4种方法预防化疗所致口腔黏膜炎效果的临床观察

目的探讨4种不同方法预防化疗所致口腔黏膜炎效果观察,选择经济、简单、有效的方法。方法将577例接受氟脲嘧啶类为主抗癌药物化学治疗的患者随机分为A、B、C、D组,A组口服别嘌呤醇片,3次/d;B组含漱0.8%别嘌呤醇溶液3次/d、20 mL/次、含漱3-5 min,含漱时间为3餐后冷开水漱口后;C组含漱口洁灵溶液,3次/d、20 mL/次、含漱3-5min,含漱时间为3餐后冷开水漱口后;D组为护理干预组,对患者进行系统健康教育。每天观察并记录发生口腔黏膜炎的病例数、程度及口腔黏膜炎持续时间。结果4组患者口腔黏膜炎的发生率、程度及发生口腔黏膜炎持续时间比较,差异无统计学意义(P<0.05)。结论通过有效的护理干预可以预防化疗所致的口腔黏膜炎,且方法经济、简单,具有一定的临床应用价值。     

4种方法预防化疗所致口腔黏膜炎效果的临床观察

目的探讨4种不同方法预防化疗所致口腔黏膜炎效果观察，选择经济、简单、有效的方法。方法将577例接受氟脲嘧啶类为主抗癌药物化学治疗的患者随机分为A、B、C、19组，A组口服别嘌呤醇片，3次／d；B组含漱0．8％别嘌呤醇溶液3次／d、20mL／次、含漱3～5min，含漱时间为3餐后冷开水漱口后；C组含漱口洁灵溶液，3次／d、20mL／次、含漱3--5rain，含漱时间为3餐后冷开水漱口后；D组为护理干预组，对患者进行系统健康教育。每天观察并记录发生口腔黏膜炎的病例数、程度及121腔黏膜炎持续时间。结果4组患者口腔黏膜炎的发生率、程度及发生口腔黏膜炎持续时间比较，差异无统计学意义（P〈0．05）。结论通过有效的护理干预可以预防化疗所致的口腔黏膜炎，且方法经济、简单，具有一定的临床应用价值。     

联合干预措施预防CF／5-FU致口腔溃疡的临床研究

目的探讨联合预防干预措施预防CF/5-FU致口腔溃疡的效果。方法65例消化道肿瘤患者随机分为A、B 2组,A组患者施加联合预防干预措施:化疗前1周给予口泰含漱液含漱;每天化疗中以4℃冷开水及别嘌呤醇液交替含漱;B组患者仅于化疗时冰水含漱。化疗过程中及疗程结束后的1~21 d内对2组所有患者行口腔黏膜观察并记录。结果A组患者轻度(Ⅰ度)口腔溃疡的发病率与B组比较无显著差别(P>0.05),但A组口腔溃疡总的发病率及重度口腔溃疡(Ⅱ度及以上)的发病率要明显低于B组(P<0.05)。结论联合性预防干预措施能极大地降低CF/5-FU化疗所致口腔溃疡的发病率。     

联合干预措施预防CF/5-FU致口腔溃疡的临床研究

目的 探讨联合预防干预措施预防CF/5-FU致口腔溃疡的效果.方法 65例消化道肿瘤患者随机分为A、B 2组,A组患者施加联合预防干预措施:化疗前1周给予口泰含漱液含漱;每天化疗中以4 ℃冷开水及别嘌呤醇液交替含漱;B组患者仅于化疗时冰水含漱.化疗过程中及疗程结束后的1～21 d内对2组所有患者行口腔黏膜观察并记录.结果 A组患者轻度(Ⅰ度)口腔溃疡的发病率与B组比较无显著差别(P＞0.05),但A组口腔溃疡总的发病率及重度口腔溃疡(Ⅱ度及以上)的发病率要明显低于B组(P＜0.05).结论 联合性预防干预措施能极大地降低CF/5-FU化疗所致口腔溃疡的发病率.     

低温碳酸氢钠液对鼻咽癌放疗口腔黏膜炎的保护作用观察

目的 观察低温碳酸氢钠液对鼻咽癌放疗口腔黏膜反应的保护作用.方法 将31例鼻咽癌患者随机分为实验组和对照组.实验组15例在放疗前、后各含漱10ml低温(4℃)2%碳酸氢钠液5 min;对照组16例患者予甲硝唑溶液(口泰)漱口,2～3次/d.比较2组口腔黏膜炎的发生情况和真菌感染率.结果 实验组和对照组2级以上口腔黏膜炎的发生例数分别为4和14例,差异有统计学意义,P＜0.01.真菌感染发生率分别为0和31.25%(P＜0.05).结论 含漱低温碳酸氢钠液可有效减轻鼻咽癌放疗患者口腔黏膜反应,减少真菌感染发生率,改善患者生活质量.     

口腔溃疡含漱液防治鼻咽癌放射性口腔黏膜炎的效果观察

目的观察口腔溃疡含漱液在鼻咽癌放疗患者放射性口腔黏膜炎防治中的效果。方法按区组随机的方法将100例初治鼻咽癌患者分为A组和B组各50例。B组在放疗期间给予常规口腔护理,当出现I级放射性口腔黏膜炎时开始使用重组人表皮生长因子外用溶液行口咽部喷射,每天4次;A组除给予常规口腔护理外,首次放疗当天开始使用口腔溃疡含漱液,每天6次,每次含漱3min以上。两组患者均从放疗当天开始观察口腔黏膜情况。结果 A组放射性口腔黏膜炎发生的时间延后,程度明显轻于B组(P0.05);使用二阶梯及三阶梯止痛药及需要静脉营养治疗病例数,A组比B组少(P0.05)。结论口腔溃疡含漱液对推迟和减轻鼻咽癌患者放射性口腔黏膜炎有较好的作用。     

中西医结合口腔护理预防化疗患者口腔黏膜炎的效果观察

目的 探讨中西医结合口腔护理预防化疗后口腔黏膜炎的效果.方法 将90例化疗患者按人院单双日分成中西医结合组50例和对照组40例.对照组行常规口腔护理,3次/d,共5 d;中西医结合组在对照组的基础上用自制的"清热解毒漱口液"漱口,3次/d,共5 d.比较化疗后第5天两组患者口腔黏膜炎的发生情况.结果 两组患者口腔护理后第5天口腔黏膜炎发生情况比较,差异均有统计学意义(P<0.01),中西医结合组口腔黏膜炎的发生率明显低于对照组.结论 中西医结合口腔护理可有效地降低化疗后口腔黏膜炎的发生率,其方法简便易行,值得临床推广应用.     

中药含漱液预防白血病化疗患者口腔黏膜炎的效果

目的探讨采用自拟中药含漱液预防急性髓细胞白血病患者化疗后口腔黏膜炎的临床疗效。方法选取2012年10月—2013年10月收治于上海中医药大学附属岳阳中西结合医院血液科行化疗的急性髓细胞白血病患者60例,按随机数字表法分为观察组和对照组各30例;观察组采用自拟中药含漱液含漱,对照组采用生理盐水含漱;比较两组患者化疗后第4天和第10天口腔黏膜炎的发生情况。结果化疗后第4天两组患者口腔黏膜炎的发生率比较,差异无统计学意义(P0.05);化疗后第10天观察组患者的口腔黏膜炎发生率低于对照组,两组比较差异有统计学意义(P0.05)。结论采用自拟中药含漱液含漱可降低急性髓细胞白血病患者化疗后口腔黏膜炎发生率,方法简便易行,且不良反应轻微,有利于患者的康复。     

益口与康复新液联用防治白血病患者化疗性口腔黏膜炎的护理

目的 评价益口与康复新液联用对防治白血病化疗性口腔黏膜炎的临床效果.方法 将80例白血病化疗患者随机分为观察组和对照组各40例.观察组采取先用益口漱口液含漱,2 h后再用康复新液含漱后慢咽,30 min内避免进食进水;对照组则只用益口含漱.采用χ2检验和t检验比较2组口腔黏膜炎改善情况及黏膜反应恢复时间.结果 观察组口腔黏膜炎的改善情况显著优于对照组,观察组口腔黏膜反应恢复时间也显著短于对照组.结论 益口与康复新液联用防治白血病化疗性口腔黏膜炎可减少其发生率,缩短口腔黏膜反应的恢复时间,提高患者的生存质量.     

化疗致口腔黏膜炎的相关因素分析

摘要：目的 探讨化疗所致口腔黏膜炎的相关因素，为制订预防口腔黏膜炎的护理干预措施提供参考。方法 对５６７例接受氟尿嘧啶类为主抗癌药物治疗患者于化疗期口服别嘌呤醇片或含漱０．８％别嘌呤醇溶液预防口腔黏膜炎，每天观察并记录患者口腔情况、化疗不良反应及睡眠情况等。对观察指标进行统计分析。结果 患者发生口腔黏膜炎４９例（８．６％），影响口腔黏膜炎发生的主要相关因素为口腔ｐＨ值、唾液黏稠度、腹泻、睡眠（均Ｐ＜０．０１）。结论 需针对化疗所致口腔黏膜炎的主要相关因素进行护理干预，以降低黏膜炎的发生率及程度，减轻患者的痛苦。关键词：肿瘤；　化疗；　口腔黏膜炎；　相关因素分析中图分类号：Ｒ４７２；Ｒ７８１．５　　文献标识码：Ａ　　文章编号：１００１-４１５２（２００７）１７-０００７-０３     

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.     

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.     

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.     

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.