应用量化评分法指导脑复苏患者高压氧治疗时机的选择和护理

目的 探讨联合应用简化急性生理学评分(SAPS Ⅱ)和9条等值护理人力应用评分法(NEMS)指导脑复苏患者高压氧治疗时机选择和护理措施制订的意义.方法 回顾性分析43例初级心肺复苏成功患者的病历资料,对入住ICU未超过24 h的患者进行SAPS Ⅱ、NEMS评分;按高压氧治疗过程中患者的状况分成发生意外情况组和未发生意外情况组,比较2组评分的差异.结果 43例患者中,有6例在高压氧治疗过程中发生意外情况.发生意外情况组的SAPS Ⅱ、NEMS评分明显高于未发生意外情况组(P＜0.05);发生意外情况的6例患者中,有4例同时存在SAPS Ⅱ评分＞60分,NEMS评分＞40分.结论 SAPS Ⅱ、NEMS评分对脑复苏患者进行高压氧治疗时机选择有指导作用;对SAPSII评分＞60分,NEMS评分＞40分的患者需要加强护理.     

血清前白蛋白对老年慢性阻塞性肺疾病急性发作期病情严重程度及预后的评估价值

目的探讨老年慢性阻塞性肺疾病（COPD）患者血清前白蛋白（PAB）与病情严重程度及预后的关系。方法选取入院治疗的65岁以上老年慢性阻塞性肺疾病急性加重期（AECOPD）患者100例,按患者简化急性生理学评分Ⅱ（SAPSⅡ）评分值将患者分为A组31例（SAPSⅡ20～30分）、B组40例（SAPSⅡ30～40分）和C组29例（SAPSⅡ〉40分）,分析3组患者血清PAB水平和预后;再根据疾病转归将患者分为生存组和死亡组,分析两组患者空腹血清PAB水平和SPASⅡ评分值。结果3组患者病死率（0%、5%、34%）比较,差异有显著性意义（P〈0.05）,A组空腹血清PAB水平[（200.05±64.49）mg/l）]明显高于B、C组[（173.79±42.47）mg/l、（140.55±30.18）mg/l]（P〈0.05）,B组明显高于C组（P〈0.05）;死亡组SAPSⅡ评分值较生存组高[（44.42±2.71）分vs（32.75±6.43）分,P〈0.05],空腹血清PAB水平较生存组低[（137.36±26.43）mg/lvs（177.05±53.55）mg/l,P〈0.05]。结论空腹血清PAB水平对评估老年AECOPD患者的病情和预后具有一定的临床意义,其水平低者病情较重,病死率较高。     

影响心肺复苏预后的相关因素分析

目的探讨影响心肺复苏预后的相关因素，为治疗提供依据。方法回顾分析我院急诊重症监护室2001—01～2005—05心肺复苏患者48例，按复苏成功与否分为复苏失败组（A组）、复苏成功组（B组）和存活出院组（C组）。分析患者年龄、合并疾病、骤停时间、抢救时间、存活时间、Glasgow评分和APACHEⅡ评分。结果与A组比较，B组和C组年龄、骤停时间、抢救时间差异具有显著性（P〈0．05），但两组间差异不明显；与A组和B组比较，C组存活时间、Glasgow评分和APACHEⅡ评分相差非常显著（P〈0．01）。三组患者均合并多种疾病，而以合并心脑血管疾病和呼吸系统疾病为首位。结论年龄是复苏成功的重要因素，合并心脑血管和呼吸系统疾病是心脏骤停高危因素，骤停时间是复苏成功的关键，脑复苏成功是存活出院的最重要因素，APACHEH评分能评估心肺复苏的预后。     

甲地孕酮改善晚期胃癌患者生活质量的作用

目的：观察甲地孕酮改善晚期胃癌化疗患者生活质量方面的作用，分析其影响患者生活质量的主要因素。方法：纳入哈尔滨医科大学附属第二医院肿瘤内科1999—01／2005—02收治的晚期胃癌患者93例，均经病理或细胞学证实。行为状态量表评分〉60分，预计生存期大于3个月。对实验内容患者知情同意。同一患者在院接受至少2个疗程的应用抗肿瘤药物治疗（简称化疗），每个疗程包括3个周期，两个疗程间隔一两个月。患者第1个疗程化疗均联用甲地孕酮为治疗组，第2个疗程不用甲地孕酮为对照组。治疗组化疗前1天开始服用甲地孕酮160mg，每天两三次，至化疗结束后2周，同时加用阿司匹林40mg／d，对照组不使用甲地孕酮。①观察每天变化评估患者进食量：增加，增加〉50g；不变，改变〈50g；减少，减少〉50g。②观察治疗后改变评估患者体质量：增加，增加〉1．0kg；稳定，改变〈1．0kg；减轻，减少〉1．0kg。⑧应用行为状态量表评分评定患者行为状态：改善，治疗后评分增加〉10分；稳定，治疗前后评分变化〈10分；降低，治疗后评分减少〉10分。④应用Spitzer生活质量指数评分评估患生活质量情况：以健康状况、劳动能力、日常生活、精神状况及是否需要帮助5项主要分析因素，每项分3个等级（0-2分），全卷得分最高为10分，最低为0分，分数越高代表患者生活质量越高。结果：按实际处理分析，进入结果分析患者66例。①两组患者进食量变化：治疗组增加患者多于对照组[64％（42／66），32％（21／66），P〈0．001]。②两组患者体质量变化：治疗组增加患者多于对照组[44％（29／66），28％（18／66），P〈0．05]。③两组患者行为状态变化：治疗组改善患者多于对照组[70％（46／66），21％（20／66），P〈0．001]。④两组患者Spitzer指数评分：治疗组患者身体自然情况评分低于对照组[（2．21&;#177;0.32），（2.36&;#177;0．73）分，P〈0．1]，治疗组患者工作能力和亲人照顾程度评分高于对照组[治疗组：（3．41&;#177;0.74），（2.35&;#177;0.56）分，对照组：（6.33&;#177;0.58），（5．96&;#177;0.67）分，P〈0．11。结论：①加用甲地孕酮治疗对晚期胃癌患者进食量、体质量有较大改善，能够提高化疗患者接受治疗的耐受性。②使患者的行为状态及工作能力有较大的提高，使终末期癌症患者对其所处客观生活状态产生良性的主观认知。     

高压氧治疗对脑复苏的康复疗效探讨

目的 探讨高压氧治疗在脑复苏的康复作用与治疗经验。方法 回顾性分析采用高压氧协助治疗86例脑复苏病人的情况。结果 早期（12h内）参与抢救36例，治愈33例，好转3例，治愈率91．67％；晚于12h再进行高压氧治疗50例，治愈21例，好转22例，无效7例（包括死亡4例），治愈率为66％，两组比较有非常显性意义（P＜0．01）。治疗＜4疗程52例中治愈26例占50％；＞4疗程34例中治愈28例占86．78％，＜4疗程与＞4疗程两组比较差异有非常显性意义（P＜0．01）。结论 高压氧是治疗脑复苏的重要手段；早期应用能显提高治愈率；疗程越长，治愈率越高。昏迷病人不要过早失去信心，要适当延长治疗的时间，能达到治疗目的。     

颅脑外伤患者高压氧介入时间对FIM评分的影响

目的：观察颅脑外伤患者高压氧介入时间对功能独立性评定（FIM）评分的影响,为探讨综合康复治疗最佳介入时机提供临床依据。方法选择中重型颅脑外伤患者130例,根据受伤时间分为对照组25例,综合康复1组（TBI〈15d）与综合康复2组（15d≤TBI≤30d）各40例,综合康复3组（TBI〉30d）25例,均给予药物治疗和康复措施,综合康复各组在前述的基础上行高压氧治疗共40次,以治疗前和治疗第30天、60天的FIM评分进行疗效评价。结果资料完整、实际纳入组TBI患者共123例,各组临床资料有可比性。各组内TBI患者在治疗第30天、60天的FIM评分差异有统计学意义（P〈0.05）。各组间TBI患者第1天FIM评分差异无统计学意义（P〈0.05）,对照组与综合康复1、2组在第30天、60天差异有统计学意义（P〈0.05）。结论三组TBI患者2个月内FIM评分改善呈匀速好转趋势,30d内的高压氧综合康复1、2组对认知与运动功能改善作用明显优于对照组,优于综合康复3组患者。     

高压氧治疗86例青年缺血性脑卒中的疗效观察

目的观察高压氧治疗青年缺血性脑卒中的临床疗效。方法选择2005年10月至2007年10月我院收治的86例青年缺血性脑卒中患者，随机分为对照组和高压氧组，对照组给予常规治疗，高压氧组在常规治疗的基础上行高压氧治疗，根据神经功能缺损评分判断临床疗效。结果高压氧组神经功能缺损评分由（29．15±8．15）降至（9．18±5．31），平均减少（70．0±11．4）％；对照组神经功能缺损评分由（29．48±6．53）降至（16．88±7．00），平均减少（42．6±20．9）％。从临床疗效看，高压氧组的有效率为81．4％，总进步率为93．0％；对照组的有效率为39．5％，总进步率为60．5％。两组比较差异有统计学意义（P〈0．05—0．01）。结论高压氧对青年缺血脑卒中具有良好的疗效。     

连续性血液净化治疗对心肺复苏术后患者脑复苏效果的影响

目的探讨连续性血液净化治疗（CBP）对心肺复苏术（CPR）后患者脑复苏效果的影响及其可能的机制。方法选取CPR术后脑复苏未成功的患者60例随机分为两组，每组30例，采用CBP＋原发病的综合治疗30例作治疗组。采用常规脱水、头部低温＋原发病的综合治疗的30例患者作对照组。观察两组患者脑复苏成功的时间、成功率。结果治疗组患者的脑复苏成功的时间较对照组明显缩短、脑复苏成功率明显高于对照组（P〈0．01），两组患者的死亡率无明显差异（P〉0．05）。结论连续性血液净化治疗对心肺复苏后患者能明显减轻脑水肿，缩短脑水肿的时间，提高脑复苏的成功率。     

高压氧在心肺脑复苏中的治疗及护理体会

目的探讨高压氧在心肺脑复苏中的治疗机制和护理体会。方法本组97例患者，心肺脑复苏后恢复心搏和呼吸，均在医护人员的陪护下进高压氧舱治疗，所有后续治疗及护理均在氧舱内进行，用以阻断脑缺氧和脑水肿的恶性循环，促进脑功能的恢复。采用200—250kPa的舱压，吸氧30min问歇吸空气10min，再吸氧30min，作为基本治疗方案，并根据病情的动态变化随时调整。结果本组97例应用高压氧后续治疗，无1例心跳、呼吸复苏后再次停止，无1例因护理因素出现并发症；随访6个月未发现有后遗脑缺氧损害患者。结论高压氧能明显改善机体对氧的摄取和利用方式，使血氧含量增多，血氧分压增高，血氧弥散能力增强，从而改善金身的缺氧状态，有利于心、脑等主要脏器的缺氧性损害的恢复。同时高压氧通过提高血氧分压，使血管收缩，减少脑血流量，因而可减轻脑水肿，使颅内压下降。从而解决了脑缺氧和脑水肿之间的矛盾。高氧分压对网状系统的刺激较其他苏醒剂，可加快脑苏醒。高压氧应用于复苏的积极效果，为复苏的理论与实践增添了新的、进一步的内容；高压氧用于心肺脑复苏的成功离不开护理工作，舱内的多项治疗是通过护理工作完成的，护理工作的紧密配合，在高压氧用于心肺脑复苏后续治疗中起到了重要作用。     

亚低温技术和常温技术对脑功能保护的比较与评估

背景：亚低温对缺血性损害的脑细胞有显著的保护作用，对脑复苏后的脑功能是否也具有保护作用. 目的：比较采用亚低温技术和常温技术评估脑复苏3个月时患者神经功能结局评分与生活自理能力评分的差异。 设计：随机对照实验。 单位：南京大学医学院附属鼓楼医院急诊中心。 对象：选择南京鼓楼医院2002-02／10在急诊抢救室经心肺复苏术抢救的患者16例，均为内科系统病变及中毒患者，在院内突发心跳与呼吸停止而进行心肺复苏术。其中男10例，女6例；年龄27-57岁；根据是否采用亚低温技术，将16例患者随机分为两组：常温组与亚低温组，每组8例。 方法：心肺复苏后亚低温组患者立即采用药物＋头部冰帽＋电子冰毯方法做降温处理，使其脑部温度控制在32-34℃，维持72h后复温；常温组患者在室温下对症处理。 主要观察指标：①两组患者复苏后第3，7天的血氧饱和度，血酸碱度，体温，颅内压，平均动脉压和格拉斯格昏迷评分。②复苏后3个月的格拉斯格神经功能结局评分（功能独立为85-100分，中度残疾为74-84分，严重残疾为10-50分，植物状态为〈10分）和生活自理能力评分（采用Bathel指数进行评价，共10项，每项0～15分不等，满分100分，〈60分为不能自理）。 结果：16例患者均进入结果分析。①第3天时亚低温组平均脑温和颅内压均低于常温组[（33．1&;#177;0．26）℃，（37&;#177;18）℃；15．7mm Hg，19．1mmHg，P=0．027，0．0431。血氧饱和度，血酸碱度，平均动脉压和格拉斯格昏迷评分两组基本接近（P〉0．05）。②第7天亚低温组的格拉斯格昏迷评分明显高于常温组[（9．1&;#177;1．4），（11．2&;#177;1．6）分，P=0．032]。③3个月后亚低温组格拉斯哥预后量表评分和Barthel指数明显高于常温组[（12．9&;#177;1．75），（9．9&;#177;1．9）分；（86&;#177;6），（52&;#177;12）分，P〈0．05-0．01]。 结论：亚低温对早期脑复苏时的颅内压减低有效，尤其对复苏远期神经功能和日常生活活动能力恢复具有良好效果，具有显著的脑功能保护作用。     

Doing more with less and less with more

The "devil is in the details" of any policy response. What forms such changes may take, and what research informs them, are critical to the profession as a whole and to practitioners on a daily basis. Research partnerships between home care agencies and university professors may provide rigorous, systematic, and validated findings necessary for meaningful solutions (Plotkin & Roche, 2000). The evidence of a dialogue between nursing researchers, home healthcare practitioners, and policymakers anticipating impacts on practice of changing fiscal and information-gathering requirements is scant. Such issues are in need a priority discussion by agencies, and collaborative investigative efforts between all involved.     

Communicating with clients and colleagues with hearing loss

Abstract:

Aside from elderly relatives, some of us may have never had any direct personal experience with a person who is deaf or hard of hearing, and so may be unfamiliar with how to effectively communicate with these people. This can make for a very awkward, frustrating and possibly embarrassing experience for both parties. This author is a wearer of hearing aids herself, and would like to share some information on hearing loss and tips on effective communication with a person with hearing loss.     

Mindfulness and Coping with Dysphoric Mood: Contrasts with Rumination and Distraction

Past research has shown that rumination exacerbates dysphoric mood whereas distraction attenuates it. This research examined whether the practice of mindfulness meditation could reduce dysphoric mood even more effectively than distraction. A dysphoric mood was induced in 139 female and 38 male participants who were then randomly assigned to a rumination, distraction, or meditation condition. As predicted, participants instructed to meditate reported significantly lower levels of negative mood than those in either of the two other conditions. Distraction was associated with a lessening of dysphoric mood when compared to rumination but was not as effective as mindfulness meditation. The implications of these findings are discussed.     

Special problems with children and adolescents with diabetes.

Treatment of children and adolescents with insulin-dependent diabetes mellitus (type 1) is different in many ways than it is for adults. Physical, cognitive, and emotional development changes affect therapeutic goals and modalities. Neonatal, early childhood, school-age, and adolescent patients all have unique needs. Further, diabetes can affect psychosocial maturation and the likelihood of difficulties with mood.     

Interaction of peptidoglycans with anti-IgGs and with complement.

This report describes the interaction of peptidoglycan (Streptococcus group A, Staphylococcus epidermidis and Micrococcus lysodeikticus) with 2 serum mediator systems, namely with the anti-IgG system and with complement. The observation that the majority of rabbits hyperimmunized with A-variant streptococcal vaccine produced anti-group carbohydrate antisera containing anti-IgGs and antibodies directed to peptidoglycan suggested that the production of these 2 latter antibodies was related. This view was supported by the finding of a monoclonal 7S anti-IgG with antibody specificity for the pentapeptide of peptidoglycan as evidenced by inhibition of the coprecipitation of 7S anti-IgG with antigen-antibody complexes by the pentapeptide. Inhibition of the anti-idiotype reaction by the pentapeptide provided further evidence for the antibody specificity of 7S anti-IgG for peptidoglycan. When added to normal human sera all peptidoglycan preparations inhibited the hemolytic activity of the sera. Consumption of C3 in C2 deficient serum and consumption of C2 in normal serum indicated the activation of both known complement pathways. Activation of the classical pathway of complement was more efficient since 50 mug of peptidoglycan consumed approximately 70% of C2 per ml normal serum whereas more than 2 mg of the same preparations was required to inactivate 17-24% of C3 in C2 deficient sera. Each of the different peptidoglycan preparations consumed similar amounts of complement in all 20 sera tested. This finding suggested that activation of the classical complement pathway by peptidoglycan was not mediated by anti-peptidoglycan antibodies present in only 20-40% of normal human sera.     

Expanded timed up and go test with subjects with stroke: reliability and comparisons with matched healthy controls

Faria CD, Teixeira-Salmela LF, Silva EB, Nadeau S. Expanded Timed Up and Go test with subjects with stroke: reliability and comparisons with matched healthy controls.ObjectivesTo investigate the intra- and interrater reliabilities of the Expanded Timed Up and Go (ETUG) test with subjects with stroke and to compare the ETUG scores between subjects with stroke and healthy control subjects.DesignCross-sectional.SettingResearch laboratory.ParticipantsStroke participants (n=48; mean age ± SD, 59.29±15.84y) and healthy controls (n=48), matched by age, sex, and levels of physical activity.InterventionsNot applicable.Main Outcome MeasuresThe time spent to complete the ETUG in absolute (s) and ratio values regarding the percentages of the total time. Intraclass correlation coefficients (ICCs), Student t tests, and 95% confidence intervals were employed to investigate the reliability and differences between the groups (α<.05).ResultsBoth intra- and interrater reliabilities showed significant and excellent results for both groups for the absolute values (0.86≤ICC≤1.00; P<.001) and ratio values (0.55≤ICC≤0.99; P<.001). The mean time, in seconds, for all of the ETUG activities was higher for the subjects with stroke than for the control subjects (3.15≤t≤5.78; P<.001). However, when the comparisons considered the ratio values, no significant differences between the groups were found (0.45≤t≤1.15; 0.25≤P≤0.65). These results were confirmed by the 95% confidence interval.ConclusionsSubjects with stroke spent more time in all of the ETUG activities when compared with control subjects. All of the activities appeared to contribute similarly to the poorer performances observed in subjects with stroke, because the ratio values were similar between the groups. Considering the positive intra- and interrater reliability results, the ETUG could be applied to assess the functional mobility of both groups.     

Hemosuccus pancreaticus: diagnosis with CT and MRI and treatment with transcatheter embolization

We report the case of a 56-year-old woman with a presyncopal episode followed by melena. A sentinel clot sign in the pancreatic duct on precontrast computed tomography and the presence of a splenic artery aneurysm on postcontrast computed tomography strongly suggested a fistula between the aneurysm and the duct, as visualized by magnetic resonance imaging. The patient was treated successfully by complete embolization of the splenic artery aneurysm. Received: 25 January 2000/Accepted: 21 February 2001