妇科恶性肿瘤患者经腹手术后早进食的研究

目的 探讨妇科恶性肿瘤患者经腹手术后6 h即给予半流质饮食的安全性和临床意义.方法 以60例经腹手术的妇科恶性肿瘤患者为研究对象,随机分成实验组30例和对照组30例,实验组术后6 h即给予半流质饮食,而对照组则采用传统方法术后6 h进流食,在肛门排气后方改为半流食,比较2组患者术后恶心、呕吐发生情况,肠蠕动恢复时间、肛门排气时间、固体饮食恢复时间、体质量差、血糖、尿酮体、血清前白蛋白变化情况、伤口愈合情况及肠梗阻发生情况.结果 2组患者无一例发生窒息或吸入性肺炎;无一例出现肠梗阻而需胃肠减压;实验组患者术后6 h进半流质饮食后恶心的发生率明显高于对照组(x2=5.51,P＜0.05),固体饮食恢复时间较对照组提早近18 h(t=4.11,P＜0.05),第7天血清前白蛋白值显著高于对照组(t=3.60,P＜0.05),而在呕吐、尿酮体、肠蠕动恢复时间、排气时间、手术前后体质量差和术后第2天血清前白蛋白值等方面差异无统计学意义(P＞0.05).结论 妇科恶性肿瘤患者经腹手术后6 h给予半流质饮食是安全的,而且有助于提早恢复固体饮食,改善患者营养状况,促进术后康复.     

剖宫产术后促使产妇早进食早泌乳的护理研究

为促使剖宫产术后产妇早进食、早泌乳，满足母乳喂养的需要，选取360例剖宫产产妇，随机分为两组，实验组于剖宫产术后6h口服果导2片，7h进流质饮食，12h进半流质饮食；对照组于术后肛门排气后再进食。结果：实验组肛门排气时间比对照组明显缩短（P＜0．05），泌乳时间提前，泌乳量也增加（P＜0．05）。认为剖宫产术后适当刺激肠蠕动，对恢复产妇饮食、改善泌乳有积极作用。     

妇科腹部手术后切口部位微波治疗120例效果观察

目的：观察对妇科腹部手术后患者应用微波治疗的疗效。方法：将240例妇科腹部手术患者随机分为观察组与对照组各120例。观察组于术后6h应用微波治疗仪照射切口部位，对照组不采用微波治疗。两组术后进流质饮食、24h进半流质饮食。结果：两组切口疼痛程度比较有显著性差异（P〈0．01），观察组肛门排气时间及肠鸣音恢复时间比对照组缩短（P〈0．05）。结论：妇科腹部手术后切口部位微波治疗对减轻患者切口疼痛、促进肠鸣音恢复及肛门排气具有显著疗效。     

妇科肿瘤患者围术期饮食方法改良的临床研究

目的 探讨围术期妇科肿瘤患者饮食方法改良对术后恢复的影响,提高妇科肿瘤患者围术期生活质量,减少手术并发症.方法 将90例妇科肿瘤手术患者按不同饮食方法分为3组:安素组、半流食组、常规组.安素组于术前4h进食配方流食125ml(内含安素20g),麻醉清醒后若无恶心、呕吐等不良反应即给予分次饮温开水250ml,若无异常每3h给安素配方流食250ml(含安素40g),改进半流食、软食期间每4h加服安素配方流食250ml共7d.半流食组术前按常规禁食,术后麻醉清醒后给予分次饮温开水250ml,若无恶心、呕吐等不良反应即给予半流食;常规组术前按常规禁食,术后按传统方法给予渐进式饮食.分别观察3组患者术后恶心、呕吐发生率,肠蠕动恢复时间、肛门排气时间;检测术后第1日空腹尿酮体、血糖;术后第2日、第7日血前白蛋白和视黄醇结合蛋白值;比较术前1日、术后第7日空腹体重差,以及伤口愈合情况和肠梗阻情况.结果 安素组和半流食组恶心发生率、术后第1日血糖、术后第2日及第7日血前白蛋白与对照组比较,差异有显著性意义(P<0.05);3组术后肠功能恢复时间及尿酮体比较,差异无统计学意义(P<0.05).结论 对无胃肠干预的妇科肿瘤手术患者,缩短术前禁食时间及术后早进食是安全可行的;围术期营养支持可改善妇科肿瘤患者的营养指标.     

咀嚼口香糖法联合早期半流质饮食对妇科腹部手术患者术后康复的影响

目的探讨咀嚼口香糖法联合早期半流质饮食对妇科腹部手术患者术后康复的影响。方法选取2017年1—12月于我院行妇科腹部手术患者140例为研究对象,随机将其等分为观察组和对照组,对照组行常规饮食指导,观察组行咀嚼口香糖法联合早期半流质饮食。比较两组患者术后胃肠功能恢复情况及并发症发生情况。结果观察组肛门排气时间、腹胀改善时间、肠鸣音恢复时间、排便时间、恢复正常进食时间、平均住院时间均短于对照组(P 0. 05)。观察组体力疲乏、贫血、腹胀、低钾血症发生率均低于对照组(P 0. 05)。结论咀嚼口香糖法联合早期半流质饮食能有效促进妇科腹部手术患者胃肠功能恢复,降低其术后并发症,值得临床推广应用。     

自制经络弹力袜对妇科腹部手术后肠功能恢复的效果研究

目的探讨妇科腹部手术后患者穿戴经络弹力袜对肠功能恢复的影响。方法选择妇科腹部手术患者100例,对照组50例患者按常规护理,实验组50例患者术后穿经络弹力袜,观察并记录患者术后腹胀、首次肛门排气和首次排便时间。结果实验组患者无腹胀发生,对照组4例患者出现腹胀;实验组患者术后首次肛门排气、排便时间均提前（P〈0．05）。结论妇科腹部手术后患者穿经络弹力袜能促进肠蠕动及胃肠功能的恢复,利于尽早康复。     

假饲联合早进食半流质饮食对改善妇科腹腔镜术后患者营养状况的影响

目的探讨假饲(咀嚼口香糖)联合早进食半流质饮食对妇科腹腔镜术后患者营养的影响。方法将234例妇科腹腔镜手术患者,按随机数字表分为咀嚼组78例、半流食组77例和流食组79例。流食组患者按传统方法于术后6h进食流质,肛门排气后进食半流质,排便后进普通饮食;半流食组患者于术后6h进食半流质,排便后进普通饮食;咀嚼组患者麻醉清醒后开始咀嚼无糖口香糖,其余同半流食组。比较3组患者术后1d的血钾值和术后2d的血清视黄醇结合蛋白值。结果咀嚼组与半流食组患者术后2d视黄醇结合蛋白值高于流食组,比较差异均有统计学意义,咀嚼组优于半流食组,比较差异有统计学意义;咀嚼组与半流食组患者术后1d低钾血症发生率低于流食组,比较差异有统计学意义,但咀嚼组与半流食组组间比较差异无统计学意义。结论妇科腹腔镜术后患者给予假饲联合早进食半流质饮食可改善患者的营养状况,降低术后低钾血症的发生。     

腹部按摩对减轻子宫肌瘤术后患者腹胀的疗效

目的探讨腹部按摩对减轻子宫肌瘤术后患者腹胀的疗效。方法将200例子宫肌瘤术后患者随机分为实验组（n=100）与对照组（n=100）。实验组术后6h开始采用腹部顺时针按摩,按摩完毕,协助患者翻身,若术后12、18h未排气,则继续予以按摩;对照组按术后常规处理。嘱患者记录肠蠕动开始时间、首次肛门排气时间,并及时转告护士。结果实验组肠蠕动开始时间为（10．2±3．01）h,第1次肛门排气时间为（16．04±3．02）h,且无腹胀感觉;对照组肠蠕动开始时间为（25．71±4．05）h,第1次肛门排气时间为（35．41±4．69）h,有不同程度的腹胀。两组各指标差异均有统计学意义（P〈0．01）。实验组患者无1例切口感染。结论腹部按摩可缩短子宫肌瘤术后肠功能恢复时间,促进肛门排气,减轻腹胀,有利于提前进食,促进康复。     

胆囊切除术后早期补钾并开塞露直肠注入的护理研究

目的 观察胆囊切除术后早期静脉补钾并开塞露直肠注入促进肛门排气的效果。方法 将胆囊切除术后病人156例平均分为实验组和对照组。实验组术后早期静脉补钾并开塞露直肠注入，对照组则不早期补钾，也不用开塞露。分别观察二组病人肠蠕动恢复时间及肛门排气时间。结果 实验组肠蠕动恢复时间平均为36．4h，肛门排气时间平均为43．9h。对照组肠蠕动恢复时间平均为43．6h，肛门排气时间平均为52．01h。结论 早期静脉补钾并开塞露直肠注入，可以促进病人肠蠕动尽早恢复，肛门排气时间提前。     

促进剖宫产术后早期恢复的护理研究

目的探讨促进剖宫产产妇术后早期恢复的护理方法。方法将200例剖宫产产妇随机分为对照组（n=100）和实验组（n=100）,对照组采用传统的护理方法。实验组术后2h协助产妇翻身,取随意卧位,鼓励产妇床上自主活动或被动活动,术后6h取半卧位或坐位,24h协助产妇下床活动,并逐步加大活动量;术后6h进食200ml无糖无奶的清流质饮食,观察消化道反应,逐步过渡到半流质饮食、普食。结果实验组产妇术后首次下床活动时间、肛门排气、排便时间较对照组明显提前;实验组与对照组24h内泌乳量差异无统计学意义（P〉0．05）,而48h和72h奶量足和奶量中的例数实验组多于对照组,有统计学意义（P〈0．01、P〈0．05）。结论剖宫产产妇术后早期翻身、取随意卧位,早期活动,早期进食,不仅可促进产妇的早期恢复,并可促进乳汁分泌。     

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.     

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.