肺叶切除术后患者持续低负压吸引的效果观察

目的探讨持续低负压吸引在肺叶切除术后患者中的应用效果。方法将行肺叶切除术的86例患者,按入院日期的单双号分组,单号为对照组41例,双号为负压吸引组45例。对照组术后胸腔闭式引流管连接三腔的胸腔闭式引流瓶(以下简称胸腔引流瓶)进行引流,未进行负压吸引;负压吸引组术后胸腔闭式引流管除连接胸腔引流瓶外,患者术后回病房时立即在胸腔引流瓶的调压阀上连接中心负压持续吸引,压力设定为-5～-10 cmH2O(1 cmH2O=0.098 kPa)。观察比较两组24 h肺复张率、气体消失的时间、拔管时间、住院时间、肺不张及肺部感染的发生率。结果负压吸引组24 h肺复张率高于对照组(P<0.01);气体消失时间、拔管时间、住院时间均短于对照组(P<0.05);肺部感染及肺不张的发生率低于对照组(P<0.05)。结论肺叶切除术后采用低负压持续吸引能促进患者肺复张,预防肺不张、肺部感染的发生,缩短胸腔引流管的留置时间及住院时间。护理中应严密观察压力的大小,避免压力波动影响吸引的效果和产生并发症。     

不同负压吸引在胸腔镜肺叶切除术后患者中的临床效果

目的探讨不同负压吸引在胸腔镜肺叶切除术后患者中的临床效果。方法选取52例胸腔镜肺叶切除术后患者为研究对象,术后根据负压吸引程度不同分为高负压吸引组与低负压吸引组。实验组22例术后采用高负压吸引,水封瓶波动-15~-20 cm H2O,对照组30例术后采用低负压吸引,水封瓶波动-8~-12 cm H2O。结果观察组术后第2~5天的引流量少于对照组,差异有统计学意义(P0.05)。观察组的置管时间、住院时间、术后第4天的体温均低于对照组,差异有统计学意义(P0.05)。结论高负压吸引能够减少胸腔镜肺叶切除术的引流量,缩短术后引流时间和住院时间,减轻患者的负担。     

胸腔数字引流系统在胸腔镜肺叶切除术后患者中的应用

目的探讨胸腔数字引流系统在胸腔镜肺叶切除术后患者康复中的作用和效果。方法选择我院2017年5月至2018年5月胸腔镜下肺叶切除术后患者149例作为研究对象,随机分为观察组76例和对照组73例,对照组患者术后引流管通过转接管道与传统胸腔闭式引流三腔水封瓶连接,观察组则采用Thopaz数字引流系统连接。观察两组术后并发症及带管时间。结果观察组术后带管时间较对照组短(P 0. 05),且并发症发生情况也较对照组少(P 0. 05)。结论数字负压吸引装置对胸腔镜肺叶切除术后患者的快速康复具有积极的意义,其具有安全性、可行性和必要性,有利于快速康复外科的推动,减少护理工作量,提高工作效率,值得进一步推广应用。     

胸腔闭式引流吸引压力与并发症相关性观察

目的：观察胸腔闭式引流吸引压力与并发症有无相关性。方法：将70例开放性特发性气胸作闭式引流持续负压吸引的病人随机分两组。治疗组吸引压力-8cmH2O，对照组-14cmH2O。比较不同吸引压力并发症的发生。结果：治疗组并发症发生少于对照组。结论：-8cmH2O吸引压力较适用于特发性气胸闭式引流吸引。     

低负压引流与单纯闭式引流在肺叶切除术病人中的应用效果

目的:探讨低负压引流与单纯闭式引流在肺叶切除术病人中的应用效果.方法:选取于医院胸外科接受胸腔镜肺叶切除术治疗的74例肺癌病人,采用前瞻性随机对照研究方法,用信封法将术后病人随机分为低负压引流组和单纯闭式引流组各37例.比较两组病人的疼痛评分、术后恢复指标和术后并发症发生率.结果:单纯闭式引流组病人术后2d、术后3d、术后4d和术后5d的视觉模拟评分法(VAS)疼痛评分均低于低负压引流组(P<0.05),单纯闭式引流组病人的术后引流量、出血时间、抗生素使用时间、拔管时间和住院时间均低于低负压引流组(P<0.05),单纯闭式引流组病人术后残腔积气积液、胸腔感染、皮下气肿和心律失常的发生率低于低负压引流组(P<0.05).结论:单纯闭式引流在肺叶切除术病人的术后引流中能够更有效地减少病人术后疼痛感,促进病人的术后恢复,减少术后并发症发生.     

低负压引流与单纯闭式引流在肺叶切除术病人中的应用效果

目的:探讨低负压引流与单纯闭式引流在肺叶切除术病人中的应用效果.方法:选取于医院胸外科接受胸腔镜肺叶切除术治疗的74例肺癌病人,采用前瞻性随机对照研究方法,用信封法将术后病人随机分为低负压引流组和单纯闭式引流组各37例.比较两组病人的疼痛评分、术后恢复指标和术后并发症发生率.结果:单纯闭式引流组病人术后2d、术后3d、术后4d和术后5d的视觉模拟评分法(VAS)疼痛评分均低于低负压引流组(P<0.05),单纯闭式引流组病人的术后引流量、出血时间、抗生素使用时间、拔管时间和住院时间均低于低负压引流组(P<0.05),单纯闭式引流组病人术后残腔积气积液、胸腔感染、皮下气肿和心律失常的发生率低于低负压引流组(P<0.05).结论:单纯闭式引流在肺叶切除术病人的术后引流中能够更有效地减少病人术后疼痛感,促进病人的术后恢复,减少术后并发症发生.     

临床应用一次性三腔水封瓶降低护士工作负荷的探讨

目的探讨在保证患者安全的前提下,使用一次性三腔水封瓶降低胸腔引流水封瓶更换频率,减轻护士工作负荷的可行性。方法对57例肺叶切除及食管癌、贲门癌患者术后48～144h的胸腔引流液进行细菌及真菌培养。结果 163例次48～144h的胸腔引流液细菌及真菌培养均为阴性。结论胸外科患者术后应用一次性三腔水封瓶,每周更换1次,可显著减轻护士工作负荷。     

数字式主动负压闭式引流装置在肺癌术后患者中的应用

目的:探讨数字式主动负压闭式引流装置在肺癌术后患者中的应用效果。方法:将200例肺癌术后患者随机分为观察组和对照组各100例,对照组采用墙式负压引流装置,观察组采用数字式主动负压闭式引流装置,比较两组临床效果。结果:两组术后第1天活动时间、置管时间、术后住院时间、术后疼痛情况、更换水封瓶数、更换水封瓶时间、负压装置观察时间比较差异均有统计学意义(P0.05)。结论:数字式主动负压闭式引流装置可增加肺癌术后患者活动时间,减轻疼痛,缩短治疗时间,促进康复。     

成人剖胸术后胸腔闭式引流的观察和护理

剖胸手术后,胸腔原有生理负压消失,几乎均有一定程度的积气、积液和渗血,又可能有肺泡漏气,所以术后常规放置胸腔引流管接水封瓶即胸腔闭式引流.胸腔闭式引流可排除胸膜腔内的积气和积液、恢复和保持胸膜腔内的负压、维持纵隔的正常位置、促使肺膨胀,并可消除死腔、预防感染.     

胸腔引流中一次性三腔水封瓶更换时间探讨

[目的]在保证病人安全的前提下探讨一次性三腔水封瓶与细菌定植的关系,以确定一次性三腔水封瓶的更换时间。[方法]对57例肺叶切除及食管癌、贲门癌病人术后使用一次性三腔水封瓶过程中48h～144h胸腔引流液进行细菌及真菌学培养。[结果]163例次病人的胸腔引流液细菌及真菌培养均为阴性。[结论]胸外科病人术后在应用一次性三腔水封瓶过程中每周更换1次是安全可行的。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.