阻塞性睡眠呼吸暂停综合征多导睡眠图分析及监测护理

目的探讨阻塞性睡眠呼吸暂停综合征(OSAS)的多导睡眠图(PSG)特征及检测护理方法。方法经多导睡眠图检查66例,确诊OSAS患者52例(OSAS组),单纯鼾症患者14例(对照组),分析比较2组睡眠参数。对监测患者进行检查前心理护理,检查时参数观察,检查后健康教育。结果与对照组相比,OSAS组患者夜间睡眠结构紊乱,主要为深睡眠减少、浅睡眠相对增加、快速动眼相(REM)睡眠减少、睡眠潜伏期缩短、呼吸暂停或低通气次数增加、夜间平均及最低动脉血氧饱和度下降(P<0.05)。66例顺利接受检查。结论OSAS患者存在睡眠结构紊乱,做好监测护理是患者完成检查的关键。     

阻塞性睡眠呼吸暂停综合征多导睡眠图分析及监测护理

目的 探讨阻塞性睡眠呼吸暂停综合征(OSAS)的多导睡眠图(PSG)特征及检测护理方法.方法 经多导睡眠图检查66例,确诊OSAS患者52例(OSAS组),单纯鼾症患者14例(对照组),分析比较2组睡眠参数.对监测患者进行检查前心理护理,检查时参数观察,检查后健康教育.结果 与对照组相比,OSAS组患者夜间睡眠结构紊乱,主要为深睡眠减少、浅睡眠相对增加、快速动眼相(REM)睡眠减少、睡眠潜伏期缩短、呼吸暂停或低通气次数增加、夜间平均及最低动脉血氧饱和度下降(P＜0.05).66例顺利接受检查.结论 OSAS患者存在睡眠结构紊乱,做好监测护理是患者完成检查的关键.     

便携式多导睡眠监测仪监测阻塞性睡眠呼吸暂停综合征患者的专科护理

目的 了解使用便携式多导睡眠监测仪对阻塞性睡眠呼吸暂停综合征(OSAS)患者进行监测的专科护理方法,总结便携式多导睡眠监测仪监测OSAS的临床护理经验.方法 将60例疑似OSAS的患者随机分为观察组和对照组各30例,使用便携式多导睡眠监测仪进行监测,观察组采用专科护理,对照组采用常规护理.观察并比较2组患者的睡眠呼吸紊乱指数、平均血氧饱和度和最低血氧饱和度.观察2组便携式多导睡眠监测仪的敏感性和特异性.结果 2组患者的睡眠呼吸紊乱指数、平均血氧饱和度和最低血氧饱和度相比无显著差异.但与对照组相比,观察组便携式多导睡眠监测仪的敏感性更高,为100％,特异性也更高,尤其是对重度OSAS患者,其特异度可达96.7％.结论 在临床使用便携式多导睡眠监测仪对OSAS患者进行监测的过程中,科学、精心的临床护理对保证临床监测的安全性和准确性具有重要意义,而且科学、精心的护理对提高患者的生活质量,减少患者住院时间和经济浪费具有现实意义.     

老年人代谢综合征与阻塞性睡眠呼吸暂停综合征相关性的研究

目的探讨老年人代谢综合征(MS)与阻塞性睡眠呼吸暂停综合征(OSAS)之间的关系.方法分别对38例轻、中度,25例重度OSAS患者及34例无OSAS的对照者进行血压(BP)、体质指数(BMI)、空腹血糖(FBG)、血清胰岛素(INS)及血脂进行测定.结果轻、中度与重度OSAS组各参数测定结果与对照组存在显著性差异(P＜0.05).结论阻塞性睡眠呼吸暂停患者较正常者更易发生代谢紊乱,导致MS的发生,重度OSAS患者发生代谢紊乱的程度更为严重.     

阻塞性睡眠呼吸暂停患者主观睡眠质量分析

目的　探讨阻塞性睡眠呼吸暂停综合征 (OSAS)患者的主观睡眠质量及特点。方法　对 2 17例经多导睡眠图 (PSG)检查确诊的OSAS患者进行Pittsburgh睡眠质量指数 (PSQI)调查。结果　根据PSQI评估结果 ,睡眠较差和睡眠很差的病例数均为 88例 (各占 40 .5 % )。PSQI各成分 (I～VII)的计分分别为 1.6± 0 .9,1.1± 1.1,1.1± 1.1,1.4± 1.2 ,0 .8± 0 .6,0 .3± 0 .9,1.9± 1.1分 (P <0 .0 1)。AHI与PSQI及其各成分 (I～VII)间的相关系数分别为 -0 .2 7(P <0 .0 1) ,-0 .15 (P <0 .0 5 ) ,-0 .42 (P <0 .0 1) ,-0 .2 8(P <0 .0 1) ,-0 .17(P <0 .0 5 ) ,-0 .0 8(P >0 .0 5 ) ,-0 .2 1(P <0 .0 1) ,0 .0 8(P >0 .0 5 )。轻、中、重度OSAS3组患者的年龄差异无显著性 ;各组PSQI分别为 9.6± 5 .3 ,8.0± 4.2 ,6.8± 3 .3 (P <0 .0 1) ;各组PSQI的成分II、III、VI计分差异有非常显著性 (P <0 .0 1) ,其它成分计分差异无显著性。结论　OSAS患者睡眠质量差 ,主要表现为白天功能障碍、主观睡眠质量差以及睡眠效率低 ,但患者主观睡眠质量差的程度与OSAS严重程度反而呈弱负相关 ,提示睡眠呼吸暂停本身并不是影响患者主观睡眠质量的主要因素。     

经鼻持续正压通气对阻塞性睡眠呼吸暂停综合征患者睡眠和生活质量的影响

目的:了解经鼻持续正压通气(nCPAP)对阻塞性睡眠呼吸暂停综合征(OSAS)患者睡眠和生活质量的影响。方法:对37例nCPAP治疗的OSAS患者(治疗组)进行电话访谈,同时访谈44例未治疗的OSAS患者为未治疗组。访谈通过匹兹堡睡眠质量指数(PSQI)、Epworth困倦问卷(ESS)和生活质量综合评定问卷(GQOLI-74)了解他们的睡眠状况、日间嗜睡程度和生活质量。结果:治疗组的PSQI总分和7个因子分(睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠障碍、催眠药物、日间功能)全部优于未治疗组,而未治疗组的日间困倦程度(ESS)显著高于治疗组。同时,治疗组的生活质量也明显高于未治疗组,涉及生活的各个方面。结论:nCPAP可以有效地改善患者的睡眠状况,减轻日间嗜睡程度,并且明显提高患者的生活质量。     

高血压合并阻塞性睡眠呼吸暂停综合征患者降压治疗后的动态血压监测

目的探讨高血压合并阻塞性睡眠呼吸暂停综合征(OSAS)患者降压治疗后血压的变化。方法选择降压治疗期间血压正常的70例高血压患者,其中单纯高血压组21例,合并OSAS组49例,选择健康对照13例。按睡眠呼吸暂紊乱指数将高血压合并OSAS患者分为轻度OSAS组22例,中度OSAS组15例,重度OSAS组12例。采用RS-611床垫式睡眠呼吸监测系统监测睡眠,并进行24 h动态血压监测。比较各组血压水平、昼夜血压节律、晨峰现象。结果在降压治疗期间,单纯高血压或者合并OSAS患者24 h动态血压控制在正常水平(<130/80 mmHg)。夜间血压下降率在单纯高血压组或者合并OSAS组均低于对照组(P<0.05或者P<0.01),合并OSAS组中、重度组下降率最低(P<0.05),合并OSAS组反杓型较单纯高血压组多(P<0.05),以重度OSAS组最多(P<0.05),晨峰现象不明显。结论老年高血压合并OSAS患者降压治疗后,白昼、夜间血压水平达标,但血压昼夜节律紊乱未能改善。     

阻塞性睡眠呼吸暂停综合征伴急性心肌梗死预后研究

目的 对阻塞性睡眠呼吸暂停综合征(OSAS)伴急性心肌梗死预后进行判断研究.方法 应用夜间多导睡眠监测仪和Holer心电及血压检测仪对158例急性心肌梗死不伴有阻塞性睡眠呼吸暂停综合征(非OSAS组)与162例急性心肌梗死伴阻塞性睡眠呼吸暂停综合征(OSAS组)病人的临床预后进行统计学分析.结果 OSAS组死亡率及并发症远高于非OSAS组,两组间差异具有显著性.结论 OSAS为急性心肌梗死预后判断的重要指标之一.     

阻塞性睡眠呼吸暂停低通气综合征对急性脑梗死患者认知功能的影响

目的 探讨阻塞性睡眠呼吸暂停对急性脑梗死患者认知功能的影响.方法 共纳入急性脑梗死患者64例,根据睡眠呼吸暂停低通气指数(AHI)分为非OSAS组(30例)、轻度OSAS组(15例)、中重度OSAS组(19例).用简易智能筛查(minimental state examination,MMSE)、画钟试验(clock drawing task,CDT)、听觉事件相关电位(P300)进行认知功能的评价,并进行组间的比较,结果 中重度OSAS组MMSE、CDT评分低于非OSAS组、轻度OSAS组,其差异有统计学意义(P＜0.05).根据MMSE及CDT结果,认知功能障碍者占的比例,中重度OSAS组高于轻度OSAS组,轻度OSAS组高于非OSAS组,且P＜0.05.P300结果显示:非OSAS组、轻度OSAS组、中重度组OSAH S组各部位的潜伏期逐渐延长,且各组间差值有统计学意义(P＜0.05).结论 急性脑梗死患者睡眠呼吸暂停严重程度与认知功能障碍相关,睡眠呼吸暂停可加重急性脑梗死者的认知功能障碍.     

肥胖对男性阻塞性睡眠呼吸暂停综合征患者性功能的影响

目的研究肥胖对男性阻塞性睡眠呼吸暂停综合征(OSAS)患者性功能的影响,并讨论OSAS患者发生性功能障碍的可能机制。方法经多导睡眠监测确诊OSAS的男性患者,并按体重指数(BMI)分为OSAS伴肥胖组(49例)和OSAHS不伴肥胖组(22例);另选27例单纯肥胖患者以及40名健康成年男性作为对照组。所有研究对象均同步行夜间阴茎勃起监测。结果与对照组比较,OSAS伴肥胖组、OSAHS不伴肥胖组及单纯肥胖组患者勃起功能障碍(ED)发生率均明显增高,差异均有统计学意义(χ2分别=13.96、4.44、4.40,P均<0.05),但OSAS不伴肥胖组、单纯肥胖组ED患者,与OSAS伴肥胖组比较,差异均无统计学意义(χ2分别=0.88、1.28,P均>0.05)。结论引起正常男性ED的肥胖因素并非是男性OSAS患者发生ED的原因,推测可能与OSAS患者夜间反复缺氧引起的一系列神经内分泌改变有关。     

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.     

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.     

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.     

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.     

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.     

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.