极低出生体重早产儿的家庭参与式护理

目的探讨家庭参与式护理(FIC)用于极低出生体重早产儿(VLBWPI)的效果。方法将NICU的VLBWPI根据入住时间分为对照组和FIC组各35例。对照组住院期间所有的护理均由护士承担,家长只在规定时间探视患儿或电话咨询患儿病情;FIC组病情稳定后与家长一同入住家庭参与式病房,患儿父母在护士指导下承担患儿的全部非医学性常规生活护理直至出院。结果FIC组母乳喂养率及体质量增长显著优于对照组,喂养不耐受发生率及出院时父母紧张焦虑评分显著低于对照组(P0.05,P0.01)。结论 FIC能有效改善VLBEPI的早期生长发育结局,缓解患儿父母紧张焦虑情绪,有利于患儿从医院顺利过渡到家庭。     

经口喂养困难早产儿的早期综合干预

目的 探讨早期综合干预对早产儿经口喂养困难的防治作用.方法 将64例经口喂养困难早产儿随机分为对照组(33例)和干预组(31例),两组均给予胃肠道外营养和/或鼻饲管喂养、早产儿常规护理、抚触等;干预组在此基础上给予口部感觉运动干预、合适的喂养护理技巧等.观察并记录两组患儿胃肠外营养、鼻饲喂养及平均住院时间;开始经口喂养、达到完全经口喂养、恢复出生体质量时的日龄;恢复出生体质量后体质量增长速率等.结果 干预组胃肠外营养时间、鼻胃管喂养时间、平均住院时间显著短于对照组;开始经口喂养、达到完全经口喂养、恢复出生体质量时日龄均早于对照组;恢复出生体质量后体质量增长速率显著高于对照组(P＜0.05,P＜0.01).结论 早期综合干预能够缩短早产儿经口喂养困难时间,促进早产儿尽早完成向经口喂养模式的转换,是一种安全、有效的早期喂养干预方法.     

对NICU出院早产儿母亲实施网络支持干预的研究

目的探讨网络支持干预对新生儿重症监护室(NICU)出院早产儿母婴的影响。方法将符合入组条件的早产儿母亲77人按时间分组,2013年6~9月入组的早产儿母亲38人设为对照组,2013年12月至2014年3月入组的早产儿母亲39人设为观察组。对照组接受早产儿常规出院指导,观察组在此基础上实施网络支持干预,持续12周。结果观察组母亲在早产儿出院后4周、12周角色适应评分及育儿胜任感评分显著高于对照组(均P0.01);观察组早产儿出院后12周体质量、身长、头围显著高于对照组(均P0.01),再入院率显著低于对照组(P0.01)。结论网络支持干预能帮助NICU出院早产儿母亲适应母亲角色,提升育儿胜任感,有利于早产儿体格生长发育,降低早产儿再入院率。     

音乐疗法在早产儿护理中的应用

目的探讨音乐疗法在早产儿护理中的应用效果.方法将50例出生体重1000～2000 g早产儿随机分为观察组和对照组各25例.对照组予以常规护理,观察组在此基础上于出生后72 h内实施音乐干预,3次/d,15 min/次,直至出院前.其他治疗两组相同.观察比较两组体重增长、对疼痛刺激即针刺足跟采血前后心率、呼吸、血氧饱和度的变化恢复时间及住院时间.结果观察组每日体重增长显著高于对照组(P＜0.05);针刺足跟采血后心率、呼吸及血氧饱和度恢复至刺激前的时间显著短于对照组(均P＜0.01);住院时间短于对照组(P＜0.05).结论音乐疗法能促进早产儿体重的增长,缩短机体疼痛刺激阈及住院时间,有利于早产儿的生长发育.     

早产儿医院-社区-家庭联动管理研究

目的探索医院-社区-家庭联动管理模式在早产儿居家护理中的实施效果。方法将84例早产儿随机分为观察组和对照组各42例。对照组接受常规早产儿院外护理健康教育及门诊随访,观察组采用医院-社区-家庭联动管理模式。矫正4、6月龄时比较两组早产儿生长发育状况、再入院率和夜晚睡眠效率。结果两组早产儿矫正6月龄神经心理发育评分比较,差异有统计学意义(P<0.05,P<0.01),身高、体质量、头围比较差异无统计学意义(均P>0.05);夜晚睡眠效率差异有统计学意义(P<0.05);观察组矫正6个月早产儿再入院率显著低于对照组(P<0.05)。结论医院-社区-家庭联动管理模式能显著提高矫正6月龄早产儿的神经心理发育,降低再入院率,短期内早产儿体格发育改善不明显。     

抚触与非营养性吸吮对早产儿食欲及体重的影响

目的探讨抚触、非营养性吸吮对早产儿食欲和体重的影响.方法将70例早产儿随机分为观察组(40例)与对照组(30例).两组均接受常规综合治疗及微量喂养;观察组在此基础上实施抚触,2次/d,非营养性吸吮每2小时1次.结果观察组每天增加的奶量和体重显著高于对照组,平均睡眠时间显著长于对照组(P＜0.05,P＜0.01),而并发症发生率显著低于对照组(P＜0.05,P＜0.01).结论抚触与非营养性吸吮有助于增加早产儿的食欲,加速体重增长,减少并发症的发生,有利于早产儿的生长发育.     

喂养延续护理对营养风险早产儿生长发育的影响

目的 对营养风险早产儿进行喂养延续护理管理,促进早产儿生长发育。 方法 将80例存在营养风险的早产儿随机分为对照组和观察组各40例。对照组进行常规护理,观察组采用延续护理喂养方案干预,评估出院早产儿纠正月龄1个月、3个月、6个月体格生长发育情况;进行体格生长发育Z评分;比较两组早产儿家长再入院率及纯母乳喂养情况。 结果 纠正月龄3、6个月观察组身长及其Z评分、体质量及其Z评分显著高于对照组（P＜0.05,P＜0.01）。观察组早产儿再入院率显著低于对照组,母乳喂养率显著高于对照组（P＜0.05,P＜0.01）。 结论 对营养风险早产儿进行喂养延续护理管理,能促进早产儿生长发育及母乳喂养。     

采用鸟巢式护理降低低体重儿并发症效果观察

目的 有效降低低体重早产儿并发症发生率,促进其生长.方法 将98例低体重早产儿随机分为观察组(50例)和对照组(48例),两组患儿入院后均置辐射式抢救台或暖箱中保暖,观察组采用鸟巢式护理,对照组实施常规护理.结果 观察组呼吸暂停、硬肿症、喂养不耐受发生率显著低于对照组(均P＜0.05),恢复出生体重时问、体重增长显著优于对照组(均P＜0.01).结论 采用鸟巢式护理能有效降低低体重早产儿并发症,促进其生长发育.     

早期肛门刺激预防早产儿胎粪排出延迟的研究

目的观察早期肛门刺激预防早产儿胎粪排出延迟的效果。方法将100例早产儿按住院号分为干预组和对照组各50例,对照组予常规治疗与护理,干预组在此基础上于早产儿出生后12h内用10～12F医用橡胶肛管进行肛门刺激。结果两组初次排胎粪时间、每天大便次数、胎粪排清时间、需光疗例数及喂养不耐受例数、体质量增长速度等比较,差异有统计学意义(P<0.05,P<0.01)。结论早期肛门刺激能有效预防早产儿胎粪排出延迟,减轻黄疸,减少喂养不耐受,加快体质量增长。     

Enteral nutrition fed to premature and very low birth weight infants with arithmetic progression

目的 探讨不同的肠内营养量对早产儿及极低出生体重儿体格发育的影响.方法 将60例早产儿及极低出生体重儿随机分对照组和观察组各30例,在静脉营养支持的基础上,根据患儿每天的体质量计算所需营养总量(15 mL/kg),对照组采用传统的平均分配营养量的方法即8次/d均分;观察组采用等差递增公式计算每次的营养量.连续14 d后评价效果.结果 患儿体质量显著重于对照组,胎便排尽及黄疸持续时间显著短于对照组,喂养不耐受发生率、胃残留量及每日排便次数显著少于对照组(P＜0.05,P＜0.01).结论 对早产儿及极低出生体重儿采用等差递增肠内营养量的方法可循序渐进地刺激患儿肠道,有利于患儿体格发育,效果优于平均分配营养量法.     

Histochemical and contractile properties of striated muscles of urethra and levator ani of dogs and sheep

AIMS: To understand their possible importance in long- and short-term control of continence, some properties of the striated muscles of the urethra and pelvic floor (levator ani) of dogs and sheep were investigated, especially fiber types and contractile characteristics. MATERIALS AND METHODS: Striated muscles of urethra and levator ani of 29 male and 6 female dogs and 11 male and 6 female sheep were removed and cut into strips. Some strips were frozen and stained for ATPase at pH 9.4 and 4.3 for fiber typing; others were set up in an organ bath to study contractile responses to nerve stimulation. RESULTS: All muscles contained both type I (slow) and type II fibers, ranging from 97% type II in female greyhound urethra to 60% in female sheep levator ani. For each muscle, there were fewer type II muscles in sheep than in dog. The diameters of the urethral fibers were about 60% of the levator ani in dogs and 34% in sheep. Contraction of the urethral muscle was faster than for levator ani and declined to about 80% of the peak, 500 msec after the beginning of stimulation at 20 Hz. The levator ani contraction rose to a steady level as long as stimulation continued. CONCLUSIONS: Both the levator ani and urethral striated muscles contain slow and fast fiber types. The levator ani muscles are capable of sustained contraction with rapid onset which will produce long-term closure of the urethra. The circular urethral muscle contraction was faster but less well maintained.     

Incorporation and release of85Sr and14C-proline-hydroxyproline in mineral and collagen of bone and incisor teeth of growing rats

The extent to which exchange and reutilization processes of mineral tracers affect skeletal mineral accretion and resorption measurements was evaluated by comparing the rates of appearance and disappearance of⁸⁵Sr and¹⁴C-proline-hydroxyproline in bones and teeth in growing rats for 12 days following simultaneous parenteral injection of these tracers. Expressions for the relative rates of collagen synthesis and breakdown, which unlike mineral metabolism are considered not to be complicated by exchange phenomena, were based on¹⁴C-proline conversion to¹⁴C-hydroxyproline; the specific activity of the latter was determined. Both the mineral and the collagen specific activities reflected the rates and patterns of growth of the samples assayed; rapid growth and a short interval of time between formation and resorption of tissue in themetaphyseal bone which contains the cartilagineous growth plate, slow growth and an interval of time between formation and resorption of tissue indiaphyseal bone and incisor teeth which is longer than the 12 days of the experiment. However, in metaphyseal bone the specific activity collagen/mineral ratio dropped by one half during the 4–12 day interval in contrast to diaphyseal bone and incisor teeth in which no change in this ratio was observed during this period of time. The data indicate that collagen in the metaphyseal growth zone is removed by resorption before it has become fully mineralized, and that exchange is a relatively unimportant factor in the long term kinetics of bone mineral.

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Zusammenfassung Das Ausmaß, bis zu welchem Austausch- und Wiederverwendungsprozesse der mineralen Tracer die Messungen des mineralen Skelett-Auf- und Abbaues beeinflussen können, wurde ausgewertet; zu diesem Zweck wurde die Geschwindigkeit des Auftretens und Verschwindens von⁸⁵Sr und von¹⁴C-Prolin-Hydroxyprolin in Knochen und Zähnen von wachsenden Ratten während der 12 auf die simultane parenterale Injektion dieser Tracer folgenden Tage verglichen.Der Ausdruck für die relative Geschwindigkeit des Kollagen-Auf- und Abbaues, bei welchem im Gegensatz zum Mineralmetabolismus kein Mitwirken des Austauschphänomens vermutet wird, basiert auf der Umwandlung von¹⁴C-Prolin zu¹⁴C-Hydroxyprolin; die spezifische Aktivität des letzteren wurde bestimmt.Aus der spezifischen Aktivität des Minerals sowie jener des Kollagens konnten die Geschwindigkeit und die Art des Wachstums der untersuchten Proben ersehen werden, d.h.schnelles Wachstum und ein kurzes Zeitintervall zwischen Bildung und Resorption des Gewebes imKnochen der Metaphyse, die auch die knorpelige Wachstumsplatte enthält, und andererseitslangsames Wachstum und längeres Zeitintervall (länger als die 12 Tage des Experimentes) zwischen Bildung und Resorption des Gewebes imKnochen der Diaphyse und in den Schneidezähnen. Immerhin fiel die spezifische Aktivität des Kollagen/Mineral-Anteils im Knochen der Metaphyse während dem 4–12tägigen Zeitintervall auf die Hälfte, im Gegensatz zum Knochen der Diaphyse und der Schneidezähne, bei welchen während dieser Zeitspanne kein Unterschied in diesem Verhältnis beobachtet wurde.Diese Ergebnisse zeigen, daß Kollagen in der Wachstumszone der Metaphyse durch Resorption verschwindet, bevor es ganz mineralisiert ist, und daß der Austausch ein relativ unwichtiger Faktor in der Kinetik auf lange Sicht des Knochenminerals ist.

     

足踝损伤的分类与治疗的要点和难点

足踝部损伤主要有踝关节骨折脱位、距骨骨折脱位、跟骨骨折以及跖骨骨折、趾骨骨折、跖趾关节脱位、踝关节周围软组织损伤等。足踝损伤防治的重点是踝关节骨折脱位、距骨骨折脱位、跟骨骨折以及踝关节周围软组织损伤。本文针对足踝损伤的要点和难点分类进行阐述。1踝关节骨折目前踝关节骨折的分类主要有:Ashhurst分类法[1]、Lauge-Hanson分类法[2]、Danis-Weber分类法[3]。Ashhurst分类法按照外力的性质分类,然后按单踝、双踝、三踝骨折分级,优点是简单易记,对认识外力的性质很有帮助,缺点是没有考虑到外伤时的体位、姿势等复合因素;Laug…     

Instrumented ligamentotaxis and stabilization of compression and burst fractures of dorsolumbar and mid-lumbar spines

Background:

Controversy continues regarding the best treatment for compression and burst fractures. The axial distraction reduction utilizing the technique employing the long straight rod or curved short rod without derotation to reduce fracture are practised together with short segment posterolateral fusion (PLF). Effects of the early postoperative mobilization without posterolateral fusion on reduction maintenance and fracture consolidation were not evaluated so far. The present prospective study is designed to assess the effectiveness of i) reduction and restoration of sagittal alignment, ii) no posterolateral fusion on the reduced, fractured vertebral body and injured disc, iii) fracture consolidation and iv) the fate of the unfused cephalad and caudal injured motion segments of the fractured vertebra.

Materials and Methods:

The study includes 15 Denis burst and two Denis type D compression fractures between T₁₂ and L₃. The lordotic distraction technique was used for ligamentotaxis utilizing the contoured short rods and pedicle screw fixator. Three vertebrae including the fractured one were fixed. The patients after surgery were braced for ten weeks with activity restriction for 2-4 weeks. The patients were evaluated for change in vertebral body height, sagittal curve, reduction of retropulsion, improvement in neural deficit. The unfused motion segments, residual postoperative pain and bone and metal failure were also evaluated.

Results:

The preoperative and postreduction percentile vertebral heights at, zero (immediate postoperative), at three, six and 12 months followup were 62.4, 94.8, 94.6, 94.5 and 94.5%, respectively. The percentages of the intracanal fragment retropulsion at preoperative, and postoperative at zero, 3, 6 and 12 months followup were 59.0, 36.2,, 36.0, 32.3, and 13.6% respectively.The preoperative and postreduction percentile loss of the canal dimension and at zero, three, six and 12 months were 52.1, 45.0, 44.0, 41.0 and 29% respectively suggesting that the under-reduced fragment was being resorbed gradually by a remodeling process. The mean initial kyphosis of 33° became mean 2° immediately after reduction and mean 3° at the final followup. The fractured vertebral bodies consolidated in an average period of ten weeks (range 8-14 weeks). The restored disc heights were relatively well maintained throughout the observation period. All paraparetic patients recovered neurologically. There were no postoperative complications.

Conclusion:

Instrument-aided ligamentotaxis for compression and burst fractures utilizing the short contoured rod derotation technique and the instrumented stabilization of the fractured spine are found to be effective procedures which contribute to the fractured vertebral body consolidation without recollapse and maintain the motion segment function.     

Selective role of vagal and nonvagal innervation in initiation and coordination of gastric and small bowel patterns of interdigestive and postprandial motility

Our previous studies suggested that extrinsic innervation modulates upper gut motility but is not requisite for cyclic interdigestive and postprandial motility of the stomach. However, the specific role of vagal and nonvagal extrinsic innervation in the initiation, coordination, and pattern of gastric motility in dogs after denervation of the entire upper gastrointestinal tract remains unclear. The aim of this study was to determine the role of vagal and nonvagal extrinsic innervation in control of gastric motility patterns. Mongrel dogs were subjected first to extrinsic denervation (in situ neural isolation) of the stomach, small bowel, proximal colon, liver, and pancreas but specifically maintaining vagal innervation to the stomach alone. After fasting and fed motility patterns were measured with indwelling gastric and small bowel manometry catheters, the dogs underwent transtboracic truncal vagotomy (completion of total extrinsic denervation of stomach), and motility studies were repeated. Vagal integrity to the stomach and pancreas was confirmed by means of a modified Hollander test and serum pancreatic polypeptide concentrations after the injection of exogenous insulin, respectively. We found that a cyclic motility pattern (migrating motor complex) persisted during fasting in both the stomach and the small bowel and that the patterns of tbe stomach and the duodenum remained temporally coordinated before and after vagotomy. However, although a cyclic phase III activity persisted in the stomach after vagotomy, the number of contractions and the motility index during phase III were decreased, and the duration between groupings of contractions was increased. No differences were noted in the duration of postprandial inhibition after feeding meals before and after vagotomy. These observations support our hypothesis that the vagal nerves are not necessary for the initiation or temporal coordination of global fasting or postprandial gastroduodenal motility patterns but are involved in modulating the pattern of contractions during gastric phase III. Supported in part by United States Public Health Service grant DK 39337 from the National Institutes of Health (M.G.S.) and by the Mayo Foundation. Presented at the Forty-First Annual Meeting of The Society for Surgery of the Alimentary Tract, San Diego, Calif., May 21–24, 2000 (Poster presentation), and published as an abstract in Gustroenterology 118:Al0S0, 2000.     

Principles and Practice of Hemofiltration and Hemodiafiltration

There is growing interest in the convective dialysis therapies, hemofiltration (HF) and hemodiafiltration (HDF). Both require dialysis membranes which are highly permeable to solutes as well as fluid, and in both cases large volumes of ultrafiltration are the condition for convective transport. In HDF the convection is combined with diffusion, and as a consequence, maximum clearance over the entire molecular weight spectrum is achieved. Optimal forms of HDF provide urea clearance 10–15% higher than the corresponding diffusive mode. The larger the solute, the greater is the impact of convection, and β₂-microglobulin (β₂m) levels may be up to 70% reduced. Traditional postdilution HF provides high clearance of medium sized and large molecules. Satisfactory clearance of small solutes requires blood flows in excess of 500 ml/min. With access to practically unlimited volumes of substitution solution through on-line ultrafiltration, predilution HF can now be used. This increases the clearance of small solutes to an acceptable range. For HDF as well as HF, large patient populations consistently treated for longer periods of time are needed to make valid outcome comparisons with other therapies.     

Recognition and management of phaeochromocytoma and paraganglioma

Phaeochromocytomas and paragangliomas (PPGL) are catecholamine-secreting neuroendocrine tumours arising from the chromaffin cells in the adrenal medulla. These tumours may be identified incidentally, as part of a work-up for multiple endocrine neoplasia or following haemodynamic surges during unrelated procedures. Advances in perioperative management and improved management of intraoperative haemodynamic instability have significantly reduced surgical mortality from around 40% to less than 3%. Surgery is the definitive treatment in most cases and laparoscopic resection where possible is associated with improved outcomes. Anaesthetic management of PPGL cases represents a unique haemodynamic challenge both before and after tumour resection. In this article we describe the physiology of these tumours, their diagnosis, preoperative optimization methods, intraoperative anaesthetic management and management of postoperative complications.