医用冰毯用于中枢性高热患者的临床观察

医用冰毯用于２１例中枢性高热患者，应用４ｈ后体温平均降至３７℃，降温幅度最大为４．３℃，最小为０．１℃，平均降温１．５℃，２１例患者治疗前后体温经配对ｔ检验，有显著性差异（Ｐ〈０．００１）。     

采用背部按摩法护理高热病人效果观察

对５０例高热病人采用背部按摩法进行护理，其中３０例体温在３９．５～４０．０℃的病人，按摩背部１次（约３０ｍｉｎ）．体温恢复正常；１０例体温在３９．０～３９．５℃（不包括３９．５℃）的病人，按摩背部两次（２０分钟／次），第１次体温下降１℃，第２次体温恢复正常；６例体温在３８．５～３９．０℃（不包括３９．０℃）的病人，按摩３次（１５分钟／次），体温恢复正常；４例３７．５～３８．５℃（不包括３８．５℃）的病人，按摩４次（１０分钟／次）体温恢复正常。此法简单易行，无不良反应，病人易于接受。     

药物热浅析

药物热占药物副反应的３％～５％［１］，常因误诊而增加病人痛苦、延长住院时间。兹就本院近年所遇的一组病例浅析如下。１　临床资料本组２３例，男７例，女１６例；年龄１４～７１岁，其中１８～３７岁１７例。住院时间为７～１００天，平均２９天。既往有药物过敏史６例，１例对虾、蟹等过敏。热型以弛张热为主，鉴于多数病人曾予物理降温或解热镇痛药，故影响热型观察。除服尼莫地平的１例体温为３７．７℃外，余为３８．５℃～４１．０℃。１８例停药后体温１～３天降至正常，４例５天、１例（７１岁）７天体温降至正常。本组２例经短…     

联用醒脑静注射液和青霉素治疗小儿感染性高热疗效观察

联用醒脑静注射液和青霉素治疗小儿感染性高热疗效观察李光芹孔祥奎侯静近３年来，我们联用醒脑静注射液和青霉素治疗小儿感染性高热４８例。报告如下。１病例与方法１．１病例：４８例患儿中男２７例，女２１例；年龄８个月～１１岁，平均６岁。体温３９．０℃～４１．０...     

温水浸足降温55例临床分析

采用低于体温２℃－３℃的温水浸足降温法，观察５５例多种原因引起的高热病人降温情况，并与常规物理降温５０例进行效果比较。结果浸足降温有效率为９４．６５，对照组为８４．０％，差异有显著性。且观察组降温后６０ｍｉｎ体温回升率为４７．３％，常规组为５６．０％。提示温水浸足降温法可用于高热病人降温。     

清开灵注射液治疗小儿暑温

探讨清开灵注射液对病毒性感染的治疗效果，应用清开灵注射液治疗小儿暑温２１例（清开灵组），并与干扰素治疗１５例（对照组）进行疗效对比。结果：平均住院天数，体温复常天数和症状、体征消失天数（分别为８．２天，１．６天和２．６天）均较对照组（分别为１１．９天，４．３天和４．８天）缩短（Ｐ值分别为＜０．０１，＜０．０１和＜０．０５）。提示清开灵注射液治疗小儿暑温疗效显著。     

中西医结合抢救成功完全性房室传导阻滞1例

中西医结合抢救成功完全性房室传导阻滞１例覃岭１病历简介患者女，３４岁。因发热４天，剧烈头痛伴晕厥４次，于１９９６年１月１６日入院。查体：体温３７．３℃，脉搏２５次／分，呼吸３２次／分，血压１０．５／８．０ｋＰａ（１ｋＰａ＝７．５ｍｍＨｇ）。意识模糊，...     

后房型人工晶体二期植入缝线固定术

１资料与方法 本组患者 ３２例 ３６眼,年龄 １１— ３７岁,平均２１．５岁,男２２例,女１０例。外伤性白内障２８眼,先天性白内障８眼（均为晶体切割术后）。裸眼视为眼前指数～０．１,平均０．０７矫正视力０．４～１．２,平均０．６２。 手术材料人工晶体为Ｐｈａｒｍａｃｉａ和Ａｌｃｏｎ双凸型、Ｃ形袢、ＰＭＭＡ后房型,固定线为Ａｌｃｏｎ １０—０聚丙烯线, Ｈｅａｌｏｎ为Ａｌｃｏｎ生产。 手术方法常规局部麻醉,适当缩瞳。显微镜下操作。于４点、１０点钟方位,做以角膜缘为底的３ ｍｍ等边三角形板层巩膜瓣,约 １／２…     

流行性出血热误诊为急性阑尾炎1例

流行性出血热误诊为急性阑尾炎１例刘维斌，韩玉民０６６０００河北省秦皇岛市第一医院１病历介绍　患者男，２８岁。主因发热、腹痛、恶心、呕吐４天到某医院就诊，当时查体：体温３８．１℃脉搏１０６次／分，血压１０．７／８．０千帕，全腹压痛，反跳痛及肌紧张，以右...     

纳洛酮治疗重度急性有机磷农药中毒致中毒性心肌病34例临床分析

中国急救医学，２００１，２１（７）：４１４．选择重度急性有机磷农药中毒性心肌病患者６８例，除外原有心脏病的患者。其中男２９例，女３９例，年龄１５岁至５６岁，平均３２．４岁。随机分成２组，对照组给予反复洗胃，解痉、给氧、利尿、抗炎等综合治疗；治疗组在上述基础上，给予盐酸纳洛酮注射液０．８mg至１．２mg静脉注射，而后每小时维持０．４mg至０．８mg静脉注射，直至清醒为止。结果，对照组死亡３例，其中２例死于多器官功能衰竭，１例死于休克；治疗组１例死于休克。２组疗效比较，治疗组与对照组治疗后起效时间分别为（１…     

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.     

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.     

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.