基于跨理论模型的护理干预在产后尿失禁患者盆底肌功能锻炼中的应用

目的探讨基于跨理论模型的护理干预在产后尿失禁患者盆底肌功能锻炼中的应用效果。方法采用便利抽样法,选取2019年8月—2020年8月于北京协和医院盆底康复中心就诊的128例产后尿失禁患者为研究对象。按照患者就诊先后时间进行分组,将2019年8—12月收治的64例患者设为对照组,将2020年1—8月收治的64例患者设为观察组。对照组接受常规护理及健康指导,观察组在此基础上进行基于跨理论模型的护理干预。干预前及干预12周后评估两组患者的1 h尿垫试验漏尿量、盆底肌锻炼依从性及所处行为改变阶段。结果干预12周后,观察组的依从性优于对照组,差异有统计学意义(P<0.01)。干预12周后,观察组患者的1 h尿垫试验漏尿量少于对照组,差异有统计学意义(P<0.01)。干预12周后,观察组行动阶段和维持阶段人数多于对照组,差异有统计学意义(P<0.01)。结论应用基于跨理论模型的护理干预能够提高产后尿失禁患者盆底肌锻炼依从性、治疗效果,促进健康行为的建立。     

盆底肌锻炼联合电刺激对产后压力性尿失禁患者盆底肌力及尿动力学的影响

目的探讨盆底肌锻炼联合电刺激对产后压力性尿失禁患者盆底肌力及尿动力学的影响。方法选取2018年5月～2019年5月我院收治的产后压力性尿失禁患者60例,依据随机数字表法分为观察组和对照组各30例。对照组采用常规尿失禁治疗,观察组采用盆底肌锻炼联合电刺激治疗。对比两组治疗前、治疗后2个月盆底肌力及尿动力学指标。结果治疗前,两组Ⅰ类肌纤维肌力与Ⅱ类肌纤维肌力等级比较,差异无统计学意义(P>0.05);治疗2个月后,两组患者Ⅰ类肌纤维肌力与Ⅱ类肌纤维肌力等级明显提高,且观察组高于对照组,差异有统计学意义(P<0.05)。治疗前,两组PQmax、PVLP、PMUC、PMU指标比较,差异无统计学意义(P>0.05);治疗2个月后,两组PQmax、PVLP、PMUC、PMU指标水平均明显提升,且观察组升高幅度大于对照组,差异有统计学意义(P<0.05)。结论产后压力性尿失禁患者采用盆底肌锻炼联合电刺激疗效确切,可有效提升盆底肌力等级,改善尿动力学指标,值得临床推广。     

日记式康复指导对女性压力性尿失禁患者盆底肌锻炼依从性的影响

目的探讨日记式康复指导对女性压力性尿失禁患者盆底肌锻炼依从性的影响。方法选取2017年12月至2018年12月我院收治的96例女性压力性尿失禁患者作为研究对象,随机将其等分为对照组和试验组,对照组给予常规康复干预,试验组在对照组基础上给予日记式康复指导。采用国际尿失禁咨询委员会尿失禁问卷调查简表(ICI-Q-SF)评估患者尿失禁症状的主观改善情况,比较两组患者干预前、干预后3个月自我效能得分、盆底肌锻炼依从性、主观改善情况、临床治疗效果。结果干预后3个月,两组患者自我效能得分均明显升高,试验组得分明显高于对照组(P<0.05);干预后3个月,两组患者盆底肌锻炼依从性均明显改善(P<0.05),试验组优于对照组(P<0.05);干预后3个月,两组ICI-Q-SF评分均明显降低,试验组低于对照组(P<0.05);试验组临床治疗效果明显高于对照组(P<0.05)。结论日记式康复指导能够明显提升女性压力性尿失禁患者盆底肌锻炼依从性,增强患者自我效能,有效改善尿失禁症状,明显提高临床治疗效果。     

五位一体专病专管延续护理在提高产妇产后盆底肌功能锻炼依从性的应用

目的观察五位一体专病专管延续护理提高产妇产后盆底肌功能锻炼依从性的效果。方法将110例行阴道分娩的初产妇按随机数字表分为观察组和对照组各55例,对照组施以常规产后延续管理,观察组接受五位一体专病专管延续护理。结果产后12周,观察组产妇盆底肌功能锻炼依从率、盆底肌张力恢复良好率高于对照组,尿失禁发生率低于对照组,比较差异有统计学意义;产后6个月,观察组生活质量综合评定问卷评分高于对照组,比较差异有统计学意义。结论采用五位一体专病专管延续护理对产妇实施干预,可提高产妇产后盆底肌功能锻炼依从率,获得较好的盆底功能恢复效果。     

非侵入式盆底肌康复疗法对产后盆底功能恢复的影响

目的观察非侵入式盆底肌康复疗法对产后盆底肌功能恢复的影响。方法选取2016年2月—2018年1月在上海交通大学医学院附属仁济医院南院尿失禁及盆底康复中心就诊的产后盆底功能障碍患者128例。将研究对象随机分为观察组(n=64)和对照组(n=64)。两组患者在治疗过程中均接受相关健康宣教、电话随访,对照组患者进行家庭自主盆底肌锻炼,每天不少于40 min;观察组在对照组基础上采用非侵入式体外压力感受生物反馈训练联合体外盆底磁刺激疗法进行干预,每次治疗40 min,每周3次,共干预12周。于患者治疗前、治疗后6周、治疗后12周时分别比较两组患者的盆底功能障碍评分和盆底肌电测评得分。结果两组患者治疗后6周及12周的盆底功能障碍得分较治疗前均有所下降(P0.05),且治疗后12周的得分均低于治疗后6周(P0.05),观察组患者治疗后各时间点盆底功能障碍得分均低于对照组(P0.05);两组患者治疗后6周及12周盆底肌电测评得分较治疗前均有提升(P0.05),且两组治疗后12周得分高于治疗后6周(P0.05),观察组患者治疗后各时间点盆底肌电测评得分高于对照组(P0.05)。结论与患者自行盆底肌锻炼相比,非侵入式盆底肌康复疗法能更好地改善患者的盆底功能状态,增强盆底肌力,提高患者的生活质量;且该疗法非侵入、无创、无痛,更容易被广泛接受,值得临床推广应用。     

低频电刺激联合生物反馈对产后盆底肌康复及压力性尿失禁发生率的影响

目的探讨低频电刺激联合生物反馈对产后盆底肌康复及压力性尿失禁发生率的影响。方法选取产科分娩且6w后复查诊断为产后盆底功能障碍(PFD)的136例产妇,采用随机数字表法分为对照组和观察组各68例。对照组进行盆底肌肉锻炼,观察组采用低频脉冲电刺激联合生物反馈治疗。对比两组盆底肌力、尿失禁症状及生活质量。结果产后半年,观察组Ⅰ类肌纤维肌力、Ⅱ类肌纤维肌力等级均高于对照组,差异有统计学意义(P<0.05);观察组漏尿频率、漏尿量、病情对生活的不良影响评分均低于对照组,WHOQOL-BREF评分高于对照组,差异有统计学意义(P<0.05)。结论低频电刺激联合生物反馈疗法较常规盆底康复训练效果显著,有助于帮助产妇恢复盆底肌肉功能,改善压力性尿失禁症状,提高生活质量。     

格林健康教育联合凯格尔盆底康复训练对产妇产后盆底功能及预后的影响

目的:探讨格林健康教育联合凯格尔盆底康复训练对产妇产后盆底功能及预后的影响。方法:选取2019年1月—2020年4月在扬州大学附属医院分娩的120例产妇为研究对象,采用随机数字表法将病人分为对照组和观察组,每组60例。对照组行常规干预措施,观察组在常规干预基础上应用格林健康教育联合凯格尔盆底康复训练治疗,对两组病人干预前及干预8周后的盆底肌力、性生活质量及干预8周后压力性尿失禁疗效进行比较。结果:干预后,观察组病人盆底肌Ⅰ类肌纤维肌力恢复正常（肌力高于Ⅲ级）率为83.3%(50/60),高于对照组[55.0%(33/60)];观察组盆底肌Ⅱ类肌纤维肌力恢复正常率为81.7%(49/60),高于对照组[56.7%(34/60)];两组Ⅰ类肌纤维、Ⅱ类肌纤维肌力比较,差异有统计学意义（P<0.05）。干预后,观察组中国女性性生活质量问卷总分及各维度得分均高于对照组,差异有统计学意义（P<0.05）。干预后,观察组压力性尿失禁治疗总有效率为93.33%,高于对照组（75.00%）,差异有统计学意义（P<0.05）。结论:格林健康教育联合凯格尔盆底康复训练治疗能够有效提高产妇...     

个性化延续性护理对初产妇产后盆底肌功能锻炼依从性、盆底肌力及性生活质量的影响分析

目的 探究个性化延续性护理对初产妇产后盆底肌功能锻炼依从性、盆底肌力及性生活质量的影响。方法 选取2020年5月至2021年5月在我院收治的80例初产妇，根据护理方法不同分为对照组和观察组各40例。对照组采用常规随访护理方法进行护理干预，观察组采用个性化延续性护理干预。随访3个月，记录两组干预前后盆底肌功能锻炼依从性、盆底肌力，以及采用女性性功能量表（FSFI）评估两组产后的性生活质量。结果 干预1个月后，两组盆底肌功能锻炼依从性评分比较，差异无统计学意义（P>0.05）；干预2个月、3个月后，观察组盆底肌功能锻炼依从性评分高于对照组，差异有统计学意义（P<0.05）。干预后，观察组盆底肌力、盆底肌最大肌电位以及盆底肌纤维疲劳度比较均优于对照组，差异有统计学意义（P<0.05）。干预前，两组性生活质量各维度评分比较，差异无统计学意义（P>0.05）；干预后，观察组性生活质量各项评分均高于对照组，差异有统计学意义（P<0.05）。结论 个性化延续性护理能够提高初产妇产后盆底肌功能锻炼依从性，改善盆底肌张力，促进产后性生活质量的提升。     

赋能教育模式在全子宫切除患者术后盆底肌功能锻炼中的应用

目的:探讨赋能教育模式在全子宫切除患者术后盆底肌功能锻炼中的应用效果。方法:选取2015年7月~2016年6月在我院行全子宫切除术患者130例,根据赋能教育模式实施前后分为对照组和观察组。对照组患者给予常规模式指导其进行盆底肌功能锻炼,观察组患者基于赋能教育模式指导其进行盆底肌功能锻炼。结果:干预后观察组患者盆底肌功能锻炼的依从性高于对照组,尿失禁频率、1 h尿垫重量、骨盆肌收缩压力、骨盆肌收缩持续时间、膀胱残余尿量等盆底功能指标均优于对照组,差异有统计学意义(P0.05)。结论:基于赋能教育模式指导患者进行盆底肌功能锻炼,可以提高患者功能锻炼的依从性,促进盆底功能恢复。     

盆底肌功能锻炼联合穴位敷贴对产妇盆底肌力及尿失禁的影响

目的探讨盆底肌功能锻炼联合穴位敷贴对产妇盆底肌力及尿失禁的影响。方法将分娩6周来医院复查的100例产妇分为试验组和对照组,每组50例。对照组行盆底肌功能锻炼,试验组在对照组的基础上行穴位敷贴。了解两组产妇干预前后盆底肌力及尿失禁发生情况。结果干预后两组产妇尿失禁发生率和盆底肌力比较,差异均有统计学意义(P0.05)。结论盆底肌功能锻炼联合穴位敷贴可提高产妇盆底肌力及降低尿失禁的发生。穴位敷贴具有方法简单、实用、无损伤及不良反应的优点,值得临床推广应用。     

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.