细节管理在颈椎骨折患者前路减压中应用效果

目的 探讨细节管理在颈椎骨折前路减压中的应用效果.方法 将我院80例采用前路减压治疗的颈椎骨折的患者分为观察组和对照组,对照组围术期采用常规护理,观察组采用细节管理,比较两组的护理效果.结果 观察组的感觉评分、运动评分、日常生活能力评分均显著高于对照组(P＜0.05),观察组的并发症的发生率、护理质量满意度、健康知识知晓率显著优于对照组(P＜0.05).结论 细节管理能够给予颈椎骨折患者正确的指导和护理,促进术后康复,减少并发症.     

“上肢瑜伽训练法”在老年髋部骨折患者肺康复护理中的应用分析

目的 探究老年髋部骨折患者肺康复护理中应用“上肢瑜伽训练法”的临床效果.方法 选择本院60例老年髋部骨折患者为研究对象,采用随机数表法分成对照组和观察组,每组各30例.对照组给予常规康复护理,观察组予“上肢瑜伽训练法”康复护理.比较两组ADL量表(Barthel指数)评分、并发症.结果 观察组ADL评分高于对照组,差异有统计学意义(P＜0.05);两组并发症比较,差异有统计学意义(P＜0.05).结论 老年髋部骨折患者肺康复护理中采用“上肢瑜伽训练法”效果显著,值得推荐.     

循证护理在下肢骨折全方位护理中的效果体会

目的:观察循证护理在下肢骨折全方位护理中的效果.方法:对50例下肢骨折患者,随机分为观察组和对照组,对照组采用常规护理,观察组采用循证护理.结果:观察组本后并发症的发生率低于对照组(P＜0.05),观察组的患者对护理工作的满意度评价显著高于对照组(P＜0.05),对照组的治疗效果明显好于观察组.结论:循证护理能有效地避免下肢骨折术后并发症的发生,改善下肢骨折患者的心理健康,提高患者对护理工作的满意度,改善护患关系.     

快速康复护理路径用于胫腓骨骨折患者护理中的效果探讨

目的 对胫腓骨骨折患者护理中快速康复护理路径应用的效果进行观察.方法 选取我院2018年5月至2020年3月收治的胫腓骨骨折患者46例,随机分为观察组(23例)实施快速康复护理路径,对照组(23例)实施常规护理.对比两组护理效果.结果 护理后,观察组VAS评分低于对照组,下肢运动功能评分高于对照组(P＜0.05);术后并发症发生率对比,观察组高于对照组,差异有统计学意义(P＜0.05).结论 快速康复护理路径在胫腓骨骨折患者护理中应用,护理效果较好,值得推广.     

跟骨骨折经皮复位固定术后渐进性康复与护理

目的观察渐进性康复护理对跟骨骨折患者经皮复位固定术后恢复的效果。方法选取跟骨骨折患者54例,随机分为对照组和研究组,每组27例。对照组采用常规护理,研究组采用渐进性康复护理。分析2组患者的足部功能恢复情况、术后并发症发生率、疼痛程度评分、疼痛缓解率及护理满意度。结果研究组足部功能恢复优良率、护理满意度均显著高于对照组(P 0.05),术后并发症发生率显著低于对照组(P 0.05);研究组干预后视觉模拟评分量表(VAS)评分显著低于对照组(P 0.05),疼痛缓解率显著高于对照组(P 0.05)。结论对经皮复位固定术后跟骨骨折患者采用渐进性康复干预护理,能有效促进患者足部功能恢复,减轻患者术后疼痛,提高护理满意度。     

快速康复护理路径在胫腓骨骨折患者中的应用

目的:探讨快速康复护理路径在胫腓骨骨折患者中的应用效果。方法:将2017年1月~2018年1月94例胫腓骨骨折患者分为观察组和对照组各47例,对照组接受常规护理,观察组接受快速康复护理路径护理,比较两组护理效果。结果:观察组并发症发生率明显低于对照组(P0.05),护理后下肢运动功能评分、运动耐力均优于对照组(P0.05),术后当天及1周视觉模拟评分法(VAS)评分低于对照组(P0.05)。结论:快速康复护理路径在胫腓骨骨折患者中的应用效果突出,能够加快患者康复,降低术后并发症发生率。     

围术期全程心理护理对神经介入治疗术后焦虑、康复的影响

目的 探讨围术期全程心理护理对神经介入治疗患者术后焦虑、康复程度的影响.方法 68例神经介入治疗的患者按照完全随机的原则分为观察组和对照组,对照组采用常规护理,观察组在对照组的基础上采用全程心理护理,比较两组患者术后的焦虑程度及康复效果.结果 观察组的术后的焦虑有显著性改善(P＜0.05),改善效果显著优于对照组(P＜0.05).观察组的神经功能缺损评分、GOS预后情况及并发症、护理质量满意度显著优于对照组(P＜0.05).结论 全程心理护理干预有利于提高患者的心理承受能力,减轻焦虑程度,提高治疗效果.     

超早期康复护理模式在脑卒中偏瘫患者中的应用

目的 探讨脑卒中患者超早期康复护理效果.方法 将160例脑卒中患者随机分为观察组和对照组(各80例),观察组采用超早期康复护理模式,对照组给予常规护理,比较两组患者护理干预前、干预1周后、4周后SIS 3.0量表评分及出院前两组患者并发症发生率.结果 观察组患者干预后1周、4周后SIS得分均高于对照组,出院前并发症发生率低于对照组,差异有显著意义(P＜0.05).结论 超早期系统、规范的康复护理能够提高患者生活质量,减少并发症的发生.     

观察焦点解决康复护理在颈椎骨折伴脊髓损伤患者术后的应用效果

目的 探讨观察观察焦点解决康复护理在颈椎骨折伴脊髓损伤患者术后康复护理中的应用效果。方法 选取 2021 年 1 月 至 2022 年 10 月在我院收治的颈椎骨折伴脊髓损伤患者 98 例作为本次实验的研究对象。按照随机数字表法,将这 98 名病患平 均分为对照组和观察组,每组 49 例。对照组病患给予常规康复护理,观察组病患给予焦点解决康复护理。比较两组的心理状 态,睡眠质量,并发症和护理满意度。结果 对照组的 SDS 评分、SAS 评分及 PSQI 评分均显著高于观察组（P<0.05）。对照 组的总并发症发生率显著高于观察组（P<0.05）。对照组的护理满意度显著低于观察组（P<0.05）。结论 颈椎骨折伴脊髓损伤 患者术后实施观察焦点解决康复护理,能够改善心理状态和睡眠质量,减少并发症,提高护理满意度。     

46例颈椎骨折脱位合并脊髓损伤的护理体会

目的探讨颈椎骨折脱位合并脊髓损伤患者行手术治疗后的护理方法。方法选取46例因颈椎骨折脱位合并脊髓损伤手术治疗后进行康复治疗的患者为实验研究对象,患者随机分为观察组(n=23)和对照组(n=23),对照组行传统常规护理,观察组在对照组的基础上再行疼痛、并发症预防以及功能锻炼护理。术后随访1年,记录比较2组患者脊椎日本骨科学会(JOA)评分、Asia分级以及并发症情况。结果术后1年,2组患者脊椎JOA评分与术前比较,脊髓损伤均有不同程度恢复,且观察组脊椎JOA评分明显大于对照组,差异有统计学意义(P0.05);2组患者术后改善率差异有统计学意义(P0.05);术后1年,2组患者Asia分级均较术前有所提高,且观察组明显优于对照组(P0.05);观察组患者并发症发生率显著小于对照组(P0.05)。结论全面的康复期护理可以减少颈椎骨折脱位合并脊髓损伤患者并发症的发生,加快脊髓损伤患者功能的恢复,值得临床借鉴。     

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.