超短波并中频电治疗急性胰腺炎致麻痹性肠梗阻26例效果观察及护理

目的:探讨超短波并中频电治疗急性胰腺炎致麻痹性肠梗阻的效果及护理方法.方法:将52例急性胰腺炎致麻痹性肠梗阻患者按病例单双号随机分为观察组和对照组各26例,对照组接受内科常规治疗,观察组在此基础上加用超短波并中频电治疗,比较两组患者治疗后出现第1次排便所需时间及肠梗阻好转时间.结果:观察组出现第1次排便时间、肠梗阻好转时间与对照组比较差异均有统计学意义(P＜0.05,P＜0.01).结论:超短波并中频电治疗急性胰腺炎致麻痹性肠梗阻疗效满意,值得临床推广应用.     

经鼻胃管注入泛影葡胺治疗急性胰腺炎致麻痹性肠梗阻病人的效果观察

[目的]观察经鼻胃管注入泛影葡胺治疗急性胰腺炎致麻痹性肠梗阻病人的效果。[方法]对23例急性胰腺炎致麻痹性肠梗阻病人采取经鼻胃管注入泛影葡胺治疗,经鼻胃管注入76%复方泛影葡胺注射液80mL～100mL后夹管2h,观察病人的病情变化。[结果]2例病人出现恶心、呕吐,无一例并发变态反应、腹痛加剧或便血、低血压等;23例病人均于腹泻后顺利恢复流质饮食。[结论]经鼻胃管注入泛影葡胺可以安全有效地治疗急性胰腺炎导致的麻痹性肠梗阻。     

伴有血脂肪酶升高的急性肠梗阻误诊为急性胰腺炎1例分析

近日我院收治伴有血脂肪酶升高的急性肠梗阻误诊为急性胰腺炎1例，现分析如下。     

合用新斯的明治疗肾绞痛引起的麻痹性肠梗阻38例

肾绞痛引起的麻痹性肠梗阻并不少见，我院自1995年起其接诊绞痛引起的麻痹性肠梗阻患者38例，现报告如下：     

重症胰腺炎合并肠梗阻的治疗体会

[目的]探讨临床诊治重症胰腺炎(SAP)合并肠梗阻的体会.[方法]本院收治的48例SAP合并肠梗阻患者,其中45例麻痹性肠梗阻,3例为机械性肠梗阻,将麻痹性肠梗阻患者随机分为两组,对照组20例采用禁食,胃肠减压、肠内营养,纠正水电解质紊乱、维持酸碱平衡,抗生素防感染等常规内科治疗.治疗组25例在常规内科治疗基础上,给予生大黄,芒硝及硫酸镁治疗,比较两组的临床疗效.[结果]治疗组25例患者治疗后禁食时间,腹痛、腹胀缓解时间,肠鸣音恢复时间,首次排便恢复时间,血淀粉酶恢复时间,住院时间及病死率等指标均显著优于对照组(P＜0.05).3例机械性肠梗阻患者采用保守治疗疗效不明显时实施了手术治疗.[结论]选择有效的治疗方法可降低SAP患者腹压,促进胃肠道蠕动,达到良好的预后效果.     

通元针法联合清肠合剂灌肠在急性胰腺炎合并麻痹性肠梗阻患者中的应用

目的：探讨通元针法联合清肠合剂灌肠在急性胰腺炎合并麻痹性肠梗阻患者中的应用效果。方法：将102例急性胰腺炎合并麻痹性肠梗阻患者按入院先后顺序分为对照组和干预组各51例,对照组实施常规护理干预,干预组在对照组基础上实施通元针法联合清肠合剂灌肠干预。采用改良Marshall评分、Balthazar CT评分、急性生理学和慢性健康评价(APACHE-Ⅱ)评分比较两组临床疗效,采集患者空腹静脉血观察肿瘤坏死因子-α(TNF-α)、白介素细胞-6(IL-6)以及白介素细胞-8(IL-8)水平。结果：观察组Marshall、Balthazar CT、APACHE-Ⅱ评分低于对照组(P<0.01);观察组TNF-α、IL-6、IL-8水平低于对照组(P<0.01)。结论：通元针法联合清肠合剂灌肠可改善急性胰腺炎合并麻痹性肠梗阻患者的胃肠功能,降低炎性因子水平,值得临床推广。     

老年性肠梗阻诊治236例分析

对我院1993～2003年收治并经手术证实的老年性肠梗阻236例分析如下。1临床资料 本组男127例，女109例；年龄60～69岁108例，70～80岁87例，80岁以上41例，平均年龄70．5岁。病因：肠道肿瘤99例，粘连性肠梗阻95例，嵌顿性腹外疝18例，腹内疝3例，肠扭转5例，粪石性肠梗阻14例，血管性疾病2例。本组术前有伴发病者163例，其中心血管系统疾病82例；呼吸系统疾病44例；糖尿病15例；前列腺增生22例。     

氯氮平致麻痹性肠梗阻临床特点与影像学分析

正麻痹性肠梗阻或肠麻痹是抗精神病药物引起的严重不良反应之一,但精神障碍患者并发的麻痹性肠梗阻不易被发现和重视,确诊较晚。现就我院抗精神病药物治疗中发生麻痹性肠梗阻24例的临床表现和X线表现作回顾性分析,报告如下。病例资料2006年3月~2012年5月期间我院住院精神疾病患者中发生肠梗阻24例,其中男性20例,女性4例;平均年龄35岁,病期4~21年,1例死亡。24例肠梗阻均经腹部X线平片及腹部超声检     

96例老年性肠梗阻临床诊治分析

目的：探讨老年性肠梗阻的处理方法。方法：回顾性分析96例老年性肠梗阻患者临床资料及处理手段。结果：96例患者中肠肿瘤42例（43.75%），肠黏连29例（30.21%），腹内外疝嵌顿14例（14.58%）， 肠扭转、肠套叠8例（8.33%），麻痹性肠梗阻3例（3.13%），手术治疗84例（87.5%），64例获良好疗效，19例伴有不同程度并发症，1例死亡。12例经保守治疗肠梗阻解除。结论：老年性肠梗阻以肿瘤性肠梗阻、黏连性肠梗阻最常见。应根据患者情况选择合理治疗方式。     

高压氧治疗术后麻痹性肠梗阻14例疗效分析

1994年8月至今我院采用高压氧治疗术后麻痹性肠梗阻14例。均获痊愈。现报告如下。     

Integrative Medicine in Family Medicine Residency

Background

As specialists who care for families and communities, family physicians have a responsibility to respond to evolving views of healthcare among their patients. Americans are using complementary and alternative medicine (CAM) with increasing frequency and family physicians are well suited to becoming the guides for ensuring the safe and effective integration of conventional and complementary approaches to healthcare.

Methods

US National Institutes of Health National Centers for Complementary and Alternative Medicine funding was used to design, implement and evaluate an educational intervention for residents and faculty members in our family medicine residency programme at the Maine Medical Center (Portland, ME, USA). Key components of the project were a series of half-day workshops, faculty development and a resident curriculum. The resident curriculum includes experiences designed to address physician Wellness, communication with patients and coordination of care with community CAM providers. The project engaged community CAM practitioners as teachers and in patient care.

Results

Faculty members and residents reported an increase in knowledge and confidence in discussing and utilising CAM modalities. They reported improvement in their ability to find reliable information on CAM and a dramatic increase in level of comfort discussing CAM with patients.

Conclusions

Our experience suggests that family physicians are well suited to becoming patient guides for the safe and effective integration of conventional and complementary approaches to healthcare.     

牛人

有了网络,便有了无穷尽的鲜活语言。 最早让我一头雾水的是女儿告诉我的“好郁闷”这个词儿。而如今,当我有了解不开或做不好的某件事时,也情不自禁的发出感叹,“好郁闷呐!”     

牛人

有了网络,便有了无穷尽的鲜活语言。 最早让我一头雾水的是女儿告诉我的“好郁闷”这个词儿。而如今,当我有了解不开或做不好的某件事时,也情不自禁的发出感叹,“好郁闷呐!”     

关于循证医学的问题与思考

本文阐述了对循证医学的"三原则"和实践循证医学的"五程式"的理解;循证医学是人类数千年形成的道德准则和公理在医学上的体现,是先进的临床医学模式和临床实践的方法论,其产生的基础是临床科研方法学的发展和完善、最佳证据数据库的产生以及信息技术的发展,归根结底是一切为了人类健康的需要.本文还就中医现代化与循证医学的关系进行了探讨,认为中医现代化的定义就是科学化和国际化,科学化的前提是标准化,中医临床实践的科学化首先就要探索诊断技术的标准化;中医理论主要是临床医学的实践理论而不是基础医学理论,循证医学是临床医学模式,循证医学模式应成为中医临床实践的标准化模式,由此推动中医诊断治疗的标准化;沟通中医与西医之桥不在于使中医的传统理论"现代化",而在于共同的疗效评价标准,由此,中医的疗效就能得到国际认可,而实现中医的国际化.     

Men of Medicine

The five-year survival rate for resection of carcinoma of the colon is now 50 per cent. The rate is higher for carcinoma of the right colon than for that of the left colon due to more radical excision of the right colon and mesocolon, heft hemicolectomy with ligation of the inferior mesenteric artery and anastomosis of the transverse colon to the rectal ampulla is the preferred procedure. Carcinoma at or below the peritoneal reflection is treated by abdominoperineal resection plus left hemicolectomy.     

Observation Medicine in Emergency Medicine Residency Programs

OBJECTIVE: To evaluate observation unit (OU) prevalence, emergency medicine (EM) resident exposure in observation medicine (OM), EM faculty/residency director (RD) OM training, and RD attitudes toward OM. METHODS: Information was obtained from residency programs by telephone during a four-month period. RESULTS: Survey respondents indicated that 36.1% have OUs and 44.9% plan to have an OU. Observation medicine resources include textbooks 32.0%, articles 45.9%, lectures 36.9%, fellowships 2.5%, and research 26.2%. Observation medicine patient care occurs: 1) during residency: 25.4% of RDs, 11.3% of entire faculty; 2) as an attending: 45.1% of RDs. CONCLUSIONS: Nearly two-thirds of EM programs have or are planning an OU. Resources are lagging behind. This survey describes current OM education strategies to teach OM.     

Men of Medicine

Although this department of POSTGRADUATE MEDICINE is regularly headed “Men of Medicine,” this month's biographic sketch is devoted to a “woman in medicine,” whose contributions to medical practice and education have been truly outstanding. For these contributions and for her devotion to the highest ideals of her profession, the Editors are pleased to include Dr. Elise L'Esperance in the list of leading contemporary physicians honored in this series.