155例行腹腔镜胆囊切除术患者围术期的护理

目的：探讨对行腹腔镜胆囊切除术患者进行围术期护理的临床疗效。方法选取2011年9月至2013年9月在本院接受腹腔镜胆囊切除术的155例患者作为研究对象,将其随机分为实验组和对照组,对照组予以常规护理,实验组在常规护理的基础上予以围术期全面护理,比较两组的患者满意度、护理质量、术中出血量、手术时间、术后排气时间及并发症发生情况。结果实验组患者满意度为96.2％,对照组为75.3％,两组患者满意度比较差异有统计学意义（ P＜0.05）;相比于对照组,实验组护理质量显著升高,术中出血量降低,手术时间及术后排气时间明显缩短,差异有统计学意义（ P＜0.05）;对照组并发症发生率为83.2％,实验组为19.3％,两组并发症发生率比较差异有统计学意义（ P＜0.05）。结论予以腹腔镜胆囊切除术患者围术期全面护理能显著提高患者满意度及护理质量,降低术中出血量及并发症发生率,临床疗效显著,值得进一步推广。     

基于临床路径的康复护理在腹腔镜胆囊切除术患者中的应用

目的探讨基于临床路径的康复护理在腹腔镜胆囊切除术患者中的应用效果,为临床护理工作指导提供参考。方法选取于该院行腹腔镜胆囊切除术患者90例为研究对象,按随机数表法随机分为观察组和对照组,各45例,对照组患者采用常规护理模式,观察组患者按临床路径予以康复护理模式干预,比较两组患者住院及术后恢复情况、不良反应发生情况及患者护理满意度,并作统计学分析。结果观察组患者术后首次胃肠排气时间、术后住院时间及住院总费用均显著低于对照组患者,差异有统计学意义(均P<0.05);观察组患者术后并发症发生率显著低于对照组,差异有统计学意义(P<0.05);观察组患者护理满意度显著高于对照组,差异有统计学意义(P<0.05)。结论基于临床路径的康复护理干预可显著加快腹腔镜胆囊切除术患者术后恢复,缩短患者住院时间,提升护理满意度。     

快速康复护理联合中医疗法在腹腔镜胆囊切除术患者中的应用

目的:探讨快速康复护理联合中医疗法在腹腔镜胆囊切除术患者中的应用效果。方法:将88例腹腔镜胆囊切除术患者随机分为实验组和对照组各44例,对照组采用常规护理措施,实验组在常规护理基础上实施快速康复护理联合中医疗法,比较两组治疗效果。结果:两组治疗总有效率比较差异无统计学意义(P0.05);实验组并发症发生率低于对照组(P0.01);实验组干预后健康知识评分高于对照组,术后VAS评分低于对照组,差异有统计学意义(P0.01);实验组肛门排气时间、首次排便时间、住院时间均短于对照组(P0.01);实验组患者护理满意度高于对照组(P0.01)。结论:快速康复护理联合中医疗法在腹腔镜胆囊切除术中应用效果显著,可提高患者满意度。     

快速康复外科护理在腹腔镜胆囊切除术围术期中的效果观察

目的:观察快速康复外科护理在腹腔镜胆囊切除术围术期中的应用效果。方法:选取2016年10月～2017年10月我院收治的110例行腹腔镜胆囊切除术患者作为研究对象,随机分为对照组和观察组,每组55例。围术期,对照组给予常规护理干预,观察组给予快速康复外科护理干预,比较两组术后恢复情况、疼痛程度、并发症发生率和满意度。结果:观察组术后肛门排气时间、引流管拔除时间、下床活动时间和住院时间均明显短于对照组,差异均有统计学意义,P0.05;观察组的输液总量少于对照组,差异有统计学意义,P0.05;观察组的疼痛程度低于对照组,差异有统计学意义,P0.05;观察组的并发症发生率低于对照组,差异有统计学意义,P0.05;观察组的护理满意度高于对照组,差异有统计学意义,P0.05。结论:快速康复外科护理在腹腔镜胆囊切除术围术期中的应用效果显著,可有效缩短患者住院时间,减轻患者的疼痛程度,减少并发症的发生,促进术后恢复。     

围手术期系统护理在腹腔镜胆囊切除术治疗胆结石中的临床应用

目的探究与分析围手术期系统护理在腹腔镜胆囊切除术治疗胆结石中的应用效果。方法选取本院自2015年4月~2016年4月收治的180例接受腹腔镜胆囊切除术治疗胆结石的患者,采取随机数字表法分为常规护理组与围手术期系统护理组,每组各90例,对比两组手术时间、肛门排气时间、住院时间、术中出血量、止痛药使用率、并发症发生率及护理满意度。结果围手术期系统护理组与常规护理组相比手术时间、肛门排气时间、住院时间均缩短,术中出血量减少,止痛药使用率较低,差异均具有统计学意义(P0.05);围手术期系统护理组与常规护理组相比腹痛腹胀率、消化不良率、切口感染率、皮下气肿率均较低,差异均具有统计学意义(P0.05);围手术期系统护理组与常规护理组相比护理满意度较高,差异具有统计学意义(P0.05)。结论将围手术期系统护理应用于腹腔镜胆囊切除术治疗胆结石患者的过程中可改善围手术期指标,降低并发症发生率,提高患者的护理满意度。     

系统化护理对腹腔镜胆囊切除术后并发症的预防效果探讨

目的:分析系统化护理对腹腔镜胆囊切除术后并发症的预防效果.方法:选取2015年5月至2016年4月104例腹腔镜胆囊切除术患者,根据随机原则分成对照组和实验组.对照组接受常规护理干预,实验组接受系统化护理干预.对比两组患者术后并发症发生率的差异结果:实验组患者术后并发症发生率明显低于对照组,组间有显著的统计学差异(P＜0.05).结论:系统化护理对腹腔镜胆囊切除术后并发症具有良好的预防作用,对减轻患者术后痛苦有益.     

腹腔镜胆囊切除术29例围术期心理护理干预

目的：探讨腹腔镜胆囊切除术患者围术期心理护理干预方法及效果。方法：将58例择期腹腔镜胆囊切除术患者随机分为对照组和干预组各29例,两组均给予常规护理措施,干预组在常规护理基础上实施围术期心理护理干预。观察患者围术期心率、血压、呼吸频率变化及术后不良心理问题发生情况。结果：术前干预组患者状态-特质焦虑问卷（STAI）评分显著低于对照组,两组比较差异有统计学意义（P ＜0.05）。术前干预组心率、收缩压、舒张压、呼吸频率显著低于对照组（P ＜0.05）;术后干预组患者心理问题发生率显著低于对照组（P ＜0.05）。结论：腹腔镜胆囊切除术患者术前心理护理干预可使患者术中和术后生命体征更平稳,降低术后不良心理问题发生率。     

腹腔镜胆囊切除术治疗胆结石围术期护理效果观察

目的:探讨腹腔镜下胆囊切除术治疗胆结石围术期护理方法和护理效果。方法:选取我院接受腹腔镜胆囊切除术的胆结石患者120例,随机分为对照组与观察组各60例。对照组接受常规护理,观察组在常规护理基础上实施围术期综合护理干预,比较两组患者手术情况、并发症发生率及满意度。结果:除手术时间外,观察组术中出血量、术后首次排气时间、住院时间以及术后并发症发生率均低于对照组(P<0.05);观察组护理满意度高于对照组(P<0.05)。结论:对腹腔镜下胆囊切除术患者围术期实施综合护理干预,可有效提高护理质量,降低并发症发生率,缩短住院时间,提高护理满意度。     

老年患者腹腔镜胆囊切除术围手术期护理体会

目的 探讨老年患者腹腔镜胆囊切除术围手术期的护理方法.方法 将256例行腹腔镜胆囊切除术的老年患者随机分为优质护理组(A组)及常规护理组(B组),其中A组130例,B组126例,观察比较2组并发症发生率及住院天数以评估护理效果.结果 2组患者手术均顺利完成;2组并发症发生率比较,A组(10.0％)显著低于B组(23.0％),差异有统计学意义(P＜0.05);2组住院天数比较,A组(13.8±2.1)d显著少于B组(18.2±2.5)d,差异有统计学意义(P＜0.05).结论 提高老年患者腹腔镜胆囊切除术围手术期的护理质量有助于减少术后并发症发生、缩短住院时间,促进患者病体康复.     

腹腔镜探查联合阴式子宫切除术36例护理干预

目的:探讨腹腔镜探查联合阴式子宫切除术患者的护理干预方法及效果。方法:将72例行腹腔镜探查联合阴式子宫切除术患者随机分为实验组和对照组各36例,对照组给予腹腔镜手术常规护理,实验组在此基础上实施围术期护理干预。比较两组患者住院时间、满意度及并发症发生情况。结果:实验组患者平均住院时间明显短于对照组,护理满意度明显高于对照组,并发症发生例数明显少与对照组,两组比较差异有统计学意义(P0.05)。结论:对腹腔镜探查联合阴式子宫切除术患者实施护理干预,可以缩短住院时间,提高满意度,减少并发症,值得临床推广。     

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.     

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.