菜花型低位直肠癌患者两种不同灌肠法的研究

为探讨改良灌肠法对菜花型低位直肠癌手术患者的影响,选择2003年7月至2005年7月在我院住院的菜花型低位直肠癌患者84例,随机分为实验组和对照组。对照组按常规法清洁灌肠;实验组则实施系统的改良灌肠措施(选择不同的灌肠卧位、肛管、肛管插入深度、灌肠液及灌肠量)。观察两组患者灌肠时舒适度、洁肠的效果、术后有无并发症,并对各项结果进行统计学分析,结果实验组和对照组比较,灌肠时患者腹胀、腹痛程度轻,洁肠效果好,术后并发症发生率降低(P<0·01)。     

菜花型低位直肠癌患者两种不同灌肠法的研究

为探讨改良灌肠法对菜花型低位直肠癌手术患者的影响,选择2003年7月至2005年7月在我院住院的菜花型低位直肠癌患者84例,随机分为实验组和对照组.对照组按常规法清洁灌肠;实验组则实施系统的改良灌肠措施（选择不同的灌肠卧位、肛管、肛管插入深度、灌肠液及灌肠量）.观察两组患者灌肠时舒适度、洁肠的效果、术后有无并发症,并对各项结果进行统计学分析,结果实验组和对照组比较,灌肠时患者腹胀、腹痛程度轻,洁肠效果好,术后并发症发生率降低（P＜0.01）.     

影响清洁灌肠满意度的因素及对策

目的:探讨影响清洁灌肠满意度的相关因素及对策。方法:将160例结直肠肿瘤患者随机分为常规组和改良组各80例,常规组采用常规清洁灌肠方法,改良组采用改良灌肠措施(选择不同灌肠体位、灌肠压力、肛管插入方式、插入深度),观察每次灌肠液量、保留时间、总灌肠次数、灌肠中不良反应及洁肠效果,患者满意度。结果:与常规组比较,改良组每次灌肠液量多,保留时间长,灌肠中无因不良反应被迫终止灌肠,总灌肠次数减少,洁肠效果明显优于常规组,患者满意度高。结论:应用改进后的灌肠方法,患者对灌肠的耐受性、满意度均提高。     

影响清洁灌肠满意度的因素及对策

目的：探讨影响清洁灌肠满意度的相关因素及对策。方法：将160例结直肠肿瘤患者随机分为常规组和改良组各80例,常规组采用常规清洁灌肠方法,改良组采用改良灌肠措施（选择不同灌肠体位、灌肠压力、肛管插入方式、插入深度）,观察每次灌肠液量、保留时间、总灌肠次数、灌肠中不良反应及洁肠效果,患者满意度。结果：与常规组比较,改良组每次灌肠液量多,保留时间长,灌肠中无因不良反应被迫终止灌肠,总灌肠次数减少,洁肠效果明显优于常规组,患者满意度高。结论：应用改进后的灌肠方法,患者对灌肠的耐受性、满意度均提高。     

改进型医用肛管在老年患者清洁灌肠中的应用

目的：探讨改进型医用肛管在老年患者中应用的可行性及效果。方法：将60例老年患者随机分为实验组和对照组各30例,实验组给予改进型医用肛管灌肠,对照组给予传统的橡胶肛管灌肠,比较两组患者的反应和临床效果。结果：与对照组比较,实验组灌肠的次数及腹痛者明显减少（P〈0．01）,无灌肠液外溢及肠黏膜损伤情况的发生,洁肠效果明显优于对照组（P〈0．01）。结论：应用改进型医用肛管灌肠效果好,患者痛苦少,提高了护理工作效率,减少了环境污染,是临床护理工作中理想的灌肠方式。     

改进型医用肛管在老年患者清洁灌肠中的应用

目的:探讨改进型医用肛管在老年患者中应用的可行性及效果.方法:将60例老年患者随机分为实验组和对照组各30例,实验组给予改进型医用肛管灌肠,对照组给予传统的橡胶肛管灌肠,比较两组患者的反应和临床效果.结果:与对照组比较,实验组灌肠的次数及腹痛者明显减少(P<0.01),无灌肠液外溢及肠黏膜损伤情况的发生,洁肠效果明显优于对照组(P<0.01).结论:应用改进型医用肛管灌肠效果好,患者痛苦少,提高了护理工作效率,减少了环境污染,是临床护理工作中理想的灌肠方式.     

两种一次性导管进行清洁灌肠效果观察

[目的]观察采用一次性导尿管与一次性肛管进行清洁灌肠的效果。[方法]将100例需进行清洁灌肠而无灌肠禁忌证的病人随机分为对照组和实验组。对照组选择一次性肛管，实验组选择一次性导尿管，在相同操作步骤下，对照组按常规灌肠插入肛管深度10cm～15cm，观察组插入导尿管25cm-35cm，观察两组病人所需的灌肠次数、每次能耐受的灌入量、有无灌肠液外溢、手术毕距第1次排大便间隔时间及手术医生对肠道清洁度的满意度。[结果]两种导管进行清洁灌肠效果比较具有统计学意义（P〈0．01）。[结论]应用一次性导尿管进行清洁灌肠效果明显优于一次性肛管。     

改良灌肠法在老年直肠癌患者术前准备中的应用

目的探讨改良清洁灌肠法用于老年直肠癌患者术前准备中清洁肠道的效果。方法将140例老年直肠癌需手术患者分为2组,对照组70例采用传统清洁灌肠法,观察组70例采用改良清洁灌肠法,观察2组患者灌肠时有无不适感,灌肠次数,每次灌肠液量以及肠道清洁情况。结果观察组在患者满意度,灌肠次数,肠道清洁等方面优于对照组,差异有显著性(p<0.01)。结论改良清洁灌肠法在老年直肠癌患者术前清洁肠道应用中,效果优于传统清洁灌肠法。     

改良清洁灌肠法在直肠癌患者术前肠道准备中的应用效果分析

目的探讨改良清洁灌肠法在直肠癌患者术前肠道准备中的应用效果。方法选取2006年1月-2008年12月在本院特诊外科住院行手术治疗的直肠癌患者50例,分为观察组28例及对照组22例。观察组采用改良清洁灌肠法行术前肠道准备,对照组采用传统清洁灌肠法行术前肠道准备。记录并比较两组患者灌肠相关指标。结果两组患者在每次灌入液体量、灌肠次数、灌肠液保留时间及自觉症状方面的差异存在统计学意义（均P〈0．05）。与对照组比较,观察组患者每次灌入液体量较多,保留时间长,而灌肠次数减少,自觉症状减轻。结论改良清洁灌肠法在直肠癌患者术前肠道准备中的应用效果优于传统清洁灌肠法。     

异常情况下灌肠的插管技巧

我科白2004年以来共为3500余例患者实施了灌肠。在进行肛管插入的操作时，遇到了许多异常情况，如外痔、肛门口赘生物、肛门松弛、菜花型低位直肠癌等。此时按照常规的灌肠方法，易致肛管插入困难，使患者疼痛不适及液体灌入量不足等。因此，我们在工作中对异常情况下的灌肠插管技巧做了改进，取得了良好的效果，现报道如下。     

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.     

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.     

Molecular characterization of virulence and antimicrobial resistance profile of Shigella species isolated from children with moderate to severe diarrhea in northeastern Brazil

Molecular characterization of virulence and antimicrobial resistance profiles were determined for Shigella species isolated from children with diarrhea in Fortaleza, Brazil. Fecal specimens were collected along with socioeconomic and clinical data from children with moderate to severe diarrhea requiring emergency care. Shigella spp. were isolated by standard microbiological techniques, and we developed 4 multiplex polymerase chain reaction assays to detect 16 virulence-related genes (VRGs). Antimicrobial susceptibility tests were performed using disk diffusion assays. S. flexneri and S. sonnei were the predominant serogroups. S. flexneri was associated with low monthly incomes; more severe disease; higher number of VRGs; and presence of pic, set, and sepA genes. The SepA gene was associated with more intense abdominal pain. S. flexneri was correlated with resistance to ampicillin and chloramphenicol, whereas S. sonnei was associated with resistance to azithromycin. Strains harboring higher numbers of VRGs were associated with resistance to more antimicrobials. We highlight the correlation between presence of S. flexneri and sepA, and increased virulence and suggest a link to socioeconomic change in northeastern Brazil. Additionally, antimicrobial resistance was associated with serogroup specificity in Shigella spp. and increased bacterial VRGs.     

护理干预对面部中重度寻常型痤疮的临床疗效影响分析

目的研究护理干预对面部中重度寻常型痤疮的临床疗效影响。方法选取本院在2014年4月~2016年7月诊治的136例面部中重度寻常型痤疮患者,随机分为研究组与对照组,每组68例;所有患者均依据其情况给予对应的治疗,其中对照组在治疗期间给予常规护理,研究组在对照组的基础上再给予综合性护理干预,比较两组的治疗效果及护理满意度情况等。结果患者在接受治疗和护理后,研究组中度与重度患者的治疗效果较对照组均明显提高(P0.05),研究组护理满意度较对照组明显增高(P0.05)。结论对面部中重度寻常型痤疮患者在其治疗期间给予综合性护理干预,具有良好的效果。