术中保温对预防经尿道前列腺电切术患者低温性寒战的效果观察

目的 观察术中保温对预防经尿道前列腺电切术患者低温性寒战的效果.方法 将60例经尿道前列腺电切术(TURP)患者随机分为保温组和对照组,每组各30例.对照组患者术中不采用任何升温装置,使用室温灌洗液进行膀胱冲洗;保温组患者术中采用输液加温器及充气升温毯加温,选用加温至37 ℃的灌洗液进行膀胱冲洗.测定术前及术后核心体温,比较2组术中出血量及发生寒战情况.结果 保温组患者术中体温维持稳定,手术前后体温无明显变化;对照组患者术中体温显著下降,与术前及保温组比较均显著下降(P＜0.05);术中出血量2组患者比较差异无统计学意义,而保温组寒战发生率显著低于对照组(P＜0.01).结论 TURP采用术中保温措施可维持患者体温的恒定,有效降低术中寒战的发生率,同时不会增加术中失血量.     

温灌洗液对经尿道前列腺电切术患者体温及寒颤的影响

目的 观察温灌洗液对经尿道前列腺电切术患者术中体温、寒颤情况及失血量的影响。方法 选择40例择期行经尿道前列腺电切术（transurethral prostatetomy，TURP）患者，随机分为两组，对照组20例，使用室温（22～24℃）灌洗液进行膀胱冲洗；观察组20例，选用加温至37℃的灌洗液。监测两组患者术中的血压、心率、呼吸、血氧饱和度和体温，观察并记录失血量及发生寒颤等情况。结果两组患者手术结束后均存在血红蛋白下降，两者差异无显著性。观察组术中体温维持稳定，手术前后体温无显著变化；对照组患者术中体温明显下降，与手术前及观察组比较，均有显著性差异（P〈0．05）。寒颤发生率明显高于观察组（P〈0．01）。结论 TURP术中使用温灌洗液冲洗可维持体温的恒定，明显降低术中寒颤的发生率。     

灌洗液加温与充气温毯对老年患者前列腺电切手术中体温保护的比较

目的比较灌洗液加温与充气温毯体温保护对老年患者前列腺电切手术中体温的影响。方法选择ASAⅡ~Ⅲ级在全麻下行前列腺电切手术老年患者60例为研究对象,随机分为3组(每组各20例),保温组1,术中输注37℃灌洗液;保温组2,充气温毯体温保护,术中输注室温(23~25℃)灌洗液;对照组接受室温灌洗液。结果 3组患者年龄、体重、ASA分级、前列腺大小、手术时间、灌洗液体总量等一般资料比较差异均无统计学意义(P0.05);3组患者术前血压和心率之间差异无统计学意义(P0.05),术毕时对照组血压显著低于术前;3组患者术前体温和寒战的发生率差异均无统计学意义(P0.05),术毕时保温组2和对照组患者体温均显著下降,寒战发生率显著升高。结论 TURP术中灌洗液加温的保温措施显著好于充气温毯体温保护措施。     

综合保温措施在经尿道前列腺电切手术中的应用

目的:观察经尿道前列腺电切手术病人在应用综合保温措施后的效果。方法:将80例经尿道前列腺切术病人随机分为观察组和对照组各40例。观察组采取综合保温措施,术中输入加温至37℃的液体,膀胱灌洗液用37℃电切液,手术床铺设一次性升温毯;对照组给予常规护理。比较两组病人术中体温变化、寒战发生情况。结果:两组病人术中60 min和术毕观察组体温较对照组高,差异有统计学意义(P<0.05)。术中病人发生寒战情况比较差异有统计学意义(P<0.05)。结论:术中采用综合保暖措施能有效维持经尿道前列腺电切术病人的体温,提高病人手术安全性和舒适度。     

充气式加温系统在经尿道前列腺电切术老年病人术后体温护理中的应用

[目的]探讨WarmTouch充气式病人加温系统在经尿道前列腺电切术老年病人术后体温护理中的应用效果。[方法]选择择期行经尿道前列腺电切术(TURP)的老年病人80例,随机均分为对照组和体温护理组各40例,体温护理组在进入麻醉恢复室(PACU)后用WarmTouch充气式病人加温系统进行保温,对照组不采取保温措施。记录病人转入和转出PACU时体温、入PACU期间寒战发生情况、病人出现疼痛及膀胱不适频率(记为膀胱痉挛)及PACU停留时间。[结果]体温护理组出PACU时腋温明显高于入PACU时腋温(P0.01),且明显高于对照组病人,PACU停留时间也明显缩短(P0.05);与对照组比较,体温护理组入PACU期间寒战发生例数及出现膀胱痉挛频率明显降低(P0.01)。[结论]WarmTouch充气式加温系统能有效预防术后低温、寒战发生及膀胱痉挛。     

充气加温法预防前列腺电切术患者术中低体温的效果

目的 探讨充气加温法预防经尿道前列腺电切术(TURP)患者术中轻度低体温的临床应用价值.方法 选择TURP患者50例,分为充气保温组和常规组,每组25例.常规组采取常规保温措施,充气加温组在采取常规措施的基础上另加充气加温措施.术中选择7个时间点监测核心体温,比较两组患者的体温变化,并观察是否发生寒战.结果 麻醉后两组患者体温均开始下降,常规组在术中40,60min及术毕各时间点体温下降幅度较充气加温组相应点的体温下降幅度显著增大(P<0.01).术毕寒战发生率常规组为19例,较充气加温组的3例显著增加(P<0.05).结论 充气加温法可有效地预防TURP患者术中低体温的发生,并可降低寒战发生率.     

综合保温措施在老年患者经尿道前列腺电切术中的应用

目的 探讨综合保温措施在老年患者经尿道前列腺电切术中的应用效果.方法 将80例经尿道前列腺电切术老年患者随机分为实验组和对照组各40例.对照组按常规进行护理,实验组在常规护理的基础上采用综合保温措施,观察2组患者围术期的体温、心率、血压的变化,观察低体温、寒战、膀胱痉挛发生率,比较术后膀胱冲洗液量、冲洗时间、出血量及对护理服务的满意度.结果 实验组患者在术中不同时间点的体温、心率、血压变化无显著差异(P＞0.05);对照组在手术30 min和手术结束时患者的体温与麻醉前及麻醉后15 min时相比,差异有统计学意义(P＜0.05);实验组患者在围术期低体温、寒战、ECG异常、MAP异常、膀胱痉挛发生率、术后冲洗液总量、冲洗时间、术后出血量方面均低于对照组,对护理服务满意度高于对照组,差异均有统计学意义(P＜0.05或P＜0.01).结论 综合保温措施应用于经尿道前列腺电切术的老年患者中,是安全、便捷、有效的,值得临床推广应用.     

前列腺电切术患者的术中灌洗液保温护理干预

目的探讨术中灌洗液保温护理干预对老年前列腺电切术（TURP）患者的影响。方法将120例老年TURP患者随机分为观察组和对照组，各60例。观察组术中采用37℃灭菌注射用水（水浴法加温）灌洗膀胱，对照组术中采用室温灭菌注射用水灌洗膀胱。观察两组手术前后生命体征的变化及术后膀胱痉挛和大出血发生情况。结果术前两组患者的心率、体温和平均动脉压比较无显著性差异（P〉0．05）。膀胱灌洗30min后（术后）观察组的心率和体温明显高于对照组，平均动脉压明显低于对照组，有显著性差异（t=5．340，3．643，7．141，P〈0．01）。观察组术后膀胱痉挛和大出血发生率分别为28．3％和1．7％，对照组分别为48．3％和11．7％，两组比较有显著性差异（x^2=5．076，4．821，P〈0．05）。结论术中灌洗液保温护理干预有助于维持TURP患者生命体征的稳定，减少术后并发症的发生。     

术前口服非那雄胺对前列腺增生症术中术后出血的疗效观察

【目的】评价良性前列腺增生症（BPH）患者术前口服非那雄胺对经尿道前列腺汽化电切（TUVP）术中术后出血的影响。【方法】120例BPH患者分为两组,术前14d口服非那雄胺5mg的60例患者纳为观察组,未服用非那雄胺的60例患者纳为对照组,比较两组TUVP术中术后失血量。【结果】观察组TUVP术中、术后出血量、甘露醇的灌洗液量、电切操作时间以及术后生理盐水连续冲洗膀胱的时间和所消耗的冲洗液量与对照组比较均显著降低,差异均有统计学意义（P〈0．05）。【结论】术前口服非那雄胺能够有效减少TURP术中、术后出血。     

经尿道前列腺电切术围手术期低体温的护理

目的观察2种保温方法对经尿道前列腺电切术患者围手术期低体温的护理效果,探讨适宜的预防围手术期低体温的护理方法。方法选取经尿道前列腺电切术患者60例,随机分成2组,每组30例。对照组采用常规保温措施,实验组采用综合保温措施即常规保温措施联合静脉输注液和灌洗液加温至37℃～38℃。观察并记录2组患者入室时、术中及术毕温度,注意有无寒战等不良反应。结果2组患者入室时体温差异无显著性(p>0.05);实验组术中及术毕体温在正常范围,并明显高于对照组(p<0.01)。结论综合保温措施更能有效维持患者围手术期体温恒定,减少并发症,是经尿道前列腺电切术围手术期体温护理的一种有效方法。     

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.