长效抗菌材料洁悠神治疗有机磷致过敏性皮炎的效果观察

目的探讨长效抗菌材料洁悠神治疗有机磷致过敏性皮炎的效果。方法对23例有机磷杀虫药引起过敏性皮炎者予以长效抗菌材料治疗,配合细心护理。结果经治疗,有机磷致过敏性皮炎区域3～6d局部收敛,7～10d痊愈,无色素沉着,无疤痕生长。结论长效抗菌材料洁悠神治疗有机磷杀虫药引起过敏性皮炎效果满意,可应用于临床。     

洁悠神在PICC皮肤护理中的应用

目的探讨洁悠神喷雾剂预防PICC置管后局部感染及皮肤过敏的疗效。方法选择44例PICC置管术后使用3M透明敷料覆盖穿刺点患者作为对照组,44例PICC置管术后使用3M透明敷料覆盖穿刺点前喷洒洁悠神长效抗菌剂的患者作为实验组,比较两组的使用效果。结果实验组局部感染发生率为2.3%,对照组为12%;实验组皮肤过敏比率为2.3%,对照组为16%,2组比较差异有统计学意义(P<0.05)。结论洁悠神长效抗菌剂预防PICC穿刺局部感染及皮肤过敏均具有良好效果。     

OB卫生棉塞肛联合达克宁粉和3M液体敷料治疗老年失禁性皮炎患者的效果观察

目的探讨OB卫生棉塞肛联合达克宁粉和3M液体敷料用于老年失禁性皮炎的临床护理效果。方法选择2015年3月~2017年3月在干部病区住院患者中出现大小便失禁引起会阴部及肛周失禁性皮炎的80例老年患者,按入院顺序分为对照组和观察组。对照组给予常规护理,观察组采用OB卫生棉塞肛联合达克宁粉和3M液体敷料予以护理干预。观察两组患者的临床效果。结果观察组患者治疗效果优于对照组,皮炎愈合疗效优于对照组,两组比较差异有统计学意义(P0.05)。结论 OB卫生棉塞肛联合达克宁粉和3M液体敷料用于老年失禁性皮炎效果确切,有助于缩短皮炎愈合时间,提高临床治疗效果,值得在临床推广使用。     

洁悠神联合红光治疗在失禁性皮炎中的应用

目的探讨洁悠神联合红光治疗失禁性皮炎的临床效果。方法将本院收治的62例失禁性皮炎患者采用随机数字表法分为观察组和对照组,每组各31例;对照组使用常规治疗方法,观察组采用洁悠神外用,同时联合红光照射;比较两组的治疗效果。结果观察组组的治疗总有效率为96.77%,高于对照组的70.97%,差异有统计学意义(P0.05)。结论洁悠神联合红光治疗失禁性皮炎的效果良好,且起效快、疗程短,能促进伤口愈合,减轻患者疼痛。     

液体敷料、造口粉用于失禁性皮炎的观察及护理

目的 观察液体敷料、造口粉用于失禁相关性皮炎护理的效果。方法 将80例失禁相关性皮炎患者随机分为实验组40例、对照组40例。实验组用液体敷料、造口粉,对照组用护臀膏。结果 实验组疗效优于对照组,平均愈合时间短于对照组（P〈0.05）,再发率低,差异有显著意义。结论 液体敷料、造口粉用于失禁相关性皮炎,效果优于护臀膏,值得在临床和家庭推广使用。     

液体敷料联合银锌霜对失禁性皮炎患者的护理效果

目的观察液体敷料联合银锌霜对失禁性皮炎患者的护理效果。方法根据随机数字表法将80例失禁性皮炎患者分为对照组和观察组,每组40例。对照组在常规护理基础上结合银锌霜涂抹,观察组在对照组基础上联合液体敷料护理,比较2组疗效和皮损愈合时间。结果观察组总有效率为100.00%,高于对照组的85.00%,差异有统计学意义(P 0.05)。观察组平均皮损愈合时间短于对照组,差异有统计学意义(P 0.05)。结论液体敷料联合银锌霜对失禁性皮炎患者的护理效果显著,可改善患者临床症状,缩短皮损愈合时间。     

洁悠神长效抗菌材料治疗急性头面部创伤的效果

目的观察洁悠神长效抗菌材料治疗急性头面部创伤的疗效。方法将81例创伤患者,随机分为两组,实验组采用洁悠神长效抗菌材料治疗创面,对照组采用传统的清创、抗感染治疗创面。观察两组治疗效果。结果两组患者创面完全愈合时闻比较,差异具有统计学意义（t=7．191,P〈0．05）;两组患者换药时疼痛情况比较,差异有统计学意义（t=21．443,P〈0．05）。结论洁悠神长效抗菌材料治疗急性头面部创伤,具有创面完全愈合时间短、患者疼痛缓解明显、依从性好等优点,值得临床上推广应用。     

激光仪、抗菌材料用于失禁性皮炎的观察及护理

目的探讨激光仪、抗菌材料用于失禁性皮炎的效果。方法将123例失禁性皮炎患者随机分成观察组和对照组,对照级采用常规护理,涂抹护臂膏;观察组用花椒油、长效抗菌材料、激光机照射、保护材料。结果观察组失禁性皮炎的疗效优于对照组(P0.05)。结论花椒油、长效抗菌材料、激光机照射、保护材料用于失禁性皮炎效果好,值得在临床上推广。     

藻酸盐敷料联合拜尔坦透明贴对重症患者失禁性皮炎的效果

目的探讨藻酸盐敷料联合拜尔坦透明贴用于重症患者失禁性皮炎的护理疗效。方法选取2015年1月~2017年1月期间本院收治的44例重度大便失禁性皮炎患者,随机分为实验组和对照组各22例,对照组给予造口护肤粉联合液体敷料进行常规护理,实验组患者采取藻酸盐敷料联合拜尔坦透明贴护理,对比2组患者的伤口愈合时间、护理有效率以及患者满意度。结果实验组护理总有效率以及患者满意度显著高于对照组,同时伤口愈合时间明显少于对照组,差异均具有统计学意义(P<0.05)。结论藻酸盐敷料联合拜尔坦透明贴用于大便失禁引起的重症皮炎,护理措施简单,可减少护士工作量,效果优于造口护肤粉联合液体敷料护理方式,值得临床推广应用。     

两种方法预防意识障碍患者失禁相关性皮炎的对比研究

目的探讨两种不同方法对意识障碍患者失禁相关性皮炎的预防效果。方法以2015年4月~2016年12月我院住院的意识障碍伴大便失禁患者98例为研究对象,随机分为对照组46例和实验组52例。对照组采用肛门插入带囊气管导管接引流袋的方法引流大便。实验组采用肛周喷涂液体敷料、人工肛袋接粗管径一次性连接管引流、生理盐水持续冲洗人工肛袋等综合护理方法。观察两组失禁相关性皮炎发生率及护理效果。结果两组每天预防护理时间比较差异有统计学意义(P0.01)。实验组失禁相关性皮炎发生率低于对照组,严重程度轻于对照组,差异有统计学意义(P0.05)。实验组治疗有效率高于对照组,差异有统计学意义(P0.05)。结论采用综合护理方法可以降低意识障碍患者失禁相关性皮炎的发生率。     

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.     

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.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.