剖宫产术后早饮食对排气的影响

目的:探讨剖宫产术后,产妇早饮食的安全性。方法:将39例初产妇随机分为实验组和对照组,两组产妇术后均禁食6 h,实验组术后6 h进普食,先给半流饮食,由少到多逐渐过渡到普食。对照组产妇术后6 h进流质饮食,排气后改普食,先半流饮食逐渐过渡到普食。观察两组肠鸣音恢复时间及肛门排气的时间。结果:实验组肠鸣音恢复及肛门排气时间均短于对照组。结论:剖宫产术后早饮食是安全的,并可促进肠鸣音的及早恢复和肛门排气。     

剖宫产术后早期应用开塞露的临床观察

目的:研究剖宫产术后6h应用开塞露与不用开塞露肛门排气、肛门排便、乳汁分泌情况。方法:观察组术后6h应用开塞露,对照组不加任何干预因素,观察并记录2组肛门排气、排便及乳汁分泌充足所需时间。结果:2组比较,P<0.05,有显著性差异。结论:剖宫产手术后应用开塞露有利于缩短肛门排气、排便时间,促进乳汁分泌。     

剖宫产术后促使产妇早进食早泌乳的护理研究

为促使剖宫产术后产妇早进食、早泌乳，满足母乳喂养的需要，选取360例剖宫产产妇，随机分为两组，实验组于剖宫产术后6h口服果导2片，7h进流质饮食，12h进半流质饮食；对照组于术后肛门排气后再进食。结果：实验组肛门排气时间比对照组明显缩短（P＜0．05），泌乳时间提前，泌乳量也增加（P＜0．05）。认为剖宫产术后适当刺激肠蠕动，对恢复产妇饮食、改善泌乳有积极作用。     

剖宫产术后两种饮食护理方法对比分析

目的:探讨剖宫产术后饮食护理对产妇身体恢复和母乳喂养的影响。方法:将剖宫产术后产妇200例随机分为观察组和对照组各100例,观察组产妇不禁食,24 h内完成由流质到普食的过渡;对照组按腹部手术后饮食护理常规护理。结果:观察组产妇肛门排气时间、初次下床活动时间、乳汁开始分泌时间早于对照组(P<0.01);观察组口渴、饥饿、焦虑发生率低于对照组(P<0.05)。结论:剖宫产术后不禁食,尽早恢复普通饮食不会诱发或加重恶心、呕吐及腹胀,且可促进产妇身体恢复及乳汁分泌。     

促进剖宫产术后早期恢复的护理研究

目的探讨促进剖宫产产妇术后早期恢复的护理方法。方法将200例剖宫产产妇随机分为对照组（n=100）和实验组（n=100）,对照组采用传统的护理方法。实验组术后2h协助产妇翻身,取随意卧位,鼓励产妇床上自主活动或被动活动,术后6h取半卧位或坐位,24h协助产妇下床活动,并逐步加大活动量;术后6h进食200ml无糖无奶的清流质饮食,观察消化道反应,逐步过渡到半流质饮食、普食。结果实验组产妇术后首次下床活动时间、肛门排气、排便时间较对照组明显提前;实验组与对照组24h内泌乳量差异无统计学意义（P〉0．05）,而48h和72h奶量足和奶量中的例数实验组多于对照组,有统计学意义（P〈0．01、P〈0．05）。结论剖宫产产妇术后早期翻身、取随意卧位,早期活动,早期进食,不仅可促进产妇的早期恢复,并可促进乳汁分泌。     

饮食护理对剖宫产术后泌乳和胃肠功能恢复的影响

目的：探讨饮食护理对剖宫产术后患者泌乳和胃肠功能恢复的影响。方法选取2013年间于本院行剖宫产术的108例产妇作为研究对象,根据入院单双号将其分为观察组和对照组两组各54例。对照组采取剖宫产术后常规护理,观察组在此基础上给予饮食干预。观察两组产妇剖宫产术后泌乳开始时间及肛门排气时间。结果观察组开始泌乳时间（36.82±3.45） h、排气时间（28.78±4.39）h明显低于对照组（P＜0.05）;观察组＜24 h产妇泌乳、排气（88.89％、70.37％）、母乳充足（87.04％）明显高于对照组（ P＜0.01）。结论饮食护理能有效促进产妇泌乳,增加乳汁分泌,改善胃肠功能,对促进产妇产后恢复及增强新生儿免疫力具有积极的临床意义。     

对剖宫产术后病人排气时间的影响

目的观察番泻叶茶饮对剖宫产术后病人排气时间的影响。方法随机将85例女性患者分为两组，观察组45例，对照组40例，观察组在手术后8h服用番泻叶茶饮直至术后第1次排气后停用，期间进少量流质饮食；对照组按剖宫产术后护理常规护理。结果观察组病人肠鸣音恢复时间、首次肛门排气时间、首次排使时间均比对照组病人明显缩短（P〈0．01），结论剖宫产术后病人术后8h服用番泻叶茶饮及进食少量流质饮食，明显有利于病人肠功能的恢复，而且早期进食可为病人提供合理营养，促进母乳分泌及利于机体早日康复。     

剖宫产术后产妇早期翻身的临床探讨

目的　探讨剖宫产术后产妇何时开始取随意卧位对促进乳汁分泌、肛门排气、提高产妇舒适度的作用。方法　选择 2 0 0 3年 7月～ 2 0 0 4年 2月本院 12 0例行剖宫产的产妇 ,根据入院号为单号者 6 0例产妇为观察组 ,在产妇剖宫产术后入病房头垫枕头平卧后早期采取随意卧位 ,即侧卧、平卧、左右半侧卧位、低半卧位 ,术后产妇意愿选择。同时以入院号为双号者 6 0例产妇为对照组 ,常规术后去枕平卧 6～ 8h后随意体位。观察 2组产妇主观舒适度、肛门排气时间、第 1次下床活动时间、泌乳时间。结果　观察组主观舒适度、肛门排气时间、泌乳时间与对照组相比有统计学意义 (P <0 .0 1)。结论　剖宫产术后早期随意卧位使产妇更舒适 ,肠蠕动恢复更快 ,乳汁分泌更早。     

服用萝卜汤促进患者术后肛门排气的效果探讨

目的探讨萝卜汤对患者术后肛门排气的作用。方法选择行腹式全子宫切除术120例。2009-04-2009-07入住我科60例患者为实验组,术后患者禁食水6 h后给予白萝卜汤少量频服。2009-08-2009-11入住我科60例患者对照组,术后患者禁食水6 h后给予温开水少量频服。结果术后患者肛门排气时间实验组为（23.5±7.2）h,对照组为（48.0±5.8）h。患者术后第一次排便时间实验组为（51.2±6.0）h,对照组为（70.2±5.8）h。两组比较差异有统计学意义。结论服用白萝卜汤对患者术后肛门排气排便有促进作用。     

剖宫产术后产妇早进食、早泌乳对母婴健康的影响

目的 观察剖宫产术后产妇早进食、早泌乳对母婴健康的影响.方法 将360例剖宫产术后产妇按随机数字表法分为观察组和对照组,每组180例.观察组术后6h给予流质饮食,10～12h后改为半流质饮食,肛门排气后恢复正常饮食;对照组产妇术后禁食6h,肛门排气后进食半流质饮食,排便后恢复正常饮食.比较2组产妇的初乳时间、泌乳量、肛门排气时间和子宫复旧情况.结果 观察组产妇的初乳时间、泌乳量、肛门排气时间及子宫复旧情况等均明显优于对照组(均P<0.05).结论 剖宫产术后产妇早进食可促进早泌乳和增加泌乳量,满足新生儿的需要量.同时,早泌乳有利于产妇早日康复,提高母乳喂养成功率,促进新生儿的健康成长.     

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.     

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.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.