充气加温法对前列腺电切术患者术中低体温的预防效果

目的 探讨充气加温法预防经尿道前列腺电切术患者术中轻度低体温的临床应用价值.方法 选择经尿道前列腺电切术患者50例,为A,B2组,每组25例.A组按常规温度处理即覆盖手术单及一层棉胎;B组采取按常规温度处理+充气加温保暖措施.术中监测核心体温,选人室时、麻醉后、截石位后、及术中每20 min为记录时间点,比较2组患者温度的变化,同时观察患者舒适度的反应.结果 麻醉后2组患者体温均开始下降,A组在术中40,60 min及术毕各时间点体温下降幅度较B组相应点体温下降幅度显著增大(P<0.01).术毕寒战发生率A组为19例,较B组的3例显著增加(P<0.05).结论 充气加温法可有效地预防经尿道前列腺电切术患者术中低体温的发生及降低寒战发生率.     

充气加温法预防前列腺电切术患者术中低体温的效果

目的 探讨充气加温法预防经尿道前列腺电切术(TURP)患者术中轻度低体温的临床应用价值.方法 选择TURP患者50例,分为充气保温组和常规组,每组25例.常规组采取常规保温措施,充气加温组在采取常规措施的基础上另加充气加温措施.术中选择7个时间点监测核心体温,比较两组患者的体温变化,并观察是否发生寒战.结果 麻醉后两组患者体温均开始下降,常规组在术中40,60min及术毕各时间点体温下降幅度较充气加温组相应点的体温下降幅度显著增大(P<0.01).术毕寒战发生率常规组为19例,较充气加温组的3例显著增加(P<0.05).结论 充气加温法可有效地预防TURP患者术中低体温的发生,并可降低寒战发生率.     

充气加温法对妇科腹腔镜手术病人低体温及手术部位感染的影响

[目的]探讨充气加温法对妇科腹腔镜手术病人低体温及手术部位感染的影响。[方法]根据随机数字表法将2018年1月—2018年12月收治的96例妇科腹腔镜手术病人分为观察组及对照组各48例,对照组围术期行妇科常规护理,观察组在常规护理基础上应用充气加温毯预防低体温发生。记录两组病人麻醉诱导即刻(T_0)、手术切皮(T_1)、手术开始时(T_2)、手术开始30 min(T_3)、术毕时(T_4)不同时间点体温,并在T_0、T_4时点取血检测血清炎症水平,比较两组术中低体温、寒战、麻醉躁动、手术切口感染情况。[结果]观察组T_1～T_4时点温度均高于对照组(P0.05);观察组T_4时点血清白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)水平均低于对照组(P0.05);观察组低体温、寒战、麻醉躁动、切口感染发生率均低于对照组(P0.05)。[结论]充气加温法能有效预防妇科腹腔镜手术病人术中体温过低,减轻病人围术期炎症反应,从而预防相关并发症发生,有利于病人术后康复。     

充气加温毯在神经外科脑膜瘤切除病人护理中的应用研究

[目的]探讨充气加温毯对预防神经外科开颅脑膜瘤切除术病人围术期低体温及手术部位感染的效果。[方法]选取神经外科开颅脑膜瘤切除术病人60例,随机分为两组,观察组采用充气加温毯保暖,对照组采用常规普通盖被保暖,术中用飞利浦腔温探头持续监测病人的直肠温度,同时记录病人术中输液量、冲洗液量、出血量,统计术中低体温、术后寒战、手术部位感染发生情况及住院天数。[结果]观察组病人术中低体温发生率为16.67%,明显低于对照组(43.33%),差异具有统计学意义(χ2=4.050,P=0.044);同时与低体温相关并发症(术后寒战)的发生率低于对照组。[结论]围术期充气加温毯的应用能够有效降低神经外科脑膜瘤切除术病人低体温的发生率,确保手术治疗效果。     

灌注液温度对膝关节镜手术病人体温的影响

[目的]观察使用加温灌注液膝关节镜手术病人围术期体温的变化,从而选择较为适宜的灌注液温度。[方法]将82例行膝关节镜手术病人随机分为观察组和对照组,各41例,术中观察组用加温至37℃±1℃的灌注液,对照组用室温下(23℃±1℃)放置的灌注液。观察并记录两组病人术中体温变化及与低体温有关的不良反应。[结果]与术前基础体温比较:观察组体温变化不大,对照组体温明显下降(P<0.01);在手术开始后60min、90min、术毕观察组体温明显高于对照组(P<0.05),观察组不良反应发生率低于对照组(P<0.05)。[结论]在关节镜手术中使用加温的灌注液可有效防止术中低体温的发生,降低寒战的发生,增加术中病人舒适程度。     

围手术期保暖策略对氩氦刀冷冻治疗肝癌患者体温及寒战的影响

目的:探讨围手术期采取保暖策略对氩氦刀冷冻治疗肝癌患者体温变化及寒战的影响。方法:选择采用氩氦刀冷冻治疗的肝癌患者60例,将其随机等分为观察组和对照组,对照组围手术期遵循氩氦刀常规护理措施;观察组在常规护理的基础上加用电暖炉、暖无菌生理盐水袋、可调节温度的恒温电热毯、输液加温器等保暖策略,分别在术前、术中、术后测量记录两组患者鼓膜温度,并观察记录寒战、冷休克出现的情况。结果:观察组患者术中、术后早期体温高于对照组(P0.05),热舒适度评分高于对照组(P0.05),低体温、寒战发生率低于对照组(P0.05)。结论:氩氦刀冷冻治疗肝癌围手术期采取的保暖策略能预防早期体温明显下降,可以有效减少低体温、寒战的发生率及减轻患者的寒冷不适感。     

脑肿瘤手术患者充气加温毯给予时机研究

目的 :通过对比充气加温毯的不同给予时机,观察其对脑肿瘤手术患者体温及并发症的影响。方法 :将83例脑肿瘤手术患者随机分为两组,干预组41例在患者进入手术间时立即给予普通毛毯+充气加温毯加温,对照组42例在进入手术间时给予普通毛毯,麻醉诱导时给予充气加温毯加温,观察两组患者围手术期体温、术中出血量、术后寒战发生率、苏醒期躁动发生率、麻醉苏醒时间、切口感染发生率。结果 :干预组麻醉诱导时、麻醉1.5h、麻醉结束时体温均高于进入手术间时,体温差异均有统计学意义(P0.05);对照组麻醉诱导时到麻醉1.5h的体温均低于进入手术间时,差异均有统计学意义(P0.05);干预组从麻醉诱导时到麻醉结束时各时间点体温均高于对照组,体温差异均有统计学意义(P0.001);干预组寒战发生率、躁动发生率及麻醉苏醒时间均低于对照组,差异有统计学意义(P0.05)。结论 :脑肿瘤手术患者进入手术间时应立即给予充气加温毯加温,并且要注意适当的温度档位调节,从而能够减少围手术期低温的发生,降低术后并发症的发生。     

改良充气保温毯复合保温措施对口腔癌患者术中体温的控制效果

目的探讨改良充气保温毯复合保温措施对口腔癌联合皮瓣修复患者术中体温的影响。方法选择2021年2月—2022年2月口腔癌根治联合同期游离皮瓣移植修复术患者91例。将未使用充气保温毯的口腔癌手术患者48例纳入对照组,使用充气保温毯的口腔癌手术患者43例纳入观察组。对照组给予常规保暖措施联合加温输液液体。观察组在对照组的基础上联合改良充气加温毯。对比两组患者在各时间点核心体温、术中出血量、复苏时间、皮瓣危象发生率、寒战发生率。结果观察组患者核心体温在麻醉后、手术开始后30 min、皮瓣血管吻合时、手术结束时、PACU转入转出体温均高于对照组,差异有统计学意义(P<0.05);观察组出血量少,寒战、皮瓣危象发生率低,与对照组比较差异均具有统计学意义(P<0.05)。结论改良充气保温毯复合保温措施能够有效预防口腔癌患者围术期低体温的发生,减少出血量,降低寒战、皮瓣危象发生率,从而促进患者加速康复。     

保温干预对子宫颈癌根治术患者体温变化的影响

目的:探讨子宫颈癌根治术中使用保温干预措施对患者体温变化的影响。方法:选择120例患者随机等分为3组,分别为A组(对照组)、B组(充气加温毯组)、C组(液体加温+充气保温毯组),记录三组入手术室时、麻醉诱导后、切皮时、术中及手术结束时的核心体温变化。结果:3组患者核心体温变化趋势比较有统计学意义(P0.05)。A组保温效果欠佳;B组能有效保护围手术期患者体温,但维持围手术期患者体温的稳定性差;C能有效的保持患者体温稳定。结论:充气保温毯+液体加温可有效地防止由于低体温带来的并发症,提高手术期患者的安全,缩短患者的住院时间,提高手术室护理质量。     

不同保温措施对肩关节镜术中核心体温的影响研究

目的 观察两种不同的保温措施对肩关节镜术中核心体温的效果.方法 纳入38例行肩关节镜下肩袖修补手术的患者为研究对象,根据随机数字表分成A组和B组各19例,A组使用加温灌洗液保温,B组使用充气加温毯保温.比较两组术中核心体温及手术持续时间、术中液体灌洗量、术后寒战发生情况、术后第1天术侧肩关节疼痛评分.结果 A组低体温发...     

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.