住院精神分裂症患者发生攻击行为的相关因素分析及护理对策

目的探讨住院精神分裂症患者发生攻击行为的相关因素,并制定切实可行的护理对策。方法对158例住院精神分裂症患者以外显攻击行为量表(MOAS)及简明精神病量表(BPRS)进行评定;比较有、无攻击行为的精神分裂症患者的BPRS评分。结果158例患者中,有攻击行为82例(51.89%),无攻击行为76例(48.10%);两组BPRS评分比较,有攻击行为组的总分及敌对猜疑、激惹性、行为紊乱等因子分均明显高于无攻击行为组(P0.01),思维障碍因子分前者高于后者(P0.05)。结论精神分裂症患者攻击行为与精神症状密切相关,护理人员及时评估攻击行为的相关因素,及早采取有效护理干预,可降低和控制攻击行为发生,并能有效减少医疗纠纷及意外事件的发生。     

精神分裂症住院患者攻击行为相关因素分析及护理

目的:探讨精神分裂症住院患者攻击行为的相关因素及护理方法。方法:将153例精神分裂症患者按修改版外显攻击行为量表(MOAS)评分分为A组(评分≥4分,伴攻击行为)80例和B组(评分<4分,不伴攻击行为)73例。采用简明精神症状量表(BPRS)和护士用住院患者观察量表(NOSIE-30)对其攻击行为相关因素进行分析,并给予针对性护理。结果:两组患者的既往攻击史、BPRS量表总分、思维障碍、敌对猜疑、激惹性及NOSIE-30两个因子分(激惹、精神症状)比较差异均有统计学意义(P<0.05)。结论:精神分裂症住院患者的攻击行为与精神症状关系密切,护理人员应及时收集患者资料,认真评估攻击行为的相关因素,尽早实施有效的护理干预,促进患者康复。     

男性精神分裂症患者攻击行为的对照研究及护理对策

目的研究男性精神分裂症患者攻击行为的相关因素及护理对策。方法对71例有攻击行为和85例没有攻击行为的男性精神分裂症患者的人口学资料、住院资料、BPRS、入院态度和治疗态度进行对照研究。结果2组患者在BPRS、住院态度、治疗态度、既往攻击行为史、诊断亚型和EEG结果等因子上差异存在显著性，其中既往攻击行为史、诊断亚型、BPPS的敌对猜疑因子和治疗态度能够预测男性精神分裂症患者的攻击行为。结论精神分裂症患者的攻击行为有精神病理学和生物学基础，及早对患者实施有效的心理干预和健康教育，可以减少攻击行为的发生。     

男性精神分裂症患者攻击行为的对照研究及护理对策

目的研究男性精神分裂症患者攻击行为的相关因素及护理对策。方法对71例有攻击行为和85例没有攻击行为的男性精神分裂症患者的人口学资料、住院资料、BPRS、入院态度和治疗态度进行对照研究。结果2组患者在BPRS、住院态度、治疗态度、既往攻击行为史、诊断亚型和EEG结果等因子上差异存在显著性,其中既往攻击行为史、诊断亚型、BPRS的敌对猜疑因子和治疗态度能够预测男性精神分裂症患者的攻击行为。结论精神分裂症患者的攻击行为有精神病理学和生物学基础,及早对患者实施有效的心理干预和健康教育,可以减少攻击行为的发生。     

精神分裂症患者攻击行为的危险因素与护理对策

目的 探讨精神分裂症患者攻击行为的危险因素及护理对策。方法 采用对照分析法，对50例有攻击行为的精神分裂症患者和50例无攻击行为的精神分裂症患者的相关资料进行分析和显著性检验。结果 两组精神分裂症病人在BPRS和临床特征上存在显著差异，提示BPRS的幻觉、敌意猜疑因子分和临床特征中既往有攻击史、易激惹、不舍作治疗、依从性差及医务人员的强制手段是精神分裂症患者攻击行为的危险因素。结论 及早对精神分裂症攻击行为患者实施心理干预及健康指导，可以将攻击行为减少到最低限度。     

精神分裂症患者攻击行为的相关因素分析及护理对策

目的探讨精神分裂症患者攻击行为的相关因素及护理对策。方法调查住院精神分裂症患者185例，分为攻击组（n=31）和非攻击组（n=154），采用SPSS13．0统计软件分析相关因素。结果诊断分型、简明精神病评定量表（BPRS）总分及因子分等两组差异有显著性。结论诊断分型等是预测攻击行为的一个方法；严格的管理制度和良好的服务态度是预防的关键。     

预见性护理对精神分裂症患者攻击行为的影响

目的:探讨精神分裂症患者攻击行为的相关因素,并提出预见性护理对策。方法:应用护士用住院患者观察量表(NOSIE)对研究组和对照组各50例有攻击行为的精神分裂症患者进行干预前后的临床对照研究。结果:研究组NOSIE中激惹、精神症状因子分显著高于对照组。结论:对病史中有攻击行为者及NOSIE量表中的敌对激惹性、精神症状等预见其可能发生的攻击行为,并制定具体的防范措施可有效地预防和减少其攻击行为的发生。     

精神分裂症患者攻击行为的危险因素与护理对策

目的探讨精神分裂症患者攻击行为的危险因素及护理对策.方法采用对照分析法,对50例有攻击行为的精神分裂症患者和50例无攻击行为的精神分裂症患者的相关资料进行分析和显著性检验.结果两组精神分裂症病人在BPRS和临床特征上存在显著差异,提示BPRS的幻觉、敌意猜疑因子分和临床特征中既往有攻击史、易激惹、不合作治疗、依从性差及医务人员的强制手段是精神分裂症患者攻击行为的危险因素.结论及早对精神分裂症攻击行为患者实施心理干预及健康指导,可以将攻击行为减少到最低限度.     

碳酸锂合用抗精神病药治疗精神分裂症患者攻击行为研究

目的 评价碳酸锂合用抗精神病药对精神分裂症患攻击行为的治疗作用。方法 对17例有攻击行为的长期住院精神分裂症患在原有抗精神病药的基础上加用碳酸锂进行为期6w的治疗，在开始治疗前及治疗第6w末用BPRS、MOAS进行评定。结果 (1)治疗前后BPRS各因子分比较，无显差异。(2)治疗后MOAS评分降低，治疗前后评分比较有显差异(P＜0．01)。结论 碳酸锂治疗精神分裂症的攻击行为安全有效。     

住院精神分裂症病人攻击行为相关因素的分析与护理

目的分析住院精神分裂症病人攻击行为的相关因素。方法对106例病例组和161例对照组的精神分裂症病人的既往攻击行为史、修订版外显攻击行为量表和护士用住院病人观察量表进行评定。结果病例组既往有攻击行为史明显高于对照组(P<0.01),病例组的修订版外显攻击行为量表加权分明显高于对照组(P<0.01),且病例组的加权分≥4分的百分率明显高于对照组(P<0.01),病例组的社会能力、激惹和精神病表现评分显著高于对照组(P<0.01),而病例组的社会兴趣分显著低于对照组(P<0.01)。结论既往有攻击行为史、修订版外显攻击行为量表加权分≥4分、社会能力差、缺乏社会兴趣、易激惹、精神病表现多是预报住院精神分裂症病人攻击行为发生重要因素。采取针对性的监测和预防护理,包括确定攻击的高危人群,作为“防黑”的对象;对修订版外显攻击行为量表评定时加权分≥4分的重点病人,观察异常行为并予行为干预;鼓励病人多参加文娱活动;高度警惕激惹病人,观察其攻击行为的先兆症状,减少正面冲突;严密观察精神症状的内容和表现、药物治疗的效果和不良反应。     

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.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

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.