上海市闵行区流动人口中的孕产妇保健状况

通过对上海市闵行区580名外来孕产妇及580名作为对照的本地孕产妇的孕产期保健现况调查分析,表明外来孕产妇缺乏必要的孕产期保健措施,有47.6％的外来孕产妇从未做产前检查,产后保健则完全没有,并由此而造成外来产妇在急产、死产、甚至孕产妇死亡等方面令人忧虑的现状。为适应和促进当前经济发展的新形势,改善流动人口的孕产妇保健状况,应对流动人口中孕产妇保健状况深入研究,并采取相应的措施。     

Cause of death after critical illness

This study reports the causes of death after discharge following treatment of life-threatening illness on an Intensive Therapy Unit. Details of survivors discharged between June 1985 and December 1988 were sent to the Registrar General for Scotland who subsequently issued copies of death certificates of those patients who had died between discharge and 1 January 1990. The results show that the commonest causes of death after discharge were malignancy and respiratory failure, although there is wide variation in the post-discharge mortality rates for different diagnostic categories. The admission diagnoses were identical to, or contributed to, the causes of death in 64% of patients who died after discharge. Eighty-five percent of patients who died from the same condition which prompted admission did so within a year following discharge, but after 2 years no deaths were attributed to the admission diagnosis.     

Glutamine and Other Amino Acid Losses During Continuous Venovenous Hemodiafiltration

Abstract: Serum amino grams and daily losses of glutamine (Gin) and other amino acids (AAs) into diafiltrate were measured during the first 5 days of continuous venovenous hemodiafiltration (CVVHDF) in 6 ICU patients with acute renal failure (ARF). Four patients had ARF as a part of multiple organ failure (MOF) of septic origin, and 2 patients had isolated ARF because of primary renal disease. During the study, all the patients received defined total parenteral nutrition (TPN). The mean daily AA losses into dialysate were relatively low (0.61 ± 0.1 g N ) and reached 4.5% of the daily AA substitution. Gln represented 32.7 ± 5.9% of the total AA losses (0.19 ± 0.04 g N ). Serum levels of Gin (p = 0.002) and of most other AAs were significantly lower in the patients than in the control subjects (AA analysis in 16 healthy volunteers). Phenylalanine (Phe) was the only AA that was increased significantly (p < 0.01) in the patients. The mean patient serum concentrations of Phe and tyrosine were significantly higher (p < 0.03) than the correspondent concentrations in dialysate, but the lysine concentration was higher in dialysate (p < 0.03). The serum and dialysate concentrations of other AAs did not differ. Gin in serum decreased significantly (p < 0.03) on the second day of CVVHDF but returned to the baseline levels subsequently. Serum concentrations of Phe increased on the second day of CVVHDF (p < 0.05). Serum concentrations of other AAs remained stable during the whole study. We conclude that Gin losses into dialysate during CVVHDF are relatively low, but CVVHDF itself may induce changes in Gin metabolism and distribution that are reflected by a decrease of serum Gin levels at the institution of this treatment. Therefore, the need for Gin supplementation in ICU patients is even greater in the first days of CVVHDF.     

妇幼保健院医疗设备配置的思考和探讨

妇幼保健院运营的模式,服务的对象都有别于综合性医院。通过对设备使用效益的调查、分析,提出妇幼保健院医疗设备的配置,应符合本院的特点。配置应遵循:适用性、特色性、经济性、先进性,不可盲目求新、求全,避免设备使用的低效益。     

The relationship between maternal needs and priorities in a neonatal intensive care environment

AIM: The aim of this study was to investigate the nature and organization of maternal needs and priorities in a neonatal unit. BACKGROUND: The relationship between maternal needs and priorities appears to be an under studied area in neonatal nursing. METHODS: A quantitative survey was carried out based on 209 mothers with premature infants. Two self-assessment schedules were used: critical care maternal needs inventory (J. Leske, Heart and Lung 15, 27-42) and a ranking scale. The data were analysed with multivariate analysis. FINDINGS: Data analysis revealed clear priorities in maternal needs. In particular the need for accurate infant related information was a priority for 93% of the mothers. Good communication practices with professionals were also valued. The mothers displayed altruistic behaviour, and self-related needs took second place. It is proposed that maternal needs demonstrate a hierarchical organization. CONCLUSION: It is important for nurses to consider the individual needs of the mothers, simply because the satisfaction of these needs is essential for maternal well-being.     

BiPAP ViSION 在慢性阻塞性肺疾病Ⅱ型呼吸衰竭的应用和护理

目的 探讨经鼻(面)罩双水平气道内正压通气(BiPAP)ViSION型呼吸机对慢性阻塞性肺疾病(COPD)伴Ⅱ型呼吸衰竭患者疗效及护理特点。方法 应用BiPAP ViSION型呼吸机对21例COPD伴Ⅱ型呼吸衰竭患者采用鼻/面罩连接单向呼气活瓣行双水平气道正压通气,观察其通气前后动脉血气及临床表现变化。结果 通气治疗后19例患者动脉血氧分压(PaO_2)及氧饱和度(SaO_2)明显升高(P<0.01),二氧化碳分压(PaCO_2)显著降低(P<0.05);肺性脑病症状消失,昏迷患者神志转清。2例病情恶化,其中1例改用有创通气后好转,1例拒绝有创通气死亡。结论BiPAP ViSION呼吸机治疗COPD伴Ⅱ型呼吸衰竭的疗效较为肯定,正确的护理对提高其疗效和减少并发症至关重要。     

Stressors in ICU: patients’ evaluation

Objective: To study the physical and psychological stressors in the intensive care unit (ICU) and to correlate stressors with different demographic variables. Design: Cross-sectional analytical survey. Setting: Intensive care unit of a private hospital. Patients and participants: 50 randomly selected ICU patients during the first week of their ICU stay. Measurements and results: The Intensive Care Unit Environmental Stressor Scale was administered to 50 patients. Pain and the impossibility of sleeping due to noise and having tubes in the nose and mouth were considered the most important physical stressors. Loss of self control and lack of understanding about the attitudes and procedures were the main psychological stressors. Conclusions: Interventions should be aimed at relieving the patient's pain and at controlling the level of noise to make sleep possible. From the psychological standpoint, the independence of the patient should be encouraged, thus stimulating the recovery of self-control. The team should also inform the patient about the procedures which will be carried out. Received: 1 April 1997 Accepted: 24 September 1997     

小儿阑尾切除术1472例分析

目的 分析l472例小儿阑尾切除术的疗效，探讨小儿阑尾炎的诊治方法。方法 我院1982.8—2002．12行小儿阑尾切除术l472例。其中男l163例，女309例，男：女=3．76：l；平均年龄5．7岁(8天至14岁)，6～14岁973例(66．10％)。急诊手术1164例(79。08％)，择期手术308例(20．92％)，脓肿引流4例(0．27％)，阑尾切除1468例(99．73％)，其中296例(20．1l％)是在先天性巨结肠根治术或Meckel憩室切除术等手术中一并行阑尾切除的。结果 急性阑尾炎阑尾切除术后伤口感染83例(7．4％)，粘连性肠梗阻1l例(0．75％)，阑尾残端瘘3例(0．20％)，腹内脓肿3例(0.20％)，死亡l例(0.07％)。结论 小儿急性阑尾炎误诊率及手术前后并发症率高，小儿阑尾炎应早期诊断及尽早手术治疗。     

连续四年ICU病房院内感染病原菌的耐药性分析

目的 :了解我院重症监护病房 (ICU)院内感染病原菌的耐药性变化趋势。方法 :对我院 ICU2 0 0 0年 1月至 2 0 0 3年 12月院内感染的各类感染标本中分离的 74 1株病原菌加以整理分析 ,并按美国国家临床实验室标准委员会 (NCCL s)标准进行药敏试验 ,并对其耐药性进行分析。结果 :分离出的菌株以革兰阴性杆菌为主 ,其次是革兰阳性球菌、真菌 ,分别占 6 2 % ,2 9% ,9% ,感染部位以肺部最多 5 5 1株 (74 .4 % ) ,泌尿道感染 5 0株 (6 .7% ) ,引起败血症35株 (4.7% ) ,来自各种体液 (胸、腹水、胆汁 ) 5 2株 (7.0 % ) ,来自各种引流液和伤口分泌物 2 5株 (3.4 % ) ,静脉导管13株 (1.8% ) ,其他 15株 (2 .0 % )。革兰阴性杆菌以非发酵菌为主 ,其中铜绿假单胞菌 135株 (18.2 % )、嗜麦芽窄食单胞菌 38株 (5 .1% )、不动杆菌属 37株 (4.9% )及其他非发酵菌 5 7株 (7.7% ) ,其次大肠埃希菌 91株 (12 .3% )、肺炎克雷伯菌 5 3株 (7.2 % )、肠杆菌属 33株 (4.5 % )、其他肠杆菌科 17株 (2 .3% )。铜绿假单胞菌对亚胺培南的耐药率达 4 1.0 % ,呈多重耐药 ,阴沟肠杆菌对头孢他啶、氨曲南的耐药率达 6 0 .0 %、73.3% ,大肠埃希菌、肺炎克雷伯菌产超广谱β-内酰胺酶 (ESBL s)的发生率分别是 4 1.0 %、4 5 .0 % ,亚胺培南?