不稳定型心绞痛患者六级法早期康复护理程序

目的探讨六级法早期康复活动对于不稳定型心绞痛(unstable angina,UA)患者的康复效果。方法将113例UA患者随机分为康复组60例和对照组53例。对康复组患者实施六级法早期康复活动,对照组采用传统护理方式。比较2组患者的康复效果。结果康复组较对照组平均住院天数明显缩短,差异有统计学意义(P<0.01);出院前6min平均步行距离康复组较对照组明显延长,差异有统计学意义(P<0.01);卧床引起的并发症(便秘)康复组显著少于对照组,差异有统计学意义(P<0.01);2组肺部感染的发生例数比较差异无统计学意义(P>0.05)。结论早期康复活动较传统护理方式优越,能够显著提高不稳定型心绞痛患者的康复效果,值得推广。     

早期康复对不稳定型心绞痛患者的效果观察

目的探讨6级法早期康复活动对不稳定型心绞痛患者的康复效果。方法将113例不稳定型心绞痛患者随机分为康复组60例和对照组53例。康复组患者实施6级法早期康复活动,对照组采用传统的护理方式。比较2组患者的康复效果。结果康复组较对照组平均住院天数明显缩短,差异有统计学意义(p<0.01);出院前6min平均步行距离康复组较对照组明显延长,差异有统计学意义(p<0.01);卧床引起的并发症(便秘)康复组显著少于对照组,差异有统计学意义(p<0.01);2组肺部感染的发生率比较差异无统计学意义(p>0.05)。结论早期康复活动较传统护理方式优越,能够显著提高不稳定型心绞痛患者的康复效果,值得推广。     

重症病毒性脑炎患儿吞咽障碍早期康复护理的效果评价

目的探讨对有吞咽障碍的重症病毒性脑炎患儿实施早期康复护理的效果。方法将44例存在吞咽障碍的重症病毒性脑炎患儿随机分为康复组和对照组各22例。对照组给予小儿神经内科常规护理治疗，康复组除给予常规护理治疗外，在成人吞咽障碍康复训练的基础上结合儿科特点，对患儿实施寓教于乐的吞咽功能康复训练。采用洼田饮水测试和才藤氏的吞咽障碍7级评定法为评定标准，对康复组和对照组患儿分别于康复训练前，康复训练后20d进行吞咽功能的评价。结果康复训练后康复组与对照组吞咽功能经洼田饮水测试比较，差异有统计学意义（P〈0．01）。康复组吞咽功能训练前后经饮水测试比较，差异有统计学意义（P〈0．01），康复组与对照组康复训练后吞咽障碍康复效果比较，差异有统计学意义（P〈0．01），康复组并发症发生率低于对照组（P〈0．01）。结论对重症病毒性脑炎吞咽障碍患儿进行早期吞咽功能康复训练，能改善吞咽功能，减少并发症发生，提高患儿的生活质量。     

脑卒中吞咽障碍早期综合康复的方法及疗效

目的：探讨脑卒中吞咽障碍早期综合康复的方法及疗效。方法：将60例吞咽障碍患者随机分组，其中15例为早期康复组，15例为延迟康复组，另外30例为对照组。根据才藤分级法分级并在康复训练前后进行评分，进行3组间比较。结果：治疗前3组间评分差异无显著性意义（P〉0．05），治疗后，早期康复组、延迟康复组分别与对照组比较差异均有显著性意义（P〈0．01）。早期康复组与延迟康复组比较差异有显著性意义（P〈0．05）。结论：早期康复治疗较延迟康复治疗改善吞咽障碍更明显，早期康复治疗较延迟康复治疗可减少肺部感染的发生，有利于患者神经功能恢复。     

自理模式在脑卒中患者早期康复护理中的应用

目的探讨奥瑞姆（Orem）自理模式在脑卒中患者早期康复护理中的作用。方法2007年1月至2008年10月某院180例脑卒中患者,按照其病例单双号分为对照组和康复组,每组各90例。对照组仅采用整体护理与早期康复护理;康复组除了运用整体护理与早期康复护理外,还根据患者情况采用Orem自理模式中完全补偿系统、部分补偿系统、支持和教育系统。结果康复组肢体运动功能Fugl—Meyer评分较对照组明显提高[（48．11±28．07）vs（63．03±21．88）],差异有统计学意义（P〈0．01）。日常生活能力Barthel指数康复组较对照组明显提高[（51．24±19．07）vs（69.77±21．34）],差异有统计学意义（P〈0．01）。结论自理模式可提高脑卒中患者肢体运动功能及患者的日常生活活动能力,从而能够改善患者的生活质量。     

放松训练对不稳定型心绞痛患者的影响

目的：探讨放松训练（PMR）对不稳定型心绞痛（UA）患者的影响。方法：将86例不稳定型心绞痛患者随机分为观察组和对照组各43例，对照组给予常规护理，观察组在常规护理基础上进行放松训练，2次／d。2周后，比较两组心绞痛改善情况。结果：2周后，观察组心绞痛缓解率明显高于对照组，两组比较有显著性差异（P〈0．05）；观察组患者焦虑、抑郁水平显著低于对照组，两组比较有极显著性差异（P〈0．01）。结论：放松训练能缓解UA患者焦虑及抑郁情绪，改善患者心绞痛症状，对UA患者的治疗有积极作用。     

综合康复对重症脑卒中患者残疾功能改善的作用

目的：探讨综合康复对重症脑卒中患者残疾功能改善的作用。方法：选择重症脑卒中患者80例分为康复组50例和对照组30例。康复组患者入院后生命体征稳定48h起即给予早期综合康复，病情好转或出院后恢复期继续给予社区或家庭综合康复与指导；对照组仅给予简单康复与指导。两组分别于1周内、1，3，6，12个月时用GCS、NIHSS、FMA、ADL进行阶段量化评分，所得数据采用SPSS10．0软件统计。结果：两组间GCS在1个月时差异有统计学意义（P〈0．05）、3个月时NIHSS、FMA差异有统计学意义（P〈0．01），6个月时ADL差异有统计学意义（P〈0．05），12个月时ADL差异有统计学意义（P〈0．05）。结论：综合康复对重症脑卒中患者残疾功能改善有着重要作用。     

人工股骨头置换术后康复干预对生活质量的影响

目的 探讨早期康复干预对人工股骨头置换术后生活质量的影响。方法 将38例人工股骨头置换术患者随机分为康复组（n=20）和对照组（n=18）。康复组于术后24h开始康复干预；对照组行常规护理及随意自我锻炼。2组患者在术后6个月我们进行了问卷调查，结果 康复组的生活质量明显高于对照组，9项评价指标中有7项差异有显著意义（P〈0．01，P〈0．05）。结论 早期康复干预可以促进人工股骨头置换术后患肢关节功能康复，提高生活质量。     

冠心病患者血清超敏C-反应蛋白的表达和意义

目的探讨血清超敏C-反应蛋白（Hs—CRP）与冠心病严重程度的关系。方法218例冠心病患者分为心肌梗死（AMI）急性期组36例、不稳定型心绞痛（UA）组48例、稳定型心绞痛（SA）组42例、AMI恢复期组47例和陈旧性心肌梗死（OMI）组45例，同时选取40例建康体检者作为正常对照组；均进行血清Hs—CRP的测定并进行组间比较。结果冠心病患者的血清Hs—CRP水平明显高于正常对照组（P〈0．01）；AMI急性期组和UA组血清Hs—CRP水平明显高于SA组、AMI恢复期组和OMI组（均为P〈0．01），AMI急性期组亦明显高于UA组（P〈0．01）。结论血清Hs-CRP在预测冠心病的严重程度及心血管事件方面具有重要意义。     

急性脑卒中早期综合康复疗效观察

[摘要]目的观察早期综合康复对急性脑卒中患者的疗效。方法80例急性脑卒中患者随机分为康复组和对照组各40例，给予神经内科常规治疗，康复组在此基础上进行早期综合康复治疗；治疗前和治疗1个月后，采用美国国立卫生研究院卒中量表（NIHSS）、Fugl—Meyer评定量表（FMA）和Barthel指数（BI），评定两组患者的神经功能、肢体运动功能与日常生活活动能力。结果治疗前，两组患者的NIHSS、FMA及BI评分差异无显著性意义（P〉0．05）；治疗1个月后，康复组患者的各项评分均明显高于对照组（P〈0．01）。结论早期综合康复治疗能促进急性脑卒中患者神经功能的恢复，提高其生活质量。     

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.