延续性围产期运动指导对胎儿体质量及分娩方式的影响

目的探讨延续性围产期运动指导对胎儿体质量及分娩方式的影响。方法将500例孕妇按建立围产期保健册的日期单双日分为对照组和实验组各250例,对照组采取传统围产期护理方法;实验组在对照组基础上接受3个阶段的围产期运动指导。结果实验组新生儿体质量和巨大儿例数低于对照组,自然分娩例数高于对照组,总产程及第一、第二产程时间少于对照组(P0.01或P0.05)。结论实施延续性围产期运动利于控制理想的胎儿体质量、缩短产程及促进自然分娩,有利于提升产科护理质量。     

延续性Kegel 运动联合Bobath球训练对二胎顺产分娩产妇产后盆底康复的疗效观察

目的：探讨延续性Kegel 运动联合Bobath球训练对二胎顺产分娩产妇产后盆底肌康复的疗效。方法：顺产分娩足月单胎二胎产妇150例,随机分为观察组和对照组各75例,对照组给予常规产后护理,出院时嘱产后第2天开始做产后盆底肌恢复操。观察组在常规产后护理基础上实施延续性Kegel 运动联合Bobath球训练指导。产后6 个月后观察两组盆底康复锻炼的依从性、盆底肌肌力康复效果;产后1天及产后12个月观察两组产妇盆腔器官脱垂（S-POP-Q）及尿失禁发生率（ICI-Q-SF）;产后6个月及产后12个月进行女性性功能（FSFI）评价,比较两组性功能恢复情况。结果：盆底功能锻炼依从性、盆底综合肌力明显高于对照组（P＜0.01）;观察组产妇产后1天时,尿失禁和盆腔器官脱垂发生率与对照组比较,差异无统计学意义(P＞0.05),观察组产妇产后12个月时,尿失禁和盆腔器官脱垂发生率均低于对照组,(P<0.05);产后6个月,观察组FSFI各维度评分与对照组比较,性欲维度评分高于对照组(P<0.01),其余两组各维度差异无统计学意义(P＞0.05),产后12个月,FSFI各维度评分高于对照组 (P<0.05),但性交疼痛维度评分低于对照组(P<0.01)。结论：开展延续性Kegel 运动联合Bobath球训练能够提高二胎顺产分娩产妇盆底肌功能锻炼的依从性,减少尿失禁和盆腔脏器脱垂的发生,改善经产妇产后盆底功能,提高生活质量,康复效果显著。     

围产期综合护理干预对产妇产程及产后康复情况的影响

目的:探讨围产期综合护理干预对产妇分娩情况与产后康复的影响。方法:选取2012年3月~2013年3月我院住院待产的产妇196例,将其随机分为试验组和对照组各98例,试验组产妇接受围产期综合护理干预措施,对照组产妇接受常规产前教育和护理。记录并比较两组产妇的总产程、产后出血、排尿情况等指标。结果:试验组产妇产程明显短于对照组(P0.05),产后出血率低于对照组(P0.05),自主排尿率高于对照组(P0.05)。结论:围产期综合护理干预有利于产程进展及产后康复。     

延续性护理对自然分娩后盆底肌力恢复的影响

[目的]探讨延续性护理对自然分娩后盆底肌力恢复的影响。[方法]将112例自然分娩产妇根据随机数字表法分为对照组和观察组各56例,对照组产妇采用常规护理,观察组产妇采用延续性护理。采用会阴肌力评价量表(GRRUG)评定病人的盆底肌力,焦虑自评量表(SAS)评估产妇焦虑状态,抑郁自评量表(SDS)评估产妇抑郁状态,世界卫生组织推荐的生活质量量表评定产妇生活质量。[结果]观察组产妇盆底肌力恢复情况优于对照组,护理后SAS和SDS评分降低且低于对照组,护理后生活质量评分升高且高于对照组(P0.05)。[结论]延续性护理可促进自然分娩产妇盆底肌力恢复,缓解抑郁和焦虑情绪,提高生活质量,效果优于常规护理。     

产后瑜伽对于产妇盆底肌张力恢复的作用

目的 探讨瑜伽锻炼对不同分娩方式的产妇盆底肌张力恢复的作用.方法 选取我经阴道分娩的产妇84例,随机分为实验组和对照组,每组42例;选取行剖宫产的产妇68例,随机分为实验组和对照组,每组34例.两种分娩方式的实验组均于产后20d给予瑜伽锻炼指导并嘱产妇进行规律定时锻炼,两种分娩方式的对照组仅给予常规产后护理.2个月后观察产妇的盆底综合肌力及性生活满意率.结果 两种分娩方式的实验组盆底综合肌力及性生活满意率均明显优于其对照组(P＜0.05);阴道分娩的实验组盆底肌张力恢复情况和性生活满意率优于选择性剖宫产的实验组(P＜0.05).结论 产后瑜伽锻炼对不同分娩方式的产妇盆底肌张力的恢复有良好的效果,尤其对经阴道分娩者效果更佳,临床可推广应用.     

自然分娩与剖宫产分娩产妇发生产后抑郁症的差异及分析

目的探讨自然分娩与剖宫产分娩产妇发生产后抑郁症的差异。方法选取呼伦贝尔市人民医院产科86例产妇,根据分娩方式将入选者分为对照组和研究组,每组43例,对照组产妇行剖宫产分娩,研究组患者行阴道分娩,比较两组产妇产后抑郁症发生情况。结果研究组产妇的EPDS及SDS评分均显著低于对照组(P<0.05),研究组产妇产后3d、7d产后抑郁发生率均显著低于对照组(P<0.05)。结论自然分娩创伤性小,有利于促进产妇产后康复,减少产后抑郁症发生率。     

产后康复治疗改善盆底功能的180例临床观察

目的探讨产后康复治疗对改善盆底功能的临床效果。方法选择分娩的360例产妇作为研究对象,采用随机数字表法分为观察组与对照组各180例。对照组予以常规产后治疗,观察组采用产后康复治疗,比较两组盆底功能改善及盆底功能障碍性疾病发生情况。结果治疗前两组静息压、盆底收缩压相比,无显著性差异(P0.05);治疗后两组静息压、盆底收缩压均显著升高,且观察组明显高于对照组,差异有统计学意义(P0.05);观察组各种盆底功能障碍性疾病的发生率均明显低于对照组,差异有统计学意义(P0.05)。结论产后康复治疗有利于改善产妇盆底功能,降低盆底功能障碍性疾病的发生,对提高女性产后生活水平具有积极作用,值得临床推广应用。     

顺产分娩产妇应用延续性Kegel运动联合Bobath球训练的效果观察

目的探讨延续性Kegel运动联合Bobath球训练在顺产分娩产妇中的应用效果。方法选取2017年10月—2019年10月山东大学齐鲁医院顺产分娩产妇160例,按照组间基本特征具有可比性的原则分为对照组和观察组,每组80例。对照组实施常规盆底肌康复操,观察组实施延续性Kegel运动联合Bobath球训练,对比两组产妇盆底肌力和性功能评分。结果观察组产妇盆底肌力明显优于对照组(P<0.05);产后6个月,观察组仅性欲维度明显高于对照组(P<0.05);产后12个月,观察组性功能各维度明显高于对照组;差异均有统计学意义(P<0.05)。结论将延续性Kegel运动联合Bobath球训练应用在顺产分娩产妇中,有效改善其产后盆底肌力,提高性功能各项指标,促进产后康复。     

生物反馈电刺激治疗联合康复护理对经阴道分娩产妇产后焦虑抑郁及盆底功能的影响

目的探讨生物反馈电刺激治疗联合康复护理对经阴道分娩产妇产后焦虑抑郁及盆底功能的影响。方法选取我院2017年2月至2019年2月收治的经阴道分娩产妇180例为研究对象,随机将其等分为对照组和观察组,对照组采取常规护理,观察组在对照组基础上采用生物反馈电刺激治疗联合康复护理,比较两组患者产后焦虑抑郁情绪及盆底功能恢复状况。结果观察组焦虑自评量表(SAS)、爱丁堡产后抑郁量表(EPDS)评分均低于对照组(P 0. 05);观察组盆底功能障碍问卷(PFDI-20)评分低于对照组(P 0. 05),Ⅰ类肌纤维、Ⅱ类肌纤维收缩压高于对照组(P 0. 05)。结论生物反馈电刺激治疗联合康复护理在经阴道分娩产妇中应用,能缓解产后焦虑抑郁情绪,促进盆底功能恢复。     

盆底康复治疗仪对初产妇产后盆底康复的影响

目的探讨盆底康复治疗仪对初产妇产后盆底康复的影响。方法选取2018年1月—12月在本院分娩的100例初产妇为研究对象,按随机数字表法将其分为对照组和观察组,每组各50例。对照组接受常规康复治疗,观察组在对照组的基础上进行盆底康复治疗仪治疗。比较两组产妇产后恢复情况、盆底肌肌力改善效果以及产后并发症发生情况。结果观察组的首次排尿时间较对照组早(P0.05),恶露持续时间较对照组短(P0.05);观察组产后1个月盆底肌肌力总改善率高于对照组(P0.05);观察组产后并发症总发生率低于对照组,差异有统计学意义(P0.05)。结论在产妇产后采用盆底康复治疗仪进行治疗,能够促进产妇产后盆底康复,降低并发症发生率,值得临床推荐。     

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.