老年慢性心力衰竭患者自我感受负担的调查分析

目的:调查老年慢性心力衰竭(CHF)患者自我感受负担(SPB)状况,分析其影响因素。方法:采用自编患者一般资料调查表、自我感受负担量表(SPBS)对200例老年CHF患者进行调查分析。结果:患者SPB得分为(36.25±6.12)分,处于中度负担水平,83.50%的患者存在不同程度的SPB。多元逐步回归分析显示,文化程度、自评家庭经济状况、心功能分级、照顾者有无健康问题是患者SPB的影响因素。结论:受多种个体因素差异的影响,大部分老年CHF患者存在明显的SPB,应采取相应的护理措施减轻其SPB。     

心理弹性和自我效能对老年维持性血液透析患者自我感受负担的影响

目的:探讨心理弹性、自我效能对老年维持性血液透析(MHD)患者自我感受负担(SPB)的影响。方法:采用自编一般资料问卷、自我感受负担量表、心理弹性量表和一般自我效能量表对106例老年MHD患者进行调查。结果:患者的SPB得分为(37.64±6.72)分,其中90.57%的患者存在不同程度的SPB;Pearson相关分析显示,心理弹性、自我效能与SPB呈负相关;分层回归分析显示,心理弹性、自我效能是患者SPB的影响因素。结论:老年MHD患者普遍存在SPB,护理人员可从增强患者心理弹性和自我效能的角度入手,制订措施来减轻其SPB。     

老年冠心病患者支架植入术后自我感受负担的调查

目的：调查老年冠状动脉内支架植入术后患者自我感受负担( SPB)状况,探讨其相关影响因素。方法采用一般情况问卷、SPB量表、一般自我效能量表( GSES),对96例老年冠心病支架植入术后患者及其家属进行调查分析。结果患者SPB平均得分为(31.21±6.51)分,照顾者自我效能得分为(28.43±3.38)分,均处于中等水平,多元逐步回归分析显示,家庭月收入、病情了解程度、病情严重程度、生活自理能力、照顾者健康状况及照顾者自我效能是患者SPB的预测因子(P<0.05),共可解释SPB总变异的53.62%。结论多数患者存在不同程度的自我感受负担,护理人员应及时给予针对性干预,重视照顾者行为特点对患者的影响,提高患者生存质量。     

维持性血液透析患者自我感受负担及影响因素调查分析

目的:调查维持性血液透析患者自我感受负担(SPB)情况,并分析其影响因素。方法:运用一般资料问卷、SPB量表、医院焦虑抑郁量表(HAD)对符合纳入标准的95例维持性血液透析患者进行问卷调查。结果:患者的SPB量表(SPBS)得分为(26.52±8.078)分;77.9%的患者存在SPB,患者的月平均医疗费用支出情况、焦虑、抑郁情况是其SPB的影响因素(P0.05)。结论:维持性血液透析患者普遍经历轻至中度的SPB,护理人员应采取相应措施减轻其SPB。     

脑卒中偏瘫患者自我感受负担及影响因素分析

目的调查脑卒中偏瘫患者自我感受负担(self perceived burden,SPB)水平,分析其影响因素。方法采用一般资料问卷、自我感受负担量表、心理弹性量表和中文版照顾者负担量表对130例脑卒中偏瘫患者及其主要照顾者进行问卷调查。结果患者的SPB得分为(37.75±6.30)分,其中91.54%的患者存在不同程度的SPB。Pearson分析结果显示,心理弹性与SPB呈负相关(r=-0.431,P=0.007),照顾者负担与SPB呈正相关(r=0.509,P=0.001)。回归分析显示:家庭经济负担、患病时间、心理弹性、照顾者负担是患者SPB的影响因素。结论 SPB在脑卒中偏瘫患者中具有普遍存在性,护理人员应做好相关评估及采取针对性的措施减轻患者的SPB。     

首次PCI术后患者自我感受负担现状及影响因素分析

目的:调查首次经皮冠状动脉介入治疗(PCI)术后患者自我感受负担(SPB)现状,并分析其影响因素,以期为临床护理干预提供参考依据。方法:采用一般资料调查表、自我感受负担量表及冠心病自我效能量表对204例首次PCI术后患者进行调查。结果:204例患者自我感受负担量表得分为(32. 19±7. 67)分,自我效能得分为(30. 84±8. 84)分,均处于中等水平;多元回归分析显示,医疗付费方式、对病情的了解程度、合并症数量、冠心病病程及自我效能为患者SPB的影响因素(P 0. 05),共可解释SPB总变异的61. 1%。结论:SPB在首次PCI术后患者中普遍存在,临床护理人员应针对相关因素采取干预措施,降低患者的SPB。     

脑梗死患者自我感受负担影响因素的临床研究

目的 探讨脑梗死患者自我感受负担(SPB)的影响因素.方法 采用自我感受负担量表对108例脑梗死患者进行横断面调查,首先对可能的影响因素进行单因素分析,然后以SPB为应变量,以单因素分析有统计学意义的因素为自变量,进行多元回归分析.结果 脑梗死患者SPB平均分为(36.72±4.23)分;多元回归分析显示,生活自理能力、偏瘫、语言障碍、住院次数是脑梗死患者SPB的影响因素.结论 脑梗死患者存在SPB,护理人员应采取相应护理措施.     

癌症患者自我感受负担状况及其影响因素分析

目的:调查癌症患者自我感受负担(SPB)状况,分析其影响因素,探讨SPB与生活质量(QOL)的关系。方法:采用一般资料问卷、自我感受负担量表(SPBS)和中文版癌症治疗功能评价系统-共性模块(FACT-G)对120例癌症患者进行调查,采用单因素分析、Pearson相关分析和多元回归分析对数据进行统计处理。结果:87.5%的患者存在不同程度的SPB,平均得分为(34.08±9.18)分,总体处于中度负担水平;SPB得分在职业状况、收入水平、医疗费用支付方式、婚姻状况、临床分期5个变量方面差异有统计学意义(P<0.05);SPB与QOL总分及其心理状况、躯体状况、功能状况维度呈负相关(r=-0.398～-0.545,P<0.01),QOL各维度能够解释SPB30.1%的变异。结论:SPB在癌症患者中具有较高的普遍性,且受多种因素影响,临床护理人员应据此有预见性地评估患者SPB水平并探索相应的干预措施,以提高癌症患者的QOL。     

维持性腹膜透析患者自我感受负担影响因素调查分析

目的:调查分析维持性腹膜透析(PD)患者自我感受负担(SPB)影响因素。方法:采用自我感受负担量表对30例维持性PD患者进行横断面调查,首先对可能的影响因素进行分析,然后以SPB为因变量,以有统计学意义的因素为自变量,进行多元回归分析。结果:维持性PD患者SPB平均为(34.72±4.93)分;患者生活自理能力、医疗费用支付方式是维持性腹膜透析患者SPB的主要影响因素。结论:维持性PD患者处于中度SPB状态,护理人员应采取相应措施进行干预,降低患者自我感受负担。     

乙型肝炎肝硬化病人自我感受负担影响因素研究

目的:调查住院乙型肝炎肝硬化病人自我感受负担(self-perceived burden, SPB)水平,分析其影响因素。方法:采用自我感受负担量表、家庭支持自评分量表、社会支持评定量表、照顾者负担量表,选取收治于武汉市某三级甲等医院的110例乙型肝炎肝硬化病人进行问卷调查。结果:94.3%的住院乙型肝炎肝硬化病人存在SPB,总得分为(30.67±7.30)分,呈中度水平。多元逐步回归分析显示病人疾病了解程度及照顾者负担水平是其SPB的主要影响因素(P<0.05)。结论:住院乙型肝炎肝硬化病人SPB现状不容乐观。SPB受多种因素影响,医务人员可通过讲解疾病知识、提高病人自理能力、减少照顾者不必要照护行为、主动评估、积极沟通等方法来减轻。     

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.