肠液回输在婴幼儿小肠造瘘术后的应用

小肠造瘘术是婴幼儿各种危重急腹症如绞窄性肠梗阻、肠坏死及肠穿孔手术处理中,常用手段之一[1]。由于术后自造瘘口丢失肠液过多,患儿可出现脱水、电解质紊乱、营养不良等,严重者不得不依赖静脉营养支持,直至二期手术闭瘘。近年来,我们对出现上述症状的9例小肠造瘘术后婴幼儿,通过收集近端造瘘口排出的肠液,经远端造瘘口回输治疗,患儿水、电解质紊乱得以控制,营养得到维持,可院外护理待闭瘘手术施行,免除长期肠     

造口综合护理对新生儿肠造瘘在减少术后并发症中应用效果

目的探讨造口综合护理对新生儿肠造瘘的术后并发症的影响。方法选取2016年12月—2017年5月收治的肠造瘘新生儿45例为观察组,给予造口综合护理。选取2016年7—11月收治的肠造瘘新生儿42例为对照组,给予造口常规护理。比较2组造口使用情况、并发症及患儿家属的护理满意度。结果观察组第1个造口袋使用时间长于对照组,造口袋护理费用少于对照组,更换造口袋时间短于对照组(P0.05);观察组的造口脱垂、周围皮炎、肠液外漏、感染等并发症发生率低于对照组(P0.05);观察组家属的护理满意度高于对照组(P0.05)。结论造口综合护理能够减少新生儿肠造瘘的并发症,延长造口袋的适应寿命,提高家属的护理满意度。     

肠瘘治疗过程中自体消化液回输方法的探讨

目的 总结肠瘘治疗过程中自体消化液回输的护理经验.方法对3例小肠外瘘患者在漏口处放置造口袋采集消化液,利用低压强式负压持续吸引回收,运用自制的肠液回输器经空肠营养管加热后回榆给恚者.结果 3倒肠痿患者均获得满意疗效,未出现相应的并发症.结论 自体消化液回榆在肠瘘治疗中有积极作用,效果满意.     

自制腹带在新生儿肠造瘘术后的护理应用

目的 探讨新生儿肠造瘘术后,造瘘口创面愈合及保持周围皮肤完整的最佳效果.方法 选择同类病例观察组20例及对照组20例,对照组采用传统的纱布敷料覆盖,一次性尿布固定,观察组采用纱布敷料覆盖,自制弹力腹带包裹,观察术后7 d,造瘘口切口愈合的时间及周围皮肤的改变.结果 观察组造口皮肤I期愈合率经x2检验P＜0.05有显著性差异.结论 自制弹力腹带应用于新生儿肠造瘘术后,减少了因新生儿啼哭、躁动而造成的腹压增高、肠液外溢,对造口周围皮肤的侵蚀而延迟切口愈合,同时弹力腹带易于患儿固定、利于护士观察、操作简捷、实惠经济,值得推广.     

自制腹带在新生儿肠造瘘术后的护理应用

目的 探讨新生儿肠造瘘术后,造瘘口创面愈合及保持周围皮肤完整的最佳效果.方法 选择同类病例观察组20例及对照组20例,对照组采用传统的纱布敷料覆盖,一次性尿布固定,观察组采用纱布敷料覆盖,自制弹力腹带包裹,观察术后7 d,造瘘口切口愈合的时间及周围皮肤的改变.结果 观察组造口皮肤I期愈合率经x2检验P＜0.05有显著性差异.结论 自制弹力腹带应用于新生儿肠造瘘术后,减少了因新生儿啼哭、躁动而造成的腹压增高、肠液外溢,对造口周围皮肤的侵蚀而延迟切口愈合,同时弹力腹带易于患儿固定、利于护士观察、操作简捷、实惠经济,值得推广.     

自制腹带在新生儿肠造瘘术后的护理应用

目的 探讨新生儿肠造瘘术后,造瘘口创面愈合及保持周围皮肤完整的最佳效果.方法 选择同类病例观察组20例及对照组20例,对照组采用传统的纱布敷料覆盖,一次性尿布固定,观察组采用纱布敷料覆盖,自制弹力腹带包裹,观察术后7 d,造瘘口切口愈合的时间及周围皮肤的改变.结果 观察组造口皮肤I期愈合率经x2检验P＜0.05有显著性差异.结论 自制弹力腹带应用于新生儿肠造瘘术后,减少了因新生儿啼哭、躁动而造成的腹压增高、肠液外溢,对造口周围皮肤的侵蚀而延迟切口愈合,同时弹力腹带易于患儿固定、利于护士观察、操作简捷、实惠经济,值得推广.     

亲情化护理结合暗示性心理护理在肠造瘘术后患儿造口护理中的应用

目的:探讨亲情化护理结合暗示性心理护理在肠造瘘术后患儿造口护理中的应用效果。方法:将2017年8月1日～2018年7月31日32例肠造瘘患儿分为对照组,采取常规护理干预;将2018年8月1日～2019年8月31日46例肠造瘘患儿分为研究组,在对照组基础上采取亲情化护理结合暗示性心理护理干预。比较两组造口袋使用情况、患儿术后并发症发生率及家长护理服务满意度。结果:研究组第1个造口袋使用时间、造口袋更换时间均长于对照组(P0.01),造口袋护理费用少于对照组(P0.01);研究组术后并发症发生率低于对照组(P0.01);研究组家长护理服务总满意度高于对照组(P0.05)。结论:亲情化护理结合暗示性心理护理可延长造口袋使用时间,减少造口袋护理费用,降低术后并发症发生率,提高患儿家长护理服务满意度。     

改良婴儿肠造口袋粘贴方法的效果观察

目的探讨改良造口袋粘贴法在婴儿肠造瘘口护理中的应用效果。方法选取2008年6月—2012年8月在本院行结肠双腔造瘘术住院患儿64例,根据抽签法分为观察组和对照组各32例,对照组采用常规方法粘贴肠造瘘袋,观察组应用水胶体敷料和3M敷贴改良粘贴肠造瘘袋方法,比较两组造口袋保留天数、造口袋松脱例数、肠液外漏例数、造瘘口周围皮肤潮红糜烂例数。结果两组患儿造瘘口均正常排气排便,观察组造口袋保留天数大于对照组,造口袋松脱例数、肠液外漏例数、瘘口皮肤潮红糜烂例数少于对照组,差异均有统计学意义(P0.05)。结论改良造口袋粘贴法在婴幼儿肠造瘘护理应用中有造口袋不易松脱,保留时间长,肠液外漏、造口周围皮潮红糜烂发生减少的优势,可提高婴儿肠造瘘护理质量。     

多学科协作模式在新生儿肠造瘘术后护理中的应用效果分析

目的 探讨多学科协作模式在新生儿肠造瘘术后护理中的应用效果。方法 选取2019年1月～2019年12月我院收治的肠造瘘手术且术后进行常规护理干预的22例新生儿纳入对照组,将2020年1月～2020年12月于我院接受肠造瘘手术且术后进行多学科协作模式护理干预的22例新生儿纳入观察组。比较两组新生儿术后并发症发生情况、第一个造口袋使用时间、家长更换造口袋所需时间及新生儿住院时间。结果观察组新生儿术后各项并发症发生率略低于对照组,但差异无统计学意义(P0.05);观察组第一个造口袋使用时间长于对照组,家长更换造口袋所需时间短于对照组,新生儿住院时间短于对照组,差异有统计学意义(P0.05)。结论 新生儿肠造瘘术后采用多学科协作模式护理,可延长造口袋使用时间,缩短家长更换造口袋时间及新生儿住院时间,一定程度降低术后并发症发生率。     

11例小肠双腔造口患者肠造口的管理

目的报告11例小肠双腔造口患者肠造口的护理。方法注重小肠双腔造口的局部管理,加强肠内营养及肠液回输时的护理。结果 11例患者肠造口血运良好,颜色红润,肠内营养及肠液回输耐受较好,未发生周围皮肤破溃、腹胀腹泻及堵管等并发症,患者营养状况改善良好。结论小肠双腔造口为暂时性造口,良好的护理可以减少和杜绝并发症的不必要发生,与患者营养等治疗同步进行,为患者的下次手术做好充分准备,使患者减少不必要的痛苦和额外的经济负担。     

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.