康复护理在重症病毒性脑炎患儿治疗中的应用价值探究

目的:探讨重症病毒性脑炎患儿采用康复护理干预的临床效果。方法:选取2017年8月～2018年8月收治的100例重症病毒性脑炎患儿作为研究对象,采用随机数字表法分为对照组和观察组,各50例。对照组采用常规护理,观察组在对照组护理基础上采用康复护理,对比两组临床症状改善时间、运动功能评分、住院时间、残疾发生情况。结果:护理后,观察组意识障碍、惊厥、肢体障碍、神经障碍等改善时间均显著短于对照组,差异有统计学意义(P0.05);观察组残疾发生率低于对照组,住院时间短于对照组,差异有统计学意义(P0.05);观察组运动功能评分高于对照组,差异有统计学意义(P0.05)。结论:采用康复护理干预重症病毒性脑炎患儿可促进患儿各项功能恢复。     

针对性护理在小儿重症病毒性脑炎合并呼吸衰竭中的应用效果观察

目的 分析重症病毒性脑炎患儿并发呼吸衰竭采用针对性护理措施的护理效果.方法 我院2021年2月至2022年6月收治的80例重症病毒性脑炎并发呼吸衰竭患儿,以随机数字表法分为对照组和观察组,每组各40例.对照组实施常规护理干预,观察组患儿实施针对性护理.比较两组患儿治疗效果、身体机能恢复时间、运动功能改善情况以及患儿家长护理满意度.结果 与对照组患儿比较,观察组治疗总有效率显著较高(P＜0.05).两组患儿经相应护理后,惊厥、肢体障碍、意识障碍、颅神经障碍等身体技能恢复时间观察组均短于对照组(P＜0.05).两组患儿经相应护理后,观察组运动功能、感觉功能、关节活动和疼痛以及总分均低于对照组(P＜0.05).观察组患儿家长护理满意度高于对照组(P＜0.05).结论 重症病毒性脑炎并发呼吸衰竭患儿实施针对性护理,提高治疗效果,促进身体机能恢复,提高护理满意度.     

早期系统化护理对病毒性脑炎患儿预后及生活质量的影响

目的:探讨早期系统化护理对重症病毒性脑炎患儿预后及生活质量的影响。方法:选取本院2013年1月~2014年12月收治的84例重症病毒性脑炎患儿为研究对象,将患儿随机等分为观察组及对照组,对照组给予常规性护理;观察组给予全程护理干预,分别于入院时及出院时应用Fugl-Meyer评分系统、Glasgow评分及简易健康量表(SF-36)对两组患儿运动功能及生活质量进行评价。结果:干预后观察组FuglMeyer评分、生理功能、生理职能、情感职能、社会功能、身体疼痛、活动、精神健康评分均高于对照组(P0.05),Glasgow评分低于对照组(P0.05)。结论:早期系统化护理干预有利于促进重症病毒性脑炎患儿运动功能的恢复,有利于纠正患儿肢体痉挛,提高患儿生活质量。     

临床护理路径在亚低温治疗重症脑炎患儿中的应用

[目的]探讨临床护理路径在亚低温治疗重症脑炎患儿中的应用。[方法]选取2015年1月—2015年12月收治的86例行亚低温治疗的重症脑炎患儿,根据分层抽样法将患儿分为观察组及对照组各43例,对照组应用常规护理,观察组在常规护理基础上应用临床护理路径。比较两组患儿预后情况、并发症发生情况及家属满意度。生活功能采用Barthel指数评定,肢体运动采用FuglMeyer运动功能积分评定。[结果]观察组恢复良好率、家属满意率、患儿依从性高于对照组(P0.05),而并发症发生率、功能障碍发生率低于对照组(P0.05);观察组出院时Barthel指数评分及Fugl-Meyer运动评分高于对照组(P0.05)。[结论]临床护理路径能有效改善重症脑炎患儿相应功能,降低患儿伤残率,促进患者预后,提高家属满意度。     

病毒性脑炎患儿实施早期康复护理对运动功能恢复和纠正肢体痉挛的作用

目的探讨病毒性脑炎患儿实施早期康复护理对运动功能的恢复和肢体痉挛的纠正作用。方法从本院2013年9月~2014年9月收治的病毒性脑炎患儿中随机选择88例进行研究,随机分为对照组（44例）和观察组（44例）,分别给予常规护理和常规护理联合早期康复护理。观察两组的运动功能恢复情况和肢体痉挛纠正情况,并进行比较。结果经统计和比较,在护理干预之前,两组Fugl-meyer运动功能评分量表 (Fugl-meyer Motor Function Assessment ,FMA)评分经比较P＞0.05;经过不同的护理之后,较之本组护理干预前,两组患者的FMA评分均出现显著上升的情况,（均P＜0.05）;且不同的护理干预之后,两组FMA评分经比较,观察组显著高于对照组,（P＜0.05）,经不同的护理干预之后,观察组基本恢复的患儿有9例,最终的治疗总有效率为90.91%,显著高于对照组的79.55%。结论对病毒性脑炎患儿在常规护理的基础上联合实施早期康复护理可以有效恢复患儿的运动功能并纠正肢体痉挛。     

康复护理干预对重症病毒性脑炎患儿运动功能恢复的影响

目的:探究康复护理干预对重症病毒性脑炎患儿运动功能恢复的影响。方法:选择2016年3月至2017年1月我院收治的重症病毒性脑炎患儿100例,根据随机数表法将所有患者分为2组,每组各50例。对照组进行常规护理,观察组在此基础上进行康复护理干预,观察比较两组患儿运动功能恢复情况。结果:护理前两组运动功能相比,差异无统计学意义(P0.05);护理后两组患儿运动功能均得到改善,且观察组改善效果优于对照组,差异具有统计学意义(P0.05)。结论:康复护理干预能显著提高重症病毒性脑炎患儿运动功能的恢复水平。     

早期康复护理对病毒性脑炎患儿肢体痉挛及运动功能的影响

目的:研究早期康复护理对病毒性脑炎患儿肢体痉挛及运动功能的影响。方法:选择2016年4月至2018年9月本院收治的病毒性脑炎患儿100例,随机分为对照组和观察组,每组50例。对照组实施常规护理,观察组实施早期康复护理,对比两组患儿日常生活活动能力、肢体痉挛程度、运动功能及临床疗效。结果:与对照组比较,观察组患儿日常生活活动能力(MBI)评分及运动功能(FMA)评分均高于对照组,肢体痉挛程度评分(Ashworth)低于对照组,差异有统计学意义(P0.05);观察组患儿治疗总有效率为98.00%显著高于对照组的80.00%,差异有统计学意义(P0.05)。结论:针对病毒性脑炎患儿,实施早期康复护理可有效促进患儿疾病恢复,提高其日常生活活动能力及治疗效果,改善肢体痉挛情况,值得临床应用和推广。     

急性期康复护理对小儿病毒性脑炎预后的影响

目的 探讨急性期康复护理对重症小儿病毒性脑炎患儿预后的影响.方法 将96例患儿,按患儿家长意愿分为康复组50例和对照组46例,对照组患儿急性期采用常规治疗和基础护理,康复组在对照组治疗的基础上给予分期康复护理干预,治疗结束后,采用对比观察的方法,比较2组患儿的意识障碍、颅神经障碍、运动功能障碍的恢复时间及1年后伤残的发生率.结果 康复组患儿在急性期昏迷、颅神经障碍、抽搐、运动功能障碍恢复方面均明显优于对照组(p＜0.05),1年后运动功能障碍、智力低下、语言障碍、行为异常等伤残方面显著低于对照组(p＜0.01).结论 对重症急性病毒性脑炎患儿实施康复护理干预是改善预后、减少伤残发生率、提高患儿生存质量的有效手段.     

早期康复干预对重症小儿病毒性脑炎预后的影响

[目的]观察早期康复干预对重症病毒性脑炎患儿预后的影响。[方法]选择我院2010年9月—2011年9月42例重症病毒性脑炎患儿征得家长同意后进行早期康复干预,本组患儿设为康复组,同时选择同期未进行康复干预的重症病毒性脑炎患儿42例作为对照组,所有患儿均得到3个月～12个月的随访,比较两组患儿伤残率及各功能障碍恢复时间。[结果]康复组患儿平均意识、惊厥、颅神经障碍及肢体功能障碍恢复时间明显短于对照组,康复组共出现伤残患儿5例,发生率为14.29%;对照组共出现12例,发生率为28.57%;康复组伤残率明显低于对照组,两组比较差异有统计学意义(P<0.05)。[结论]早期康复干预对患儿运动、意识功能的恢复具有积极的作用,是降低致残率,提高患儿预后的有效方法。     

早期康复护理在小儿重症病毒性脑炎护理中的应用效果分析

目的 观察早期康复护理在小儿重症病毒性脑炎护理中的应用效果。方法 选取 2021 年 7 月至 2022 年 12 月期间我院重 症病毒性脑炎患儿 68 例作为研究对象。随机将患儿分为对照组和观察组,每组各 34 例。对照组采用常规护理;观察组采用早 期康复护理。分析对比两组的恢复时间、智力达标率、伤残率、运动功能以及护理满意度。结果 观察组惊厥、颅神经障碍、 意识障碍、肢体障碍等症状恢复时间比对照组显著缩短（P<0.05）。观察组的智力达标率比对照组显著提高,伤残率显著降低 （P<0.05）。观察组的 FMA 评分显著高于对照组（P<0.05）。观察组的护理满意度显著高于对照组（P<0.05）。结论 在小儿 重症病毒性脑炎护理中应用早期康复护理,能缩短患儿的恢复时间,提高智力达标率,降低伤残率,提高运动功能以及护理满 意度。     

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.     

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.