食管癌合并糖尿病患者术后切口感染的护理

总结食管癌合并糖尿病患者手术后切口感染的护理.回顾性分析我院在2010年1月至2012年1月收治的756例食管癌患者术后切口感染护理措施.经过临床换药及护理后,患者术后切口愈合良好,疗效满意.对于术后发生切口感染的患者使用爱康肤银换药,加上实施科学有效的护理,严格控制血糖,能降低手术并发症,提高手术成功率.     

长期气管切开患者进行切口氧疗的效果观察

目的 通过对长期气管切开患者的切口在常规切口护理的基础上进行切口氧疗以降低切口感染率.方法 选择气管切开时间大于1个月的患者60例,随机分成对照组与观察组.对照组按气管切开的常规护理方法进行切口护理,观察组按气管切开的常规护理方法加切口氧疗.采用组间对照的方法,进行切口感染率的对比观察.结果 观察组的切口感染率低于对照组,经统计学处理(χ2检验)具有显著性意义(P＜0.01).结论 对切口采用氧气疗法,使切口改变无氧环境,能够降低切口感染率.     

脊柱侧凸后路矫形术患者手术前后护理

总结行单纯后路椎弓根钉棒系统植骨融合内固定矫形术治疗脊柱侧弯患者的护理经验.术前行心理护理,评估肺功能及指导患者呼吸功能锻炼.术后严密监测生命体征,进行神经系统观察,做好体位护理、胃肠道护理、切口和引流管管理及呼吸道护理,进行并发症的观察与护理.本组1例患者出现切口感染,1例脑脊液漏,经及时治疗与护理,切口均Ⅰ期愈合.     

腹部手术后患者切口裂开的原因分析及护理

目的 分析并探讨腹部手术患者术后切口裂开的原因及护理对策.方法 回顾性分析1998年1月-2008年6月腹部手术后切口裂开患者的临床资料,了解切口裂开的原因分布,总结护理措施.结果 腹部伤口裂开受多方面因素综合影响,与患者基础疾病,术中麻醉,缝合技巧,术后护理等有关.结论 从患者入院开始就应注意与切口裂开的有关因素,并进行相应治疗护理.纠正营养不良,加强基础疾病的治疗,注意缝合技巧均有助于降低腹部切口裂开的发生率.     

泌尿外科后腹腔镜手术后患者疼痛的原因分析及护理对策

目的 探讨引起泌尿外科后腹腔镜手术后的疼痛因素,总结相应的护理对策,以期缓解或消除患者术后疼痛感.方法 将腹腔镜术后疼痛分为切口疼痛及非切口疼痛,分别给予相应的护理措施如引流管护理、音乐干预、体位纠正及心理护理等措施,对于疼痛严重且不能耐受者给予药物镇痛,观察护理效果.结果 95例术后出现疼痛的患者中切口疼痛42例占44.2%,非切口疼痛73例占76.8%.非切口疼痛者以颈肩部、腰背部疼痛为主.经相应的护理后,87例占91.6%的患者疼痛感减轻,可以耐受疼痛.音乐护理疗法可显著缩短非切口疼痛的持续时间.结论 引起泌尿外科后腹腔镜手术后疼痛的因素较多,非切口疼痛者所占比例较大,针对不同的疼痛类别,在术后给予相应护理,可降低患者疼痛感,提高其生活质量.     

跟骨骨折术后切口皮缘坏死及感染55例预防和护理

目的:探讨跟骨骨折术后切口皮缘坏死及感染的预防和护理方法及效果.方法:对55例患者术前进行情志护理、肿胀部位的护理、疼痛的护理、皮肤护理;术后进行体位护理,保持切口敷料干燥,并进行中药烫熨.结果:2例术后发生切口皮缘坏死,均为手术切口选择过低引起,治疗后愈合.均未发生切口感染.结论:跟骨骨折术后做好预防和护理可加快局部血液循环,促进切口愈合.     

降低外阴癌术后切口感染的相关因素探讨及护理

目的 探讨降低外阴癌根治术切口感染率的手术切口方式和护理方法等相关因素,减轻患者痛苦,预防并发症.方法 选取2009年5月～2011年10月我科收治的行外阴癌根治术患者56例,其中,手术切口和术后卧位改进的27例设为实验组,另外29例为对照组,将两组进行比较.结果 实验组切口感染率较对照组显著降低,无并发症发生.结论 手术方法的改进结合护理卧位改进是降低切口感染率的重要手段,引流管护理、压迫止血、伤口管理、术后排尿排便护理等均为降低切口感染率行之有效的方法.加强围手术期护理,可促进外阴癌根治术患者术后康复,提高患者的生活质量.     

手术患者发生切口感染的手术室相关因素分析及护理对策

目的 探讨手术室切口感染的相关因素,提出手术室预防护理对策,并检验预防护理对策的临床效果.方法 将2010年1～12月在我院手术室接受手术治疗的568例患者作为对照组,通过对患者的一般资料、手术情况以及手术部位切口感染情况进行分析,找出手术室切口感染的相关影响因素,由此提出手术室预防护理对策;2011年1～12月在我院手术室接受手术治疗的574例患者作为观察组,根据提出的手术室预防护理对策进行护理干预,比较对照组和观察组的手术切口感染情况.结果 对照组切口感染率为4.96％,单因素及多因素分析显示,急诊手术、非层流室手术、手术时有参观人员、手术时间＞3 h、接台手术是手术切口感染的独立影响因素.观察组根据手术室护理对策进行护理后,切口感染率为2.09％.对照组和观察组切口感染率比较差异有显著意义(P＜0.01).结论 针对手术室切口感染的相关影响因素提出合理的护理对策,可显著降低手术患者的切口感染率.     

巨大腹壁切口疝修补术32例围术期护理

目的:探讨巨大腹壁切口疝修补术患者围术期护理方法.方法:对32例巨大腹部切口疝患者行无张力疝修补术,并给予精心围术期护理,观察疗效.结果:本组32例患者住院7~10 d,平均7.6 d;I级切口甲级愈合30例,Ⅰ级切口乙级愈合2例;术后3年内复发2例.结论:对巨大腹壁切口疝修补术患者实施围术期整体护理干预,可减少术后并发症,降低复发率,促进患者早日康复.     

糖尿病足18例中西医结合护理

目的 探讨糖尿病足患者的中西医结合护理方法.方法 对18例糖尿病足患者在有效控制血糖、合理应用抗生素,加强营养支持的基础上,进行足部个体化治疗和护理,并给予心理健康指导.结果 本组15例切口一期愈合;3例因低蛋白血症严重,切口水肿渗出,纠正全身营养状况,局部切口换药二期愈合.结论 在控制血糖、控制感染、足够营养支持等系统规范治疗的情况下给予针对性的心理护理、生活护理、局部切口的护理能够提高治疗效果.     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.