临床护理路径在耳鼻喉科择期手术病人中的应用

[目的]探讨运用临床护理路径护理耳鼻喉科择期手术病人的效果。[方法]选取耳鼻喉科择期手术病人120例随机分为观察组与对照组各60例。观察组按临床护理路径实施护理,对照组采用耳鼻喉科常规护理。[结果]观察组平均住院天数、术前天数、住院费用明显降低,病人及家属对疾病相关知识知晓率和对护理服务满意度显著升高。[结论]在耳鼻喉科择期手术病人中应用临床护理路径值得临床中推广。     

临床护理路径在自发性气胸病人中的应用

[目的]探讨临床护理路径在自发性气胸病人中的应用.[方法]将96例自发性气胸病人随机分为观察组(47例)和对照组(49例),观察组实施临床路径进行护理,对照组采用传统的常规护理.比较两组病人住院天数、住院费用、健康知识评分情况以及并发症发生情况和对护理服务的满意度.[结果]观察组病人住院天数短于对照组,住院费用低于对照组,健康知识评分高于对照组(P均＜0.05);观察组病人并发症发生率低于对照组(P＜0.05);观察组病人对护理服务的满意度高于对照组(P＜0.05).[结论]在自发性气胸病人护理中应用临床护理路径可缩短病人的住院时间,降低住院费用,减少并发症,提高护理质量.     

临床护理路径在住院糖尿病病人治疗中的应用

[目的]探讨临床护理路径在住院糖尿病病人治疗中的实施效果.[方法]84例住院糖尿病病人随机分成两组,观察组43例,对照组41例,对照组进行常规护理,观察组按临床护理路径进行护理.观察并比较两组病人平均住院天数、病人的护理满意度及健康知识掌握程度.[结果]两组病人的住院天数、病人的护理满意度及健康知识掌握比较,差异有统计学意义(P＜0.05).[结论]临床路径应用于糖尿病病人治疗中,可以明显缩短病人住院时间,降低医疗成本,并使其获得最佳的医疗护理服务质量.     

临床护理路径在颅底骨折病人护理中的应用

[目的]观察临床护理路径在颅底骨折病人护理中的应用效果.[方法]将120例颅底骨折病人随机分为观察组与对照组,每组60例,对照组采用常规整体护理管理模式,观察组在整体护理的基础上采用颅底骨折住院病人的临床护理路径管理模式.比较两组病人疾病相关知识掌握情况、病人对护理工作的满意度、住院时间.[结果]观察组病人疾病相关知识掌握情况优于对照组;观察组病人对护理工作的满意度高于对照组;观察组病人术后住院时间低于对照组.[结论]在颅底骨折病人护理中的应用临床护理路径可提高护理质量和工作效率.     

临床路径在腭咽成形术病人护理中的应用

[目的]探讨临床路径应用于腭咽成形术病人的效果.[方法]采用随机抽样法将50例病人分为两组,每组25例.对照组采用常规护理,实验组采用临床路径护理,观察两组病人住院天数、医疗费用及病人满意度.[结果]实验组住院时间比对照组明显缩短,满意度高于对照组(P＜0.05).[结论]临床路径在腭咽成形术病人中的应用可提高工作效率和病人满意度,可控制成本和保证护理质量.     

临床护理路径在肾穿刺活检术中的应用

[目的]探讨临床护理路径在肾穿刺活检术中的应用效果.[方法]将202例需做肾穿刺活检术以明确诊断病人随机分为观察组和对照组,每组101例,对照组采用传统护理模式,观察组采取临床护理路径模式.观察并比较两组病人的住院天数、住院费用、肾穿刺活检术后并发症及不良反应的发生情况.[结果]观察组病人住院天数、住院费用均低于对照组(P＜0.05);观察组发生并发症或不良反应7例,对照组45例,两组比较差异有统计学意义(P＜0.05).[结论]在肾穿刺活检术中实施临床护理路径管理,可缩短病人的住院时间,降低医疗成本,减少术后并发症及不良反应.     

临床护理路径在脑出血中的应用

[目的]探讨临床护理路径在脑出血中的临床效果.[方法]将40例脑出血病人随即分为观察组和对照组各40例,观察组实施临床护理路径,对照组采用常规护理,比较两组临床护理效果.[结果]观察组住院时间、住院费用、健康知识知晓率、病人和家属对护理满意度及治疗有效率均优于对照组,差异有统计学意义（P＜0.05）.[结论]临床护理路径能提高脑出血病人健康教育效果及满意度,降低并发症,提高病人生存质量.     

临床路径在妇科住院病人健康教育中的应用效果观察

[目的]探讨临床路径在妇科住院病人健康教育中的应用效果.[方法]240例妇科择期手术病人随机分为对照组和观察组,各120例,对照组采用传统的健康教育方法,观察组采用我院编写的表格式健康教育路径,对病人进行有计划、规范、系统的健康教育.观察并比较两组病人对各项护理工作满意度情况.[结果]观察组病人对各项护理工作满意度均优于对照组,两组比较差异有统计学意义(P<0.05).[结论]临床路径应用于妇科住院病人健康教育中可提高病人对护理质量的满意度.     

肝囊型包虫病临床护理路径应用效果评价

[目的]探讨临床护理路径在肝囊型包虫病病人中的应用效果.[方法]将80例住院肝囊型包虫病病人随机分为实验组和对照组,每组40例,对照组采用常规护理,实验组采用临床护理路径护理,比较两组病人住院时间、住院费用和病人满意度.[结果]实验组病人住院天数、住院费用均低于对照组,实验组病人满意度优于对照组(P＜0.05).[结论]在肝囊型包虫病病人中应用临床护理路径,可缩短病人住院天数,降低住院费用,提高病人满意度.     

临床护理路径在预防脊柱骨折病人

[目的]观察临床护理路径在预防脊柱骨折病人便秘中的应用效果.[方法]将80例脊柱骨折病人随机分为观察组和对照组,每组40例,对照组采取传统护理方法,观察组制订临床护理路径干预.比较两组病人疾病相关知识掌握情况、病人的满意度、便秘发生情况及通便药物使用情况.[结果]观察组病人疾病相关知识掌握情况优于对照组;观察组病人的满意度高于对照组;观察组病人便秘发生及使用通便药物低于对照组.[结论]应用临床护理路径可预防脊柱骨折病人便秘的发生.     

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.