腕式电子血压计袖带套的制作及应用

目的探讨较好的腕式电子血压计袖带的保护隔离方法,预防交叉感染。方法选用市售针织布制作袖带套,对40例住院脑卒中患者采用自身对照法应用腕式电子血压计套用袖带套和不套用袖带套各测量血压2次,取其平均值。结果两种方法测量的血压值比较,差异无统计学意义(均P>0.05)。结论应用袖带套可较好地保护、隔离腕式电子血压计袖带,一定程度地避免交叉感染,对血压测量值无影响。     

水银血压计测量血压常见误差原因分析

从血压计的发展简史和水银血压计测量血压存在的误差及原因进行综述.提出仪器、护理人员技术、受测者心理和生理因素以及环境是发生误差的主要原因,为规范临床护理人员护理技术操作,改善护理服务质量提供借鉴和参考.     

水银血压计测量血压常见误差原因分析

从血压计的发展简史和水银血压计测量血压存在的误差及原因进行综述。提出仪器、护理人员技术、受测者心理和生理因素以及环境是发生误差的主要原因，为规范临床护理人员护理技术操作，改善护理服务质量提供借鉴和参考。     

系统评价导引治疗骨质疏松症的Meta分析

目的系统评价导引治疗骨质疏松症的有效性及安全性。方法计算机检索中、英文数据库(自建库至2019年4月)中收录的导引治疗骨质疏松症的临床随机对照文献,依据JADAD评估质量,并用Rev Man 5.3进行Meta分析。结果检索文献共289篇,纳入9篇,总样本量808例。Meta分析得出:导引+常规VS常规干预改善VAS评分[MD=-1.06,95%CI(-1.31,-0.82),P0.00001]、腰椎骨密度[MD=0.09,95%CI(0.01,0.16),P=0.02]、股骨颈骨密度[MD=0.13,95%CI(0.00,0.25),P=0.05]、血清磷[MD=0.02,95CI(0.00,0.04),P=0.05]均优于常规治疗,且差异有统计学意义。对血清钙[MD=-0.53,95%CI(-1.48,0.41),P=0.27]、血清碱性磷酸酶[MD=-0.18,95%CI(-11.90,11.53),P=0.98]的改善未见明显差异。导引VS传统锻炼改善VAS评分[MD=-1.66,95%CI(-2.57,-0.74),P=0.0004]、腰椎骨密度[MD=0.11,95%CI(0.02,0.20),P=0.01]、股骨颈骨密度[MD=0.08,95CI(0.01,0.14),P=0.02]疗效均优于传统锻炼。结论导引治疗骨质疏松症在改善VAS评分、腰椎骨密度、股骨颈骨密度均优于常规干预,且与西药联用具有增效作用。     

脉搏血氧仪筛查儿童亚临床先天性心脏病准确性的系统评价和Meta分析

目的 评价脉搏血氧饱和度测定诊断儿童亚临床先天性心脏病的准确性。 方法 制定详细的检索策略,计算机检索建库至2013年2月间维普中文科技期刊数据库、中国期刊全文数据库、中国生物医学文献数据库、万方数据库、PubMed、 Excerpta Medica Database、The Cochrane Library,纳入脉搏血氧仪用于筛查儿童亚临床先天性心脏病的相关研究,两名研究者背对背提取有效数据,以诊断性研究质量评价标准（QUADAS）评价文献质量,应用RevMan 5.1.1软件进行Meta分析。 结果 最终纳入12个研究,共包括137 582例新生儿。12个研究均符合QUADAS 14条,12个研究中,只有待评价试验结果阳性的样本接受了金标准试验;12个研究中仅有1个研究描述了金标准试验的操作,有10篇文献是在知晓待评价试验结果的情况下进行的金标准试验结果判读。Meta分析结果显示：脉搏血氧仪诊断先天性心脏病的合并敏感度和特异度分别为22% ［95% CI （19%,25%）］、99% ［95% CI （99%,99%）］,合并阳性似然比和阴性似然比分别为157.30 ［95% CI （11.80,2 096.95）］、0.61 ［95% CI （0.46,0.82）］,合并诊断比值比为398.25 ［95% CI （34.5,4 596.81）］,受试者工作特征（SROC）曲线下面积为0.809,Q＊指数为0.744。 结论脉搏血氧仪用于诊断儿童先天性心脏病的敏感度较低,而特异度较高,有助于早期诊断先天性心脏病。     

Beyond冷光美白疗效分析的系统评价及Meta分析

目的：对Beyond冷光美白的疗效进行系统评价。方法：通过系统检索中国学术期刊网全文数据库及中文科技期刊数据库发表的文献,收集有关Beyond冷光美白疗效临床研究文献,建立纳入和排除标准,采用广义倒方差模型进行Met a分析。结果：共纳入21篇文献,以牙数为实验单位的加权合并的显效率为81.30（95%可信区间：78.33～84.38）,以人数为实验单位的加权合并的显效率为66.84（95%可信区间：58.75～76.05）。结论：Beyond冷光美白是一种较好的牙齿美白技术。     

磁共振成像对直肠癌术前放化疗后再分期准确性的Meta分析

目的评价磁共振成像（MRI）对直肠癌术前放化疗后再分期的准确性。方法利用PubMed、EMBASE、Ovid和wok数据库,全面检索MRI对直肠癌术前放化疗后再分期相关的英文文献,检索日期1985年1月至2012年3月。对MRI用以直肠癌术前放化疗后再分期的敏感性和特异性进行Meta分析。结果最终纳入15篇,共749例患者。MRI对直肠癌术前放化疗后T3～T4分期诊断的敏感性为82．1％（95％CI：67．9％～90．9％）,特异性为53．5％（95％CI：39．3％．67.3％）,诊断比数比（DOR）为5．34（95％C1：2．73～10．45）;对阳性淋巴结诊断的敏感性、特异性及DOR分别为61．8％（95％CI：50．7％～71．8％）、72．0％（95％CI：61．3％～80．7％）和4．33（95％CI：2．84～6．59）;对环周切缘阳性诊断的敏感性、特异性及DOR分别为85．4％（95％CI：60．5％～95．7％）、80．0％（95％CI：57．4％～92．2％）和27．62（95％CI：13．03～58．55）。结论MRI对于直肠癌术前放化疗后B～T4和阳性淋巴结诊断准确性一般,而对环周切缘诊断准确性高。推荐术前常规利用MRI对直肠癌患者进行放化疗后再分期,以避免过度治疗。     

马应龙麝香痔疮膏治疗痔的系统评价及Meta分析

目的:系统评价马应龙麝香痔疮膏治疗痔病的临床疗效。方法:通过计算机检索中国知网及万方数据库,检索时间范围为各数据库的建库时间至2022年6月4日,检索所有关于马应龙麝香痔疮膏治疗痔的文献。并由2名文献研究员对文献进行筛选和评价,使用RevMan5.4.1软件对纳入文献进行Meta分析。结果:筛选后获得11篇中文文献,对筛选出的11篇文献进行Meta分析,共包括患者2 125例。分析结果显示,与常规痔治疗方法相比,马应龙麝香痔疮膏能够提升临床总有效率,显著减缓患者水肿情况。结论:基于现代文献研究,马应龙麝香痔疮膏治疗痔效果显著,能提升患者临床有效率,能够为中药外用治疗痔病提供更多依据。     

全胃切除术后消化道重建方式的系统评价和Meta分析

目的：通过比较空肠造袋与否及十二指肠的利用与否探讨全胃切除术后最佳的消化道重建方式。 方法：检索相关的全胃切除术后消化道重建方式的随机对照临床试验（RCT）的文献,对纳入的研究行系统评价或Meta分析。 结果：9篇关于Roux-en-Y术后空肠造袋与否的RCT以及4篇关于空肠造袋的Roux-en-Y术与空肠造袋的空肠间置术比较的RCT被纳入Meta分析;此外,关于单纯的Roux-en-Y术后与空肠间置术后的2篇RCT、空肠间置术后造袋与否的2篇RCT未行Meta分析,但结果以描述性的形式给出。分析结果显示,与不造袋者比较,空肠造袋在不增加患者的围手术期病死率、围手术期并发症的发生率等的同时,倾倒综合征、烧灼感等术后消化道症状的发生率明显降低,食物吸收明显改善,患者生存质量也得到提高（均P<0.05）。与十二指肠不利用者比较,无论单纯的利用十二指肠还是在空肠造袋的基础上利用十二指肠均未发现证据表明其在改善术后消化道症状、提高患者生存质量等方面存在优势（均P>0.05）。 结论：空肠造袋是全胃切除术后有效的消化道重建方式,但是对十二指肠的利用尚未发现优势。     

不同手术方式治疗慢性肛裂疗效评价的网状Meta分析

目的评价不同手术方式治疗慢性肛裂的效果。 方法通过计算机检索传统肛裂切除术、纵切横缝法、改良纵切横缝术、肛裂切除术+外括约肌切开术、肛裂切除术+内括约肌切开术5种手术治疗慢性肛裂的国内外临床研究,采用Stata13及GeMTC软件对其治愈率和并发症发生率进行传统Meta分析和网状Meta分析。 结果共纳入21项临床研究2 430例患者。网状Meta分析显示肛裂切除术+内括约肌切开术和肛裂切除术+外括约肌切开术的治愈率均高于传统肛裂切除术,OR值分别为2.27（95%CI=1.14~4.36）、3.26（95%CI=1.67~6.75）。在并发症的发生率方面,纵切横缝术、传统肛裂切除术排前两位,肛裂切除术+内括约肌切开术最低。 结论在5种常见的慢性肛裂手术方式中,肛裂切除术+内括约肌切开术的疗效和并发症发生均优于传统肛裂切除术、纵切横缝法、改良纵切横缝术、肛裂切除术+外括约肌切开术。     

Ankle blood pressure measured by automatic oscillotonometry: a comparison with Doppler pressure measurements.

Oscillotonometry using Dinamap machine was investigated for the measurement of ankle and brachial blood pressures in our vascular practice. It was validated by comparison with intra-arterial pressure measured by transducer. Systolic ankle and brachial pressures in 43 patients were compared using the Dinamap and Doppler techniques, and significant correlation was found. Ankle and brachial systolic, diastolic and mean pressures and ankle/brachial pressure indices for all three pressures were measured in a group of 12 normal subjects supine at rest, and after treadmill exercise, and a range of normal values defined. The main limitation of the Dinamap is its failure to measure pressures below 50mmHg. The Dinamap technique is a noninvasive, simple, reproducible and quick method of measuring ankle and brachial pressures in vascular surgical practice.     

Influence of semi-recumbent position on intra-abdominal pressure as measured by bladder pressure

BACKGROUND: Intra-abdominal pressure (IAP) obtained by bladder pressure measurement is used to detect impending abdominal compartment syndrome (ACS), but, while it is recommended to use a supine position, the literature describes IAP measurement in varying positions. This study evaluated the impact of body position at differing head-of-bed (HOB) elevations on bladder pressure when planned to be used as a surrogate IAP measurement. MATERIALS AND METHODS: Forty-five trauma patients admitted to a surgical intensive care unit underwent bladder pressure measurements at 0, 15, 30, 45 degrees HOB position and 30 degrees HOB position plus 15 degrees of reverse Trendelenburg tilt; these measurements were performed in counterbalanced fashion and assessed by built-in angle indicators on the bed rails of each bed. Study participants were connected to an IAP monitoring kit via their indwelling Foley catheter. RESULTS: A total of 675 bladder pressure measurements were obtained with 135 measurements at each of five HOB elevations (0 degrees , 15 degrees , 30 degrees , 45 degrees , 30 degrees +15 degrees tilt). Statistically significant differences occurred between all HOB elevations. Statistically significance differences also occurred at different BMI statuses. CONCLUSIONS: Elevating HOB significantly increases bladder pressure measurement. Bladder pressure measurements in nonsupine positions may not provide valid interpretation for IAP, and more so in cases of increased body mass index.     

Comparison of blood pressure measured at the arm,ankle and calf

The suitability of alternative sites for non‐invasive blood pressure (NIBP) measurement was investigated in 100 awake healthy volunteers. The calf and the ankle were chosen for comparison with the arm, and the results analysed subjected to Bland–Altman analysis. Discomfort was graded using a Visual Analogue Scale. There was a poor agreement between the different sites with respect to systolic blood pressure: the agreement was closer for diastolic and mean measurements. The mean blood pressure calf measurement was on average 4 mmHg (95% limits of agreement ?12 to 20), higher than the arm. The ankle was 8 mmHg higher (?8 to 24) than the arm. ANOVA demonstrated a statistically significant difference in the discomfort scores between the sites (p < 0.001). The calf demonstrated the highest discomfort score and the ankle the lowest. We suggest that the ankle should be considered in preference to the calf as an alternative site for NIBP measurement if use of an arm is undesirable or impossible.     

应用电子冰帽患者头部压疮的预防护理

目的探讨预防头部压疮的有效护理措施。方法将入选的244例危重患者(均应用电子冰帽)按入院顺序分为两组,2010年3～12月收治的142例作为对照组,采用常规护理方法预防头部压疮;2011年1～10月收治的102例作为预防组,采取强化预防护理措施,包括充分评估压疮的危险因素,积极观察、加强防护、及时对症处理等。结果预防组头部压疮的发生率显著低于对照组(P<0.05)。结论头部压疮的护理重在预防,采取有效的护理措施,可减少及避免头部压疮的发生。     

Measurement of grip strength: validity and reliability of the sphygmomanometer and jamar grip dynamometer

Quantitative measurement of grip strength is an important variable when plotting the progress of a hand-injured patient. When utilizing traditional commercially available apparatuses, obtaining meaningful grip strength measurement in these subjects is frequently difficult due to severe deformity, high tissue sensitivity, and low levels of force generated. The purpose of this study was to measure hand grip strength using two instruments having different physical characteristics and units of measurement to determine the reliability of repeated measures with each instrument. Additionally, validity of the sphygmomanometer for strength measurement was established through comparison with the values obtained from measurements using the research-validated Jamar dynamometer. Twenty-nine right hand dominant female college-age subjects volunteered to perform hand grip strength testing. Measurements were taken with a sphygmomanometer and a Jamar dynamometer while utilizing standardized measurement procedures. A Spearman Rho correlation coefficient test utilized in measuring within-instrument reliability showed a high correlation for each instrument at .85 for the sphygmomanometer and .82 for the Jamar dynamometer. Construct validity testing performed to determine validity of the measurements by the sphygmomanometer compared with the Jamar dynamometer produced a .75 correlation. A formula for conversion of the sphygmomanometer scores into Jamar units was developed to enhance reporting of sphygmomanometer scores utilizing the Jamar standard. The study showed that the sphygmomanometer and Jamar dynamometer exhibit good within-instrument reliability. Validity of the sphygmomanometer as a grip measurement device is acceptable and reportable using the conversion formula developed. Therefore, it can be utilized with confidence as essentially equal to the Jamar unit for grip strength measurement. J Orthop Sports Phys Ther 1992;16(5):215-219.     

Improving blood pressure control among adults with CKD and diabetes: provider-focused quality improvement using electronic health records

Current evidence demonstrates poor provider knowledge and compliance to clinical practice guidelines (CPGs) for CKD screening, blood pressure (BP) goals specific to people with diabetes mellitus (DM) and CKD, and underutilization or incorrect drug selection for antihypertensive therapy. This 12-week provider-focused quality improvement project sought to (1) increase primary care provider (PCP) adherence to CPG in the treatment and control of BP among adults with CKD and DM by using electronic health records (EHRs) and patient-level feedback (scorecards); (2) increase PCP delivery of basic CKD patient education by using EHR-based decision support; and (3) assess whether electronic decision support and scorecards changed provider behavior. The project included 46 PCPs, physicians, and nurse practitioners, in a statewide federally qualified health center that operates 12 comprehensive primary care sites in Connecticut. There were 6781 DM visits, among 3137 unique, racially diverse patients. There was a statistically significant increase in CKD screening, diagnosis, and use of angiotensin-converting enzyme inhibitor/angiotensin-receptor blocker. There was a statistically, but not clinically, significant increase in CKD basic education and ancillary service provider use when the provider was aware of the diagnosis or used EHR enhancements. EHR decision support and real-time provider feedback are necessary but not sufficient to improve uptake of CPG and to change PCP behavior.     

Effects of progressive blood loss on coagulation as measured by thrombelastography

The effects of progressive blood loss on coagulation were studied in 87 adults (age 23-66 yr) undergoing a variety of operations under general anesthesia. None had preoperative alterations in coagulation or liver function and none were receiving anticoagulant or antiplatelet medication. Whole blood coagulation status was quantitated using thrombelastography (TEG). Blood samples for TEG were obtained 5 min before and 15 min after induction of anesthesia, after each increment of blood loss (EBL) equalling 5% of estimated blood volume (EBV), at the end of surgery, and 2 hr post-operatively. Patients with EBL exceeding 0.15 EBV were given packed red cells and crystalloid solution. Patients with EBL less than 0.15 EBV received only crystalloid. Thrombelastography analysis showed a trend toward increased coagulability with progressive blood loss. Two of four patients with 80% loss of EBV maintained normal to enhanced coagulation status, although the other two developed clinical and thrombelastographic evidence of coagulopathy. Thrombelastography allowed rapid intraoperative diagnosis and specific treatment of loss of platelet activity in the latter two patients. We conclude that during moderate to massive blood loss, use of supplemental fresh frozen plasma and/or platelets should be reserved for patients with documented defects in coagulation. Thrombelastography is useful for the detection and management of coagulation defects associated with intraoperative blood loss.