新生儿甲壳质脐带包临床应用研究

目的 探讨甲壳质医用无纺布脐带包对新生儿脐带残端的止血、消炎、收敛作用;为新生儿脐带残端的康复护理提供一个更为理想的健康产品.方法 选择足月新生儿100名,对脐带残端按常规进行消毒、结扎后,随机分为观察组使用甲壳质脐带包;对照组使用传统中药脐带包,跟踪观察脐带残端变化,对脐带残端停止出血、渗血时间,脐周皮肤表现、有无分泌物及脐带结痂的脱落时间做了统计学处理和对比分析.结果 新生儿甲壳质脐带包好于传统中药脐带包;甲壳质脐带包对新生儿脐周皮肤无刺激,无分泌物出现;弥补了中药脐带包的一些临床不足.结论 新生儿甲壳质脐带包,能促进新生儿脐带残端的愈合,预防新生儿脐部感染,缩短脐带结痂脱落时间,促进新生儿身体健康.     

新生儿甲壳质脐带包临床应用研究

目的探讨甲壳质医用无纺布脐带包对新生儿脐带残端的止血、消炎、收敛作用；为新生儿脐带残端的康复护理提供一个更为理想的健康产品。方法选择足月新生儿100名，对脐带残端按常规进行消毒、结扎后，随机分为观察组使用甲壳质脐带包；对照组使用传统中药脐带包，跟踪观察脐带残端变化，对脐带残端停止出血、渗血时间，脐周皮肤表现、有无分泌物及脐带结痂的脱落时间做了统计学处理和对比分析。结果新生儿甲壳质脐带包好于传统中药脐带包；甲壳质脐带包对新生儿脐周皮肤元刺激，元分泌物出现；弥补了中药脐带包的一些临床不足。结论新生儿甲壳质脐带包，能促进新生儿脐带残端的愈合，预防新生儿脐部感染，缩短脐带结痂脱落时间，促进新生儿身体健康。     

纳米银齐邦医用脐带包应用于新生儿脐带护理的效果观察

目的探讨纳米银齐邦医用脐带包应用于新生儿脐带护理的效果。方法选择足月新生儿200例,按新生儿出生先后顺序编号,奇数分入观察组,偶数分入对照组,两组各100例。对脐带残端按常规结扎后,观察组使用纳米银齐邦医用脐带包进行包扎;对照组使用传统纱布脐带包进行包扎,比较两组脐带残端停止出血时间、停止渗血时间、脐带残端干燥时间和结痂脱落时间。结果纳米银齐邦医用脐带包对脐带残端的止血作用、收敛作用优于传统纱布脐带包,脐带脱落时间明显较对照组缩短,差异均有统计学意义（P〈0.01）,纳米银齐邦医用脐带包效果优于传统纱布脐带包。结论新生儿纳米银齐邦医用脐带包能促进新生儿脐带残端的愈合,预防新生儿脐部感染,缩短脐带结痂脱落时间,促进新生儿身体健康。     

不干预法在新生儿脐带护理中的应用研究

目的探索不干预法护理新生儿脐带,缩短脐带断端自然脱落时间的临床应用。方法采用不干预法即少用消毒剂、不取结扎气门芯、不二次断脐(剪断端结痂)与传统方法比较,观察脐带断端脱落时间,对结果进行统计分析,并对护理过程中,新生儿体温、脐周皮肤、断端渗液、渗血情况进行分析。结果使用不干预法护理新生儿脐带,脐带自然脱落时间较传统方法平均缩短3.5d,差异有显著意义(P0.05),而且新生儿脐出血、脐炎及脐部肉芽肿明显减少。结论不干预法护理新生儿脐带,能促进脐带断端自然脱落,减少脐炎发生,避免了临床人为过多干预而引起新生儿脐带延迟干燥、创伤出血、感染的伤害,对提高临床新生儿护理质量有积极的作用。     

不同脐部护理方法对新生儿脐部愈合的影响及效果评价

[目的]观察自然干燥法与传统护理法对新生儿脐部感染、脐带残端脱落时间及新生儿高胆红素血症的影响。[方法]选取产科60例新生儿,采用随机数字表法将其分为试验组和对照组各30例。试验组新生儿严格无菌操作下断脐后暴露脐带残端,无纱布覆盖,直至脐带残端脱落;对照组新生儿,断脐后定期用0.5%碘伏消毒残端,纱布覆盖包扎。观察两组新生儿脐部感染、脐带残端脱落时间及新生儿高胆红素血症情况。[结果]对照组脐部感染1例,试验组无脐部感染发生;试验组脐带残端脱落时间为11.50d±5.89d、对照组脐带残端脱落时间为14.80d±8.65d,差异无统计学意义(P0.05);两组第1天、第2天、第3天及第30天经皮胆红素水平比较差异无统计学意义(P0.05)。[结论]新生儿断脐后自然干燥可预防脐部感染,促进脐带残端脱落,其效果与传统法比较差异无统计学意义,减少护理工作量。     

新生儿脐带残端两种处理方法的效果比较研究

[目的]探讨两种处理方法对脐带残端干燥、脐部并发症和脐带残端脱落时间的影响.[方法]将1000例正常新生儿分为两组,实验组常规断脐后双气门芯平脐双重结扎,在距脐根0.5 dm处断脐后,彻底清除脐带残端内的华通胶和血管,新生儿出生48 h～72 h后,脐带残端干燥期进行二次剪脐.对照组采用传统处理脐带方法.观察并比较两组新生儿脐带残端干湿情况,脐部并发症和脐带残端脱落时间.[结果]两组新生儿脐带残端干湿情况和脱落时间比较,差异有统计学意义(P<0.01或P<0.05);两组新生儿脐部并发症比较,差异有统计学意义(P<0.05).[结论]实验组处理脐带残端的方法使脐带残端早干燥、早脱落,脐部愈合快,脐部并发症少,降低了新生儿脐部感染几率.     

新生儿脐带残端两种处理方法的效果比较研究

[目的]探讨两种处理方法对脐带残端干燥、脐部并发症和脐带残端脱落时间的影响。[方法]将1000例正常新生儿分为两组,实验组常规断脐后双气门芯平脐双重结扎,在距脐根0．5cm处断脐后,彻底清除脐带残端内的华通胶和血管,新生儿出生48h～72h后,脐带残端干燥期进行二次剪脐。对照组采用传统处理脐带方法。观察并比较两组新生儿脐带残端干湿情况,脐部并发症和脐带残端脱落时间。[结果]两组新生儿脐带残端干湿情况和脱落时间比较,差异有统计学意义（P〈0．01或P〈0．05）;两组新生儿脐部并发症比较,差异有统计学意义（P〈0．05）。[结论]实验组处理脐带残端的方法使脐带残端早干燥、早脱落,脐部愈合快,脐部并发症少,降低了新生儿脐部感染几率。     

肾上腺素用于新生儿脐带残端止血的临床观察

新生儿脐带于断脐后3d～7d自然脱落,脱落后脐窝呈浅黄色、干燥,外周脐轮皮肤色泽正常。而在实际临床工作中,经常见到脐带脱落后脐部仍有少许出血,形成一黑色结痂,将整个脐带残端盖住,经常规处理后,黑色结痂脱落,但仍可见活动性出血,不久便再次形成一黑色结痂,影响脐带残端愈合。脐带残     

两种新生儿脐带消毒方法的对比分析

目的比较安尔碘作新生儿脐带消毒和传统碘酊、酒精消毒法的临床效果.方法剖宫产出生的足月新生儿200例随机分为A、B 2组.A组100例,采用安尔碘作新生儿脐带消毒处理;B组100例,采用传统的碘酊、酒精消毒脐带法.对2种新生儿脐带消毒方法的皮肤灼伤率、脐带残端结痂时间,以及脐炎发生率进行分析比较.结果应用安尔碘作新生儿脐带消毒皮肤灼伤率为0,脐炎发生率低(1%),脐带残端干燥结痂脱落时间早,该方法明显优于传统的新生儿脐带碘酊、酒精消毒法,2组差异有显著性,p＜0.05.结论安尔碘作新生儿脐带消毒法优于传统的碘酊、酒精消毒法.     

中药敷脐法在新生儿脐部护理中的应用研究

[目的]探讨中药敷脐法在新生儿脐部护理中的疗效。l方法l胎儿娩出脐部常规处理后,对照组642例采用普通护脐带,观察组630例采用中药敷脐法,比较两组新生儿脐部情况、脐带残端脱落时间、新生儿父母对脐带护理方法的满意度。[结果]观察组新生儿脐部渗血发生率、潮湿发生率、炎性分泌物发生率、3d～4d脐带残端脱落发生率均低于对照组（P〈0．05）;新生儿父母满意度评分优于对照组（P〈0．05）。[结论]中药敷脐法用于新生儿脐部护理疗效显著。     

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.