结肠造口患者残障接受度与社会关系质量的相关性研究

目的 探讨直肠癌永久性结肠造口患者的残障接受度与社会关系质量的相关性.方法 采用方便抽样的方法,调查111例直肠癌永久性结肠造口患者.采用一般资料调查表、残障接受度量表和社会关系质量量表分别调查研究对象的一般情况、残障接受度和社会关系质量水平,并使用SPSS 17.0软件包进行统计分析.结果 结肠造口患者的残障接受度得分处于中等水平,残障接受度量表的总分及各维度与社会关系质量量表总分、家庭承担维度、朋友关系维度均明显相关(P＜0.05).结论 结肠造口患者的残障接受度与社会关系质量具有明显相关性,应提高社会关系质量、增加心理干预,使二者相互促进,共同改善.     

永久性结肠造口患者社会关系质量与希望水平的相关性研究

目的探讨永久性结肠造口患者社会关系质量与希望水平的相关性。方法采用一般状况调查表、社会关系质量量表、Herth希望量表,于2012年7~12月对广州市某三级甲等医院86例直肠癌永久性结肠造口患者进行问卷调查,运用SPSS 17.0软件包进行统计分析。结果结肠造口患者的社会关系质量总分和希望总分分别为(49.42±4.98)分和(38.52±4.64)分,两者总分及各维度之间呈显著正相关关系(r=0.324~0.680,P<0.01)。结论结肠造口患者的社会关系质量与希望水平具有显著的相关性,医护人员给予造口患者希望与力量的同时,应动员家属发挥对患者的支持作用,促进其对造口的接受,以利于更好地适应造口的生活。     

结肠造口患者生活质量与残障接受度的相关性研究

目的 探讨直肠癌永久性结肠造口患者的生活质量与残障接受度的相关性.方法 采用方便抽样的方法,调查111例直肠癌永久性结肠造口患者.采用一般资料调查表、癌症患者生活质量专用量表(QLQ-C30)、直肠癌特异性症状量表(QLQ-CR38)和残障接受度量表分别调查研究对象的一般情况、生活质量和残障接受度,并使用SPSS17.0软件包进行统计分析.结果 结肠造口患者的整体健康状况得分高于参考值,残障接受度得分处于中等水平.结肠造口患者的整体健康状况、各功能维度、症状维度中的疼痛、失眠、食欲、经济困难的感知、泌尿、胃肠道、化疗不良反应、造口相关问题、体质量减轻等维度/条目得分与患者的残障接受度得分呈显著相关.结论 造口患者残障接受度水平与生活质量密切相关,应提高患者的残障接受度水平来帮助患者获得更好的生活质量.     

永久性结肠造口患者自我护理能力与主要照顾者生活质量的相关性研究

目的分析永久性结肠造口患者自我护理能力与主要照顾者生活质量的相关性。方法采用一般资料调查表、自我护理能力测定量表、SF-36健康调查量表对138例直肠癌腹会阴联合切除永久性结肠造口患者及138例主要照顾者进行调查。结果永久性结肠造口患者自我护理能力总分为(115.09±24.55)分,患者总体自我护理能力1.5%为低等水平、53.6%为中等水平、44.9%为高等水平;主要照顾者生活质量明显低于国内常模(P0.05)。永久性结肠造口患者自我护理能力总分及4个维度得分与主要照顾者生理功能、躯体疼痛、精神健康、活力、总体健康及健康变化呈正相关(r=0.238~0.507,P0.01)。结论永久性结肠造口患者自我护理能力与主要照顾者生活质量具有显著的相关性。     

直肠癌永久性结肠造口患者残障自我接受能力与社会关系质量的相关性研究

目的探讨直肠癌永久性结肠造口患者残障自我接受能力与社会关系质量的相关性。方法选取2010年4月~2012年5月我科已行直肠癌永久性结肠造口术的82例患者作为研究对象,采用残障接受度量表(ADS)、社会关系质量量表(SORS)对患者进行问卷调查,对不同水平的残障接受度患者和社会关系质量结果分别进行分析,并对残障接受度与社会关系质量进行相关性分析。结果结肠造口患者残障接受度处于中等水平,得分为(182.01±39.85),除扩大维度外,其它维度得分较低;社会关系质量中家庭亲密度和家庭承担维度得分明显高于朋友关系维度;结肠造口患者转变和控制维度与社会关系质量各个维度及总分呈明显正相关,造口患者残障接受度量表中扩大和服从维度与社会关系质量量表中各维度几乎没有相关性。结论直肠癌永久性结肠造口患者残障自我接受能力与社会关系质量之间具有明显的相关性,因此术后应注意加强心理干预、提高社会关系质量,促进两者共同改善和提高。     

结直肠癌术后永久性结肠造口患者自我效能与生活质量的研究

目的了解结直肠癌术后永久性结肠造口患者的生活质量和自我效能水平,并探索自我效能和生活质量的相关性。方法采用造口相关的自我效能量表和癌症患者生活质量问卷(QLQ-C30)调查了69例结直肠癌术后永久性结肠造口患者的自我效能和生活质量水平,并分析其相关性。结果51%永久性结肠造口患者的自我效能处于中等水平,19%的患者处于低自我效能水平;结直肠癌术后永久性结肠造口患者的生活质量显著低于欧洲癌症研究治疗组织推荐的生活质量水平(P<0.01);自我效能与生活质量的各功能维度呈正相关,而与生活质量的各症状之间呈负相关。结论结直肠癌术后永久性结肠造口患者的自我效能与生活质量密切相关,提示护理中可以通过提高患者的自我效能水平,来提高患者的生活质量。     

80例永久性结肠造口患者伤残接受度与希望水平相关性分析

目的 探讨永久性结肠造患者伤残接受度与希望水平之间的相关性关系.方法 采用便利抽样,选取2016年1月—2017年1月在我院造口门诊随访和住院的80例永久性结肠造口患者作为研究对象.采用一般资料调查量表、伤残接受度量表及Herth希望量表对其进行问卷调查,采用Pearson相关性检验分析永久性结肠造口患者伤残接受度与希望水平的相关性.结果 永久性结肠造口患者伤残接受度总分为(73.08±5.24)分,处于中等接受水平;希望水平总分为(34.30±2.74)分,处于中等水平.Pearson相关性分析结果显示:永久性结肠造口患者伤残接受度总分与希望水平总分及态度维度得分呈密切正相关(r=0.418,0.436,P<0.001).结论 永久性结肠造口患者伤残接受度处于中等水平,伤残接受度与希望水平呈密切正相关.护理人员应关注永久性结肠造口患者伤残接受度水平,并加强健康指导,从而提高患者的希望水平,最终提高其生存质量.     

永久性结肠造口患者自我护理能力与生活质量的相关性研究

目的 了解结直肠癌术后永久性结肠造口患者自我护理能力与生活质量水平,并探索两者的相关性,为提高患者自我护理能力和生活质量水平提供理论依据和实践指导.方法 采用自我护理能力测定量表和癌症患者生活质量问卷对行结直肠癌根治术(Mile's术式)后1个月以上的90例患者进行自我护理能力和生活质量问卷调查,采用Pearson相关分析法分析两者的相关性.结果 本组患者自我护理能力总分为(108.40±21.83)分,2%的患者总体自我护理能力处于低等水平,67%处于中等水平,31%处于高等水平;结肠造口患者的生活质量明显低于欧洲癌症研究治疗组织推荐的生活质量水平(P＜0.01);除自我护理责任感维度外,本组患者自我护理能力总分及其他维度得分与生活质量各功能维度和总体健康状况/生活质量得分呈正相关,而与生活质量各症状维度和单项条目得分呈负相关.结论 永久性结肠造口患者自我护理能力大体处于中等水平,生活质量水平低,自我护理能力与生活质量水平密切相关.提示临床护理结肠造口患者时,应重视提高患者自我护理知识和技能,提高患者自我护理能力,进而提高其生活质量水平.     

直肠癌结肠造口患者正念水平对其自我管理行为的影响

目的了解直肠癌结肠造口患者的正念水平对其自我管理行为的影响,为临床护理工作提供指导依据。方法应用一般资料调查表、五因素正念量表和自我管理行为量表对258例直肠癌永久性结肠造口患者进行调查。结果直肠癌结肠造口患者的正念水平评分为(97.45±10.28)分;自我管理行为评分为(41.50±5.21)分;直肠癌结肠造口患者的文化程度、肿瘤临床分期和正念水平是自我管理行为的主要影响因素。结论直肠癌永久性结肠造口患者的正念水平越高,自我管理行为越好,有利于其家庭康复和生活质量的提高。     

直肠癌永久性造口患者的病耻感与适应水平、生活质量的相关性

目的探讨直肠癌永久性造口患者的病耻感水平及其与适应水平、生活质量的相关性。方法选取在我院治疗的79例直肠癌造口患者,出院后3个月应用社会影响量表、造口适应量表和生活质量量表进行问卷调查。结果患者的病耻感量表总分为(55.20±10.42)分,适应总分为(129.01±20.10)分,生活质量中总体健康得分为(61.01±20.69)分。患者的病耻感与适应水平、生活质量呈负相关(P0.01或P0.05)。结论病耻感可影响直肠癌患者的适应能力和生活质量,应采取适当的干预减少或消除患者的病耻感。     

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.