CPM在膝关节强直松解术后的应用

１４例膝关节强直患者于松解术后第２天至第１０天应用持续被动关节活动器（ＣＰＭ）和微波治疗，每日二次，每次１小时。１０例对照，只用微波治疗。结果显示：切口拆线时ＣＰＭ治疗组膝关节主动活动度（ＡＲＯＭ）为６７．４±９．６，显著大于对照组４８．３±１２．１（Ｐ＜０．０１），住院天数、患膝关节水肿消除时间均比对照组缩短，但无统计差异，ＣＰＭ治疗组无一例发生切口延期愈合，且疼痛感比对照组轻。     

胰胆合剂灌肠治疗急性水肿性胰腺炎疗效观察

目的：观察胰胆合剂对急性水肿性胰腺炎的临床治疗作用。方法：将８１例急性水肿性胰腺炎患者随机分成治疗组４１例和对照组４０例，治疗组采用中药胰胆合剂灌肠治疗，对照组采用西医综合治疗。结果：（１）治疗组与对照组显效率分别为８７．８％和７０．０％，２组比较有显著性差异（Ｐ＜０．０５）。（２）治疗组在疼痛缓解时间〔（９．５３±３．４８）小时〕、疼痛消失时间〔（１６．８０±１０．４４）小时〕、发热消退时间〔（２．１８±１．１３）日〕及尿淀粉酶恢复正常时间〔（２．３３±１．２５）日〕等方面均明显优于对照组〔分别为（１５．９０±６．１２）小时、（３４．０６±１３．１８）小时、（３．４２±１．４２）日和（４．２６±１．６０）日，Ｐ均＜０．００１〕。结论：中药胰胆合剂灌肠治疗急性水肿性胰腺炎在尽快解除患者痛苦、缩短疗程、促进康复等方面有着一定的价值。     

无创气道咳痰机辅助咳痰无效患者排痰效果观察

摘要：目的 观察无创气道咳痰机辅助咳痰无效患者排痰的临床效果。方法 将６４例患者按住院时间顺序分为对照组（３３例）和观察组（３１例）。对照组采用体位引流、翻身叩背等常规方法排痰，观察组采用无创气道咳痰机协助排痰，１次治疗４～６个片段（１个片段包括４～５个循环，１个循环包括１次气体吸入和１次气体呼出）。连续治疗３ｄ。结果两组患者第１次排痰护理后呼吸频率、血氧饱和度、心率、血气分析、首次排痰时间及排痰量比较，差异有显著性意义（均Ｐ＜０.０１）。结论 无创气道咳痰机协助排痰，减少了二氧化碳的潴留，对畅通呼吸道、维持血氧饱和度作用显著。关键词：肺部感染；　咳痰无效；　无创气道咳痰机；　排痰；　护理中图分类号：Ｒ４７２　　文献标识码：Ｂ　　文章编号：１００１-４１５２（２００７）０１-００４４-０２     

早期康复治疗对手外伤患者Barthel指数影响探讨

目的：探讨早期康复治疗对手外伤伤患Ｂａｒｔｈｅｌ指数的影响。方法：随机抽取手外伤患６０例,分为康复组（Ａ组）３０例和对照组（Ｂ组）３０例,Ａ组病人采取早期康复治疗。Ｂ组病人按常规治疗,治疗前后进行Ｂａｒｔｈｅｌ指数评定。结果：治疗后Ａ组Ｂａｒｔｈｅｌ指数评定分数明显高于Ｂ组病人（Ｐ〈０．１）。结论：早期康复治疗有助于手外伤患日常生活能力提高。     

中西医结合治疗睡眠呼吸暂停综合征50例

对５０例睡眠呼吸暂停综合征（ＳＡＳ）患者采用药物治疗。分为安宫牛黄组（第１组）、黄体酮组（第２组）、氨茶碱组（第３组）、鼾立停组（第４组）和上述４种药合用的中西医结合治疗组（第５组），每组各１０例。治疗结果显示：各组最大呼吸暂停时间、平均呼吸暂停时间、呼吸暂停指数和血氧饱和度均较治疗前有显著性差异（Ｐ均＜０．０１），其中以第５组更为明显，且与其它各组比较有非常显著性差异（Ｐ＜０．０１），而第１～４组组间比较无显著性差异。提示：中西医结合治疗ＳＡＳ较单一药物治疗效果好。     

核素扫描评估空气气压泵式肢体循环驱动仪改善乳腺癌术后的上肢淋巴水肿

目的:观察压力循环驱动对乳腺癌术后上肢淋巴水肿的治疗效果,并以双侧上肢放射性核素扫描检查评估治疗效果。方法:①分组:48例患者为2005-11/2006-07解放军第四军医大学第一附属医院血管内分泌外科乳腺癌术后出现上肢水肿的住院患者,根据患侧上肢水肿程度分为轻度、中度和重度3组。②治疗:所有患者应用FLOWTRONR肢体循环驱动仪(英国Huntleigh Healthcare(Luton) Limited公司产品)进行治疗,轻、中、重度水肿组充气压力分别为为5.3,6.7,8kPa,充气时间均为60s,放气时间均为30s,30min/次,2次/d,连续治疗3周。③评估:治疗前后测量上臂周径,计算患侧和健侧差值,治疗后差值减少≥25%为有效;治疗前随机抽选15例在治疗前后分别行双侧上肢放射性核素扫描检查,观察淋巴流量的变化。结果:48例患者均进入结果分析。①患侧肢体周径:轻度和中度水肿组治疗后较治疗前明显减少[轻度水肿组:(27.2±1.3),(28.8±1.6)cm;中度水肿组:(28.3±1.6),(31.1±1.4)cm;P均<0.01]。②疗效:治疗后总有效率为88%(42/48),其中轻、度水肿组有效率分别为96%(23/24),90%(18/20),重度水肿组4例仅1例有效。③双侧上肢放射性核素扫描检查,治疗前患测淋巴流量明显低于健侧,而治疗后两者时间-放射性曲线近似重合。结论:对于乳腺癌术后的轻、中度上肢淋巴水肿,肢体压力循环驱动治疗是一种简便而又十分有效的方法,能显著减轻患肢水肿。     

生长抑素治疗急性水肿型胰腺炎的价值──附72例临床分析

目的：评估生长抑素（施他宁,ｓｔｉｌａｍｉｎ）对急性水肿型胰腺炎（ＡＥＰ）的治疗价值及应用指征。方法：用回顾性分析方法,将１６３例ＡＥＰ按年龄及有否加用生长抑素分为４组。按下列指标评估：腹痛消失时间、血淀粉酶复常时间、转为急性重症胰腺炎（ＡＮＰ）发生率、手术率、病死率。结果：大于５５岁的两组,腹痛消失时间生长抑素治疗组（治疗组）为（２．５±１．７）天;无生长抑素组（对照组）为（４．９±２．２）天,Ｐ＜０．０５;血淀粉酶复常时间治疗组为（３．２±１．８）天;对照组为（４．８±２．８）天,Ｐ＜０．０５;转为ＡＮＰ的发生率,治疗组为８％（３／４０）;对照组为２３％（７／３１）,Ｐ＞０．０５;转手术率,治疗组为５％（２／４０）;对照组为１６％（５／３１）,Ｐ＞０．０５。小于或等于５５岁的两组,腹痛消失时间和血淀粉酶复常时间均无统计学差别。结论：ＡＥＰ高龄患者早期应用生长抑素治疗,能缩短病程,改善预后。     

肢体压力泵治疗用于乳腺癌根治术后上肢淋巴水肿的效果观察

目的探讨肢体压力泵用于乳腺癌术后患侧上肢淋巴水肿的疗效。方法将86例乳腺癌术后患者随机分为观察组和对照组各43例。对照组按常规以肢体功能锻炼操进行治疗,观察组采用肢体压力泵治疗仪,比较2组治疗效果。结果2组患者治疗效果比较,差异无统计学意义（P〉0．05）;2组患者治疗时间、治疗依存性比较,差异有统计学意义（均P〈0．05）。结论肢体压力泵治疗仪用于乳腺癌术后预防和治疗患侧上肢淋巴水肿,可提高患者肢体治疗依从性和控制治疗时间,保证治疗效果。     

乳腺癌术后上肢淋巴水肿的护理干预及效果评价

目的探讨不同护理干预对乳腺癌术后淋巴水肿患者上肢水肿程度、患肢感染及肢体功能恢复的效果方法将280例乳腺癌术后淋巴水肿患者按水肿发生时间先后分为常规组及干预组,每组140例。常规组按常规护理;干预组给予手部皮肤护理、手法促淋巴回流、多层绷带加压包扎、配合呼吸运动进行手功能主、被动锻炼,抬高患肢、教育干预等。对2组患者护理效果、双上肢周径差值、患肢感染及上肢功能恢复情况进行比较。结果常规组上肢水肿护理总有效率89.3%,干预组上肢水肿护理总有效率99.3%,2组总有效率比较差异有统计学意义（P〈0.05）。常规组轻、中度水肿患者,干预组轻、中、重度水肿患者护理干预后上肢周径差值均低于护理干预前（P〈0.05或P〈0.01）。干预组手功能恢复优秀率为82.1%,未出现患肢感染;常规组手功能恢复优秀率为49.3%,患肢感染发生率8.6%,2组比较差异均有统计学意义（均P〈0.05）。结论手部皮肤护理、手法促淋巴回流、多层绷带加压包扎、配合呼吸运动进行手功能主被动锻炼、抬高患肢、教育干预等综合护理干预能有效地改善乳腺癌早期发现的上肢淋巴水肿症状,促进上肢功能恢复,控制患肢皮肤感染发生。     

脑梗死偏瘫患者手肿胀训练方法及效果分析

目的探讨综合训练法对脑梗死偏瘫患者手肿胀训练的作用。方法将 4 0例脑梗死偏瘫手肿胀患者随机分为两组 ,训练组用综合训练的方法进行训练 ,包括在急性期抬高患手 ,保持正确体位 ;患手固定 ;主动运动消除水肿 ;压力治疗 ;温冷水交替泡手 ;进行手的精细训练。传统组除常规早期活动外 ,无特殊治疗。结果训练组手肿胀与传统组比较 ,P <0 .0 5 ,训练组水肿消退快 ,手功能恢复好。结论应用综合训练方法 ,对偏瘫手肿胀有较好作用。     

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.