双腔气囊导尿管闭式引流治疗气胸患者疗效观察

目的：观察双腔气囊导尿管用于胸腔闭式引流治疗气胸与传统硅胶管胸腔闭式引流治疗气胸的效果差异。方法：选择52例气胸患者,随机分为治疗组和对照组,每组26例。治疗组采用双腔气囊导尿管行闭式引流治疗,对照组采用传统硅胶管行闭式引流治疗。观察两组置管引流时间、脱管发生率及皮下气肿发生情况及引流管阻塞发生率。结果：治疗组置管引流时间短于对照组,治疗组脱管率及皮下气肿发生率低于对照组,治疗组引流管阻塞发生率高于对照组,但无统计学意义。结论：采用双腔气囊导尿管行胸腔闭式引流术治疗气胸效果优于传统硅胶管闭式引流治疗。     

双腔气囊导尿管用于胸腔闭式引流的效果观察及护理

目的比较硅胶管与双腔气囊导尿管用于胸腔闭式引流治疗气胸患者的效果。方法自发性气胸患者68例,按床号单双号分为观察组36例及对照组32例,行胸腔闭式引流时观察组用双腔气囊导尿管、对照组用硅胶管。观察两组疼痛程度、置管引流时间及发生皮下气肿、导管滑脱、引流管阻塞情况。结果观察组术后疼痛程度明显低于对照组,置管引流时间少于对照组,发生皮下气肿及导管滑脱少于对照组,两组比较均有统计学意义;观察组发生引流管阻塞多于对照组,但两组比较无统计学意义。结论胸腔闭式引流宜用双腔气囊导尿管。     

双腔弗来氏尿管行胸腔闭式引流治疗气胸

目的比较灭菌双腔弗来氏尿管与传统方法行胸腔闭式引流治疗气胸的效果。方法将13例需行胸腔闭式引流的患者随机分为弗来氏尿管组、套管针1组和粗硅胶管组，比较肺复张时间、平均住院时间、脱管、皮下气肿等临床指标。结果弗来氏尿管组的平均肺复张时间、平均住院时间、肺复张程度、引流管脱出、皮下气肿等临床指标均优于套管针组和粗硅胶管组。结论灭菌双腔弗来氏尿管行胸腔闭式引流治疗气胸临床疗效优于传统方法。     

硅胶球囊导尿管胸腔闭式引流治疗气胸的临床研究

目的:观察以双腔硅胶球囊导尿管胸腔闭式引流治疗气胸的疗效.方法:91例气胸患者随机分为两组.对照组45例,胸腔内置入中心静脉导管.治疗组46例,胸腔内置入双腔硅胶球囊导尿管.2周后比较有效率、脱管及堵管情况.结果:对照组总有效率80.0％,治疗组总有效率86.9％,两组比较无显著性差异(P＞0.05).对照组堵管8例、脱管5例,治疗组堵管2例、无脱管,两组比较有显著性差异(P＜0.05).结论:双腔硅胶球囊导尿管胸腔闭式引流治疗气胸是一种简便、有效的方法,不良反应少,优于中心静脉导管法.     

有效咳嗽训练对老年自发性气胸胸腔闭式引流术后肺复张时间的影响

目的:探讨有效咳嗽训练对老年自发性气胸胸腔闭式引流术后肺复张时间的影响.方法:将46例老年自发性气胸胸腔闭式引流患者随机分为对照组25例和训练组21例.对照组按气胸和胸腔闭式引流术后护理常规进行护理,训练组在此基础上,于引流术后当天指导其进行有效咳嗽训练.结果:训练组肺复张的时间明显少于对照组(P<0.05).结论:有效咳嗽训练能促进老年自发性气胸患者压缩的肺组织复张,缩短胸腔闭式引流术后肺复张时间,减轻患者痛苦,提高临床疗效.     

双腔气囊尿管胸腔闭式引流术治疗自发性气胸的效果

目的探讨双腔气囊尿管胸腔闭式引流术对自发性气胸(SP)患者的治疗效果。方法将78例SP患者根据术中使用引流管不同分为2组:观察组39例采用双腔气囊尿管胸腔闭式引流术,对照组39例采用粗硅胶管胸腔闭式引流术。比较2组的临床疗效及手术情况(包括手术时间、引流气体时间、复张拔管时间、住院时间、术中出血量),观察2组并发症发生情况。结果观察组治疗总有效率显著高于对照组(94.87%比79.49%,χ2=4.129、P=0.042),手术时间、复张拔管时间、住院时间及术中出血量均较对照组显著减少(P<0.05),术后切口感染、胸腔积液、皮下气肿、明显瘢痕、明显疼痛发生率均显著低于对照组(P<0.05)。结论双腔气囊导尿管胸腔闭式引流术治疗SP效果显著,手术创伤小,术后恢复快,能明显降低术后并发症。     

猪尾巴导管行胸腔闭式引流术在急诊自发性气胸的临床应用

目的:通过对3种不同胸腔闭式引流术在治疗自发性气胸的疗效对比分析评价猪尾巴导管治疗自发性气胸的临床效果。方法:回顾性分析我院90例自发性气胸患者,根据不同手术方式分为3组,粗硅胶管组、中心静脉导管组及猪尾巴导管组。对3组疗效、并发症等方面进行比较分析。结果:猪尾巴导管组在肺复胀时间和肺复张成功率方面与硅胶管组比较差异无统计学意义,明显优于中心静脉导管组(P0.05),堵管发生率显著低于单腔中心静脉导管组,差异具有统计学意义(P0.05)。猪尾巴导管在并发症发生率较粗硅胶管组明显降低,拔管时间、住院时间较粗硅胶管组及中心静脉导管组明显缩短(P0.05)。结论:猪尾巴导管行胸腔闭式引流治疗自发性气胸与传统硅胶管引流疗效相当,明显优于中心静脉导管,带管舒适度及并发症方面明显优于粗硅胶管,值得临床推广应用。     

膀胱冲洗的护理进展

膀胱冲洗法是将药液经导尿管注入膀胱进行冲洗的方法。其目的是冲洗膀胱内异物、保持尿管引流通畅、防止感染、治疗膀胱炎等疾病[1]。国内护理同仁在膀胱冲洗器材、操作技术及注意事项等方面做了大量的研究,现综述如下。1膀胱冲洗器材的改进1.1硅胶导尿管与传统橡胶管相比,与组织相容性好,表面光滑、质地柔软,细菌不易粘附,有降低感染的发生率,减轻对尿路刺激的优点[2]。1.2一次性球囊乳胶导尿管、双腔球囊式导尿管和三腔球囊式导尿管3者均为硅胶管,一腔为气囊管,球囊端注入空气或生理盐水15~20 ml,即可起到固定和防止尿液外溢的作用。三腔…     

双腔气囊导尿管行胸腔闭式引流的观察及护理体会

目的观察并总结双腔气囊导尿管行胸腔闭式引流的临床效果与护理措施。方法 40例自发性气胸或血气胸患者随机分为对照组与观察组,各20例。对照组采用硅胶管行胸腔闭式引流,观察组采用18F或20F气囊导尿管行胸腔闭式引流,对比2组术后不良事件发生率及患者满意度。结果观察组术后不良事件发生率为6.7%(2/30),低于对照组的13.3%(4/30),但差异无统计学意义(P0.05)。观察组对舒适度满意度93.3%,高于对照组的73.3%(22/30),差异有统计学意义(P0.05)。结论双腔气囊导尿管行胸腔闭式引流安全、有效、围术期系统化护理措施可减少不良事件的发生,提高患者的满意度。     

76例慢性阻塞性肺病合并自发性气胸的治疗效果比较

目的分析并比较两种方法治疗慢性阻塞性肺病合并自发性气胸临床效果。方法选取2009年1月至2012年2月收治的慢性阻塞性肺病合并自发性气胸患者76例,采用随机数字表法分为硅胶管组和中心静脉置管组,每组各38例,分别采用硅胶管闭式引流和中心静脉置管闭式引流治疗;比较两组患者临床治疗总有效率、肺复张时间、创口愈合时间、住院时间及术后并发症发生情况等。结果中心静脉置管组患者临床治疗总有效率较硅胶管组高,组间比较差异有统计学意义(P<0.05);中心静脉置管组患者创口愈合时间及住院时间较硅胶管组少,组间比较差异有统计学意义(P<0.05);但两组患者肺复张时间组间比较差异无统计学意义(P>0.05);中心静脉置管组患者术后创口感染、皮下气肿及管腔堵塞等并发症发生率较硅胶管组少,组间比较差异有统计学意义(P<0.05)。结论中心静脉置管闭式胸腔引流治疗慢性阻塞性肺病合并自发性气胸临床效果确切,能够有效改善临床症状,促进伤口愈合,缩短病程,且术后并发症发生风险减低。     

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.