高龄老年卧床病人大便失禁护理方法研究

[目的]探讨因肛门括约肌松弛引起大便失禁的长期卧床高龄老年病人的有效护理方法。[方法]将68例长期卧床高龄老年病人按肛塞材料种类分为灭菌棉球组(16例)、一次性肛管组(14例)、卫生棉条组(18例)、灭菌纱球组(20例),比较不同肛塞材料肛周皮肤清洁效果及在体内保留时间。[结果]卫生棉条组保持肛周皮肤清洁时间明显长于其他3组(P<0.05)体内保留时间也较其他3组延长(P<0.05)。[结论]卫生棉条用于长期卧床高龄老年病人由于肛门括约肌松弛导致大便失禁效果较好。     

卫生棉条在老年长期卧床患者大便失禁护理中的应用

目的 探讨卫生棉条在肛门括约肌松弛导致大便失禁的长期卧床高龄老年患者护理中的应用效果。方法 将36例长期卧床高龄老年患者随机分为实验组和对照组各18例，实验组使用卫生棉条,对照组使用传统方法进行护理。观察比较不同护理方法对患者排便次数及保持肛周皮肤干燥时间的影响。结果 经过不同护理方式后，2组排便次数改变差异有显著性（P值=0．007）；2组肛周皮肤干燥时间差异有显著性（P值=0．003）。结论 采用卫生棉条对长期卧床高龄老年患者大便失禁情况进行肛周皮肤护理，是一种理想的护理方法。     

卫生棉条在老年长期卧床患者大便失禁护理中的应用

大便失禁的发病原因较多,其中长期卧床高龄老年患者由于肛门括约肌松弛而导致大便失禁,不仅会引起患者肛周皮肤渗出液增多、红肿,而且严重者肛周皮肤发生溃烂[1]。原因:一方面由于此类患者肛周皮肤不能有效保持干燥,另一方面由于清洁肛周次数增多,而引起肛周皮肤受到机械摩擦过     

OB内置卫生棉条在老年肛门括约肌松弛患者保留灌肠中的应用

目的探讨OB内置卫生棉条在老年肛门括约肌松弛患者保留灌肠中的应用效果。方法将印例高龄肛门括约肌松弛老年患者随机分为实验组和对照组各30例,实验组灌肠后使用OB卫生棉条填塞肛门,对照组灌肠后采用传统处理措施。比较两种方法对老年患者第1次灌肠后排便时间、每天排便次数、肛周皮肤完整程度和预后的影响。结果实验组灌肠后第1次排便时间为（5．90±1．96）h,每天排便次数为（3．27±1．05）次,对照组分别为（3．40±1．37）h,（4．57±0．86）次,两组比较差异均有统计学意义（t=-7．633,5．255;P〈0．01）,OB内置卫生棉条延长了患者灌肠后第1次排便时间,减少了排便次数;实验组治疗有效率为96．7％,对照组为76．7％,差异有统计学意义（x2=5．192,P=0．023）;实验组肛周皮肤的完整性优于对照组（P〈0．05）。结论采用OB内置卫生棉条对老年的肛门括约肌松弛患者进行保留灌肠后填塞是一种合理的、有效的护理手段。     

介绍1种高龄糖尿病危重病人大便失禁的护理方法

临床上大便失禁的病人护理比较繁琐,不仅增加了护理工作量,还容易造成病人肛周皮肤溃烂,促进压疮的发生,过量的清洁则易使局部皮肤抵抗力下降,出现破损,增加了病人的痛苦.糖尿病病人皮肤容易发生破溃并不易愈合;高龄病人,由于生理性改变,肛周括约肌松弛、收缩力下降,自控力降低,便液常在翻身、叩背、咳嗽、吸痰或很小腹压下,不经意自肛门流出,浸湿肛周造成皮肤损害.2009年5月-2010年7月,我科对87岁~95岁危重糖尿病大便失禁病人9例(均卧床,生活不能自理,解稀水样便),经使用肛管引流袋和内置卫生棉条两种方法护理后,无一例压疮发生.现将该护理方法介绍如下.     

卫生棉条在神经外科大便失禁护理中的应用

[目的]探讨卫生棉条在神经外科大便失禁病人中的应用效果。[方法]将56例神经外科大便失禁病人随机分为实验组和对照组,实验组使用卫生棉条,对照组使用传统方法进行护理。观察两组每天排便次数、皮肤并发症、每天护理时间、护理满意度等情况。[结果]实验组每天排便次数少于对照组,皮肤并发症发生率低于对照组,每天护理时间短于对照组,满意度高于对照组（P〈0.05）。[结论]应用卫生棉条对神经外科大便失禁病人进行肛周皮肤护理,是一种理想的护理方法。     

OB内置式卫生棉在老年大便失禁患者中的应用

大便失禁是医院长期卧床患者护理中遇到的较为棘手的问题.老年患者由于肛门括约肌松弛,大便控制功能发生障碍,使大便不由自主地溢出肛门,并且因消化道疾病或药物不良反应,很容易发生腹泻.由于反复擦洗导致肛门皮肤炎性反应,甚至引起肛周皮肤溃烂坏死,不仅给患者带来了极大的痛苦,也大大增加了护士的工作量.为了解决大便失禁患者的护理问题,我病房将OB内置式卫生棉应用于大便失禁的患者,经临床应用效果满意,现报道如下.     

OB内置式卫生棉条在大便失禁护理中的应用

临床上发生大便失禁的病人，大便对皮肤的刺激，易造成病人肛周皮肤红肿、溃烂，促进压疮的发生，过量的清洗又能造成局部皮肤抵抗力下降，易破损，增加了病人的痛苦。我科对40例卧床病人发生大便失禁，解稀水样便的病人，实施OB内置式卫生棉条填堵肛门，定时开放肛门排便的护理，取得满意的效果，无一例压疮发生，为大便失禁病人的护理提供了一种可行有效的新方法。现将该护理方法介绍如下。[第一段]     

康惠尔透明贴联合卫生棉条塞肛法预防老年大便失禁病人肛周皮肤损伤的临床观察

[目的]探讨康惠尔透明贴联合卫生棉条预防大便失禁病人肛周皮肤损伤的护理措施及效果。[方法]选取我院2012年10月—2015年4月收治的大便失禁病人60例,依照护理方式不同分为A组、B组各30例,A组病人采用肛周贴敷康惠尔水胶体透明贴,B组病人采用肛周贴敷康惠尔水胶体透明贴联合OB卫生棉条肛内填塞,比较两组预防肛周皮肤损伤的临床效果。[结果]从治疗后第3天起,B组日排便次数、肛周护理时间及费用均有所下降,A组排便次数、肛周护理时间及费用无明显变化;B组肛周皮肤损伤率10.0%,显著低于A组36.7%,差异具有统计学意义(P0.05);B组病人皮肤损伤愈合时间显著短于A组(P0.05);B组日护理肛周费用显著低于A组(P0.05)。[结论]康惠尔透明贴联合卫生棉条可显著降低大便失禁病人肛周皮肤损伤率,减少排便次数,降低护理费用。     

OB卫生棉条在大便失禁病人中的应用

<正>大便失禁主要原因是因为肛门括约肌失去了控制能力,一般发生于危重病人、昏迷及截瘫病人。如果大便未及时给予处理,肛周皮肤因受潮湿刺激,容易发生压疮。护理的重点主要是使病人清洁、舒适和防止发生压疮等并发症。笔者采用OB卫生棉条护理大便失禁病人,收效甚佳。现将方法介绍如下:1操作方法将OB卫生棉条置入肛门内,棉条的拉线留于肛门口外面,由于棉条的拉线是由棉条顶端密实地缝到尾端,所以当棉条吸满大便变得湿润后,轻拉线尾取出     

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.