护理干预及早期观察在手足口病重症患儿的临床应用

目的：探讨护理干预及早期观察在手足口病重症患儿的临床应用效果。方法选取我院诊治的手足口病重症患儿106例,根据护理方案分为对照组和观察组,每组53例。对照组患儿实施常规护理,观察组患儿实施护理干预及早期观察。比较两组患儿的病症消失情况、住院情况、继发感染情况。结果观察组患儿发热消失时间、头痛呕吐消失时间、肢体抖动消失时间、住院时间均明显少于对照组（均P＜0.05）,观察组患儿继发感染发生率明显低于对照组（P＜0.05）。结论护理干预及早期观察可明显改善手足口病重症患儿的临床病症,显著缩短患儿的治疗时间,并发症少且安全性高,值得临床推广使用。     

综合性护理在重症手足口患儿中的应用效果

目的探讨综合性护理在重症手足口患儿中的应用效果。方法选取2016年1月~2016年12月所收治的120例接受治疗的重症手足口病患儿,依据患儿入院时接受治疗的顺序进行相应分组,单号设定为对照组,而双号设定为观察组,各60例,对照组患儿实施常规的对症护理措施,而观察组患儿在治疗期间实施综合性护理干预措施,对比2组患儿的并发症发生率以及患儿的住院时间。结果观察组患儿的并发症发生率显著低于对照组,并且观察组患儿的住院时间也显著低于对照组,比较差异具有统计学意义(P0.05)。结论对重症手足口病患儿实施综合护理措施,能够有效降低患儿的并发症发生率,缩短患儿的住院时间,值得在临床上推广。     

综合性护理对重症手足口病患儿的应用效果

目的:探讨综合性护理对重症手足口病患儿的应用效果及生活质量的影响。方法:选取2014年5月~2017年5月我院收治的重症手足口病患儿90例,随机分为对照组与观察组各45例。对照组给予常规护理,观察组给予综合性护理干预,比较两组临床症状消失时间、住院时间及并发症发生率,干预前后生活质量评分和护理满意度情况。结果:(1)观察组临床症状消失时间、住院时间及并发症发生率均显著低于对照组(P<0.05);(2)干预前两组患儿CIVIQ评分比较无明显差异(P>0.05),干预后两组患儿CIVIQ评分均有所提高,且观察组明显高于对照组(P<0.05);(3)观察组护理满意度显著高于对照组(P<0.05)。结论:与常规护理比较,综合性护理干预在重症手足口患儿中应用效果显著,可有效改善患儿生活质量,提高护理满意度,促进康复,值得临床推广应用。     

分期集束化护理干预在重症手足口病患儿中的应用

目的:探讨分期集束化护理干预在重症手足口病患儿中的应用效果。方法:将2011年1月~2012年6月收治的重症手足口病患儿30例作为对照组,2012年8月~2013年12月收治的重症手足口病患儿31例为观察组,对照组给予常规护理,观察组给予分期集束化护理干预,比较两组主要症状消失时间、住院时间、医生和家属对护理工作的满意度及治愈率。结果:观察组主要症状消失时间、住院时间、医生和家属对护理工作的满意度、治愈率均优于对照组(P0.05,P0.01)。结论:分期集束化护理能有效阻断重症手足口病患儿病情的进一步发展,缩短住院时间,提高家属满意度。     

强化护理干预对手足口病合并脑炎患儿治疗效果及预后的影响

目的探讨强化护理干预在手足口病合并脑炎患儿治疗中的应用效果。方法将80例重症手足口合并脑炎患儿随机分为观察组和对照组,对照组采用常规护理,观察组在对照组的基础上采用强化护理干预,比较患儿的治疗依从性、效果、预后以及家长的护理满意度。结果观察组的治疗依从性、总有效率高于对照组,高热、皮疹、神经内系统症状等消失时间均短于对照组,差异有统计学意义(P0.05)。观察组的并发症少于对照组,住院时间短于对照组,预后评分高于对照组,家长的护理满意度高于对照组,差异有统计学意义(P0.05)。结论强化护理干预能够提高手足口病合并脑炎患儿的临床疗效,加速症状缓解,改善患儿的预后。     

手足口病患儿的护理干预效果观察

[目的]观察手足口病患儿的护理干预效果.[方法]将64例手足口病患儿随机分为观察组和对照组,每组32例,对照组给予常规护理,观察组在对照组基础上给予护理干预.比较两组患儿病情恢复情况（包括精神状况好转时间、病情好转时间及住院时间）、并发症发生情况（包括皮肤感染、上呼吸道感染、心脏损害、脑炎）.[结果]观察组病人精神状况好转时间、病情好转时间及住院时间短于对照组（P＜0.05）;观察组并发症发生率低于对照组（P＜0.05）.[结论] 护理干预可促进手足口病患儿病情恢复,减少并发症的发生.     

护理干预对重症手足口病重型病例预后的影响

目的探讨护理干预对小儿重症手足口病重型病例疗效和预后的影响。方法将收治的52例小儿重症手足口病重型病例随机分为观察组和对照组,观察组给予全面护理干预,包括健康教育、消毒隔离、皮肤及口腔护理、症状护理等,对照组仅给予一般护理,观察两组患儿疾病康复情况。结果观察组26例患儿经过精心治疗与护理均康复出院,对照组有2例病情恶化转院治疗,与对照组相比,观察组退热时间、肢体抖动康复时间及住院时间均明显缩短,两者差异有统计学意义(P<0.05);观察组头痛伴呕吐的康复时间短于对照组,继发感染的发生率也低于对照组。结论对小儿重症手足口病重型病例加强病情观察,及时给予护理干预,可促进疾病康复,缩短住院时间,改善预后。     

持续性护理对手足口病患儿治疗依从性及焦虑情绪的影响

目的 探讨持续性护理对手足口病患儿治疗依从性及焦虑情绪的影响.方法 将74例手足口病患儿随机分为观察组和对照组各37例.对照组给予手足口病一般护理,观察组在一般护理基础上实施持续性护理.结果 干预后,观察组患儿行为、运动、饮食及用药的依从性都高于对照组患儿,差异均有统计学意义(P＜0.05或P＜0.01);干预后,观察组患儿焦虑评分、抑郁评分都低于对照组,差异均有统计学意义(P＜0.01);观察组患儿发热缓解时间、疱疹缓解时间、溃疡缓解时间、住院时间、住院费用都低于对照组患儿,差异均有统计学意义(P＜0.01);观察组并发症发生率低于对照组,差异有统计学意义(P＜0.05).结论 持续性护理能够为手足口病患儿在住院期间和出院后提供有效的护理指导,缓解患儿焦虑情绪,提高患儿治疗依从性,降低并发症发生率,还能缩短患儿住院天数,减轻患者家庭经济负担.     

护理干预对重症手足口患儿治疗效果的影响

目的探讨护理干预在重症手足口患儿中的应用效果。方法将我院2012年2月至2013年2月收治的60例重症手足口患儿随机分为观察组和对照组,各30例。对照组采用常规护理,观察组在对照组的基础上采用综合护理,比较两组的护理效果。结果观察组家长的健康知识知晓率显著高于对照组,高热消退、疱疹消退、转入ICU的例数、并发症、住院时间显著少于对照组,生活能力显著高于对照组,有统计学意义（P〈0．05）。观察组在焦虑标分、生活标分、躯体标分等生活质量评分显著高于对照组,有统计学意义（P〈0．05）。结论综合性护理干预使护理更加全面、具体、有针对性,能够显著改善重症手足口患儿治疗的转归,缩短治疗时间,减少并发症。     

综合护理对重症手足口患儿生活质量及并发症的影响分析

选取2015年1月~2016年8月我院收治的57例重症手足口病患儿。随机分为对照组28例和观察组各29例。对照组采用常规护理,观察组在对照组的护理基础采用综合护理干预。记录两组患儿的临床症状消失时间、并发症发生情况,且对患儿干预后的生活质量进行评估。结果与对照组相比,观察组的临床症状消失时间明显较短,并发症发生率明显较低,生活质量评分更高(P0.05)。重症手足口病施行综合护理干预有助于降低患儿的并发症发生风险,提高其生活质量,值得广泛推广。     

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.     

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.     

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.     

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.