Barthel自理能力评分与护理工作量的相关性研究

[目的]研究病人自理能力评分与护理工作量之间的相关性。[方法]采用Barthel评分量表评估病人的自理能力,依据病人自理能力分为完全需要照顾、大部分需要照顾、少部分需要照顾和生活基本自理4组,采用工时测算法测算住院病人的每日直接护理工作量。[结果]不同自理能力病人所需直接护理工作量不同,完全需要照顾组和大部分需要照顾组差异无统计学意义（P〉0.05）,其他各组间差异均有统计学意义（P〈0.05）。13类直接护理项目中10类直接护理工作量与Barthel自理能力评分存在负相关（P〈0.01）。[结论]病人自理能力是反映护理工作量的重要因素,但并不是唯一因素,能反映临床护理工作量的各因素,建立适合我国国情的病人分类系统,以实现科学合理地配置和使用护理人力目标。     

基于家庭模式的延续性护理对老年脑梗死病人治疗依从性的影响

[目的]探讨基于家庭模式的延续性护理对老年脑梗死病人依从性的影响。[方法]选取2015年7月—2016年7月我院神经内科老年脑梗死病人400例,采用随机数字表法将其分为两组,每组200例。全部病人住院期间采用常规护理,对照组采用常规出院指导,研究组采用基于家庭模式的延续性护理。采用依从性评定量表、Fugl-Meyer评分量表、巴塞尔(Barthel)指数与生活质量测定量表评定两组治疗依从性、运动功能、日常生活自理能力与生活质量的差异。[结果]研究组治疗依从率明显高于对照组(P0.05)。护理前两组Fugl-Meyer评分、Barthel指数与生活质量评分比较差异无统计学意义(P0.05),护理后两组病人Fugl-Meger评分与Barthel指数明显高于护理前(P0.05),且研究组病人明显高于对照组(P0.05),护理后两组病人生活质量评分明显低于护理前(P0.05),且研究组病人评分明显低于对照组(P0.05)。[结论]基于家庭模式的延续性护理有助于明显改善老年脑梗死病人治疗依从性,从而改善运动功能、日常生活自理能力与生活质量。     

基于工时测量的神经内科病人分类标准的设计与应用

[目的]设计基于护理工作量工时测量的神经内科病人分类标准,并应用于构建护理人力配置的测算模型,以实现依据各科室实际护理工作量科学、合理、有效地配置护理人力的目的。[方法]通过护理工作流程再造、直接护理工作量的工时测算结合卫生部文件要求设计神经内科病人分类标准,并测算各类病人的每日护理时数,以此护理时数为基础构建神经内科直接护理的护理人力配置模型。[结果]依据病人分类标准评分分值的不同将神经内科病人分为A,B,C,D类,各类病人每日平均直接护理时间分别为120.11min、111.21min、99.99min和37.13min。[结论]所设计的病人分类标准能较全面、真实地反映病人对护理服务的需求和临床实际护理工作量,可应用于测算神经内科直接护理的护理人力配置。     

督脉中药湿热敷对中风病人肢体活动及自理能力的影响

[目的]探讨督脉中药湿热敷对中风病人肢体活动功能及自理能力的影响。[方法]将68例中风恢复期病人随机分为两组各34例,对照组给予常规治疗及护理,观察组在常规治疗及护理的基础上加用温经散寒、祛风除湿、活血化瘀中药湿敷督脉1个疗程,治疗前后采用卒中病人运动功能评估量表(MAS)和日常生活活动量表(Barthel指数)对两组病人分别进行评定。[结果]治疗后两组MAS评分和Barthel指数评分比较差异有统计学意义(P0.05)。[结论]督脉中药湿热敷有助于中风病人肢体活动功能和自理能力的恢复。     

授权理论在脑卒中后运动康复护理中的应用

[目的]探讨授权理论在卒中后肢体运动障碍病人运动康复护理中的应用效果。[方法]选取脑卒中病人78例,随机分为观察组和对照组各39例。对照组采用常规运动康复护理,观察组在常规运动康复护理的基础上采用授权式干预。比较两组病人入院时、出院时、出院3个月后肢体运动功能和生活自理能力的变化以及出院后3个月护理满意度。[结果]两组病人出院时、出院后3个月Fugl-meyer运动量表、Barthel指数评分与入院时比较差异均有统计学意义(P0.05);观察组出院后3个月Fugl-meyer运动量表、Barthel指数评分高于对照组(P0.05);观察组出院后3个月护理满意度评分高于对照组(P0.05)。[结论]授权式运动康复能帮助病人出院后实施自我康复管理,有助于肢体功能及生活自理能力的恢复,提高护理满意度。     

护理干预对脑卒中病人及照顾者生活质量的影响

[目的]探讨护理干预对脑卒中病人及照顾者生活质量的影响。[方法]将90例脑卒中病人及90例照顾者按照病房号随机分为干预组和对照组,每组病人及照顾者各45例。对照组接受常规护理、治疗及各项康复训练,干预组病人及照顾者接受健康宣教、训练指导等多种形式的协同护理干预措施。运用总体健康状况量表、Zarit 照顾者负担量表及日常生活活动能力的 Barthel 指数评定评价入院干预前和出院时病人及照顾者的生活质量。[结果]干预前,两组病人总体健康状况量表、Zarit 照顾者负担量表及日常生活活动能力的 Barthel 指数评分比较差异无统计意义(P >0.05),干预后,干预组病人及照顾者总体健康状况量表、Zarit 照顾者负担量表及病人日常生活活动能力的 Barthel 指数均优于对照组,差异有统计学意义(P <0.05)。[结论]协同护理干预可提高脑卒中病人及照顾者的生活质量,指导病人及照顾者养成良好的生活习惯,促进病人早日康复。     

人性化护理联合心理诱导在烧伤病人护理中的应用

[目的]了解人性化护理联合心理诱导在烧伤病人中的干预效果。[方法]选取2017年4月—2018年4月进行治疗的烧伤病人70例,采用随机数字表法分为对照组和观察组,每组35例,对照组病人实施常规护理与心理诱导,观察组病人在对照组基础上实施人性化护理。采用Barthel指数、健康状况调查简表(SF-36)对两组病人的日常生活活动能力、生活质量进行评价,并对两组病人护理满意度进行比较。[结果]干预后两组病人的Barthel指数均有提高(P0.05),其中观察组病人Barthel指数明显高于对照组(P0.05);干预后观察组病人生活质量评分高于对照组(P0.05)、总满意度高于对照组(P0.05)。[结论]人性化护理能改善烧伤病人的日常生活自理能力,提高生活质量和护理满意度。     

基于工时测量的神经内科病人分类标准的设计与应用

[目的]设计基于护理工作量工时测量的神经内科病人分类标准,并应用于构建护理人力配置的测算模型,以实现依据各科室实际护理工作量科学、合理、有效地配置护理人力的目的.[方法]通过护理工作流程再造、直接护理工作量的工时测算结合卫生部文件要求设计神经内科病人分类标准,并测算各类病人的每日护理时数,以此护理时数为基础构建神经内科直接护理的护理人力配置模型.[结果]依据病人分类标准评分分值的不同将神经内科病人分为A,B,C,D 类,各类病人每日平均直接护理时间分别为120.11min、111.21min、99.99min和37.13min.[结论]所设计的病人分类标准能较全面、真实地反映病人对护理服务的需求和临床实际护理工作量,可应用于测算神经内科直接护理的护理人力配置.     

脑卒中病人延续护理方案的建立和应用效果临床评价

[目的]建立脑卒中病人延续性护理方案,分析其护理效果。[方法]选择脑卒中病人82例,按照随机数字表法将病人分为研究组和对照组各41例。对照组病人给予常规出院护理,研究组病人给予脑卒中延续性护理。观察两组病人出院前、出院后3个月Barthel指数量表变化、生活质量(QOL)量表变化、依从性评分及护理满意度。[结果]出院前两组病人Barthel指数评分比较差异无统计学意义(P0.05),出院后3个月研究组病人Barthel指数评分均显著高于对照组(P0.05)。出院后3个月研究组病人QOL各项评分和总分均显著高于对照组(P0.05)。研究组病人按时服药、按时锻炼、按时复诊和合理饮食比例均高于对照组,两组比较差异无统计学意义(P0.05)。研究组病人对护理工作的总满意率显著高于对照组(P0.05)。[结论]延续护理可以有效地提高脑卒中病人治疗依从性和满意度,提高脑卒中病人的护理效果。     

脑梗死急性期中医护理方案临床应用效果评价

[目的]探讨脑梗死急性期中医护理方案临床应用效果。[方法]选取2015年3月—2015年8月在我院治疗的脑梗死急性期病人60例,按入院先后顺序编号,单号为对照组,双号为观察组。对照组给予常规护理,观察组在对照组基础上实施中医护理方案,比较两组病人治疗前后Barthel指数评分、疗效。[结果]观察组病人治疗后Barthel指数评分为(52.7±3.1)分,对照组为(43.9±2.6)分,两组比较差异有统计学意义(P0.05);观察组总有效率为90.0%,对照组总有效率为63.3%,两组比较差异有统计学意义(P0.05)。[结论]脑梗死急性期中医护理方案的实施有助于提升病人生活自理能力,改善病人肌张力,提高生活质量。     

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.