影响糖尿病足坏疽愈合的因素及针对性护理研究

目的 探讨针对影响糖尿病肢端坏疽患者愈合因素进行针对性的护理.方法 在600例糖尿病足坏疽住院患者中随机抽取168例分成2组,根据2组患者血浆蛋白、动脉硬化下肢血流量、微循环障碍程度、患足骨质破坏情况、缺乏糖尿病足坏疽的防治知识进行分析,找出影响愈合的因素,并做好针对性的护理工作.结果 168例糖尿病足坏疽患者,下肢血流量、足背动脉搏动及甲襞微循环比较,2组差异有显著性意义(P＜0.05);2组足坏疽合并肾病、骨质破坏和血红蛋白改变情况比较,2组差异有显著性意义(P＜0.05).结论 根据糖尿病足坏疽患者影响愈合的因素,进行针对性的护理,加快了糖尿病足坏疽患者的愈合速度,同时综合治疗有利于糖尿病足坏疽的早日愈合,可以减少截肢,提高了糖尿病足坏疽患者的生活质量.     

影响糖尿病足坏疽愈合的因素与针对性护理

目的 了解影响糖尿病足坏疽(diabetic foot gangrene,DFG)愈合的因素,探讨针对影响因素的护理.方法 对106例糖尿病足坏疽的影响因素如患者血浆蛋白、年龄、微循环障碍程度、足骨质破坏情况、对糖尿病知识的了解情况等进行分析.结果 年龄、微循环障碍、糖尿病肾病、足骨质破坏情况等对糖尿病足坏疽愈合影响有明显的差异.一般护理与全面的护理对糖尿病足坏疽愈合影响有明显差异.结论 根据患者存在的影响愈合的因素采用针对性的护理有利于患者的早日愈合、减少截肢,提高患者的生活质量.     

影响糖尿病足坏疽愈合的因素与针对性护理

目的了解影响糖尿病足坏疽（diabetic foot gangrene,DFG）愈合的因素,探讨针对影响因素的护理。方法对106例糖尿病足坏疽的影响因素如患者血浆蛋白、年龄、微循环障碍程度、足骨质破坏情况、对糖尿病知识的了解情况等进行分析。结果年龄、微循环障碍、糖尿病肾病、足骨质破坏情况等对糖尿病足坏疽愈合影响有明显的差异。一般护理与全面的护理对糖尿病足坏疽愈合影响有明显差异。结论根据患者存在的影响愈合的因素采用针对性的护理有利于患者的早日愈合、减少截肢,提高患者的生活质量。     

糖尿病足28例临床护理

目的:探讨糖尿病足患者的临床护理方法.方法:对28例糖尿病足患者在严格控制饮食的基础上使用胰岛素强化治疗控制血糖,同时给予降压、降脂及抗感染治疗.结果:本组痊愈18例,好转5例,足坏疽、骨质破坏截肢4例,合并多器官功能衰竭死亡1例.结论:对糖尿病足患者进行综合治疗,给予针对糖尿病的整体护理和对糖尿病下肢神经、血管病变的局部护理,能降低糖尿病足的截肢率,提高患者的生活质量.     

糖尿病足28例临床护理

目的：探讨糖尿病足患者的临床护理方法。方法：对28例糖尿病足患者在严格控制饮食的基础上使用胰岛素强化治疗控制血糖，同时给予降压、降脂及抗感染治疗。结果：本组痊愈18例，好转5例，足坏疽、骨质破坏截肢4例，合并多器官功能衰竭死亡1例。结论：对糖尿病足患者进行综合治疗，给予针对糖尿病的整体护理和对糖尿病下肢神经、血管病变的局部护理，能降低糖尿病足的截肢率，提高患者的生活质量。     

护理干预对糖尿病足患者的影响

目的 探讨护理干预对糖尿病足患者的影响,寻找适合糖尿病足患者的临床护理方法.方法 对56例糖尿病足患者在严格控制饮食的基础上使用胰岛素强化治疗控制血糖,同时给予降压、降脂及抗感染治疗;给予针对糖尿病的整体护理和针对下肢神经、血管病变的局部护理.同时观察皮肤皲裂、麻木感、疼痛及足背动脉搏动消失等足部症状改善情况.结果 患者采用降糖、整体护理和抗感染相结合的治疗措施后,痊愈41例,好转10例,因足坏疽、骨质破坏截肢4例,合并多器官功能衰竭死亡1例.结论 重视对糖尿病足患者的综合治疗和整体护理,提高患者的生活质量,对于糖尿病足得以顺利治愈具有重要意义.     

护理干预对糖尿病足患者的影响

目的探讨护理干预对糖尿病足患者的影响,寻找适合糖尿病足患者的临床护理方法。方法对56例糖尿病足患者在严格控制饮食的基础上使用胰岛素强化治疗控制血糖,同时给予降压、降脂及抗感染治疗;给予针对糖尿病的整体护理和针对下肢神经、血管病变的局部护理。同时观察皮肤皲裂、麻木感、疼痛及足背动脉搏动消失等足部症状改善情况。结果患者采用降糖、整体护理和抗感染相结合的治疗措施后,痊愈41例,好转10例,因足坏疽、骨质破坏截肢4例,合并多器官功能衰竭死亡1例。结论重视对糖尿病足患者的综合治疗和整体护理,提高患者的生活质量,对于糖尿病足得以顺利治愈具有重要意义。     

糖尿病足的预防和护理进展

糖尿病足(D F)是因糖尿病(D M)血管病变或神经病变和感染等因素导致糖尿病患者足或下肢组织破坏的一种病变[1]。是糖尿病四大并发症(高血压、糖尿病足、缺血性心脏病、脑血管病)之一。患者从皮肤到骨与关节各层组织均可受累,严重者可以发生局部或全足坏疽,甚至截肢,对于糖尿病患者的糖尿病足最根本的治疗是预防,对治愈的患者是预防再发,对高危人群是确定诊断和教育患者如何预防发生足部损伤[2]。预防和护理糖尿病足作为防治糖尿病足的有效手段,可降低糖尿病足的发生率和截肢率,提高患者的生活质量,是临床刻不容缓的研究课题。1糖尿病足的诊断D F的诊断并不困难,一般可根据患者有糖尿病病史、年龄偏大、病程较长,且伴有下肢局部溃疡和坏疽症状和体征等作出诊断。本病的主要表现为:间歇性跛行,夜间痛性痉挛、足下垂时缓解;足变畸形;皮温减低,肢端发凉,足背动脉搏动减弱或消失;皮肤搔痒,干而无汗,麻木及感觉迟钝或丧失,脚踩棉絮感;趾甲增厚且生长缓慢,常伴有真菌感染,严重时出现足溃疡、坏疽。D oppler超声可见受累的相应部位血流速度和波形变平,血流量减少;动脉造影有利于了解血管闭塞的部位、性质及病变范围;X线检查可显示病变处有骨质稀疏和破...     

综合康复治疗糖尿病足的临床疗效及血液流变学分析

目的 观察综合康复治疗糖尿病足患者的临床疗效及血液流变学变化。 方法 采用随机数字表法将96例糖尿病足患者分为观察组及对照组,每组48例。2组患者均常规给予糖尿病健康教育、降糖改善微循环、抗感染等内科治疗和局部清创换药处理,观察组患者在上述干预基础上给予综合康复治疗,包括有氧运动、电针刺穴、超短波及红外线照射治疗等。观察组患者每周治疗6d,连续治疗4～6周。于治疗前、后观察2组患者足部溃疡创面愈合情况及下肢动脉血流参数变化。 结果 治疗后观察组患者总有效率（94.8%）明显优于对照组（76.3%）,组间差异具有统计学意义（P<0.05）;另外观察组患者下肢血流参数改善情况亦明显优于对照组（P<0.05）。观察组Wagner分级1至3级患者其足部溃疡愈合时间分别为（13.8±5.13）d,(25.73±8.16)d和(50.14±9.25)d,均较对照组明显缩短（P<0.05）。 结论 综合康复治疗能明显改善糖尿病足患者下肢血液流变学参数,提高愈合率及缩短治疗时间,对改善患者预后具有重要意义,该联合疗法值得临床推广、应用。     

糖尿病足21例的护理

目的总结21例糖尿病足患者护理体会。方法结合21例糖尿病足患者的护理,在临床工作中找出预防糖尿病足针对性的方法和措施。结果本组14例糖尿病足患者痊愈,5例患者创面缩小,局部干燥,2例患者足趾出现坏死截趾。结论加强糖尿病足溃疡的护理可促使溃疡愈合,减少肢端坏疽等并发症的发生。     

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.     

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.