天幕脑膜瘤的术后护理

目的 探讨天幕脑膜瘤患者的术后护理.方法 加强患者术后病情观察,监护生命体征的变化,防治并发症,维持良好的营养状态.结果 15例患者术后未发生手术相关的感染或死亡.患者出院后经6个月～5年的随访,12例治愈;2例分别于手术后1年、4年复发,行再次手术治愈;1例肿瘤生长活跃,有恶性倾向.结论 做好天幕脑膜瘤患者术后的护理,积极防治并发症,是促进患者早日康复的重要环节.     

嗅沟脑膜瘤的术后观察与护理

目的:探讨嗅沟脑膜瘤术后的观察护理对策。方法:对18例嗅沟脑膜瘤患者的术后并发症及护理措施进行回顾性分析。结果:术后发生脑脊液漏3例,癫痫2例,高热1例,尿崩症3例,精神症状3例,肺部感染1例,所有并发症经治疗与护理,除1例患者仍存在精神症状外,其余均治愈。结论:嗅沟脑膜瘤术后经及时有效的观察护理能减少并发症的发生,提高治愈率。     

颅底穿通大型脑膜瘤术后护理

目的 降低颅底穿通大型脑膜瘤手术的术后并发症,提高护理质量.方法 回顾性分析我院2001年1月～2011年12月收治的颅底穿通大型脑膜瘤12例患者术后护理.结果 12例病人在术后发生继发性颅内血肿再次手术1例,继发性脑水肿所致过程性颅内高压5例,脑脊液鼻漏3例,继发颅内感染2例,肺部感染2例,均早期发现和正确处理,最终康复出院.结论 对大型脑膜瘤手术患者早期发现和正确处理并发症是术后护理的关键.     

102例巨大脑膜瘤显微手术护理

[目的]探讨颅内巨大脑膜瘤显微手术的护理经验.[方法]回顾性分析本院开展颅内巨大脑膜瘤显微手术病人术前准备、心理护理、术后的病情观察及并发症防治等围手术的护理方案.[结果]临床痊愈80例,好转18例,死亡4例,颅内继发血肿再手术3例,气管切开5例.[结论]术前有效心理护理,术后加强病情观察,积极防治并发症是脑膜瘤术后病人顺利康复的重要条件.     

复发窦镰旁脑膜瘤手术探讨

回顾性分析我院在2006年8月~2011年8月收治的20例复发窦镰旁脑膜瘤患者显微手术治疗的临床资料。20例复发窦镰旁脑膜瘤患者,经过手术治疗及术后的积极护理和采取一定的措施,肿瘤Ⅰ级切除15例,Ⅱ级切除5例,无手术死亡,随访1~3年后,所有患者未复发,无并发症。选取适当的手术措施,可明显提高深部大脑镰旁脑膜瘤的全切除率,并且最大限度的减少术后的并发症及术后复发率,可以有效地治疗复发窦镰旁脑膜瘤手术,对复发窦镰旁脑膜瘤有重要意义。     

老年患者无张力疝修补术后并发症的防治及护理

目的:总结老年患者行无张力疝气修补术后并发症的防治及护理经验。方法:回顾性分析我院2011年7月~2013年6月收治住院的38例65岁以上行无张力疝修补术的老年腹股沟疝患者的一般资料、术后治愈情况及护理方法。结果:本组38例经手术治疗后发生尿潴留10例,便秘6例,切口脂肪液化、感染各1例,切口疼痛3例,阴囊积液1例,肺部感染2例。均经治疗治愈出院,术后随访6~12个月无1例复发。结论:术后积极合理的护理干预能够较好地防治并发症发生,提高手术成功率,改善患者的生活质量。     

蝶骨嵴脑膜瘤的术后护理

目的：探讨蝶骨嵴脑膜瘤患者的术后护理。方法：加强术后密切观察病情，监护生命体征的变化，防治并发症，维持良好的营养状态等护理。结果：例患者术后恢复良好，无护理并发症。结论：做好蝶骨嵴脑膜瘤患者的术后护理，积极防治并发症，对于患者的术后康复有重要意义。     

显微手术治疗颅底大型脑膜瘤的临床分析及护理

目的探讨颅底脑膜瘤患者的护理措施。方法对2002年1月-2007年12月在我科显微手术治疗的75例颅底大型（最大径〉4．5cm）脑膜瘤患者的临床资料进行回顾性分析,并对大型脑膜瘤显微手术要点和术后并发症的防治及其护理进行分析。结果桥小脑角脑膜瘤、蝶骨嵴脑膜瘤、嗅沟脑膜瘤、鞍结节鞍膈脑膜瘤的手术全切率分别达到86．9％（20／23）82．1％（23／28）81．8％（9／11）69．2％（9／13）。本组无死亡病例（术后4周内统计）。结论显微手术切除是目前治疗颅内大型脑膜瘤的首选方法。术前、术后正确的护理措施可以有效地提高原发病的治愈率,减低致残率及病死率。     

天幕切迹脑膜瘤的手术治疗

目的:探讨天幕切迹脑膜瘤的手术治疗方法。方法:回顾性分析华中科技大学同济医学院附属同济医院2001-2004年手术治疗的35例天幕切迹脑膜瘤资料。结果:根据肿瘤起源部位及生长方向将35例天幕切迹脑膜瘤分为2类:外侧型29例,后内侧型6例。肿瘤获得全切31例,次全切3例,部分切除1例。术后无死亡,2例新出现眼球运动障碍,其余病例未出现新的神经功能障碍。结论:根据肿瘤的起源部位和生长方向,采用适当的手术入路,大部分天幕切迹脑膜瘤可取得满意的疗效。     

巨大型嗅沟脑膜瘤患者的术后护理

目的探讨巨大型嗅沟脑膜瘤患者的术后护理措施。方法对10例巨大型嗅沟脑膜瘤患者术后采取常规的一般护理及有针对性的并发症的护理，观察护理效果。结果患者术前均出现头痛及嗅觉障碍，有视力减退8例，精神异常2例，意识障碍1例。经精心的术后护理，头痛、精神异常及意识障碍均有缓解，视力好转6例，但嗅觉障碍无改善，未出现新的并发症。结论根据巨大型嗅沟脑膜瘤的特点，术后及时采取针对性的护理措施，可改善患者手术的预后。     

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.     

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.