滴液式灌肠器的设计及临床应用

目的 评价自行设计滴液式灌肠器的应用效果.方法 自行设计滴液式灌肠器,将60例需行保留灌肠的Ⅱ级肝性脑病患者随机分为2组,观察组采用滴液式灌肠器灌肠;对照组使用传统的开放式袋状灌肠器灌肠,比较2组灌肠液保留时间、灌肠前后血氨浓度、药液外溢情况、患者满意度.结果 观察组、对照组灌肠液在肠腔内保留时间分别为(9.0±2.5)、(42.6±3.7)min,有显著性差异(P＜0.01);2组灌肠前血氨浓度分别为(105.2±15.4)、(103.6±14.3)μmol/L,无显著性差异(P＞0.05),2组灌肠后血氨浓度分别为(59.5±10.1)、(94.7±8.8)μmol/L,有显著性差异(P＜0.01);2组灌肠过程中药液外溢发生率分为0、73.3%,有显著性差异(P＜0.01);2组患者的满意度分别为93.3%、70.0%,有显著性差异(P＜0.05).结论 应用滴液式灌肠器保留灌肠可延长药物在肠腔内的保留时间,明显减少灌肠过程中药液外溢,有效提高治疗效果,同时可减轻患者的痛苦.     

带气囊肛管的滴液式灌肠器应用于肝性脑病保留灌肠效果研究

目的评价自行设计的带气囊肛管的滴液式灌肠器应用于肝性脑病保留灌肠的临床效果。方法自行设计带气囊肛管的滴液式灌肠器,将60例需行保留灌肠的II—III级肝性脑病患者按简单数字随机法分为两组,实验组30例采用带气囊肛管的滴液式灌肠器保留灌肠;对照组使用传统的开放式袋状灌肠器保留灌肠,观察并比较两组在灌肠过程中药液外溢情况、灌肠液在肠腔内保留时间、患者的耐受性、舒适度及每次灌肠前后静脉血氨浓度。结果两组在灌肠过程中药液外溢发生率、灌肠液在肠腔内保留时间、患者的耐受性、舒适度及静脉血氨浓度均存在明显差异,差异有显著性意义（P〈0．01）。结论应用带气囊肛管的滴液式灌肠器保留灌肠可延长药物在肠腔内的保留时间,明显减少灌肠过程中药液外溢,有效提高治疗效果,减轻患者的痛苦,提高患者的舒适度。     

输液式灌肠器在中药保留灌肠患者中的应用

目的:探讨输液式灌肠器在保留灌肠中的应用效果。方法:将104例保留灌肠患者随机分为实验组和对照组各52例。实验组使用输液式灌肠器进行保留灌肠,对照组使用简易灌肠器进行保留灌肠,比较两组患者灌肠所需时间、灌肠液保留时间、显小时间、灌肠液外溢、插管时疼痛、堵管等情况。结果:实验组灌肠时间、显效时间低于对照组(P0.01),灌肠液保留时间长于对照组(P0.01),灌肠液外溢、插管时疼痛、堵管发生率均低于对照组(P0.05,P0.01)。结论:输液式灌肠器可明显提高护士的工作效率、患者的治疗效果和舒适度,简化了工作程序,避免了灌肠时的外溢和不适,具有良好的推广前景。     

滴液式灌肠装置的改进及效果评价

[目的]评价自行设计滴液式灌肠装置的临床应用效果.[方法]自行设计滴液式灌肠装置,将104例需大量不保留灌肠的病人随机分为两组.观察组用滴液式灌肠装置灌肠,对照组用传统灌肠装置灌肠.比较两组灌肠效果及脱管、漏液情况.[结果]两组灌肠效果比较差异有统计学意义(P＜0.01).两组灌肠过程中脱管、漏液发生率比较差异也有统计学意义(P＜0.01).[结论]应用滴液式灌肠装置可以提高灌肠效果,明显减少脱管、漏液问题.     

不同保留灌肠法在溃疡性结肠炎应用的效果分析

目的比较三种不同灌肠方法对溃疡性结肠炎的治疗效果。方法将60例溃疡性结肠炎患者随机分为A、B、C三组，各20例，配制相同药物浓度的灌肠液，A组采用传统保留灌肠法，B组采用点滴式保留灌肠法，C组采用改良式保留灌肠法。结果对三组患者行保留灌肠后药液在肠腔内的保留时间以及临床疗效进行比较分析。药液在肠腔内保留时间及临床疗效，B组与A组比较有显著性差异（P〈0．05），C组与A组比较有显著性差异（P〈0．01）。结论改良式保留灌肠法对溃疡性结肠炎疗效显著，可作为溃疡性结肠炎患者优选的保留灌肠法。     

马蹄形防喷溅灌肠器的设计及在肝性脑病病人中的应用

目的:探讨自行设计制作的马蹄形防喷溅灌肠器在肝性脑病病人灌肠中的应用效果.方法:选取2016年10月—2017年5月符合纳入与排除标准的63例肝性脑病病人为研究对象,随机分为试验组31例与对照组32例.两组病人均进行保留灌肠操作,试验组使用自行研制的马蹄形防喷溅灌肠器,对照组使用传统灌肠器.观察两组病人灌肠后静脉血氨浓度、肝功能下降程度,床单位污染、医务人员衣裤污染情况,病人及护理人员满意度.结果:试验组病人灌肠后血氨浓度、肝功能指标(丙氨酸氨基转移酶)明显低于对照组(P<0.05),床单位污染、医务人员衣裤污染发生率明显低于对照组(P<0.05),病人满意度及护理人员操作满意度评分明显高于对照组(P<0.05).结论:将马蹄形防喷溅灌肠器应用于肝性脑病病人保留灌肠中,可在一定程度上提高灌肠液利用率,减少灌肠液的浪费,从而加快病人康复进程,同时有效避免灌肠过程中及拔除肛管后污染床单位及医务人员衣裤的发生,提高病人及护理人员满意度.     

点滴式保留灌肠法的临床应用研究

目的探讨点滴式保留灌肠法在临床应用的护理效果。方法将60例需保留灌肠患者随机分为实验组和对照组各30例。对照组采用传统保留灌肠方法,实验组采用点滴式保留灌肠法,观察2组患者灌肠液保留时间、灌肠液是否外溢、临床疗效及灌肠过程中患者的满意度和护士接受程度。结果与对照组比较,实验组灌肠液保留时间长(P<0.01)、灌肠液外溢明显减少(P<0.01)、患者满意度和护士接受程度显著优于对照组(P<0.01)。结论点滴保留灌肠法可以提高灌肠效果,减轻患者灌肠中的不适,减少药液外溢,延长药物在肠内保留时间,提高治疗护理效果,具有较好的临床推广价值。     

脉冲推注式保留灌肠在治疗溃疡性结肠炎中的应用

目的探讨脉冲推注式保留灌肠对溃疡性结肠炎治疗护理效果。方法100例溃疡性结肠炎患者随机分为观察组和对照组,观察组采用脉冲推注式保留灌肠,对照组采用常规保留灌肠。结果观察组药液在肠内保留时间为6.43±2.70h,对照组为4.33±1.35h;观察组治疗溃疡性结肠炎有效率为90.00%,对照组治疗有效率为74.00%,P<0.05,两组比较,差异有显著意义。结论脉冲推注式保留灌肠治疗溃疡性结肠炎使药液在肠腔保留时间延长,疗效显著,更有利于溃疡性结肠炎的局部治疗。     

温蒲屯汤点滴式保留灌肠治疗慢性盆腔炎的疗效观察

目的 探讨温蒲屯汤点滴式保留灌肠法在治疗慢性盆腔炎中的护理效果.方法 将60例慢性盆腔炎患者随机分为实验组和对照组各30例.对照组采用一般抗菌液传统灌肠法,实验组采用温蒲屯汤点滴式灌肠法,观察两组灌肠液保留时间、灌肠液外溢情况、治愈率及患者满意度.结果 与对照组比较,实验组灌肠液保留时间长(P《0.01)、灌肠液外溢明显减少(P《0.01),治愈率高,患者满意度优于对照组(P《0.01).结论 温蒲屯汤点滴式灌肠法治疗慢性盆腔炎明显优于抗菌药液传统式灌肠法治疗慢性盆腔炎.     

一次性灌肠器的改良与临床应用

目的探讨三通气囊、负压吸引式一次性灌肠器在清洁灌肠中的应用效果。方法将240例结肠癌采用术前清洁灌肠的病人随机分成2组,实验组120例采用改良式一次性灌肠器灌肠;对照组120例采用传统的灌肠法,观察2组病人的不良反应、肠道清洁度、清洁肠道所用的时间及病人的依从性。结果实验组不良反应降低(P<0.01);肠道清洁满意度提高(P<0.01);清洁肠道所用时间缩短(P<0.001);病人依从性提高(P<0.01)。结论改良后的灌肠器设计合理;操作简便;省时省力;减轻病人痛苦,提高了肠道清洁率,值得推广应用。     

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.