重型颅脑损伤患者入院前规范救护对其预后影响

目的探讨GCS≤8分的重型颅脑损伤患者入院前规范救护对预后的影响。方法回顾性分析86例重型颅脑损伤患者急救情况。分为治疗组45例,经过规范的院前救护措施,如保持呼吸道通畅、吸氧等;对照组41例,未经过规范的院前救护措施。比较两组入院时血气分析结果。结果两组的氧合指数及预后差异有统计学意义（P〈0.05）,治疗组优于对照组。结论重型颅脑损伤患者入院时血气分析结果与其入院前救治密切相关。规范的入院前救护,特别是保持呼吸道通畅及吸氧,可降低重型颅脑损伤患者的病死率,改善预后。     

临床护理路径在重型颅脑损伤急诊救护中的应用

目的:探讨临床护理路径在重型颅脑损伤急诊救护中的应用效果.方法:将120例急诊救治的重型颅脑损伤患者随机分观察组和对照组各60例,对照组按常规的急救流程进行抢救,观察组按临床护理路径进行抢救.比较两组患者的急救时间、病情稳定、并发症、死亡率.结果:观察组患者急救时间、并发症发生情况、死亡率均低于对照组,观察组病情稳定例数明显高于对照组,差异有统计学意义(P＜0.05).结论:临床护理路径应用于重型颅脑损伤急诊救护中可缩短患者急救时间,减少并发症,降低死亡率,提高生存质量.     

重型颅脑损伤306例院前救护流程分析

目的探讨重型颅脑损伤患者的院前救护流程,提高颅脑损伤患者的抢救成功率。方法回顾性分析2009-01-2009-12广西柳州市医疗急救指挥中心各急救站急诊出车院前急救306例重型颅脑损伤患者的临床资料。结果 258例重型颅脑损伤患者院前急救成功,抢救成功率为84.31%;死亡48例,病死率15.69%。结论对重型颅脑损伤患者采取及时有效的院前救护流程,可提高患者的成活率,降低致残率和致死率,减少并发症,提高患者生存质量。     

早期综合康复措施对重型颅脑损伤患者意识复苏和生活能力的影响

目的观察早期综合康复措施对重型颅脑损伤患者意识复苏和生活能力的影响.方法将60例无手术适应证的重型颅脑损伤患者随机分为观察组和对照组,各30例.对照组按常规治疗护理,观察组结合早期康复护理、高压氧、激光等综合措施.2组患者在入院时和30 d行GCS评分及Barthel指数评分.结果入院后30 d观察组GCS评分及Barthel指数评分明显高于对照组(P＜0.01).结论采用早期综合康复模式能促进重型颅脑损伤患者意识复苏和生活能力的提高.     

重型颅脑损伤患者院前救护效果分析

目的：探讨院前急救及护理对重型颅脑损伤患者抢救的重要性。方法：选择2003年1月至2006年12月经急诊收治的重型颅脑损伤患者60例进行回顾性分析。对有院前救护和无院前救护患者的愈后进行对比。结果：经院前救护32例患者中治愈率为50％、病死率为12％，无院前救护的28例患者中治愈率为29％、病死率为36％。结论：院前救护提高了重型颅脑损伤患者的生存率，可以改善预后，提高生存质量。对重型颅脑损伤患者加强院前救护是成功救治的关键     

交通伤院前死亡的发生特点及护理对策

目的系统分析交通伤院前死亡的发生特点及其规律。探讨交通伤院前急救的护理对策。方法回顾性分析2001年至2004年交通伤院前救治4760例的临床资料。结果交通伤死亡810例中,院前死亡752例。占92．84％（其中现场死亡413例,占54．92％;运送途中死亡92例,占12．23％;急诊室死亡247例,占32．85％）;死亡的直接原因为重型颅脑损伤481例（63．96％）、严重多发伤113例（15．03％）。结论交通伤死亡病例主要发生在院前阶段,而现场死亡的比例最大,主要致死原因为重型颅脑损伤。可见,注重人员培训和现场救护技术,迅速到达现场,加强对重型颅脑损伤的早期救护,是降低交通伤死亡率的关键和重点。     

早期综合康复措施对重型颅脑损伤患者意识复苏和生活能力的影响

目的观察早期综合康复措施对重型颅脑损伤患者意识复苏和生活能力的影响.方法将60例无手术适应证的重型颅脑损伤患者随机分为观察组和对照组,各30例.对照组按常规治疗护理,观察组结合早期康复护理、高压氧、激光等综合措施.2组患者在入院时和30 d行GCS评分及Barthel指数评分.结果入院后30 d观察组GCS评分及Barthel指数评分明显高于对照组（P＜0.01）.结论采用早期综合康复模式能促进重型颅脑损伤患者意识复苏和生活能力的提高.     

重型颅脑损伤患者急救阶段护理路径应用研究

目的：分析护理路径在重型颅脑损伤患者急救阶段中的实施价值。方法将110例重型颅脑损伤患者随机分为对照组和观察组,每组各55例患者。对照组患者在急救过程中采用传统的急救流程;观察组患者则在急救过程中采用临床护理路径。比较对照组与观察组患者的抢救所用时间,以及病情稳定患者、发生并发症的患者及死亡患者所占比例。结果观察组患者所用时间,以及病死率和发生并发症的患者所占比例均少于对照组患者,且观察组患者病情稳定的患者所占比例高于对照组患者,各指标组间比较差异均有统计学意义（P＜0．05）。结论在重型颅脑损伤患者的急救过程中应用护理路径,能够减少并发症的发生,缩短患者抢救所需时间,降低患者病死率,提高生存率,保证患者的生存质量。     

临床护理路径在重度颅脑损伤救护中的应用

目的 评价临床护理路径在重度颅脑损伤救护中的应用效果。 方法 将收治的重度颅脑损伤患者100例按入院先后顺序分为对照组和观察组各50例。以构建的临床护理路径对观察组颅脑损伤患者实施救护,对照组则使用常规护理路径进行救护。比较2组急救时间、急救费用、病死率及护理满意度。 结果 观察组所用急救时间短、急救费用低、病死率低、护理满意度高。 结论临床护理路径应用于重度颅脑损伤患者,能缩短急救时间、减少急救费用、降低病死率、提高患者及家属的满意度。     

临床急救路径在院前急救颅脑损伤病人中的应用观察

[目的]探讨临床急救路径在院前重型颅脑损伤病人中的应用效果.[方法]从2011年12月-2013年4月院前急救的重型颅脑损伤病例中选取100例为研究对象,随机分为对照组和观察组各50例,对照组按常规急救护理,观察组运用临床急救路径护理.[结果]观察组平均出车反应速度、诊治等待时间、死亡率均比对照组低（P〈0.05）,医患满意度比对照组高（P〈0.05）.[结论]临床急救路径提高院前重型颅脑损伤病人抢救成功率及医患满意度,降低伤残率.     

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.