全程导乐陪伴分娩对初产妇和新生儿的影响

目的 探讨导乐陪伴分娩服务模式对初产妇和新生儿预后的影响.方法 选择2005年6-12月在我科住院分娩的初产妇310例,随机分为观察组160例,对照组150例.观察组实施全产程导乐陪伴分娩护理,对孕妇进行生理、心理、体力的全面支持.对照组按常规进行产程观察.结果 观察组导乐陪伴分娩能稳定产妇心理状态、缓解产时疼痛、缩短产程,与对照组相比有显著性差异(P＜0.05或P＜0.01);观察组产妇分娩结局及新生儿预后明显优于对照组,而且产妇对助产士、护士满意度较对照组有提高(P＜0.01).结论 导乐陪伴分娩更多照顾到产妇的生理和心理需求,是一种更人性化的新型的分娩服务模式,提高了产科的服务质量,在确保母婴安全方面上了一个新的台阶,值得推广.     

全程导乐陪伴分娩对初产妇和新生儿的影响

目的探讨导乐陪伴分娩服务模式对初产妇和新生儿预后的影响。方法选择2005年6-12月在我科住院分娩的初产妇310例,随机分为观察组160例,对照组150例。观察组实施全产程导乐陪伴分娩护理,对孕妇进行生理、心理、体力的全面支持。对照组按常规进行产程观察。结果观察组导乐陪伴分娩能稳定产妇心理状态、缓解产时疼痛、缩短产程,与对照组相比有显著性差异(P<0.05或P<0.01);观察组产妇分娩结局及新生儿预后明显优于对照组,而且产妇对助产士、护士满意度较对照组有提高(P<0.01)。结论导乐陪伴分娩更多照顾到产妇的生理和心理需求,是一种更人性化的新型的分娩服务模式,提高了产科的服务质量,在确保母婴安全方面上了一个新的台阶,值得推广。     

丈夫全程陪伴分娩对初产妇身心影响的临床观察

目的探讨丈夫全程陪伴分娩对初产妇身心方面的影响。方法选择由丈夫全程陪伴分娩的初产妇106例（观察组）和无陪伴分娩的初产妇98例（对照组）进行临床观察。对两组产妇分娩时的心理状况、疼痛情况、产程时间、产后出血量及剖宫产率进行比较。结果观察组产妇分娩时心理状态相对稳定，比对照组产妇的担心、焦虑、恐惧心理明显减轻（P〈0．01）；两组产妇产时的疼痛情况比较有显著性差异（P〈0．01）；产程时间缩短（P〈0．05）；产后出血量减少及剖宫产率显著降低（P〈0．01）。结论丈夫全程陪伴分娩可使产妇在分娩过程中身心更为安全、健康，是一种产时服务模式。     

导乐陪伴分娩与初产妇产后抑郁的相关性研究

目的：探讨导乐陪伴分娩与初产妇产后抑郁发生的相关性。方法：将符合入选标准的初产妇443例中以参加导乐陪伴分娩者225例为研究组，未参加导乐陪伴分娩者218例为对照组，产后第3d采用抑郁自评量表对两组产妇进行评估。结果：研究组产妇产后抑郁的发生率为5．33％，对照组为14．22％，两组间差异有显著性（P〈0．01）。结论：导乐陪伴分娩所提供的服务和环境使初产妇心身处于最佳心理、生理状态，明显降低初产妇分娩过程中紧张、恐惧、疼痛引起的产后抑郁。     

全程导乐陪伴分娩的临床效果

目的探讨全程导乐陪伴分娩模式的临床效果。方法选择正常妊娠足月孕妇320例，均为单胎头位，经阴道分娩的初产妇，无妊娠合并症、并发症及心理问题。导乐陪伴分娩160例为导乐组，非导乐分娩160例为对照组。比较2组的产程时间、产后出血量、宫缩情况（宫缩乏力）和分娩方式等。结果导乐组第1、3产程均较对照组明显缩短（P〈0．01），产后出血量显著低于对照组（P〈0．05），宫缩乏力的发生率明显低于对照组（P〈0．05），剖官产少于对照组（p〈0．01）。结论导乐陪伴分娩能够消除孕妇过分焦虑和缺乏自信的心理状态，可显著缩短产程和减少产后出血量，减轻疼痛，减少分娩的并发症，提高了产科护理质量。     

导乐陪伴分娩1176例临床分析

目的 分析导乐陪伴对分娩过程的影响。方法 回顾性分析自2003年11月至2005年10月接受导乐陪伴分娩的1176例产妇的临床资料（观察组），以2001年11月至2003年10月非导乐陪伴分娩的882例产妇为对照组，对2组的自然分娩率、剖宫产率、产程时间、产后出血量及新生儿窒息率进行比较。结果 观察组的自然分娩率明显提高，剖宫产率下降（x^2=181．35，p〈0．01）；产程时间缩短（t=14，07，p〈0.01），产后出血减少（t=15．45，p〈0．01），新生儿窒息率降低（x^2=38．52，p〈0．01）。结论 导乐陪伴分娩可提高自然分娩率，降低剖宫产率及新生儿窒息率，减少产后出血量，有利于提高产科服务质量。     

导乐陪伴分娩200例效果观察

我院自 2 0 0 2 - 0 1开始开展导乐陪伴分娩 ,收到了很好的临床效果 ,尤其是剖宫产率明显下降 ,产程缩短 ,产妇分娩疼痛减轻 ,新生儿窒息率下降 ,总结如下。1　对象和方法1.1　对象　 2 0 0 2 - 0 1～ 2 0 0 2 - 0 6临产前无剖宫产指征 [1 ] 的初产妇 2 0 0例为观察组 (导乐组 ) ,随机选同期同类的初产妇 2 0 0例为对照组。两组的年龄、孕周、文化程度等无差异。1.2　方法　观察组 :进行导乐陪伴分娩。具体方法 :1产妇临产后进入导乐待产室 ,整个产程中由一位有临床经验且经过导乐培训的助产士观察产程 ,并给予产妇持续的心理、生理及感情上…     

导乐陪伴分娩的临床意义

目的观察导乐陪伴分娩对产程的影响。方法把2006年8月至12月期问在本院分娩的自然临产或催产素引产的无妊娠合并症与并发症且头盆相称的初产妇，随机分成两组。观察组62例用导乐陪伴分娩，由一位有过生育经历，并有分娩经验的助产士，在整个分娩过程中，以谈心的方式与产妇亲切交谈。了解产妇对分娩有关知识的掌握情况，并持续给产妇生理上、心理上和感情上的支持；对照组121例是在家属或无人陪伴下分娩。结果两组分娩方式、产程及产后2h出血量均有显著差异（P〈0．05）。结论导乐陪伴分娩能降低剖宫产率，缩短产程，减少了产科病率及围产儿病率。     

全程导乐分娩对缩短经阴道分娩产程及减少产后并发症的效果观察

目的观察全程导乐分娩对缩短经阴道分娩产程及减少产后并发症的临床效果，探讨提高经阴道分娩产妇生产体验的护理方法。方法选取2010年1月～2012年6月在我院产科生产的280例经阴道分娩产妇，将其随机分为导乐分娩组（140例）和对照组（140例）。其中导乐分娩组由具有分娩经验的助产士进行一对一全程陪护，给予产妇心理、生理上的全面支持。对照组采取产科常规护理措施。结果导乐分娩组第一产程时长为（358．4±162．3）min，第二产程时长为（46．5±22．6）min，总产程时长为（412．4±189．7）min．均较对照组明显缩短．差异有显著意义（P〈0．01）。同时，导乐分娩组产后平均出血量、产后尿潴留发生率均显著低于对照组，差异有显著意义（P〈0．01）；新生儿早吸吮成功率明显高于对照组，差异有显著意义（P〈0．05）。结论全程导乐分娩可显著缩短经阴道分娩产程，减轻产妇分娩痛苦，并有效减少产后并发症，有助于降低剖宫产率，值得临床推广。     

全程导乐陪伴联合分娩镇痛对自然分娩的影响

目的:探讨导乐陪伴联合分娩镇痛对自然分娩的作用和影响。方法:将正常足月分娩的初产妇500例随机分为两组,导乐陪伴联合分娩镇痛的初产妇260例为观察组,实行分娩镇痛不给予导乐陪伴的240例初产妇作为对照组,对两组产妇的负性情绪状态、产程时间、镇痛效果、产后出血量、新生儿评分情况等指标进行观察对比。结果:观察组与对照组相比较,产妇产后2 h出血量和新生儿窒息发生率无统计学意义;观察组产妇的负性情绪明显改善,镇痛效果明显优于对照组(P<0.05),产程时间明显缩短,两组比较有统计学意义。结论:导乐陪伴联合分娩镇痛可以明显改善产妇的负性情绪状态,缩短产程,促进产妇顺利度过分娩期。     

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.