藻酸盐敷料治疗糖尿病足溃疡的临床观察和护理

目的探讨藻酸盐敷料对糖尿病足溃疡的疗效,总结护理方法。方法将36例糖尿病足溃疡患者随机分为两组,对照组18例,采用内科治疗加普通纱布换药治疗,观察组18例,采用内科治疗加藻酸盐敷料换药治疗,比较其在肉芽组织成熟度、创面愈合速度、换药次数、换药时间、创面愈合时间和疗效方面的差异,并对护理方法进行总结。结果观察组在第10和13天创面肉芽组织成熟度优于对照组(P<0.05);在第14、21和第28天创面愈合速度优于对照组(P<0.05);观察组换药次数、换药时间少于对照组(P=0.00),观察组创面愈合时间为(28.32±4.53)d,对照组为(35.27±4.62)d,两组比较具有显著性意义(P=0.00);治疗4周后观察组疗效优于对照组(P=0.01)。结论藻酸盐敷料对糖尿病足溃疡具有良好的治疗效果;恰当的护理方法有助于患者的康复。     

自体富血小板凝胶治疗烧伤残余创面的临床研究

[目的]探讨自体富血小板凝胶(APG)对重度烧伤残余创面的疗效.[方法]将56例烧伤残余创面患者分为两组,对照组29例,采用内科治疗加局部换药治疗,APG治疗组27例,采用内科治疗加局部换药并外涂APG进行治疗,比较其在肉芽组织成熟程度、创面愈合速度、创面愈合时间方面的差异,并对其治疗前后的血尿常规和肝肾功能指标进行检测,评估治疗的安全性.[结果]APG治疗组在7 d、14 d肉芽组织成熟度优于对照组(P＜0.01);治疗后7、11、15 d,APG治疗组创面愈合速度快于对照组(P＜0.05);治疗组创面愈合时间为(15±3.12)d,对照组为(23±3.58)d,两组比较具有统计学差异(P＜0.01);APG治疗组患者治疗前后的血尿常规和肝肾功能指标基本正常,与对照组比较差异无显著性(P＞0.05).[结论]APG对重度烧伤残余创面具有良好的疗效且安全性可靠.     

综合护理对小面积糖尿病足部溃疡的效果研究

目的 探讨小面积糖尿病足部溃疡的综合护理措施.方法 将58例小面积糖尿病足部溃疡患者随机分为2组.综合护理组(综护组)30例采用外科清创+红外线照射创面+生长因子(碱性成纤维细胞生长因子和重组人表皮细胞生长因子)+水胶敷料"安普贴"敷贴的综合护理治疗措施;对照组28例采用0.5%多聚维酮碘液或0.5%呋喃西林液湿敷.临床观察2组患者创面愈合进展情况、平均愈合时间以及创面细菌培养阳性率. 结果 综护组创面平均愈合时间(29.6±9.4)d,较对照组(39.2±13.5)d显著缩短(P<0.05),差异有统计学意义.第7天和第14天创面细菌培养阳性例数2组间比较差异有统计学意义(P<0.05). 结论 在常规内科治疗和一般护理措施基础上,外科清创+红外线照射+生长因子+水胶敷料敷贴的综合护理措施对小面积糖尿病足部溃疡具有较好的促进愈合效果.     

中药足浴联合湿润烧伤膏外敷治疗早期糖尿病足的疗效观察

目的观察中药足浴联合湿润烧伤膏治疗糖尿病足的临床疗效。方法将68例糖尿病足患者在知情同意且平等自愿选择的情况下分成对照组(32例)和观察组(36例),对照组在中药足浴治疗后常规换药,观察组在中药足浴治疗后常规换药的基础上使用湿润烧伤膏足部伤口外敷,记录两组患者治疗中的不良反应,同时比较两组患者溃疡创面的愈合面积、换药次数以及创面愈合所需时间。结果两组患者治疗过程中均未见药物不良反应;创面愈合面积观察组第14天、第21天、第28天与对照组比较,差异均有统计学意义(P0.05);观察组平均换药次数(15.3±0.2)次,少于对照组(21.4±0.3)次,两组比较差异有统计学意义(P0.05);观察组平均创面愈合时间(38.6±0.4)d,明显短于对照组(48.7±0.3)d,两者比较差异有统计学意义(P0.05)。结论中药足浴联合湿润烧伤膏治疗糖尿病足,可有效促进溃疡创面的愈合面积,减少换药次数,缩短创面愈合时间,有效改善了患者的生活质量。     

磺胺嘧啶银乳膏联合金因肽治疗糖尿病足溃疡的疗效观察

目的探讨磺胺嘧啶银乳膏联合金因肽对糖尿病足溃疡的治疗效果。方法将糖尿病足30例随机分为对照组和治疗组。对照组创面应用碘伏换药,治疗组创面以磺胺嘧啶银乳膏联合金因肽治疗,每日换药1次,两组其他治疗相同。治疗6周后,观察两组肉芽生长情况和创面愈合率。结果治疗组肉芽生长和创面愈合率明显高于对照组(P<0.05)。结论磺胺嘧啶银乳膏联合金因肽能有效抑制糖尿病足创面细菌生长,促进创面愈合。     

美洲大蠊提取液治疗糖尿病慢性溃疡的疗效及护理体会

目的 观察美洲大蠊提取液对糖尿病慢性溃疡的治疗效果.方法 将符合标准的41例糖尿病慢性溃疡患者随机分为对照组和治疗组,两组均予内科治疗糖尿病,控制血糖.治疗组在此基础之上,体表溃疡给予美洲大蠊提取液局部换药;对照组在内科治疗的基础上体表溃疡给予普通纱布局部换药,对比两组在总体疗效,溃疡愈合率、溃疡肉芽生长情况,愈合时间的差异.结果 治疗组在总体疗效方面优于对照组(P<0.05).溃疡愈合率及肉芽情况方面治疗组与对照组比较差异有统计学意义(P<0.05).治疗组愈合时间短于对照组(P<0.05).临床运用美洲大蠊提取液换药过程及整个治疗过程中未出现严重不良反应.结论 美洲大蠊提取液促进糖尿病慢性溃疡愈合临床疗效肯定,能提高愈合率,促进肉芽组织生长,缩短愈合时间,值得临床推广.     

封闭负压引流在糖尿病足部皮肤溃疡患者中的应用及护理

目的 探讨封闭负压引流对糖尿病足部皮肤溃疡愈合的影响及机制.方法 纳入我科住院的糖尿病足部皮肤溃疡伴窦道形成患者23例,在控制血糖,对症治疗及清创换药的基础上使用封闭负压引流治疗,充分引流脓性分泌物和坏死组织,并予精心护理与严密观察.结果 23例患者行封闭负压引流6-14d,平均(8±2.4)d,足溃疡平均愈合时间(45±9.5)d,足溃疡治愈18例,好转5例.结论 封闭负压引流治疗有利于伴窦道形成的糖尿病足部皮肤溃疡患者的分泌物引流,能控制感染,并能促进肉芽组织的生长,加速创面愈合.     

持续封闭式负压引流治疗糖尿病足的效果观察与护理

目的:探讨持续封闭式负压引流技术(VSD)在糖尿病足的应用效果并总结其护理措施。方法:选取本院内分泌科2012年4月~2013年8月收治的60例糖尿病足患者为对照组,采用清创、引流和换药治疗;选取本院内分泌科2013年9月~2015年2月收治的60例糖尿病足患者为观察组,采用VSD治疗。观察两组患者的肉芽组织生长时间、创面愈合时间、换药次数以及治疗效果。结果:观察组行VSD治疗后患者的肉芽组织生长时间、创面愈合时间、换药次数均少于对照组(P0.05),观察组患者的治疗效果优于对照组(P0.05)。结论:VSD治疗的糖尿病足可促进溃疡的快速康复,促进患者的痊愈,护理配合可减少堵管及营养不良等情况的发生,提高了治疗效果。     

艾灸治疗糖尿病足的疗效观察及护理

[目的]探讨艾灸治疗糖尿病足的疗效.[方法]将入选的糖尿病足病人64例按入院先后顺序分为治疗组34例,对照组30例,两组均予常规内科综合治疗,加强全身及局部护理.治疗组在常规治疗及护理基础上创面加用艾条依次使用温和灸、回旋灸、雀啄灸三步法施灸,每日1次或2次,4周后观察两组病人临床疗效、局部溃疡愈合时间及不良反应发生情况.[结果]治疗组糖尿病足具有较好的临床疗效,局部溃疡愈合时间短,与对照组比较差异有统计学意义(P<0.05).[结论]常规治疗护理结合中医艾灸疗法治疗糖尿病足具有较好的临床疗效,局部溃疡愈合时间短.     

局部远红外照射对老年糖尿病足的影响

目的：探讨老年精尿病足局部的护理。方法：50例老年患者随机分为观察组和刘照组，对照细用生理盐水及过氧化氢冲洗溃疡伤口，再以胰岛素加生理盐水及新霉素混合液浸泡的纱布湿敷于创面；观察组在对照组的基础上，给予加用局部红外线照射治疗。结果：观察组溃疡愈合较为理想．总有效率叫显高于对照组。结论：老年糖尿病足溃疡局部护理配合红外线照射治疗可提高糖尿病足溃疡的愈合率。     

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.