ICU腹泻患者失禁性皮炎防治中的集束化护理

目的探讨集束化护理在ICU腹泻患者失禁性皮炎防治中的应用效果。方法选取本院ICU腹泻患者100例,随机分成对照组和观察组各50例,对照组采用传统皮肤护理,观察组在传统皮肤护理的基础上实施集束化护理,评价2种护理方式的应用效果。结果观察组护理后失禁性皮炎的发生率显著低于对照组(P 0. 05),且观察组的失禁性皮炎的严重程度显著较对照组更轻(P 0. 05),观察组失禁性皮炎的愈合时间和每日护理工作时间短于对照组(P 0. 05)。结论集束化护理应用于ICU腹泻患者失禁性皮炎防治中,可有效降低患者失禁性皮炎的发生率,促进失禁性皮炎的愈合,缩短护理工作时间。     

基于HFMEA模式的护理干预对预防失禁性皮炎的应用效果

目的：探讨基于医疗失效模式与效应分析模式的护理干预在预防失禁性皮炎中的应用效果。方法：选择2018年5月~2019年5月实施常规护理干预大小便失禁患者109例作为对照组,2019年6月~2020年6月实施基于医疗失效模式与效应分析模式护理干预大小便失禁患者109例作为观察组。比较两组失禁性皮炎发生情况,干预前及干预2周后失禁性皮炎皮肤损伤评估量表评分。结果：干预前两组失禁性皮炎皮肤损伤评估量表评分比较,差异无统计学意义（P＞0.05）;干预后观察组失禁性皮炎皮肤损伤评估量表评分为（6.19±1.62）分,低于对照组的（9.52±2.16）分,差异有统计学意义（P＜0.05）。观察组失禁性皮炎发生率为2.75%,低于对照组的21.10%,差异有统计学意义（P＜0.05）。结论：基于医疗失效模式与效应分析模式的护理干预能够减少大小便失禁患者失禁性皮炎的发生,减轻皮肤受损程度,利于患者康复。     

赛肤润在老年失禁相关性皮炎患者皮肤护理中的应用

目的探讨赛肤润在老年失禁相关性皮炎患者皮肤护理中的应用及效果。方法按人院先后将2012年1月至2013年3月第二军医大学长海医院老年病科收治的45例老年失禁相关性皮炎患者分为观察组23例和对照组22例,分别采用赛肤润和鞣酸软膏进行皮肤护理。结果经积极治疗及护理,观察组23例患者中,显效及有效23例,有效率为100％;对照组22例患者中,显效及有效18例,无效4例,有效率为81．81％,两组比较,差异有统计学意义（X2=4．59,P〈0．05）。观察组和对照组患者的治愈时间分别为（4．1±0．72）d、（5．3土0．64）d,两组比较,差异有统计学意义（f=5．56,P〈0．05）。结论将赛肤润应用于老年失禁相关性皮炎患者的皮肤护理,能够有效地促进糜烂、破溃皮肤的愈合,缩短愈合时间。     

结构化皮肤护理方案对失禁性皮炎患者预防和控制效果研究

目的探讨结构化皮肤护理方案对失禁性皮炎患者预防和控制的效果研究。方法回顾性分析2017年12月至2018年12月93例失禁性皮炎患者资料,随机将患者分为研究组47例和对照组46例,对照组患者实施常规护理,研究组患者实施结构化皮肤护理方案。比较两组患者接受不同护理干预方法后失禁性皮炎严重程度和骶尾部皮肤损伤情况。结果研究组患者接受结构化皮肤护理方案后失禁性皮炎严重程度评分、骶尾部压力性损伤发生率低于对照组,差异有统计学意义(P 0. 05)。结论大便失禁性皮炎患者应用结构化皮肤护理方案,可有效减少频繁皮肤暴露,降低压力性损伤发生率,具有临床研究价值。     

护理干预对神经内科患者失禁相关性皮炎发生率及其治疗效果的影响

目的探讨护理干预对神经内科患者失禁相关性皮炎发生率及其预防效果的影响。方法选取2014年1月至2015年12月期间本院神经内科患者545例作为本次研究的对象。对照组实施常规护理,观察组实施针对性护理干预。对观察组和对照组患者失禁相关性皮炎的发生率、失禁相关性皮炎的治疗效果指标进行观察比较。结果在本次研究中,观察组患者的失禁相关性皮炎患病率为23.27%,对照组的失禁相关性皮炎发生率为36.30%,差异具有统计学意义(P0.05)。观察组患者的失禁相关性皮炎的治疗有效率为96.87%,对照组患者的治疗有效率为81.63%,差异具有统计学意义(P0.05)。结论在神经内科患者治疗的过程中,失禁相关性皮炎的发生率较高,需要对患者实施有效的护理,进而预防失禁性皮炎并提高失禁性皮炎的治疗效果。     

结构化皮肤护理管理模式应用于重症监护室大便失禁患者对预防失禁性皮炎、压疮的影响

目的探讨通过应用结构化皮肤护理模式对重症监护室大便失禁患者失禁性皮炎、压疮的预防作用。方法选取本院2013年6月~2015年6月接诊的重症监护室120例大便失禁患者进行研究。按照随机数字表法,随机均分为两组。对照组患者应用常规护理措施实施干预,观察组应用结构化皮肤护理管理模式实施护理管理。观察两组患者压疮、失禁性皮炎的发生率,患者对护理的满意度。并对护理开展情况及并发症发生率进行比较分析。结果观察组患者的压疮及失禁性皮炎的发生率明显低于对照组,差异有统计学意义(P0.05);患者对护理的满意度明显高于对照组,差异有统计学意义(P0.05);观察组患者的大便溢出次数、内置脱落次数、护垫消耗张数明显少于对照组(P0.05);护理时间明显短于对照组(P0.05);专项护理费用也明显少于对照组(P0.05);观察组患者的并发症发生率明显低于对照组,差异有统计学意义(P0.05)。结论结构化皮肤护理模式可显著降低重症监护室大便失禁患者压疮、失禁性皮炎发生率,改善护理效果,降低并发症的发生率,值得广泛应用。     

熟茶籽油在护理老年失禁相关性皮炎患者中的效果分析

目的探讨熟茶籽油对老年失禁相关性皮炎患者的防治效果。方法选择本院2014年10月~2016年5月入住综合内科发生失禁性皮炎患者60例,随机分成观察组和对照组各30例。观察组采用熟茶籽油进行护理,对照组遵医嘱采用红霉素软膏进行护理,观察两组疗效及愈合情况。结果观察组肛周、会阴部皮肤损伤发生率显著低于对照组,平均愈合时间少于对照组,差异有统计学意义(P0.05)。结论熟茶籽油能有效降低老年失禁相关性皮炎的皮肤损伤发生率,减轻患者痛苦,减少并发症,取材方便,经济成本低,易于推广。     

基于评估的分级皮肤护理干预方案在防治ICU失禁相关性皮炎中的应用

目的 探讨基于评估的分级皮肤护理干预方案在防治ICU失禁相关性皮炎(IAD)中的应用效果.方法 选取2015年1月~2016年10月该院收治的152例ICU失禁患者作为研究对象,根据随机数字表法将患者分为对照组和观察组各76例.对照组患者给予常规护理干预,观察组患者给予基于评估的分级皮肤护理干预方案.观察比较ICU治疗期间的IAD发生情况和发生IAD患者的治疗情况.结果 ICU治疗期间,观察组的IAD发生例数、IAD平均形成时间以及IAD严重程度均明显低于对照组,差异有统计学意义(均P<0.05);观察组的治疗有效率高于对照组,但差异无统计学意义(P>0.05);观察组的平均IAD愈合时间明显低于对照组,差异有统计学意义(P<0.05).结论 基于评估的分级皮肤护理干预方案在防治ICU失禁相关性皮炎中的应用效果显著,能够有效地降低ICU失禁患者的IAD发生率,提高发生IAD患者的治疗效果,值得临床推广应用.     

改良失禁皮肤护理方案在神经外科失禁患者失禁性皮炎防护中的应用

目的 探讨改良失禁皮肤护理方案在神经外科失禁患者失禁性皮炎防护中的临床应用效果。方法 采用历史对照法,在2016年6月—2017年5月、2017年6月—2018年5月分别对神经外科2组失禁患者应用常规法、改良法进行护理干预,比较常规组68例、改良组71例患者失禁性皮炎防护的应用效果。结果 失禁皮肤护理干预方案实施前,2组失禁患者在性别、年龄、自理能力、意识、营养、大便性状、大小便控制能力、失禁类型、失禁频次及失禁性皮炎风险因素评分方面的差异无统计学意义（P>0.05）;实施后,改良组患者在失禁性皮炎的发生率、失禁性皮炎分级、失禁性皮炎发生面积优于常规组（P<0.05）。结论 改良失禁皮肤护理方案在神经外科中的应用,可以有效简化神经外科失禁患者皮肤护理流程,减少皮肤刺激,从根本上降低失禁性皮炎发生率及严重程度。     

4R危机管理理论在ICU患者失禁相关性皮炎管理中的应用

目的 探讨4R危机管理理论对ICU患者失禁相关性皮炎的防控效果。方法 选取2018年6-12月ICU收治的270例失禁患者为对照组,采取传统的皮肤护理方法对失禁患者进行管理。选取2019年1—7月ICU收治的254例失禁患者为观察组,采取4R危机管理理论对失禁患者进行管理。比较2组失禁相关性皮炎发生率以及失禁相关性皮炎严重程度。结果 观察组发生失禁相关性皮炎发生率为14.9%低于对照组的23.3%,2组比较,差异有统计学意义(χ²= 5.897,P= 0.015)。观察组失禁相关性皮炎严重程度轻于对照组(Z=-2.491,P=0.013)。结论 应用4R危机管理理论对ICU失禁患者进行管理,能有效降低失禁相关性皮炎发生率,减轻失禁相关性皮炎的严重程度,促进了护理质量持续的改进。     

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.