舒泰联合石蜡油在前列腺增生患者导尿中的应用

目的探讨舒泰联合石蜡油在前列腺增生患者导尿中的应用。方法将160例不同程度前列腺增生患者随机分为2组(各80例),对照组采用常规导尿法,实验组在常规导尿法的基础上使用局麻药舒泰注入尿道,从尿道口灌注石蜡油润滑剂的导尿方法。结果在导尿时有无疼痛、一次性插管成功率和尿道黏膜损伤方面,2组比较差异有统计学意义(均p<0.05)。结论应用舒泰联合石蜡油为前列腺增生患者导尿,可以减轻患者疼痛,提高插管成功率,减少尿道黏膜的损伤。     

前列腺增生患者应用利多卡因及石蜡油导尿的效果观察

目的观察利多卡因、石腊油用于前列腺增生患者导尿的临床效果。方法 80例前列腺增生患者随机分为两组(各40例),对照组采用常规导尿法,观察组在常规导尿法的基础上加用尿道内灌注利多卡因、液体石蜡润滑剂的导尿方法。两组均以有无疼痛、一次性插管成功和尿道损伤为判断指标。结果在导尿时有无疼痛、一次性插管成功率和尿道损伤方面,两组比较均有显著性差异(均P<0．05),其中观察组明显优于对照组。结论利多卡因、石腊油用于前列腺增生患者导尿,可明显减轻插管时的疼痛和尿道损伤及提高导尿成功率。     

盐酸利多卡因胶浆在前列腺增生患者导尿术中的应用

目的:探讨盐酸利多卡因胶浆在前列腺增生患者导尿术中的应用及效果。方法:将100例前列腺增生患者随机分为实验组与对照组各50例,实验组导尿时使用盐酸利多卡因胶浆,对照组给予常规操作。结果:实验组一次导尿成功率明显高于对照组(P<0.01),疼痛程度及尿道黏膜损伤率均低于对照组(P<0.05)。结论:将盐酸利多卡因胶浆应用于前列腺增生导尿患者,可提高一次导尿成功率,减轻患者痛苦,减轻尿道黏膜损伤,值得临床推广应用。     

循证护理在前列腺增生患者导尿中的应用

目的探讨循证护理在前列腺增生患者导尿中的应用。方法将2013年1月至2014年12月在重庆三峡中心医院就诊的207例前列腺增生患者根据入组时间分为对照组92例和研究组115例。对照组行常规导尿方法,研究组在循证护理的指导下行导尿术,比较两组患者的一次性插管成功率、疼痛程度及尿道黏膜损伤情况。结果研究组的一次性插管成功率高于对照组,疼痛程度及尿道黏膜损伤率均低于对照组,差异有统计学意义(均P0.05)。结论在循证护理的指导下行前列腺增生患者的导尿术,可提高插管成功率和患者舒适度,减轻插管时的疼痛及尿道损伤,从而提高护理质量,确保护理安全。     

舒泰在前列腺增生患者导尿中的应用

目的探讨舒泰在前列腺增生患者导尿中的应用效果。方法将80例不同程度前列腺增生患者随机分为两组,对照组与实验组各40例,对照组采用常规导尿法,实验组在常规导尿时使用局麻药舒泰。结果实验组疼痛程度较对照组减轻,一次性导尿成功率明显高于对照组,尿道黏膜损伤率较对照组低(均P<0.05)。结论在为前列腺增生患者行导尿术时,使用舒泰可以减轻患者痛苦,提高导尿成功率,减少尿道黏膜损伤。     

局部麻醉剂和润滑剂在前列腺增生患者导尿术中的临床应用

目的探讨局部麻醉剂和润滑剂在前列腺增生患者导尿术中的临床应用。方法将重庆市永川区中医院2009年1月至2012年3月收治住院的98例前列腺增生患者进行导尿术,随机分为对照组与观察组,每组49例。对照组给予常规导尿方法导尿,观察组给予局部麻醉剂和润滑剂导尿,观察两组导尿时的疼痛发生率、一次插管成功率、尿道损伤情况。结果观察组的疼痛发生率和尿道损伤率明显低于对照组(P<0.05)、一次插管成功率明显高于对照组(P<0.05)。结论在前列腺增生患者导尿术中,应用局部麻醉剂和润滑剂进行导尿,可以明显减轻疼痛和减少尿道损伤,提高导尿成功率,在临床应用效果良好。     

改良男性导尿术的应用及效果

目的探讨男性改良导尿术的应用并评价其应用效果。方法将本科自2015年4月~2015年8月收治的术前需留置尿管的130例男性患者随机分为对照组和观察组各65例。对照组采用常规导尿术,观察组采用改良导尿方法,对2组患者导尿时疼痛程度、一次性插管成功率、导尿后发生尿道损伤率、感染率进行比较。结果观察组插管时疼痛程度及插管后尿道损伤发生率及尿道感染率明显低于对照组,一次性插管成功率明显高于对照组,2组比较,差异有统计学意义(P0.05)。结论改良导尿方法是安全可行的,可明显减少男性患者导尿时尿道损伤的发生及感染,提高一次性插管成功率。     

盐酸丁卡因胶浆在男性患者术前留置导尿中的应用

目的探讨盐酸丁卡因胶浆在术前导尿中的应用效果。方法将70例需术前留置尿管的男性患者随机分为对照组（35例）和实验组（35例）。对照组采用石蜡油棉球润滑导尿管前端,实验组采用盐酸丁卡因胶浆润滑导尿管前端和尿道。观察两组患者插管一次成功率,插尿管时患者的疼痛等级及插管后10min尿道刺激反应程度。结果实验组插管一次成功率为85．7％,对照组为54．3％,差异有统计学意义（x2=8．231,P〈0．01）;两组患者插管时疼痛程度及插管后10min尿道刺激反应程度差异均有统计学意义（x2=17．437,9．69;P〈0．05）。结论男性患者导尿时,用盐酸丁卡因胶浆润滑尿管和尿道能明显减轻插管时的疼痛,降低患者插管后10min尿道刺激反应程度,提高了一次性插管成功率。     

盐酸丁卡因胶浆在前列腺增生病人导尿中的应用

目的:探讨盐酸丁卡因胶浆在前列腺增生病人导尿中的应用效果。方法:将111例前列腺增生病人随机分为试验组56例和对照组55例,试验组采用盐酸丁卡因胶浆作润滑剂行导尿术,对照组采用液体石蜡油作润滑剂行导尿术,比较两组病人在尿道刺激反应和一次性导尿成功率方面的差异。结果:试验组尿道刺激反应较对照组轻,一次性导尿成功率较对照组高,差异有统计学意义(P<0.05)。结论:前列腺增生病人导尿时采用盐酸丁卡因胶浆作为润滑剂,可减轻尿道刺激反应,提高一次性导尿成功率。     

改良润滑方法在男患者导尿中的应用

目的观察不同的润滑方法对男患者导尿的影响。方法60例需留置尿管的男患者随机分为对照组和实验组。对照组采用石腊油棉球润滑导尿管前端,实验组采用润滑止痛胶润滑导尿管前端和尿道。观察2组插尿管时患者疼痛等级及插导尿管所需时间。结果2组患者插尿管时疼痛等级及插尿管所需时间均有显著性差异(P<0.01)。结论男患者导尿时,用润滑止痛胶润滑尿管和尿道能明显减轻插尿管时的疼痛,缩短插尿管时间,提高插管成功率。     

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.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

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.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.