吴茱萸贴敷神阙穴配合腹部按摩预防脑卒中后便秘的效果评价

目的 研究吴茱萸外敷神阙穴配合腹部按摩预防脑卒中后便秘的临床效果.方法 将2012年1～11月入住广东省中医院脑卒中阴类证患者120例,随机分为观察组和对照组各60例.对照组予以常规护理,观察组在常规护理的基础上予以腹部按摩和吴茱萸贴敷神阙穴.观察2组便秘发生率及使用生理盐水不保留灌肠情况.结果 观察组与对照组的脑卒中后便秘发生率比较差异有统计学意义;2组的灌肠使用次数比较差异有统计学意义.结论 吴茱萸外敷神阙穴配合腹部按摩对预防脑卒中后便秘有较好的意义.     

中药热奄包联合吴茱萸粉调醋贴敷神阙穴治疗胫腓骨骨折患者术后腹胀、便秘的临床研究

目的探究胫腓骨骨折患者术后应用中药热奄包热敷神阙和吴茱萸粉调醋贴敷神阙穴后,患者腹胀、便秘的发生情况,以期研究中药热奄包热敷神阙和吴茱萸粉调醋贴敷神阙穴综合作用的治疗范围。方法收集2016年1月~2016年12月在本院创伤骨科住院手术的骨折患者共80例,随机分成4组,每组20人。A组为联合治疗组,在术后常规护理的基础上,加用中药热奄包热敷神阙和吴茱萸粉调醋贴敷神阙穴进行干预2周。B组和C组分别为中药热奄包组和吴茱萸粉调醋组,D组为对照组,单纯采用常规护理。分别记录4组患者术后首次排气时间(h)、排便时间(d)、术前及术后6个时间点(第2d、5d、7d、2周)腹胀便秘积分情况。结果A组患者术后首次排气时间、排便时间均明显早于其他组,具有统计学意义(P0.05)。A组干预期间(术后2周内)各时间点腹胀便秘积分明显低于对照组,且能够较快恢复至术前水平,各项指标表明术后胃肠功能恢复均明显优于其他组。结论中药热奄包热敷神阙和吴茱萸粉调醋贴敷神阙穴综合作用能够有效降低患者术后腹胀便秘的发生程度,促使胃肠功能尽快恢复至正常水平。     

吴茱萸肉桂贴敷神阙穴联合腹部按摩对脓毒症胃肠功能疗效的观察

目的探讨吴茱萸肉桂粉醋调后贴敷神阙穴联合腹部按摩对脓毒症患者胃肠功能恢复的疗效。方法将脓毒症伴胃肠功能障碍患者60例,采用随机数字表法分为对照组和治疗组,在常规治疗基础上,对照组给予吴茱萸肉桂贴敷神阙穴,治疗组给予吴茱萸肉桂贴敷神阙穴联合腹部按摩,均于治疗前第1天、治疗后第3天、第7天评效。结果茱萸肉桂贴敷神阙穴联合腹部按摩后肠鸣音评分、胃潴留、大便情况明显优于对照组。结论茱萸肉桂贴敷神阙穴联合腹部按摩能促进肠鸣音恢复,改善严重脓毒症患者的预后,有效促进脓毒症胃肠功能的恢复。     

中药穴位贴敷联合静脉镇痛对二次剖宫产术后疼痛的效果观察

目的观察中药穴位贴敷联合静脉镇痛对二次剖宫产术后的镇痛效果。方法将61例瘢痕子宫、择期行二次剖宫产手术孕妇随机分为对照组31例和观察组30例。对照组术后采用患者静脉自控镇痛方式,观察组在对照组基础上辅以中药穴位贴敷。术后24 h内每隔4 h分别以视觉模拟评分法记录产妇术后切口痛程度以及催产素治疗时的宫缩痛程度。结果观察组产妇剖宫产术后各时间点切口痛以及应用催产素时宫缩痛视觉模拟评分明显较对照组低(P0.05)。结论中药穴位贴敷联合静脉镇痛较单纯静脉镇痛对缓解二次剖宫产术后疼痛效果好。     

吴茱萸粗盐热奄包联合大黄神阙穴贴敷预防中风后便秘的临床效果和护理

目的探讨吴茱萸粗盐热奄包联合大黄神阙穴贴敷对中风后便秘的预防效果和相关护理措施。方法 120例中风患者随机分为观察组和对照组,各60例。对照组给予常规护理,观察组在对照组基础上,给予吴茱萸粗盐热奄包联合大黄神阙穴贴敷。观察2组实施干预后7 d内便秘发生情况。结果观察组发生便秘80次,平均(11.4±4.0)次/d;对照组发生便秘136次,平均(19.4±8.0)次/d,观察组便秘发生频率低于对照组(P0.05)。结论吴茱萸粗盐热奄包联合大黄神阙穴贴敷干预能有效预防中风恢复期便秘的发生。     

耳穴贴压超前镇痛对全膝关节置换术后疼痛的影响

目的观察耳穴贴压超前镇痛对全膝关节置换术后疼痛的影响。方法将60例行首次单侧人工膝关节置换术的患者按照随机数字表分为观察组和对照组各30例,观察组术前3d行耳穴贴压,对照组术后6h行耳穴贴压,两组均于术后常规使用静脉自控镇痛泵,比较两组术后镇痛效果、镇痛药物用量及药物不良反应。结果观察组术后6h、12h、24h、36h、48h静息状态下的疼痛评分均低于对照组(P0.05);观察组术后6h、12h、24h、48h的PCA消耗量均低于对照组(P0.05);观察组发生恶心呕吐、嗜睡的例数低于对照组(P0.05),两组发生尿潴留的例数差异无统计学意义(P0.05)。结论耳穴贴压超前镇痛能提高全膝关节置换术后的镇痛效果。     

中药贴敷神阙穴对心力衰竭心肾阳虚型便秘的疗效观察

目的观察中药贴敷神阙穴对心力衰竭心肾阳虚型患者便秘的临床效果。方法按随机数字表将86例患者分为观察组和对照组,各43例。对照组采用便秘常规护理,观察组在对照组基础上予中药贴敷神阙穴。比较两组患者便秘干预效果。结果观察组在干预期间口服缓泻剂或灌肠及不良反应和并发症例数均低于对照组;干预后观察组便秘观察指标评分优于对照组,总有效率高于对照组,经比较,差异有统计学意义。结论中药贴敷神阙穴能有效解除心力衰竭心肾阳虚型患者的便秘。     

腹部穴位按摩联合中药贴敷神阙穴预防颅脑损伤患者便秘的效果观察

目的研究腹部穴位按摩联合中药贴敷神阙穴预防颅脑损伤患者便秘的效果。方法将80例颅脑损伤患者按随机分为观察组和对照组各40例,在常规护理的基础上,观察组入院24h内行穴位按摩联合中药贴敷神阙穴,对照组行中药贴敷神阙穴,比较两组患者便秘发生情况。结果观察组便秘发生率为10％,对照组便秘发生率为30％,差异有统计学意义（P〈0.05）。结论穴位按摩联合中药贴敷神阙穴能预防颅脑损伤患者便秘,不良反应少,通便作用缓和。     

中药贴敷神阙穴治疗产后宫缩痛的疗效观察

[目的]观察中药神阙穴贴敷治疗产后宫缩痛的疗效。[方法]将120例产妇随机分为观察组和对照组各60例,对照组给予传统护理,包括改变体位、局部热敷、按摩等,观察组在对照组的基础上于产后2h开始进行神阙穴中药贴敷治疗,采用疼痛视觉模拟评分法(VAS)评价宫缩痛程度,比较两组产妇产后24h、48h、72h宫缩痛程度。[结果]观察组产妇产后24h、48h、72h宫缩痛程度明显低于对照组(P0.05)。[结论]神阙穴中药贴敷能有效减轻产后宫缩痛。     

揿针联合穴位贴敷在肾绞痛患者围术期护理中的效果观察

目的 探讨揿针联合穴位贴敷对肾绞痛患者围术期护理的影响。方法 将2021年6月—2022年5月收治的120例肾结石患者按照组间基线资料具有可比性的原则分为揿针组、穴位贴敷组和揿针联合穴位贴敷组,每组40例。对3组患者干预后疼痛（采用NRS）评分、术后12 h的疼痛评分、术后相关指标（首次下床活动时间、首次通气时间、首次进食时间）、住院时间及患者满意度等进行分析比较。结果 入院即给予疼痛干预,干预后,与穴位贴敷组比较,揿针组、揿针联合穴位贴敷组患者的疼痛评分降低,差异均具有统计学意义（P<0.05）。3组患者术后首次下床时间比较差异无统计学意义（P>0.05）。此外,与揿针组比较,揿针联合穴位贴敷组和穴位贴敷组患者术后首次通气时间以及术后首次进食时间均缩短,差异有统计学意义（P<0.05）。与揿针组、穴位贴敷组比较,揿针联合穴位贴敷组患者的住院时间短于对照组,满意度评分低于对照组,组间差异均有统计学意义（P<0.05）。结论 采用揿针联合穴位贴敷可以减轻肾绞痛围术期患者疼痛,术后胃肠功能恢复快,缩短住院时间,提高患者满意度。     

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.     

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.