围术期人性化护理干预对剖宫产产妇情绪的影响

目的探讨人性化护理干预对缓解剖宫产围术期焦虑程度的临床效果。方法将294例择期剖宫产产妇分成干预组与对照组,每组147例。对照组给予围术期常规护理,干预组在对照组的基础上实施人性化护理干预,采用焦虑自评量表评估两组产妇不同时间(入院时、手术前、手术后)焦虑程度的变化,比较两组产妇不同时间(入院时、手术前、手术中)呼吸、心率、血压的变化,比较两组产妇手术时间、下床活动时间、肛门排气时间及住院时间,比较术后并发症发生率及护理满意度。结果观察组手术前、手术后焦虑自评量表评分均显著低于对照组,差异有统计学意义(P0.05);观察组手术前、手术中呼吸、心率及血压波动幅度均显著低于对照组,差异有统计学意义(P0.05);观察组手术时间、下床活动时间、肛门排气时间及住院时间均较对照组显著缩短,差异有统计学意义(P0.05);观察组并发症发生率为8.84%,显著低于对照组的21.77%,差异有统计学意义(P0.05),护理满意度为96.60%,显著高于对照组的88.44%,差异有统计学意义(P0.05)。结论人性化护理干预可有效缓解剖宫产围术期焦虑程度,有助于稳定生理状态、缩短手术时间、促进康复、减少并发症,从而提高护理满意度,值得临床推广应用。     

围术期护理干预对腹腔镜子宫肌瘤切除术患者的影响

目的:探讨围术期护理干预对腹腔镜子宫肌瘤切除术患者的影响.方法:将100例腹腔镜子宫肌瘤切除术患者随机分为干预组和对照组各50例,对照组给予常规护理,干预组在此基础上给予围术期护理干预,观察比较两组术后下床时间、胃肠道功能恢复时间、住院天数及术后并发症发生情况.结果:干预组术后下床活动时间、胃肠道功能恢复时间、住院天数与对照组比较差异有统计学意义(P﹤0.05),干预组术后出血、皮下气肿及肩背酸痛发生率低于对照组(P﹤0.05).结论:对腹腔镜子宫肌瘤切除术患者给予围术期护理干预,可降低并发症发生率,促进患者康复.     

快速康复外科理念指导下甲状腺癌围术期护理观察

目的探究快速康复外科理念指导下实施围术期护理干预对甲状腺癌患者的临床效果。方法选取88例甲状腺癌患者进行研究,根据字母表法随机均分为观察组和对照组各44例。对照组采用常规护理,观察组实施快速康复外科理念指导下的围术期护理。比较2组患者术后下床活动时间、术后疼痛评分、并发症发生情况、平均住院时间以及患者对护理的满意度。结果观察组术后疼痛评分、平均住院时间、术后下床活动时间均低于对照组(P0.05);观察组临床治疗效果以及对护理的满意度均高于对照组(P0.05),而术后并发症发生率低于对照组(P0.05)。结论对甲状腺癌患者实施快速康复外科理念指导下的围术期护理,可以有效缓解患者的疼痛,缩短平均住院时间和术后下床活动时间,提高患者对护理的满意度,减少并发症发生率,具有临床使用价值。     

围术期综合护理措施在宫外孕患者腹腔镜手术中的应用

目的研究围术期护理干预对宫外孕腹腔镜手术患者的护理效果,为宫外孕腹腔镜患者提供合理的护理方案。方法选取本院接诊的100例行腹腔镜手术的宫外孕患者进行研究。研究组60例,给予围术期综合护理方案,对照组40例给予常规护理。比较2组患者的手术时间、术后下床活动时间、胃肠功能恢复正常时间及住院时间,并对护理前后患者的SAS、SDS评分进行比较,记录2组患者并发症发生率。术后2年,随访调查2组患者妊娠状况。结果研究组患者的手术时间、术后下床活动时间、胃肠功能恢复正常时间及住院时间均短于对照组(P0.05);护理后,2组患者的SAS、SDS评分均降低,且研究组低于对照组(P0.05);研究组患者的宫内妊娠率高于对照组,宫外孕发生率低于对照组;研究组术后并发症发生率低于对照组。结论围术期护理干预可显著改善宫外孕腹腔镜手术患者的护理效果及妊娠状况,降低并发症发生率,值得推广应用。     

腹腔镜胆囊切除术治疗胆结石围术期护理效果观察

目的:探讨腹腔镜下胆囊切除术治疗胆结石围术期护理方法和护理效果。方法:选取我院接受腹腔镜胆囊切除术的胆结石患者120例,随机分为对照组与观察组各60例。对照组接受常规护理,观察组在常规护理基础上实施围术期综合护理干预,比较两组患者手术情况、并发症发生率及满意度。结果:除手术时间外,观察组术中出血量、术后首次排气时间、住院时间以及术后并发症发生率均低于对照组(P<0.05);观察组护理满意度高于对照组(P<0.05)。结论:对腹腔镜下胆囊切除术患者围术期实施综合护理干预,可有效提高护理质量,降低并发症发生率,缩短住院时间,提高护理满意度。     

宫外孕患者腹腔镜手术治疗的围术期护理

目的探讨宫外孕患者腹腔镜手术治疗的围术期护理效果。方法选取本院行腹腔镜手术治疗的宫外孕患者92例,按随机对照、双盲法分为对照组和观察组,各46例,对照组行围术期常规护理,观察组实施综合护理干预,比较2组术后胃肠功能恢复时间、下床活动时间、住院时间,记录2组术后并发症发生情况,同时采用焦虑自评量表(SAS)、抑郁自评量表(SDS)对患者心理状态进行评定。结果观察组术后胃肠功能恢复时间、下床活动时间及住院时间均短于对照组(P0.05),观察组术后并发症发生率低于对照组(P0.05),观察组术后SAS、SDS评分均低于对照组(P0.05),2组术后SAS、SDS评分较术前均降低(P0.05)。结论宫外孕患者腹腔镜围术期实施综合护理干预,改善患者心理状态,促进患者术后恢复,且降低术后并发症发生率。     

探讨快速康复外科理念应用于胸腔镜肺癌手术围术期护理中的效果

目的分析胸腔镜肺癌手术围术期护理中应用快速康复外科理念的效果。方法选择行胸腔镜肺癌手术治疗的肺癌患者100例,随机分为对照组和观察组各50例。对照组行常规围术期护理,观察组将快速康复外科理念应用于围术期护理过程中,对比两组并发症发生情况、术后恢复指标及疼痛情况。结果观察组住院时间、下床活动时间、排气时间、抗生素使用时间均显著短于对照组,差异显著(P0.05);观察组术后VAS评分2.02±0.25分,显著低于对照组的3.68±0.98分(P0.05);观察组并发症发生率为6%,显著低于对照组的28%,差异显著(P0.05)。结论胸腔镜肺癌手术围术期护理中应用快速康复外科理念的效果显著,值得推广。     

护理干预应用于后腹腔镜下肾上腺嗜铬细胞瘤的疗效及体会

目的探讨护理干预应用于后腹腔镜下肾上腺嗜铬细胞瘤的临床疗效及体会。方法选取本院46例肾上腺嗜铬细胞瘤患者,均给予后腹腔镜下肾上腺嗜铬细胞瘤切除术治疗,根据随机数字法,将其分为对照组(常规护理)和观察组(护理干预),各23例,比较2组术后排气时间、术后下床活动时间、术后住院时间比较,以及术后并发症发生率及护理满意度。结果与对照组相比,观察组术后排气时间、术后下床活动时间、术后住院时间均显著缩短(P0.05);与对照组相比,观察组术后并发症发生率显著降低(P0.05);与对照组相比,观察组患者对护理服务满意度显著改善(P0.05)。结论护理干预能够促进后腹腔镜下肾上腺嗜铬细胞瘤患者的术后康复,降低并发症发生率,提升患者对护理服满意度。     

围术期护理干预对腹腔镜腹膜前补片植入法腹股沟疝修补术的效果

目的：探讨优质护理干预对腹腔镜腹膜前补片植入法腹股沟疝修补术( TAPP)的影响。方法选取在我院行TAPP治疗的127例腹股沟疝患者,将其随机分为对照组和观察组。对照组予以常规的普外科护理,观察组予以围术期护理干预,比较两组患者的手术时间、下床活动时间、住院时间、术后3 d疼痛评分( VAS视觉模拟评分法)、并发症发生率、复发率等。结果观察组与对照组患者的手术时间差异无统计学意义(P﹥0.05);观察组患者的下床活动时间及住院时间均明显短于对照组(均P<0.05)。术后3 d,观察组患者的VAS评分明显低于对照组( P<0.05)。随访3~24个月,观察组并发症发生率及复发率均明显低于对照组( P<0.05)。结论在腹腔镜腹膜前补片植入法腹股沟疝修补术中实施围术期护理干预,能有效缩短患者的住院时间、减轻患者的疼痛,降低并发症发生率及术后复发率。     

快速康复外科理念在肝癌切除术围手术期护理中的应用

目的探讨快速康复外科(fast track surgery,FTS)理念运用于肝癌切除术围手术期护理措施中的效果和安全性。方法 2013年1月至2015年6月行肝脏切除术的肝癌患者共80例,按照手术时间分为对照组和观察组各40例。对照组采用一般围手术期护理模式,观察组采用FTS理念指导下的围手术期护理模式,比较两组患者的术中、术后情况,并发症发生率和血清学指标。结果对照组患者腹腔引流管拔除时间、术后下床活动时间、肛门排气时间、进食时间、排便时间、住院天数和住院费用均高于观察组,发生肝功能损害人数多于观察组,差异有统计学意义(P0.05);两组患者手术方式、术中出血量、术中输血量、手术时间和肝门阻断时间比较,差异无统计学意义(P0.05);两组患者术后3 d的C反应蛋白、前蛋白和谷丙转氨酶比较,差异有统计学意义(P0.05)。结论 FTS理念运用于肝癌切除术围手术期护理中能有效改善患者的术后应激反应,减少术后不良反应,加快肝功能恢复,从而改善患者的预后。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.