慢性心力衰竭患者应用心脏再同步治疗的CCU观察及护理

心力衰竭是各种器质性心脏病的终末阶段,病死率随着病情的加重而升高,5年病死率可高达50％。随着人口老龄化和常见心血管疾病发病率的上升,心力衰竭患病率正在逐步升高。研究发现,心力衰竭患者恶性心律失常发生率极高,且50％～70％的心力衰竭患者死于快速性室性心律失常,即室速和室颤。     

Roy适应模式在CCU睡眠障碍患者中的临床护理

目的探讨Roy适应模式在CCU睡眠障碍患者护理中的应用,为提高CCU患者睡眠障碍的护理效果提供依据。方法对2009-10~2010-03收治我院CCU的患者60例,入院时进行匹兹堡睡眠质量指数(PSQI)和健康状况问卷(SF-36)评定后随机分为2组,干预组用Roy适应模式为指导的护理程序对患者进行护理干预,对照组常规护理。结果 CCU中63.4%的病人有睡眠质量问题,实施护理干预后,干预组患者睡眠质量PSQI总分5.79±2.62,生存质量改善有效率为82.3%。结论运用Roy适应模式进行护理干预后,显著改善了患者的睡眠质量,同时也提高了生存质量。     

CCU患者神经性压力源分析及与谵妄发病率的影响

目的：调查分析CCU （冠心病监护病房）患者神经性压力源及对谵妄发病率的影响。方法采用调查问卷的方式统计我院2013‐01—2013‐12入住CC U 的50例患者的神经性压力源,分析神经性压力源与谵妄发病率的关系。结果CCU患者的精神压力来源于多个方面,其中发病突然、无法与家人见面及生活习惯的被迫改变是患者精神压力的主要来源。通过对不同精神压力程度患者的谵妄发生率观察发现,精神性压力程度越高,谵妄的发生率也越高。结论 CCU患者的神经性压力来源于多个方面,过大压力会导致谵妄发生率上升,应针对压力源为CCU患者进行心理护理。     

对CCU急性心肌梗塞病人的心里干预

目的 探讨心里干预对心肌梗塞病人病人心里压力及治疗配合程度的影响.方法 将80例CCU住院病人随机分为观察组和对照组,每组40例,对照组进行CCU常规护理,观察组在CCU常规护理的基础上进行心里干预.观察并比较两组病人在CCU期间的心里不适反应和治疗配合程度.结果 观察组病人在焦虑、紧张、抑郁、不安全感、绝望、恐惧、孤独等方面的心里不适明显低于对照组(P<0.05).结论 心里干预可改善ccu病人的不适心里反应,提高病人对冶疗的配合程度.     

Multimicroprocessor system for online monitoring in a CCU

A real-time monitoring system for physiological signals, developed for patients in coronary care units (CCUs), is described. This system monitors the signals that have the greatest clinical value in a CCU environment (ECG and cardiovascular pressures), taking charge of detecting dangerous situations and of extracting information significant to the correct monitoring of the patient. The information it extracts, mainly from the ECG, is presented to the user in an ergonomic way using written reports and graphs which collect and compile the information, facilitating its interpretation. Some utilities have been developed to allow the user to modify certain monitoring conditions as well as to correct results derived from them, thereby improving the reliability of the monitoring process. The system uses a multimicroprocessor architecture (imposed by the need to perform a large number of tasks in real time) with a block based on the VME bus, charged with acquiring and processing the monitored signals, and an IBM-compatible PC/XT which is used as a system user interface and a massive storage device in which the information resulting from the monitoring of signals is stored.     

Venous thromboembolism risk assessment and thromboprophylaxis among hospitalized acute medical patients in China - the RAMP study

Background

In developed countries, hospitalized patients with acute medical conditions are at significant risk for venous thromboembolism (VTE). Little is known about VTE risk and prophylaxis practices in China.

Objective

To determine the VTE risk and the frequency of recommended VTE prophylaxis in hospitalized Chinese patients with acute medical conditions.

Methods

Multi-center, cross-sectional, observational study. Eligibility criteria: ≥ 30 years, admitted to an intensive care unit (ICU)/coronary care unit (CCU) for acute medical illness, had ≥ 1 VTE risk factor/1 disease that predisposes to VTE, and provided informed consent. We used 2004 American College of Chest Physicians (ACCP) evidence-based consensus guidelines to assess VTE risk and the frequency of recommended VTE prophylaxis.

Results

1247 patients from 19 hospitals in 11 cities across 11 provinces of China were enrolled from July 2007 to June 2008. 57.3% patients had > 2 VTE risk factors. Only 20.2% received ACCP-recommended VTE prophylaxis (CCU patients: 22.7%, ICU patients: 16.9%, p = 0.0117).

Limitations

Excluding some patients with VTE risk factors did not allow assessment of the prevalence of VTE risk in the acute hospital-care setting. We could not determine whether the duration of prophylaxis complied with the ACCP recommendations. Our results may not be representative of hospitals in small cities/rural areas in China.

Conclusions

The prevalence of VTE risk factors in Chinese patients was similar to that in developed countries; however, only a small proportion of eligible patients received the recommended VTE prophylaxis. Our findings highlight the need for dissemination and implementation of appropriate VTE prophylaxis guidelines in China.     

Peplau人际关系理论用于CCU患者家属的沟通实践

目的探讨Peplau人际关系理论用于CCU（心脏病重症监护室）医护人员与患者家属沟通实践的效果。方法对366例患者家属采取Peplau人际关系理论指导临床沟通实践,根据不同时期、不同患者采取不同的沟通方法。结果CCU患者家属总体满意率逐年上升,2006年满意率为94．1％,2007年满意率为97．5％,2008年满意率为99．05％．结论应用Peplau人际关系理论可促进护士与患者家属的沟通,有效避免了因护患沟通问题而引发的医疗纠纷,有助于构建和谐的医患关系。     

Twice vs three times daily heparin dosing for thromboembolism prophylaxis in the general medical population: A metaanalysis

OBJECTIVES: Prophylaxis with unfractionated heparin (UFH) has been proven to reduce rates of venous thromboembolism (VTE) in hospitalized medical patients. While twice-daily (BID) and three-times-daily (TID) dosing regimens have been studied, the two have never been directly compared. We performed a metaanalysis to assess whether TID is superior to BID dosing in the prevention of VTE. METHODS: Medline, EMBASE, and Cochrane Controlled Trials Register from 1966 through December 2004 were searched for randomized trials comparing subcutaneously dosed UHF (either BID or TID) with placebo or control for VTE prophylaxis in medical patient populations. Two reviewers independently rated study quality on the basis of predetermined criteria. Data were extracted on patient age, hospital setting, comorbidities, VTE rates, and bleeding complications. RESULTS: Twelve studies were identified; 7,978 patients (1,664 patients in the TID arm, and 6,314 patients in the BID arm) were included. After adjustment for baseline risk, there was no difference in the overall rate (per 1,000 patient-days) of VTE (BID, 5.4; vs TID, 3.5; p = 0.87). TID heparin showed a trend toward a decrease in pulmonary embolism (PE) [BID, 1.5; vs TID, 0.5; p = 0.09] and in proximal DVT and PE (BID, 2.3; vs TID, 0.9; p = 0.05). The risk for major bleeding was significantly increased with TID heparin (BID, 0.35; vs TID, 0.96; p < 0.001). CONCLUSIONS: BID heparin dosing causes fewer major bleeding episodes, while TID dosing appears to offer somewhat better efficacy in preventing clinically relevant VTE events. Practitioners should use underlying risk for VTE and bleeding to individualize pharmacologic prevention.