胆结石引起重症急性胰腺炎24例综合护理干预

目的:探讨胆结石引起重症急性胰腺炎(SAP)患者的综合护理干预方法及效果。方法:将48例胆结石引起的SAP患者随机分为干预组和对照组各24例,对照组给予常规护理干预,干预组在此基础上给予综合护理干预,比较两组护理干预效果。结果:两组感染消退时间、病死率、肠瘘发生率、再次手术率、住院时间比较差异均有统计学意义(P0.05)。结论:综合护理干预措施可降低胆结石引起的SAP患者病死率、肠瘘发生率、再次手术率,缩短住院时间。     

集束化护理管理在重症急性胰腺炎患者早期护理的应用

目的 探讨集束化管理在重症急性胰腺炎患者中的应用.方法 将56例重症急性胰腺炎患者随机分为观察组和对照组各28例,对照组采取常规综合护理,而观察组实施集束化护理干预管理.比较2组患者病死率、腹痛缓解时间、住院天数和并发症发生率.结果 观察组病死率、腹痛缓解时间、并发症发生率及住院时间均显著优于对照组,差异有统计学意义(P＜0.05).结论 集束化护理管理可降低重症急性胰腺炎并发症的发生率,对患者预后有积极作用.     

微创外科干预治疗重症急性胰腺炎22例综合护理

目的:探讨微创外科干预治疗重症急性胰腺炎患者的综合护理方法及效果。方法:将42例采用微创外科干预治疗的重症急性胰腺炎患者分为对照组20例和观察组22例,对照组实施常规护理,观察组在此基础上给予综合护理,比较两组护理效果。结果:两组住院时间、症状缓解时间、体质指数(BMI)降低幅度、不良事件发生率、不良心理发生率比较差异有统计学意义(P0.05)。结论:对采用微创外科干预治疗的重症急性胰腺炎患者实施综合护理,可缩短住院时间,缓解症状,减少不良事件,缓解负性心理状态。     

重症急性胰腺炎并呼吸窘迫综合征临床护理观察

目的分析重症急性胰腺炎并呼吸窘迫综合征临床护理观察。方法选择本院2018年7月至2019年7月收治80例重症急性胰腺炎并呼吸窘迫综合征患者,按随机数表分为两组,对照组40例采用常规护理,研究组40例给予针对性护理,比较两组住院时间、住院费用及满意度。结果研究组患者住院时间与住院费用分别为(8.26±2.67)d、(10080.33±1354.36)元,比对照组少(P<0.05);对照组满意度为72.50%,比研究组低92.50%(P<0.05)。结论对重症急性胰腺炎并呼吸窘迫综合征患者实施针对性护理干预,能缩短患者住院时间,减少其住院费用,还能提高其护理满意度,临床上值得推广使用。     

护理干预在重症急性胰腺炎患者中的应用

目的:探讨护理干预在重症急性胰腺炎(AP)患者中的应用效果。方法:将74例重症急性胰腺炎患者随机分为观察组和对照组各37例,对照组给予常规护理,观察组在此基础上给予护理干预,观察两组治疗效果、住院时间及护理满意度。结果:观察组治愈率、转诊率、住院时间、患者满意度与对照组比较差异有统计学意义(P0.05)。结论:重症AP患者在常规护理的同时予全面有效的护理干预能够提高患者的治愈率,缩短住院时间,提高护理满意度及护理质量。     

自制健康教育视频结合全面护理对重症急性胰腺炎患者的疗效研究

目的探讨自制健康教育视频结合全面护理干预对重症急性胰腺炎患者的疗效及预后。方法选择该院2016年3月至2017年3月160例重症急性胰腺炎患者,根据数字随机表法分为2组,各80例。对照组患者采用常规护理,试验组使用自制健康教育视频结合全面护理干预。比较2组患者的治疗总有效率;腹痛症状消失时间、体温恢复正常时间、住院时间、患者依从性评分;干预前后患者急性生理与慢性健康评分(APACHE-Ⅱ)、焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分;患者护理满意度。结果试验组治疗总有效率高于对照组(P0.05);试验组腹痛症状消失时间、体温恢复正常时间、住院时间短于对照组,患者依从性评分高于对照组(P0.05);干预前2组APACHE-Ⅱ评分、SAS评分、SDS评分相近(P0.05);治疗后试验组APACHE-Ⅱ评分、SAS评分、SDS评分优于对照组,护理满意度高于对照组(P0.05)。结论自制健康教育视频结合全面护理干预对重症急性胰腺炎患者疗效及预后具有良好的临床价值。     

重症急性胰腺炎集束化护理与早期肠内营养干预

目的探讨集束化护理联合早期肠内营养干预对重症急性胰腺炎治疗效果。方法选取82例重症急性胰腺炎患者,随机分为对照组与治疗组,各41例。在常规治疗的基础上,对照组采用常规护理联合早期肠内营养干预的方式,治疗组采用集束化护理联合早期肠内营养进行干预,对比观察2组患者的并发症发生率、护理满意度。结果治疗组患者急性呼吸窘迫综合征(ARDS)、消化道出血、肾衰竭、心力衰竭、静脉血栓、弥漫性血管内凝血(DIC)的并发症发生率显著低于对照组(P 0. 05);治疗组患者的满意度显著高于对照组(P 0. 05)。结论集束化护理联合早期肠内营养干预可提升重症急性胰腺炎的治疗效果,患者住院时间缩短,并发症减少,护理满意度提高。     

护理干预对经鼻胆管引流术治疗急性胆源性胰腺炎患者的效果

目的 探讨护理干预在经鼻胆管引流术治疗急性胆源性胰腺炎中的应用效果.方法 选取急性胆源性胰腺炎患者60例,随机分为观察组和对照组,每组30例.对照组采用常规护理,观察组采用全方位的综合护理.比较两组患者的并发症、住院时间、住院费用、遵医行为以及护理满意度情况.结果 观察组的治疗依从性高于对照组（P＜0.05）,术后并发症、住院时间和住院费用均少于对照组（均P ＜0.05）,心理护理、健康教育以及治疗性护理的满意度方面均高于对照组（均P＜0.05）.结论 综合护理干预有利于减少急性胆源性胰腺炎术后并发症,缩短住院时间,提高患者护理满意度.     

综合护理干预对急性坏死型胰腺炎的临床效果

目的 探讨综合护理干预对急性坏死型胰腺炎患者的临床效果.方法 选取收治的急性坏死型胰腺炎患者60例,随机分为观察组和对照组,每组30例.对照组患者实施常规护理,观察组患者在此基础上实施综合护理干预.观察两组患者焦虑、抑郁程度及健康状况,并统计患者的舒适度和对护理工作的满意度.结果 观察组SAS、SDS与APACHEⅡ评分明显低于干预前（P＜0.05）,亦明显低于对照组（P＜0.05）.舒适度及对护理工作的满意度明显高于对照组（P＜0.05）.结论 对急性坏死型胰腺炎患者实施综合护理干预能够有效降低患者的焦虑、抑郁程度,明显提高患者的健康状况及舒适度,增加对护理服务的满意程度,具有进一步推广应用的价值.     

综合护理干预应用于儿童急性胰腺炎的效果研究

目的探讨综合护理干预在儿童急性胰腺炎的临床应用价值。方法选取2014年10月～2017年12月本科室收治的66例胰腺炎患儿为研究对象,按入院时间为序将其分为对照组和观察组,2组患儿均给予常规护理,观察组在此基础上给予综合护理干预,对比2组护理后治愈率、并发症发生率、住院天数及家属对护理满意度情况等。结果与对照组相比,观察组治愈率有所提高(P0.05),并发症发生率有所降低(P0.05),住院时间缩短,差异有统计学意义(P0.05)。观察组护理满意度为96.8%,高于对照组的76.5%,差异有统计学意义(P0.05)。结论对急性胰腺炎患儿实施综合护理干预能促进护患配合,缩短患者住院时间,提升其护理满意度,具有较高应用价值,值得推广。     

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.