护理干预对眼眶肿瘤手术患者的影响

目的 探讨护理干预对眼眶肿瘤手术患者预后的影响,完善眼眶肿瘤手术患者的护理模式.方法 选择眼眶肿瘤手术患者80例,随机分为对照组和干预组各40例.对照组采用传统护理模式,干预组采用临床护理路径模式进行护理,重点做好心理护理和视力监测.对2组患者健康教育知识的掌握程度、主观感觉、对护理的满意度、对疾病治愈的信心、并发症发生情况、视力监测异常发现次数等项目进行比较.结果 干预组患者对健康教育知识的掌握程度、主观感觉、护理满意度、疾病治愈的信心、视力监测发现异常情况、并发症情况均显著优于对照组.结论 结合眼眶肿瘤的特点使用临床护理路径,并在护理过程中突出护理重点,可提高护士工作效率,保证护理质量.     

心理护理对妊高征患者的影响与研究

目的 探讨心理护理对妊高征患者预后的影响,完善妊高征患者顺利经过围产期的护理模式.方法 选择妊高征患者80例,随机分为对照组和干预组各40例.对照组采用传统护理模式,干预组重点加用心理护理.对两组患者健康教育知识的掌握程度、主观感觉、对护理的满意度、对疾病治愈的信心、并发症发生情况等项目进行比较.结果 干预组对健康教育知识的掌握程度、主观感觉、护理满意度、疾病治愈的信心、并发症发生情况均显著优于对照组.结论 妊高征患者在护理过程中突出心理护理,可提高护士的工作效率,保证护理质量.     

整体护理对妊娠滋养细胞肿瘤患者化疗不良反应的影响

目的:探讨整体护理干预对培养细胞肿瘤患者化疗不良反应的影响。方法:选取妊娠滋养细胞肿瘤患者86例随机分为对照组40例和干预组46例,化疗方案均为联合应用长春新碱、氟尿嘧啶、放线菌素D和环磷酰胺,对照组采用传统护理模式,干预组采用专人负责的整体护理,在健康教育知识的掌握、化疗不良反应、护理满意度方面对两组患者进行比较。结果:干预组患者发生化疗不良反应明显低于对照组(P<0.05)。结论:对妊娠滋养细胞肿瘤患者实施整体护理,可以降低患者的负性心理状态,增加治愈疾病的信心,提高生活质量。     

临床护理路径在食道癌患者围手术期护理中的应用效果

目的探讨临床护理路径(CNP)在食道癌患者围手术期应用的效果。方法选取本科2016年8月~2017年3月入住本科并手术的56例食道癌患者为研究对象,采用随机分组法分为对照组28例和观察组28例。对照组予以常规护理,观察组按CNP模式进行护理。比较两组护理干预后健康知识掌握、术后并发症、护理满意度、住院时间等。结果观察组健康知识掌握、护理满意度均高于对照组(P0.05);术后并发症、住院时间明显低于对照组(P0.05)。结论应用临床护理路径(CNP)对食道癌患者围手术期进行全程护理可以预防术后并发症、缩短住院时间,提高患者健康知识水平及护理满意度。     

临床护理路径管理在胃大切手术患者围手术期中的实施效果评价

将90例胃大切手术患者随机分为观察组和对照组各45例,对照组患者围手术期接受常规护理干预,观察组患者接受临床护理路径管理模式,比较两组患者一般临床指标及健康知识掌握情况、满意度等指标。结果观察组平均住院日缩短,并发症减少,遵医行为提高、对疾病健康知识的掌握程度及满意度提高,明显优于对照组(P0.05),差异有统计学意义。临床护理路径模式应用于胃大切手术患者的围手术期管理,利于规范医疗护理行为、提高医疗护理质量,并减少患者住院时间,有利患者康复。     

应用临床路径对重症急性胰腺炎患者实施健康教育的效果评价

目的探讨应用临床路径对重症急性胰腺炎患者实施健康教育的效果。方法将60例重症急性胰腺炎随机分为研究组与对照组各30例。研究组采用临床护理路径对患者进行健康教育,对照组采用传统随机健康教育方式,比较两组相关疾病知识掌握情况、治愈信心、健康教育达标率、住院时间、满意度和并发症的发生情况。结果研究组在疾病相关知识掌握率、治愈信心、健康教育达标率、患者护理质量满意度、总住院天数、并发症的发生率等方面均优于对照组(P<0.05)。结论应用临床路径对重症急性胰腺炎患者实施健康教育,为整体护理提供了更有效的指导,可提高医疗护理质量,减少并发症的发生。     

临床护理路径在经外周静脉置入中心静脉导管化疗患者健康教育中的应用研究

目的 探讨临床路径在经外周静脉置入中心静脉导管（PICC）化疗患者健康教育中的作用.方法 行PICC的患者164例,随机分为对照组和实验组.对照组采用传统的健康教育方法,实验组采用临床护理路径模式,对患者及家属进行健康指导.比较两组PICC置管知识掌握率、服务质量满意度、健康教育达标率、疾病治疗信心、住院天数、并发症.结果 实验组健康宣教的达标率及满意度、对PICC置管知识掌握率、对疾病的治疗信心明显高于对照组,患者的住院天数和并发症的发生率明显低于对照组（P＜0.01）.结论 PICC置管者应用临床护理路径进行护理,能增加患者对健康知识的掌握度、提高了患者的满意度、节省了护理人力资源、同时也能提高护理服务质量.     

临床护理路径在急性心肌梗死患者中的应用

目的:探讨临床护理路径在急性心肌梗死患者中的应用效果。方法:将2009年1～12月入院的90例急性心肌梗死患者作为对照组,2010年1～12月入院的90例心肌梗死患者作为干预组,对照组采用常规护理,干预组应用临床护理路径护理。比较两组患者的疾病知识掌握情况、SCL-90因子评分及患者对护理工作的满意度。结果:干预组SCL-90因子得分明显低于对照组(P<0.05),疾病知识掌握率和对护理工作的满意度高于对照组(P<0.05)。结论:临床护理路径的开展可降低患者不良情绪发生率,掌握必要的疾病知识,提高患者对护理工作的满意度。     

临床路径在农村合作医疗白内障患者中的应用

目的研究临床护理路径应用于新型农村合作医疗（新农合）白内障手术患者的实施效果。方法对住院择期行白内障超声乳化联合人工晶体植入术患者分为新农合组（观察组）和非新农合组（对照组）各108例，对照组实施传统治疗和护理，观察组实施临床护理路径，比较2组的护理效果。结果观察组患者的平均住院日及平均住院费用均低于对照组（p〈0.05）；而健康知识掌握及患者住院满意度情况均高于对照组（p〈0.01）；2组术后并发症差异无统计学意义（p〉0.05）。结论临床护理路径应用于新合白内障手术患者能缩短住院日，降低住院费，同时能提高患者对健康教育知识的掌握和对住院满意度。临床护理路径值得在新农合患者中推广应用。     

临床护理路径在腹股沟疝手术中的应用

目的:探讨临床护理路径在腹股沟疝手术治疗中的应用。方法:将60例腹股沟疝行无张力修补术患者随机分为对照组和观察组各30例,对照组给予常规护理干预,观察组按照临床护理路径进行护理干预,分析比较两组患者的住院时间、费用,术后的并发症、满意度、健康教育掌握程度。结果:在住院时间、费用、术后并发症上,观察组明显少于对照组(P<0.05);在满意度、健康教育掌握程度上,观察组明显优于对照组(P<0.05)。结论:对腹股沟疝手术治疗的患者,临床护理路径能够缩短住院时间,减少住院费用和术后并发症,提高对健康教育掌握的程度和术后满意度。     

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.     

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.