整体化护理在维持性血液透析患者中的应用

整体化护理自90年代引入我国后一直蓬勃发展,大多应用于住院患者,而门诊患者开展很少,其中包括血液透析患者。血液透析患者是一个特殊群体,他们需要终身治疗才能维持生命,稳定规律的血液透析患者不需住院,只需定时来医院进行血液透析,故对其开展整体化护理较困难。我院血液透析     

整体护理在血液透析患者饮食指导中的应用

目的 探讨整体护理在血液透析患者饮食指导中的应用,使血液透析患者知晓科学的饮食能延缓病情进展,提高生活质量,降低并发症的发生.方法 应用整体护理程序对55例血液透析患者实施个性化的饮食指导,并评价其效果.结果 55例患者的营养状况均得到明显的改善,且减少了并发症,提高了生存质量,延长了生命.结论 整体护理的开展,不但提高了患者的保健知识和生活质量,融洽了护患关系,增加了患者满意度,还持续性的提高了护理人员的业务水平和沟通能力,体现了以人为本的护理内涵.     

预见性护理干预预防肾衰血液透析患者高磷血症的效果观察

目的探讨肾衰血液透析患者实施预见性护理干预对高磷血症的预防效果。方法按照随机抽样的方式选取肾衰血液透析治疗患者120例进行研究,按照就诊奇偶顺序分为2组,各60例,对照组(奇数)按照常规护理处理,而研究组(偶数)按照预见性护理干预处理。观察记录2组患者血液透析达标率、住院时间、患者对护理满意率、高磷血症发生率及其他并发症发生率。结果研究组患者护理满意率、血液透析达标率均明显高于对照组,而住院时间、高磷血症及其他并发症发生率均明显低于对照组,组间比较差异有统计学意义(P0.05)。结论肾衰血液透析患者采取预见性护理干预可提高血液透析达标率、护理满意率,并缩短住院时间,降低高磷血症及其他并发症发生率,值得借鉴。     

责任制整体护理在高龄心血管疾病患者住院期间的应用价值

目的:分析责任制护理在高龄心血管疾病患者住院期间的应用价值。方法:选取在我科责任制整体护理开展前(2015年6月～2016年5月)住院的86例高龄心血管疾病患者作为对照组,在我科责任制整体护理开展后(2016年6月～2017年5月)住院的86例高龄心血管疾病患者作为观察组,对照组给予常规护理,观察组给予责任制整体护理。比较两组患者的住院时间、住院期间的并发症发生率及出院时对护理工作的满意度评分。结果:观察组的平均住院时长明显低于对照组,差异有统计学意义,P0.05;观察组住院期间的并发症发生率明显低于对照组,差异有统计学意义,P0.05;观察组出院时对护理工作满意度评分高于对照组,差异有统计学意义,P0.05。结论:责任制整体护理有助于缩短高龄心血管疾病患者的住院时间,降低住院期间的并发症发生率,提高患者对护理工作的满意度。     

减少血液透析心血管并发症的护理方法探讨

目的探讨减少尿毒症患者血液透析中心血管并发症的护理方法。方法对160例尿毒症患者随机分为2组，每组80例。1组在常规护理下行血液透析。另1组采用适当的护理程序对血液透析患者实施整体护理。结果实施整体护理组病例在血液透析中心血管并发症——高血压、低血压、心律衰竭发生率明显低于常规护理组（P〈0．05）。结论科学的透析方案和完善的整体护理，严密的病情观察可以保证血透治疗的安全和效果，减少尿毒症患者血液透析心血管并发症，提高尿毒症心血管并发症患者的抢救成功率。     

预见性护理在血液透析患者感染控制中的应用

目的:研究并分析预见性护理在血液透析患者感染控制中的应用效果.方法:选取本院2018年6月至2021年6月接受血液透析治疗的120例患者参与本项研究,经电脑盲选法分组,各60例,对照组和以往实施的常规护理保持一致,研究组在此之上又开展预见性护理,比较两组患者的住院时间、医院感染发生率、生存质量改善情况及护理满意度.结果...     

人性化护理对肾功能衰竭血液透析患者生活质量的影响效果分析

探讨在开展肾功能衰竭血液透析护理工作期间,观察应用人性化护理方法施护后对生活质量产生的影响。选择我院2015年1月~2016年12月收治的2000例肾功能衰竭血液透析患者作为实验对象;凭借数字奇偶法对本次研究收治的肾功能衰竭血液透析患者分组;对照组:临床开展肾功能衰竭血液透析护理工作期间,选择传统方法施护;观察组:临床开展肾功能衰竭血液透析护理工作期间,选择人性化护理方法施护;对最终两组肾功能衰竭血液透析患者的生活质量评分变化以及满意度评分回顾性分析。同对照组肾功能衰竭血液透析患者生活质量评分对比,观察组肾功能衰竭血液透析患者获得显著性提高(P<0.05)。同对照组肾功能衰竭血液透析患者满意度评分对比,观察组肾功能衰竭血液透析患者获得显著性提高(P<0.05)。临床在开展肾功能衰竭血液透析护理工作期间,合理选择人性化护理方法施护,对于最终生活质量评分结果的改善可以做出充分保证,从而优化肾功能衰竭血液透析患者的预后能力。     

维持性血液透析患者实施临床护理路径的效果评价

目的 探讨对维持性血液透析患者实施临床护理路径的应用效果.方法 选择2009年1～12月血液透析室120例维持性血液透析患者,随机分为对照组和观察组各60例.对观察组实施临床护理路径进行护理,对照组接受常规护理.比较2组并发症发生情况,遵医行为及对护理质量的满意度.结果 实施临床护理路径后观察组患者较对照组患者并发症减低和护理差错降低,患者遵医行为明显提高,对护理质量的满意度评分显著提高.结论 临床护理路径在维持性血液透析患者中的应用,可以提高整体护理质量以及患者对护理的满意度,对提高患者透析和生存率有重大意义,是全面提高血液透析整体护理质量的有效方法.     

住院患者血液透析转运交接单设计与应用

目的:探讨住院患者血液透析转运交接单在病房和血透中心安全转运过程中的应用效果。方法:将住院患者的一般情况、病情、透析特殊要求、透析方式、脱水量等信息设计成表格式记录单,病房、输送中心、血透中心工作人员持交接单转运患者。结果:应用住院患者血液透析转运交接单后,转运过程中不良事件发生率明显降低,转运相关投诉减少,患者满意度上升。结论:住院患者血液透析转运交接单设计合理、填写便捷,规范了转运交接流程,有效降低了转运交接过程中不良事件的发生率,营造了病房、输送中心、血透中心工作人员及患者整体满意度提高的多赢局面,为更好地推行优质护理服务创造了必要条件。     

血液透析患者自我管理行为依从性的研究现状

随着社会的发展和医疗护理水平的提高，血液透析患者这一特殊群体越来越受到社会的关注。本文从血液透析现状及影响血液透析患者生活质量、生存率的因素等方面进行综述，以期为临床护理科研的开展提供借鉴，旨在通过改善影响血液透析患者生活质量的主观因素（自我管理行为），来提高其健康相关生活质量，现报道如下。     

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.