急性心肌梗死并上消化道出血、多器官衰竭成功抢救1例

1 临床资料 患者,女性,75岁.以"反复头晕10年,加剧伴双下肢浮肿5天"为主诉入院.有"高血压病"史10年,"2型糖尿病"史7年,均有不规则治疗史.     

以反复腹泻为主要表现的非霍奇金淋巴瘤1例

患者男,60岁,医护退休人员.因"反复慢性腹泻1年半,再发2个月余"于2009年9月5日入院.2008年4月患者因"便秘"自服"红豆杉粉"后出现腹泻.每天4～6次,为稀糊状便,无黏液、脓血、里急后重,无腹痛、腹胀,无咳嗽、胸闷、气促,无盗汗、发热.     

回肠异位胰腺1例

患者女,21岁,大学生.因反复脐周疼痛3年,于2008年2月18日10:00入院.既往史:3年前,因"急性阑尾炎"在外院行"阑尾切除术"史.术后半年开始出现脐周疼痛,在门诊拟"肠粘连"给予"解痉、抗炎"等治疗缓解.     

美国护理教学的模式

笔者于2005年8月-2006年8月在美国做访问学者.期间主要在宾西法尼亚州立大学学习.参加了本科大部分课程的学习,全程学习了"老年护理学"、"社区护理学"、"成人护理学"、"护理研究"等本科课程和部分研究生课程,感受颇深.     

"产后12小时监护单"在产科病房的运用

目的 回顾性总结我院22年"产后12 h监护单"在产科病房运用的实施效果.方法 对我陆军产科病房运用"产后12 h监护单"前后2年(1984年及1985年)及运用"产后12 h监护单"后3年(1985年、1995年及2006年)产妇产后并发症发生率进行比较.结果 (1)1984年、1985年"产后12 h监护单"的运用前后分娩后早期产后出血发生率比较,经X2检验,P＜0.005,有极显著差异.(2)对1985年与1995年及2006年3年共15 381例分娩早期并发症发生率比较,经X2检验,产后出血、阴道出血、阴道血肿、尿潴瘤P值均＜0.005,有极显著差异.结论 运用"产后12 h监护单",能降低分娩后早期并发症的发生率,有效提高产科质量,体现妇幼保健专科医院专业化水平,值得向各级医院推广应用.     

护理缺陷原因分析及对策

为了进一步探讨规范护理质量安全管理,分析2005年-2007年我科护理缺陷的原因,针对原因提出整改措施.其中责任性因素40例,护理技术性因素8例.如何提高"病人的安全管理"、"护士行为的安全管理"、"管理者的风险管理"等值得大家探讨.     

动脉瘤47例术后中心静脉压监测与护理

为提高护理服务质量,我院护理部自2006年7月与"医院管理年"活动紧密结合,坚持"以患者为中心,以质量为核心,创优质服务,让群众满意"的宗旨,积极组织实施以"创新护理,重塑自我"为核心的"5S"人性化护理管理模式,取得满意效果.现报告如下.     

护理缺陷原因分析及对策

为了进一步探讨规范护理质量安全管理,分析2005年-2007年我科护理缺陷的原因,针对原因提出整改措施.其中责任性因素40例,护理技术性因素8例.如何提高"病人的安全管理"、"护士行为的安全管理"、"管理者的风险管理"等值得大家探讨.     

“一对一”全程分娩临床效果观察

2003年以来,我们对125例孕妇行"一对一"全程分娩,取得满意效果.现报告如下. 1 资料与方法 1.1 临床资料随机选择2006年7月～2007年11月住院孕妇,采用"一对一"全程分娩125例作为观察租,排除头部、臀位等胎先露异常者.     

误诊为获得性免疫缺陷综合征二例分析

我院2009年10月至2011年10月年共收治获得性免疫缺陷综合征(AIDS)住院患者2021例,另有3例为误诊AIDS的患者,误诊AIDS少见,现将其中2例报道如下. 患者1:女,42岁.因HIV抗体"确认阳性"1年,发热、咳嗽7d于2009年10月30日入院.1年前因发热到一省级医院初筛HIV抗体阳性,于广西中国疾病预防控制中心"确认"阳性.7d前发热、咳嗽,伴胸痛、乏力、纳差、消瘦,因经济困难未就诊,病情渐加重,经"绿色通道"人院.     

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.