术前体位训练联合围术期优质护理在老年甲状腺肿瘤患者中的应用

目的:探讨术前体位训练联合围术期优质护理在老年甲状腺肿瘤患者中的应用。方法:将100例老年甲状腺肿瘤患者随机分为观察组和对照组各50例,对照组实施常规护理措施,观察组给予术前体位训练和围术期优质护理干预,比较两组患者并发症发生率及汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)评分。结果:观察组术后并发症发生率明显低于对照组(P0.05);两组护理干预后HAMA、HAMD评分明显低于同组干预前(P0.05),观察组干预后HAMA、HAMD评分低于对照组干预后(P0.05)。结论:术前体位训练联合围术期优质护理可降低老年甲状腺肿瘤患者并发症及负性心理发生率。     

心理分级管理在冠状动脉介入手术患者中的应用

目的:探讨心理分级管理在冠状动脉介入手术患者中的应用效果。方法:将384例冠状动脉介入手术患者随机分为观察组和对照组各192例,对照组实施常规围术期护理,观察组在对照组基础上进行心理分级管理,采用匹兹堡睡眠指数(PSQI)、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)评定两组患者治疗前后睡眠质量及心理状况,比较两组患者护理满意度。结果:干预后观察组PSQI、HAMA、HAMD评分低于对照组(P0.05);观察组护理满意度高于对照组(P0.05)。结论:心理分级管理应用于冠状动脉介入手术患者效果较好,可有效改善患者睡眠质量,控制不良情绪,提高护理服务质量。     

分级心理护理对老年急性脑梗死手术患者睡眠质量及认知功能的影响

目的探讨分级心理护理对老年急性脑梗死手术患者睡眠质量及认知功能的影响。方法选取本院2017年6月—2018年12月收治70例老年急性脑梗死手术患者作为研究对象,采用随机数字法分为观察组和对照组各35例,两组患者均给予围术期常规护理,其中对照组患者给予常规健康宣教,观察组患者则在对照组的基础上给予分级心理护理干预。采用汉密尔顿焦虑量表(HAMA)对两组护理干预前后的焦虑心理进行评价,采用匹兹堡睡眠质量指数量表(PSQI)、简易智能状态检查量表(MMSE)对两组患者护理干预前后的睡眠质量、认知功能进行评价和比较。结果两组患者护理干预后的HAMA评分均较干预前明显下降,干预后观察组明显优于对照组(P0.05);观察组患者干预后的PSQI各项评分及总评分、MMSE评分均明显优于对照组,差异具有统计学意义(P0.05)。结论分级心理护理干预能有效降低老年急性脑梗死手术患者的焦虑情绪,明显提高患者的睡眠质量及认知功能,其对于提升患者术后生活质量具有重要意义。     

快速康复流程在改善大肠癌患者围手术期睡眠质量及心理状态中的应用

目的:探索分析快速康复流程对于改善大肠癌患者围术期睡眠质量以及心理状态的效果。方法:选取2012年7月~2013年9月我院收治的大肠癌且行手术治疗的80例患者作为研究对象,随机等分为对照组和观察组,对照组应用常规模式进行护理,观察组在对照组基础上实施快速康复流程,比较两组患者睡眠质量以及心理状态。结果:两组患者住院时匹兹堡睡眠质量指数(PSQI)得分、汉密尔顿抑郁(HAMD)以及汉密尔顿焦虑量表(HAMA)量表评分组间差异均无统计学意义(P0.05)。术后1周,观察组PSQI总分明显低于对照组,HAMD以及HAMA量表评分均低于对照组,差异均有统计学意义(P0.05)。结论:针对大肠癌手术患者进行快速康复流程护理,可以有效改善患者围手术期的睡眠质量及心理状态。     

心理干预与健康教育在脑梗死恢复期患者康复护理中的应用

目的探讨心理干预与健康教育对脑梗死恢复期患者护理效果。方法选取2020年03月至2021年2月期间南阳市第八人民医院收治的60例脑梗死恢复期患者为研究对象, 按照入院单双顺序分为对照组和观察组各30例, 对照组给予常规护理干预, 观察组给予心理干预与健康教育, 比较两组患者心理状态〔汉密顿焦虑量表(HAMA)、汉密顿抑郁量表(HAMD)〕、神经功能缺损(NIHSS)评分、睡眠质量(PSQI)评分、生活质量(SF-36)评分、遵医率及患者满意度的变化。结果干预后两组患者HAMA与HAMD评分及NIHSS、PSQI评分均显著降低, 生活质量评分升高(P<0.05)且观察组患者HAMA与HAMD评分及NIHSS、PSQI评分均显著低于对照组, 生活质量评分高于对照组(P<0.05);干预后观察组遵医率为93.33%, 满意度为96.67%, 均显著高于对照组的76.67%和80.00%(P<0.05)。结论心理干预与健康教育可有效缓解脑梗死恢复期患者心理状态, 改善神经功能和睡眠质量, 提高生活质量、遵医行为及护理质量。     

优质护理对子宫肌瘤患者围术期情绪及睡眠的影响

目的:探究优质护理对子宫肌瘤患者围术期情绪及睡眠的影响。方法:选取2018年1月至2019年11月泉州妇幼保健院·儿童医院的子宫肌瘤手术患者68例作为研究对象,随机分为对照组与观察组,每组34例。对照组进行常规护理,观察组在常规护理的基础上行优质护理。比较2组患者护理前后的情绪状态[汉密尔顿焦虑量表(HAMA)及汉密尔顿抑郁量表(HAMD)]、疼痛程度[视觉模拟评分法(VAS)]及睡眠质量[匹兹堡睡眠质量指数(PSQI)]。结果:护理后观察组的HAMA评分及HAMD评分显著低于对照组,术后PSQI评分及1 d、2 d、3 d的VAS评分显著低于对照组,差异有统计学意义(P 0.05)。结论:优质护理模式可显著改善子宫肌瘤患者围手术期心理状态,并可缓解术后疼痛,提高睡眠质量。     

俱乐部式心理护理联合团队认知干预对白血病患者情绪、应对方式及睡眠质量的改善效果

目的 探索俱乐部式心理护理联合团队认知干预对白血病患者不良情绪、应对方式及睡眠质量的影响。方法 以2018年9月—2021年12月医院收治的154例白血病患者为研究对象,按照组间基本特征具有可比性的原则将患者分为对照组与观察组,各77例,对照组给予常规护理,观察组在对照组基础上采用俱乐部式心理护理联合团队认知干预,比较两组患者的不良情绪、应对方式及睡眠质量。结果俱乐部式心理护理联合团队认知干预前,两组汉密尔顿焦虑量表（HAMA）、汉密尔顿抑郁量表（HAMD）评分比较差异无统计学意义（P>0.05）;干预后,观察组患者的HAMA及HAMD评分低于对照组,差异有统计学意义（P<0.05）。俱乐部式心理护理联合团队认知干预前,两组面对、回避、屈服评分比较差异无统计学意义（P>0.05）;干预后,观察组患者的面对量表评分高于对照组,回避及屈服量表评分低于对照组,差异有统计学意义（P<0.05）。俱乐部式心理护理联合团队认知干预前,两组匹兹堡睡眠质量指数（PSQI）量表评分比较差异无统计学意义（P>0.05）;干预后,观察组患者的PSQI量表评分低于对照组,差异有统...     

积极心理干预护理对肝癌手术后患者睡眠质量及心理状态的影响

目的:探讨积极心理干预护理对肝癌手术后患者睡眠质量及心理状态的影响。方法:选取2018年5月至2019年8月在福建省立医院进行肝癌手术患者84例作为研究对象,随机分为对照组与观察组,每组42例,对照组接受常规护理,观察组在对照组基础上实施积极心理干预护理,对2组患者干预前后睡眠质量及心理状态进行观察。结果:2组患者干预前的匹兹堡睡眠质量指数(PSQI)差异无统计学意义(P 0.05),观察组干预后的PSQI评分明显低于对照组(P 0.05); 2组患者干预前的汉密尔顿抑郁量表(HAMD)及汉密尔顿焦虑量表(HAMA)评分差异无统计学意义(P 0.05),观察组干预后的HAMA及HAMD评分均较对照组低(P 0.05)。结论:积极心理干预护理可提高肝癌手术后患者睡眠质量,也能改善其心理状态,值得推广。     

基于根因分析法针对性护理结合正念心理干预对精神分裂症患者心理状态及睡眠质量的影响

目的：分析基于根因分析法针对性护理结合正念心理干预对精神分裂症患者心理状态及睡眠质量的影响。方法：选取2020年3月至2022年3月福建省泉州市第三医院精神科收治的精神分裂症患者102例作为研究对象,按照随机数字表法分为对照组(n=48)和观察组(n=54)。对照组给予常规护理模式干预,观察组给予基于根因分析法针对性护理联合正念心理干预。比较2组干预前后汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表17项(HAMD17)、匹兹堡睡眠质量指数量表(PSQI)、生命质量量表(SF-36)变化。结果：干预后,2组HAMA、HAMD评分均较本组干预前降低,且观察组干预后HAMA、HAMD评分均低于对照组(P<0.05)。2组干预后PSQI评分较本组干预前均降低,且观察组干预后PSQI评分显著低于对照组(P<0.05)。干预后2组SF-36评分较本组干预前升高,且观察组干预后SF-36评分显著高于对照组(P<0.05)。结论：精神分裂症患者应用基于根因分析法针对性护理结合正念心理干预可有效缓解焦虑、抑郁的心理状态,提高睡眠质量。     

心理护理干预对老年慢性心力衰竭患者的睡眠质量影响观察

目的：研究心理护理在老年慢性心力衰竭护理中的应用价值,并分析此种护理模式对患者睡眠质量的影响。方法：选取2019年6月至2020年4月在泉州市光前医院就诊的老年慢性心力衰竭患者60例作为研究对象,按照随机数字表法随机分为对照组和观察组,每组30例。对照组采用常规护理,而观察组采用常规护理联合心理护理,比较2组患者汉密尔顿焦虑量表(HAMA)评分、汉密尔顿抑郁量表(HAMD)评分、匹兹堡睡眠质量指数量表(PSQI)和生命质量(WHOQOL-100)评分。结果：护理后,2组患者HAMA评分及HAMD评分均下降,观察组HAMA评分及HAMD评分均低于对照组,2组比较差异均有统计学意义(均P<0.05);护理后,2组患者PSQI评分均降低,观察组PSQI评分低于对照组,2组比较差异有统计学意义(P<0.05);护理后,观察组患者WHOQOL-100评分较对照组高,2组比较差异有统计学意义(P<0.05)。结论：将心理护理运用在老年慢性心力衰竭护理中不仅可以缓解不良情绪,还有利于减轻睡眠障碍,从而提高患者的生命质量,因此,此种护理措施可在临床上进一步推广和应用。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.