突发性耳聋患者预后的影响因素分析

目的探讨突发性耳聋患者预后的影响因素。方法回顾性分析87例突发性耳聋患者的临床资料,所有患者接受常规药物治疗,根据预后情况将患者分为预后良好组(受损频率平均听力提高≥15 d B) 61例及预后不良组(受损频率平均听力提高15 d B) 26例。设计一般情况调查问卷,并将可能的影响因素纳入,采用单因素与多因素分析找出突发性耳聋患者预后不良的影响因素。结果经卡方检验单因素分析与非条件多项Logistic回归分析检验,糖尿病、发病至就诊时间、伴眩晕或耳鸣、听力损失程度、纯音测听听力图类型均可能是突发性耳聋患者预后的影响因素(OR 1,P 0. 05)。结论糖尿病、发病至就诊时间、伴眩晕或耳鸣、听力损失程度、纯音测听听力图类型均可能是突发性耳聋患者预后的影响因素,临床需重点关注并予以相应干预措施。     

突发性耳聋患者心理状态的影响因素分析及其预见性护理策略

目的 分析突发性耳聋患者心理状态的影响因素,并探究预见性护理策略对患者心理状态的影响。方法 回顾性分析2019年1月至2020年6月深圳市宝安区石岩人民医院收治的82例突发性耳聋患者的临床资料,采用症状自评量表对突发性耳聋患者的心理状态进行评估。收集患者的一般资料,采用多重线性回归分析突发性耳聋患者心理状态的影响因素,并探寻对突发性耳聋患者进行预见性护理的措施。结果 单因素分析结果显示,突发性耳聋患者的心理状态与年龄、家庭经济情况、耳聋程度和社会支持度均有关（P均<0.05）。多因素分析结果显示,年龄、家庭人均月收入、耳聋程度和社会支持度均是突发性耳聋患者心理状态的主要影响因素（P均<0.05）。结论 年龄、经济情况、耳聋程度、社会支持度是影响突发性耳聋患者心理状态的主要因素,临床护理人员可根据患者的具体情况采用预见性护理干预,从而改善其心理健康状态。     

620例突发性耳聋的治疗及预后

目的探讨影响突发性耳聋疗效及预后的相关因素.方法回顾分析620例突发性耳聋患者的临床资料.结果突发性耳聋的疗效和预后与发病到初治时间、残留听力多少,是否伴眩晕,年龄大小,单、双耳聋,是否复发,是否病毒感染等有关.结论突发性耳聋初治时间在1周内、残留听力多的中青年患者疗效佳,伴有眩晕、复发、两极年龄、有病毒感染及双耳聋患者疗效欠佳.     

突发性耳聋患者预后相关因素分析及护理干预

目的探讨影响突发性耳聋患者预后的相关因素,并有针对性地制定积极有效的护理干预措施,以达到最大限度挽救患者听力,提高患者生活质量。方法选取2004年1月～2009年1月本院收治的突发性耳聋患者118例,采用χ2检验和Logistic逐步回归分析法分析影响预后的因素,并制定相对应的护理干预措施。结果性别、患耳侧别、诱因、职业及耳鸣对突发性耳聋患者治疗预后无影响。患者年龄、眩晕、头痛、就诊时间、入院时精神状态、听力损失程度、听力损失曲线类型对突发性耳聋患者治疗预后具有显著性影响(p0.05)。Logistic逐步回归模型进行多因素分析:年龄、就诊时间、听力损失程度、听力损失曲线类型是影响突发性耳聋患者预后的主要因素(p0.05)。结论根据影响预后的相关因素,给予患者有针对性的护理干预措施对于改善患者预后,提高患者生活质量具有十分重要的意义。     

突发性耳聋患者疾病不确定感现状及其影响因素分析

目的 探讨突发性耳聋患者疾病不确定感现状及其影响因素。方法 选取2020年2月-2022年2月我院收治的96例突发性耳聋患者作为调查对象,对患者一般资料、疾病不确定感进行调查。根据疾病不确定感量表(MUIS-FM)评分结果,将出现疾病不确定感的患者纳入发生组,未出现疾病不确定感的患者纳入对照组,比较两组基础资料,分析突发性耳聋患者疾病不确定感的影响因素。结果 96例突发性耳聋患者中56例(58.33%)出现疾病不确定感;单因素分析结果显示,不同月收入、耳鸣主观分级、对睡眠造成影响、接受自身病情的突发性耳聋患者疾病不确定感比较,差异有统计学意义(P<0.05);多因素Logistic回归分析结果显示,月收入<3000元、耳鸣主观分级≥3级、对睡眠造成影响、无法接受自身病情是突发性耳聋患者发生疾病不确定感的独立危险因素(P<0.05且OR≥1)。结论 突发性耳聋患者具有较高的疾病不确定感,月收入<3000元、耳鸣主观分级≥3级、对睡眠造成影响、无法接受自身病情是其独立影响因素,临床需予以高度重视。     

突发性耳聋94例临床疗效分析

目的 探讨突发性耳聋的临床特点及治疗.方法 回顾性分析2005年12月至2008年6月间94例突发性耳聋患者的临床资料.结果 94例患者中,听力曲线低频型19例(20.2%)、平坦型43例(45.7%)、高频型23例(24.5%)、全聋9例(9.6%);痊愈18例,显效14例,有效16例,无效46例,总有效率为51%.结论 突发性耳聋患者治疗有效者,多在5～20天内显效,延长疗程并不能增加治愈的机会.     

老年突发性耳聋患者的预后分析

目的探讨老年突发性耳聋的临床特点及疗效预后。方法回顾性分析2008年1月至2015年12月扬州市第一人民医院耳鼻咽喉头颈外科住院,年龄在60岁以上(含60岁)的261例老年突发性耳聋患者的临床资料,了解其临床特征并分析不同因素(包括性别,侧别,初诊时间,不同听力曲线类型,是否伴发高血压,糖尿病等)对预后的影响。结果 261例老年突发性耳聋患者中,单侧耳聋240例(92.0%),双侧21例(8.0%);其中男性129例,女性132例;年龄60~84岁,平均(68.2±12.3)岁;发病至就诊时间0.5~62 d,中位时间4 d;患者听力曲线中全聋型115例(44.1%),中高频下降型63例(24.1%),平坦型56例(21.5%),低中频下降型27例(10.3%)。治疗后的总有效率分别为54.8%(63/115)、44.4%(28/63)、71.4%(40/56)和81.5%(22/27);261例患者经过规范的药物治疗,痊愈45例,好转106例,未愈110例,治疗总有效率为57.9%(151/261)。经过统计学分析,不同患者听力曲线类型,侧别,初诊时间总有效率有统计学差异(P<0.05)。来自城市与农村患者经规范治疗后总有效率比较差异有统计学意义(P<0.05)。结论老年突发性耳聋一般听力损失重,但及时治疗,患者仍有恢复的可能。单侧老年突聋患者较双侧预后好;听力曲线以全聋型和中高频下降型居多,预后以低中频下降型最好。患者初诊时间越短,疗效越好;来自城市的老年突聋患者预后较好。     

鼓室联合全身应用地塞米松治疗突发性耳聋的疗效及影响因素

目的探讨鼓室联合全身应用地塞米松治疗突发性耳聋的疗效及影响因素。方法对2019年1月至2020年12月我院耳鼻喉科收治的80例突发性耳聋患者实施鼓室联合全身注射地塞米松治疗,统计治疗效果,并对影响突发性耳聋患者疗效的危险因素进行分析。结果80例患者的治疗总有效率为67.50%。治疗后,患者0.5、1.0、2.0 kHz测试频率的纯音听阈值均低于治疗前(P<0.05)。多因素Logistic回归分析结果显示,年龄、糖尿病、高血压、初诊时间、听力损失程度、眩晕、血浆黏度、血清C反应蛋白水平是影响突发性耳聋患者疗效的危险因素(P<0.05)。结论鼓室联合全身注射地塞米松治疗突发性耳聋的疗效良好,但其疗效受到年龄、糖尿病、高血压等因素的影响,临床上需针对影响突发性耳聋患者疗效的危险因素进行积极干预。     

突发性耳聋53例临床分析

目的 探讨影响突发性耳聋治疗效果的相关因素。方法 对53例突发性耳聋患者的临床资料作回顾性分析并对影响其预后的相关因素作一初步探讨。结果 A（克栓酶组）、B（基础用药组）两组疗效比较差异无统计学意义,突聋的听力恢复与治疗时间早晚有关,发病在两周以内与两周以上比较,疗效差异有统计学意义（P（0．05）;与年龄、耳聋程度,是否伴有眩晕无相关性（P〉0．05）。结论 早期、综合治疗及能量合剂的提前应用,在神经的再生和功能的恢复上起到了促进作用。应进一步开展前瞻性研究,以便能更客观、准确地分析影响突聋治疗及预后的相关因素。     

156例突发性耳聋病人的护理

[目的]总结突发性耳聋病人的临床护理.[方法]回顾性分析156例突发性耳聋病人的临床治疗护理资料.[结果]124例病人的听力完全恢复,32例病人听力得到改善.[结论]加强突发性耳聋病人的护理对病人听力的回复与改善非常重要.     

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.