不同年龄患儿应用静脉留置针并发症发生情况观察

目的探讨不同年龄患儿应用静脉留置针并发症的发生情况。方法选择住院患儿160例,按年龄不同分成新生儿组(<1个月)、婴幼儿组(1个月～3周岁)、学龄前期组(3～6周岁)和学龄期组(6～12周岁)4组,各40例。比较4组留置过程中堵塞、脱出、外渗、静脉炎等并发症的发生情况及留置时间。结果新生儿组和学龄期组出现并发症的总发生率和外渗的发生率明显低于婴幼儿组和学龄前期组,留置时间长,经统计学处理有显著性差异(P<0.01)。结论不同年龄患儿,并发症的发生情况不同,应根据患儿的年龄特点给予针对性的护理,保证静脉留置针的应用。     

Physicians' recommendations for patients who undergo noncardiac surgery

OBJECTIVE: To investigate how consulting physicians attempt to modify perioperative cardiac risk for patients who undergo noncardiac surgery by comparing the preoperative cardiac recommendations of consulting physicians in 2 university centres. DESIGN: Retrospective cross-sectional analysis. SETTING: Five hospitals affiliated with 2 Canadian universities. PATIENTS: Three hundred and eight preoperative consultations were evaluated in 297 patients who were 40 years of age or older and scheduled for noncardiac surgery. OUTCOME MEASURES: Cardiac drug recommendations at the preoperative consultation [corrected]; overall recommendations and practice variation between the 2 centres. RESULTS: The greatest changes in drug management suggested by consultants were the initiation of nitrates in 13% of the patients and a decrease in acetylsalicylic acid administration from 27% to 17%. Centre A physicians recommended adding an angiotensin-converting enzyme inhibitor 11% of the time, whereas centre B physicians recommended such an inhibitor in only 1% of the patients (p = 0.001). In patients taking acetylsalicylic acid at the preoperative consultation, Centres A and B physicians recommended withholding the drug 47% and 22% of the time, respectively (p = 0.03). These differences persisted between the 2 centres after controlling for physician estimates of risk. CONCLUSIONS: Consultants frequently recommended perioperative changes in the use of cardiac medications, and there were differences in practice patterns between the 2 centres. These differences may be affecting patient outcomes and highlight the need for randomized clinical trials to determine the impact of perioperative drug administration on bleeding, myocardial infarction and death.     

Anxiety and postoperative pain in children who undergo major orthopedic surgery.

Anxiety and pain are major concerns not only for children who undergo surgery, but also for their parents and health care professionals. A convenience sample of 74 adolescents who underwent major orthopedic surgery for repair of idiopathic scoliosis and their parents was used to investigate the relationships among children's and parents' preoperative and postoperative anxiety and children's postoperative pain. Age-appropriate versions of Spielberger's State-Anxiety scales measured children's and parents' anxiety, and a visual analog scale assessed children's pain intensities. Children's state anxiety increased from preoperative to postoperative levels, and their postoperative anxiety levels positively related to their pain intensities on days 2 and 4 following the operation. Parents' anxiety decreased from preoperative to postoperative levels, and their postoperative anxiety positively related to their children's postoperative anxiety. Studying both parents and children helped to explain the variance in children's self-reported anxiety. Parents' emotional states are important indicators of children's emotional states and, subsequently, their pain experience. The results of this study suggest that allowing children to assist in the assessment of their postoperative pain may help health care professionals better understand the subjective component of pain. The findings also emphasize the importance of including parents in future studies in which the aim is to understand children's behavioral responses and recovery outcomes.     

Role of screening for hepatitis C virus in children with malignant disease and who undergo bone marrow transplantation

BACKGROUND: Children with malignant disease who received multiple blood transfusions before the clinical definition of hepatitis C virus (HCV) require evaluation for HCV infection. STUDY DESIGN AND METHODS: The role of HCV infection in 54 children with primary malignant disease was evaluated in terms of the following aspects: prevalence of HCV infection, distribution of HCV subtype, the benefit of screening of blood donors, and the presence of chronic liver disease. The benefit of screening for HCV in a subset of patients who underwent bone marrow transplantation (BMT) was also evaluated. RESULTS: Seventeen patients (31.4%) of 54 tested were seropositive in a second-generation HCV antibody test. Thirteen patients (24.0%) were also positive for circulating HCV RNA. HCV subtype 1b and HCV subtype 2b were found in six and two patients, respectively. Multiple HCV genotypes were present in two patients. One of these two patients had relatively progressive liver disease. Before the introduction of blood screening with a second- generation HCV antibody test, 15 of 35 patients seroconverted, whereas none of 7 patients seroconverted after the screening was used (p = 0.032). For patients who underwent BMT, the screening drastically decreased the seroconversion rate, from 7 of 11 patients to 0 of 6 (p = 0.016). CONCLUSION: A considerable number of children with primary malignant disease who received multiple blood transfusions became infected by HCV before HCV screening was used. Patients who underwent BMT were at high risk for HCV infection. Screening with a second- generation HCV antibody test has proven to be remarkably beneficial in preventing HCV infection in these children.     

不同年龄段儿童免疫性血小板减少症的临床特点分析

目的 探讨儿童原发性免疫性血小板减少症（ITP） 与年龄相关的临床特点。 方法 回顾性分析257例ITP患儿的临床资料,对< 1岁组、1 ~ 3岁组和> 3岁组的性别、发病季节、发病诱因、出血情况、初诊时血小板参数、治疗方法、疗效及预后情况进行统计学分析。 结果 ①257例患儿中< 1岁118例（45.9％）,1 ~ 3岁70例（27.2％）,> 3岁69例（26.9％）。< 1岁组男女比例3.06∶1,但随着年龄增长,男性百分率相对降低,女性百分率相对增高,< 1岁组与其他2组性别构成比比较差异有统计学意义（P均< 0.05/3）。②儿童ITP在各季节均可发病,但夏冬季相对较多,秋季最低,< 1岁组和> 3岁组发病有明显的季节性,而1 ~ 3岁组各季节持平。> 3岁组与其他2组发病季节比较差异有统计学意义（P均< 0.05/3）。③患儿中52.9%有前驱感染史,以呼吸道感染为主,11.3%有疫苗接种史,< 1岁组发病诱因中疫苗接种史高于其他2组（P均< 0.05/3）。< 1岁组与其他2组发病诱因比较差异有统计学意义（P均< 0.05/3）。④临床表现以皮肤黏膜出血为主,< 1岁组尤甚,> 3岁组鼻出血比例较高,3组间出血情况比较差异均有统计学意义（P均< 0.05/3）。⑤初诊时均有血小板计数（PLT）、血小板比容（PCT）降低,平均血小板体积（MPV）、血小板体积分布宽度（PDW）升高,< 1岁组前两者明显下降,> 3岁组后两者明显升高（P均< 0.05/3）。⑥在治疗方式中,< 1岁组静脉注射Ig（IVIG）使用比例高于其他2组,而> 3岁组IVIG联用激素的比例更高（P均< 0.05/3）。经初始同种治疗,< 1岁组完全反应率高于其他年龄组,尤其是初始治疗3 d后更显著（P均< 0.05/3）。⑦慢性ITP发病率随年龄增大而增多,< 1岁组慢性病例比例最低（P均< 0.05/3）。结论 < 1岁ITP患儿百分率最高,且男性高于女性。ITP夏冬季多发,秋季最少。ITP患儿临床表现以皮肤黏膜出血为主。大多数患儿有发病诱因,< 1岁患儿以疫苗接种最常见。< 1岁患儿的初始血小板参数PLT与PCT明显下降,> 3岁患儿的MPV与PDW明显升高。< 1岁患儿初始治疗3 d后完全反应率最高,转为慢性ITP的比例最低。     

不同年龄儿童中腺病毒所致喘息性支气管炎分析

目的通过分析儿童各年龄段喘息性支气管炎中腺病毒感染所致的比例特点,指导临床诊治。 方法收集1132例于2014年1月~2016年7月在清远市人民医院儿科门急诊就诊或住院部治疗,临床并结合胸片结果诊断为喘息性支气管炎的儿童,依据年龄分为5组：<6个月组、≥6个月且<1岁组、≥1岁且<3岁组、≥3岁且<6岁组、≥6岁且<14岁组,分别根据呼吸道病毒检测结果,记录各组腺病毒阳性例数,计算腺病毒感染率并予统计分析。 结果各组腺病毒感染率差异有统计学意义,以≥6岁且<14岁组腺病毒感染率最高（38.2%,χ²=35.216,P=0.000)。 结论腺病毒感染所致儿童喘息性支气管炎在≥6岁且<14岁年龄段所占喘息性支气管炎比例最高,临床中应引起重视。     

Pulmonary rehabilitation for patients who undergo lung-volume-reduction surgery or lung transplantation

Patients preparing for or recovering from lung-volume-reduction surgery (LVRS) or lung transplantation represent a selected group of patients with advanced chronic respiratory disease. Such patients typically have severe ventilatory limitation and disability and are at high risk of preoperative and postoperative complications. Pulmonary rehabilitation is an ideal setting in which to: address the patient's questions and knowledge-deficits regarding his or her disease and its treatment; ensure that the patient understands the nature, potential benefits, risks, and expected outcomes of the surgery relative to medical therapies, and; prepare physically and emotionally for the surgery. Pulmonary rehabilitation also may improve survival to and/or outcomes of LVRS and transplantation, at least in part by stabilizing and improving the patient's exercise tolerance and muscle function. Further work is needed to determine whether pulmonary rehabilitation can augment the benefits and outcomes of LVRS or lung transplantation, reduce postoperative complications, or improve patient survival to or following the surgery.     

不同年龄段重型地中海贫血患儿心理行为分析

目的调查重型地中海贫血患儿心理行为,比较各年龄段患儿的心理行为差异。方法采用阿亨巴赫儿童行为量表(CBCI)对124例不同年龄段重型地中海贫血患儿进行心理行为的调查分析。结果①与正常儿童相比,各年龄段重型地中海贫血患儿活动情况、社交情况、学校情况评分均偏低,且活动能力、社交情况与年龄无明显相关,而学校情况与年龄呈正相关。②各年龄段重型地中海贫血患儿心理行为问题评分均高于正常儿童;学龄前患儿(3~6岁)在抑郁、体诉、多动、攻击性等因子上得分高于正常儿童;小学段(7~12岁)患儿在抑郁、强迫性、攻击性、违纪等因子上得分高于正常儿童;初中段(13~16岁)患儿在抑郁、交往不良、社交退缩、攻击性等因子上得分高于正常儿童。结论重型地中海贫血患儿在社会能力上,活动能力、社交情况和学校情况均较正常健康儿童低;在行为问题上,各年龄段患儿不尽相同,普遍存在抑郁、攻击性心理行为问题。     

不同年龄段功能性构音障碍儿童错误辅音分析

目的：研究功能性构音障碍儿童错误辅音在不同年龄段内的具体表现,了解错误辅音在大年龄组儿童中是否存在好转或自愈倾向。方法：采用中国康复研究中心研制的汉语构音障碍评定法,按照6种不同发音部位（唇音、舌尖中音、舌根音、舌面音、舌尖前音、舌尖后音）的辅音分类方法,对不同年龄段功能性构音障碍儿童的错误辅音进行分析,收集3个年龄段6种不同发音部位发生错误构音的人数和未发生错误构音的人数。结果：90例患者在唇音发音时,不同等级错音个数时的人数分布状况在4岁年龄段、5岁年龄段以及6岁以上年龄段3个不同年龄段的人数分布差异无统计学意义。6种不同发音部位中,只有当患者在舌尖后音发音时,患者辅音构音错误和未发生辅音构音错误人数分布在3个不同年龄段之间在统计学上存在显著性差异（ P＝0．018）。其余5种发音部位发音时,3个不同年龄段差异无统计学意义。结论：辅音构音错误在大年龄段内无好转或自愈倾向。一旦发现儿童存在辅音构音错误应该及时诊治,尽早接受语音康复训练。     

Perception of the social support for adolescents who undergo corrective back surgery for scoliosis

The objective of this study is to compare the perception of social support upon admission and 6 weeks postoperation of adolescents aged 13 to 19 years (M = 14.7 years), who underwent corrective back surgery for scoliosis. Twenty-two French-speaking participants were found from three different hospital centers located in two large cities in the Quebec province. Data were collected using the French version of Interpersonal Relationships Inventory (IPRI). No significant difference was observed between the results obtained on admission and those obtained 6 weeks later for the global measures of social support available. Nevertheless, analysis of data at the two time points showed a significant difference with regard to intimacy of adolescents. Adolescents reported feeling more invaded in the postoperative period (6 weeks after the surgery) than on admission at the hospital. These results serve to point out the nursing care involvement as well as the surgical techniques and ambulatory care that reduce hospitalization time. The results raise questions about the nurse's role in the adequate support for adolescents as well as the impact of reduced length of hospitalization.     

The need for counselling of women who undergo hysterectomy: a feminist perspective

Many women have hysterectomies in Australia each year, yet the consequences of hysterectomy in women's lives are not well understood. Approximately 36,015 hysterectomies are performed annually in Australia (Australian Institute of Health and Welfare 1998). Recent nursing literature suggests that information regarding hysterectomy is inadequately discussed with the patient, and for whatever reason the patient has made the 'choice' to undergo hysterectomy, it appears little information or counselling is available to many women in this position. Many women view the uterus as their 'function' and with its removal, they may perceive that their femininity is challenged. Nursing literature is gathering momentum, and proposing a greater commitment from nurses to counsel in the gynaecological area (McQueen 1997). Nurses working in all specialities need to develop an awareness of how illness can impact upon the sexuality or sexual health of their client group, and be able to facilitate the provision of appropriate support (Palmer 1998). This paper will explore the symbolic themes of hysterectomy identified in Wood & Giddings' (1991) research, and will consider the reasons why women who undergo hysterectomy are not receiving sufficient information, counselling and follow-up.     

不同封管液对小儿静脉留置针留置效果的Meta分析

目的 比较小儿静脉留置针生理盐水封管和肝素盐水封管的临床效果.方法 通过数据库检索相关文献,采用Review Manager 4.2分析软件进行Meta分析,比较小儿静脉留置针生理盐水封管和肝素盐水封管静脉炎发生率、局部渗漏发生率、堵管发生率和留置时间长短等四项指标.结果 9篇文献1 250例患儿纳入研究,Meta分析结果显示：两组静脉炎的发生率（OR=1.35,95%CI：0.60～3.02,P=0.47）和局部渗漏发生率（OR=0.86,95%CI：0.50～1.46,P=0.57）差异无统计学意义;肝素盐水组留置时间长于生理盐水组（WMD=0.53,95% CI：0.04-1.21,P：0.03）,堵管发生率低于生理盐水组（OR=0.31,95%CI：0.13-0.76,P=0.01）,差异具有统计学意义.结论 与生理盐水相比,肝素盐水小儿静脉留置针封管的堵管发牛率低、留置时间长,静脉炎和局部渗漏的发生率差异无统计学意义.     

28895名健康体检者不同年龄段生活习惯现状分析

目的分析28895名健康体检者与健康相关的一般生活习惯现状。方法对28895名在我院进行健康体检者,询问记录其饮食习惯、运动习惯、工作压力及不良生活习惯,并进行统计分析。结果①28895名健康体检者,饮食习惯一般者仅14245人（49.3%）,不饮酒者仅15772人（54.58%）,不吸烟者仅19972人（69.12%）,很少运动者19869人（68.76%）,工作压力大者11466人（39.68%）;②不同年龄段体检者饮食习惯、运动习惯、不良生活习惯（吸烟史、饮酒史）及工作压力等差异均具有统计学意义（P〈0.01）。青年受检者的各种不良生活习惯比率均明显高于其他年龄段人群。结论①现代人群的一般生活习惯不容乐观,需改善生活方式,提倡健康的生活习惯。②青年人群作为社会生活主体及压力主要承受体,其不良的一般生活习惯更应引起社会及青年人群本身的重视。③不同年龄段的人群拥有健康生活方式的人群比率随年龄增长而增加。老年人群拥有比中/青年更健康的生活方式。     

不同年龄儿童疼痛反应特点及护理研究

疼痛是一种不愉快的经历与感受。而小儿对疼痛刺激的反应更为强烈，常常伴有较强烈的生理变化，如呼吸、心率加快、血压升高、机体耗氧量增加等。在临床上，儿童无法拒绝打针、抽血或手术等治疗。这些侵入性治疗对他们来说是非常恐惧的，以至于在刚住院的几天内处于惊恐状态，特别是当看见端着盘子的护士时。由于儿童的认知、语言表达和发育水平的不同，各个年龄阶段儿童发生疼痛时表现也有所不同。可受年龄、应对方式、父母对疼痛的反应、过去疼痛的经历以及文化背景等影响。作为儿科护理人员，有责任使患儿在住院期问得到最有效最安全的减轻疼痛的护理措施。现就其各阶段对疼痛反应的特点和护理介绍如下。     

腹腔镜治疗非寄生虫肝囊肿18例的护理

肝囊肿可分为寄生虫性与非寄生虫性两大类,其中非寄生虫性又分为先天性、后天性(创伤性、炎症性和肿瘤性囊肿),以先天性肝囊肿(亦称真性肝囊肿)最常见[1].在腹腔镜手术开展之前,对有症状的肝囊肿的治疗,一般采用剖腹肝囊肿开窗引流术、B超引导下囊肿穿刺抽液或介入手术注射酒精.     

Smear test from the point of view of women who undergo it

This research is the result of my experience with women in cervical cancer prevention at the Gynecology and Obstetrics National Health Clinic of the Federal University of Minas Gerais. I tried to understand what it means to women who are submitted to a smear test. To achieve this, I have used a qualitative research, in a phenomenological approach. I gathered the data from interviews about the main subject. The analysis of those eleven interviews have helped me to build three analytical categories that are the located structure of the phenomenon, as follows: A--The preventive cervical cancer examination: a woman as a human being conscious of the world; B--Facing the smear test: manifestation of the existence; C--Working with the health professional during the examination: as interfaces of the attendance.