ULI在治疗脑血管病早期中的应用及护理

光量子透射液体疗法（ＵＬＩ）主要是通过少量液体经紫外线照射和充入氧、臭氧后输入人体所致血液体的一系列变化及它对机体生理病理方面的作用和影响，从而达到治疗脑血管病的目的，自１９９８年３月至１９９９年２月我科共收治脑血管病早期患者８０例，用此疗法治疗４０例，我们从护理角度观察，显效时间快，住院时间短，且取材方便，操作简单，现报告如下： １资料与方法 １．１对象：液疗组：４０例，男２６例，女１４例，年龄４６～８２岁，平均６７岁，其中脑梗塞２８例，脑出血１２例，均为发病至１０日内的首发住院病人，诊断标准按…     

脑卒中偏瘫后遗症期老年患者抑郁的治疗研究

目的 评价道家认知疗法对脑卒中偏瘫后遗症期老年患者抑郁及生活质量的影响.方法 77例脑卒中偏瘫后遗症期伴发抑郁的老年患者,按随机数字表法分为常规治疗组(38例)和综合治疗组(39例),常规治疗组采用抗抑郁剂联合一般支持性心理治疗,综合治疗组在此基础上进行道家认知治疗,两组均治疗8周,随访6个月.于治疗前,治疗后2、4、8周末及随访期末,采用汉密尔顿抑郁分级量表(HAMD)、脑卒中专用生活质量量表(SS-QOL)分别对患者的抑郁症状及生活质量进行评定,并进行统计学分析.结果 常规治疗组治疗后HAMD评分逐渐下降,治疗后8周[(22.35±4.69)分]与治疗前[(29.62±5.95)分]比较差异有统计学意义(t=6.425,P＜0.01);随访期末HAMD评分[(24.48±4.12)分]又升高,与治疗后8周比较差异有统计学意义(t=2.014,P＜0.05),但较治疗前HAMD评分仍显著降低(t=4.836,P＜0.01).常规治疗组SS-QOL评分在治疗后逐渐升高,治疗后8周[(105.39±25.84)分]与治疗前[(86.63±23.84)分]比较差异有统计学意义(t=4.933,P＜0.01);随访期末SS-QOL评分[(96.09±21.37)分]较治疗后8周又有所下降(t=2.543,P＜0.05),但较治疗前仍显著升高(t=2.790,P＜0.05).综合治疗组治疗后HAMD评分持续下降,治疗后8周[(20.08±4.60)分]及随访期末[(15.21±3.42)分]与治疗前[(30.14±4.92)分]比较差异均有统计学意义(t=8.341、15.443,P＜0.01),并且随访期末HAMD评分显著低于治疗后8周(t=4.724,P＜0.01).综合治疗组治疗后SS-QOL评分呈逐渐升高趋势,治疗后8周[(117.56±26.22)分]及随访期末[(126.57±21.82)分]较治疗前[(86.54±23.90)分]显著升高(t=6.716、8.916,P＜0.01);随访期末SS-QOL评分也较治疗后8周显著升高(t=2.378,P＜0.05).综合治疗组治疗后8周及随访期末HAMD评分显著低于常规治疗组同时间点评分(t=2.118,P＜0.05;t=8.405,P＜0.01),SS-QOL评分显著高于常规治疗组同时间点评分(t=3.123,P＜0.05;t=6.580,P＜0.01).结论 抗抑郁剂联合一般支持性心理治疗或在此基础上进行的道家认知治疗均可不同程度地改善脑卒中偏瘫后遗症期老年患者的抑郁症状,提高其生活质量.道家认知疗法起效虽慢,但远期疗效好.

Abstract：

Objective To evaluate the effects of Taoist cognitive psychotherapy on depression of aged patients with cerebral stroke hemiplegia convalescence. Methods Seventy-seven hemiplegia convalescence patients with depression were divided into general treatment group (38 patients, received general back-up psychology therapy) and combined treatment group (39 patients, received general back-up psychology therapy and Taoist cognitive psychotherapy) by random digits table. All patients were treated for 8 weeks and followed up for 6 months. Two groups were evaluated with HAMD and SS-QOL before treatment and at the end of the 2 weeks,4 weeks, 8 weeks and 6 months after treatment. The results were analyzed with statistics. Results In general treatment group, the HAMD scores were gradually decreased, and the HAMD scores of patients after 8 weeks' treatment were significantly lower than those before treatment[(22.35 ± 4.69)scores vs. (29.62 ± 5.95 ) scores,t = 6.425 ,P ＜ 0.01]. At the end of 6 months after treatment, the scores increased [(24.48 ± 4.12 ) scores vs. (22.35 ± 4.69 ) scores, t = 2.014, P ＜ 0.05], but they were lower than those before treatment(t = 4.836, P ＜ 0.01 ). At the end of 6 months after treatment, the SS-QOL scores were lower than those after 8 weeks' treatment (t =2.543,P ＜0.05),but they were higher than those before treatment (t = 2.790,P ＜ 0.05 ). In combined treatment group, the HAMD scores decreased continuously,and the scores after 8 weeks' treatment [(20.08 ± 4.60) scores] and 6 months' treatment [( 15.21 ± 3.42)scores] were significantly lower than those before treatment [( 30.14 ± 4.92 ) scores] (t = 8.341,15.443, P ＜0.01). Meanwhile,the HAMD scores after 6 months'treatment were significantly Iower than those after 8 weeks' treatment (t =4.724,P ＜ 0.01 ). The SS-QOL scores after 8 weeks' treatment [( 117.56 ± 26.22)scores] and 6 months' treatment [(126.57 ±21.82) scores] were significantly higher than those before treatment[(86.54 ± 23.90) scores] (t = 6.716,8.916,P ＜ 0.01 ) ,and there was significantly difference(t=2.378,P ＜ 0.05). The HAMD scores of combined treatment group after 8 weeks' and 6 months' treatment were significantly lower than those of general treatment group at the same time(t = 2.118, P ＜ 0.05 ;t = 8.405,P＜ 0.01 ) ,and SS-QOL scores were significantly higher than those of general treatment group at the same time (t = 3.123,P ＜ 0.05 ;t = 6.580,P ＜ 0.01 ). Conclusions General back-up psychology therapy combined with Taoist cognitive psychotherapy can improve depression and life quality of cerebral stroke hemiplegia convalescence in aged patients. The effects of Taoist cognitive psychotherapy is slower, but it is more beneficial in the long time.     

延续性护理模式在脑卒中患者中应用的效果评价

目的 探讨延续性护理模式在脑卒中患者中的临床应用效果.方法 选取2008年6月至201 1年6月收治的脑卒中患者58例,根据区组化随机分组法将入选病例分成研究组和对照组各29例.对照组患者给予一般常规护理干预措施,研究组患者则在此基础之上加用延续性护理干预模式,并对2组患者的日常生活活动能力、遵医行为、生活质量、护理满意度等相关指标进行比较分析.结果 研究组与对照组患者相比,在出院时的日常生活活动能力未呈现显著改善,而在患者出院后第1,3,6个月时的日常生活活动能力较对照组显著提高;研究组患者按时服药、按时锻炼、按时复诊、合理饮食等遵医行为均较对照组显著改善;研究组患者在出院时的生活质量评分未呈现显著改善,而在患者出院后的第3个月,其生活质量评分显著高于对照组;研究组患者对医护人员的素质以及服务态度和服务内容的满意程度均显著高于对照组.结论 延续性护理模式对于改善脑卒中患者的日常生活活动能力、遵医行为、生活质量、护理满意度均具有十分重要的现实意义,值得进一步的临床应用和推广.     

医院感染管理 预防院内感染发生

医院内感染存在各种原因：不合理滥用抗生素，引起菌群失调，耐药菌株上升；大量使用侵袭性诊断、治疗手段；环境污染严重；易感人群增加等。有组织、有目的地加强医院感染管理，杜绝医院内感染。我院的院内感染发生率由2003年的8％左右下降至2004年的5％左右，有力地说明了加强医院感染管理，是减少或预防院内感染发生的有效措施。