SARS病人的护理研究进展

参考国际国内主要护理杂志及SARS书籍上的护理研究最新成果和In—temet网上有关sARs最新的医学资讯，对SARS的流行病学、治疗、预防和护理问题等方面的最新进展进行了综述。     

SARS病房护理人力资源管理

面对SARS的突发疫情,作者针对SARS救治过程中护理工作量变化的特点,采取动态调整、补充护理人员;科学排班、合理安排工作程序,以缩短工作时数的方法,保证了临床护理工作质量,有效地控制了SARS的院内感染,保障了抗SARS一线护理人员的身心健康。     

中国首例SARS患者的急救与护理

中国首例SARS患者抢救及时，护理得当，45天痊愈出院，且未有医务人员感染。护理上除采取各种先进的综合重症监护技术和护理外，科学而有效的呼吸道管理技术，心理护理，严密的消毒隔离以及自我防护措施尤为重要。     

SARS病房护士应对方式与社会支持的调查研究

目的:了解SARS病房护士对突发事件的应对方式及社会支持情况。方法:采用问卷调查法,对在SARS病房工作的护士进行简易应对方式量表与领悟社会支持量表评定。结果:1 .护士年龄(r=0 1 74,P <0 0 1 )、工龄(r =0 1 81 ,P <0 0 1 )、学历(r=0 1 63 ,P <0 0 5)与积极应对得分呈正相关;2 .社会支持总分(r=0 444,P <0 0 1 )、家庭内支持(r=0 347,P <0 0 1 )及家庭外支持(r=0 439,P <0 0 1 )与积极应对得分均呈显著正相关。结论:护理管理者应注重社会支持对护士应对突发事件的积极作用,从而有针对性地进行干预,指导护士更好地应对突发事件,最大程度地减轻心理问题     

Towards a more place-sensitive nursing research: an invitation to medical and health geography

During recent years, nursing research has adopted and integrated perspectives and theoretical frameworks from a range of social science disciplines. I argue however, that a lack of attention has been paid in past research to the subdiscipline of medical geography. Although this may, in part, be attributed to a divergence between research priorities and foci, traditional 'scientific' geographical approaches may still be relevant to a wide range of nursing research. Furthermore, a recasting, redirecting and broadening of medical geography in the 1990s, towards what is termed health geography, has enhanced the discipline and provided a more cultural and expansive recognition of health, and a more comprehensive understanding of the dynamic relationship between people, health and place. Given the increasing range of places where health-care is provided and received, and some recent linkages made between nursing and place by nurse-theorists, these newer perspectives and concepts may be particularly useful for interpreting nurses' and patients' relationships both within and with a variety of healthcare settings and living spaces. Indeed, although a more place-sensitive nursing research is potentially a trans-disciplinary academic endeavor, a range of geographical approaches would be central to such a project.     

广州不同人群血清SARS冠状病毒抗体研究

目的　了解广州不同人群血清SARS冠状病毒 (SARS CoV)抗体水平。方法　用酶联免疫分析 (ELISA)和免疫荧光分析(IFA)对SARS临床确诊病人、病人接触者、野生动物销售人员及正常人群的血清SARS冠状病毒IgG抗体进行检测和分析。结果　SARS确诊病人、病人接触者、野生动物销售人员及正常人群的血清抗体阳性率分别为 6 8.7% (36 6 / 5 33)、4 .9% (13/ 2 6 7)、13.2 % (4 8/ 36 3)、2 .3% (7/ 310 ) ;抗体几何平均滴度 (GMT)分别为 15 6 .97、18.90、2 8.73、11.0 4 ;SARS病人、野生动物销售人员的抗体水平明显高于正常人群 (P <0 .0 1)。SARS病人的血清IgG抗体阳性率及抗体滴度随发病天数逐渐上升 ,15d后阳性率达6 5 .0 %以上 ,GMT超过 93.3,30～ 4 0d达峰值 (阳性率和GMT分别为 77.8%、189.3) ,15 0d左右仍维持较高水平。各年龄组和性别组的抗体水平无显著性差异 (P >0 .0 5 )。结论　广州不同人群血清中都有不同程度的SARS冠状病毒IgG抗体 ,经过本次SARS流行 ,人群的免疫性有所提高。     

Writing place: a comparison of nursing research and health geography

The concept of ‘place’, and general references to ‘geographies of …’ are making gradual incursions into nursing literature. Although the idea of place in nursing is not new, this recent spatial turn seems to be influenced by the increasing profile of the discipline of health geography, and the broadening of its scope to incorporate smaller and more intimate spatial scales. A wider emphasis within the social sciences on place from a social and cultural perspective, and a wider turn to ‘place’ across disciplines are probably equally important factors. This trend is raising some interesting questions for nurses, but at the same time contributes some confusion with regard to imputed meanings of ‘place’. While it is clear that most nurse clinicians and researchers certainly understand that place of care matters to their practices and patients, many diverse uses of ‘place’ are found within nursing literature, and contemporary understandings of the term ‘place’ within nursing are not immediately clear. It is in this context that this article plans to advance the discussion of place. More specifically, the aims of this paper are threefold: to critique ‘place’ as it appears in nursing literature, to explore the use of ‘place’ within health geography, whence notions of place and ‘geographies of’ have originated and, finally, to compare and contrast the use of ‘place’ in both disciplines. This critique intends to address a deficit in the literature, in this era of growing spatialization in nursing research. The specific questions of interest here are: ‘what is “place” in nursing?’ and ‘how do concepts of place in nursing compare to concepts of place in health geography?’     

SARS与医护人员的自我防护

严重急性呼吸综合征是一种新型的呼吸道传染病 ,其发病急、传染性强 ,医护人员由于与病人接触密切 ,感染率较高。通过对严重急性呼吸综合征病原体和传播途径研究现状的简介 ,以及医护人员易感原因的分析 ,提高医护人员的自我防护意识 ,加强综合有效的职业防护措施 ,以保证医护人员的安全。     

严重急性呼吸综合征120例死亡与康复病例的临床分析

目的　探讨SARS患者死亡与康复的影响因素 ,以降低病死率 ,提高治愈好转率。方法　回顾 12 0例SARS死亡与康复病例的流行病学、临床表现、实验室检查及治疗措施的临床资料 ,并进行分析。结果　 12 0例SARS病例中 ,死亡病例组平均年龄 (5 4 .86± 16 .0 1)岁 ,康复病例组平均年龄 (40 .6 6± 17.72 )岁 ;死亡病例组有基础疾病者 2 7例 ,占 4 5 % ,康复病例组有基础疾病者 5例 ,占 8.3% ;死亡病例组临终前 ,除有淋巴细胞与血小板计数下降外 ,还有血糖的显著升高 ;死亡病例组胸片中 ,有弥漫性肺部病变的病例数较康复病例组明显增多 ;死亡病例组糖皮质激素的最大使用剂量较康复病例组明显增加。结论　年龄、有无基础疾病、高血糖、肺部病变范围及低氧血症程度、淋巴细胞与血小板计数的降低、是否滥用糖皮质激素是SARS患者死亡与康复的影响因素 ,其中pH、动脉血氧分压及血小板计数与疾病的预后关系最为密切。     

江门市传染性非典型肺炎(SARS)的血清流行病学调查研究

目的分析江门市各类人群SARS冠状病毒血清IgG抗体水平。方法采集不同人群血标本,检测血清SARS冠状病毒IgG抗体。结果检测各类人群血清标本208份,SARS冠状病毒血清IgG抗体阳性53份,阳性率为25.48%;其中临床确诊SARS病人和高暴露人群阳性率分别为100.00%(47/47)和11.54%(6/52);临床发热的疑似病人及健康人群血标本,检测血清SARS冠状病毒IgG抗体,结果均为阴性。结论SARS冠状病毒是江门市本次SARS流行的主要病原体,在这次疫情暴发之前,人群对SARS冠状病毒普遍易感,江门市SARS监测和防控工作任务相当艰巨,面临极大的挑战。     

伴有腹泻的危重型SARS病人的临床特点分析与治疗

目的　了解伴有腹泻的危重型严重急性呼吸综合征 (SARS ,即非典型肺炎 )病人的临床特点以及探索临床有效的治疗方法。方法　对 2 0 0 3- 0 4～ 0 5入院的 8例出现消化道症状的危重SARS病人的临床资料进行分析。这些危重病人除采取综合治疗措施以外 ,及早使用甲泼尼龙冲击治疗 ,并给予无创呼吸机辅助通气。结果　 8例病人 5例死亡 ,3例病情逐渐缓解 ,好转后出院。结论　 8例出现消化道症状的危重SARS病例 ,其病情严重 ,临床进展快 ,死亡率高 ,病人应在出现发热症状后及早诊断和治疗 ,并高度注意出现合并症。     

护士长在收治SARS病人中的组织与管理

护士长在收治严重急性呼吸综合征病人中严格组织和管理 ,通过及时合理地建立健全病区的消毒隔离制度 ,并狠抓制度落实 ,教育病人共同参与疾病预防与管理 ,帮助病人树立战胜疾病的信心 ,关心部属 ,带领全体护士较好地完成了救治任务 ,且无 1例院内感染发生     

SARS-coronavirus modulation of myocardial ACE2 expression and inflammation in patients with SARS

Background  Angiotensin converting enzyme 2 (ACE2), a monocarboxylase that degrades angiotensin II to angiotensin 1–7, is also the functional receptor for severe acute respiratory syndrome (SARS) coronavirus (SARS-CoV) and is highly expressed in the lungs and heart. Patients with SARS also suffered from cardiac disease including arrhythmias, sudden cardiac death, and systolic and diastolic dysfunction.
Materials and methods  We studied mice infected with the human strain of the SARS-CoV and encephalomyocarditis virus and examined ACE2 mRNA and protein expression. Autopsy heart samples from patients who succumbed to the SARS crisis in Toronto (Canada) were used to investigate the impact of SARS on myocardial structure, inflammation and ACE2 protein expression.
Results  Pulmonary infection with the human SARS-CoV in mice led to an ACE2-dependent myocardial infection with a marked decrease in ACE2 expression confirming a critical role of ACE2 in mediating SARS-CoV infection in the heart. The SARS-CoV viral RNA was detected in 35% (7/20) of autopsied human heart samples obtained from patients who succumbed to the SARS crisis during the Toronto SARS outbreak. Macrophage-specific staining showed a marked increase in macrophage infiltration with evidence of myocardial damage in patients who had SARS-CoV in their hearts. The presence of SARS-CoV in the heart was also associated with marked reductions in ACE2 protein expression.
Conclusions  Our data show that SARS-CoV can mediate myocardial inflammation and damage associated with down-regulation of myocardial ACE2 system, which may be responsible for the myocardial dysfunction and adverse cardiac outcomes in patients with SARS.     

From SARS to strategic actions reframing systems

Background.  The developed world responds to new and re-emerging diseases through the discovery of medications. Disease can be transmitted around the world in a day, but the development of medications does not occur at this rate. The world has one environment and the focus in health care must be on identifying factors in this environment that coalesce to produce disease.
Aim.  The aim of this paper is to introduce the integrative model of environmental health and explore its potential to illuminate the Toronto SARS experience.
Discussion.  SARS affected people on three continents in a matter of days. Response to this new disease varied from one area to another and was dependent upon the level of integration of health services and communication across services. The present focus of the health care system is on treating the results of disease rather than the causative factors. Reacting to a new disease had grave social and economic consequences. The time for a new global environmental approach to health is now. The Toronto SARS experience was examined using the integrative model of environmental health and the upstream perspective as exemplars to interrupt the traditional approach to disease. All health care providers share the responsibility to learn about and to understand how our environment creates disease. This knowledge comes through research on topics such as; chemicals, pesticides, soil erosion, killing of forests, contamination of water, destabilization of climate, and social disruption from wars.
Conclusions.  Health care systems in the developed world continue to focus on the treatment of disease. A global ecological initiative for an integrated disease prevention system must be negotiated among nations.     

Comparative study of patients with and without SARS who fulfilled the WHO SARS case definition

To differentiate severe acute respiratory syndrome (SARS) from non-SARS illness, we retrospectively compared 53 patients with probable SARS and 31 patients with non-SARS who were admitted to Mackay Memorial Hospital from April 27 to June 16, 2003. Fever (> 38°C) was the earliest symptom (50/53 SARS vs. 5/31 non-SARS, p < 0.0001), preceding cough by a mean of 4.5 days. The initial chest X-ray study was normal in 22/53 SARS cases versus 5/31 non-SARS cases. SARS patients with an initially normal chest X-ray study developed infiltrates at a mean of 5 ± 3.44 days after onset of fever (21/22 SARS vs. 0/5 non-SARS). Rapid radiographic progression of unifocal involvement to multifocal infiltrates was seen in 22 of 24 SARS vs. 0 of 26 non-SARS patients (p < 0.0001). Pleural effusion was not present in any SARS patients but was seen in 6 of 26 non-SARS cases (p < 0.0001). Initial lymphopenia, thrombocytopenia, and elevated lactate dehydrogenase were all more common in SARS than non-SARS (p < 0.0001). They may help differentiate SARS from non-SARS if a reliable and rapid diagnostic test is not available.     

SARS and its impact on current and future Emergency Department operations

A long-standing concern for international spread of new, virulent pathogens became a reality with the advent of Severe Acute Respiratory Syndrome (SARS). This respiratory syndrome, caused by a coronavirus, spread rapidly across 30 nations since its first recognition in late 2002. SARS has presented the greatest recent threat to U.S. public health, and has come at a time when purposeful introduction of pathogens by terrorists is also of heightened concern. SARS has forced the international medical establishment to reexamine how best to manage such incidents.     

Learning from the severe acute respiratory syndrome (SARS) epidemic

Aims and objectives. This study uses two models of nursing practice, conventional and modular design, to compare nursing activities, hand hygiene, time efficiency and nurse–patient satisfaction in medical and surgical wards. Background. Learning from the SARS epidemic pointed to the importance of quality nursing practice considerations that minimize cross‐transmission of infection while maximizing patient‐focused care. Hence, a modular nursing model was adopted. Design and method. This study comprised pre‐ and postintervention phases. Data collection tools to evaluate modular nursing practice included a work sampling observation checklist, focused group interviews with nurses, questionnaires addressing nurses’ perceived competence and caring attributes, a patient satisfaction questionnaire, and a hand hygiene audit. A series of education sessions were conducted between the two phases. Quantitative and qualitative analyses were used for data triangulation. Results. Modular nursing practice, focusing on continuity of care, led to changes in the nature of direct care activities and improvement in patient/family education frequency. Also, a general increase in nurses’ hand washing frequency was noted. However, when nurses perceived time pressure, a lapse in hand hygiene compliance was found. Because of human resource and inefficiency issues, some nurses in the studied wards did not embrace geographical separation for infection control. Positive correlations were found for nurses’ perceived infection control practice competence and their perceived caring attributes. Relevance to clinical practice. In examining nursing practice models within complex clinical situations, the significance lies not only in the model's effects but also in other operational outcomes.     

SARS恢复期患者临床表现及康复治疗对策

目的：了解SARS患者恢复期临床情况，以指导康复治疗。方法：对21例感染过SARS的本院职工进行恢复期状况的调查，并将结果进行统计学分析。结果：SARS患者恢复期症状有轻度咳嗽咯痰、憋气、乏力，中等强度活动时气短、足跟痛和关节痛等，部分患者安静心率增快，肺弥散功能和动脉血氧分压异常，肺部CT显示肺间质病变，少数患者有抑郁倾向。结论：SARS患者恢复期存在肺间质病变、肺功能异常及体力下降等问题，康复治疗应以有氧运动、深呼吸运动为主，必要时配合物理因子治疗和心理治疗。     

严重急性呼吸综合征患者人工通气策略的探讨

目的　探讨严重急性呼吸综合征 (severeacuterespiratorysyndrome ,SARS)患者应用有创通气治疗过程中的策略。方法　 1 2例重症SARS患者 ,男 8例 ,女 4例 ,年龄 (31± 75 )岁 ,平均 (5 1 3± 1 1 0 )岁。常规治疗和无创通气失败后 ,经鼻气管插管进行有创人工通气 ,采用压力控制通气模式 ,通气过程中予以镇静。监测通气前后和充分镇静后的生命体征和血气分析 ,氧合功能的变化 ,对通气过程中的并发症和患者的转归进行分析。结果　 (1 ) 1 2例患者均高热 (体温 >38 5℃ ) ,1 0例 (83 3% )患者的WBC总数在正常范围 ,仅 1例高于正常。合并其他脏器损害 9例 (75 % )。 (2 )应用模式为压力调节 +呼气末正压 ,即PCV +PEEP或PRVC +PEEP ,起始PCV的压力为 (1 7 2± 2 9)cmH2 O ,PEEP的压力为 (9 8± 3 5 )cmH2 O ,平均通气时间为 (1 4 7± 1 1 2 )d。 (3)静脉应用咪唑安定或异丙酚充分镇静后可使患者的呼吸频率(RR)下降 ,氧合指数 (OI)升高 ,避免了因吸痰等引起的SpO2 的下降。通气前有 1例患者出现气胸 ,通气过程中 1例出现双侧气胸并纵膈气肿。 (4 )全部患者均接受了皮质激素治疗 ,剂量 2 4 0 - 5 0 0mg d (5 0 0mg d 6例 )。 (5 ) 8例患者成功撤离人工通气并拔除人工气道 ,4例死亡。死亡病例均有严重基础