吹气球呼吸功能训练对肺癌患者术后康复的影响

目的:探讨吹气球呼吸功能训练对肺癌患者术后康复效果的影响.方法:将116例符合标准的肺癌患者随机分为对照组和观察组各58例,对照组行常规护理,观察组在常规护理基础上于术后6 h行吹气球呼吸功能训练.结果:观察组术后胸导管留置时间短,肺部并发症发生率明显低于对照组(P＜0.05).结论:吹气球呼吸功能训练能有效减少术后肺部并发症的发生.     

沙袋联合气球在高龄瓣膜置换术患者呼吸功能锻炼中的应用

目的探讨沙袋联合气球在瓣膜置换术患者呼吸功能锻炼中的应用效果。方法选择76例拟行瓣膜置换术的患者作为研究对象,随机分为对照组与观察组,各38例,对照组实施常规的术前护理及呼吸功能锻炼,观察组加用沙袋及气球对患者进行腹式呼吸训练,比较2组患者术前1 d的肺功能、术后肺部并发症的发生率、术后动脉血气、机械通气时间及ICU停留时间。结果观察组患者术前1 d肺功能、术后肺部并发症的发生率以及术后动脉氧分压(Pa O2)、氧合指数(Pa O2/Fi O2)、动脉氧饱和度(Sa O2)的均值、机械通气时间及ICU停留时间均优于对照组,比较差异均有统计学意义(P<0.05)。结论利用沙袋联合气球进行围术期腹式呼吸训练能明显改善瓣膜置换术患者术前肺功能、减少术后并发症的发生、改善术后肺通气功能、缩短机械通气时间及ICU停留时间,值得临床借鉴。     

肺部功能训练在下颈髓损伤患者围手术期中的应用效果

目的探讨肺部功能训练对下颈髓损伤患者围手术期呼吸功能的影响。方法将80例下颈髓损伤患者按随机数字表法分为观察组42例和对照组38例,对照组围手术期采取常规护理,包括定时翻身、拍背、鼓励深呼吸、排痰、雾化吸入、口腔护理。观察组除常规护理外,进行肺部功能训练,包括腹式呼吸训练、吹气球训练及咳嗽训练。观察2组患者入院当天、术前1d、术后3d、术后5d及出院当天的呼吸频率和经皮指脉氧饱和度的变化情况,比较2组围手术期肺部感染发生率与住院时间。结果观察组术后3、5d及出院当天呼吸频率呼吸频率均较对照组明显减慢(P<0.05),术后1、3、5d及出院当天经皮指脉氧饱和度均较对照组显著升高(P<0.05),围手术期肺部感染发生率较对照组显著减少(P<0.05),住院时间较对照组显著缩短(P<0.05)。结论早期肺部功能训练可以明显改善下颈髓损伤患者的呼吸功能,降低肺部感染发生率。     

吹气球法预防老年人术后肺部并发症的效果观察

目的探讨老年人术后应用吹气球行呼吸功能训练对减少术后肺部并发症的效果。方法将100例60岁以上老年手术患者按住院时间分为2组,对照组50例行常规护理,观察组50例在常规护理的基础上于术后清醒后采用吹气球进行深呼吸气训练,至术后10天。结果观察组术后肺部并发症发生率显著低于对照组(p<0.05),差异有统计学意义。结论老年手术患者在常规护理基础上应用吹气球行深呼吸功能锻炼能有效减少术后肺部并发症的发生。     

体外振动排痰仪联合吹气球呼吸训练在胃癌术后患者中的应用效果观察

目的观察体外振动排痰仪联合吹气球呼吸训练法在胃癌术后患者中的应用效果。方法将145例胃癌患者按入院先后顺序分为两组,对照组69例实行常规护理,观察组76例在常规护理的基础上采用体外振动排痰仪联合吹气球呼吸训练法。观察两组患者术后7d内的有效排痰情况及肺部并发症发生情况。结果观察组有效排痰率86.84%,明显高于对照组的59.42%,两组比较P0.01;术后肺部感染、肺不张、胸腔积液发生率观察组分别为2.63%、3.95%、3.95%,明显低于对照组的13.04%、14.49%、15.94%,经比较P均0.05。结论胃癌手术患者术后采用体外振动排痰仪联合吹气球呼吸训练法能促进有效排痰,减少肺部并发症的发生。     

吹气球呼吸训练法在肺癌术后的应用研究

[目的]通过对吹气球呼吸训练法在肺癌术后病人呼吸功能训练的研究,探索一种简单、安全、有效的呼吸训练方法。[方法]选择肺癌切除术病人150例,随机分为对照组和实验组,对照组用常规方法即咳嗽、排痰、叩背,实验组在常规方法的基础上加用吹气球呼吸训练法进行术后呼吸训练,通过观察对照组与实验组病人胸腔引流管引流时间、引流量、平均术后住院日进行分析。[结果]实验组引流时间、引流量、平均术后住院日均比对照组缩短(P<0.05),两组均无肺部并发症。[结论]吹气球呼吸训练法能促进肺癌术后病人康复。     

吹气球法在老年慢性阻塞性肺疾病中的应用

目的探讨吹气球法在老年慢性阻塞性肺疾病中的应用效果。方法选取2015年6月～2017年1月本院内科收治的老年慢性阻塞性肺疾病患者98例作为此次研究对象。按照随机数字表法将其分成观察组和对照组,每组各49例。对照组患者给予腹式呼吸训练法进行训练,观察组患者给予吹气球呼吸训练法进行训练。对比两组患者肺功能改善情况以及对训练方法的掌握情况。结果两组患者在使用不同方法接受训练后,观察组患者在肺功能指标的改善情况以及对训练方法的掌握情况上,均明显优于对照组,组间对比差异有统计学意义(P 0.05)。结论相比较腹式呼吸训练法而言,吹气球的训练方式具有减轻患者呼吸困难效果明显,训练方式易掌握的优点,因此,值得在临床实践中进行大范围的推广和使用。     

术前不同呼吸训练方案结合心理干预对胸腔镜食管癌手术患者康复的影响

目的比较术前不同呼吸训练方案结合心理干预对胸腔镜食管癌手术患者康复的影响。方法选取我院2017年2月至2018年1月120例胸腔镜食管癌手术患者为研究对象,按随机数表法分为缩唇呼吸组、吹气球组、呼吸训练器组,每组40例。三组患者入院后在常规心理干预基础上给予不同呼吸训练方案,缩唇呼吸组给予缩唇呼吸训练,吹气球组给予吹气球训练,呼吸训练器组给予呼吸训练器。检测患者血气分析指标,比较三组呼吸训练依从性与术后康复指标、肺部并发症发生率。结果呼吸训练器组完全依从率为95. 0%,显著高于缩唇呼吸组的75. 0%及吹气球组的60. 0%(P 0. 013);动脉血氧分压(PaO2)、二氧化碳分压(PaCO2)、氧合指数(OI)比较差异无统计学意义(P 0. 05)。呼吸训练器组呼吸机使用时间、住院时间显著短于其他两组(P 0. 05),留置引流管时间差异无统计学意义(P 0. 05)。三组肺部并发症总发生率比较差异无统计学意义(P=0. 115)。结论呼吸训练器可以提高胸腔镜食管癌手术患者术前呼吸训练依从性,避免术后肺功能进一步下降,加快康复进程。     

围手术期强化呼吸功能训练在食管癌患者中的应用效果评价

目的：探讨实施围手术期强化呼吸功能训练在食管癌患者中的应用效果。方法将需行食管癌根治手术的84例患者随机分为观察组（42例）和对照组（42例）,对照组给予常规呼吸功能训练,观察组实施围手术期强化呼吸功能训练方案。比较两组患者术后心率、呼吸频率、动脉血氧饱和度、肺功能及肺部并发症的发生情况。结果观察组术后心率、呼吸频率、动脉血氧饱和度、肺功能等相关指标均优于对照组,差异有统计学意义（P<0.05）;观察组肺部并发症的发生率低于对照组,差异有统计学意义（P<0.05）。结论实施围手术期强化呼吸功能训练方案可以有效改善患者的呼吸功能,促进术后病体康复,减少术后并发症的发生。     

吹气球呼吸训练法对肋骨内固定患者术后康复的影响

目的 探讨吹气球呼吸训练对肋骨骨折内固定患者术后康复的影响。方法 将50例符合标准的肋骨内固定患者随机分为对照组22例和实验组28例,对照组进行术后常规护理,实验组在常规护理的基础上行吹气球呼吸锻炼。结果 实验组术后胸管留置时间短,肺部并发症发生率、疼痛程度低于对照组(P<0.05)。结论 吹气球呼吸训练能有效减少肋骨内固定患者术后并发症的发生,促进康复。     

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.