不同肠道准备方法在结肠镜检查中的应用及护理

目的：探讨不同肠道准备方法在结肠镜检查中的应用及护理体会。方法：将2004年6月～2008年1月518例接受结肠镜检查的病人随机分为A组、B组和C组，A组应用20％甘露醇口服，B组蓖麻油联合番泻叶口服，C组蓖麻油联合复方聚乙二醇电解质散口服。观察服药过程中肠腔清洁效果和副反应发生情况。结果：C组肠道清洁显效率（1级）68．68％，有效率（1级和2级）92．86％，且不良反应发生率低，与A组及B组相比有显著性差异。结论：复方聚乙二醇电解质散联合蓖麻油进行肠道准备的方法效果佳，耐受性好。     

电子肠镜检查前3种肠道清洁方法效果比较

目的 探讨电子肠镜检查前3种肠道清洁方法 的效果比较.方法 将1236例接受电子肠镜检查与治疗的患者随机分为口服甘露醇组408例、口服复方聚乙二醇电解质散组394例和口服硫酸镁组434例,根据电子肠镜检查前肠道清洁度和肠道清洁范围评价肠道清洁效果.结果 复方聚乙二醇组肠道清洁有效率为98.7%,显著高于口服甘露醇组95.7%和口服硫酸镁组86.7%(P<0.05);肠道清洁范围最大,全结肠清洁率92.5%,显著高于口服甘露醇组86.9%和口服硫酸锾组71.5%.复方聚乙二醇不良反应发率为11%,显著低于甘露醇组34%和口服硫酸镁组41%(P<0.05).结论 口服复方聚乙二醇电解质散是比较理想的全结肠清洁方法 ,不良反应相对少,但临床中应根据患者经济能力选择最佳的肠道准备方法 .     

结直肠手术3种机械肠道准备方法的比较研究

目的 比较采用磷酸钠盐(SP)、复方聚乙二醇电解质散(PEG)与甘露醇3种肠道准备剂进行机械肠道准备的安全性和实用性.方法 将60例结直肠手术患者随机分为SP组、PEG组和甘露醇组各20例,分别用口服磷酸钠盐溶液、复方聚乙二醇电解质散和甘露醇行术前肠道准备,观察各组患者血清学指标、肠道清洁程度、药物耐受性及围手术期一般情况.结果 3组血清学指标、肠道清洁程度等方面比较无明显差异,但甘露醇组的腹泻次数明显多于SP组及PEG组,且药物耐受性较低.结论 磷酸钠盐和复方聚乙二醇电解质散用于机械肠道准备是安全的、可靠的,较甘露醇具有更好的实用价值.     

复方聚乙二醇电解质散在妇科手术病人术前肠道准备中的应用

[目的]观察复方聚乙二醇电解质散在妇科手术病人术前肠道准备中的应用效果,探讨其护理措施。[方法]将150例妇科择期手术病人随机分为两组,观察组78例应用复方聚乙二醇电解质散进行术前肠道清洁准备,对照组72例口服硫酸镁及常规灌肠。比较两组病人肠道清洁度、肠道清洁过程中不良反应发生情况。[结果]观察组病人肠道清洁度优于对照组(P<0.05);观察组病人肠道清洁过程中发生不良反应为8.9 7%,对照组为19.44%,观察组明显少于对照组(P<0.05)。[结论]复方聚乙二醇电解质散用于妇科手术病人术前肠道清洁效果优于口服硫酸镁及常规灌肠,且不良反应少。     

复方聚乙二醇电解质散在老年腹部非胃肠道术前肠道准备中的应用

[目的]探讨口服复方聚乙二醇电解质散进行肠道准备对老年腹部非胃肠道全身麻醉手术后肠功能恢复的影响。[方法]将120例全身麻醉下行腹部非胃肠道手术的老年病人随机分为两组,观察组术前1d18:00口服复方聚乙二醇电解质散,对照组采用常规肠道准备,观察复方聚乙二醇电解质散药物不良反应及两组病人腹胀程度、肠鸣音及首次肛门排气时间。[结果]观察组术前无严重药物不良反应,术后腹胀程度、肠鸣音恢复情况优于对照组,首次肛门排气时间短于对照组(P<0.01)。[结论]复方聚乙二醇电解质散用于老年腹部非胃肠道术前肠道准备安全可行并有利于术后肠功能恢复。     

复方聚乙二醇电解质散在妇科手术前肠道准备中的应用

目的探讨复方聚乙二醇电解质散在妇科手术前肠道准备的清洁效果、患者的耐受性及其安全性。方法2010年5月至2011年3月方便性抽样选择我院需行妇科手术患者140例,按随机数字表法分为观察组和对照组各70例。观察组患者于术前日16：00口服复方聚乙二醇电解质散进行肠道准备,对照组患者口服20％甘露醇进行肠道准备,对两组患者服药后情况进行统计学分析。结果观察组患者肠道清洁有效率（97．1％）高于对照组（82．9％）、腹泻持续时间、术后排气时间均短于对照组（P〈0．01或P〈0．05）。观察组服药前后血电解质含量无明显变化（P〉0．05）,而对照组服药后较服药前血电解质降低（P〈0．05）,且低于观察组（P〈0．05）。观察组治疗后乏力发生率低于对照组（P〈0．05）,两组间其他不良反应发生率比较差异无统计学意义（P〉0．05）。结论采用复方聚乙二醇电解质散行妇科手术前肠道准备,其肠道清洁效果较甘露醇更佳,且不易引起血电解质降低及乏力反应,值得临床应用与推广。     

结肠镜检查前两种清洁剂肠道准备效果比较

目的 比较口服复方聚乙二醇电解质散法与口服硫酸镁法对结肠镜检查前肠道清洁的效果及不良反应.方法 将120例结肠镜检查的患者随机分为观察组和对照组, 肠道准备观察组采用口服复方聚乙二醇电解质散,对照组口服硫酸镁.比较两组肠道清洁度及患者的耐受度.结果 两组肠道清洁效果均满意,比较差异无统计学意义;患者耐受性观察组显著高于对照组.口服复方聚乙二醇电解质散法较口服硫酸镁法不良反应轻,准备时间短.结论 口服复方聚乙二醇电解质散法肠道清洁效果好,患者耐受性高,安全有效,有广阔的临床应用前景.     

不同肠道准备方法在结肠镜检查中的应用及护理

目的：探讨不同肠道准备方法在结肠镜检查中的应用及护理体会。方法：将568例接受结肠镜检查的患者随机分为A组、B组和C组，A组应用20％甘露醇，B组应用蓖麻油联合番泻叶，C组应用蓖麻油联合复方聚乙二醇电解质散。观察服药过程中肠腔清洁效果和副反应发生情况。结果：C组肠道清洁显效率（1级）68．5％，有效率（1级和2级）92．7％，且不良反应发生率低，与A组及B组相比有显著性差异。结论：复方聚乙二醇电解质散联合蓖麻油进行肠道准备的方法效果佳，耐受性好。     

老年慢性便秘患者结肠镜检查不同肠道准备方法的比较

【】目的 探讨用于老年慢性便秘患者安全及有效的肠道准备方法,以增加肠镜检查的成功率及患者的依从性,并减少肠镜检查的不良反应及并发症。方法 将150例在我院行电子结肠镜检查的老年慢性便秘患者采用方便取样的方法分为A组、B组和C组。分别采用复方聚乙二醇电解质散(A组),番泻叶、甘露醇和口服补液盐(B组),番泻叶和复方聚乙二醇电解质散(C组)作为肠道准备药物。在肠道准备过程中观察并详细记录肠道准备效果,肠镜中肠道准备清洁程度(Ⅰ—Ⅳ级),病人的依从性和不良反应发生率。结果 ①C组的肠道清洁度满意率为92.0%高于A组的66.0%和B组的74.0%;②3组均无严重不良反应发生,C组的不良反应发生率为10%低于A组的26%和B组的30%.A组与B组在清洁效果与不良反应发生率方面均无统计学意义(P＞0.05),C组与A组和B组比较,差异有统计学意义(P＜0.05)。结论 口服番泻叶和复方聚乙二醇电解质散组应用于老年慢性便秘者肠道准备效果满意,不良反应小,可提高患者结肠镜检查的成功率,使老年慢性便秘者得到最佳的诊疗,值得临床广泛应用,尽可能避免医疗资源的浪费。     

电子肠镜检查前3种肠道清洁方法效果比较

目的：探讨电子肠镜检查前3种肠道清洁方法的效果比较。方法：将1236例接受电子肠镜检查与治疗的患者随机分为口服甘露醇组408例、口服复方聚乙二醇电解质散组394例和口服硫酸镁组434例，根据电子肠镜检查前肠道清洁度和肠道清洁范围评价肠道清洁效果。结果：复方聚乙二醇组肠道清洁有效率为98．7％，显著高于口服甘露醇组95．7％和口服硫酸镁组86．7％（P〈0．05）；肠道清洁范围最大，全结肠清洁率92．5％，显著高于口服甘露醇组86．9％和口服硫酸镁组71．5％。复方聚乙二醇不反应发率为11％，显著低于甘露醇组34％和口服硫酸镁组41％（P〈0．05）。结论：口服复方聚乙二醇电解质散是比较理想的全结肠清洁方法，不良反应相对少，但临床中应根据患者经济能力选择最佳的肠道准备方法。     

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.