支气管肺泡灌洗治疗小儿非固体类异物吸入的护理

总结纤维支气管镜下行支气管肺泡灌洗治疗11例肺部非固体类异物吸入患儿的护理体会,认为术前及时对患儿进行体位引流,全面身心评估,解除思想顾虑,完善各项术前检查;术中加强配合,密切观察病情变化;术后重视并发症的观察和残留灌洗液的清除,有助于支气管肺泡灌洗治疗小儿肺内非固体类异物吸入取得较好疗效.     

支气管肺泡灌洗术治疗肺脓肿的护理配合

总结了25例肺脓肿患者行纤维支气管镜下支气管肺泡灌洗术的护理配合.认为术前、术中、术后的有效配合与精心护理,能使支气管肺泡灌洗术顺利进行,减少术中、术后并发症的发生.     

纤维支气管镜钳取异物的配合与护理

[目的]探讨支气管异物的临床特征,经纤维支气管镜钳取异物时的护理配合方法,以减少并发症的发生。[方法]对我院9例病人进行术前充分准备,术中密切配合,术后加强护理。[结果]支气管异物右侧多见,纤维支气管镜钳取支气管异物成功率达96%,术后咳嗽及胸痛缓解。[结论]要求操作医生熟练的操作技术,护士密切配合是成功取出异物的关键     

经电子支气管镜行支气管内异物取出术的护理

目的 探讨电子支气管镜钳取支气管内异物的护理配合.方法 采用电子支气管镜钳取26例支气管内异物,并在术前、术中、术后采取有针对性的护理.结果 26例支气管异物均经口腔成功取出,成功率100％.其中一次成功取出者20例,二次成功取出者6例;18例患者在入镜时出现低氧血症、心率增快,15例患者术后有少量血痰,经对症处理后均好转.结论 经电子支气管镜行支气管内异物取出术安全、有效,术前有针对性的心理护理、术中细致的护理观察与配合是成功取出异物的关键,做好术后并发症的护理对促进患者康复有着积极的作用,贴心的健康教育可有效预防支气管异物的再次发生.     

支气管肺泡灌洗治疗呼吸衰竭60例的护理

目的 总结呼吸衰竭患者行支气管肺泡灌洗治疗的护理体会.方法 对60例Ⅱ型呼吸衰竭患者行纤维支气管镜肺泡灌洗治疗实施的护理.结果 所有患者行支气管肺泡灌洗后症状明显好转,血气分析较灌洗前明显改善( P＜0.05).结论 Ⅱ型呼吸衰竭患者行支气管肺泡灌洗治疗,充分的术前准备、术中配合、术后的严密观察是提高临床疗效的关键.     

经纤维支气管镜篮形异物钳在儿童隐匿性支气管异物取出术围术期护理中的应用

目的探讨经纤维支气管镜篮形异物钳取出儿童隐匿性支气管异物的疗效及其围术期护理措施。方法选择该院2013年1月～2016年12月儿童隐匿性支气管异物经纤维支气管镜篮形异物钳取出术病例24例,进行术前的心理、患儿及物品准备,术中体位配合、监护、钳取配合、并发症观察,术后监护与健康宣教等护理。结果所有患儿均成功取出异物,术中配合术者尝试使用篮形异物钳操作次数为（2．32±1．44）次,用时为（69．60±43．06）s,术后未发生严重并发症。术后呼吸科专科门诊随诊随访率为91．67％（22／24）,首次复诊时间平均（9．74±5．10）d,复查胸部影像均有改善。结论经纤维支气管镜篮形异物钳取出术配合围术期精心护理是成功取出儿童隐匿性支气管异物的可靠方案。     

支气管镜肺泡灌洗治疗矽肺合并肺内感染的护理

[目的]探讨支气管镜肺泡灌洗治疗矽肺合并肺内感染的护理方法。[方法]对65例矽肺合并肺内感染病人进行常规治疗和纤维支气管镜肺泡灌洗治疗,并给予护理。[结果]经纤维支气管镜肺泡灌洗治疗后,65例病人症状明显减轻,病情好转出院。[结论]进行纤维支气管镜肺泡灌洗操作过程中配合相应的护理措施,熟练掌握术前、术中、术后护理及预防并发症护理方法,可明显提高临床疗效。     

经纤支镜钳取异物14例的护理配合

目的探讨经纤支镜钳取异物的护理方法。方法对14例支气管异物的患者应用纤支镜下异物取出术,同时护理人员加强术前宣教、术中配合和术后严密观察。结果 14例患者中有13例成功取出,1例经硬支气管镜取出,成功率93%,所有患者未发生明显并发症。结论周密的术前准备、心理护理、术中熟练的操作配合,严密观察病情及术后健康指导等护理配合是经纤支镜钳取异物成功的重要保证。     

支气管肺泡灌洗术治疗难治性肺部感染围术期护理

目的：总结纤维支气管镜行支气管肺泡灌洗术（BAL）治疗难治性肺部感染术前、术中、术后护理配合要点。方法：选取21例经多种抗生素全身给药效果不佳的肺部感染病例，所有病例在综合治疗基础上做支气管肺泡灌洗术，1次／5d。护士在支气管肺泡灌洗术前周密准备，术中密切配合，术后严密观察。结果：21例灌洗后临床症状体征明显改善，其中10例阻塞肺不张灌洗3次即复张。结论：BAL围术期精心准备，密切观察、护理对手术成功至关重要。     

经纤维支气管镜钳取小儿支气管异物的术中配合及体会

目的总结经纤维支气管镜钳取小儿支气管异物的术中配合。方法对经纤维支气管镜钳取小儿支气管异物35例患者临床资料进行回顾性分析。结果该组35例小儿支气管异物经纤维支气管镜成功取出33例。结论通过严密的气道管理、娴熟的操作技术与默契配合、体位改变,从而进一步缩短手术时间,降低手术风险,提高手术成功率,减少并发症。     

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.     

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.     

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.     

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.