新生儿硬肿症的临床护理

目的 探讨综合护理干预在治疗新生儿硬肿症中的临床作用.方法 选取收治的新生儿硬肿症患儿52例,随机分为观察组和对照组,每组26例.对照组患儿采用常规护理；观察组患儿采用综合护理干预,包括复温、吸氧、合理喂养、严密的观察患儿病情变化、正确的维生素E药浴等治疗及护理,并做好消毒隔离和预防感染的发生.结果 与对照组比较,观察组硬肿症消失时间和住院时间均明显缩短（P＜0.05）.结论 综合护理干预对提高新生儿硬肿症的治愈率及降低死亡率,具有积极的意义.     

复方丹参佐治新生儿硬肿症45例分析

目的 :报告应用复方丹参佐治新生儿硬肿症的效果。方法 :总结 1996年 1月至 2 0 0 3年 12月我科收治新生儿硬肿症 87例 ,其中 4 5例用复方丹参佐治的临床观察及疗效的分析。结果 :复方丹参佐治新生儿硬肿症 4 5例 ,治愈 93 3% ,死亡 3例 ,病死率 6 7% ,对照组 4 2例 ,治愈 36例 ,治愈率 85 7% ,死亡 6例 ,病死率14 3% ,对照组肿变软消失时间 1～ 7天 2 5例 ,- 10天 8例 ,- 14天 3例 ,治疗组消失时间 1～ 7天 32例 ,余 10例 8天内消失 ,治疗组硬肿变软与消失时间较对照组 ,经统计学处理P <0 0 1,有明显差异。结论 :复方丹参佐治新生儿硬肿症有较好的疗效。     

鸟巢式护理在新生儿硬肿症中的应用效果观察

目的:探讨鸟巢式护理在新生儿硬肿症中的护理效果。方法:选取2015年3月~2017年6月本院诊治的42例硬肿症新生儿作为研究对象,并随机等分为对照组(常规新生儿硬肿症护理)和观察组(鸟巢式护理)。比较两组患儿护理后的疗效、体温恢复时间、硬肿消退时间、住院时间、并发症发生率及患儿家长对护理的满意度。结果:观察组患儿护理后的疗效优于对照组(P0.05),体温恢复时间、硬肿消退时间及住院时间均短于对照组(P0.05),并发症发生率低于对照组(P0.05),患儿家长对护理的满意度高于对照组(P0.05)。结论:鸟巢式护理在新生儿硬肿症中的护理效果较好,可辅助提高临床治疗效果,更受患儿家长的认可。     

维生素E胶丸抚触干预在新生儿硬肿症患儿中的应用

目的:探讨维生素E胶丸抚触护理干预在新生儿硬肿症患儿中的应用效果。方法:将2014年1月~2017年2月在我院新生儿科住院治疗的新生儿硬肿症患儿78例随机等分为观察组和对照组,两组均采用暖箱复温、抗感染、补充热量及改善循环等综合治疗,观察组患儿除常规治疗外,还采用维生素E胶丸抚触按摩硬肿部位,比较两组患儿的治疗效果。结果:观察组患儿肛温回升时间、硬肿消散吸收时间及住院时间均短于对照组(P0.05),并发症发生率低于对照组(P0.05)。结论:维生素E胶丸抚触干预新生儿硬肿症患儿,可促进局部血液循环,加快硬肿消散吸收,降低并发症发生率,提高临床治疗效果。     

新生儿硬肿症应用培养箱和辐射台保暖的疗效比较

目的探讨新生儿硬肿症应用婴儿培养箱或远红外线辐射台进行治疗的疗效。方法将经治的94例硬肿症新生儿随机分成2组，各47例，治疗、护理上采取一致的标准和措施。观察组将新生儿硬肿症患儿置于婴儿培养箱内，对照组将新生儿硬肿症患儿置于远红外线辐射台。结果相同程度的硬肿症，分别用婴儿培养箱或远红外线辐射台保温进行治疗观察，结果4d内，观察组患儿硬肿消褪率明显高于对照组，两者经统计学检验有显著性差异（P〈0．05）。结论婴儿培养箱比远红外线辐射台对新生儿硬肿症患儿的治疗效果更优。     

儿科护理学

053306石蜡油按摩治疗新生儿硬肿症的疗效观察/李海燕…//现代护理.-2004,10(12).-1120-1130将56例患儿随机分为两组。对照组采用中药持续外敷,每24h更换1次,加常规综合护理;观察组采用石蜡油按摩,2～3次/d,加常规综合护理。结果:治疗组患儿不仅硬肿症消失,而且睡眠延长,易入睡,哭闹减少,缩短了住院天数。观察组用石蜡油按摩治疗新生儿硬肿症与对照组中药外敷治疗新生儿硬肿相比,安全可靠,方法简单,便于观察。表1参5(原文摘要)     

芫荽、韭菜水外洗佐治新生儿硬肿症的效果观察

目的:探讨芫荽、韭菜水外洗治疗新生儿硬肿症的效果。方法:将88例硬肿症的患儿随机分为两组,对照组(42例)采用综合治疗的方法,观察组(46例)在综合治疗的基础上加用芫荽、韭菜水外洗,观察两组的治疗效果。结果:两组治疗方法均能治愈新生儿硬肿症,但观察组治疗总有效率、治愈天数明显优于对照组(P<0.05)。结论:芫荽、韭菜水外洗佐治新生儿硬肿症,疗效确切。     

石腊油按摩治疗新生儿硬肿症的疗效观察

目的　探索新生儿硬肿症的治疗方法 ,从而减轻或消除新生儿硬肿病变 ,提高治愈率 ,减少并发症 ,降低死亡率。方法　将 5 6例新生儿硬肿症随机分为 2组 ,对照组采用中药持续外敷 ,每 2 4小时更换 1次 ,加常规综合护理 ;观察组采用石腊油按摩 ,每日 2～ 3次 ,加常规综合护理。结果　治疗组患儿不仅硬肿消失快 ,而且睡眠延长 ,易入睡 ,哭闹减少 ,缩短住院天数。结论　观察组用石腊油按摩治疗新生儿硬肿与对照组中药外敷治疗新生儿硬肿相比 ,安全可靠 ,方法简单 ,便于观察     

石腊油按摩治疗新生儿硬肿症的疗效观察

目的探索新生儿硬肿症的治疗方法,从而减轻或消除新生儿硬肿病变,提高治愈率,减少并发症,降低死亡率.方法将56例新生儿硬肿症随机分为2组,对照组采用中药持续外敷,每24小时更换1次,加常规综合护理;观察组采用石腊油按摩,每日2～3次,加常规综合护理.结果治疗组患儿不仅硬肿消失快,而且睡眠延长,易入睡,哭闹减少,缩短住院天数.结论观察组用石腊油按摩治疗新生儿硬肿与对照组中药外敷治疗新生儿硬肿相比,安全可靠,方法简单,便于观察.     

水胶体敷料在新生儿硬肿症中的应用效果

目的探讨水胶体敷料在新生儿硬肿症中的应用效果。方法选取2016年1月至2019年1月我院收治的60例新生儿硬肿症患儿为研究对象,采用随机数表法将其等分为观察组和对照组。对照组采用常规护理,观察组在对照组基础上增加水胶体敷料贴敷。比较两组患儿临床疗效及恢复时间。结果观察组临床疗效优于对照组,差异有统计学意义(P 0. 05);观察组体温恢复时间、硬肿消失时间均短于对照组,差异有统计学意义(P 0. 05)。结论在新生儿硬肿症中应用水胶体敷料,能够提高治疗有效性,缩短硬肿时间,加快体温恢复,值得临床推广。     

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.