责任制健康教育在维持性血液透析患者中的应用

目的 探讨责任制健康教育护理模式在维持性血液透析(MHD)患者治疗中的作用.方法 选择在本中心透析的186例MHD患者,采用前后对照方法实施健康教育.实验组实施责任制健康教育:首次行血液透析的管床护士即为责任制健康教育护士,即患者在本中心接受规律透析治疗开始,循环进行宣教,通过提问了解患者对健康教育知识的掌握情况,并有针对性、计划性对薄弱环节进行个性化健康教育.对照组实施随机健康教育.结果 责任制健康教育组与对照组在透析并发症控制情况的比较,实验组在心衰发生率、高血钾发生率、内瘘闭塞发生率均低于对照组,差异有统计学意义(p＜0.05).两组健康教育满意度情况比较,病人满意度和医生满意度实验组均高于对照组,差异有统计学意义(P＜0.05).结论 通过责任制健康教育护理模式的实施,提高了患者自我管理能力及治疗依从性,减少了透析并发症的发生,提高了患者的生活质量,提高了医患的满意度.     

健康教育在维持性血液透析患者中的应用

目的 探讨对维持性血液透析患者进行健康教育的效果及其影响因素.方法 以安贞医院血液净化中心做血液透析治疗的122例尿毒症患者做为研究对象,通过自设问卷调查并有计划、有针对性地进行健康教育.结果 健康教育后,患者掌握了血液透析相关知识(P＜0.01);提高了自我管理能力(P＜0.01);患者文化程度对健康教育效果有影响(P＜0.05);透析年限对健康教育效果无影响(P＞0.05);患者的营养状况、透析充分性、贫血得到改善(P＜0.05).结论 健康教育是患者获得血液透析相关知识和提高自我管理能力的有效途径,是治疗的重要组成因素;健康教育有利于患者,也有利于教育者自身素质的提高.     

88例膀胱灌注患者相关知识掌握状况的调查

目的 探讨膀胱灌注患者对相关知识掌握的影响因素,提出健康教育的改进措施,供临床护士参考.方法 应用自行设计的调查表,于患者出院后第1周回医院行膀胱灌注时,以问答方式对88例患者进行问卷调查,了解患者对膀胱灌注相关知识的掌握状况及影响因素.结果 患者对膀胱灌注相关知识掌握率为70.4%,不同年龄、文化程度患者对膀胱灌注相关知识的掌握率有显著性差异(P＜0.01),不同人员进行健康教育的患者对膀胱灌注相关知识掌握率有显著性差异(P＜0.05),医生组与护士组单独进行健康教育的患者对膀胱灌注相关知识掌握率分别为60%和61.9%,2者比较无显著性差异(P＞0.05),医护合作进行健康教育效果最好,掌握达92.3%,医护合作组分别与医生组和护士组比较有显著性差异(P＜0.01).结论 膀胱灌注相关知识教育应因人施教,医护合作施教,合理安排时间施教.     

健康信念模式教育对腹膜透析患者容量相关依从性的影响

目的 探讨健康信念模式教育对腹膜透析患者容量相关依从性的影响.方法 运用健康信念模式对41例腹膜透析门诊随访患者进行容量控制相关教育,分析患者容量状况、依从性及认知情况的变化趋势.结果 经过健康信念模式教育,患者的总液体清除量和KT/V显著下降,但容量状况无统计学意义(P＞0.05);患者在透析处方、服药方面依从性保持较好水平均＞80%,水盐摄入方面的依从性有统计学意义(P＜0.05);患者对各方面的认知均有显著提高(P＜0.05).结论 应用健康信念模式教育,有利于提高腹膜透析患者容量相关依从性,促进其达到并维持容量平衡状态.     

两种透析方法治疗老年尿毒症患者91例临床分析及护理体会

目的探讨老年尿毒症患者较为理想的透析护理方法.方法对60例血液透析(HD)和31例非卧床持续性腹膜透析(CAPD)的老年尿毒症患者进行比较,观察两组患者透析前后的临床和生化指标,透析后主要并发症、生存率、死亡原因.结果透析前伴有高血压、冠心病、糖尿病的患者行CAPD后并发症出现机会少于HD(P＜0.05).HD或CAPD治疗后1年和3年生存率无显著性差异(P＞0.05).结论透析前合并有高血压、冠心病、糖尿病的老年尿毒症患者以选择CAPD为好.     

颈外静脉与前臂静脉留置针在持续滴注化疗药物中的对比研究

目的通过颈外静脉与前臂静脉留置针方式的比较研究,探讨如何减少化疗患者静脉炎及并发症的发生率和化疗中再次静脉穿刺的发生率,从而提高患者生活自理能力及生活质量.方法对100例鼻咽癌患者用5-FU加入微量泵进行持续滴注3 d,用随机分组法将患者分为颈外静脉留置组(简称A组)与前臂静脉留置组(简称B组)进行临床观察与研究.结果A组患者能留针1次完成整个化疗疗程者为100%,B组为76%,经统计学处理有显著性差异(P＜0.001).A组患者静脉炎发生率6%,B组为36%,组间比较有显著性差异(P＜0.001).A组患者并发症发生率为2%,B组为12%,组间比较无显著性差异(P＞0.05).A组患者生活自理能力基本正常,B组患者生活自理能力较差,需人照顾.结论在持续滴注化疗药物中选用颈外静脉留置针的效果明显优于前臂静脉留置针方式,值得临床推广.     

老年冠心病患者实施健康教育的远期效果分析

目的探讨老年冠心病患者实施健康教育的远期效果.方法 110例老年冠心病患者被随机分为健康教育组(教育组)及对照组,每组各55例.在常规治疗的基础上教育组在住院期间及出院后4年内给予健康教育处方结合口头卫生宣教及科普板报知识等经常性的健康教育活动,而对照组不予健康教育.结果教育组患者对冠心病知识的了解情况、饮食控制情况、规律服药治疗情况比对照组好(P＜0.01),出院后再次住院次数比对照组少(P＜0.01).而情绪及吸烟量控制两组无显著性差异(P＞0.05).结论对老年冠心病患者实施经常性的健康教育是控制疾病恶化的重要措施.     

实施家属健康教育对维持性血液透析患者远期生活质量的影响

目的探讨向维持性血液透析(MHD)患者家属同步实施健康教育对患者远期生活质量的影响.方法选择49例MHD患者,随机分为观察组(24例)和对照组(25例),2组患者在常规治疗的同时接受健康教育;观察组在此基础上同步实施家属健康教育.分别在患者透析第1年和第5年后,采用生存质量指数评定量表(SF-36QOL),对2组患者生存质量进行评分并记录.结果第1年和第5年后,组间比较,观察组总体生存质量明显高于对照组,差异有显著性(1年后P＜0.01,5年后P＜0.001).结论对MHD患者家属同步实施健康教育,可提高家属的照料水平、配合程度及患者远期的生活质量.     

健康教育联合心理干预在维持性血液透析患者中的应用效果

目的 探讨健康教育联合心理干预在维持性血液透析患者中的应用效果.方法 将100例维持性血液透析患者分为观察组和对照组各50例,对照组采用常规护理,观察组在对照组的基础上加强健康教育和心理干预,比较两组患者的护理效果.结果 观察组的透析依从性、健康知识知晓率显著高于对照组,并发症显著少于对照组(P均＜0.05).观察组在躯体功能、心理功能、社会功能、物质生活状态方面的生活质量评分显著高于对照组(P＜0.05).结论 健康教育联合心理干预能够显著提高维持性血液透析患者的透析依从性,减少并发症的发生,改善生活质量.     

蛋白质膳食管理对腹膜透析患者血浆蛋白的影响

目的:探讨蛋白质膳食管理对腹膜透析患者血浆蛋白的影响.方法:将腹膜透析患者40例随机分为实验组和对照组各20例,实验组除进行口头护理健康教育外,还根据患者体重、饮食习惯,制定每天蛋白质摄入方案;对照组则只进行口头护理健康教育.3个月后比较两组总蛋白和蛋白变化情况.结果:实验组患者的总蛋白值和白蛋白值在管理前后差异均有统计学意义(P＜0.05),球蛋白值在管理前后差异无显著性(P＞0.05);对照组患者的总蛋白值、白蛋白值和球蛋白值在管理前后的差异均没有统计学意义(P＞0.05).结论:对腹膜透析患者实行长期的蛋白质膳食管理可有效提高患者的血浆蛋白.     

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.     

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.     

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.     

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.