探讨无保护会阴接生法与传统接生法对会阴裂伤程度的效果比较

目的探讨无保护会阴接生法与传统接生法对会阴裂伤程度的效果比较。方法选取我院2013年11月~2014年3月间接收的516例临产妇作为观察对象,随机分为观察组和对照组各258例,观察组采取无保护会阴接生法,对照组采用传统接生法,比较两组产妇会阴裂伤程度。结果对照组产妇的会阴裂伤程度明显比观察组严重,比较有明显差异,P0.05。结论无保护会阴接生法相对于传统接生法能够明显降低产妇的会阴撕裂程度。     

Identification of five pyrrolidinyl substituted cathinones and the collision‐induced dissociation of electrospray‐generated pyrrolidinyl substituted cathinones

This article reports on the analytical properties of five pyrrolidinyl substituted cathinones: α ‐pyrrolidinononaphenone (α ‐PNP, 1 ), 4‐chloro‐α ‐pyrrolidinopropiophenone (4‐Cl‐α ‐PPP, 2 ), 4‐chloro‐α ‐pyrrolidinovalerophenone (4‐Cl‐α ‐PVP, 3 ), 5‐dihydrobenzofuranpyrovalerone (5‐DBFPV, 4 ), and 2‐(pyrrolidin‐1‐yl)‐1‐(5,6,7,8‐tetrahydronaphthalen‐2‐yl)hexan‐1‐one (β ‐THNPH, 5 ). These identifications were based on liquid chromatography–quadrupole time‐of‐flight‐mass spectrometry (LC–QTOF–MS), gas chromatography–mass spectrometry (GC–MS) and nuclear magnetic resonance spectroscopy (NMR). To our knowledge, no analytical data about α ‐PNP, 4‐Cl‐α ‐PPP, 4‐Cl‐α ‐PVP, and β ‐THNPH have appeared until now, making this the first report on these compounds. Moreover, in order to study the collision‐induced dissociation (CID) characteristic fragmentation routes of pyrrolidinyl substituted cathinones, a total number of 13 pyrrolidinyl substituted cathinones were selected and discussed. The major fragmentation pathways under CID mode are produced, leading to the formation of characteristic ions. Product ions of [M‐C₄H₉N]⁺ and C_nH_2nN⁺ indicate the presence of pyrrolidinyl substitution. Characteristic fragments are also produced via the cleavages of the CH–N(CH₂)₄ bond and the CO‐CHN bond. Copyright © 2016 John Wiley & Sons, Ltd.     

A Comparative Study of Paediatric Thermal Burns Treated with Topical Heparin and Without Heparin

Following reports of heparin use in burn treatment, an ethics-committee-approved prospective randomized study with controls compared results obtained using traditional usual burn treatment without heparin with results in similar patients similarly treated with heparin added topically. The subjects were 100 consecutive burn patients (age <15 years) with second-degree superficial and deep burns of 5–45 % total body surface area size. Two largely similar cohort groups—a control group (C) and a heparin group (H) with 50 subjects per group—were randomly treated. The 50 control group patients received traditional routine treatment, including topical antimicrobial cream, debridement, and, when needed, skin grafts in the early postburn period. The 50 heparin group patients, without topical cream, were additionally treated, starting on day 1 postburn, with 200 IU/ml sodium aqueous heparin solution USP (heparin) dripped on the burn surfaces and inserted into the blisters two to four times a day for 1–2 days, and then only on burn surfaces for a total of 5–7 days, before skin grafting, when needed. Thereafter, control and heparin group treatment was similar. It was found that the heparin patients complained of less pain and received less pain medicine than the control patients. The heparin group needed fewer dressings and oral antibiotics than the control group. The 50 heparin group patients had 4 skin graftings (8 %), while the 50 control group patients had 10 (20 %). Five control group patients died (mortality 10 %). No heparin group patients died. The number of days in hospital for the heparin group versus control group was significantly less (overall P < 0.0001): 58 % of heparin group patients were discharged within 10 days versus 6 % of control group patients; 82 % of heparin group patients were out in 20 days versus 14 % of control group patients; 98 % of the heparin group versus 44 % of the control group were out in 30 days; and while 100 % of heparin group patients were discharged by day 40, 56 % of the control group required up to another 10 days. Burns in heparin group patients healed on average in 15 days (maximum period 37 days) versus an average of 25 days (maximum >48 days) in control group patients (P < 0.0006). Procedures and costs in the heparin group were much reduced compared with the control group. Differences between the heparin and control groups are presented for the sake of comparison. It was concluded that heparin applied topically for 5–7 days improved burn treatment: it reduced pain, pain medicine, dressings, and use of antibiotics; it significantly reduced IV fluids (P < 0.04), days in hospital (P < 0.0001), and healing time (P < 0.0006); and it reduced skin grafts, mortality, and costs.     

右美托咪啶联合用药新方案用于重症医学科长时间镇静的研究

目的比较在重症医学科内长时间镇静状态下不同镇静方案的差别，找出较适合长时间镇静的方案。方法选取在我院重症医学科住院的患者80例，随机分为4组，即右美托咪啶持续泵注联合咪达唑仑间断应用组（A组，n=20），右美托咪啶与咪达唑仑联合持续泵注组（B组，n=20），咪达唑仑单独持续泵人组（C组，n=20），右美托咪啶单独持续泵人组（D组，n=20）。镇静目标为肌肉活动评分法（monitor activity assessment scale, MAAS）3分．镇静过程中持续心电监护，监测镇静满意程度，记录4组患者3日用药量变化，并监测患者不良反应发生率。比较4组患者后3种指标的差别。结果A、B两组较C、D两组镇静满意程度显著增高，用药量变化幅度较小，不良反应较少，其中又以A组不良反应为最少，且与B组相比咪达唑仑用药量显著减少。结论右美托眯啶持续泵注联合咪达唑仑间断应用可显著减少长时间镇静所需药物用量．且减少不良反应。     

医院满意度综合测评体系的建立及实施分析

目的:对医院各科室的满意度进行测评,着力提升医院服务品质。方法:通过文献回顾、专家咨询等方法制定测评方案,设计问卷调查表,分别对患者及院内工作人员进行问卷调查。结果:通过每月的问卷调查获得各科室满意度,并与绩效挂钩;及时反馈意见和建议,为改善医疗服务提供依据。结论:建立的医院综合满意度测评体系覆盖医院所有科室,对进一步提高服务质量,全面提升医院的服务意识及管理能力起到积极的推动作用。     

四肢烧伤患者行急诊负压封闭引流术的疗效观察

目的探究应用急诊切痂植皮配合负压封闭引流术治疗四肢烧伤的临床疗效。方法按随机抽取法将医院2018年2月—2019年1月间收治的57例四肢烧伤患者分为常规组和实验组,常规组28例,实验组29例。给予常规组患者急诊切痂植皮,用常规换药配合治疗,而实验组在常规组的基础上用负压封闭引流术配合治疗。比较常规组患者和实验组患者的临床效果、疼痛程度评分。结果两组患者的总有效率对比,实验组总有效率吗,明显高于常规组的总有效率,实验和常规组差异具有统计学意义(P<0.05)。常规组患者的疼痛评分高于实验组患者,差异具有统计学意义(P<0.05)。结论四肢烧伤患者通过应用急诊切痂植皮配合负压封闭引流术治疗后,临床效果得到有效改善,质量生活水平得到提高。     

人性化理念提升心内科患者护理满意度的效果研究

目的 探讨人性化理念在提升心内科患者护理满意度中的效果.方法 选取心内科260例患者为研究对象,随机分为对照组(常规程序护理组)和观察组(人性化理念护理组)各130例,比较护理后1周及出院时2组患者对健康宣教、基础护理、护理态度及护理效率的总满意率.结果 观察组护理后1周及出院时对健康宣教、基础护理、护理态度及护理效率的总满意率均高于对照组(P＜0.05).结论 人性化理念在提升心内科患者护理满意度中的效果较好,可显著提升患者对各个方面护理的认可程度.     

Reappraisal of the Traditional Wenckebach Phenomenon with a Modified Ladder Diagram

Understanding of the traditional Wenckebach phenomenon is enhanced by using a modified ladder diagram where AV conduction in any cycle is represented by a slanted line in the AV bar together with similar AV conduction lines of all the preceding cycles. The diagram facilitates calculation of the duration of RR intervals (equal to the basic PP or sinus interval minus the PR or AV increment applied to this particular cycle) and the duration of the pause (equal to 2 × PP or sinus interval minus the sum of all the increments applied to the AV delay). The modified Wenckebach diagram should help students understand the mysterious clustering of QRS complexes or “paradoxical” increase of the ventricular rate that occurs during a Wenckebach sequence. Ann Noninvasive Electrocardiol 2012;17(1):3–7