1例输液反应结果分析

临床输液治疗时，输液反应经常发生。非手术科室的输液治疗过程中微生物污染性输液反应，占50％以上。对患者发生输液反应并发菌血症进行分析，意在提示临床加强院内感染控制，严格遵守无菌操作规程，减少院内微生物污染性输液反应的发生。     

1例输液反应结果分析

临床输液治疗时，输液反应经常发生。非手术科室的输液治疗过程中微生物污染性输液反应，占50％以上。对患者发生输液反应并发菌血症进行分析，意在提示临床加强院内感染控制，严格遵守无菌操作规程，减少院内微生物污染性输液反应的发生。     

静脉输液反应原因与预防研究进展

目的：总结静脉输液反应的原因,减少输液反应的发生。方法：归纳与分析发当前静脉输液反应存在的因素。结果：最大限度地降低输液反应的发生,确保患者生命安全。结论：加强医护人员的自我防范意识,才能预防和减少输液反应的发生,才能更好地为患者负责。     

临床静脉输液反应的分析与防治

目的：系统分析输液反应的发生原因，寻找积极的预防措施和有效的处理方法。方法：收集2003～2007年发生的40例输液反应资料，按输液反应的发生原因，联合用药情况，加用药物情况，输液反应的类型及分布进行临床研究和分析。结果：发生原因以药物，操作原因发生率高；加用药物以加入中成药发生率高，输液中加入的药物种类越多，输液反应的发生率越高；反应以发热反应最为多见。结论：把好药品和输液器具关，严格掌握病人的输液指征和禁忌，加强无菌观念，规范操作技术，做好三查七对，以减少输液反应的发生；加强对病人的临床观察，若发生输液反应征兆，应立即采取必要的抢救措施，以防止意外事故发生。     

输液反应相关原因分析

输液反应为临床采用输液疗法治疗疾病时出现的各种非治疗效应，是医源性不良反应。导致输液反应的因素较多，患者个体差异的不同又使其临床表现有较大的变异性。为能多环节控制预防输液反应的发生，笔者根据近年来的研究进展和我院临床输液反应发生的情况，对输液反应发生的相关原因进行分析。     

引起静脉输液反应常见因素的探讨

目的分析引起静脉输液反应的相关因素,探讨预防对策,降低临床输液反应发生率。方法对100例发生输液反应患者疾病诊断、体质、病情、输液及配伍药物等项目进行调查和整理,分析影响输液反应的各种因素。结果输液反应原因复杂,主要与药物、气候、患者年龄、所患疾病、过敏史等因素有关。结论输液反应是临床治疗中常见的不良反应,针对其影响因素,制定出行之有效的临床输液安全防范措施,有利于减少输液反应的发生。     

47例老年患者输液反应的分析

目的：探讨老年患者输液反应的原因。方法：收集2003年1月至2004年4月老年患者输液反应记录47例，分析其用药、输液配制操作、患者生理病理等与输液反应的关系。结果：药物、输液配制操作、患者生理、病理状况等均有可能导致老年患者输液反应的发生。结论：重视老年患者输液的各个环节，以减少输液反应的发生和危害。     

发生输液反应的可控制性因素分析与防范对策

[目的]分析门诊病人发生输液反应的可控制性因素,采取积极的防范措施防止异常反应发生,提高输液安全性。[方法]对910例门诊输液病人出现输液反应现象进行观察分析,归类为可控制性、相对可控制性和不可控制性3类因素,相应采取主动防范措施,并观察910例输液病人采取主动防范措施后输液反应的发生率,与原来的发生率进行对比。[结果]采取防范措施前各种输液反应总发生率为3.74%,采取防范措施后总发生率为1.76%,下降了一半,前后对比差异有统计学意义(P<0.05),其中可控制性因素输液反应的发生率由1.43%下降至0.55%。[结论]根据输液反应可控制性、相对可控制性和不可控制性因素采取主动的防范措施可减少输液异常反应的发生,提高输液安全性,保证了病人的健康。     

我院19例输液反应原因分析及防治对策

目的：分析引起输液反应的原因，确定防治对策。方法：通过本院发生的输液反应结合临床工作实践和查阅有关文献资料分析引起反应的原因。结果：对照原因通过积极防治，输液反应明显下降。结论：应加强各方面正规化管理，减少输液反应的发生。     

发生输液反应的可控制性因素分析与防范对策

[目的]分析门诊病人发生输液反应的可控制性因素,采取积极的防范措施防止异常反应发生,提高输液安全性。[方法]对910例门诊输液病人出现输液反应现象进行观察分析,归类为可控制性、相对可控制性和不可控制性3类因素,相应采取主动防范措施,并观察910例输液病人采取主动防范措施后输液反应的发生率,与原来的发生率进行对比。[结果]采取防范措施前各种输液反应总发生率为3.74%,采取防范措施后总发生率为1.76%,下降了一半,前后对比差异有统计学意义（P〈0.05）,其中可控制性因素输液反应的发生率由1.43%下降至0.55%。[结论]根据输液反应可控制性、相对可控制性和不可控制性因素采取主动的防范措施可减少输液异常反应的发生,提高输液安全性,保证了病人的健康。     

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.