全程陪伴分娩实施心理干预的效果观察

目的探讨全程陪伴分娩过程中实施心理干预的效果.方法干预组采取常规护理,分别观察产程时间、分娩方式、产后大出血及新生儿Apgar评分情况.结果干预组第一产程、第二产程及总产程时间与对照组对比均明显缩短(p＜0.01).干预组剖宫产及产后出血均显著少于对照组(p＜0.01),Apgar评分0～7分者低于对照组(p＜0.05).结论全程陪伴分娩过程中实施心理干预可缩短产程、降低产后出血率和剖宫产率,有利于母婴安全.     

激励式心理干预对初产妇产程情况及分娩结局的影响

目的:探讨激励式心理干预对初产妇产程情况及分娩结局的影响。方法:将160例行自然分娩的初产妇随机分为观察组和对照组各80例,观察组给予常规护理联合激励式心理干预,对照组仅给予常规护理;比较两组患者的负面情绪、产程情况及分娩结局。结果:观察组产妇的HAMA评分、HAMD评分、SAS评分、SDS评分明显均低于对照组(P0.05),第一产程、第二产程、第三产程和总产程时间均短于对照组(P0.05),产后出血量、产褥期感染例数、分娩后卧床时间均少于对照组(P0.05),新生儿Apgar评分高于对照组(P0.05)。结论:激励式心理干预能够缓解焦虑和抑郁情绪、缩短产程、改善分娩结局,具有积极的临床应用价值。     

心理干预联合地西泮、利多卡因用药对产程的影响研究

目的探讨心理干预联合地西泮、利多卡因用药对产程的影响。方法观察组50例使用药物及心理干预与常规对照组50例进行比较。结果观察组的产程明显短于对照组(P0.01);观察组的产后出血量少于对照组(P0.01),观察组新生儿Apgar评分及自然分娩方式均优于对照组(P0.01)。结论心理干预联合地西泮、利多卡因药物应用,可短缩产程,降低产后出血率和新生儿窒息率。     

阶段性护理干预对改善初产妇分娩疼痛感及促进产程进展的影响

目的观察阶段性护理干预对改善初产妇分娩疼痛感及促进产程进展的影响。方法选取在本院待产的168例初产妇为研究对象,采用随机数字表分为观察组及对照组各84例,对照组给予产科常规护理,观察组给予阶段性护理干预,并采用自我效能量表、分娩控制量表、疼痛评分、产程时间、剖宫产率、产后出血率、新生儿窒息率来比较干预效果。结果观察组干预后自我效能及分娩控制感评分显著高于对照组,分娩疼痛评分低于对照组,第一产程、第二产程、总产程时间短于对照组,产后出血量少于对照组,新生儿阿氏评分高于对照组,比较差异均有统计学意义(P0.05);观察组剖宫产率、产妇产后出血率、新生儿窒息率均低于对照组,差异具有统计学意义(P0.05);观察组家属满意率高于对照组,差异具有统计学意义(P0.05)。结论阶段性护理干预能有效缓解初产妇分娩疼痛感,增强产妇自我效能,缩短产程,降低不良妊娠结局的发生,提高家属满意度。     

综合护理干预在产妇分娩中的应用效果

目的：探讨在产科应用综合护理干预对产妇产程、分娩方式、心理状态、产后出血及新生儿评分等影响。方法选取我院产科2013年12月至2014年12月住院待产的产妇280例作为研究对象,按住院顺序随机分为对照组和研究组各140例;对照组产妇接受常规产科护理,研究组产妇接受综合护理干预,记录并比较产妇产程、分娩方式、心理状态、产后出血及新生儿评分等指标。结果研究组产妇自然分娩率(80.71%)较对照组明显提高,剖宫产率(19.29%)较对照组明显降低,差异有统计学意义(P<0.05);研究组产妇第一产程时间(350.41±56.65)min、第二产程时间(41.54±4.11)min及总产程时间(413.65±73.22)min均较对照组相应数据明显减少,差异有统计学意义( P<0.05);而两组第三产程时间比较差异无统计学意义( P>0.05);研究组产妇干预后SAS评分(32.17±4.03)分和SDS评分(30.19±4.11)分均较自身干预前和对照组干预后明显减少,差异有统计学意义( P<0.05);研究组产妇产后2 h出血量(115.53±10.43) ml、产后24 h出血量(185.10±17.14) ml及新生儿Apgar评分(7.42±0.52)ml,均较对照组相应数据明显减少,差异有统计学意义(P<0.05)。结论综合护理干预用于产妇分娩中可提高自然分娩率,促进产妇产程进展,消除其心理压力,减少产后出血,提高分娩质量,值得推广。     

助产士综合护理对于会阴无保护分娩产妇会阴裂伤及满意度的影响

目的:探讨会阴无保护分娩产妇实施助产士综合护理对产妇产程中配合程度、会阴裂伤情况、住院时间、满意度的影响.方法:选取2018年2月—2019年12月期间我院会阴无保护分娩产妇170例,随机抽签分为对照组和观察组各85例,对照组实施常规护理,观察组在对照组基础上实施助产士综合护理.比较产妇产程中配合程度、会阴切开率、会阴完整率、会阴裂伤程度、产后2h出血率、第二产程时间、疼痛程度、产后住院时间、新生儿Apgar评分及护理满意度.结果:观察组产妇配合度高于对照组(P<0.05),观察组会阴侧切率、Ⅰ度和Ⅱ度裂伤率、产后2 h出血率均低于对照组,会阴完整率高于对照组(P<0.05);观察组第二产程时间、住院时间短于对照组,VAS评分低于对照组,Apgar评分高于对照组(P<0.05);观察组产妇护理满意度高于对照组(P<0.05).结论:助产士综合护理可提升会阴无保护分娩产妇配合度和满意度,降低会阴裂伤程度及侧切率,母婴不良情况少,产程和住院时间均缩短,效果显著.     

温馨助产护理在初产妇围产期的应用

目的研究探讨温馨助产护理在初产妇围产期的应用效果。方法选择2017年1月—2018年7月本院产房待产的100例临产初产妇,按照随机数字表法,分为对照组和观察组,每组各50例。对照组实施常规助产护理干预,观察组实施温馨助产护理干预。比较两组产妇的产程时间、分娩方式、产后出血情况、新生儿Apgar评分、焦虑抑郁评分、母亲角色适应能力评分、护理满意度。结果 (1)观察组的第一产程时间、第二产程时间、总产程时间均短于对照组(P0.05),而两组第三产程时间比较无统计学意义(P0.05)。(2)观察组的阴道自然分娩率高于对照组(P0.05),其剖宫产率低于对照组(P0.05)。(3)观察组的产后2、24 h出血量均少于对照组(P0.05),其产后出血发生率低于对照组(P0.05)。(4)观察组新生儿娩出1、5 min的Apgar评分均高于对照组(P0.05)。(5)护理后,观察组的焦虑评分、抑郁评分均低于对照组(P0.05),其母亲角色适应能力评分高于对照组(P0.05)。(6)观察组的护理总满意率高于对照组(P0.05)。结论温馨助产护理干预可有效缩短初产妇的产程时间,减少剖宫产和产后出血,降低新生儿窒息风险,有利于改善分娩结局,还可有效减轻初产妇的焦虑抑郁情绪,促使其尽快适应母亲角色,使其对产科助产护理更加满意。     

适时综合护理干预对产妇分娩质量及产后心理状态的影响

目的:探讨适时综合护理干预对产妇分娩质量及产后心理状态的影响。方法:将2013年6~11月住院待产且要求经阴分娩的100例产妇作为研究对象,随机分为对照组和干预组各50例,对照组采取常规产程指导,干预组采取适时产程护理干预。结果:干预组产妇阴道分娩率、新生儿Apgar评分均明显高于对照组(P0.05),产妇总产程时间、产后出血量、干预后焦虑自评量表(SAS)评分和抑郁自评量表(SDS)评分均少于对照组(P0.05),产后出血、尿潴留、产褥感染、宫内窘迫及新生儿窒息发生率均低于对照组(P0.05)。结论:适时综合产时护理干预对提高经阴分娩质量、改善产妇不良心理反应、降低剖宫产率均有显著效果,适合临床借鉴并进行推广应用。     

产前应用细致化措施联合助产士干预对产妇分娩情况及产后出血率的影响

目的探讨产前应用细致化措施联合助产士干预对产妇分娩情况及产后出血率的影响。方法选取2019年6月至2020年12月广州市第一人民医院收治的分娩产妇150例, 随机数字表法将其分为观察组和对照组, 每组75例。观察组产妇在产前应用细致化措施联合助产士干预进行护理, 对照组产妇产前采用常规护理。对比两种护理方式对产妇分娩情况及产后出血率的影响。结果观察组第一产程和第二产程所需时间短于对照组, 差异有统计学意义(P<0.05);观察组第三产程所需时间与对照组比较差异无统计学意义(P>0.05);观察组干预后产妇下床时间、住院时间均短于对照组, 产后2 h出血量低于对照组, 胎儿产后1 min Apgar评分和产后5 min Apgar评分均高于对照组, 产后出血率低于对照组, 护理满意度高于对照组, 差异有统计学意义(P<0.05)。结论产前应用细致化措施联合助产士干预能够显著提升产妇分娩质量, 降低产妇产后出血率, 缩短产程。     

产妇分类管理联合安抚教育在降低产妇分娩风险及提高顺产率中的应用效果

目的探究产妇分类管理联合安抚教育在降低产妇分娩风险及提高顺产率中的应用效果。方法选取2016年1月—2018年1月于本院进行分娩的79例产妇为研究对象,按照随机数字表法将其分为实验组(39例)和对照组(40例),对照组产妇实施常规产前干预,实验组产妇实施产妇分类管理联合安抚教育,比较两组产妇各产程时间、产后出血量、产后24 h疼痛度及顺产率,两组新生儿阿氏评分(Apgar评分)、窘迫发生率及酸中毒发生率。结果 (1)实验组各产程时间均短于对照组(P0.05);(2)实验组产妇产后出血量、产后24 h疼痛度均低于对照组,但顺产率高于对照组(P0.05);(3)实验组新生儿窘迫、酸中毒等不良事件的发生率低于对照组,同时实验组新生儿Apgar评分高于对照组(P0.05)。结论产妇分类管理联合安抚教育能够显著降低产妇分娩风险,同时提高产妇顺产率,且有利于降低新生儿各类不良事件的发生率。     

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.     

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.