艾条灸法联合心理干预治疗妊娠剧吐的效果观察

目的观察艾条灸法联合心理干预治疗妊娠剧吐的效果。方法妊娠剧吐孕妇80例,按随机数字表分为对照组和观察组各40例,对照组采用常规治疗及心理干预,观察组在对照组的基础上加艾灸治疗,治疗1周后评价两组患者治疗效果、住院时间和患者对护理满意度。结果观察组治疗效果、护理满意度优于对照组,住院时间短于对照组,差异均有统计学意义。结论艾条灸法联合心理干预治疗妊娠剧吐可提升疗效。     

体外受精-胚胎移植术后妊娠剧吐患者的护理对策

目的 探讨体外受精-胚胎移植术(IVF-ET)受孕后妊娠剧吐患者的护理对策。 方法选取2016年3~12月生殖中心收治的59例IVF-ET受孕后妊娠剧吐的患者,采用随机数字表法将其分为实验组30例与对照组29例。对照组实施常规护理,实验组在此基础上进行护理干预。比较2组患者焦虑评分、住院时间和患者满意度。 结果 干预后实验组患者焦虑得分明显低于对照组(t=9.973,P<0.001);住院时间明显短于对照组(t=5.799,P<0.001),患者的满意度得分明显高于对照组(t=8.134,P<0.001)。 结论 护理干预能减轻IVF-ET受孕后妊娠剧吐孕妇的焦虑情绪,有效改善妊娠剧吐症状,从而缩短住院时间,提高患者满意度。     

穴位敷贴中脘、内关、足三里穴治疗妊娠剧吐的效果观察

目的观察穴位敷贴中脘、内关、足三里穴治疗妊娠剧吐的临床效果。方法选取妊娠剧吐孕妇80例,随机分为对照组和观察组各40例,对照组采用中医妇科妊娠恶阻护理常规,观察组在对照组的基础上增加穴位敷贴中脘、内关、足三里穴治疗,治疗2周后评价两组患者治疗效果、住院时间和患者对护理的满意度。结果观察组治疗效果、护理满意度优于对照组,住院时间短于对照组,差异均有统计学意义(P0.05)。结论穴位敷贴中脘、内关、足三里穴治疗妊娠剧吐,可有效改善妊娠剧吐患者症状,缩短住院时间,提升护理满意度。     

心理干预配合中药治疗妊娠剧吐的临床疗效观察

[目的]观察心理干预配合中药治疗妊娠剧吐的效果.[方法]46例妊娠剧吐孕妇随机分为观察组和对照组,各23例,对照组采用常规对症治疗,观察组在常规对症治疗基础上,加用心理干预方法配合口服中药.现察并比较两组病人治疗效果.[结果]观察组治疗总有效率为100.0%,对照组为82.6%,两组总有效率比较差异有统计学意义(P<0.05).[结论]心理干预配合口服中药治疗可明显提高妊娠剧吐治疗效果.     

中药贴敷神阙穴联合温针内关穴治疗妊娠剧吐效果观察及护理

目的探讨中药贴敷神厥穴联合温针内关穴治疗妊娠剧吐的效果,总结护理措施。方法妊娠剧吐孕妇60例分为对照组和观察组,各30例。对照组常规治疗和护理,观察组在对照组基础上采用中药贴敷神厥穴联合温针内关穴进行干预。观察2组妊娠剧吐改善情况,比较2组干预前后中医症候积分,记录2组干预后进食情况。结果观察组妊娠剧吐改善总有效率为96.67%(29/30),高于对照组的73.33%(22/30),差异有统计学意义(P<0.05)。干预后,2组恶心、呕吐及饮食障碍、神疲倦怠、倦怠思睡症候积分均降低,且观察组各项症候积分低于对照组(P<0.05)。观察组每日进食量优于对照组。结论中药贴敷神厥穴联合温针内关穴刺激治疗妊娠剧吐并给以相应护理可有助于改善孕妇呕吐症状,提高孕妇生活质量。     

心理干预对改善妊娠剧吐患者焦虑症状的效果观察

目的 探讨心理干预对改善妊娠剧吐住院患者焦虑症状的效果.方法 将80例妊娠剧吐住院患者采用单双号法随机分为观察组40例,对照组40例.两组均采用常规治疗方法和护理,观察组给予心理干预.结果 心理干预后妊娠剧吐患者的焦虑程度明显低于心理干预前.结论 实施心理干预可有效降低妊娠剧吐患者的焦虑程度,对妊娠剧吐的治疗有积极意义.     

梅花针叩刺联合穴位贴敷在妊娠剧吐患者中的应用

目的:探讨梅花针叩刺联合穴位贴敷在妊娠剧吐患者中的应用方法及效果。方法:将88例妊娠剧吐患者随机分为观察组和对照组各44例,对照组采用常规护理措施,观察组在此基础上采用梅花针叩刺联合穴位贴敷,比较两组干预效果。结果:观察组总有效率高于对照组(P0.05)。两组干预后中医症候评分及恶心呕吐指数问卷(RINV)、贝克焦虑量表(BAI)评分低于干预前(P0.05),观察组干预后中医症候评分及RINV、BAI评分低于对照组(P0.05)。两组干预后生活质量综合评定量表(GQOLI-74)评分高于干预前(P0.05),观察组干预后GQOLI-74评分高于对照组(P0.05)。两组止吐时间、住院时间、离院复发率比较差异有统计学意义(P0.05,P0.01)。结论:梅花针叩刺联合穴位敷贴对妊娠剧吐有明显的改善作用,有利于缩短住院时间,提高患者生活质量。     

评判性护理干预在妊娠剧吐患者心理健康管理中的应用

目的探讨评判性护理干预在妊娠剧吐患者心理健康管理中的应用效果。方法选取2014年8月~2016年12月本科收治的妊娠剧吐患者106例,按先、后顺序分为观察组56和对照组50例,观察组对其心理健康进行评判性护理干预,对照组采用常规心理护理方法,比较2组患者SAS评分、舒适度及治疗效果。结果入院第1天观察组与对照组SAS评分、舒适度差异无统计学意义(P0.05);入院第7天观察组相对对照组,SAS评分明显降低,舒适度、治疗效果则显著提高,差异有统计学意义(P0.05)。结论对妊娠剧吐患者心理健康状态采取评判性护理干预,能有效减轻其焦虑程度,提高舒适度及治疗效果,增强护理服务质量和水平。     

三通混合补液对妊娠剧吐孕妇输液时间的影响

目的观察采用三通混合静脉补液在妊娠剧吐输液中对输液时间的影响。方法将60例妊娠剧吐的孕妇随机分为观察组和对照组各30例,观察组采用三通混合静脉补液,对照组使用普通钢针输液器进行补液。比较两组患者输液完成时间及患者的满意度。结果观察组输液完成时间为（9．50±0．51）h,对照组输液完成时间为（15．97±1．79）h,差异有统计学意义（P〈0．05）,观察组孕妇对静脉输液满意度高于对照组（P〈0．01）。结论采用三通混合静脉补液的方式在妊娠剧吐输液治疗中,可缩短每天输液时间,提高孕妇对治疗的满意度。     

护理干预对妊娠剧吐患者心理和临床症状的影响

目的探讨护理干预对妊娠剧吐患者心理和临床症状的影响,寻求提高妊娠剧吐患者生活质量的方法。方法将62例妊娠剧吐患者随机分为两组,对照组（n=30）给予常规治疗护理,试验组（n=32）在常规治疗护理的基础上给予护理干预。于护理干预前和4周末采用焦虑自评量表（SAS）分析对两组患者评定,比较两组的治疗效果。结果护理干预前两组患者SAS评分差异无统计学意义（P〉0．05）;4周末试验组SAS评分（30．12±5．68）分,对照组为（35．28±6．57）分;临床症状改善情况比较,试验组有效率为96．88％,对照组有效率为80．00％;两组比较,差异均有统计学意义（P〈0．05）。结论护理干预有助于改善妊娠剧吐患者负性情绪,减轻妊娠剧吐症状,提高患者的生活质量,有临床应用价值。     

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.     

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.     

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.     

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.