喉罩全麻复合骶麻用于婴幼儿先天性心脏病介入术后喂养时机的研究

目的探讨婴幼儿喉罩全麻复合骶管神经阻滞麻醉应用于先天性心脏病介入封堵治疗术后喂养的安全性及舒适度。方法纳入100例先天性心脏病介入封堵治疗术后的患儿,方便抽样分为两组。患儿先心介入术后,当改良Aldrete苏醒评分≥10分时,在不同的时机进行喂养。试验组采用按需喂养方法,对照组采用一般全麻术后护理常规的按时喂养,即患儿改良Aldrete苏醒评分≥10分仍需禁食禁饮6小时方可进食。两组患儿的进食顺序均一致。记录两组患儿麻醉清醒后出现胃肠道不良反应、呼吸循环异常情况,并评估两组患儿麻醉清醒及清醒后30 min、1 h、2 h、3 h、4 h、6 h的舒适度评分。结果试验组喂养时间早于对照组(P0.05),两组均未发生恶心、呕吐等胃肠道不良反应。麻醉清醒后不同时间点两组舒适度比较差异有统计学意义(P0.05)。结论经喉罩全麻复合骶管神经阻滞麻醉的先天性心脏病介入封堵治疗手术后,可以根据患儿的清醒程度尽早开始喂养,不会增加患儿术后与麻醉相关的胃肠道不适的发生。     

小儿先天性心脏病术后早期置胃管对胃肠道并发症发生的影响

目的:探讨小儿先天性心脏病术后早期留置胃管对胃肠道并发症发生的影响。方法:将66例先天性心脏病患儿随机分为观察组与对照组。观察组36例在患儿术后入ICU同时放置胃管,行间断减压及排气,至拔除气管插管后无明显胃肠道并发症后再拔除胃管;对照组30例患儿做常规处理,不留置胃管。结果:观察组患儿恶心、呕吐、腹胀和应激性溃疡等胃肠道并发症的发生率低于对照组,两组比较有显著性差异(P0.01?。结论:小儿先天性心脏病术后早期置胃管可降低胃肠道并发症的发生率,促进患儿术后恢复。     

幼儿先天性心脏病介入封堵术后进食时间的研究

目的:探讨幼儿先天性心脏病在全麻和气管插管下行介入封堵术后早进食的可行性。方法:将我科2014年1月~2015年1月在全麻和气管插管下行小儿先天性心脏病介入封堵手术患儿150例随机分为对照组和试验组,试验组拔出气管插管后经STIWARD评分,根据患儿需要清醒后给予少量饮水,无呛咳、恶心、呕吐后给予流质饮食。对照组患儿拔出气管插管后4~6 h清醒后给予少量饮水,无呛咳、恶心、呕吐后给予饮食。结果:两组患儿恶心、呕吐及呛咳的发生率比较差异无统计学意义(P0.05)。两组患儿哭闹时间比较,差异有统计学意义(P0.05);两组患儿家长的焦虑评分比较,差异有统计学意义(P0.05)。结论:全麻气管插管下小儿先心病介入封堵术后早进食是可行的,可增加患儿的舒适度,减轻患儿家长的焦虑。     

喉罩在小儿先天性心脏病介入治疗麻醉中的应用

目的探索喉罩在小儿先天性心脏病介入治疗麻醉中应用的可行性和安全性。方法选择ASAⅠ～Ⅱ级,择期先天性心脏病介入治疗的患儿60例,随机分为喉罩组和气管插管组,每组各30例。喉罩组麻醉诱导,静脉注射丙泊酚1.5mg/kg、雷米芬太尼2μg/kg,药物达峰效应后置入喉罩;气管插管组麻醉诱导时加用罗库溴铵0.6mg/kg。麻醉维持采用丙泊酚和雷米芬太尼持续输注。分别记录两组患儿手术时间、苏醒时间、麻醉诱导前、麻醉诱导后及喉罩或导管置入前、置入后、拔除前、拔除后的平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO2)值,并对置入喉罩和气管插管的一次成功率进行比较。监测术毕麻醉后恢复情况。结果两组患儿手术时间、苏醒时间、麻醉诱导前及喉罩或导管置入前、拔除前MAP、HR、SpO2值比较差异无统计学意义(P>0.05);喉罩或导管置入后及术后拔除时喉罩组MAP、HR低于气管插管组(P<0.05);术后呼吸系统并发症喉罩组少于气管插管组(P<0.05)。结论喉罩应用于小儿先天性心脏病介入治疗全麻,患儿血流动力学平稳、呼吸道并发症少,安全可靠性优于全麻插管,值得临床推广。     

婴幼儿先心病术后当日疼痛管理现状调查

目的 ：描述婴幼儿先天性心脏病（以下简称＂先心病＂）外科术后当日拔除气管插管后8h内疼痛情况以及护理人员进行疼痛管理现状。方法 ：采用一般资料登记表、疼痛行为评估量表（FLACC）、镇痛镇静药物及非药物镇痛措施登记表对北京市某心血管病专科医院20名PICU患儿进行调查。结果 ：先心病婴幼儿外科术后当日拔除气管插管后疼痛情况存在波动,0h、2-4h疼痛评分较高,镇痛镇静药物以及非药物镇痛措施在2-4h中使用比例由15%增加到了70%,5-8h疼痛评分明显降低。结论：先心病婴幼儿术后当日疼痛状况较重,药物及非药物镇痛措施使疼痛状况得到一定改善,但疼痛管理仍须加强。     

水胶体敷料对先天性心脏病术后患儿气管插管处皮肤的效果观察

目的探讨水胶体敷料对6个月以下先天性心脏病术后患儿气管插管处皮肤的效果。方法选择6个月以下先天性心脏病术后带气管插管的患儿80例,分为对照组和实验组各40例,对照组使用3 M弹力胶布固定气管插管,实验组使用水胶体敷料保护脸颊后再使用3M弹力胶布固定气管插管。比较2组患儿气管插管拔管后面部皮肤情况。结果实验组患儿在拔除气管插管后面部皮肤完好情况优于对照组(P0.05)。结论使用水胶体敷料做前瞻性保护脸颊,可以降低气管插管后面部皮肤撕脱伤发生率及压疮发生率。     

先天性心脏病患儿手术后应用无创通气的护理

先天性心脏病手术后一些气管插管时间长、心功能不全的患儿在拔管后容易发生气道和肺泡的萎陷以及支气管痉挛,导致呼吸困难发生低氧血症或高碳酸血症。如果及早应用无创通气,可以改善通气和氧合,减少呼吸作功、减轻心脏负担,更重要的是避免了再次插管带来的与气管插管相关的并发症。我院2004年1月~2005年1月对先天性心脏病患儿手术后应用无创通气机取得了较好的疗效,现将护理体会报道如下。1临床资料2004年1月~2005年1月我科收治先天心脏病患儿30例。男21例,女9例,平均年龄(6.0±4.8)个月,平均体重(5.1±2.5)kg,手术后在拔除气管插管时应用…     

婴幼儿先天性心脏病术后胃肠营养的应用与护理

目的：探讨婴幼儿先天性心脏病术后胃肠营养的应用与护理。方法：本组56例忠儿均在气静麻醉和体外循环下前胸正中切口行纠治术。所有患儿术后均留置胃管，气管插管12h可开始经鼻胃管注入5％葡萄糖，首次10—15ml，2--3h后观察胃肠通反应，有无腹胀、恶心、潴留等情况发生。如无上述症状可给予母乳、牛奶、果汁，开始量要小，逐渐增加。间隔时间2～3h。患儿拔除气管插管4-6h后开始经口进食。结果：本组患儿除1例术后低心排死亡外，其余患儿均存活。无胃肠道并发症发生，术后恢复良好。结论：采用合理有效的胃肠营养护理措施，可防止因腹胀引起的各种并发症，减少应激性溃疡的发生率。同时胃肠道的供给营养是人类固有的消化吸收和获取营养的最佳途径，这对促进患儿的康复，减少和防止感染有十分重要的意义。     

房间隔缺损及室间隔缺损患儿术后早拔管的护理

近年来,随着先天性心脏病外科的不断进步,一种新的理念正在逐渐兴起,即选用合适的麻醉处理方案,争取在心脏手术后早期(<6 h)拔除气管插管,缩短在ICU滞留时间,以求尽量缩短机械通气时间,预防患儿肺部感染,改善患儿的预后,降低医疗费用[1,2].     

小儿先心病术后气管插管期间的呼吸监护

小儿先心病术后气管插管期间的呼吸监护２２１００９江苏省徐州第四人民医院王娜莎我院自１９８１年已运用体外转流技术进行先天性心脏病的纠治手术，小儿患者约占８０％。因条件所限，患儿苏醒生命体征平稳后即拔除全麻插管送回病房进行简单的ＥＣＧ、循环指标监测，弊端...     

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。