不同健康教育方式对放化疗所致口腔黏膜炎的影响

目的 探讨健康教育方式对放化疗所致口腔黏膜炎的影响.方法 将100例头颈部肿瘤放化疗患者分2组,试验组采用系统的个体化健康教育方式,对照组采用传统的健康教育,比较同样应用重组人粒细胞巨噬细胞集落刺激因子喷雾剂治疗放化疗所致的口腔黏膜炎不同健康教育方式对其疗效的影响.结果 试验组患者口腔黏膜反应的程度较对照组轻,两组反应差异有统计学意义(P＜0.05),试验组患者及家属在护理技能和保健知识获得方面优于对照组,差异有统计学意义(P＜0.01).两组患者及家属对健康教育满意度的评价有差异.结论 系统的个体化健康教育模式能更好地发挥健康教育的特殊意义和作用.     

加味二辛煎在乳腺癌化疗患者口腔护理中的应用研究

目的 探讨自制的“加味二辛煎”在预防乳腺癌化疗患者口腔黏膜炎的效果与安全性.方法 将2013年1月-2014年3月在我科住院的80例乳腺癌化疗病人随机分为两组,每组40例.对照组患者采用0.05％的醋酸氯己定溶液进行常规口腔护理,实验组患者采用本院自制的“加味二辛煎(冰镇使用)”进行常规口腔护理后,再用“加味二辛煎”喷雾剂对口腔进行全方位喷雾;观察两组患者进行口腔护理1～5 d后,口腔菌斑指数、牙龈指数、口腔真菌感染和口腔黏膜炎分度情况.结果 两组患者口腔真菌感染率比较,差异无统计学意义(P＞0.05);两组患者菌斑指数、牙龈指数及口腔黏膜炎分度比较,差异均有统计学意义(P＜0.05或P＜0.01).结论 用“加味二辛煎”进行口腔护理及“加味二辛煎”喷雾剂喷口腔,能有效地预防乳腺癌化疗患者口腔黏膜炎发生率,明显降低口腔黏膜炎分度.     

医护一体化工作模式在放化疗性口腔黏膜炎中的应用及实践

[目的]探讨医护一体化工作模式在放化疗性口腔黏膜炎中的应用及效果。[方法]选取200例鼻咽癌同期放化疗病人,随机分为观察组和对照组各100例。对照组给予常规护理模式,观察组给予医护一体化工作模式。比较两组病人放射性口腔黏膜炎分级、放化疗性口腔疼痛分级、营养风险及治疗中断情况。[结果]观察组放化疗性口腔黏膜炎分级显著轻于对照组(P0.05);观察组病人放化疗性口腔疼痛分级显著轻于对照组(P0.05);观察组营养风险筛查量表(NRS2002)评分显著低于对照组(P0.05)。与对照组相比,观察组因放化疗性口腔黏膜炎导致治疗中断情况显著改善(P0.05)。[结论]医护一体化工作模式可降低鼻咽癌同期放化疗病人放化疗性口腔黏膜炎及放化疗性口腔疼痛的发生程度,改善营养状况,提高放化疗耐受性。     

康复新冰块含服防治鼻咽癌放射性口腔黏膜炎的效果观察

目的 观察康复新冰块含服防治鼻咽癌放射性口腔黏膜炎的临床疗效.方法 将110例鼻咽癌放疗患者分为观察组和对照组各55例.对照组采用常规口腔护理,观察组在常规口腔护理基础上予康复新冰块含服,观察两组患者放射性口腔黏膜炎的发生情况及口腔疼痛程度.结果 观察组口腔黏膜炎的发生率低于对照组,差异有统计学意义(P＜0.05).观察组口腔黏膜炎严重程度低于对照组,差异有统计学意义(P＜0.05).观察组和对照组疼痛程度分布比较,差异有统计学意义(P＜0.05).结论 康复新冰块含服能降低口腔黏膜炎发生率,减轻口腔黏膜炎发生程度及口腔疼痛程度.     

尼妥珠单抗联合放化疗与单纯放化疗治疗中晚期鼻咽癌的对比研究

[目的]探讨尼妥珠单抗联合放化疗治疗中晚期鼻咽癌的临床疗效及不良反应.[方法]回顾性分析在本院放疗科接受鼻咽癌调强放疗的Ⅲ～Ⅳa期鼻咽癌初诊患者183例的临床资料,其中尼妥珠单抗组联合放化疗组为观察组(22例);单纯放化疗组为对照组(161例),比较两组疗效.[结果]观察组近期有效率达100％;对照组为98.75％(159/161),两组相比较差异无显著性(P＞0.05).观察组的3年生存率、无疾病进展生存率较对照组高,但两组相比较差异无显著性(P＞0.05).两组患者的毒副反应均可耐受,仅放射性咽喉黏膜炎、贫血程度上观察组较对照组严重(P＜0.05),在白细胞下降、放射性口腔黏膜炎、放射性皮炎、口干、皮肤纤维化、听力下降、颞下颌关节纤维化方面两组相比较差异均无显著性(P＞0.05).[结论]尼妥珠单抗联合放化疗较单纯放化疗治疗中晚期鼻咽癌,对总生存率的提高有帮助;其治疗安全性可靠,毒副反应患者能耐受.     

延续性护理在化疗所致口腔黏膜炎患者中的应用效果

目的 探讨对化疗引起的口腔黏膜炎患者实施延续性护理的效果。方法 选取2019年4月至2020年5月我科收治的化疗引起的口腔黏膜炎患者80例作为研究对象。将其随机分为试验组和对照组(40 例 / 组)。在两组患者出院前,对对照组进行常规护理。试验组患者在进行常规护理的前提下再进行延续性护理。对比两组患者漱口水治疗依从性、创面愈合状况、生活质量和对护理的满意度。结果 实验组患者接受延续性护理后其对漱口水治疗的依从性、患者的生活质量及患者对护理的满意度均高于对照组患者,差异有统计学意义(P＜0.05)。试验组患者炎症及溃疡面愈合总有效率显著大于对照组,差异有统计学意义(P＜0.05)。结论 对化疗所致口腔黏膜炎患者实施延续性护理可显著提高患者对治疗的依从性和对护理的满意度,同时也提高了创面愈合的有效率。     

放化疗致放射性皮炎以及口腔黏膜炎的临床护理对策

目的 探讨针对性护理干预对策在防治放化疗致放射性皮炎、口腔黏膜炎中的应用效果.方法 选择于该院接受放化疗并发生放射性皮炎或口腔黏膜炎的鼻咽癌患者80例为研究对象.根据患者治疗期间护理方式差异分为观察组与对照组,观察组40例接受放化疗并发症针对性护理干预措施,对照组40例仅接受常规临床护理干预,比较两组干预后放射性皮炎、口腔黏膜炎发生程度以及生活质量、护理满意度、治疗依从性.结果 观察组干预后放射性皮炎、口腔黏膜炎发生程度明显低于对照组(P<0.05);观察组干预后生活质量、护理满意度、治疗依从性评分明显高于对照组(P<0.05).结论 对放化疗所致的放射性皮炎、口腔黏膜炎患者实施针对性护理干预可有效改善放射性皮炎、口腔黏膜炎发生程度,并可显著提高患者生活质量、护理满意度以及治疗依从性,具有应用及推广价值.     

整体护理观在预防化疗所致口腔黏膜炎护理中的应用

目的 观察用整体护理观指导预防氟脲嘧啶类为主抗癌药物化疗所致口腔黏膜炎的效果.方法 将448例恶性肿瘤病人随机分为实验组和对照组.对照组在化疗期间用口腔护理液对病人进行口腔护理,并对病人行健康宣教.实验组在对照组的基础上,将整体护理观应用于病人的口腔护理中.结果 实验组在口腔黏膜炎发生率、口腔黏膜炎持续时间等方面明显低于对照组,两组比较有显著差异(P＜0.01).结论 用整体护理观指导病人的口腔护理有明显效果,可以提高护理的内在质量.     

精细化护理干预在剖宫产手术产妇中的应用

目的 探讨精细化护理干预在剖宫产产妇中的应用效果.方法 将90例行剖宫产手术的患者随机分为对照组和实验组,每组45例.对照组采用常规护理干预,实验组采用精细化护理干预.比较2组术后不同时期疼痛评分、胃肠功能恢复及乳房泌乳情况和护理满意率.结果 2组患者术后24、48 h疼痛评分均低于术后30 min,差异有统计学意义(P＜0.05);2组患者术后48 h疼痛评分均低于术后24 h,差异有统计学意义(P＜0.05).实验组患者术后24、48 h疼痛评分低于对照组,差异有统计学意义(P＜0.05).实验组肠鸣音、排气、排便恢复时间均短于对照组,差异有统计学意义(P＜0.05).实验组泌乳始动时间、乳房胀痛发生率均低于对照组,48 h内泌乳充足率高于对照组,差异有统计学意义(P＜0.05);实验组护理满意率为97.78％,高于对照组的86.67％,差异有统计学意义(P＜0.05).结论 精细护理干预措施可更有效缓解剖宫产患者术后疼痛,促进胃肠功能功能恢复及产后泌乳,提高患者满意度.     

冰生理盐水含漱在护理鼻咽癌患者放疗所致口腔疼痛中的应用

目的:探讨冰生理盐水含漱在护理鼻咽癌患者放疗所致口腔疼痛中的应用效果。方法:选取2020年1月1日～12月31日160例接受放疗的鼻咽癌患者,经随机数字表法分为观察组和对照组各80例;对照组采用常规护理,观察组在对照组基础上使用冰生理盐水含漱;比较两组口腔黏膜炎发生情况、放射性损伤程度、口腔疼痛程度、干预前后口腔舒适度及护理满意度。结果:观察组口腔黏膜炎发生率低于对照组(P0.01);观察组口腔黏膜放射性损伤程度轻于对照组(P0.05);观察组口腔疼痛程度低于对照组(P0.05);干预后,两组味觉改变、咽痛、口干等舒适性量表维度评分低于干预前(P0.05),且观察组低于对照组(P0.01);观察组护理满意度高于对照组(P0.05)。结论:冰生理盐水含漱能缓解鼻咽癌患者放疗所致口腔疼痛,减少口腔黏膜炎的发生,降低放射性损伤程度,提高舒适度及护理满意度。     

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.