快速康复外科护理在加速肝胆外科手术患者术后康复中的应用

目的探讨快速康复外科护理在加速肝胆外科手术患者术后康复中应用效果。方法将本科收治的160例患者采用随机数字表法分为对照组和观察组各80例。对照组围术期给予常规护理,观察组采用快速康复外科护理,比较2组手术应激、术后康复情况及住院费用。结果观察组术后1d的皮质醇、肾上腺素、CRP水平低于对照组,HAMA评分均低于对照组,差异有统计学意义(P0.05);观察组的术后恢复时间(下床活动、排气、排便等)均短于对照组,并发症、住院费用少于对照组,差异有统计学意义(P0.05)。结论快速康复外科护理能够降低肝胆外科手术患者的手术应激,加快患者的术后康复,降低治疗费用,值得推广。     

快速康复外科在38例十二指肠球部溃疡穿孔患者中的应用分析

目的采用一系列有循证医学依据的围术期处理的优化措施,以减少十二指肠球部溃疡穿孔患者的生理及心理的创伤应激,达到患者快速康复的目的。方法选择2008年1月-2011年12月72例十二指肠球部溃疡穿孔患者,随机分为快速康复外科组（FTS组）和对照组,其中38例FTS组采用快速康复外科处理措施。结果快速康复外科组患者术后下床活动时间、进食时间、首次肛门恢复排气排便时间、住院时间均短于对照组,痛苦程度和治疗费用均明显低于对照组,2组术后并发症发生率差异无统计学意义。结论十二指肠球部溃疡穿孔患者采用快速康复外科处理措施,与常规处理比较,有着较为明显的优势。     

基于快速康复外科理念的多模式镇痛对腹腔镜手术患者术后康复的影响

目的探讨基于快速康复外科理念的多模式镇痛对腹腔镜手术患者术后康复的影响。方法选取腹腔镜手术患者112例,按照随机数字表法分成对照组和观察组,各56例,对照组接受常规镇痛,观察组接受基于快速康复外科理念的多模式镇痛,比较2组康复效果、视觉模拟评分法(VAS)评分、匹兹堡睡眠质量指数(PSQI)评分及并发症情况。结果观察组进食时间、排气时间、下床活动时间、排便时间显著早于对照组,住院时间显著短于对照组(P 0. 05);术后12、24、72 h时,观察组VAS评分、PSQI评分及并发症总发生率均显著低于对照组(P 0. 05)。结论基于快速康复外科理念的多模式镇痛可有效改善腹腔镜手术患者的康复效果,降低患者疼痛程度及并发症发生率,提高睡眠质量。     

快速康复外科护理对老年腹股沟疝患者术后早期应激反应及康复的影响

目的探讨快速康复外科护理对老年腹股沟疝患者术后早期应激反应及康复的影响。方法选取深圳市宝安区松岗人民医院普通外科腹腔镜下行腹股沟疝无张力修补术治疗的老年患者80例, 随机分为对照组与观察组, 每组40例, 对照组采取常规护理, 观察组采取快速康复外科护理。观察术前、术后24 h和72 h时C反应蛋白(CRP)、白细胞介素-6(IL-6)、血清淀粉样蛋白A(SAA)及胰岛素抵抗指数(IR)变化, 术后下床活动时间、首次排气时间、首次进食时间、术后住院时间。结果两组术前血清CRP、IL-6、SAA、IR比较差异无统计学意义(P>0.05), 术后24 h、72 h时血清CRP、IL-6、SAA、IR均高于术前(P<0.05), 且观察组低于对照组同期(P<0.05)。观察组患者术后下床活动时间、首次排气时间、首次进食时间、术后住院时间均明显短于对照组(P<0.05)。结论快速康复外科护理能有助于减轻老年腹股沟疝手术患者术后应激反应, 加速康复进程。     

快速康复外科护理在腹腔镜结直肠癌患者围手术期的应用

目的 探讨快速康复外科护理在腹腔镜结直肠癌患者围手术期中应用的效果.方法 将60例行腹腔镜结直肠癌手术的患者随机分为对照组与观察组各30例.对照组患者给予常规护理,观察组患者接受快速康复外科护理,比较2组手术情况、临床效果及术后并发症发生率.结果 2组麻醉时间、手术时间及术中出血量比较无显著差异;观察组患者术后下床时间、排气时问、住院时间显著少于对照组;观察组与对照组术后并发症发生率分别为26.7％和46.7％,差异显著.结论 对腹腔镜结直肠癌围手术期患者实施快速康复外科护理,可促进患者更快地康复,减少住院时间和术后并发症.     

快速康复在甲状旁腺全切加前臂移植术围手术期中的应用

目的探讨快速康复外科在甲状旁腺全切加前臂移植术治疗重症继发性甲状旁腺功能亢进患者围手术期的应用效果。方法选取28例重症继发性甲状旁腺功能亢进患者,随机分为对照组和观察组各14例。所有患者均行采用手术完整切除甲状旁腺,将其切成大小为2mm×2mm×2mm,8~18块移植于无瘘上肢前臂肌膜下,对照组给予普通围手术期护理,观察组应用快速康复外科指导下的围手术期护理。比较2组术后下床时间、术后住院时间、总体并发症、C-反应蛋白(CRP)及白细胞介素-6(IL-6)等应激指标。结果 2组患者术后住院时间、术后下床时间以及术后第1天CRP、IL-6值比较,FTS组优于对照组,差异有统计学意义(P0.05)。术后第5天CRP、IL-6以及总体并发症发生率比较,2组无明显差异(P0.05)。结论快速康复外科在甲状旁腺全切加前臂移植术围手术期护理中的应用,能减轻患者生理和心理的应激,缩短住院时间,达到快速康复的目的。     

快速康复外科管理在急性阑尾炎围手术期的临床研究

目的探讨快速康复外科在急性阑尾炎围手术期的临床应用。方法选取我院2016年10月～2018年5月收治住院治疗的86例阑尾炎患者,所有患者均接受腹腔镜手术,分为快速康复组和对照组各43例。快速康复组实行快速康复管理,对照组按照常规管理方式。比较两组患者术后首次肛门排气时间、下床活动时间、切口拆线时间、术后3d C反应蛋白(CRP)水平、住院时间、治疗花费等相关临床指标及并发症发生率。结果快速康复组患者术后首次肛门排气时间、切口拆线时间、术后3d C反应蛋白(CRP)水平、住院时间、治疗花费等指标及并发症发生率均明显低于对照组,差异有统计学意义(P0.05)。结论快速康复外科管理有利于腹腔镜治疗的阑尾炎患者早期恢复,节省治疗花费,降低并发症的发生。     

快速康复外科手术室护理对腹腔镜下手术患者术后恢复及并发症的影响

目的探讨快速康复外科手术室护理对腹腔镜下手术患者术后恢复及并发症的影响。方法选取2017年1月～2018年12月我院收治的腹腔镜手术患者180例,随机分成观察组和对照组各90例。对照组行手术室常规护理,观察组行快速康复外科手术室护理,观察两组术后恢复及并发症发生情况。结果观察组术后胰岛素抵抗指数(IR)和C-反应蛋白等应激指标水平明显低于对照组,差异有统计学意义(P0.05);观察组术后下床活动时间、首次排气时间、胃肠功能恢复时间、住院时间均明显低于对照组,差异有统计学意义(P0.05);观察组术后并发症发生率3.33%,明显低于对照组的13.33%,差异有统计学意义(P0.05)。结论快速康复外科手术室护理能够明显减轻患者术后应激,提高术后恢复能力,减少并发症,具有较高的临床应用价值。     

腹腔镜与开腹修补术治疗上消化道溃疡穿孔的临床疗效对比分析

目的探讨分析腹腔镜与开腹修补术治疗上消化道溃疡穿孔的临床疗效。方法从本院2015年1月~2017年1月收治的上消化道溃疡穿孔患者中选取80例,分为对照组和观察组各40例。对照组患者接受传统开腹修补术穿孔法治疗,观察组患者接受腹腔镜穿孔修补术治疗。比较两组疗效和并发症情况。结果观察组手术时间、排气时间及住院时间明显短于对照组,术中出血量更少(P0.05);观察组并发症发生率显著少于对照组(P0.05)。结论在治疗上消化道溃疡穿孔上,相较于传统开腹修补术,腹腔镜修补术具有创伤小、出血量低、恢复快的优势,同时并发症发生率更低,具有更高的安全性,值得推广使用。     

腹腔镜与开腹修补术治疗上消化道溃疡穿孔的临床疗效对比分析

目的探讨分析腹腔镜与开腹修补术治疗上消化道溃疡穿孔的临床疗效。方法从本院2015年1月~2017年1月收治的上消化道溃疡穿孔患者中选取80例,对其临床资料进行回顾性分析,对照组40例患者接受传统开腹修补术治疗,观察组40例患者接受腹腔镜修补术治疗,比较两组疗效和并发症情况。结果在手术时间、术中出血量、排气时间及住院时间上比较,观察组手术时间、排气时间及住院时间比对照组明显更短,术中出血量更少(P0.05);在并发症发生率上比较,观察组比对照组明显更低(P0.05)。结论在治疗上消化道溃疡穿孔上,相较于传统开腹修补术,腹腔镜修补术具有创伤小、出血量低、恢复快的优势,同时并发症发生率更低,具有更高的安全性,值得推广使用。     

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.