PICC联合便携式化疗泵在肿瘤患者5-氟尿嘧啶化疗中的应用

目的观察经外周静脉穿刺中心静脉置管(PICC)联合便携式化疗泵,在肿瘤患者5-氟尿嘧啶化疗中的应用效果。方法将57例肿瘤化疗患者随机分为两组,观察组27例,对照组30例。观察组采用PICC联合便携式化疗泵持续输注,对照组采用浅静脉留置针。观察并比较两组患者静脉炎和胃肠道反应发生情况。结果观察组患者静脉炎和胃肠道反应发生情况明显低于对照组,差异有统计学意义(P<0.05)。结论在肿瘤患者5-氟尿嘧啶化疗中应用PICC联合便携式化疗泵持续输注可减少静脉炎的发生,减轻5-氟尿嘧啶的胃肠道不良反应。     

爱朋全自动注药泵连接PICC管持续输注氟尿嘧啶的护理

总结了25例胃肠癌患者采用爱朋全自动注药泵连接PICC管持续输注氟尿嘧啶的临床护理经验.包括加强化疗前宣教、正确选择静脉和化疗后副反应的观察护理.25例患者均PICC穿刺成功,按要求顺利完成化疗,效果满意.认为爱朋全自动注药泵应用于胃肠癌患者持续输注氟尿嘧啶进行化疗,疗效好、安全、方便,配合PICC管穿刺置管可以预防化疗药物外渗的发生.     

便携式化疗泵联合PICC运用5-氟尿嘧啶的化疗护理

总结了40例使用便携式化疗泵联合PICC输注进行化疗的大肠癌术后患者的护理经验.主要包括PICC的护理、化疗泵的护理、并发症的观察及护理、饮食指导及心理护理等.经治疗护理40例大肠癌术后患者均顺利完成全程治疗,未出现任何不良反应及并发症.认为便携式化疗泵联合PICC输注5-氟尿嘧啶进行化疗能保证化疗准确性、减少不良反应,明显改善患者的生活质量.     

PICC导管与静脉留置针联合便携式化疗泵的应用比较

目的比较经外周静脉穿刺中心静脉置管(PICC)与静脉留置针两种静脉通路联合便携式化疗泵持续输注的应用效果。方法随机选取2012年1月~2014年12月间收治的55例使用便携式化疗泵化疗的患者,25例患者在化疗时应用PICC置管联合便携式化疗泵为A组,30例患者在化疗时应用静脉留置针联合便携式化疗泵为B组,对两组患者静脉炎及患者满意度进行比较分析。结果 A组患者的静脉炎发生情况明显低于B组,两组比较差异有统计学意义(P=0.002);A组患者的满意度高于B组(P=0.011)。结论 PICC导管联合便携式化疗泵持续输注较应用静脉留置针联合便携式化疗泵能有效减少静脉炎的发生,PICC应用于化疗泵具有安全有效,操作简单,使用方便等优点,并能提高患者的生活质量,从而提高患者对护理工作的满意度,值得临床广泛应用。     

便携式化疗泵配合PICC化疗的护理

目的探讨便携式化疗泵联合外周导入中心静脉置管（PICC）化疗的护理方法,旨在提高治疗效果。方法选择2009年1月~2010年1月在我院行便携式化疗泵加PICC化疗癌症患者62例,根据护理方式的不同分为观察组和对照组,观察组31例给予整体护理,对照组给予常规护理。对比分析两组的不良反应及并发症。结果观察组病人不良反应减轻,无1例发生药物外渗性损伤及药物性静脉炎。而对照组有5例患者出现药物外渗,2例发生药物性静脉炎,两组间差异有显著意义（P〈0.05）。两组在10个因子间的得分均有显著意义（P〈0.05）,并且观察组具有更好的患者满意度。结论应用便携式化疗泵配合PICC的化疗具有良好的治疗效果,在此过程中,配合整体护理模式能有效减轻并发症的发生,有效改善患者的生活质量,具有良好的患者满意度。     

两种静脉通路联合化疗泵在消化道肿瘤患者化疗中的应用效果比较

目的:比较外周静脉穿刺中心静脉置管(PICC)与周围静脉留置针(PIV)两种静脉通路联合化疗泵在消化道肿瘤患者化疗中的应用效果。方法:将182例消化道肿瘤患者按入组意愿分为观察组100例和对照组82例,观察组采用PICC联合化疗泵持续输注5-Fu,对照组采用PIV联合化疗泵持续输注5-Fu,比较两组一次置管成功率、导管留置时间、各级静脉炎发生率、药液外渗率以及舒适度情况。结果:两组一次置管成功率、导管留置时间、各级静脉炎发生率和药液外漏率和舒适度比较差异均有统计学意义(P0.05)。结论:在消化道肿瘤患者化疗中应用PICC联合化疗泵治疗,能明显提高一次置管成功率,延长留置时间,明显降低静脉炎发生率和药液外渗率,提高患者舒适度,从而提高患者生活质量。     

PICC不同置管位置配合便携式化疗泵在FORFOX4方案中的应用比较

【目的】比较外周中心静脉导管（PICC）两种置管部位配合便携式化疗泵在行FORFOX4方案中完成化疗药物输注时间的准确性。【方法】将87例行FORFOX4方案的肿瘤患者按置管部位分成2组，A组为经超声下行肘上置管、B组为盲插行肘窝部置管；按无菌技术正确配置化疗泵，按医嘱要求设定泵内液体量为220mL（22h），分别观察比较两组置管位置在携带便携式化疗泵完成输注时间的准确性。【结果】A组按时完成化疗例次比例为95．7％，显著高于B组的81．6％，2组相比较，差异有统计学意义（P〈0．05）。【结论】超声引导下肘上置管其置管部位不影响手臂屈伸运动，也不易打折，能够使患者按时完成化疗，获得了最佳化疗疗效，值得临床推广应用。     

家庭信息化4C模式在结肠癌便携式化疗泵配合PICC持续化疗患者中的应用

目的:探讨家庭信息化4C模式在结肠癌便携式化疗泵配合外周静脉穿刺中心静脉置管(PICC)持续化疗患者中的应用方法及效果。方法:将102例便携式化疗泵配合PICC持续化疗结肠癌患者随机分为观察组50例和对照组52例,对照组采用常规护理,观察组实施家庭信息化4C模式,比较两组干预效果。结果:两组干预后红细胞(RBC)、白细胞(WBC)、血清血红蛋白(Hb)及自我护理能力量表评分高于干预前(P0.05),观察组干预后RBC、WBC、Hb及自我护理能力量表评分高于对照组(P0.05,P0.01)。观察组导管相关感染、液体外渗、导管堵塞、皮肤过敏、消化道症状等不良事件发生率低于对照组(P0.05)。两组干预后焦虑自评量表(SAS)、抑郁自评量表(SDS)评分低于干预前(P0.05),观察组干预后SAS、SDS评分低于对照组(P0.01)。结论:家庭信息化4C模式可提高便携式化疗泵配合PICC持续化疗结肠癌患者的自护能力,改善营养状态,缓解不良情绪,降低不良事件发生率。     

经艾克夫泵输注地塞米松预防氟尿嘧啶化疗性静脉炎的效果观察

目的观察经艾克夫泵持续输注小剂量地塞米松预防氟尿嘧啶化疗引起静脉炎的临床效果。方法将90例氟尿嘧啶2 d化疗方案患者分为观察组和对照组各45例,采用外周浅静脉留置针,观察组在化疗泵注药结束后予原泵注入生理盐水100 mL+地塞米松10 mg持续静脉内缓慢输注冲管,对照组在化疗泵注药结束后撤泵,用生理盐水100 mL+地塞米松10 mg快速静脉滴注冲管,观察两组患者穿刺局部静脉炎发生情况。结果观察组静脉炎发生率9%,对照组42%,两组比较差异具有统计学意义(P0.05)。结论经艾克夫泵持续输注小剂量地塞米松能有效减少氟尿嘧啶化疗性静脉炎的发生,值得临床推广应用。     

PICC联用化疗泵减轻5-Fu导致静脉炎的观察及护理

目的 研究PICC联用化疗泵减轻5-Fu导致静脉炎的观察及护理.方法 将150例患者随机分为观察组和对照组两组,观察组50例,PICC联用化疗泵;对照组100例,化疗药物稀释后直接输入静脉.观察两组静脉炎发生情况.结果 观察组发生静脉炎的几率低于对照组.结论 PICC联用化疗泵能够减轻5-Fu导致的静脉炎.     

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.     

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.