行气通便贴预防口服吗啡所致便秘中的应用

目的观察行气通便贴对口服阿片类癌痛患者便秘的应用效果。方法将口服阿片类患者随机分为观察组和对照组,各46例,对照组采用多食粗纤维食物,多饮水,并配合腹部按摩预防便秘。观察组在对照组基础上采用行气通便贴用于脐部。根据《中医病征诊断疗效标准》判断疗效。结果观察组便秘发生率明显低于对照组（P〈0．05）。结论行气通便贴可用于预防口服阿片类所致的便秘。     

协同护理模式在肺癌晚期疼痛患者中的应用

目的：探讨协同模式在肺癌晚期疼痛患者护理中的应用效果。方法选择2013年1-12月收治的肺癌晚期疼痛患者80例,按照入院顺序随机分为对照组和观察组各40例。对照组患者应用常规护理方法,观察组患者在常规护理基础上应用协同护理干预,在协同护理干预2周后进行疼痛缓解程度、疼痛药物不良反应发生率及干预前后生活质量的比较。结果两组患者干预前疼痛程度差异无统计学意义（P＞0．05）,协同护理2周后,观察组患者疼痛缓解率为95．0％,高于对照组的77．5％,差异有统计学意义（χ2＝6．64,P＜0．01）;阿片类药物不良反应中,观察组患者便秘发生率为47．5％,恶心/呕吐发生率35．0％,低于对照组的70．0％,62．5％,差异有统计学意义（χ2值分别为4．18,6．05;P＜0．05）;两组患者干预前生活质量各领域评分比较差异无统计学意义（P＞0．05）,干预后,观察组患者在生理领域、心理领域、社会关系领域、环境领域评分分别为（13．4±1．8）,（12．1±1．9）,（12．6±1．7）,（12．5±1．8）分,均优于对照组的（12．3±2．0）,（11．0±1．8）,（11．7±1．6）,（12．0±1．9）分,差异有统计学意义（t值分别为4．45,4．24,3．57,2．49;P＜0．05）。结论协同护理能增强癌症晚期患者疼痛的治疗效果,提高疼痛缓解率;降低阿片类药物引起的便秘以及恶心/呕吐的发生率,提高患者的生活质量。     

穴位按摩预防脑出血患者便秘的效果

目的探讨穴位按摩对脑出血患者便秘的预防效果。方法将2009年7月至2011年7月武汉市第一医院神经内科160例发病7d内的脑出血患者按入院时间顺序分成对照组和观察组,每组患者80例。对照组给予常规护理,观察组在此基础上实施穴位按摩,比较两组患者便秘的发生率及观察组患者干预前后血压、心率变化情况。结果观察组便秘的发生率为16．25％（13／80）,对照组便秘的发生率为43．75％（35／80）,两组比较,差异具有统计学意义（x2=14．40;P〈0．01）。观察组干预前后血压、心率的变化均不明显,差异无统计学意义（t分别为0．21,-0．28,0．44;P〉0．05）。结论穴位按摩对脑出血后患者的便秘有较好的预防效果。     

康复按摩加中频电对预防腰椎压缩性骨折患者便秘的效果

目的探讨康复按摩加中频电对预防腰椎压缩性骨折患者便秘的影响。方法将44例腰椎压缩性骨折患者按随机数字表法分成观察组和对照组各22例。两组患者均接受腰椎压缩性骨折常规治疗及护理。对照组予口服大黄碳酸氢钠预防便秘;治疗组予康复按摩并中频电预防便秘。结果观察组便秘发生率明显低于对照组,差异有统计学意义（x^2=15．395,P〈O．05）;治疗后初次排便时间观察组明显低于对照组,差异有统计学意义（t=15．208,P〈0．05）。结论康复按摩并中频电治疗能促进患者排便,降低腰椎压缩性骨折患者便秘的发生。     

穴位贴敷联合按摩干预对手外伤患者术后疼痛及生活质量的影响

目的：探讨穴位贴敷联合按摩干预对手外伤患者术后疼痛及生活质量的影响。方法：按随机数字表法将2021年3月至2023年3月于郑州市骨科医院治疗的88例手外伤患者分为两组,每组44例。对照组采用常规护理干预,观察组于对照组基础上采用穴位贴敷联合按摩干预。比较两组疼痛程度、生活质量、上肢功能、心理状态及不良事件发生情况。结果：干预后,两组疼痛评分、心理状态评分均低于干预前,生活质量评分、上肢功能评分均高于干预前,且观察组疼痛评分、心理状态评分低于对照组,生活质量评分、上肢功能评分高于对照组,差异有统计学意义（P<0.05）;观察组不良反应发生率低于对照组,差异有统计学意义（P<0.05）。结论 ：穴位贴敷联合按摩干预能够减轻手外伤患者术后疼痛感,降低不良事件发生率,促进患者手部功能恢复,改善患者心理状态及生活质量。     

穴位按摩配合中药四子散熨敷腹部治疗老年骨折患者便秘的效果观察

目的探讨腹部穴位按摩配合中药四子散熨敷腹部穴位治疗老年骨折患者便秘的效果。方法将本科2012年3月~9月80例住院的老年骨折合并便秘患者随机分为观察组（40例）、对照组（40例）,观察组在常规方法的基础上采用腹部穴位按摩后用四子散熨敷腹部穴位,对照组施行预防便秘的常规方法,观察5天内的排便情况。结果第2天~第5天治疗后观察组肠鸣音次数多于对照组,首次排便时间短于对照组,便秘发生率低于对照组,2组治疗效果比较差异有统计学意义（P〈0.05）。结论对老年便秘患者采用腹部按摩配合四子散熨敷腹部效果优于常规预防便秘的方法,值得推广。     

指法扩肛联合穴位按摩治疗腰椎压缩性骨折患者便秘的效果

目的：探讨指法扩肛联合穴位按摩治疗腰椎压缩性骨折患者便秘的临床疗效。方法选择住院的腰椎压缩性骨折便秘患者120例,按入院先后顺序随机分成对照组和干预组,每组60例。两组均行便秘常规治疗护理,干预组在此基础上采用指法扩肛联合穴位按摩。比较两组便秘症状积分和临床疗效。结果治疗前两组患者便秘症状积分比较差异无统计学意义（P＞0．05）;治疗1个疗程后干预组患者便秘症状积分为（2．04±0．61）分,低于对照组的（8．70±2．18）分,两组比较差异有统计学意义（t＝6．926,P＜0．01）;治疗结束后2周两组患者便秘症状积分比较差异有统计学意义（t＝6．336,P＜0．01）;干预组便秘痊愈25例,显效31例,对照组分别为8,29例,两组比较差异有统计学意义（ U＝6．926,P＜0．05）。结论指法扩肛联合穴位按摩可以有效解除腰椎压缩性骨折患者的便秘症状,且不良反应少,值得临床推广应用。     

腹部穴位按摩联合中药贴敷神阙穴预防颅脑损伤患者便秘的效果观察

目的研究腹部穴位按摩联合中药贴敷神阙穴预防颅脑损伤患者便秘的效果。方法将80例颅脑损伤患者按随机分为观察组和对照组各40例,在常规护理的基础上,观察组入院24h内行穴位按摩联合中药贴敷神阙穴,对照组行中药贴敷神阙穴,比较两组患者便秘发生情况。结果观察组便秘发生率为10％,对照组便秘发生率为30％,差异有统计学意义（P〈0.05）。结论穴位按摩联合中药贴敷神阙穴能预防颅脑损伤患者便秘,不良反应少,通便作用缓和。     

穴位按摩防治妇科腹腔镜术后颈肩痛的效果

目的探讨穴位按摩对防治妇科腹腔镜术后颈肩部疼痛的作用。方法妇科腹腔镜手术病人109例,随机分为两组,观察组53例,给予妇科腹腔镜术后常规护理并施以穴位按摩;对照组56例,给予妇科腹腔镜术后常规护理。观察并比较两组病人术后颈肩痛的发生率、疼痛持续时间及疼痛的程度。结果观察组术后颈肩痛的发生率低于对照组（x2=4．25,P〈0．05）,疼痛持续时间短于对照组（t=4．35,P〈0．05）,疼痛的程度轻于对照组（u=2．35～3．42,P〈0．05）。结论穴位按摩能有效防治妇科腹腔镜术后病人出现的颈肩部疼痛。     

穴位按摩结合健康教育改善晚期肺癌患者化疗致末梢神经炎的效果

目的探究穴位按摩结合健康教育改善晚期肺癌患者化疗致末梢神经炎的效果。方法选择在本院进行治疗的90例晚期肺癌患者,按照入院顺序分组原则将其分为观察组和对照组,各45例,观察组接受穴位按摩结合健康教育,对照组接受穴位按摩,比较两组的护理效果。结果干预后,观察组的整体功能、角色功能、情绪功能、认知功能、躯体功能评分均高于对照组(P<0.05)。干预后,观察组的焦虑、抑郁评分均低于对照组(P<0.05)。干预后,观察组的麻木感和刺痛感评分均低于对照组(P<0.05)。观察组的化疗致末梢神经炎发生率低于对照组,差异具有统计学意义(P<0.05)。结论穴位按摩结合健康教育改善晚期肺癌患者化疗致末梢神经炎的效果显著,值得研究和推广。     

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.     

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.     

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.     

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.