ICU患者身体约束现状及问题分析

目的了解目前临床ICU患者身体约束及护理现状,并分析存在的问题。方法通过查阅病例及身体约束相关护理文件获得患者资料,观察目前临床针对患者身体约束的评判依据、采取的约束方法、约束时间等,并参考临床实践指南相关指标,分析其差距及存在的问题。结果共纳入231例患者,其中64例患者使用身体约束,约束使用率为27.7%,约束总时长为7 906 h,平均约束时长为123.5 h,约束工具全部为约束带。在身体约束护理方面,医嘱与执行不相符合率为18.0%,护士在使用身体约束前均未使用评估工具进行评估。结论 ICU患者身体约束存在约束方法欠规范,缺乏适时有效的评估等问题,还需进一步规范约束方法,正确评估约束适用对象,提高约束效果,进而改善患者健康结局。     

Gamma-glutamyltransferase and its isoenzymes: progress and problems

Because of its sensitivity to disturbances of excretory liver function, gamma-glutamyltransferase (GGT; EC 2.3.2.2) assay has become one of the most important diagnostic tests for hepatobiliary disorders. However, its value in the differential diagnosis of liver diseases is limited. It is present in kidney, liver, pancreas, and intestine in electrophoretically distinct but not necessarily organ-specific forms. Much effort has been expended to relate diseases of these organs to isoenzyme findings in serum. Although the activities of GGT isoenzymes in disease differ from those in health, the existence of disease-specific patterns is controversial. Much is known about the biochemistry, structure, and immunochemistry of GGT, but more work is needed on methods, standardization of terminology, and correlation of isoenzyme findings with diseases. Further progress in the last area should improve the clinical applicability of the isoenzyme activities.