心电检测论文

网址： 或一篇现成的 群体性豆角碱中毒的急救与护理效果研究 目的 探讨豆角碱中毒的急救与护理及其临床效果。方法 对患者施行抢救组织管理、有效的催吐洗胃、静脉输液排毒，密切观察病情变化及群体心理护理。结果 125例中毒患者全部痊愈出院。结论 健全的急救系统、急诊护士的熟练的技术、有序分工合作和具备有条不紊的应急能力，是提高抢救成功率和护理质量的关键。 【关键词】 豆角碱；中毒；急救；护理 进食一定数量的未完全烧煮熟透或贮藏时间过久的豆角易致豆角碱中毒。我院于2005年8月成功抢救125例中毒患者，由于组织得力，措施合理及时，所有患者未出现严重的后遗症，全部痊愈出院。现报告如下。 1 临床资料 一般资料 125例患者均系某工厂工人，共同进食人数为196人，食用未煮熟的四季豆后发生中毒125例（占），均为急诊抢救患者。其中男47例，女78例；年龄20～52岁，平均32岁。食用四季豆量为250～480g，发病时间为进食后1～12h，平均。 临床表现 临床表现以急性胃肠炎为主，所有病例均有上腹部疼痛不适、恶心呕吐。呕吐物为胃内容物和胆汁，腹泻次数5～22次不等，平均为次。大便为稀水样，无脓血，无里急后重感。出现中度发热9例，有轻度畏寒和寒战。15例患者有头昏、眩晕、乏力、口干苦。123例神清，2例神志恍惚，均有轻到中度脱水貌，四肢冷，血压低于正常，心率快，心律不齐，出现频发早搏3例。大便常规检查无异常。 治疗及转归 问明病史后，125例中毒者全部实施急诊催吐，效果不佳者予以洗胃、灌肠；开放静脉通路，吸氧，心电监测并给予大剂量维生素C、维生素K、地塞米松、补液等对症治疗。2例较重者转住院治疗，余123例在急诊留院观察。125例中毒患者全部痊愈。 2 抢救与护理体会 抢救工作的组织管理 在抢救集体中毒患者时，有秩序地组织抢救工作对抢救的成功起着重要作用。当急救中心护士接到120急救电话后，确定需要集体抢救时，立即报告科主任、护士长、医院值班领导，启动急诊科应急预备方案，急诊科全体医护人员5～15min到岗。在大批患者未入院前，参与的抢救人员迅速准备好抢救物品、药品、洗胃器械等用物，以便患者到达后能得到及时有效的救治。护理部从各科室抽调护士长充实护理队伍，分成接诊组、观察组、治疗实施组。根据病情的轻重缓急实施催吐、洗胃、生命指征的监护等抢救措施。 有效清除胃肠道毒物，减少毒素吸收，催吐、洗胃是抢救的关键［1］ 对于轻、中度中毒患者，护理人员指导饮温开水催吐，每次300～500ml，用手指或压舌板压迫舌根刺激咽后壁催吐，反复进行，直至胃内容物吐出，并在旁说明催吐、洗胃的重要性，劝导说服病人，以取得患者的密切配合。重度中毒患者给予洗胃直至洗出液澄清、无味为止。洗胃液一般选用生理盐水，温度控制在30℃～35℃之间，以免洗胃液过热而加速毒物吸收，过冷则易产生寒战导致高热。洗胃时患者左侧卧位，头偏向一侧，插胃管时动作应轻柔，切忌粗暴，以免损伤食管及胃黏膜引起出血，洗胃过程中经常按摩患者胃部以促进毒物排出。并严密观察患者生命体征的变化。洗胃结束后，自胃管注入50％硫酸镁或20％甘露醇导泻药促使毒物排出。在洗胃过程中同时要密切观察患者的面色、脉搏，注意有无血性液体洗出，如有异常情况，及时报告医生。 迅速建立静脉通路，静脉输液可稀释和促进毒物排泄［2］ 按病情轻重为全部患者建立静脉通路，输入维生素C、维生素K等药物，达到稀释毒素，促进吸收的毒物排泄，以减轻中毒症状的目的。患者几乎同时到达医院，数量多、秩序一般较混乱，患者容易出现恐惧心理，争先用药，护士应冷静、果断做到忙而不乱，严格执行“三查八对”制度，对于口头医嘱一定要复述一遍，核实无误后再执行，用药后及时记录，做好安全用药。

随着人们法制观念的不断提高，病人维权意识逐渐增强，对医疗护理提出了更高的要求，因心电监护仪使用不当导致的投诉也逐渐增加。本院2003年6月至2004年6月被投诉4起，2004年7月至2005年6月5起，2005年7月至2006年6月9起；护士巡视不到位、责任心不强、病情变化未及时发现8例，心电监护仪参数设置不当或报警系统不工作5例，对心电监护仪性能不了解影响抢救治疗2例，设备本身问题2例，监护收费问题1例。病人自我保护意识增强与护士服务观念转变相对滞后的矛盾 随着病人及家属法制观念的逐渐加强,对医护质量的要求也越来越高〔1〕。在医疗护理活动中过去根本不会酿成纠纷的问题，现在都可能引发投诉，病家认为花了钱就要得到最好的服务及疗效，稍有不当病人或家属就要“讨个说法”，更有甚者，认为病人进了医院，化了钱，就得治好病，如病情反复或恶化就会千方百计寻找医疗工作中的缺陷和漏洞，进行投诉；而心电监护仪又是摆在他们面前看得见，摸得着的东西，稍有不慎就会成为投诉对象。护理服务质量与病人期望值之间的矛盾 需要心电监护的病人相对病情都比较重，家属特别关注治疗护理情况，以为使用心电监护仪后病情就能得到控制，当病情出现变化时就难以接受；而护士在护理过程中操作稍不仔细，解释不到位，对病人关心与理解不够，没有形成良好的护患关系，也就会受到病人及家属的迁怒。 护理队伍的年轻化，护理人员对心电监护仪性能不熟、使用不到位 当前医院发展速度较快，年轻护士较多，护理队伍的年轻化也已经成为护理投诉的主要原因之一〔2〕。首先年轻护士资历浅，工作经验不足，加之上岗前没有进行系统培训，不同程度地存在对心电监护仪使用性能及设置不熟悉，其次，年轻护士缺乏必要的医患沟通技巧和交谈艺术。心电监护仪故障延误病情 有些心电监护仪由于长时间连续使用，或者使用不当，或者年久失修等各种原因发生故障，特别是一些平时使用心电监护仪很少的科室，医护人员没有定期检查，不能及时发现和处理故障，一旦病情有变化需要时，却未能及时监护而延误了病情的监测、治疗，导致病家投诉。心电监护仪的使用费用相对较高，以每小时计算，且药费、检查费、一次性物品的广泛应用，给病家带来沉重的经济负担，因此，他们对收费特别敏感，对心电监护仪所用时数常有争议，加之新闻媒体过分渲染，对收费不放心，而多数家属在高额的医疗费用支出后疾病仍未明显好转，故将怨气发泄到仪器的使用和收费上导致投诉。为了适应目前新形势下病人对护理服务质量的要求，必须不断强化护士的优质服务意识，牢固树立“以人为本，以病人为中心”的服务观念，尊重病人的合法权益，尽量满足其要求。如在行心电监护前应耐心向病人及家属做好解释宣教工作,介绍心电监护的目的及仪器的安全性,告知可能出现的报警声。在整个监护过程中应加强巡视和观察，注意心电监护仪参数的变化，出现报警声时能迅速做出处理，并及时记录和保存。As the legal concept of continuous improvement, the patient gradually build up their human rights awareness, health care for a higher demand, due to the use of ECG monitor misconduct also led to a gradual increase in complaints. Hospital from June 2003 to June 2004 were 4 complaints since July 2004 to June 2005 5, July 2005 to June 2006 9; nurse visits are not in place, do not have a strong sense of responsibility, timely detection of the disease did not change in 8 cases, ECG monitor improper parameter setting alarm system does not work or five cases, the ECG monitor the performance of emergency treatment do not understand the impact of two cases, two cases of the issue of the equipment itself, the issue of guardianship fees and charges in 1 case. Self-protection awareness of patients and nurses to enhance the concept of service is lagging behind changes in the conflict Patients and their families with the legal concept of the gradual strengthening of the quality of health care have become more sophisticated [1]. Activities in health care will not lead to disputes over the issue, now may lead to complaints that the patient and his family will be花了钱the best services and the efficacy, some patients or their family will be inappropriate "to have a say" and, worse, that the patient into the hospital, of the money, you must heal the disease, such as illness or deterioration of repeated medical work will do everything possible to find defects and flaws in the conduct complaints; and ECG monitor is placed in front of them visible and tangible things, a little carelessness will become the target of complaint. Quality and patient care services in the conflict between the expectations The need for ECG monitoring of patients is relatively heavier than the disease, their families pay special attention to health care situation, that the use of ECG Monitor can be brought under control after the disease, when a change in condition when it is difficult to accept; and nurses in the care process is not operating slightly careful to explain in place, concern and understanding for patients not enough, there is no good nurse-patient relationship, but also patients and their families will be the vent. Care of the younger teams, nursing staff on ECG monitor the performance of the wake of the use of non-place Faster development of the current hospital, more young nurses, care of the younger team care has become one of the main causes of complaints [2]. First of all, the young junior nurses, lack of work experience, coupled with no systematic pre-training, varying degrees of ECG monitor and the setting up of the use of performance are not familiar with, and secondly, the younger the patient the nurses lack the necessary communication skills and conversation art. ECG monitor the delay fault condition ECG monitor some time as a result of continuous use, or improper use, or repair a variety of reasons such as failure, in particular, a number of normal ECG monitor the use of small sections, medical personnel do not conduct regular inspections, timely detection and to deal with failure, once the necessary conditions have changed, but failed to delay care and monitoring of the condition, treatment, patient and his family led to complaints. ECG monitor the use of the relatively high cost per hour basis, and drugs, inspection fees, the widespread application of a one-time items, to the patient and his family a heavy financial burden, so that they are particularly sensitive to charges of heart Monitor electricity used by a number of often controversial when, in addition to the news media exaggerated the charges do not trust, and the majority of families in the high medical costs to be incurred in a marked improvement after the disease has not yet, it will vent their grievances to the use of equipment and fees the lead to complaints. In order to adapt to the new situation at present patients quality care, nurses must continue to strengthen the services, and firmly establishing the "people-oriented, patient-centered" concept of service, respect for the legitimate rights and interests of patients, as far as possible to meet their requirements. If the line before ECG patience to do a good job to explain the patients and their families and education on the purpose of ECG and the security apparatus, this may sound the alarm. In the guardianship process should strengthen the inspection and observation, attention to ECG monitor changes in parameters, sound alarms when there quickly to deal with, and to record and preserve a timely manner.

Abstract: Objective analysis of HRV data and the autonomic nervous system function test results of the relationship that exists between, systematic preliminary study of Tai Chi Chuan training on the impact of the status of autonomic nervous system. Methods 12 non-sports professionals as a control group of girls, girls 11 Tai Chi Chuan as a special experimental group. 23 subjects, respectively, in a quiet state, lie down - vertical test stand - lie down under the application of test techniques Holter monitoring for heart rate variability analysis of the frequency domain. Results (1) quiet at the high-frequency components of the experimental group (HF) ~ was significantly higher than that. (2) vertical - back lying lie down when the pilot of the high-frequency components of the experimental group (HF) ~ , total power (TP) ~ Hz was significantly higher than that. (3) the control group and experimental group the results of autonomic nervous system function tests, there was a significant difference. (4) lie down - vertical test of the added value of heart rate and RR interval adjacent to the margin of the square root of mean square (RMSSD), poor adjacent RR interval> 50ms total number of the percentage of the number of heartbeats (pNN50), high frequency component (HF) ~ , total power (TP) ~ Hz showed a significant negative correlation. Vertical - Test Center lie down to reduce the rate of value and high-frequency component (HF) ~ were significantly negatively correlated. Conclusion Long-term tai chi training will enable the systematic body resting vagal tone enhancement. Taijiquan special athletes in the supine position to a better state of vagal tone reflects the strength. Taijiquan athletes vagus nerve excitability is higher than the general population, less than sympathetic excitatory general population. Autonomic function tests and HRV-related indicators to reflect the body's autonomic nervous system function the same conclusion. Key words: autonomic nervous system; heart rate variability; Taijiquan; upright lie down experiments, upright lie down experiment .摘要: 目的 分析HRV数据和植物神经系统功能检查结果之间存在的关系，初步探讨系统化的太极拳训练对植物神经系统状况的影响。 方法 选取12名非体育专业女生作为对照组、11名太极拳专项女生作为实验组。23名受试者分别在安静状态、卧倒-直立试验、直立-卧倒试验下应用动态心电图监测技术对其心率变异性进行频域分析。 结果 （1）安静时实验组的高频成分(HF)显著高于对照组。（2）直立-卧倒试验后仰卧位时实验组的高频成分(HF)、总功率(TP) ~ Hz显著高于对照组。（3）对照组与实验组植物神经系统功能检查结果存在显著差异。（4）卧倒-直立试验心率的增加值与相邻RR间期差值均方的平方根（RMSSD）、相邻RR间期差>50ms的个数占总心跳次数的百分比（pNN50）、高频成分(HF)、总功率(TP) ~ Hz均呈显著性负相关。直立-卧倒试验中心率的减小值与高频成分(HF)呈显著性负相关。 结论 长期系统化的太极拳训练可使安静时机体的迷走神经张力增强。太极拳专项运动员在仰卧位状态下能更好的反映出迷走神经张力的强弱。太极拳运动员的迷走神经兴奋性高于普通人群、交感神经兴奋性低于普通人群。植物神经功能检查与HRV相关指标在反映机体自主神经功能状态的结论一致。 关键词：植物神经系统；心率变异性；太极拳；卧倒直立实验，直立卧倒实验 以下专业词汇不用翻： 直立-卧倒试验、卧倒-直立试验、高频成分(HF)、总功率(TP) ~ Hz、心率的增加值与相邻RR间期差值均方的平方根（RMSSD）、相邻RR间期差>50ms的个数占总心跳次数的百分比（pNN50）、HRV