按压法促使便秘患者排便的临床观察

便秘即大便硬结不能自行排出或较长时间未能排便,感下腹胀满不适,有便意,但又排不出大便。临床上常采用开塞露肛注或大量不保留灌肠、口服药物等方法进行治疗,但用开塞露肛注效果不是很理想,李蓉梅等报道用开塞露肛注24例,仅有16例排出大便[1],而大量不保留灌肠效果虽好,但操作     

急性心肌梗塞病人最佳通便方法研究

目的探讨急性心肌梗塞病人的最佳通便方法,保证急性心肌梗塞溶栓后的治疗效果,提高治愈率.方法将45例经过急性心肌梗塞溶栓治疗患者随机分为自然排便组、开塞露肛注排便组和肥皂水低压灌肠组,比较3组的通便效果.结果肥皂水低压灌肠组效果优于其他2组,差异有显著意义(p＜0.01).结论肥皂水低压灌肠对3天内无大便或以开塞露肛注后仍不能排便者是很有必要且较为理想的方法.     

急性心肌梗塞患者通便方法对比观察

目的探讨急性心肌梗塞(AMI)患者的最佳通便方法.方法45例急性心肌梗塞患者随机分为3组,各15例,A组为患者系用自然排便,B组为患者给予开塞露肛注排便,C组为患者给予肥皂水低压灌肠排便.结果A组患者自然排便尤为困难,用力排便易导致心脏负荷加重;开塞露肛注排便法,只起到润滑作用,不能有效软化大便;肥皂水低压灌肠法,效果好,不良反应少;三组比较,差异有显著性(P＜0.01).结论低压灌肠对于急性心肌梗塞患者,是较为理想的通便方法.     

急性心肌梗塞患者通便方法对比观察

目的:探讨急性心肌梗塞(AMI)患者的最佳通便方法。方法:45例急性心肌梗塞患者随机分为3组,各15例,A组为患者系用自然排便,B组为患者给予开塞露肛注排便,C组为患者给予肥皂水低压灌肠排便。结果:A组患者自然排便尤为困难,用力排便易导致心脏负荷加重;开塞露肛注排便法,只起到润滑作用,不能有效软化大便;肥皂水低压灌肠法,效果好,不良反应少;三组比较,差异有显著性(P<0.01)。结论:低压灌肠对于急性心肌梗塞患者,是较为理想的通便方法。     

开塞露肛内注入新法

便秘是长期卧床病人常见的症状,临床上对3d以上无大便者常采用传统的开塞露肛内注入、灌肠等方法。传统方法肛内注入开塞露效果较差,有时必须多次重复使用。自2 0 0 2年3月,我们采用新法肛内注入开塞露5 0例,取得了满意的疗效。现介绍如下。1　方法　　取开塞露2支或3支剪开最前端,润滑导尿管前端4cm～6cm或更长,连接开塞露,轻轻插入肛门10cm～15cm后,边退边挤入液体,嘱病人保留10min～15min后排便。2　结果　　15min～3 0min后40例病人排出大便;4例病人可排出部分大便;其余病人15min～3 0min后仍不能排出大便。3　讨论　　开塞露的主要成分…     

2种常用辅助促排便措施对急性心肌梗死早期患者心脏功能的影响

目的对开塞露肛注和蓖麻油口服2种促排便措施对急性心肌梗死(AMI)早期患者排便时心脏功能状态的影响进行比较,为临床护理提供依据。方法将需采取促排便措施的AMI早期患者随机分为开塞露组和蓖麻油组,开塞露组给予开塞露20~40ml肛注,蓖麻油组给予蓖麻油10~30ml口服。观察比较患者在平静、促排便前、促排便后、便中前期、便中后期、便后整理、便后5min、便后30min8个时段中心率、血压、心肌耗氧量等指标的变化。结果开塞露组与蓖麻油组在促排便后开塞露组的心率和心肌耗氧量显著高于蓖麻油组,且有显著性差异(P<0.05),其他时段无显著性差异。结论开塞露肛注者与蓖麻油口服者在排便过程中各时段心脏自律性和心肌缺血情况的变化基本相同。但在开塞露肛注后等待排便期间,患者的心肌耗氧量较蓖麻油口服者增加明显,不宜过多延长开塞露肛注后等待排便的时间。     

2种常用辅助促排便措施对急性心肌梗死早期患者心脏功能的影响

目的 对开塞露肛注和蓖麻油口服2种促排便措施对急性心肌梗死(AMI)早期患者排便时心脏功能状态的影响进行比较,为临床护理提供依据.方法 将需采取促排便措施的AMI早期患者随机分为开塞露组和蓖麻油组,开塞露组给予开塞露20～40 ml肛注,蓖麻油组给予蓖麻油10～30 ml口服.观察比较患者在平静、促排便前、促排便后、便中前期、便中后期、便后整理、便后5 min、便后30 min 8个时段中心率、血压、心肌耗氧量等指标的变化.结果 开塞露组与蓖麻油组在促排便后开塞露组的心率和心肌耗氧量显著高于蓖麻油组,且有显著性差异(P＜0.05),其他时段无显著性差异.结论 开塞露肛注者与蓖麻油口服者在排便过程中各时段心脏自律性和心肌缺血情况的变化基本相同.但在开塞露肛注后等待排便期间,患者的心肌耗氧量较蓖麻油口服者增加明显,不宜过多延长开塞露肛注后等待排便的时间.     

2种常用辅助促排便措施对急性心肌梗死早期患者心脏功能的影响

目的对开塞露肛注和蓖麻油口服2种促排便措施对急性心肌梗死（AMI）早期患者排便时心脏功能状态的影响进行比较，为临床护理提供依据。方法将需采取促排便措施的AMI早期患者随机分为开塞露组和蓖麻油组，开塞露组给予开塞露20～40ml肛注，蓖麻油组给予蓖麻油10～30ml口服。观察比较患者在平静、促排便前、促排便后、便中前期、便中后期、便后整理、便后5min、便后30min8个时段中心率、血压、心肌耗氧量等指标的变化。结果开塞露组与蓖麻油组在促排便后开塞露组的心率和心肌耗氧量显著高于蓖麻油组，且有显著性差异（P〈0．05），其他时段无显著性差异。结论开塞露肛注者与蓖麻油口服者在排便过程中各时段心脏自律性和心肌缺血情况的变化基本相同。但在开塞露肛注后等待排便期间，患者的心肌耗氧量较蓖麻油口服者增加明显，不宜过多延长开塞露肛注后等待排便的时间。     

不同促排便措施对早期急性心肌梗死病人心肌耗氧量的影响

[目的]了解不同促排便护理干预措施对早期急性心肌梗死（AMI）病人排便过程中不同时段心肌耗氧量（MVO2）的影响,为临床采取合理、有效的促排便护理干预措施,减少排便时严重并发症的发生提供依据。[方法]将28例需采用促排便护理干预措施的早期AMI病人随机分为开塞露组和蓖麻油组,采用多功能心电监护仪记录两组病人排便过程中心率和血压,并比较两组病人排便过程中不同时段心率、血压及MVO2变化。[结果]两种促排便措施效果差异无统计学意义。开塞露组病人在促排便后心率和MVO2较蓖麻油组同期升高,其他时段两组病人心率、血压及MVO2无统计学意义。[结论]在开塞露肛注后等待排便期间,病人MVO2较蓖麻油口服者增加,不宜过多延长开塞露肛注后等待排便的时间。促排便措施的选择应视病人具体情况而定。     

肛肠病病人术前清洁灌肠方法探讨

[目的]探讨有效的清洁灌肠方法.[方法]将60例术前清洁灌肠病人随机分为实验组和对照组,每组30例,对照组在2次生理盐水1 000 mL大量不保留灌肠后不能解出大便或只能解出少许大便后,继续用生理盐水1 000 mL行大量不保留灌肠,每次灌肠后均保留10 min后排便.实验组在2次大量不保留灌肠无效后用开塞露40 mL塞肛,保留10 min后排便.[结果]实验组病人灌肠效果明显优于对照组(P<0.01).[结论]在2次大量不保留灌肠后加用开塞露塞肛清洁肠道效果好.     

Barriers and incentives of physicians and patients to cancer screening.

It is imperative that the health care system provide mechanisms to improve cancer control. The most effective way of limiting cancer morbidity and mortality is by prevention (modification of behaviors that increase cancer risk), and by early diagnosis in the asymptomatic stage of the disease, which allows for curative therapies. This article has enumerated barriers that make preventive and early diagnostic maneuvers more difficult for both patients and physicians. Some of the barriers are common to both patients and physicians, such as discontinuity of care. The barriers were discussed from both perspectives. Suggestions were made for modification of these barriers, so that incentives might make provision of the preventive and early diagnosis more likely. The incentives are attainable; however, to make improvements on a large scale will require the efforts of the public, physicians, and the health care system. It will effect physicians from the beginning of their medical education and through their entire practice. A large amount of effort directed at a focused population by a small team of health care workers can make a large difference in preventive care. This was shown effectively by a general practitioner in England who undertook a 15-month "campaign" on a "deprived" community, and raised the level of preventive care to that of an "endowed" community. This type of effort by an individual is desirable, but much smaller individual efforts directed over an entire population can have a much greater ultimate effect. That is why the efforts must be directed toward the primary care physician. These physicians care for the majority of the population, so if each primary care doctor increased current efforts of prevention by just three patients per day, then over the entire population inestimable improvements on preventive care would result. There is some evidence that improvements in preventive care are occurring. As further research is directed at how best to provide preventive services in the physician's office, our skills and effectiveness will improve. Each physician should accept as his or her responsibility the ongoing preventive needs of the population he or she serves. The prevention and early diagnosis of cancer can be coordinated in the office with episodic care to minimize costs. The necessary knowledge and technology are available, application is the key. By applying these in a cost-effective way, we can hopefully attain control of cancer in the next decade.     

阶段转变模型在慢性疼痛管理中的应用进展

为了更好地减轻慢性疼痛给患者造成生理和心理的痛苦,患者参与慢性疼痛自我管理在疼痛护理中的作用也越来越受到重视.近年来阶段转变模型在慢性疼痛领域的应用研究,将心理和行为的理论引入到慢性疼痛患者自我管理过程当中,通过心理和行为的不同阶段反映自我管理的意图,从而有针对性地对不同阶段慢性疼痛患者采取不同的护理干预,构建更完善的疼痛自我管理的护理模式.本文通过对阶段转变模型的内容、价值及应用现状进行综述,从心理和行为层面为我国慢性疼痛患者的自我管理提供新的方法和视角.     

Working with complex care patients

The following article provides the authors' definition of complex care patients. It is based on what they have learned about these special patients from the literature and from their personal clinical experiences. When I received this article for review, I decided to do a literature search on the term complex care patient and had a difficult time finding relevant articles. I asked a wonderful librarian from the Boston Children's Hospital, Alison Clapp, to help me with the search, and she had to maneuver through a maze of clinical subheadings. She described the search as "a difficult one." It is ironic that the search for information pertaining to these patients mirrors the complexity of care that they require from us. Are complex care patients the same as complex patients? The insertion of the word care may make a difference: You decide. There are complex patients who challenge us technically and intellectually, and then there are those who require even more from us--they challenge us technically, intellectually, physically, emotionally, and spiritually. The term complex care patient encompasses all these care dimensions. I think it is an excellent choice of words to make us consider what we are increasingly expected to do--and how we cannot do it alone.--Maura MacPhee, RN, PhD, Clinical Practice Column Editor.     

阶段转变模型在慢性疼痛管理中的应用进展

为了更好地减轻慢性疼痛给患者造成生理和心理的痛苦,患者参与慢性疼痛自我管理在疼痛护理中的作用也越来越受到重视.近年来阶段转变模型在慢性疼痛领域的应用研究,将心理和行为的理论引入到慢性疼痛患者自我管理过程当中,通过心理和行为的不同阶段反映自我管理的意图,从而有针对性地对不同阶段慢性疼痛患者采取不同的护理干预,构建更完善的疼痛自我管理的护理模式.本文通过对阶段转变模型的内容、价值及应用现状进行综述,从心理和行为层面为我国慢性疼痛患者的自我管理提供新的方法和视角.     

Autonomy, privacy and the implementation of the principle of "informed consent" with regard to nursing intervention from the view point of the aged

The aim of this study was to describe patient autonomy, privacy and the implementation of the principle of informed consent in the care of elderly patients in facilities experienced by themselves. This study is part of the BIOMED 2 project "Patients' autonomy and privacy in nursing interventions" supported by the European Commission. Interview data (n = 95) were collected among elderly people in German facilities for geriatrics and in nursing homes. The results showed there was a lack of opportunity by the elderly people to make self-determined decisions. The principle of "informed consent" was hardly realised. The participants felt their privacy was not respected in multi-bedded rooms and in situations of dressing and eliminating. One can proceed on the assumption that the lack of information, the need of help and the fixed organizing structures of the facilities are the reasons why elderly people play a rather passive role as patients. It might be possible to improve the autonomy of elderly people if the nurses as an advocate supported them to make self-determined decisions. The implementation of the principle of informed consent with regard to nursing interventions would promote both autonomy and respect of privacy. Furthermore, one can assume that the autonomy and quality of life of elderly people could be promoted if the organizing structures of the facilities were more flexible.     

应用等离子刀治疗椎间盘突出症的护理

目的探讨等离子刀技术经皮椎间盘消融手术配合的体会。方法针对47例患者的护理特点,从以下几方面进行手术配合:(1)做好患者局麻的心理护理及安慰,引导放松;(2)做好术前的器械准备;(3)熟悉等离子刀的性能与使用配合;(4)摆好手术体位;(5)术中密切观察病情,指导患者配合手术。结果47例手术疗效满意,消融过程中有3例出现心慌,心率增快;2例因怕痛而加大麻药剂量。结论熟悉等离子刀的使用,掌握手术配合技巧,做好患者心理疏导,是手术成功和预防并发症的关键。     

Pulmonary emergencies in the elderly

The aging process results in changes in pulmonary physiology that make the elderly population more susceptible to pulmonary disease. These physiologic changes also alter the clinical presentation of such diseases, making the diagnosis and treatment of pulmonary disorders particularly challenging for the clinician. It is important for the clinician to have a high index of suspicion for pulmonary disorders to make the proper diagnosis. It is essential to keep in mind the subtle differences between pulmonary diseases in the elderly compared with younger patients.     

CPR in hospitalized patients: when is it futile?

When cardiac or pulmonary arrest occurs in hospitalized patients, cardiopulmonary resuscitation (CPR) is often futile. Although "do-not-resuscitate" orders are widely used and presumably screen out many patients who are poor candidates for CPR, recent studies have shown that an average of only 13 percent of patients receiving CPR in the hospital survive to discharge. An average of 4 percent of patients receiving CPR in general ward settings survive. Of those who do survive after CPR, many are in a persistent vegetative state or a chronic dependent condition. Patients with malignancy, sepsis, pneumonia, renal failure, diabetes or advanced age have a low chance of surviving after CPR. It is important for both patients and physicians to make a realistic appraisal of the likely outcome of CPR.     

The Cologne internet-manual of pain therapy--33 months online,experiences and evaluation

OBJECTIVE: The improvement of ambulant treatment for patients with chronic headache or cancer pain. METHODS: Distribution of accepted guidelines and standards by means of the internet in order to make this knowledge known among general practitioners and to give patients better access to this information. RESULTS: We have built an internet manual about the treatment of chronic headache and cancer pain. About 9100 readers accessed the manual during a period of 33 months. The manual has been completely downloaded 279 times. Physicians and patients very often used search engines to access the manual in their search for information about headache. The terms "migraine" and "tension type headache" were looked up the most. CONCLUSIONS: It is worthwhile editing medical information for use on the internet and thus making it available to the public.     

Cascade use of plasmapheresis and plasma filtration in the treatment of rheumatoid arthritis

The effect of incorporation of cascade plasmapheresis and plasma filtration in multimodality therapy was studied in 4 patients with rheumatoid arthritis (RA). The result was estimated as "excellent" (complete disappearance of clinical symptoms of the articular syndrome and normalization of the activity laboratory indices) in one patient; "good" (the reduction of clinicolaboratory activity) in 2 patients and "satisfactory" (the reduction of symptoms of the articular syndrome without changes of a degree of general activity of disease) in one patient. Cascade plasmapheresis and plasma filtration significantly improved clinical and many laboratory indices of RA activity and humoral immunity indices during treatment. A long period of observation is required to assess long-term results of the effect of this method. A great advantage of the method is a possibility of decreasing substitution protein solutions without negative effects with relation to the blood total protein level. The absence of a necessity of catheterization of central vessels, more complete blood separation into plasma and erythrocytes make cascade plasmapheresis and plasma filtration more preferable. Good tolerance of the procedure, fast improvement, a chance to avoid side-effects of drug therapy, a lower risk of allergic reactions to plasma substitutes as compared to those in plasmapheresis and lymphocytoplasmapheresis make the method promising for RA treatment.