人工气道计划外拔管的原因分析及护理对策

目的:探讨机械通气患者意外拔管的原因与预防措施。方法:在我科接受机械通气治疗的414例患者中,发生意外拔管24例,占5.8%。对其发生意外拔管的次数、人工气道方式和发生的原因进行分析并提出相应的护理对策。结果:患者烦躁或意识不清是造成计划外拔管的主要原因;导管固定不当占第二位因素;其次为呼吸机管道牵拉、气管插管过短过浅等。结论:对建立人工气道的患者应高度重视意外拔管的预防,肢体约束、适度镇静、加强沟通、正确固定气管套管及呼吸机管道、选择合适的气管套管型号和置管深度是有效的护理对策。     

Evaluation of the benefit of early valve surgery in the treatment of infective endocarditis. Contribution of propensity analyses

Early valve surgery for infective endocarditis, that is surgery performed during the course of antibiotic therapy, is widely used. However, this intervention has never been proven effective in any clinical trial. Five recently published observational studies, using propensity analysis, analyzed the relationship between surgery and mortality. But they gave conflicting results, mainly because of their methodological limitations. Thus, to date, there is no reliable estimation of early valvular surgery impact on mortality. In addition, this example allows for discussing the interest of propensity analyses and to emphasizing their limitations.     

La position temporelle et spatiale dans les « histoires hallucinées »: Étude de la position spatiale et temporelle dans les discours de patients schizophrènes entendant des voix

Introduction

Hallucinations are often defined as perceptions when there is no object to perceive. However, clinical practitioners only have access to what their patients tell them about their hallucinations. By cooperating in the construction of a meaning for the hallucination, practitioner and patient can reach a common ground. This “co-construction” produces “hallucinatory stories” that are narratives, which revolve around this phenomenon. This raises the question of where the voices are temporally and spatially in the structure of the narrative.

Methods

Fourteen patients meeting the DSM-IV schizophrenia criteria were included and took part in a filmed standardized interview. The markers of temporal and spatial localization were listed and their occurrence in the narrative calculated (Student t test and Wilcoxon test).

Result

The results revealed that:

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  a significant difference between the present and perfect tenses. There is a distinction between what is happening now and what has happened in the past;

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  a significant difference between the markers of temporal localization such as accomplishment and position. The hallucinatory phenomena repeat themselves. Furthermore, the subjects’ judgments concerning the moment at which the hallucinatory phenomenon arises are objective and are accompanied by a temporal reference associated with their story;

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  a significant difference between the markers of spatial localization, with relative positions being preferred. The voices constitute a distinct, autonomous spatial reference for hallucinating subjects.

Conclusion

The narrative makes it possible to give the hallucinatory voices a place in the subject's story. The “hallucinatory stories” represent a transition from the private to the intersubjective world, a way for subjects to appropriate these experiences. When articulated in words, this experience is a product distinct from the self. This distinction between self and non-self, the hallucinating patient and his/her voices, seems to be conveyed in part by the markers of temporal and spatial position.     

新生儿窒息的相关因素分析及复苏护理体会

目的探讨新生儿窒息发生的相关因素、复苏原则及护理措施。方法回顾性分析180例新生儿窒息的临床资料。结果脐带因素、产程延长、早产及胎膜早破等是导致窒息的常见原因。结论产程中加强监护,及时发现胎儿宫内窘迫,正确选择分娩方式,可有效预防和降低新生儿窒息的发生。     

实习阶段本科护生心理健康状况调查分析

目的了解实习阶段本科护生的心理健康状况,为护理学专业临床带教工作提供参考。方法采用问卷调查法,对正在实习的46名五年制护理学本科生进行心理健康状况调查。结果本科护生实习期间总体心理健康状况较好,但就个体的健康因子分值来看,有11%左右的护生处于亚健康状态。护生心理健康与应激水平呈高度正相关。结论实习阶段本科护生心理健康状况较好,应激可以对护生的心理健康产生影响。     

男性肝硬化患者血清性激素水平的分析

目的了解男性肝硬化患者血清性激素水平的变化情况及临床意义。方法检测67例肝硬化患者和34例正常健康人员的血清卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)、睾酮(T)及催乳素(PRL),并进行统计学分析。结果肝硬化患者血清T、E2水平较正常对照组显著性降低(P<0.01),血清PRL水平较正常对照组显著性增高(P<0.01)。结论男性肝硬化患者体内存在性激素水平的失衡和紊乱,检测血清中T、E2和PRL水平对肝硬化的诊断有一定价值。