快速康复外科护理在跟骨骨折患者围手术期护理中的应用

目的 探究快速康复外科护理对跟骨骨折患者围手术期疼痛、护理满意度及训练依从性的影响效果。方法 选取2018年3月—2019年7月在本院进行跟骨骨折手术治疗的96例患者,将患者随机分为常规组及康复组,对常规组患者施行常规干预,对康复组患者在常规干预基础上实施快速康复外科护理,观察并比较两组患者术后1～3 d疼痛程度、训练依从性、干预前后足部功能以及手术相关指标结果(手术总时间、手术后伤口肿胀消退时间、总的住院花费以及住院总时间)。结果 康复组患者术后1～3 d内疼痛程度均显著低于常规组,有统计学意义(P<0.05);康复组患者术后3 d VAS评分、手术相关指标(手术总时间、手术后伤口肿胀消退时间、总的住院费用以及住院总时间)及训练依从性均显著优于常规组,差异均有统计学意义(P<0.05);康复组患者Maryland评分、根骨交叉角度(Gissane角)及根骨结节关节角度(Bohler角)均显著优于常规组,差异均有统计学意义(P<0.05)。结论 对跟骨骨折患者实施快速康复外科护理,能够有效降低患者围术期疼痛程度,对提高训练依从性、缩短手术时间、促进患者术后恢复、缩短住...     

Footscan足底压力分析系统对骨骨折患者术后康复疗效的评定

目的观察系统康复训练对跟骨骨折患者术后患足功能恢复的促进作用，并同时研究Footscan足底压力分析仪对患者康复疗效的评定价值。 方法共选取62例单侧跟骨骨折患者，经手术治疗后将其随机分为康复组与对照组。康复组患者于术后早期介入系统、规范、全程康复治疗，对照组则遵医嘱进行功能训练。分别于术后3个月、6个月时应用Footscan足底压力分析系统对其进行检测。所得数据采用自身配对比较法进行分析。 结果术后3个月时，2组病例患足在站立相各时期接触时间、足底平均压力及压力时间积分与健足比较，差异均有统计学意义(P<0.05)；在术后6个月时，发现康复组健、患足间上述指标差异无统计学意义（P&rt;0.05），而对照组健、患足间上述指标差异仍有统计学意义（P<0.05）。 结论早期康复训练可显著促进跟骨骨折患者患足运动功能恢复，进一步提高术后疗效；Footscan足底压力分析系统可对跟骨骨折患者术后康复疗效进行客观评定。     

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。     

快速康复理念下早期被动训练在踝关节骨折患者中的应用

目的观察快速康复理念下早期被动训练在踝关节骨折患者中的应用效果。方法选取2016年2月～2017年2月本院收治的90例踝关节骨折病例为研究对象,所有患者均接受踝关节切开内固定术,以随机抽签法将其分为两组,每组各45例,对照组术后予以传统护理,观察组术后实施快速康复理念下早期被动训练。比较两组干预前与干预12周后踝关节运动度数(伸、屈、旋前及旋后)、AOFAS后足评分与Baird踝关节评分、生活质量(GQOLI)评分、干预前与干预4周后踝关节肿胀程度与初始下地行走疼痛(VAS)评分、并发症情况。结果干预12周后,观察组踝关节伸、屈、旋前及旋后角度均显著大于对照组(P 0.05); AOFAS后足评分、Baird踝关节评分、GQOLI量表中躯体功能、社会功能以及心理功能评分明显高于对照组(P 0.05);观察组干预4周后踝关节肿胀程度与初始下地行走VAS评分显著低于对照组(P 0.05);观察组康复期间并发症总发生率(2.22%)明显低于对照组(13.33%)(P 0.05)。结论快速康复理念下早期被动训练可有效减轻踝关节骨折患者术后关节肿胀与疼痛程度,促进踝关节运动功能恢复,提高其生活质量,同时降低并发症风险,对改善患者预后非常有益。     

活血消肿方在经皮撬拨复位克氏针内固定治疗SandersⅡ—Ⅲ型跟骨骨折术后的应用效果

目的观察经皮撬拨复位克氏针内固定术治疗SandersⅡ—Ⅲ型跟骨骨折患者术后应用活血消肿方的效果。方法将97例行经皮撬拨复位克氏针内固定术治疗的SandersⅡ—Ⅲ型跟骨骨折患者按随机数字表法分为2组:对照组48例术后按常规行功能恢复训练;观察组49例术后在常规行功能恢复训练基础上给予活血消肿方煎服。比较2组的临床效果及术前术后Bohler角、Gissane角、疼痛程度(VAS评分)、足部功能(Maryland评分)的变化情况。结果观察组术后Bohler角、Maryland评分及优良率显著高于对照组,Gissane角、VAS评分显著低于对照组,2组比较差异均有统计学意义(P<0.05)。结论经皮撬拨复位克氏针内固定术治疗SandersⅡ—Ⅲ型跟骨骨折患者术后给予活血消肿方,可有效促进患者Bohler角、Gissane角恢复,减轻术后疼痛,改善足部功能。     

髌骨横行骨折经张力带加克氏针固定术后的早期康复

目的:观察髌骨横行骨折经张力带加克氏针固定术后早期床旁一对一指导下的运动康复治疗对患者膝关节功能障碍的疗效。方法:选择髌骨横行骨折经张力带加克氏针固定术后患者35例,采用简单随机抽样的抽签法分为康复组18例和对照组17例。康复组在术后第1天进行康复宣教,再进行一对一指导运动康复治疗2周;对照组在术后第1天康复宣教后自行康复训练。2周后比较2组的膝关节活动度、西安大略和麦克马斯特大学骨关节炎指数(WOMAC)。结果:与对照组比较,康复组的屈膝活动度更大(P0.05);WOMAC指数分值在疼痛和关节功能分值上均较对照组低(P0.05)。结论:髌骨横行骨折经张力带加克氏针固定术后早期床旁一对一指导下的运动康复治疗对膝关节功能恢复有显著的促进作用,显著提高患者术后早期的生活质量。     

静脉泵联合气压泵治疗在踝关节骨折术后患者康复干预中的应用

目的探讨静脉泵联合气压泵治疗在踝关节骨折术后患者康复中的应用效果。方法选取2018年4月至2019年7月我院骨科进行微创手术的92例踝关节骨折术后患者作为研究对象,随机等分为观察组和对照组,对照组给予分阶段康复护理,观察组在对照组基础上实施静脉泵联合气压泵治疗。比较两组患者关节肿胀程度、疼痛评分以及功能恢复情况。结果治疗干预4周后,两组患者踝关节肿胀及疼痛均明显改善,且观察组指标评分明显低于对照组(P 0.05);观察组患者踝关节功能恢复效果明显优于对照组(P 0.05)。结论静脉泵联合气压泵治疗可有效缓解踝关节骨折术后患者肿胀及疼痛程度,促进踝关节功能恢复,改善其预后与生活质量水平。     

加速康复外科护理在跟骨骨折围手术期中的应用效果

目的探讨加速康复外科护理应用于跟骨骨折围手术期的临床效果。方法选取2017年1月—2018年7月本院收治的60例跟骨骨折患者作为研究对象,根据护理方式不同分为观察组及对照组,每组各30例。对照组接受常规外科护理,观察组接受加速康复外科护理,对两组患者伤后第2、4d疼痛VAS评分、术前时间,评估两组患者术后2、4、6d疼痛(VAS评分)、并发症(血栓形成、皮缘坏死、切口裂开、切口感染)的发生率、足部功能(Maryland足部评分)及患者的满意度情况。结果术前观察组伤后第2、4d疼痛VAS评分低于对照组、伤后至手术时间较对照组短,差异有统计学意义(P0.05);术后观察组2、4、6d疼痛VAS评分较对照组低(P0.05),观察组血栓形成及皮缘坏死并发症发生率较对照组低(P0.05),观察组足部功能(Maryland足部评分)及患者满意度高于对照组,差异有统计学意义(P0.05)。结论跟骨骨折围手术期加速康复外科护理,可减轻患者术前及术后疼痛程度,缩短术前消肿时间,降低血栓形成及皮缘坏死的发生率,促进足部功能的恢复,提高患者的满意度,是一种确实有效的方法,值得推广。     

TDP神灯配合肌内效贴对骨折术后功能影响的分析

目的探讨TDP神灯配合肌内效贴对骨折术后功能康复效果的影响。方法选取2020年6月至2021年6月我院收治的下肢骨折术后患者120例,按照不同术后康复方案分为常规康复组和综合康复组各60例。常规康复组术后给予常规康复治疗和训练,综合康复组在常规康复组的基础上给予TDP神灯和肌内效贴治疗。比较两组康复前后患者疼痛程度、患处肿胀程度、膝关节功能及生活质量情况。结果康复治疗前,两组VAS评分、HSS评分、SF-36评分及肿胀程度比较,差异无统计学意义(P>0.05);康复治疗1周后,两组VAS评分均降低,HSS评分、SF-36评分均升高,肿胀程度均减轻(P<0.05),综合康复组治疗1周后VAS评分低于常规康复组,HSS评分、SF-36评分高于常规康复组,肿胀程度轻于常规康复组(P<0.05)。结论TDP神灯配合肌内效贴可显著减轻骨折术后患者疼痛及肿胀程度,促进膝关节功能恢复,提高患者生活质量,临床疗效满意。     

切开复位钢板内固定治疗跟骨骨折30例报告

目的探讨切开复位钢板内固定治疗跟骨骨折的临床疗效。方法对30例（共36足）跟骨骨折患者采用切开复位钢板内固定治疗。术中侧位C臂监测Bohler角及Gissane角,并于术后6周、1年分别摄片观测Bohler角及Gissane角恢复情况。采用AOFAS评分标准评定足部功能恢复情况。结果 30例术后均获随访,随访时间12～24个月,平均16个月。优22足,良8足,可6足,优良率达83.3%。结论切开复位钢板内固定治疗跟骨骨折疗效满意。     

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.