脑梗死患者吞咽和肢体功能障碍的早期康复护理

目的探讨早期康复护理对脑梗死患者吞咽和肢体功能障碍的影响。方法将96例脑梗死患者随机分为康复组和常规组,每组48例,2组均按脑梗死常规治疗护理,康复组配合早期康复护理和康复训练。采用吞咽能力分级标准,洼田饮水试验法和Fugl-Meyer运动功能评分法分别于治疗前及治疗后第3周进行疗效评定。结果康复组吞咽功能康复总有效率为83%,常规组总有效率为50%,2组差异有显著性(p<0.01);肢体运动功能情况康复组明显优于常规组(p<0.01)。结论早期的康复护理能明显改善脑梗死患者的吞咽和肢体功能障碍,有助于脑梗死患者的全面康复。     

脑卒中后吞咽障碍康复护理的疗效观察

目的探讨脑卒中后吞咽障碍康复护理治疗的疗效。方法31例脑卒中后吞咽障碍患者分为康复护理治疗组(17例)和对照组(14例)。治疗组进行早期吞咽康复护理治疗,疗程3周。采用吞咽X线透视检查法(VFSS)对2组患者治疗前后吞咽障碍进行评分。结果治疗组治疗后VFSS评分(7.2±2.1)比治疗前(4.0±1.9)及对照组(4.7±2.1)明显提高(P<0.01)。结论早期积极地吞咽康复护理训练对于脑卒中后吞咽障碍有明显疗效。     

脑卒中后吞咽障碍康复护理的疗效观察

目的 探讨脑卒中后吞咽障碍康复护理治疗的疗效.方法 31例脑卒中后吞咽障碍患者分为康复护理治疗组(17例)和对照组(14例).治疗组进行早期吞咽康复护理治疗,疗程3周.采用吞咽X线透视检查法(VFSS)对2组患者治疗前后吞咽障碍进行评分.结果 治疗组治疗后VFSS评分(7.2±2.1)比治疗前(4.0±1.9)及对照组(4.7±2.1)明显提高(P＜0.01).结论 早期积极地吞咽康复护理训练对于脑卒中后吞咽障碍有明显疗效.     

针对性早期康复护理对假性球麻痹患者吞咽功能障碍的影响

目的:探讨针对性早期康复护理对假性球麻痹患者吞咽功能障碍的影响。方法:将95例假性球麻痹致吞咽功能障碍患者按吞咽功能分级分为轻度组32例、中度组33例、重度组30例,给予有针对性的早期康复护理措施,观察护理效果。结果:三组患者护理1、2、3、4周有效率比较差异有统计学意义(P0.05)。结论:对假性球麻痹吞咽功能障碍患者进行针对性早期康复护理,能明显提高治疗效果。     

康复护理对脑梗死患者吞咽和肢体功能的影响

目的 :探讨早期康复护理对脑梗死患者吞咽和肢体功能的影响。方法 :93例脑梗死患者随机分为常规组和训练组 ,训练组在常规治疗的基础上配合早期康复护理和康复训练 ,并分别观察 2组患者吞咽及运动功能恢复状态。结果 :训练组总有效率为 77.4 % ,与常规治疗组 4 7.5 %比较差异有显著性 (P <0 .0 1) ;肢体运动功能比较 ,康复组明显优于常规组 (P <0 .0 1)。结论 :早期康复护理 ,指导患者开展康复训练能明显促进脑梗死患者吞咽及肢体功能的恢复。     

脑卒中吞咽障碍患者的早期康复护理

目的 :探讨脑卒中吞咽障碍患者的早期康复护理。方法 :对 18例脑卒中吞咽障碍患者随机分为康复护理治疗组 9例(简称康复组 )和神经科常规护理治疗组 9例 (简称对照组 ) ,用藤岛一郎吞咽疗效评价标准和才藤氏提出的吞咽障碍 7级评价法为观察标准 ,康复治疗组进行系统康复护理训练治疗。结果 :早期康复护理治疗组藤岛一郎吞咽疗效评价平均得分和才藤氏吞咽障碍分级均明显高于对照组 (P <0 .0 1)。结论 :对脑卒中吞咽障碍患者进行早期吞咽功能训练 ,使患者恢复了经口吞咽进食 ,提高了患者的生活质量。     

对急性脑卒中吞咽障碍患者的吞咽摄食训练护理

目的对急性脑卒中患者的吞咽功能障碍进行早期康复护理,使患者尽早恢复吞咽和摄食功能。方法患者入院即进行吞咽功能及摄食训练。在入院时和治疗1个月后进行吞咽功能评定,并进行统计学处理。结果早期康复组患者的吞咽功能得到了明显的改善,吞咽功能及摄食情况明显优于对照组(两组比较P<0.01)。结论对脑卒中吞咽功能障碍的早期康复护理是功能恢复的重要环节,可减少后遗症的发生。     

颅脑外伤患者吞咽障碍的康复护理研究

目的 评价颅脑外伤后吞咽障碍的康复护理效果.方法 将42例颅脑外伤后伴有吞咽障碍的患者随机分为康复组和对照组,对照组按神经外科的常规治疗护理及留置胃管护理,康复组除上述治疗护理外,还进行早期吞咽功能康复训练.结果 康复组患者的吞咽功能及摄食情况明显改善,两组之间有显著性差异(P＜0.01).结论 早期积极的吞咽功能康复训练,能显著改善颅脑外伤患者吞咽障碍的吞咽能力,减少并发症的发生,提高患者生活质量.     

护理干预及早期康复训练对脑卒中后吞咽困难的影响

目的 探讨护理干预及早期进行吞咽功能训练对急性脑卒中后吞咽困难的影响.方法 将我科收治的急性脑卒中后吞咽困难患者112例分为康复治疗组58例与常规治疗组54例.康复治疗组早期进行护理干预及吞咽功能训练;常规治疗组未进行早期康复训练,而是依患者意愿辅助进食.结果 康复治疗组吞咽困难的有效率明显优于常规治疗组,吸入性肺炎发生率显著低于常规治疗组.结论 早期进行护理干预及康复训练能明显改善急性脑卒中后吞咽困难患者的吞咽功能和营养状况,显著降低吸入性肺炎的发生率.     

护理干预及早期康复训练对脑卒中后吞咽困难的影响

目的 探讨护理干预及早期进行吞咽功能训练对急性脑卒中后吞咽困难的影响.方法 将我科收治的急性脑卒中后吞咽困难患者112例分为康复治疗组58例与常规治疗组54例.康复治疗组早期进行护理干预及吞咽功能训练;常规治疗组未进行早期康复训练,而是依患者意愿辅助进食.结果 康复治疗组吞咽困难的有效率明显优于常规治疗组,吸入性肺炎发生率显著低于常规治疗组.结论 早期进行护理干预及康复训练能明显改善急性脑卒中后吞咽困难患者的吞咽功能和营养状况,显著降低吸入性肺炎的发生率.     

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.