抗生素控制尿管感染的临床观察

烧伤病人留置尿管时，尿路感染的发生率较高，作者随机抽取５３例留置尿管病人，２７例（治疗组）用氯霉素眼膏作润滑剂，贮尿袋内注入庆大霉素，２６例（对照组）采用一般护理法。     

热敏灸对中风患者留置尿管的影响

目的观察热敏灸提高中风留置尿管患者拔出尿管的成功率。方法将140例患者随机分为干预组及对照组，每组70例；对照组：采用常规拔出尿管的方法；干预组：采用热敏灸后拔出尿管的方法。结果拔除留置尿管有效率比较，对照组为71．42％，干预组为95．71％，两组差异有显著性意义（P〈0．05）。结论热敏灸能提高中风尿潴留留置尿管患者拔出尿管成功率。     

膀胱注射0．1％碘伏稀释液防治尿路感染效果观察

目的探讨对留置尿管患者采用拔管前膀胱注射0．1％碘伏稀释液防治尿路感染的临床效果。方法将42例留置尿管并发菌尿症的患者随机分为观察组和对照组，各21例。观察组采用0．1％碘伏稀释液行膀胱注射后拔除尿管；对照组直接拔除尿管。于拔管后第2天行尿细菌培养。结果观察组尿培养细菌阳性率为9．52％，对照组尿培养细菌阳性率为23．81％，两组比较有显著性差异（P〈0．05）。结论采用0．1％碘伏稀释液于拔管前行膀胱注射可有效防治留置导尿引起的尿路感染。     

芬太尼复合丁卡因胶浆缓解男性患者术后留置尿管不适的疗效观察

目的探讨芬太尼复合丁卡因胶浆在缓解男性患者术后留置尿管不适中的作用。方法选择我科全麻手术后留置尿管不适的男性患者100例，随机分为观察组和对照组，各50例。观察组采用芬太尼lug／kg缓慢静脉注射，并以丁卡因胶浆5g涂抹尿道口。对照组采用常规护理。观察两组术后留置尿管不适情况和躁动发生情况。结果观察组8例（16％）主诉不适，对照组46例（92％）主诉不适，两组比较有显著性差异（X^2=58．13，P〈0．01）。观察组6例（1．2％）发生躁动，对照组32例（64％）发生躁动，两组比较有显著性差异（X^2=28．69，P〈0．01）。结论芬太尼复合丁卡因胶浆可有效缓解男性患者术后留置尿管不适，且明显减少患者烦躁的发生率。     

剖宫产术后90例产妇改进留置尿管护理方法的效果观察

目的：探讨剖宫产术后留置尿管的产妇导尿管放置及拔除的最佳方法。方法：将180例剖宫产术后留置尿管的产妇，随机分为观察组和对照组，每组各90例。观察组采用改进放置尿管的方法和拔管方法，对照组采用常规尿管放置法和拔管法。观察产妇舒适度和拔管后的首次排尿时间及尿路刺激症的发生情况。结果：观察组留置尿管的不适感明显降低，拔管后1h内排尿成功率，观察组为32．22％，而对照组仅为5．56％，差异具有非常显著性（P〈0．01）；观察组尿路刺激症发生率也明显低于对照组，具有显著性差异（P〈0．05）。结论：对剖宫产术后留置尿管的产妇改进尿管的放置方法及拔管方法，可降低产妇的不适感，促进其排尿，值得临床推广应用。     

综合措施对膀胱、前列腺术患者拔尿管后排尿的效果观察

目的探讨膀胱、前列腺术留置尿管患者拔管后能顺利排尿及减少相关并发症的有效措施。方法将300例留置尿管10d以上患者分为观察组150例，对照组150例。观察组拔尿管前30min口服泌尿灵0．4g，同时夹闭尿管；拔管时肛门内注入开塞露20ml；以后每隔6h口服泌尿灵0．2g，连续2d。对照组采用常规拔尿管法。结果观察组患者一次排尿成功率99％，对照组一次排尿成功率70％，两组比较差异有统计学意义（P〈0．01）；排尿时患者疼痛评估观察组低于对照组（P〈0．01）；拔管后3d内相关并发症比较，观察组低于对照组（P〈0．01）。结论泌尿灵与开塞露联合用药可提高长期留置尿管患者拔管后排尿成功率，减轻患者拔尿管后排尿疼痛的痛苦，减少拔管后相关并发症的发生。     

新型导尿管留置方法在老年髋部骨折围术期中的应用

【目的】探讨新型导尿管留置方法在老年髋部骨折围术期的应用效果。【方法】选择100例老年髋部骨折手术患者,按照治疗时间顺序分为对照组和观察组各50例,对照组采用骨科常规方法留置导尿管,即术前30rain留置导尿管,术后训练膀胱功能后拔除,观察组在治疗方案确定后即予留置导尿管,术后静脉镇痛结束后直接拔除尿管。比较两组自主排尿、排尿困难、尿潴留等发生率,观察两组拔除尿管后不适感比较以及护理服务满意度的变化。【结果】观察组和对照组自主排尿、排尿困难、尿潴留的发生率分别为96．00％vs76．00％,4．00％vs16．00％,0．00％vs8．00％,组间比较差异显著（P〈O．05）。观察组拔除尿管后不适感明显低于对照组（P〈0．05）,护理服务满意情况显著优于对照组（P〈0．05）。【结论】新型导尿管留置方法在老年髋部骨折围术期的应用效果优于常规留置方法。     

尿石清冲剂对输尿管留置内支架的中西医结合治疗

目的：探讨尿石清颗粒冲剂对输尿管留置内支架的中西医结合治疗效果。方法：将328例尿路结石患者分为治疗组172例和对照组156例，治疗组给予173服尿石清颗粒冲剂和一般治疗，对照组仅给予一般治疗，结果：治疗组加服尿石清颗粒后治愈率为86．05％，明显高于对照组（69．87）．两组相比差异有显著性（P＜0．05）；复发率为2．68％明显低于对照组（8．91％），两组相比差异有显著性（P＜0．05）。结论：采用尿石清颗粒对输尿管留置内支架的患者，能提高治愈率、减少尿路结石的复发率和并发症的发生。     

拔除留置尿管时机对减少尿潴留的临床研究

目的 为探讨拔除留置尿管的不同时机对尿潴留的影响。方法 将150例留置尿管病人随机分组，甲组50例在膀胱充盈时拔管，乙组50例在膀胱空虚时拔管、丙组50例随机（不论膀胱是否充盈）拔除尿管。结果 甲组自动排尿率为98％（49／50），乙组为80％（40／50），丙组为84％（42／50）。乙组和丙组自动排尿成功率明显低于甲组（P＜0．01），乙组和丙组自动排尿成功率无明显差异（P＞0．05）。结论 膀胱充盈时拔除尿管比膀胱空虚时拔除尿管能明显减少尿潴留。     

留置尿管患者预防尿路感染的护理

目的：为降低留置尿管患者的尿路感染发生率。方法：将64例留置尿管患者分为两组，每组各32例，采用新方法消毒与护理为观察组，常规方法为对照组，比较两组疗效。结果：观察组尿路感染的发生率为6．2％，对照组尿路感染的发生率为87．5％（P〈0．05），差异有显著性。结论：采用新法消毒与护理效果优于常规消毒和护理，可显著降低尿路感染的发生率，值得提倡。     

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.     

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.     

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.     

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.