产后早期乳房护理干预对母乳喂养的影响

目的探讨产后早期乳房护理干预对母乳喂养的影响。方法将200例产妇分为对照组和观察组,每组100例。对照组进行常规产科护理和母乳喂养指导,观察组在对照组的基础上给予早期乳房护理干预,包括刺激乳头、乳房按摩、母乳喂养知识强化健康教育。观察并比较两组产妇的首次泌乳时间、泌乳量、乳房胀痛发生情况及产后42 d母乳喂养情况。结果观察组产妇首次泌乳时间早于对照组,且泌乳量多于对照组,两组比较差异有统计学意义(P0.05);观察组产妇乳房胀痛发生率低于对照组,产后42d纯母乳喂养率高于对照组,两组比较差异也均有统计学意义(P0.05)。结论产后早期乳房护理干预能缩短产妇首次泌乳时间、增加泌乳量、降低乳房胀痛发生率及提高产后42 d纯母乳喂养率,对提高产科护理服务质量和促进持续母乳喂养具有积极作用。     

医用吸乳器对剖宫产产妇乳汁分泌及预防母乳喂养相关性乳房疼痛的临床观察

目的:探讨应用医用吸乳器干预剖宫产产妇后乳汁分泌及预防母乳喂养相关性乳房疼痛的效果。方法:将2015年1~10月在我院行剖宫产分娩的200例产妇分为对照组和观察组各100例。对照组指导产妇给婴儿每天勤吸吮,按需哺乳。观察组在对照组的基础上每天应用医用吸乳器进行干预。比较两组产妇的泌乳始动时间、产后72 h乳房胀痛程度、母乳喂养情况、舒适度和对护士满意度。结果:观察组产妇泌乳始动时间、产后72 h乳房胀痛程度、母乳喂养情况、舒适度和对护士满意度均明显优于对照组(P0.05)。结论 :早期应用医用吸乳器,可促进剖宫产产妇的早期乳汁分泌,能有效预防母乳喂养相关性乳房疼痛的发生,对提高剖宫产产妇纯母乳喂养率和护士满意度有显著作用。     

康复治疗仪结合乳房按摩对剖宫产术后初产妇泌乳的影响

目的:探讨康复治疗仪联合乳房按摩对剖宫产术后初产妇泌乳的影响。方法:选取剖宫产初产妇334例,将其随机等分为对照组和观察组,对照组患者单纯实施乳房按摩;观察组产妇在对照组基础上给予康复治疗仪治疗,比较两组产妇始动泌乳时间、24 h和48 h泌乳量、母乳喂养率、乳房胀痛程度和硬度。结果:观察组产妇泌乳时间早于对照组(P0.05),泌乳充足率、母乳喂养率均高于对照组(P0.05),产妇产后24 h和48 h泌乳量评分均高于对照组(P0.05),乳房胀痛程度、硬度轻于对照组(P0.05)。结论:使用康复治疗仪结合乳房按摩可以有效促进剖宫产初产妇泌乳,提高产妇泌乳量,进而提高母乳喂养率,并可减轻产妇乳房胀痛等不适,具有良好的应用前景。     

耳穴压豆配合穴位埋针促进择期剖宫产产妇乳汁分泌效果观察

目的:探讨耳穴压豆配合穴位埋针促进择期剖宫产产妇乳汁分泌的效果。方法:将2017年6～12月300例择期剖宫产产妇随机分为对照组和观察组各150例,对照组给予耳穴压豆加常规母乳喂养指导,观察组在对照组基础上配合穴位埋针,比较两组住院期间泌乳始动时间、泌乳有效率、纯母乳喂养率、乳房胀痛发生率及满意率。结果:观察组泌乳始动时间短于对照组,泌乳有效率、纯母乳喂养率及满意率高于对照组,乳房胀痛发生率少于对照组,两组比较差异有统计学意义(P 0. 05)。结论:耳穴压豆配合穴位埋针能够促进择期剖宫产产妇乳汁分泌,提高住院期间纯母乳喂养率,减轻产妇乳房胀痛,提高产妇满意度。     

剖宫产术后早期刺激乳头对产妇泌乳的影响

目的 探讨剖宫产术后早期刺激乳头对产妇泌乳的影响.方法 将剖宫产术后2h无乳汁分泌的368例产妇随机分为两组,观察组183例,对照组185例,观察组在给新生儿常规吸吮的基础上加以乳头刺激;对照组采用常规新生儿吸吮.结果 观察组产妇早泌乳和泌乳量充足产妇数量均高于对照组(P＜0.05).结论 剖宫产术后早期刺激乳头可提早泌乳始动时间,增加泌乳量.     

饮食指导配合产后早期乳房手法按摩护理对促进剖宫产后乳汁分泌的效果观察

目的:分析饮食指导配合产后早期乳房手法按摩护理对促进剖宫产后乳汁分泌的效果。方法:选取2016年6月～2018年6月接受剖宫产产妇146例,采用随机数字表法分为对照组和观察组各73例。对照组采用常规护理模式,观察组采取饮食指导配合产后早期乳房手法按摩护理。比较两组护理效果。结果:观察组泌乳始动时间明显短于对照组,乳汁分泌量明显多于对照组(P0.05);观察组乳房胀痛率明显低于对照组,母乳喂养率明显高于对照组(P0.05)。结论 :剖宫产产妇采用饮食指导联合产后早期乳房手法按摩,可缩短泌乳始动时间,提高母乳喂养率。     

剖宫产产妇术后早期乳房按摩对泌乳的影响

目的探索早期乳房按摩对剖宫产产妇术后泌乳始动时间，泌乳量及乳头状况的影响。方法将300例剖宫产产妇随机分为观察组和对照组各150例。对照组产妇仅接受常规产后护理，观察组产妇在此基础上于术后半小时施行皮肤接触，3h施行乳房按摩3d。观察两组产妇泌乳始动时间，泌乳量及乳头平坦，凹陷的改善情况。结果观察组与对照组比较，产妇泌乳时间明显提前，泌乳量增加，乳头状况显著改善。结论早期乳房按摩可使剖宫产产妇术后乳汁分泌始动时间提前，泌乳量增加，还能缓解产后乳房胀痛，纠正乳头状况，保证母乳喂养。     

快速康复外科护理模式对剖宫产产妇的影响

目的:探讨快速康复外科(FTS)护理模式对剖宫产产妇的影响。方法:回顾性收集2017年1~12月200例剖宫产产妇临床资料,根据不同护理方法分为FTS组和对照组各100例,FTS组实施FTS护理模式,对照组实施常规护理。比较两组产后泌乳、喂养、乳房胀痛及术后恢复等情况。结果:FTS组产妇泌乳始动时间明显早于对照组(P0.05),产后48 h内乳汁量明显多于对照组(P0.05),产后6周母乳喂养率明显高于对照组(P0.05),乳房胀痛程度明显轻于对照组(P0.05),早期离床活动时间、胃肠功能恢复时间、住院时间均明显短于对照组(P0.05)。结论:对剖宫产产妇实施围术期FTS护理模式干预,可有效促进产妇泌乳,提高泌乳量及母乳喂养率,缓解乳房胀痛程度,有利于产妇术后康复。     

医护一体化干预模式对剖宫产术后产妇母乳喂养自我效能和心理状态的影响

目的:探讨医护一体化干预模式对剖宫产术后产妇母乳喂养的效果及自我效能和心理状态的影响。方法:选择我院2015年1~6月收治的剖宫产术后产妇120例,将其随机等分为观察组和对照组,对照组给予常规的住院基础治疗,观察组在住院常规治疗的基础上出院给予医护一体化干预。观察两组产妇泌乳始动时间、产后早吸吮情况、乳头凹陷纠正情况等母乳喂养情况,并采用自我效能量表评价行为改变的效果,抑郁自评量表(SDS)及焦虑自评量表(SAS)评价产妇心理状态。结果:观察组产妇泌乳始动时间早于对照组(P0.05),新生儿产后吸吮状况优于对照组(P0.05),观察组产妇乳头凹陷纠正率高于对照组(P0.05),自我效能总分高于对照组(P0.05),SDS及SAS评分均低于对照组(P0.05)。结论:对剖宫产术后产妇母乳喂养实施医护一体化干预,可提高剖宫产术后产妇自我效能,对产妇分娩后行乳头刺激能使产妇泌乳始动时间提前,有效改善产妇负性情绪,对母乳喂养改善具有重要的临床意义。     

反向施压联合改良马迈式手法促进Ⅱ型乳头凹陷

目的 探讨反向施压联合改良马迈式手法促进Ⅱ型乳头凹陷产妇母乳喂养的实践效果。方法 将2015年7月至2017年6月于如皋市人民医院产科生产的符合纳入标准的120例Ⅱ型乳头凹陷产妇作为研究对象,按数字表法随机分为观察组(60例)和对照组(60例)。观察组采用反向施压联合改良马迈式手法护理乳房,对照组给予常规护理手法。结果 观察组产妇新生儿有效吸吮率、母乳喂养自我效能、母乳喂养率均高于对照组,而乳房胀痛发生率低于对照组,差异均有统计学意义(P<0.05)。结论 反向施压联合改良马迈式手法能显著提高Ⅱ型乳头凹陷产妇新生儿的有效吸吮率,有效预防产后乳房胀痛,提高母乳喂养自我效能,进而提高母乳喂养率,值得临床推广。     

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.     

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.