紫癜性肾炎患儿的中西医护理

儿童过敏性紫癜是全身毛细血管变态反应性炎症,其中伴有肾脏损害者,即称为过敏性紫癜性肾炎[1].2009年中华医学会儿科学分会肾脏病学组制定的儿童《紫癜性肾炎的诊治循证指南(试行)》中统一使用紫癜性肾炎作为疾病诊断名称[2].在我国的发病率占儿童肾脏疾病的9.6％～19.3％,约2.21％的患儿会发展到慢性肾衰竭[3].中医学根据其症状与"尿血""溺血""发斑""葡萄疫""紫癜风"等病症有美,中医药在临床紫癜性肾炎的治疗和预后上显示出了独特的优势和潜力.我院于2010年2月-2011年2月共收治36例紫癜性肾炎患儿,经过中西医结合有效治疗和精心护理,预后良好.现将护理方法报道如下: 1临床资料     

过敏性紫癜患儿变应原的分析及护理

过敏性紫癜是常见的毛细血管变态反应性疾病,其主要病变为皮肤紫癜、关节肿痛、胃肠道症状及肾脏损害为临床特点.本病变好发于春冬季节及2～10岁儿童,病因复杂.引起毛细血管变态反应的致病因素有感染、食物、花粉、虫螨等.为了进一步了解过敏性紫癜患儿致病因素与变应原的关系,本文分析90例过敏性紫癜患儿的变应原测试结果及采取的针对性护理措施.     

血清PCT联合CRP检测在儿童过敏性紫癜中的临床意义

目的探讨血清降钙素原(PCT)和C反应蛋白(CRP)联合检测在儿童过敏性紫癜中的临床意义,为临床寻找诱因及治疗提供依据。方法选取该院2017年6月至2018年6月住院的过敏性紫癜患儿50例(无肾脏损害组30例、有肾脏损害组20例),门诊健康体检儿童20例(对照组),采用免疫化学发光法和免疫散射比浊法同时检测血清PCT和CRP水平。结果过敏性紫癜患儿血清PCT和CRP水平明显高于对照组儿童,差异有统计学意义(P0.05);有肾脏损害组的PCT和CRP均高于无肾脏损害组和对照组,差异有统计学意义(P0.05);有肾脏损害组的PCT、CRP阳性率显著高于对照组,差异均有统计学意义(P0.05)。结论过敏性紫癜合并肾脏损害患儿血清PCT和CRP均升高,联合检测可以提高HSP合并肾脏损害的检出率。     

28例过敏性紫癜患儿行长春新碱冲击治疗的观察及护理

[目的]总结过敏性紫癜患儿行长春新碱冲击治疗的观察及护理。[方法]对28例过敏性紫癜患儿采用长春新碱冲击治疗,同时加强一般护理、冲击治疗全程的护理、不良反应的观察及护理。[结果]出现便秘4例,肝功能损害3例,轻度胃肠道反应1例,轻度末梢神经炎1例,轻度静脉炎1例,在给予相应的护理和对症治疗后完全缓解。[结论]加强过敏性紫癜患儿行长春新碱冲击治疗的观察及护理,可提高治疗效果、减少不良反应的发生。     

2例过敏性紫癜并发抽搐患儿的护理

目的分析2例过敏性紫癜并发抽搐患儿的抢救与护理。方法回顾性总结分析2例过敏性紫癜并发抽搐患儿的护理。结果2例患儿中1例于第17天脑电图检测好转,第20天出院;1例第20天检测无异常痊愈出院。结论 合并神经系统损害的过敏性紫癜患儿起初表现不一,在护理过程中应特别注意观察患儿的精神状态,以便及早发现病情及早治疗,以防神经系统的进一步损害。     

儿童过敏性紫癜75例分析

目的探讨儿童过敏性紫癜（HSP）的临床特点。方法对2007-01-2008-11在广西民族医院儿科住院的75例过敏性紫癜患儿进行回顾分析。结果 75例过敏性紫癜患儿中,100%有皮肤紫癜,42.67%有关节症状,40%有消化道症状,继发肾脏损害者占29.33%。结论儿童过敏性紫癜可造成多器官、多系统损害,应予重视。     

小儿过敏性紫癜23例的护理

目的：探讨过敏性紫癜患儿的护理常规、病情观察及健康教育，以提高对此病的护理认识。方法：收集我科2004-01／2006-01 23例过敏性紫癜患儿的临床资料、护理情况进行总结分析。结果：23例患者中除1例并发肾脏损害转上级医院治疗外其余患者均康复出院。结论：患儿入院后采取心理护理、健康教育、严格饮食管理、病情观察等护理措施对疾病的康复有促进作用。     

中药结肠给药治疗腹型过敏性紫癜的护理

目的：总结中药结肠给药治疗腹型过敏性紫癜的护理体会。方法：对2009年1月-2010年7月收治的56例腹型过敏性紫癜患儿进行中药结肠给药治疗并给予中西医护理，严密观察病情变化。结果：56例腹型过敏性紫癜患儿，经中西医结合有效治疗和精心护理，预后良好。结论：中药结肠给药，加强心理护理和临床护理可促进腹型过敏性紫癜患儿的康复。     

尿微量白蛋白联合血清胱抑素C在过敏性紫癜早期肾损伤中的探讨

目的:探讨尿微量白蛋白、血清胱抑素C在评价过敏性紫癜早期肾损害的临床价值。方法:选取本院住院的过敏性紫癜、紫癜性肾炎患儿各50例,健康对照组50例。免疫比浊法测定尿微量白蛋白;乳胶颗粒增强免疫透射比浊法测定血清胱抑素C。结果:紫癜性肾炎组尿微量白蛋白、血清胱抑素C均大于过敏性紫癜组和健康对照组,差异有统计学意义。紫癜性肾炎组血清胱抑素C与血肌酐、尿蛋白定量及尿微量白蛋白呈正相关;肾活检显示,血清胱抑素C水平与肾脏病理损害、血管损害呈正相关。结论:尿微量白蛋白、血清胱抑素C可作为儿童过敏性紫癜肾脏损害的早期检测指标。     

活血化瘀法结合辨证治疗儿童紫癜性肾炎分析

紫癜性肾炎是小儿继发性肾脏病变中较常见的一种，为过敏性紫癜而致肾脏损害的疾病，好发于学龄期儿童。2000年1月至2005年6月作运用活血化瘀法结合辨证治疗42例紫癜性肾炎患儿，取得了满意疗效，现报告如下。     

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.