品管圈干预对肿瘤患者疼痛护理及满意度的影响

目的 观察品管圈对肿瘤患者疼痛状态、疼痛知识知晓率及满意度的影响.方法 80例肿瘤患者根据入院先后顺序随机分为2组,对照组(n=40例)采取常规护理措施,观察组(n=40例)采用疼痛专项品管圈干预.两组护理周期均为3个月,比较两组患者护理干预后疼痛状态、疼痛知识知晓率及医护满意度.结果 观察组无痛及轻度疼痛比例明显高于对照组(P＜0.05),而重度疼痛及剧痛比例明显低于对照组(P＜0.05);观察组疼痛自我评估、疼痛相关知识认知、按时口服止痛药、不良反应预防及疼痛正确护理等疼痛知识知晓率均明显高于对照组(P＜0.05);观察组言语沟通、宣传教育、答疑、随访效果等医护满意度均明显高于对照组(P＜0.05).结论 品管圈干预可明显缓解肿瘤患者疼痛程度,提高患者疼痛知识知晓率及满意度.     

不同护理模式在慢性胃炎患者中的护理效果比较

目的:探讨护理干预对慢性胃炎患者的临床疗效、健康知识水平以及护理服务满意度的影响。方法:选择2009-01～2011-01住院的60例慢性胃炎患者,随机分为对照组和观察组,每组30例,对照组按常规进行护理,观察组采取护理干预措施。观察两组患者护理后的临床疗效、健康知识评分以及对护理服务的满意度。结果:观察组的治疗总有效率为86.67%,明显高于对照组的76.67%,P<0.05;观察组的健康知识评分、护理满意度显著高于对照组,P<0.05。结论:护理干预能有显著提高慢性胃炎患者的健康知识水平和临床疗效,提高护理服务满意度。     

护理干预在冠状动脉CT造影中的应用研究

目的:探究护理干预在冠状动脉CT造影患者中的临床应用及影响。方法:选取2016年6月-2017年6月于我院行冠状动脉CT造影的患者84例,将患者随机分为对照组及干预组,各42例。对照组检查期间行常规化护理,干预组在常规化护理基础上进行护理干预。对两组患者造影前后的血压、心率及检查后并发症发生情况、护理满意度进行比较和评价。结果:冠状动脉造影前后20min时干预组的血压及心率均明显低于对照组,差异有统计学意义(P <0.05);干预组患者造影后心律失常、心绞痛及腰部不适发生率明显低于对照组,差异有统计学意义(P <0.05);干预组患者护理满意度明显优于对照组,差异有统计学意义(P<0.05);干预组冠状动脉图像质量优于对照组,差异有统计学意义(P <0.05)。结论:对行冠状动脉CT造影的患者行有效的护理干预措施是帮助其检查成功的重要保障,不仅有效降低病人血压及心率,减少术后并发症的发生,提高CT冠状动脉成像质量,还可提高病人的护理满意度。     

开塞露在前列腺疾病磁共振DWI成像中的应用

目的探讨开塞露对前列腺疾病磁共振DWI成像检查中图像质量的作用。方法选取前列腺疾病患者27例,在使用开塞露前及使用开塞露15 min后进行磁共振DWI扫描,由2名医师对开塞露使用前后的图像质量进行评价。结果2名医师对于图像质量的评价结果具有较好的一致性,分别为使用开塞露前组K值0.706(P<0.0001),使用开塞露后组K值0.519(P=0.003);使用开塞露组磁共振DWI成像时前列腺的图像质量明显提高(P<0.0001)。结论使用开塞露可显著提高前列腺疾病磁共振DWI成像检查中的图像质量,建议作为前列腺疾病磁共振检查前的常规准备应用。     

人性化护理在产后护理中的应用

目的:通过对产妇的人性化护理,提高护理服务质量,加强产妇的舒适感.方法:随机将产妇分为观察组(20例)和对照组(20例),对观察组实施人性化护理,对照组实施常规产科护理,分别对两组患者于产后5天进行服务满意度调查及分析.结果:通过产后护理干预,观察组患者对护理服务质量的满意度明显高于对照组,并且产妇产后自我护理的知识和技能也有明显提高.结论:人性化护理有利于产妇的理和生理康复,不仅可以增强患者的舒适度,而且可以改善护惠关系.提高护理服务满意度.     

经导管肝动脉化疗栓塞术联合微波消融治疗肝癌的精准护理研究

目的：探讨精准护理在经导管肝动脉化疗栓塞术（TACE）联合微波消融（MWA）治疗肝癌患者中的应用效果。 方法：将我院介入血管外科2016年11月至2017年10月收治60例TACE联合MWA治疗的肝癌患者,按前后时间顺序分为对照组（30例）和观察组（30例）,对照组采取常规护理,观察组在对照组的基础上,采用精准护理方法,对比两组患者术后尿储留、恶心呕吐、腰酸背痛、失眠发生率,健康知识知晓率和护理满意率。 结果：观察组患者的术后尿储留、恶心呕吐、腰酸背痛、失眠发生率明显低于对照组（P<0.05）;健康知识知晓率和护理满意率高于对照组（P<0.05）。 结论：精准护理方法运用于TACE联合MWA治疗肝癌患者中,可显著降低术后不良反应的发生,增加介入治疗术后整体舒适度,提高健康知识知晓率和护理满意率。     

心理护理在心肌梗死患者护理中的应用

目的探讨和总结心理护理在心肌梗死患者护理中的应用。方法将108例心肌梗死患者随机分为2组，观察组54例按照制定的心理护理路径实施护理，对照组54例采用传统的护理方法。结果临床上应用心理护理干预，观察组对疾病知识的率及患者的满意率方面明显高于对照组，在并发症发生率及平均住院时间等方面观察组有明显优势，两组相比较差异有统计学意义（P〈0．05）。结论临床上对心肌梗死患者采用心理护理干预，不仅提高患者对相关疾病知识的掌握率和自我护理能力，使治疗结果更满意，而且使治疗过程满意度提高，降低并发症的发生率。     

医院门诊护理中的风险因素管理探讨

目的:探讨医院门诊护理中应用的风险因素管理的效果.方法:对医院门诊护理工作存在的风险因素及缺陷进行分析和评估,并提出相应的管理干预措施,比较实施管理措施前后患者对护理工作的满意率及投诉率.结果:观察组总满意率99.54%,对照组总满意率为90.0%,观察组满意率明显高于对照组(P＜0.01);观察组未出现投诉案例,对照组出现8例投诉,观察组投诉率明显低于对照组(χ2=6.24,P＜0.05).结论:将风险因素管理应用于医院门诊护理工作中,能够大大的提高患者对护理工作的满意率和有效的预防、控制护理风险的发生,提高医护人员的工作积极性和护理质量,减少医疗纠纷,赢得医疗市场.     

白内障患者采用路径式精细化围术期护理干预的效果及对满意度的影响

目的 探析路径式精细化围术期护理干预对白内障患者治疗效果的影响。方法 此次研究定于2022年06月至2022年12月开展,纳取本院收治的白内障患者100例配合研究,依据随机数字表法分2组,50例/组。对照组实行传统护理干预,观察组实行路径式精细化围术期护理干预,比较两组患者视力恢复情况、心理情绪、疾病知识掌握度及护理满意度。结果 观察组视力恢复情况显示>0.2患者占比98.00%高于对照组的86.00%,组间差异显著(P<0.05),术后1个月,两组眼压、眼部VAS评分均降低,且观察组低于对照组(P<0.05),两组患者干预前SAS、SDS、疾病知识掌握度比较无差异(P>0.05)观察组干预后SAS评分(27.21±3.12)分、SDS评分(21.15±3.08)分较对照组低,疾病知识掌握度(91.56±4.32)分较对照组高,组间差异显著(P<0.05),观察组护理满意率96.00%较对照组84.00%高,组间差异显著(P<0.05)。结论 路径式精细化围术期护理干预开展后,白内障患者视力恢复效果明显,眼压及疼痛程度显著降低,其不良心理状态有所缓解...     

家庭协同护理模式对首次行冠脉CTA检查的老年患者负性情绪及检查结局的影响

【摘要】 目的 探讨家庭协同护理模式对首次行冠状动脉CT血管成像（CCTA）检查的老年患者负性情绪及检查结局的影响。 方法 采用便利抽样的方法,选取郑州市某三级甲等综合医院首次行CCTA检查的老年患者238例,2018年8至9月行CCTA检查的老年患者125例作为对照组,2018年10至11月行检查的老年患者113例作为干预组,对照组采用常规的护理和健康教育,干预组在常规护理的基础上采用家庭协同护理模式的健康教育,比较两组患者干预前和干预后焦虑、抑郁负性情绪、CCTA检查知识及一次性检查成功率的差异。结果 两组患者干预后焦虑、抑郁均低于健康教育前,干预组低于对照组,差异具有统计学意义（P＜0.05）;干预组检查知识、一次性检查成功率均高于对照组,差异具有统计学意义（P＜0.05）。结论 运用家庭协同护理模式进行健康教育,能显著降低老年冠状动脉CT血管成像检查患者的负性情绪,增强老年冠状动脉CT血管成像的检查知识,提高一次性检查成功率。     

Rectal carcinoma: double-contrast MR imaging for preoperative staging

PURPOSE: To evaluate and compare the imaging findings and staging of rectal carcinoma by using conventional magnetic resonance (MR) imaging, MR imaging with an enema of superparamagnetic ferristene-based contrast material, and MR imaging with an enema of ferristene solution plus intravenous injection of gadodiamide. MATERIALS AND METHODS: Twenty-nine patients (17 women, 12 men; age range, 39-91 years) referred with a diagnosis of rectal carcinoma were examined. Analysis of the rectal wall and staging of the tumor were performed. In all patients, the MR imaging findings were correlated with the histopathologic findings. RESULTS: The contrast material enema caused distention of the rectum and an intraluminal signal void, whereas the gadodiamide injection caused enhancement of the mucosa on T1-weighted images. This enhancement enabled evaluation of the normal rectal wall and differentiation of the mucosa, tunica muscularis, and perirectal space, which was not possible on the nonenhanced images. Double-contrast (ferristene solution plus gadodiamide) MR imaging was superior to imaging with only ferristene-based contrast material and had a sensitivity of 100%, specificity of 70%, and accuracy of 90% in distinguishing tumor stages worse than Dukes A. CONCLUSION: Double contrast material-enhanced MR imaging enables accurate rectal carcinoma staging, which is not possible at nonenhanced imaging.     

Rectal cancer: review with emphasis on MR imaging

One concern after rectal cancer surgery is the high local recurrence rate. Randomized trials have shown that the best local control rate for rectal cancer patients as a group is achieved after a short course of radiation therapy followed by optimal surgery. It is debatable, however, whether all patients with rectal cancer should undergo preoperative radiation therapy. Preoperative identification of those most likely to benefit from neoadjuvant therapy is important. Therefore, the challenge for preoperative imaging in rectal cancer is to determine subgroups of patients with different risks for recurrence: those with superficial tumors, who can be treated with surgery alone; those with operable tumors and a wide circumferential resection margin, who can be treated with a short course of radiation therapy followed by total mesorectal excision; and those with advanced cancer and a close or involved resection margin, who require a long course of radiation therapy, with or without chemotherapy, and extensive surgery. So far, there is no consensus on the role of diagnostic imaging (endorectal ultrasonography, computed tomography, and magnetic resonance [MR] imaging) in the care of patients with primary rectal cancer. Preoperative staging has long relied on digital examination alone, which indicates that it has been difficult to achieve accuracy levels high enough for clinical decision making with preoperative imaging. In this review, the relevance of preoperative imaging in staging the local extent of primary rectal cancer will be discussed. Research on various imaging modalities, with an emphasis on MR, will be discussed under four main headings that address the most relevant aspects of local spread of rectal tumors: T stage, circumferential resection margin, locally advanced rectal cancer, and N stage.     

Rectal carcinoma: staging at MR imaging with endorectal surface coil. Work in progress

To increase the accuracy of local staging of rectal carcinomas at magnetic resonance (MR) imaging, the authors placed on endorectal coil mounted on a balloon in a position adjacent to the lesion. Use of such a local coil resulted in increased signal-to-noise ratio compared with use of a body coil; higher-resolution images were obtained because the field of view was decreased. The depth of wall invasion by rectal carcinoma was correctly staged with endorectal MR imaging in 11 of 12 patients. In the detection of perirectal adenopathy, use of MR enabled correct identification of positive perirectal nodes in four of seven patients (57%). There were no false-positive diagnoses of perirectal adenopathy at MR. Endorectal MR imaging is an evolving and promising technique for the local staging of rectal carcinomas, but further studies are needed to demonstrate its efficacy.     

Prostate cancer: correlation of MR imaging and MR spectroscopy with pathologic findings after radiation therapy-initial experience

PURPOSE: To prospectively evaluate magnetic resonance (MR) imaging and MR spectroscopy for depiction of local prostate cancer recurrence after external-beam radiation therapy, with step-section pathologic findings as the standard of reference. MATERIALS AND METHODS: Study received institutional approval, and written informed consent was obtained. Study was compliant with Health Insurance Portability and Accountability Act. Sextant biopsy, digital rectal examination, MR imaging, MR spectroscopy, and salvage radical prostatectomy with step-section pathologic examination were performed in nine patients with increasing prostate-specific antigen levels after external-beam radiation therapy. MR imaging criterion for tumor was a focal nodular region of reduced signal intensity at T2-weighted imaging. MR spectroscopic criteria for tumor were voxels with choline (Cho) plus creatine (Cr) to citrate (Cit) ratio ([Cho + Cr]/Cit) of at least 0.5 or voxels with detectable Cho and no Cit in the peripheral zone. Sensitivity and specificity of sextant biopsy, digital rectal examination, MR imaging, and MR spectroscopy were determined by using a prostate sextant as the unit of analysis. For feature analysis, MR imaging and MR spectroscopic findings were correlated with step-section pathologic findings. RESULTS: MR imaging and MR spectroscopy showed estimated sensitivities of 68% and 77%, respectively, while sensitivities of biopsy and digital rectal examination were 48% and 16%, respectively. MR spectroscopy appears to be less specific (78%) than the other three tests, each of which had a specificity higher than 90%. MR spectroscopic feature analysis showed that a metabolically altered benign gland could be falsely identified as tumor by using MR spectroscopic criteria; further analysis of MR spectroscopic features did not lead to improved MR spectroscopic criteria for recurrent tumor. CONCLUSION: In summary, MR imaging and MR spectroscopy may be more sensitive than sextant biopsy and digital rectal examination for sextant localization of cancer recurrence after external-beam radiation therapy.     

Magnetic resonance colonography without bowel cleansing using oral and rectal stool softeners (fecal cracking)—a feasibility study

The aim of our study was to assess the effect of oral and rectal stool softeners on dark-lumen magnetic resonance (MR) colonography without bowel cleansing. Ten volunteers underwent MR colonography without colonic cleansing. A baseline examination was performed without oral or rectal administration of stool softeners. In a second set, volunteers ingested 60 ml of lactulose 24 h prior to MR examination. In a third examination, water as a rectal enema was replaced by a solution of 0.5%-docusate sodium (DS). A fourth MR examination was performed, in conjunction with both oral administration of lactulose and rectal application of DS. A T1-weighted data set was acquired at scanning times of 0, 5 and 10 min after colonic filling. A fourth data set was acquired 75 s after i.v. injection of contrast agent. Signal intensity of stool was calculated for all colonic segments. Without oral ingestion of lactulose or rectal enema with DS stool signal intensity was high and did not decrease over time. However, lactulose and DS caused a decrease in stool signal intensity. Both substances together led to a decreasing signal intensity of feces. Combination of lactulose and DS provided the lowest signal intensity of stool. Thus, feces could hardly be distinguished from dark rectal enema allowing for the assessment of the colonic wall.     

Small bowel hydro‐MR imaging for optimized ileocecal distension in Crohn's disease: Should an additional rectal enema filling be performed?

PURPOSE: To assess the impact of an additional rectal enema filling in small bowel hydro-MRI in patients with Crohn's disease. MATERIALS AND METHODS: A total of 40 patients with known Crohn's disease were analyzed retrospectively: 20 patients only ingested an oral contrast agent (group A), the other 20 subjects obtained an additional rectal water enema (group B). For small bowel distension, a solution containing 0.2% locust bean gum (LBG) and 2.5% mannitol was used. In all patients, a breathhold contrast-enhanced T1w three-dimensional volumetric interpolated breathhold examination (VIBE) sequence was acquired. Comparative analysis was based on image quality and bowel distension as well as signal-to-noise ratio (SNR) measurements. MR findings were compared with those of conventional colonoscopy, as available (N = 25). RESULTS: The terminal ileum and rectum showed a significantly higher distension following the rectal administration of water. Furthermore, fewer artifacts were seen within group B. This resulted in a higher reader confidence for the diagnosis of bowel disease, not only in the colon, but also in the ileocecal region. Diagnostic accuracy in diagnosing inflammation of the terminal ileum was 100% in group B; in the nonenema group there were three false-negative diagnoses of terminal ileitis. CONCLUSION: Our data show that the additional administration of a rectal enema is useful in small bowel MRI for the visualization of the terminal ileum. The additional time needed for the enema administration was minimal, and small and large bowel pathologies could be diagnosed with high accuracy. Thus, we suggest that a rectal enema in small bowel MR imaging be considered.     

Preoperative staging of rectal carcinoma with MR imaging: surgical and histopathologic correlation

Twenty-nine patients with rectal carcinoma were examined with magnetic resonance (MR) imaging at 1.0 T. In most patients a Helmholtz coil was used and a bowel distention obtained with a barium enema balloon tip. The MR findings were graded according to the modified Astler-Coller staging classification and correlated with the surgical or histopathologic results. Correct diagnosis was made in nine of the 12 patients with stage A and B1 tumors. Overestimation occurred in the other three patients, who had previously undergone radiation therapy or surgery. Local stage was correctly assessed in 11 patients with stage B2 carcinoma and in six patients with stage B3 tumors. Enlarged lymph nodes were detected in four of seven patients with nodes containing carcinoma. In two other patients with enlarged nodes, no carcinoma was identified at histologic examination. MR imaging may enable correct staging of local extent of rectal carcinoma, particularly in patients who have not previously undergone radiation therapy or surgery. However, evaluation of lymph nodes is less accurate.     

婴儿腹腔入路肾盂成形术中口服西甲硅油乳剂联合甘油灌肠剂的效果

 目的 探讨口服西甲硅油乳剂联合甘油灌肠剂灌肠在婴儿经腹腔入路腹腔镜肾盂成形术中的应用效果。方法 选取2020-06至2021-06解放军总医院第七医学中心收治的需经腹腔入路腹腔镜肾盂成形术治疗的80例肾盂输尿管连接部梗阻婴儿作为研究对象。采用随机数字表法分为试验组和对照组,各40例。对照组术前常规采用甘油灌肠剂灌肠,试验组术前采用甘油灌肠剂灌肠同时口服西甲硅油乳剂。比较两组患儿手术操作时间、术中经皮穿刺肠管抽气次数,术中辅助孔增加数目,患儿术后首次排气时间及术后进食时间。结果 试验组患儿手术操作时间[(2.1±0.3)h]较对照组[(2.8±0.2)h]缩短,术中经皮穿刺肠管抽气次数[(2.3±0.8)次]较对照组[(5.1±1.1)次]减少,术后首次排气时间[(1.05±0.23)d]较对照组[(2.75±0.93)d]缩短,术后进食时间[(3.17±0.74)d]较对照组[(4.31±0.95)d]缩短,差异具有统计学意义(P<0.05)。试验组患儿术中增加辅助孔数目[(0.55±0.39)个]较对照组[(1.15±0.73)个]少,术后胃肠道并发症发生率(7.5%)低于对照组(22.5%),差异均具有统计学意义(P<0.05)。结论 接受经腹腔入路腹腔镜肾盂成形术治疗的婴儿,在术前采用甘油灌肠剂灌肠联合口服西甲硅油乳剂治疗,可以使肠道瘪陷,便于手术操作,且安全性好。     

Rectal carcinoma: thin-section MR imaging for staging in 28 patients

PURPOSE: To evaluate the accuracy of thin-section magnetic resonance (MR) imaging (in-plane resolution, 0.6 x 0.6 mm) in the preoperative assessment of the depth of extramural tumor infiltration, which is a major prognostic indicator in rectal cancer. MATERIALS AND METHODS: In a prospective study of 28 consecutive patients, preoperative MR imaging was performed. The tumor stage according to the TNM classification system and the measured depth of extramural tumor invasion in matched MR images and histopathologic slices were compared. RESULTS: Preoperative MR imaging correctly indicated the histopathologic tumor stage in all 25 patients in whom comparisons were possible. The difference between the depth of extramural tumor measured on preoperative MR images and corresponding measurements on histopathologic slices of the resection specimen ranged from -5.0 mm to +5.5 mm (mean difference, +0.13 mm; 95% CI: -2.72, +2.98 mm), indicating good agreement. The mesorectal fascia, and the relation of the tumor to it, could be visualized in every case. In all five patients with involvement of the circumferential excision margins of resection specimens, extensive extramural invasion was identified on preoperative MR images. CONCLUSION: Preoperative thin-section MR imaging accurately indicates the tumor stage of rectal cancer and depth of extramural tumor infiltration. It provides valuable information for identifying T3 tumors for preoperative adjuvant therapy in patients who are at high risk of failure of complete excision.