护理学研究

962433头颈部持续冷敷预防化疗药物所致脱发的临床研究库丽朝…//中华护理杂志一1995,30(11),-醉3~作抖 对30例癌症化疗病人,使用海绵冷敷枕持续头颈部冷敷,对化疗药物所致脱发进行了临床研究。结果表明:使用海绵冷敷枕持续头颈部冷敷,可以减轻化疗药物对毛囊的抑制或损害,达到     

如何护理急性白血病化疗病人？

应认真执行医嘱，减少化疗药物的毒副作用。静注化疗药物时，血管要轮换使用，必须小心，注射速度要慢，以减轻药物对血管壁的刺激。如发生静脉炎，应及时使用普鲁卡因局部封闭或冷敷。药物不可外渗，避免造成组织损伤。为减轻化疗药物对消化道的影响，可按医嘱在化疗前给予镇静、止吐剂。环磷酰胺易引起脱发，但治疗停止后，头发可再生，应向病人解释清楚。环磷酰胺还可引起血尿，     

气囊止血带环头阻滞预防化疗药脱发的方法介绍

抗肿瘤药物多有程度不同的脱发作用,从而增加了病人,特别是女性病人的精神压力。为了防止或减轻化疗中药物的脱发作用,提高病人的生活质量,自1988年以来,我们在化疗中应用气囊止血带阻滞头皮血液供应的方法来预防脱发,其效果满意。临床资料将乳腺癌根治术后行     

MELODIE输液泵在头颈部恶性肿瘤时辰化疗中的应用及护理

[目的]探讨MELODIE输液泵在头颈部恶性肿瘤时辰化疗中的应用,总结护理措施.[方法]总结66例次MELODIE输液泵在头颈部恶性肿瘤时辰化疗中的应用及护理方法,包括MELODIE输液泵的原理及构造、使用方法、化疗泵的观察、心理护理、导管的护理、化疗药物的配制、化疗药物毒副反应的观察及护理.[结果]无一例出现严重不良反应与并发症.[结论]使用MELODIE输液泵时辰化疗减轻了化疗药物的毒副反应,为头颈部恶性肿瘤病人开辟一种新的既保证疗效又降低毒副反应的治疗护理模式.     

巧用一次性手术帽

临床中,脑出血病人常规头部持续用冷敷。常用方法是冰袋冷敷前额及枕后,病人在翻身更换体位时冰袋易脱落或移位。鉴此,我科就地取材,利用病人手术后带回的一次性手术帽来固定冰袋,效果好。现介绍如下。     

巧用一次性手术帽

临床中,脑出血病人常规头部持续用冷敷.常用方法是冰袋冷敷前额及枕后,病人在翻身更换体位时冰袋易脱落或移位.鉴此,我科就地取材,利用病人手术后带回的一次性手术帽来固定冰袋,效果好.现介绍如下.     

三种治疗化疗药物渗漏性损伤的方法的疗效观察与研究

目的：通过对我院肿瘤科病人三种治疗化疗药物渗漏性损伤的临床疗效观察和研究，探讨治疗化疗药物渗漏性损伤的行之有效的方法。方法：对我院肿瘤科2001年1月-2007年1月有化疗药物渗漏性损伤的病人按时间先后依次随机分为ABC组，并将有局部组织肿胀，静脉炎和浅层组织坏死患者均衡的分配到ABC三组中。A组（38例）为发现渗漏后用50％MgSO4持续加压冷敷24h后热敷；B组（40例）为发现化疗药物渗漏后立即用2％山莨菪碱注射液1～2ml局部封闭后用50％MgSO4持续加压冷敷24h后热敷；C组（39例）为发现化疗药物渗漏后用2％山莨菪碱注射液1～2ml加1％利多卡因1～3ml局部封闭治疗后用50％MgSO4持续加压冷敷24h后热敷。结果：A组一周总有效率为52．63％；B组一周总有效率为80％；C组一周总有效率为94．87％。结论：2％山莨菪碱注射液1-2ml＋1％利多卡因1～3ml局部封闭治疗后用50％MgSO4持续加压冷敷24h后热敷是治疗化疗药物渗漏性损伤的行之有效的方法。     

英语会话及医院常用词汇

癌症病人化疗前的护理Nursing care for a Cancer Patient before Chemotherapy病人:那,要脱发吗?护士:化疗不一定都会脱发。它主要与使用某些药物有关,大部分药物是不会引起脱发的。脱发也只是暂时的,停药以后,头发就自然长好了,同时,也存在着个体差异。     

盐酸恩丹西酮预防肿瘤化疗所致恶心呕吐36例临床观察

我们门诊部病房二年收治各种类型癌肿病人需要进行化疗有36例。化疗给患者带来的负面影响除了抑制骨髓造血系统、脱发等，但最常见最主要是影响患者食欲，造成患者恶心呕吐，有的患者还放弃了治疗。为了消除患者对化疗的恐惧心理，除了耐心解释使病人积极配合治疗，更主要是用药物来减轻患者的痛苦。我们用西南合成制药厂合成药物研究所生产     

常用缩略语（英文）

病人：那，要脱发吗？ 护士：化疗不一定都会脱发。它主要与使用某些药物有关，大部分药物是不会引起脱发的。脱发也只是暂时的，停药以后，头发就自然长好了，同时，也存在着个体差异。即使出现脱发，也可以戴发套、戴帽子或扎丝巾，同样非常漂亮的。关于这个问题，您先生已有充分的思想准备，我们已经交流过了，您不用担心。在治疗过程中，我还会具体地给您讲解，与您交流，希望我们合作得很好。     

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.