循证护理对气压弹道碎石术患者术后疼痛及并发症的影响

目的探讨循证护理对气压弹道碎石术患者术后疼痛及并发症的影响。方法选取住院治疗的肾结石患者100例,随机分为对照组和观察组,两组均采用气压弹道碎石术进行治疗。对照组患者气压弹道碎石术后采用常规护理,观察组在对照组的基础上采用循证护理,观察两组患者术后的疼痛程度、并发症的发生率、满意度和住院时间。结果观察组术后的疼痛程度显著低于对照组（P〈0．05）,并发症显著少于对照组（P〈0．05）,满意度显著高于对照组（P〈0．05）,住院时间显著短于对照组（P〈0．05）。结论循证护理有利于减少气压弹道碎石术患者术后疼痛程度和并发症,提高患者护理满意度。     

健康教育路径在腹腔镜下子宫全切患者围术期中的应用

目的：观察临床健康教育路径在子宫肌瘤患者腹腔镜子宫全切术围术期护理中的应用效果。方法选取子宫肌瘤患者腹腔镜子宫全切术围术期患者160例,随机分为观察组80例和对照组80例,观察组采用临床健康教育路径进行护理,对照组进行传统的常规护理,比较两组患者对健康知识的掌握程度、对护理工作满意度、术后并发症发生率和平均住院日。结果观察组患者对健康知识的掌握度为95．0％,满意度为97．5％,均高于对照组;术后并发症发生率为2．5％,低于对照组;差异均有统计学意义（χ^2值分别为58．46,72．97,7．35;P＜0．01）。观察组平均住院时间为（4．56±1．48） d,对照组为（6．91±1．33）d,两组比较差异有统计学意义（t＝5．82,P＜0．05）。结论健康教育路径应用于医院子宫肌瘤患者腹腔镜下子宫全切术围术期患者护理,可缩短住院天数,降低并发症的发生率,提高护理质量及患者满意度,值得临床推广应用。     

经皮肾镜手术41例术后循证护理

将81例行经皮肾镜手术患者随机分为对照组（常规护理组）40例和观察组（循证护理组）41例,于术后分别对两组患者行常规护理和循证护理,统计分析两组患者的住院时间及并发症发生率、患者满意度,并加以比较。结果观察组患者住院时间短于对照组（P〈0．05）,患者并发症发生率也低于对照组（P〈0．05）,患者满意度却明显高于对照组（P〈0．05）。表明在经皮肾镜手术后的护理中采用循证护理的模式对于提高患者满意度、缩短患者住院时间、降低并发症发生率效果较为明显,值得临床推广应用。     

临床护理路径在子宫全切术病人中的应用

[目的]观察临床护理路径在子宫全切术病人中的应用效果。[方法]将140例子宫全切术病人随机分为观察组和对照组,每组70例,对照组采用常规护理,观察组采用临床护理路径进行护理。比较两组病人住院时间、住院费用及病人满意度。[结果]观察组病人住院时间、住院费用低于对照组（P〈0．05）;观察组病人的护理满意度高于对照组（P〈0．05）。[结论]应用临床护理路径对子宫全切术病人进行护理,可缩短住院时间、降低住院费用、提高病人对护理服务的满意度。     

快速外科康复理念在妇科腹腔镜围术期患者护理中的运用

目的：比较快速康复外科理念与常规护理方案对妇科腹腔镜围术期患者的护理效果。方法随机将患者分为实验组和观察组,每组患者30人,实验组采取快速外科康复理念,对照组采取常规护理方案,比较两组患者在术后并发症发生率、术后排气时间、平均住院时间和住院医疗负担方面的差异性。结果干预组在术后平均住院天数、首次排气时间及SAS评分方面明显低于对照组（P＜0．05）,在患者满意度方面明显高于对照组（P＜0．05）,干预组术后并发症发生率明显低于对照组（P＜0．05）。结论快速外科康复理念有利于减少术后并发症发生率,缩短住院时间,降低患者围术期的心理焦虑程度,提升患者对医疗服务的满意度,在临床护理工作中值得进一步推广。     

循证护理对预防妇科腹腔镜术后并发症的效果

目的：探讨循证护理对预防妇科腹腔镜术后并发症的效果。方法选取我院2011年1月至2013年10月行腹腔镜手术治疗的妇科疾病患者108例,随机分为对照组和观察组,每组54例。对照组患者实施常规护理,观察组患者实施循证护理。比较两组患者的术后恢复情况及并发症发生情况。结果观察组患者术后下床活动时间、术后肛门排气时间、术后住院时间均明显少于对照组（均P＜0．05）,患者恶心呕吐发生率、尿潴留发生率、腹胀发生率、血压下降发生率均明显低于对照组（均P＜0．05）。结论循证护理可明显缩短妇科腹腔镜术后患者的治疗时间,降低术后并发症发生率,有助于改善患者的预后。     

妇科宫腔镜术后并发症的早期护理干预

目的：探讨早期护理干预对妇科宫腔镜手术患者的影响。方法将400例妇科患者按照入院时间分为观察组和对照组。观察组：202例患者,进行早期护理干预;对照组：198例患者,进行常规护理。对比两组并发症、住院时间、VAS评分及满意度。结果观察组术后并发症发生率明显低于对照组,差异有显著统计学意义（ P＜0．05）。观察组术后1、3、5、7 d的VAS评分明显低于对照组,差异有显著统计学意义（P＜0．05）。观察组术后住院时间少于对照组,差异有统计学意义（t ＝9．8897,P＝0．0000）。观察组满意度明显高于对照组,差异有显著统计学意义（ P＜0．01）。结论对宫腔镜手术患者采取早期护理干预,可以改善患者术后疼痛程度,减少并发症,缩短住院时间,节约治疗费用,提高患者满意度。     

循证护理在妇科肿瘤患者术后康复过程中的应用研究

目的：探讨和分析循证护理在妇科肿瘤患者手术治疗后康复过程中的应用效果。方法将本院2008年1月至2014年3月收治的62例进行手术治疗的妇科肿瘤患者随机分为对照组和护理组,对照组给予常规护理,护理组对患者生活质量、尿潴留、精神状态及深静脉血栓四个方面进行循证护理,比较和分析两组患者的护理效果。结果护理组患者并发症的发生率显著低于对照组（P＜0．05）;护理组患者HAMA、MUIS评分显著低于对照组（P＜0．05）;护理组患者护理总满意率显著高于对照组（P＜0．05）。结论妇科肿瘤患者术后康复过程中应用循证护理可有效降低并发症的发生,缓解患者的不良情绪,有利于患者满意度的提高,值得临床推广使用。     

非脱垂子宫阴式子宫全切术68例临床疗效分析

【目的】探讨非脱垂子宫阴式子宫全切术的临床应用价值。【方法】分析比较68例非脱垂子宫的阴式子宫全切术（TVH）和80例同期指征相近的腹式子宫切除术（TAH）及62例腹腔镜辅助下阴式子宫全切除术（LAVH ）的术后镇痛率,住院时间及排气时间,手术费用及术后并发症等。【结果】TVH 组的手术时间显著短于TAH 组和LAVH 组,且差异有显著性（ P ＜0．05）;术中出血量 TAH组显著多于 TVH组和LAVH组,且差异有显著性（ P ＜0．05）,但TVH 组与LAVH组相比较差异无显著性（ P ＞0．05）;术后镇痛率TAH组显著多于TVH 组和LAVH组,且差异有显著性（ P ＜0．05）。排气时间三组相比较差异无显著性（ P＞0．05）;术后住院时间TAH组显著长于TVH组和LAVH组,且差异有显著性（ P＜0．05）。住院费用LAVH明显高于 TVH与TAH 组,且差异有显著性（ P ＜0．05）。TAH的术后并发症明显高于 TVH及LAVH组,且差异有显著性（ P＜0．05）。【结论】对子宫良性病变需子宫切除者,如无阴道手术禁忌,行阴式子宫全切术具有手术时间短,术中出血少,术后恢复快等优点,且腹部无瘢痕,符合微创手术原则,值得临床推广应用。     

临床路径对急性心肌梗死患者术后心脏康复的应用效果

目的：探讨临床路径对急性心肌梗死（AMI）患者术后心脏康复中的应用效果。方法选取我院行PCI手术治疗的AMI患者86例,随机分为观察组和对照组,每组43例。对照组患者采用传统的护理模式进行护理,观察组患者则根据临床路径表进行护理。比较两组患者的LVEF、心功能分级、并发症发生情况、生活自理能力、住院时间以及住院费用情况。结果观察组患者的心室功能好于对照组（P＜0．05）,Ⅰ级患者人数多于对照组（P＜0．05）;患者发生心衰、心律失常的发生率均明显低于对照组（ P＜0．05）,心源性休克的发生率与对照组无显著性差异,患者总并发症发生率显著低于对照组（ P＜0．05）;患者的生活自理能力好于对照组（P＜0．05）,住院时间及住院费用均少于对照组（均P＜0．05）。结论通过临床路径对AMI患者术后进行护理,患者的心脏康复效果显著,同时缩短了住院时间、减少了住院费用,值得临床应用与推广。     

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.     

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.