护理干预在超选择支气管动脉栓塞术治疗反复大咯血中的应用研究

目的：探讨围术期全程护理干预在超选择支气管动脉栓塞术治疗反复大咯血中的应用效果。方法将2012年7月至2013年12月本院收治的反复大咯血患者48例随机分为观察组和对照组,每组各24例。两组患者均行超选择支气管动脉栓塞术。对照组患者给予常规护理,观察组患者给予围术期全程护理干预,比较两组患者止血成功率、并发症发生率、咯血持续时间及住院时间。结果观察组止血成功率为100．0％,并发症发生率为3．6％,对照组分别为83．3％、12．5％,组间比较差异有统计学意义（ P＜0．05）。观察组咯血持续时间及住院时间均短于对照组（P＜0．05）。结论对超选择支气管动脉介入栓塞术治疗反复大咯血患者实施有效的围术期全程护理干预,可降低术后并发症发生率,缩短咯血持续时间及住院时间,值得临床推广应用。     

永久性栓塞材料支气管动脉栓塞治疗大咯血的临床疗效

目的：探讨用聚乙烯醇（PVA）、弹簧圈经支气管动脉栓塞（BAE）治疗大咯血的临床疗效。方法：151例内科治疗无效的大咯血患者分为两组进行支气管动脉栓塞治疗。治疗组98例用PVA进行栓塞,其中27例用PVA+弹簧圈联合栓塞;对照组53例用明胶海绵进行栓塞。所有病例随访6月以上。结果：151例患者均成功进行支气管动脉栓塞。治疗组即时止血98例,有效率为100％;对照组即时止血52例,1例止血失败,有效率为98.1％（52/53）,两组无显著性差异（P＞0.05）。治疗组术后1月内咯血复发7例,复发率为7.1％（7/98）;对照组术后1月内咯血复发11例,复发率为20.7％（11/53）,两组有显著性差异（P＜0.05）。治疗组术后1～6月咯血复发8例,复发率为8.2％（8/98）;对照组术后1～6月内咯血复发6例,复发率为11.3％（6/53）,两组无显著性差异（P＞0.05）。所有患者栓塞后均没有出现严重并发症。结论：用PVA、弹簧圈做栓塞材料治疗大咯血安全、有效,可作为经内科治疗无效患者的首选治疗方法。     

超选择性肺内动脉栓塞术治疗大咯血的临床观察

收集大咯血患者60例,将其随机均分为观察组与对照组,分别采用超选择性肺内动脉栓塞术和药物止血法进行治疗。观察组在总有效率、并发症发生率及远期复发率均优于对照组（P〈0.05）。超选择性肺内动脉栓塞术用于治疗大咯血疗效确切,值得推广应用。     

大咯血患者介入治疗围术期开展优质护理效果研究

目的：探讨优质护理在大咯血患者介入术中的应用方法及效果观察。方法选择60例大咯血行介入术治疗的患者,随机分为两组。对照组30例,行常规护理;优质护理组30例,施行围术期的优质护理。对比两组患者术后的疗效和生活质量。结果行介入术后优质护理组患者的有效率为96．6％,高于对照组的76．7％,其生活质量也明显高于对照组。结论通过对支气管动脉栓塞治疗大咯血患者的围术期实施优质护理,提高了支气管动脉栓塞术的疗效、减少了术后并发症的发生,减轻患者经济负担,改善了患者生活质量。     

优质护理在支气管动脉介入栓塞治疗大咯血患者中的应用

目的:探讨优质护理在支气管动脉介入栓塞治疗大咯血患者中的应用效果。方法:将2016年6月~2017年6月选择采用支气管动脉介入栓塞治疗的80例大咯血患者随机分为对照组和实验组各40例,对照组给予一般护理,实验组给予优质护理。比较两组疗效、满意度及心理状态。结果:实验组治疗有效率、满意率均高于对照组(P0.05),护理后焦虑自评量表(SAS)及抑郁自评量表(SDS)评分均低于对照组(P0.05)。结论:针对支气管动脉介入栓塞治疗的大咯血患者,采取优质护理可有效提高治疗有效率和患者满意度,改善其心理状况。     

选择性支气管动脉双重栓塞治疗大咯血的疗效分析

目的探讨选择性支气管动脉双重栓塞治疗大咯血的疗效。方法32例大咯血患者行选择性支气管动脉插管造影、确认病变血管,分别在支气管动脉主干或分支行栓塞术,栓塞物质为明胶海绵颗粒、明胶海绵条。结果选择性双重栓塞支气管动脉治疗大咯血有效率93.8%,复发率9.3%,无脊髓栓塞、下肢血栓形成严重并发症病例发生。结论选择性双重栓塞支气管动脉治疗大咯血安全、有效。     

肺结核大咯血患者锁骨下动脉造影及其出血分支栓塞的临床意义

目的分析锁骨下动脉及分支栓塞对肺结核大咯血临床疗效的影响。方法 257例肺结核大咯血患者根据治疗方法分为两组:对照组103例,行支气管动脉和肋间动脉分支栓塞;治疗组154例,行支气管动脉、肋间动脉造影、锁骨下动脉分支栓塞。观察两组临床疗效,术后反应及并发症。结果治疗组和对照组有效率分别为94.2%和80.6%,差异有统计学意义(P<0.05);复发率分别为3.2%和11.7%,差异有统计学意义(P<0.05);患者术后有胸背痛或发热,无脊髓损伤及异位栓塞等并发症出现。治疗组和对照组疼痛发生率分别为66.9%和48.5%,差异有统计学意义(P<0.05)。但严重疼痛发生率分别为7.8%和2.9%,没有统计学差异(P>0.05)。结论锁骨下动脉分支栓塞可明显提高有效率,降低复发率。     

采用不同栓塞剂行支气管动脉栓塞治疗大咯血的疗效

目的 探讨明胶海绵（GS）颗粒和聚乙烯醇（PVA）颗粒支气管动脉内栓塞治疗急性大咯血的临床疗效.方法 48例急性大咯血患者,先行选择性支气管动脉插管造影,然后用导管插管至出血支气管动脉分支,A组（21例）用GS颗粒栓塞,B组（31例）用PVA颗粒栓塞.结果 A组21例患者,栓塞后即止血18例（85.7%）,72小时止血2例（9.5%）,止血有效率95.2%,B组31例患者栓塞后即止血26例（83.9%）,72小时止血5例（16.1%）,止血有效率100%,A、B两组有效率差异无统计学意义（P＞0.05）;随访1年,A组复发5例（23.8%）,B组复发1例（3.2%）,1年复发率差异有统计学意义（P＜0.01）.结论 支气管动脉栓塞术是治疗大咯血的有效方法,应用PVA颗粒为栓塞剂,安全有效,不易复发,临床疗效显著.     

海藻酸钠微球与明胶海绵栓塞肺结核大咯血的效果比较:143例分析

背景:在诸多治疗方案中,介入栓塞肺结核大咯血的疗效最明确、显著.而多种栓堵材料也随之而出现,从传统的明胶海绵、聚乙烯醇颗粒,到目前应用广泛的微弹簧圈、海藻酸钠微球栓塞剂,疗效各不相同.目的:比较海藻酸钠微球与明胶海绵支气管动脉内栓塞治疗肺结核大咯血的疗效.方法:143例肺结核大咯血患者,根据栓塞材料不同分为明胶组与海藻酸钠微球组.先行选择性支气管动脉插管造影,再做超选择支气管动脉插管,最后注入栓塞材料栓塞末梢支气管动脉.结果与结论:明胶组共栓塞靶血管92支,44例(58.7%)患者栓塞后即刻止血,总有效率为81.3%.随访2年,复发12例(25 3%).海藻酸钠微球组共栓塞靶血管83支,60例(89.1%)患者栓塞后即刻止血,总有效率为92.6%.随访2年,复发5例(7.8%).两组比较,海藻酸钠微球组即刻止血效果显著优于明胶组(P<0.05),治愈率显著高于明胶组(P<0.05);海藻酸钠微球组复发率显著低于明胶组(P<0.05);海藻酸钠微球组总有效率显著高于明胶组(P<0 05).并发症的发生率两组差异无显著性意义(P>0.05).结果提示,海藻酸钠微球支气管动脉栓塞治疗肺结核大咯血安全、有效,复发率低,值得临床推广应用.     

系统护理干预在支气管动脉栓塞咯血患者中的应用

目的:探讨系统护理干预在支气管动脉栓塞咯血患者中的应用效果。方法:将80例行支气管动脉栓塞治疗咯血患者随机分为观察组和对照组各40例,对照组实施常规护理,观察组给予系统护理干预;比较两组护理质量、术后并发症及处理情况。结果:观察组有效备皮、完善辅助检查、有效压迫伤口及有效下肢制动优于对照组(P0.05),观察组发生术后并发症低于对照组(P0.05)。结论:对行支气管动脉栓塞治疗咯血患者实施有效的系统护理干预,可完善术前准备,保证术后护理质量,从而减少并发症的发生。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.