复方聚乙二醇电解质散(Ⅰ)不同服用方法在结肠镜检查肠道准备中的应用

[目的]探讨复方聚乙二醇电解质散(Ⅰ)不同服用方法在结肠镜检查肠道准备中的应用。[方法]根据随机数字表法将2017年3月—2017年7月96例行结肠镜检查病人分为单次给药组及分次给药组各48例,单次给药组行常规肠道准备后在结肠镜检查前5 h于60 min内口服完2 L复方聚乙二醇电解质散(Ⅰ)溶液(2盒恒康正清),分次给药组在结肠镜检查前15 h于60 min内口服1L复方聚乙二醇电解质散(Ⅰ)溶液(1盒恒康正清),余下的1 L(1盒恒康正清)在检查前5 h于60 min内口服完。比较两组病人肠道准备评分、肠道清洁合格率、肠道不良反应分级。[结果]分次给药组直肠-乙状结肠、横结肠/降结肠、升结肠/盲肠等部位肠道清洁评分及肠道清洁总评分均低于单次给药组(P<0.05);分次给药组肠道清洁合格率及肠道准备依从率高于单次分药组(P<0.05);分次给药组肠道不良反应分级程度低于单次给药组(P<0.05)。[结论]复方聚乙二醇电解质散(Ⅰ)溶液分次给药能有效减轻结肠镜检查病人肠道反应,提高病人肠道准备依从性及肠道清洁度,从而提高肠镜检查病人肠道准备效果。     

老年便秘患者联合应用普芦卡必利与复方聚乙二醇电解质散行结肠镜检查肠道准备的效果观察

目的观察老年便秘患者结肠镜检查前联合应用普芦卡必利与复方聚乙二醇电解质散行肠道准备的效果及安全性。方法选择我院2016年2月—2018年3月收治的108例择期行结肠镜检查的老年便秘患者,采用随机数字表法分为观察组及对照组,每组54例。检查前两组均行肠道准备,对照组在检查前4 h给予复方聚乙二醇电解质散137. 12 g用温水2 L溶解后在2 h内饮完,观察组在检查前3 d联合应用普芦卡必利2 mg每日1次口服,检查前4 h同法服用复方聚乙二醇电解质散。采用Boston肠道准备量表(BBPS)对两组患者肠道清洁效果进行评价,同时观察两组肠道准备及检查期间不良反应发生情况。结果观察组直肠-乙状结肠、升结肠-回盲部、横结肠-降结肠以及左侧结肠、中段结肠、右侧结肠BBPS评分和总评分均高于对照组,差异均有统计学意义(P 0. 01);两组患者肠道准备及检查期间不良反应总发生率比较差异无统计学意义(χ~2=0. 121,P=0. 728)。结论老年便秘患者结肠镜检查前联合应用普芦卡必利与复方聚乙二醇电解质散行肠道准备可提高肠道清洁效果,且无严重不良反应。     

不同时间口服复方聚乙二醇电解质散对结肠镜检查前肠道准备的影响

目的探讨在结肠镜检查前的肠道准备中,在不同时间给予患者口服复方聚乙二醇电解质散的效果。方法将228例行结肠镜检查的患者随机分成对照组(n=113)与研究组(n=115),2组均采取口服复方聚乙二醇电解质散的方式进行肠道清洁,研究组口服药物时间选择在检查前13 h进行,对照组口服药物时间选择在检查前5 h进行,对2组患者肠道清洁情况[采用肠道准备量表(BBPS)评定]及并发症(恶心呕吐、腹胀、虚脱)发生情况进行统计。结果 2组患者BBPS各部位评分及总分比较差异无统计学意义(P>0.05);研究组相关并发症的总发生率(6.96%)明显低于对照组(21.24%)(P<0.01)。结论在行结肠镜检查前13 h给予患者口服复方聚乙二醇电解质散有较高的肠道清洁度,相关并发症的发生率也较低。     

利那洛肽联合复方聚乙二醇电解质散在结肠镜检查肠道准备中的应用效果

目的 观察复方聚乙二醇（PEG）电解质散联合利那洛肽行肠道准备，在结肠镜检查中的效果和安全性。方法 选取2022年3月1日-2022年8月30日该院收治的拟进行结肠镜检查的75例患者作为研究对象，采用随机数表法，将75例患者随机分为观察组、对照组A和对照组B，每组各25例。对照组A单用2L复方PEG电解质散行肠道准备，对照组B单用3 L复方PEG电解质散行肠道准备，观察组采用利那洛肽联合2 L复方PEG电解质散行肠道准备。使用波士顿肠道准备评估量表（BBPS）评估患者肠道清洁度情况，统计患者满意度、不良反应发生率和肠道息肉检出率。结果 观察组的肠道准备效果优于对照组A，息肉检出率高于对照组A；观察组患者满意率高于对照组B，不良反应总发生率低于对照组B，差异均有统计学意义（P <0.05）。结论 利那洛肽联合2 L复方PEG电解质散的方案，可提高BBPS、息肉检出率和患者满意度，降低肠道准备过程中不良反应发生率，值得临床应用。     

无痛结肠镜前聚乙二醇口服时间对肠道准备效果的影响

目的观察无痛肠镜术前不同时间口服复方聚乙二醇电解质散剂进行肠道准备的清肠效果和舒适性。方法收集消化内科住院期间173例行无痛结肠镜检查患者的资料,根据口服复方聚乙二醇电解质散剂的时间不同分为3组,A组检查前1天22:00服用4盒,检查时间为当天8∶30~10∶30。B组检查前1天20∶00服用1盒,检查当天5∶00服用3盒,检查时间为当天10∶30~12∶30。C组检查前1天20∶00服用1盒,检查当天7∶00服用3盒,检查时间为当天13∶30~15∶30。比较3组患者结肠准备质量,并评估患者舒适度。结果 A、B和C组结肠准备清洁充分率分别为61.4%、78.7%和72.7%,差异无统计学意义(P=0.111),3组患者主观舒适度比较,B、C组患者肠道准备中舒适度优于A组,不良反应发生率偏低,差异有统计学意义(P=0.036),但B组与C组患者在肠道准备中舒适度差异无统计学意义(P=0.921)。结论无痛肠镜术前3种不同时间口服复方聚乙二醇电解质散剂对肠道清洁度无影响,但分次口服聚乙二醇电解质散剂比单次服用不良反应小,患者容易接受,是比较理想、安全的无痛结肠镜前肠道准备方法。     

行结肠镜检查前患者单次和分次服用聚乙二醇电解质散溶液的效果观察

目的探讨行结肠镜检查前患者单次和分次服用聚乙二醇电解质散溶液的应用效果。方法选取行结肠镜检查患者160例,采用随机数字表法分为单次服药组(n=80)和分次服药组(n=80)。单次服药组,采用常规肠道准备方法,结肠镜检查前5 h将3 L聚乙二醇电解质散溶液30~60 min口服完。分次服药组,结肠镜检查前10 h将1.5 L聚乙二醇电解质散溶液30~60 min口服完;结肠镜检查前5 h再将1.5 L聚乙二醇电解质散溶液30~60 min口服完。观察比较2组患者结肠镜检查前肠道清洁度、肠道气泡情况及肠道准备不适症状。结果 2组行结肠镜检查患者肠道准备评分较低,肠道清洁效果均较满意,2组患者肠道准备评分、肠道气泡情况比较差异无统计学意义(P0.05);2组患者肠道准备不适症状中恶心、腹痛、肛门刺激、失眠及饥饿平均秩次比较差异有统计学意义(P0.05)。结论单次和分次服用聚乙二醇电解质散溶液肠道清洁效果相当,但分次服药肠道准备不适症状较轻,值得临床借鉴使用。     

复方聚乙二醇电解质散联合伊托必利应用于慢性便秘患者肠道准备的疗效观察

【目的】比较2L复方聚乙二醇电解质散＋伊托必利与4L复方聚乙二醇电解质散对慢性便秘患者肠道准备的清洁度及不良反应。【方法】选取本院内镜室接受结肠镜检查的患者205例,随机分为两组：观察组在检查前一晚20：30口服伊托必利50mg,21：00口服复方聚乙二醇电解质散1000mL,检查当天早晨5：00口服伊托必利50mg,5：30口服复方聚乙二醇电解质散1000mL进行肠道准备;对照组在检查前一晚21：00口服复方聚乙二醇电解质散2000mL,检查当天早晨5：30口服复方聚乙二醇电解质散2000mL进行肠道准备。比较两组患者的肠道准备质量BBPS评分、患者耐受性及依从性。【结果】两组左半结肠、横结肠及右半结肠BBPS评分及总分比较差异无统计学意义（P〉0．05）;观察组患者服药后恶心、呕吐、腹痛、腹胀等症状发生率明显少于对照组;观察组愿意再次接受此肠道准备的百分比明显高于对照组,说明患者依从性及耐受性更好。【结论】复方聚乙二醇电解质散联合伊托必利并不会明显增强慢性便秘患者的肠道准备质量,但能有效降低腹部不适,从而提高患者的耐受性和依从性。     

聚乙二醇电解质溶液分次与单次口服肠道准备不良反应的Meta分析

目的:评价聚乙二醇电解质溶液分次与单次口服肠道准备不良反应,有针对性的指导患者肠镜检查和(或)治疗前服药准备。方法:通过对国内外期刊文献进行搜索查阅,搜索主题词为"肠镜""肠道准备""清洁肠道""分次与单次"和"聚乙二醇电解质溶液",检索年限为2000~2015年。收集肠镜检查和(或)治疗前给予肠道清洁药物聚乙二醇电解质溶液分次与单次干预的随机、对照实验。根据纳入和排除标准选取文献,提取资料并评价试验质量,采用Rev Man5.3软件进行Meta分析。结果:共纳入文献5篇作Meta分析,共计患者1 849例,Meta分析结果显示:聚乙二醇电解质溶液分次服用的不良反应发生率低于单次服用(RR=0.71,95%CI=0.58,0.87,P=0.0008)。结论:分次口服聚乙二醇电解质溶液肠道准备不良反应患者的恶心、呕吐、腹痛、腹胀不良反应发生少、从而提升患者肠镜检查和(或)治疗的耐受性。     

两种不同清洁肠道方式在结肠镜肠道准备患者中的应用

目的:探讨两种不同清洁肠道方式在结肠镜肠道准备患者中的应用效果.方法:将2019年10月1日～2020年3月31日行结肠镜检查的100例患者随机分为观察组和对照组各50例,对照组提供传统聚乙二醇散剂单次大剂量服用方案,观察组提供分次分剂量聚乙二醇散剂联合番泻叶方案;比较两组肠道准备质量[采用Boston肠道准备评估量表...     

服药时间对结肠镜检查肠道准备效果的影响

目的探讨行结肠镜检查时服药时间对肠道准备效果的影响。方法选取行结肠镜检查的200例患者,分为两组,A组:5:00~7:00,B组:10:00~12:00,于肠镜检查前4 h口服复方聚乙二醇电解质散(PGEP)(恒康正清)139.12 g(2 000 ml)作为清肠剂,内镜医师行Boston肠道准备量表(BBPS)和肠腔内气泡评分,记录患者肠道准备时间,问卷调查患者对肠道准备的耐受性,记录肠道准备过程中的不良反应。结果所有患者均完成肠道准备及全结肠镜检查。A组BBPS总分明显高于B组(P0.05),A组肠腔内气泡评分明显低于B组(P0.05),A组肠道准备时间少于B组(P0.05),A组耐受性高于B组(P0.05),A组不良反应明显低于B组(P0.05)。结论 5:00~7:00服用PGEP行结肠镜检查肠道准备时间短、效果好,方便患者就医,能减少患者空腹等待及不适(头晕、饥饿感)等潜在风险,增加其依从性和耐受性,使肠镜检查顺利进行。     

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.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Molecular characterization of virulence and antimicrobial resistance profile of Shigella species isolated from children with moderate to severe diarrhea in northeastern Brazil

Molecular characterization of virulence and antimicrobial resistance profiles were determined for Shigella species isolated from children with diarrhea in Fortaleza, Brazil. Fecal specimens were collected along with socioeconomic and clinical data from children with moderate to severe diarrhea requiring emergency care. Shigella spp. were isolated by standard microbiological techniques, and we developed 4 multiplex polymerase chain reaction assays to detect 16 virulence-related genes (VRGs). Antimicrobial susceptibility tests were performed using disk diffusion assays. S. flexneri and S. sonnei were the predominant serogroups. S. flexneri was associated with low monthly incomes; more severe disease; higher number of VRGs; and presence of pic, set, and sepA genes. The SepA gene was associated with more intense abdominal pain. S. flexneri was correlated with resistance to ampicillin and chloramphenicol, whereas S. sonnei was associated with resistance to azithromycin. Strains harboring higher numbers of VRGs were associated with resistance to more antimicrobials. We highlight the correlation between presence of S. flexneri and sepA, and increased virulence and suggest a link to socioeconomic change in northeastern Brazil. Additionally, antimicrobial resistance was associated with serogroup specificity in Shigella spp. and increased bacterial VRGs.     

护理干预对面部中重度寻常型痤疮的临床疗效影响分析

目的研究护理干预对面部中重度寻常型痤疮的临床疗效影响。方法选取本院在2014年4月~2016年7月诊治的136例面部中重度寻常型痤疮患者,随机分为研究组与对照组,每组68例;所有患者均依据其情况给予对应的治疗,其中对照组在治疗期间给予常规护理,研究组在对照组的基础上再给予综合性护理干预,比较两组的治疗效果及护理满意度情况等。结果患者在接受治疗和护理后,研究组中度与重度患者的治疗效果较对照组均明显提高(P0.05),研究组护理满意度较对照组明显增高(P0.05)。结论对面部中重度寻常型痤疮患者在其治疗期间给予综合性护理干预,具有良好的效果。