期常规护理,优质组进行围术期优质护理。对比两组的护理质量、SDS评分、SAS评分。与常规组的护理质量比较,优质组的较优;与常规组的SDS评分、SAS评分比较,优质组的较低,差异显著(P0.05)。玻璃体切割治疗外源性眼内炎患者进行围手术期护理,有效的改善了患者的负性情绪,提升了护理质量,值得借鉴和推广。     

康柏西普眼内注射联合玻璃体切割的围术期护理

目的:探讨康柏西普眼内注射联合玻璃体切割术治疗糖尿病视网膜病变引发的玻璃体积血患者,总结有效围术期护理方法。方法:将糖尿病视网膜病变引起玻璃体积血的39例(42眼)患者纳入研究对象,将单纯行玻璃体切割手术患者(27眼)作为对照组,将康柏西普眼内注射联合玻璃体切割手术患者(15眼)作为观察组,比较两组手术时间、住院天数、并发症发生率及卧位不适发生率。结果:观察组平均手术时间及平均住院天数明显短于对照组(P0.05),并发症发生率及卧位不适发生率明显低于对照组(P0.05)。结论:将康柏西普眼内注射联合玻璃体切割手术应用于临床,通过有针对性地围术期护理,能减轻患者痛苦,提高手术效果。     

眼玻璃体切割术46例围术期护理

目的:探讨眼玻璃体切割术围术期的护理方法.方法:对46例(46眼)不同眼疾病患者行眼玻璃体切割术,并给予精心围术期护理.结果:46眼中43眼视力不同程度提高,2眼无改变,1眼比术前差.4眼出现术后眼压升高,3眼术后并发玻璃体内出血.结论:加强眼玻璃体切割术患者围术期护理,对确保手术疗效和患者顺利康复具有决定性意义.     

玻璃体切割术后患者循证护理效果观察

目的：探讨循证护理在玻璃体切割术后患者中的临床应用效果。方法：选取2020年1月1日～2021年2月1日行玻璃体切割术患者56例,采用随机数字表法分为对照组和观察组各28例;对照组给予常规护理,观察组在对照组基础上给予循证护理。比较两组术后并发症发生情况、舒适度及生活质量。结果：观察组并发症发生率低于对照组(P<0.05);观察组舒适度量表、生活质量量表评分均高于对照组(P<0.05)。结论：将循证护理用于玻璃体切割术后患者中,能减少术后并发症的发生,提高舒适度,改善生活质量。     

玻璃体切割术38例围术期护理

目的:探讨玻璃体切割术的围术期护理方法及效果.方法:对38例眼科患者行玻璃体切割术,术前对患者加强健康宣教、进行体位训练,术后加强病情观察,及时发现和处理并发症.结果:本组38例患者均获得解剖学复位,32例患者术后视力提高,5例保持术前视力,1例视力下降.结论:加强围术期护理是手术成功的重要保障.     

循证护理模式在改善普外科患者术前恐惧情绪及围手术期生存质量中应用的效果评价

目的 观察采用循证护理模式改善普外科患者术前恐惧情绪及围手术期生存质量的效果.方法 选择2009年9月至2010年9月普外科手术患者160例作为研究对象,将160例患者随机分为对照组及观察组各80例,予以对照组患者普外科手术围手术期常规护理,予以观察组患者围手术期循证护理模式护理,比较2组患者术前恐惧评分(FAVS)、围手术期的生存质量(QOL)评分及治疗依从性.结果 2组患者术前恐惧情绪评分比较,观察组明显低于对照组患者,术前及术后生存质量评分比较,观察组患者明显高于对照组患者.观察组的治疗依从性显著优于对照组.结论 循证护理模式可有效改善普外科患者术前恐惧情绪及围手术期生存质量,提高患者治疗过程中的依从性,促进手术成功及疾病恢复,值得临床推广应用.     

循证护理在腹腔镜下宫颈癌术后的应用效果评价

目的:探讨循证护理在腹腔镜下宫颈癌术后的应用效果。方法:选择我院2014年3月~2016年1月接受腹腔镜下宫颈癌术治疗的患者75例作为研究对象,随机分为常规组和循证组。常规组围术期采取常规护理模式;循证组围术期采取循证护理模式。比较两组患者围术期护理满意度;对宫颈癌疾病的认知、手术治疗认知、手术配合评分;手术并发症发生情况;护理前后患者焦虑、抑郁等不良情绪;护理前后患者生活质量的改变。结果:循证组患者围术期护理满意度及对宫颈癌疾病的认知、手术治疗认知、手术配合评分比常规组高(P0.05);循证组手术并发症发生率比常规组低(P0.05)。循证组较常规组生活质量明显提高(P0.05)。结论:循证护理在腹腔镜下宫颈癌术后的应用效果确切,可有效提升患者对宫颈癌和手术治疗的认识,提高手术配合度,减轻不良情绪,减少并发症的发生,改善患者生活质量,提高护理满意度,值得推广。     

23G微创玻璃体切割手术的护理体会

目的：探讨23G微创玻璃体切割手术的术中护理配合要点及围手术期的护理,以提高护理配合质量和手术疗效。方法对56例采用23G微创玻璃体切割手术治疗的玻璃体视网膜疾病患者的临床资料与护理体会进行回顾性分析。结果56例手术均在护士及时有效的手术配合护理下顺利完成,所有病例术后均无出血、低眼压、结膜下气体、眼内炎等并发症,手术效果满意。结论术前做好宣教和充分准备,了解23G玻璃体切割术器械特点,术中密切配合,术后正确处理和健康指导,可为23G微创玻璃体切割手术成功提供良好的保证。     

基于循证护理干预在心脏手术患者围手术期低体温的防护研究

目的 探究基于循证护理干预在心脏手术患者围手术期低体温的防护效果。方法 选取 2021 年 7 月至 2022 年 10 月于中 山市人民医院行心脏手术的患者 180 例为研究对象。按照组间特征基本符合原则将患者分为常规组和循证组。常规组采用常规 保温护理，循证组在常规组的基础上给予循证护理。比较两组患者诱导结束、手术开始、手术结束时的体温。比较两组患者的 术中液体总入量、总尿量、手术时间、低体温发生率、伤口感染发生率及护理满意程度。结果 手术开始及手术结束时，循证 组体温均显著高于常规组（P<0.05）。循证组低体温发生率、伤口感染发生率低于常规组，护理满意度高于常规组（P<0.05）。 结论 基于循证护理干预应用于心脏手术患者围手术期，能够提高体温稳定效果，降低心脏手术患者围手术期低体温发生率及 伤口感染发生率，提高患者护理满意度。     

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.     

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.