老年患者肠镜检查前肠内营养支持的临床探讨

目的 探讨老年患者肠镜检查前实施肠内营养支持的方法和临床效果.方法 选取我科门诊及病房拟行电子肠镜检查的老年患者40例,随机分为传统组、改良组,每组20例.传统组采用常规方法进行肠道准备,改良组则采用口服肠内营养液,进行肠道清洁准备.结果 改良组的血糖、电解质、自我感觉问卷较传统组有统计学意义(P＜0.05),血压及肠道清洁度无明显差异.结论 老年患者肠镜检查前以口服肠内营养液辅助肠道准备可避免低血糖、电解质紊乱等不良反应及不适的发生,同时可有效地清洁肠道.     

品管圈在降低肠镜患者肠道准备不合格率中的应用效果

目的探讨品管圈活动在我科肠道准备过程中解决实际问题的作用。方法选取该院2016年1~8月行肠镜检查的患者60例作为对照组,实施常规护理;另选取该院2016年9月至2017年4月行肠镜检查的患者60例作为实验组,采用品管圈管理方法,对两组患者肠道清洁度情况、肠道准备不合格率进行比较。结果实验组的肠道清洁度情况与对照组比较,差异有统计学意义(P<0.05),实验组的Ⅰ级和Ⅱ级的比例均高于对照组,差异有统计学意义(均P<0.05)。肠道准备不合格率由实施品管圈前的48.3%显著降低到品管圈后的8.3%,差异有统计学意义(P<0.05)。结论品管圈在肠镜患者肠道准备过程中起到了至关重要的作用,解决了许多细节问题,降低了肠道准备不合格率,提升了护理工作质量,也提高了肠镜成功率。     

共情护理对喉癌术后放疗CT模拟定位的影响

[目的]探讨共情护理在喉癌术后放疗CT模拟定位准备中的应用效果。[方法]选取2014年6月—2016年8月拟行放疗的喉癌术后病人200例,随机分成两组各100例。对照组实施常规肿瘤放疗专科护理,观察组在其基础上给予共情护理干预。比较两组病人放疗CT模拟定位前的生理指标(心率、血压)、定位时的不适程度、满意度。[结果]观察组病人满意度评分为(135.74±5.73)分,对照组病人满意度评分为(117.11±8.92)分,两组比较差异有统计学意义(P0.05);两组病人护理后心率、血压、定位时的不适程度比较差异均有统计学意义(P0.05)。[结论]共情护理能提高喉癌术后放疗病人的CT模拟定位准备效果和满意度。     

专科护理质量指标提高肠道清洁度的临床研究

目的探讨在肠镜前肠道准备中实施专科护理质量指标管理的效果。方法选取2016年1-2月于我院行肠镜检查住院的60例患者为对照组,实施肠道常规准备。选取2016年6-7月行肠镜检查的62例住院患者作为观察组,在常规肠道准备护理基础上,建立包括肠道评估正确率、药物服用正确率、患者肠镜知识知晓率、肠道清洁达标率、肠镜护理记录正确率、医患满意度6方面的护理质量指标及内容,运用专科指标对肠镜前患者肠道准备进行质量管理。比较两组患者肠镜前肠道准备护理质量中肠道评估正确率、用药正确率、患者肠镜知识知晓率、肠道清洁达标率等情况。结果观察组专科质量指标6方面得分均高于对照组,差异有统计学意义(P0.05)。结论肠镜前肠道准备质量指标的实施,能提高肠道清洁度,使肠道准备工作规范标准化,并能提升专科护理质量和护士专科能力。     

精准护理干预应用于结肠镜检查患者肠道准备的效果评价

目的探讨精准护理在结肠镜检查患者肠道准备中的应用效果。方法选取2018年12月至2019年4月在该院住院行结肠镜检查的64例患者作为研究对象,随机分为对照组和试验组,每组32例。对照组进行常规治疗与护理,试验组在此基础上实施精准护理,记录并比较两组的肠道清洁度评分、患者依从性、满意度、不良反应发生率、护士宣教接受度及精准护理干预对心理的影响。结果试验组患者肠道清洁度、肠道准备充分率明显高于对照组,差异有统计学意义(P0.05)。试验组在满意度、依从性、宣教知识接受度、心理影响方面高于对照组,不良反应发生率低于对照组,差异有统计学意义(P0.05)。结论精准护理应用于住院肠镜检查患者肠道准备过程中,提高了患者肠道清洁度,降低了不良反应发生率,保证了治疗的安全、有效。     

老年患者肠镜检查前肠内营养支持的临床探讨

目的探讨老年患者肠镜检查前实施肠内营养支持的方法和临床效果。方法选取我科门诊及病房拟行电子肠镜检查的老年患者40例,随机分为传统组、改良组,每组20例。传统组采用常规方法进行肠道准备,改良组则采用口服肠内营养液,进行肠道清洁准备。结果改良组的血糖、电解质、自我感觉问卷较传统组有统计学意义(P<0.05),血压及肠道清洁度无明显差异。结论老年患者肠镜检查前以口服肠内营养液辅助肠道准备可避免低血糖、电解质紊乱等不良反应及不适的发生,同时可有效地清洁肠道。     

协同护理在小儿肠镜检查前肠道准备中的应用效果分析

目的 分析小儿肠镜检查前肠道准备中应用协同护理的临床效果。方法 选取 2020 年 1 月至 2022 年 2 月我院接受肠镜检 查的患儿 100 例作为研究对象。采用随机数字表法分为对照组和观察组,每组各 50 例。对照组肠镜检查前实施常规肠道准备, 观察组肠镜检查前以协同护理为基础实施肠道准备。比较两组的肠道准备用药情况、肠道清洁度、肠道准备中不良反应发生情 况、护理满意度。结果 观察组的开塞露灌肠次数、术前口服乳果糖天数均比对照组显著减少（P＜0.05）。观察组的肠道清洁 度显著高于对照组（P＜0.05）。观察组的头晕乏力、恶心呕吐、腹痛腹胀、肛周不适等不良反应发生率均低于对照组,不良反 应发生率显著低于对照组（P＜0.05）。观察组的护理满意度显著高于对照组（P＜0.05）。结论 协同护理应用于小儿肠镜检查 前肠道准备中的作用效果显著,可减少开塞露灌肠次数、术前口服乳果糖天数以及肠道准备中不良反应发生率,提升肠道清洁 度和护理满意度。     

共情护理在无痛肠镜检查患者中的应用

目的：探讨共情护理在无痛肠镜检查患者中的应用方法及效果。方法：将85例行无痛肠镜检查患者随机分为观察组43例和对照组42例,对照组给予常规护理,观察组在对照组基础上实施共情护理,比较两组护理效果。结果：两组患者护理后焦虑自评量表（SAS）及抑郁自评量表（SDS）评分、满意度、依从性、并发症发生率比较差异有统计学意义（P ＜0.05）。结论：共情护理能有效改善无痛肠镜检查患者的焦虑、抑郁情绪,提高患者依从性及满意度,减少并发症。     

探讨复方聚乙二醇电解质散与二甲硅油散对老年结肠镜检查前肠道准备效果的影响

目的 探究复方聚乙二醇电解质散与二甲硅油散对老年结肠镜检查前肠道准备效果的影响。方法 选取徐州市中医院2020年1月—2021年12月期间198例接受结肠镜检查的老年患者,以随机数表法分为对照组99例、观察组99例,在其结肠镜检查前肠道准备中,对照组应用复方聚乙二醇电解质散干预,观察组应用复方聚乙二醇电解质散联合二甲硅油散干预。比较两组不良反应发生率、肠道清洁度、肠道内气泡量、结肠镜检查时间、生理盐水冲洗量及医生对肠道准备的满意度。结果 观察组不良反应发生率为10.10%,低于对照组的23.23%,差异有统计学意义(χ²=6.146,P<0.05);观察组肠道清洁度D级占比为86.87%,肠道内气泡量Ⅳ级占比为85.86%,较对照组的72.73%、70.71%高,差异有统计学意义(χ²=6.141、6.684,P<0.05);观察组肠镜检查时间(12.37±2.39)min短于对照组的(17.43±2.70)min,生理盐水冲洗量(32.59±6.26)mL少于对照组的(57.24±8.47)mL,差异有统计学意义(t=13.96...     

漫画示意法在肠镜检查患者肠道准备中的应用

目的探讨漫画示意法对提高门诊肠镜检查患者肠道准备效果价值。方法选择门诊首次肠镜检查患者300例,采用口服聚乙二醇电解质散行肠道准备,随机分成常规组148例,采用常用宣教方式,漫画组152例应用漫画进行肠道准备宣教。比较两组肠道准备效果。结果肠道清洁评分、患者接受度漫画组为(3.20±0.54)、(3.50±0.38)分,常规组为(2.50±0.50)、(2.80±0.35)分,两组间肠道准备质量及接受度有统计学意义(P0.05);两组不良反应发生率漫画组和常规组分别为19.7%及20.9%,差异没有统计学意义(P0.05)。结论漫画示意法门诊患者接受度高,可以提高门诊患者肠道准备质量。     

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.