青年强直性脊柱炎全髋置换术的预见性护理效果

[目的]探讨对青年强直性脊柱炎髋关节病变行全髋置换术病人进行预见性护理的效果。[方法]对全髋关节置换术治疗的16例强直性脊柱炎髋关节病变病人实施预见性护理干预,采用 Harris评分评估术前、术后髋关节功能。[结果]病人末次随访时 Har-ris评分明显高于术前(P<0.05)。术后切口均Ⅰ期愈合,无下肢深静脉血栓形成、肺栓塞、深部感染等并发症发生。[结论]加强对强直性脊柱炎髋关节病变行全髋置换术病人的预见性护理干预,可以提高手术疗效,减少术后并发症,促进病人髋关节功能恢复。     

强直性脊柱炎病人髋关节置换术的护理

[目的]探讨强直性脊柱炎病人进行双侧人工全髋关节同期置换围术期的护理。[方法]对骨科21例强直性脊柱炎病人行双侧人工全髋关节同期置换术,术前做好心理护理,术后密切观察病情、预防并发症、做好各项护理、功能康复以及出院指导等。[结果]21例病人住院期间经精心护理均顺利地度过了围术期,无并发症发生,均痊愈出院。[结论]强直性脊柱炎并双侧人工全髋关节同期置换围术期护理对病人的康复尤为重要,可解除疼痛,提高病人的生命质量。     

强直性脊柱炎强直髋全髋关节置换术45例临床分析

目的观察强直性脊柱炎髋关节受累强直时行全髋关节置换术的临床疗效。方法对2003年1月2008年1月45例（78髋）强直性脊柱炎患者行全髋关节置换术,其中38例（55髋）进行了平均4.5年（2～7年）的随访。结果 38例患者术后髋关节功能均明显改善,Harris评分由术前（16.3±1.7）分提高到术后（83.4±4.6）分。髋关节屈曲畸形矫正,55个髋关节总活动度（屈伸、内收、外展、内旋、外旋等6个方向活动总和）由术前（38.7±7.6）°增加至术后（191.2±10.3）°。术后髋关节疼痛消失,膝关节痛、腰骶部疼痛明显改善,步态较术前改善,生活自理。结论短期随访全髋关节置换术治疗强直性脊柱炎髋关节受累强直安全、有效。     

强直性脊柱炎伴全髋关节置换术术中的体位护理

[目的]探讨强直性脊柱炎伴髋关节畸形施行全髋关节置换术巡回护士体位护理方法。[方法]在全身麻醉下行强直性脊柱炎伴髋关节畸形病人20例,施行全髋关节置换术,包括巡回护士术前病人访视、健康指导、麻醉、手术中体位护理等。[结果]强直性脊柱炎伴髋关节畸形施行全髋关节置换术病人20例全部麻醉插管顺利,术中病人生命平稳,手术体位医生满意,病人骨凸部位无压疮。[结论]巡回护士对特殊病人良好体位护理可以降低手术病人术后并发症,减轻病人创伤,加速病人康复。     

老年强直性脊柱炎病人行全髋关节置换术后股骨假体周围骨折的护理

[目的]总结老年强直性脊柱炎(AS)病人行全髋关节置换术后股骨假体周围骨折的护理。[方法]对5例老年AS病人全髋关节置换术股骨假体周围骨折病人术前着重心理护理、营养支持、术前训练,术后强调体位护理、病情观察、并发症的观察和预防、功能康复训练。[结果]5例病人生活自理能力提高,无护理并发症发生。[结论]加强老年AS病人行全髋关节置换术后股骨假体周围骨折的护理有利于预后。     

人工全髋关节置换术病人的康复护理

[目的]总结人工全髋关节置换术病人的康复护理。[方法]对40例行全髋关节置换术的病人从心理疏导、基础护理、并发症预防、康复锻炼及出院指导方面进行系统规范的康复护理。[结果]40例病人均在2周内出院,均未发生人工关节脱位,切口均甲级愈合;均获6个月~24个月的随访,随访期间1例病人发生下肢深静脉血栓,及时处理后症状缓解;术前髋关节功能Harris评分为64.5分±4.3分,术后6个月随访时提高至83.5分±6.3分。[结论]加强人工全髋关节置换术病人的康复护理是手术成功的保证。     

35例全髋关节置换术病人的围术期护理

[目的]总结全髋关节置换术病人的围术期护理。[方法]对35例病人行全髋关节置换术,同时加强围术期护理。[结果]本组病人均顺利手术,术后恢复良好。[结论]加强全髋关节置换术病人的围术期护理是手术成功的保证。     

71例人工髋关节翻修术病人的护理

[目的]总结人工髋关节翻修术病人的护理。[方法]71例人工全髋关节置换术后病人行人工髋关节翻修术,同时加强术前准备及术后病情观察、负压引流的护理、并发症的预防及护理、心理护理及防止伤口感染等。[结果]71例病人均顺利手术,住院16d～32d(20.0d±10.5d);出院后随访6个月～12个月,发生假体松动1例,因其他疾病死亡1例,其他病人均得到良好的恢复。[结论]加强人工髋关节翻修术病人的护理是手术成功的保证。     

双侧同期人工全髋关节置换术病人的康复护理

[目的]总结双侧同期人工全髋关节置换术病人的康复护理措施。[方法]对15例病人行双侧同期人工全髋关节置换术,同时加强心理护理、术前呼吸运动、肢体及关节功能锻炼治疗以及训练床上排便,术后保持合适体位、循序渐进进行康复训练和日常生活康复护理。[结果]15例病人均顺利完成手术,切口均Ⅰ期愈合,无一例并发症;术后随访1个月~6个月,按照美国特种外科医院膝关节评分（HSS）标准,优11例,良4例。[结论]加强双侧同期人工全髋关节置换术病人的康复护理是手术成功的保证。     

全髋关节置换治疗强直性脊柱炎髋关节强直的临床分析

选取2012年6月~2015年5月我院收治的31例(48髋)强直性脊柱炎合并髋关节强直畸形患者。均行人工全髋关节置换治疗。观察对比术前、后Harris(髋关节评分)、关节整体功能的恢复情况以及髋关节活动范围。结果术后患者髋关节评分87.6±4.8分显著高于术前髋关节评分33.4±6.7分;术后患者髋关节的活动范围115.8°±22.7°显著大于术前髋关节活动范围24.5°±10.2°。所有患者关节疼痛感受均得到一定程度的缓解,29例(93.55%)患者的疼痛感受完全消失,能够自如行走。人工全髋关节置换术治疗,能够有效改善强直性脊柱炎患者髋关节的活动范围,提高生活自理能力,是治疗髋关节强直畸形的有效手段。     

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.