住院病人自杀对护士的影响及相关对策

<正>住院病人自杀是指病人在住院期间自愿并主动结束自己生命的行为,是一种由心理冲突而产生的自我毁灭行为。自杀行为是精神分裂症和抑郁症的常见并发症,住院精神分裂症病人自杀数占住院总数的0.1%~0.15%[1]。据调查[2],住院抑郁症病人中重性抑郁病人中25%发生自杀行为,15%最终死于自杀。综合医院中严重或慢性难治性躯体疾病病人也可继发抑郁导致自杀[3]。综合性医院住院病人自杀发生虽不多见,但造成的危害及后     

护理干预对老年住院病人自杀行为的影响

[目的]观察护理干预对老年住院病人自杀行为的影响。[方法]分析2005年1月-2006年12月老年住院病人发生自杀的行为的原因、时闻、方式等特点,制订并实施老年住院病人安全管理措施,对自杀高危病人进行评估、跟踪、护理干预等方法;2007年1月-2008年12月进行护理干预。观察并比较干预前后自杀行为发生情况。[结果]护理干预前发生自杀行为15例,发生率为1．86％,护理干预后发生自杀行为13例,发生率为0．90％（χ^2=3．93,P〈0．05）。[结论]通过护理干预和病房安全管理可减少老年住院病人自杀行为的发生。     

综合医院住院病人自杀心理行为特征分析

[目的]探讨综合医院住院病人自杀规律,为预防病人自杀提供参考依据.[方法]对2005年1月-2012年3月在我院发生的15例住院病人自杀事件进行回顾性调查,分析住院病人自杀的心理行为特征.[结果]肿瘤病人是自杀的高危人群;病人在自杀前多明显表现出低落情绪或流露出自杀意念;自杀方式主要为坠楼;多选择在陪护人员离开病房或睡觉、工作人员少的夜班时间采取自杀行为.[结论]采取自杀行为的病人其心理行为具备一定特征,可以针对性地制定预防措施.     

护理干预对老年住院病人自杀行为的影响

[目的]观察护理干预对老年住院病人自杀行为的影响.[方法]分析2005年1月-2006年12月老年住院病人发生自杀的行为的原因、时间、方式等特点,制订并实施老年住院病人安全管理措施,对自杀高危病人进行评估、跟踪、护理干预等方法;2007年1月-2008年12月进行护理干预.现察并比较干预前后自杀行为发生情况.[结果]护理干预前发生自杀行为15例,发生率为1.86%,护理干预后发生自杀行为13例,发生率为0.90%(X<'2>=3.93,P<0.05).[结论]通过护理干预和病房安全管理可减少老年住院病人自杀行为的发生.     

精神分裂症急性期伴自杀行为35例临床特征分析及护理

目的:调查精神分裂症急性期伴自杀行为患者的临床特征及护理方法.方法:分析35例急性期精神分裂症伴自杀行为患者的临床特征,研究经过自杀干预护理措施治疗后的成效.将没有发生自杀行为倾向的154例住院患者作为对照组进行比较.结果:精神分裂症急性期自杀发生率18.51%,常发生于女性、年龄较大、病程短和发病年龄较晚的患者;经过自杀干预护理措施治疗后自杀行为发生率明显降低,第2周时社会兴趣、迟缓、抑郁和精神症状因子明显改善,第8周时多项因子明显改善,与对照组比较差异有统计学意义(P＜0.05).结论:及时发现急性期精神分裂症伴自杀行为患者的临床特征,实施正确的护理干预有助于减少自杀行为的发生.     

自杀精神分裂症病人急诊入院原因分析

精神分裂症病人出现自杀行为是常见的。为了解高危自杀人群的状况并进行有效危机干预，现对我院以自杀行为而急诊入院的69例精神分裂症病人进行分析，以便为其提供针对性的有效的护理。     

住院抑郁症病人自杀未遂情况调查

[目的]探讨住院抑郁症病人自杀发生率、性别差异、自杀因素及护理干预对策。[方法]利用问卷调查表对150例自杀未遂的抑郁症病人自杀相关资料进行回顾性调查。[结果]住院抑郁症病人出现自杀意念、自杀意图、自杀行为较高;女性病人自杀行为明显多于男性,但男性自杀行为的后果更为严重;精神病家族史、自杀家族史、家庭环境等均与自杀行为密切相关。[结论]住院抑郁症病人存在较多的自杀问题,特别是病程长、多次住院、具有精神病家族史和自杀家族史者是自杀预防的重点人群。     

拓展式风险管理在精神分裂症患者自杀防范中的应用研究

目的分析拓展式风险管理在精神分裂症患者自杀防范护理中的应用效果。方法选择实施拓展式风险管理措施前(2014年)和实施后(2015年)收治于该院的精神分裂症患者各150例作为研究对象,实施前后患者分别设为对照组与试验组,对两组自杀中、高危风险率和自杀行为发生率进行评价。结果试验组患者经干预后,出院时、出院1个月时的自杀中、高危风险率及自杀行为发生率均显著低于对照组,差异有统计学意义(P0.05)。结论精神分裂症防自杀拓展式风险管理的应用,可显著降低精神分裂症患者自杀风险和自杀行为发生率,值得临床广泛推广使用。     

自杀精神分裂症病人急诊入院原因分析

精神分裂症病人出现自杀行为是常见的。为了解高危自杀人群的状况并进行有效危机干预,现对我院以自杀行为而急诊入院的69例精神分裂症病人进行分析,以便为其提供针对性的有效的护理。1资料与方法1.1一般资料在我院1998年1月—2004年12月入院且符合国际疾病分类中(ICD—10)精神与行为障碍分类、临床描述与诊断要点[1]精神分裂症诊断标准的543例病人中,有自杀行为而急诊入院的69例(12.7%),男37例,女32例,年龄14岁～52岁,病程6个月至23年,其中偏执型38例,未分化型18例,其他亚型13例。单身者(含未婚或离异)23例(33.3%),有阳性家族史21例(30.4%…     

护士用简明精神病量表在伴焦虑症状的抑郁症病人自杀风险预防中的应用

[目的]探讨护士用简明精神病量表(N-BPRS)在伴焦虑症状抑郁症病人自杀风险预防中的应用效果。[方法]根据随机数字表法将2016年6月—2018年6月收治的92例伴焦虑症状抑郁症病人分为观察组及对照组各46例,对照组行精神科常规护理,观察组于病人入院48 h内应用N-BPRS量表对其自杀风险进行评定,根据评定结果采取有效的干预措施。比较两组病人干预前后心理困扰状况及自杀发生率。[结果]观察组病人干预后N-BPRS评分及心理困扰状况评分低于对照组(P0.05)。观察组病人住院期间自杀意念、自杀行为发生率低于对照组(P0.05)。[结论]基于N-BPRS量表的护理干预能有效减轻伴焦虑症状抑郁症病人心理症状困扰,降低病人自杀风险。     

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.