急性一氧化碳中毒患者的院前急救与护理

目的：探讨急性一氧化碳中毒患者的有效院前急救方法。方法：总结分析57例急性一氧化碳中毒患者的院前急救措施资料。在接警、出诊途中迅速指导现场人员急救处理，为挽救患者生命赢得时间，为后续救治创造条件。结果：经过有效的院前急救，在到达医院前．浅昏迷转为昏睡者15例，昏睡转为嗜睡者13例，头晕、恶心、全身乏力症状减轻者21例，病情好转8例。结论：提前干预指导现场急救，及早通风，注重保暖，正确搬运，合理的院前急救措施是急性一氧化碳中毒患者有效的院前急救方法。可以提高一氧化碳中毒抢救成功率。     

群发性急性一氧化碳中毒36例的应急预案护理

目的急性一氧化碳中毒患者病情危重,对群发性患者采取有效的措施将应急预案应用于急救的全过程,可以提高一氧化碳中毒抢救的成功率,降低死亡率和预防并发症的发生。方法对7起共36例急性一氧化碳中毒患者的急救和护理进行分析和总结。结果经紧急救护后除1例死亡外,34例治愈出院,1例好转。结论在对急性一氧化碳中毒患者的救治中,要具有完善的护理应急预案,并加强急救护理能力,对提高抢救成功率,减少并发症起到了重要作用。     

49例急性一氧化碳中毒患者的护理观察

目的探讨对急性一氧化碳中毒患者实施有效的观察与护理措施。方法回顾性分析49例急性一氧化碳中毒患者的临床资料及护理措施。结果 47例轻度患者全部治愈出院,未出现后遗症;好转1例(患者年龄偏大,营养状况差以致恢复欠佳);1例因本院医疗设备所限,转至90医院继续治疗。结论及时有效地实施护理观察是抢救急性一氧化碳中毒患者成功的关键。     

急性一氧化碳中毒病人的护理

[目的]探讨急性一氧化碳中毒病人的急救配合与护理措施对急救成功率的影响.[方法]对66例急性一氧化碳中毒病人的急救配合与护理进行回顾性总结.[结果]66例病人除3例现场已死亡外,其余63例均抢救成功,并无后遗症.[结论]对急性一氧化碳中毒病人及时采取有效的急救与护理,可提高病人的存活率,减少后遗症的发生.     

硫酸二甲酯中毒19例的急救与护理

目的探讨硫酸二甲酯中毒的急救与有效护理措施。方法对19例硫酸二甲酯中毒患者急救与护理体会,结合相关医学文献资料,探索硫酸二甲酯中毒的急救与有效护理措施。结果 19例患者中,10名医护人员治疗6 d后恢复,9例患者治疗14～30 d后陆续治愈出院。结论硫酸二甲酯中毒虽然发病急,但只要及时急救、实施有效的护理,就可提高成功率。     

一氧化碳中毒患者高压氧治疗中的护理管理

一氧化碳中毒是指短时间内吸入过多或过长时间吸入一氧化碳引起的局部和全身中毒疾病,大脑和心脏受累最为明显,轻者头昏、头痛、恶心、呕吐,重者意识不清、尿失禁或尿潴留、大便失禁、昏迷甚至死亡[1].急性一氧化碳中毒为临床常见病,发病急、症状重,如不及时救治就会有生命危险,目前高压氧治疗是当今各种急救措施中效果最佳方法之一[2].一氧化碳中毒后高压氧治疗的目的:①迅速排除体内一氧化碳.②恢复Hb运输氧的能力.③促进脑、心脏、肝等重要器官功能恢复,防治迟发脑病导致的精神神经系统损害[1].在患者进行高压氧治疗过程中实施有效的护理管理,可有效缓解患者的心理压力,减少高压氧意外及并发症的发生,提高抢救成功率和护理水平.现将高压氧治疗中的护理管理总结如下.     

急性一氧化碳中毒病人的护理

[目的]探讨急性一氧化碳中毒病人的急救配合与护理措施对急救成功率的影响。[方法]对66例急性一氧化碳中毒病人的急救配合与护理进行回顾性总结。[结果]66例病人除3例现场已死亡外，其余63例均抢救成功，并无后遗症。[结论]对急性一氧化碳中毒病人及时采取有效的急救与护理，可提高病人的存活率，减少后遗症的发生。     

群体性急性亚硝酸盐中毒29例急救护理

目的:探讨群体性急性亚硝酸盐中毒患者的急救护理方法。方法:回顾性分析2010年10月17日救治的29例群体性亚硝酸盐中毒患者的临床资料及急救护理过程。结果:本组29例急性中毒患者,经医护人员及时催吐、洗胃、静脉推注亚甲蓝、高压氧治疗等综合救护措施,27例轻、中度中毒患者均在8~24 h出院;2例重度中毒患者经抢救后给予对症支持、高压氧等综合治疗,3 d后痊愈出院。于患者出院1~3个月后随访未发生并发症和后遗症。结论:医务部门应加强肉食加工的卫生监督及知识培训,可预防亚硝酸盐中毒的发生;医护人员及时正确诊断,迅速清除毒物,并进行综合治疗;给予高压氧治疗能有效纠正缺氧和科学分流急诊患者。     

79例急性重度乙醇中毒患者的急救与护理

目的 探讨急性重度乙醇中毒患者的有效急救方法及护理措施。 方法 对79例急性重度乙醇中毒患者的救治护理进行总结。 结果 经及时的救治及有效护理,78例中毒患者于2~26h(平均12.1h)意识清醒、痊愈,1例因抢救无效死亡。 结论 对急性重度乙醇中毒患者及时采取有效救治方法和护理是抢救成功的关键。     

一氧化碳中毒病人的急救护理体会

[目的]探讨急性一氧化碳中毒有效的院内急救护理措施。[方法]回顾性分析2010年10月-2011年2月急性一氧化碳中毒病人79例,其中重度23例,中度29例,轻度27例。均采用综合抢救和积极的护理,稳定病人的生命体征,尽快使用高压氧治疗。[结果]治愈69例,显效8例,无效2例,总有效率97.47%。[结论]一氧化碳中毒后,如能采取综合抢救措施稳定病人的生命体征尽快使用高压氧治疗,可提高治愈率。     

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.     

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.