静舒氧治疗老年髋部骨折围手术期低氧血症的临床观察

目的　探讨静舒氧治疗老年髋部骨折围手术期低氧血症疗效。方法　 10 0例 6 5岁以上髋部骨折围手术期病人分为 2组 :吸氧组和静舒氧组 ;吸氧组采用单鼻导管低流量持续吸氧 ,氧流量 1～ 2L/min ,浓度 2 5 %～ 2 9% ;静舒氧组采用静脉输氧 5 0 0ml/次 ,2次 /d。分别于术后 1周内持续监测SPO2 变化。动脉血气结果正常后即停氧 ,停氧后 3、5d检查动脉血气分析。结果　吸氧组与静舒氧组比较 ,氧疗期间 2组SPO2 与PO2 差异无显著性 ,停氧后第 3天和第 5天 ,SaO2 和PO2 2项指标差异均有显著性。结论　静舒氧能有效的治疗老年髋部骨折病人围手术期低氧血症 ,并能减少术后低氧血症发生率     

舒氧灵治疗老年股骨颈骨折围手术期低氧血症的疗效观察

目的:探讨舒氧灵治疗老年股骨颈骨折围手术期低氧血症的疗效。方法:将60例患者随机分为舒氧灵组和吸氧组各30例,分别给予舒氧灵及单纯吸氧,比较术后1周内PaO2、SaO2变化及停氧后低氧血症发生率。结果:氧疗期间两组SaO2与PaO2差异无显著性,停氧后3d和停氧后5d两组低氧血症发生率有显著性差异(P<0.05)。结论:舒氧灵能有效治疗老年股骨颈骨折患者围手术期低氧血症,减少术后低氧血症发生率。     

静舒氧治疗老年髋部骨折围手术期低氧血症的临床观察

目的 探讨静舒氧治疗老年髋部骨折围手术期低氧血症疗效。方法 100例65岁以上髋部骨折围手术期病人分为2组：吸氧组和静舒氧组；吸氧组采用单鼻导管低流量持续吸氧，氧流量1～2L/min，浓度25％～29％；静舒氧组采用静脉输氧500ml/次，2次／d。分别于术后1周内持续监测SPQ2变化。动脉血气结果正常后即停氧，停氧后3、5d检查动脉血气分析。结果 吸氧组与静舒氧组比较，氧疗期间2组SPQ2与PQ2差异无显著性，停氧后第3天和第5天，SaO2和PQ2 2项指标差异均有显著性。结论 静舒氧能有效的治疗老年髋部骨折病人围手术期低氧血症，并能减少术后低氧血症发生率。     

舒氧灵改善肝破裂术后低氧血症的观察

目的探讨舒氧灵改善肝破裂术后低氧血症的效果.方法将84例急性肝破裂术后病人随机分为2组,各42例.一组为吸氧组(对照组),一组为舒氧灵组(观察组);吸氧组采用单鼻导管低流量持续吸氧,氧流量2～3 L/min术后常规3 d给氧;舒氧灵组采用静脉输液500毫升/次,2次/天,连续治疗3 d后评价疗效.结果吸氧组与舒氧灵组比较,氧疗后3d血氧饱和度(SaO2)虽有一定升高,但无显著性差异,舒氧灵组动脉血氧分压(PaO2)水平较吸氧组升高,丙氨酸氨基转氨酶(ALT)水平较吸氧组下降,两者间差异均有显著性(P＜0.01).结论舒氧灵能有效改善肝破裂术后病人的低氧血症,使PaO2正常范围,从而减少低氧血症发生率,改善预后.     

舒氧灵改善肝破裂术后低氧血症的观察

目的探讨舒氧灵改善肝破裂术后低氧血症的效果。方法将84例急性肝破裂术后病人随机分为2组，各42例。一组为吸氧组（对照组），一组为舒氧灵组（观察组）；吸氧组采用单鼻导管低流量持续吸氧，氧流量2～3L／min术后常规3d给氧；舒氧灵组采用静脉输液500毫升／次，2次／天，连续治疗3d后评价疗效。结果吸氧组与舒氧灵组比较，氧疗后3d血氧饱和度（SaO2）虽有一定升高，但无显著性差异，舒氧灵组动脉血氧分压（PaO2）水平较吸氧组升高，丙氨酸氨基转氨酶（ALT）水平较吸氧组下降，两者间差异均有显著性（P〈0．01）。结论舒氧灵能有效改善肝破裂术后病人的低氧血症，使PaO2正常范围，从而减少低氧血症发生率，改善预后。     

麻醉苏醒室低氧血症病人不同给氧方式的效果观察

[目的]观察麻醉苏醒室低氧血症病人不同给氧方式的效果。[方法]将麻醉苏醒室发生低氧血症的60例病人随机分为观察组和对照组各30例,对照组采取双孔鼻导管吸氧,观察组采取非重复式呼吸面罩吸氧。观察两组病人入苏醒室后即刻(T1)、入苏醒室30min(T2)2个时间点的二氧化碳分压(PaCO_2)、氧分压(PaO_2)、pH值、动脉血氧饱和度(SaO_2);调查两组病人对T2时间点的鼻腔干燥不适、吸氧异味、恶心呕吐及胸闷不适的满意度;观察病人在T1、T2时间点平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SPO_2)。[结果]两组病人组内吸氧前后PaO_2、SPO_2比较,吸氧后T2时间点PaO_2、SPO_2比较,差异有统计学意义(P0.05);观察组在T2时间点心率减慢程度显著高于对照组,差异有统计学意义(P0.05);观察组病人鼻腔干燥不适、吸氧异味满意度高于对照组,差异有统计学意义(P0.05)。[结论]麻醉苏醒室低氧血症病人采取非重复式呼吸面罩吸氧能有效改善氧分压和生命体征,利于术后康复。     

注射用内给氧在抢救脑卒中急性缺氧的作用

目的　观察注射用内给氧治疗脑血管病急性缺氧的疗效及安全性。方法　将发病 1周内存在低氧血症的 6 4例急性脑血管病患者随机分为内给氧治疗组和对照组各 32例 ,观察PaO2 、PaCO2 及SaO2 的改变、临床疗效和副反应。结果　治疗组治疗后PaO2 、SaO2 升高较治疗前有显著性差异 (P <0 0 1) ,治疗组PaO2 、SaO2 升高较对照组有显著性差异 (P <0 0 5 ) ,SaO2 上升时间治疗组较对照组有显著性差异 (P <0 0 5 )。治疗组临床总有效率较对照组有显著性差异 (P <0 0 5 )。结论　注射用内给氧可改善急性脑血管患者的低氧血症 ,特别对抢救有呼吸道梗阻、存在通气和换气功能障碍的脑血管病患者的急性缺氧有独特的作用。     

不同氧疗法对腹部手术后患者低氧血症的影响

目的 :探讨腹部手术后低氧血症的最佳氧疗法。方法 :随机将上中腹部术后 10 0例分为观察组和对照组 ,每组 5 0例 ,观察组吸氧加止痛剂 ,对照组单用氧。比较两组术后低氧血症患者吸氧后 ,SPO2 变化及术后下床活动康复程度。结果 :术后 8h观察组 4 7例SPO2 达 98% ,有效率占 94 %。与对照组差异有高度显著性 (P <0 0 1)。观察组吸氧加止痛剂 ,80 %的患者术后第 6天能下床活动 ,与对照组差异有高度显著性 (P <0 0 1)。结论 :吸氧加止痛剂可使患者早期下床活动 ,有利于术后增加氧合 ,减少耗氧量 ,是改善术后低氧血症的有效措施。     

经鼻高流量吸氧在呼吸衰竭低氧血症患者中的应用

目的:探讨经鼻高流量吸氧在呼吸衰竭低氧血症患者中的应用效果。方法:将2017年5月1日～10月31日收治的20例呼吸衰竭低氧血症患者作为对照组,给予面罩氧疗;将2017年11月1日～2018年3月31日收治的20例呼吸衰竭低氧血症患者作为观察组,给予经鼻高流量吸氧。比较两组循环氧合情况、ICU停留时间、气管插管率及氧疗舒适度。结果:观察组治疗后24 h及治疗结束时循环氧合指标均优于对照组(P0.05),ICU停留时间短于对照组(P0.05),氧疗舒适度评分高于对照组(P0.01)。结论:经鼻高流量吸氧在改善呼吸衰竭低氧血症患者氧合效果方面优于面罩吸氧,能提高患者氧疗舒适度,缩短ICU停留时间。     

血气分析仪在肝硬化患者中的应用价值

[目的]探讨血气分析仪在肝硬化患者中的应用价值，分析肝硬化患者动脉血氧变化的临床意义。[方法]用全自动血气分析仪检测112例肝硬化患者的动脉血氧水平，包括动脉血氧分压（PaO2）和血氧饱和度（SaO2），选择50例健康者作为对照组同时检测。分析肝硬化者的血氧变化以及与肝功能分级和临床表现的关系。[结果]肝硬化组动脉血氧分压（PaO2）和血氧饱和度（SaO2）与对照组比较均有显著性差异（P〈0．01）。肝硬化患者低氧血症总发生率为51．79％，并随着肝功能Child—Pugh分级的增高而上升。在肝硬化者的临床表现中，有胸腹水者、门静脉增宽者、出现蜘蛛痣者其动脉血氧变化均有显著性差异（P〈0．01），上消化出血者动脉血氧变化无显著性差异（P〉0．05）。[结论]通过用血气分析仪进行血氧水平监测，早期发现肝硬化患者低氧血症，有助于及时处理，以提高生存质量。     

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.