肺表面活性物质联合持续气道正压通气在早产儿呼吸窘迫综合征中的应用及护理

目的观察肺表面活性物质（PS）联合持续气道正压通气（NCPAP）对早产儿呼吸窘迫综合征（NPDS）的治疗效果及总结护理要点。方法2006年5月～2007年12月对26例呼吸窘迫综合征的早产儿于人院后30min-2h内给予经气管内滴人PS，用药后联合应用NCPAP辅助呼吸，观察治疗的效果。结果26例患儿在PS给药后5min呼吸窘迫明显缓解，其中12例NCPAP给氧2h，9例NCPAP给氧3h，4例NCPAP给氧5h后改用面罩给氧，并逐步撤氧，1例死亡。结论PS联合NCPAP能有效地治疗早产儿NRDS，护理过程注意配合医生使用PS，加强给药后NCPAP机管理及呼吸道护理，严密监测早产儿动脉血氧饱和度（SaO2）、呼吸、心率、血压及不良反应，同时做好保暖，抗感染及纠正电解质紊乱是治疗成功的保证。     

同步鼻塞间歇正压通气在新生儿呼吸窘迫综合征中的应用及护理

目的探讨同步鼻塞间歇正压通气(SNIPPV)治疗新生儿呼吸窘迫综合征(NRDS)的临床疗效及护理方法。方法选择2010年10月～2011年10月患呼吸窘迫综合征的早产儿,应用肺表面活性物质固尔苏100～200mg/kg。对于仍有呼吸困难需无创通气的患儿46例,随机分成为SNIPPV组22例和鼻塞持续正压通气(NCPAP)组24例。比较两组通气后血气指标及无创通气时间。结果两组早产儿一般资料无差异,SNIPPV组血气指标较NCPAP组恢复时间迅速,PaCO2下降明显,无创通气时间缩短。结论SNIPPV作为应用肺表面活性物质后治疗NRDS是可行的,且比NCPAP模式更有效,精心、细致、周到的护理是治疗成功的关键。     

固尔苏预防早产儿呼吸窘迫综合征60例疗效观察及护理

目的:探讨肺泡表面活性物质固尔苏预防早产儿呼吸窘迫综合征的临床疗效及护理方法.方法:将胎龄≤33周、体重＜2 500 g、生后6 h内入院的早产儿120例随机分成两组进行对比性研究,观察组60例出生后6 h内气管内一次性滴入固尔苏,对照组60例未应用固尔苏,其余治疗及护理相同.结果:观察组未发生呼吸窘迫综合征,与对照组比较有明显差异(P<0.01);出生后12、24、48、72 h动脉血气分析结果显示,观察组优于对照组(P<0.05).结论:早产儿生后应尽早预防性应用固尔苏,可显著降低新生儿呼吸窘迫综合征的发病率,提高早产儿的存活率.     

肺泡表面活性物质联合鼻塞持续气道正压通气治疗早产儿呼吸窘迫综合征的疗效及护理

目的:观察肺泡表面活性物质治疗早产儿呼吸窘迫综合征的疗效。方法:将156例呼吸窘迫综合征患儿随机分为治疗组(78例)及对照组(78例)。治疗组于出生后30min～2h从气管插管内滴入肺泡表面活性物质(固尔苏),每次100～200mg/kg,用药后应用鼻塞持续气道正压(NCPAP)装置辅助呼吸;对照组单纯应用NCPAP装置辅助呼吸。两组其他治疗及护理措施相同。结果:治疗组辅助呼吸、机械通气、住院时间明显缩短,与对照组比较,差异有显著性(均P0.05);治疗组72h胸部X线摄片正常率高于对照组(P0.05)。结论:保持呼吸道通畅,采取正确的氧疗和加强机械通气的管理,配合早期足量的应用肺泡表面活性物质,可提高呼吸窘迫综合征患儿的疗效和缩短病程。     

固尔苏治疗早产儿呼吸窘迫综合征的疗效

目的:观察肺表面活性物质固尔苏(curosurf)治疗早产儿呼吸窘迫综合征NRDS的效果。方法:对42例早产儿应用固尔苏治疗,观察临床反应、血气变化及疗效。结果:应用固尔苏后不久26例患儿呼吸急促、呻吟、三凹征、紫绀症状减轻或消失,16例辅助机械通气治疗患儿用药后30 min均下调呼吸机参数;42例患儿用药前与用药后2hPaO2、PaCO2、pH比较有显著差异(P<0.01);42例患儿治愈39例,治愈率92.8%,死亡3例。结论固尔苏能有效治疗早产儿呼吸窘迫综合征,且合理掌握用药指征和时机及对并发症的防治对固尔苏的疗效较为重要。     

固尔苏在防治早产儿呼吸窘迫综合征中的护理支持

[目的]探讨应用肺表面活性物质固尔苏(PS)气管内给药治疗新生儿呼吸窘迫综合征的护理支持.[方法]选取我院儿科新生儿病房20例早产儿呼吸窘迫综合征患儿进行治疗和护理,将肺表面物质固尔苏在患儿右侧卧位、仰卧位、左侧卧位经气管匀速注入用药量的各1/3量.[结果]18例患儿好转及治愈,1例放弃治疗,1例极低体重儿并发肺出血、DIC死亡.[结论]在用药过程中给予正确的护理干预支持是PS发挥其疗效的保障.     

早产儿呼吸窘迫综合征的护理

目的 探讨肺表面活性物质(PS)联合鼻塞式持续气道正压通气(NCPAP)治疗早产儿呼吸窘迫综合征的护理方法.方法 对于应用PS联合NCPAP治疗早产儿呼吸窘迫综合征的69例患儿,做好给药的护理,加强给药后NCPAP机管理及呼吸道管理,严密监测病情变化,实施相应的护理.比较该组患儿在治疗和护理前后的血气分析结果和治疗结局.结果 患儿在接受冶疗和护理后的血气分析结果优于治疗前(P<0.05),治疗效果满意.结论 PS联合NCPAP治疗早产儿呼吸窘迫综合征的临床效果满意.而细致、周到的护理是治疗成功的保证.     

肺表面活性物质治疗新生儿呼吸窘迫综合征的临床疗效分析

目的探讨肺表面活性物质治疗新生儿呼吸窘迫综合征的临床疗效。方法选取2013年2月至2016年5月呼吸窘迫综合征早产儿120例,随机分成两组,每组60例。甲组采用固尔苏治疗,乙组采用珂立苏治疗,比较两组临床疗效。结果两组治疗24 h后,PaO_2、p H值明显高于治疗前,PaCO_2明显低于治疗前,差异有统计学意义(P0.05);甲组持续正压通气(continuous positive airway pressure,CPAP)时间明显短于乙组,差异有统计学意义(P0.05);两组血气指标、住院时间、用氧时间和并发症发生率差异未见统计学意义(P0.05)。结论固尔苏和珂立苏两种肺表面活性物质治疗新生儿呼吸窘迫综合征的疗效相似,能有效改善患儿肺功能和临床症状,减少并发症的发生,促使患儿早日恢复健康,具有较高的临床应用价值。     

早期应用固尔苏联合NCPAP治疗新生儿呼吸窘迫综合征的护理

新生儿呼吸窘迫综合征(NRDS)又称肺透明膜病,是肺泡表面活性物质(PS)缺乏而致广泛的肺泡萎陷和肺顺应性降低,以致生后不久即出现呼吸窘迫并呈进行性加重的临床综合征.多见于早产儿,胎龄愈小,发病率愈高[1],是早产儿围生期死亡的主要原因.近年来,由于PS的应用使其抢救成活率有了显著提高.固尔苏是从猪肺中分离出来的天然PS,能显著改善NRDS患儿的呼吸困难,维持充分的气体交换,从而降低病死率.2008年-2009年我科收治10例早产儿呼吸窘迫综合征患儿,应用固尔苏联合鼻塞式管道正压通气(NCPAP)治疗,取得了良好的临床效果.现将护理介绍如下.     

肺表面活性物质配合NCPAP治疗新生儿呼吸窘迫综合征的效果观察

目的研究采用肺表面活性物质配合鼻塞式持续气道正压通气(NCPAP)治疗新生儿呼吸窘迫综合征的效果。方法选取收治的新生儿呼吸窘迫综合征患儿50例,按随机数字表法分为对照组和观察组各25例。对照组采用肺表面活性物质(固尔舒)配合机械通气治疗,观察组行肺表面活性物质(固尔舒)配合NCPAP治疗。结果观察两组疗效、血气指标和治疗一般情况。观察组总有效率(92.00%)显著高于对照组(68.00%),差异有统计学意义(P<0.05);观察组机械通气时间、症状缓解时间和住院时间均显著短于对照组,差异有统计学意义(P<0.05);观察组治疗后PaO2、PaCO2均优于对照组,差异有统计学意义(P<0.05)。结论肺表面活性物质配合NCPAP治疗新生儿呼吸窘迫综合征疗效确切,可恢复患儿血气指标,提高临床症状恢复速度,明显缩短治疗时间,值得临床推广应用。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.     

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.