人工股骨头置换术与全髋关节置换术治疗高龄股骨颈骨折的临床效果分析

目的探讨与分析高龄股骨颈骨折患者分别采用人工股骨头置换术与全髋关节置换术治疗的效果。方法选取本院2017年1月～2018年1月收治的高龄股骨颈骨折患者128例患者,将其按奇偶排序,64例奇数患者作为观察组,接受全髋关节置换术进行治疗,64例偶数患者作为对照组,接受人工股骨头置换术进行治疗。对比两组患者治疗效果,观察两组患者手术基本情况以及术后生活质量评分、并发症发生情况。结果观察组患者治疗优良率显著高于对照组(P0.05);观察组患者手术时间、术中出血量均高于对照组,住院时间低于对照组(P0.05);观察组患者治疗后躯体功能、心理功能、社会功能、健康评分均高于对照组(P0.05);观察组患者治疗后并发症发生率低于对照组(P0.05)。结论全髋关节置换术治疗高龄股骨颈骨折效果确切,能促进患者髋关节功能的恢复,提高患者的生活质量,降低术后并发症发生率,值得推广使用。     

综合护理配合在全髋关节置换术治疗老年股骨颈骨折中的应用

目的:探讨全髋关节置换术治疗老年股骨颈骨折患者的综合护理配合方法及效果。方法:将106例行全髋关节置换术治疗的老年股骨颈骨折患者随机分为观察组和对照组各53例,对照组实施常规护理,观察组实施综合护理配合,比较两组临床疗效、并发症发生情况、患者生活质量以及对护理的满意度。结果:观察组临床疗效优良率和有效率均高于对照组(P0.05),术后并发症发生率低于对照组(P0.05),术后健康调查简表(SF-36)评分高于对照组(P0.01),患者对护理的满意度明显高于对照组(P0.05)。结论:综合护理配合应用于全髋关节置换术治疗老年股骨颈骨折患者临床效果满意。     

基于护理程序实施整体护理干预对老年股骨颈骨折术后患者的影响

目的:探讨基于护理程序实施整体护理干预对老年股骨颈骨折术后患者的影响。方法:将2018年2月1日～2020年2月1日收治的106例老年股骨颈骨折手术患者随机分为对照组和观察组各53例,对照组行常规护理,观察组基于护理程序实施整体护理干预,比较两组护理效果。结果:观察组髋关节功能恢复总优良率高于对照组(P0.05),并发症发生率低于对照组(P0.05),总满意度高于对照组(P0.05);干预后,两组生活质量评分均高于干预前(P0.01),且观察组高于对照组(P0.01)。结论:基于护理程序实施整体护理干预,可促进老年股骨颈骨折术后患者髋关节功能恢复,减少并发症的发生,提高患者生活质量和护理满意度。     

髋关节置换术治疗股骨颈骨折患者的围术期护理

目的:探讨髋关节置换术治疗股骨颈骨折患者的围术期护理方法及效果。方法:将100例行髋关节置换术治疗的股骨颈骨折患者随机分为观察组和对照组各50例,对照组行常规护理干预,观察组在对照组基础上加强围术期护理,比较两组患者髋关节功能、并发症发生、术后生活质量情况。结果:观察组护理后Harris髋关节功能评分高于对照组(P0.05);观察组并发症发生率低于对照组(P0.05);观察组护理后心理领域、生理领域、社会关系领域、环境领域、总体感觉以及生活质量总评分均高于对照组(P0.05)。结论:髋关节置换术治疗股骨颈骨折患者的围术期护理效果显著,有利于改善患者的髋关节功能状况,降低并发症发生率,提高患者术后生活质量。     

全髋关节置换与内固定治疗股骨颈骨折的临床效果研究

目的比较全髋关节置换术与切开复位内固定术治疗股骨颈骨折的临床效果。方法选取我院2014年3月~2016年3月收治的股骨颈骨折患者74例,根据手术方案不同分为对照组和观察组各37例,对照组采用切开复位内固定术治疗,观察组采用全髋关节置换术治疗,比较两组患者临床疗效。结果对照组手术时间和术中出血量均明显低于观察组,卧床时间和住院时间均明显高于观察组,差异显著(P0.05);术后观察组髋关节功能明显高于对照组,差异显著(P0.05);观察组术后并发症发生率为8.11%,明显低于对照组的32.43%,差异显著(P0.05)。结论相比于切开复位内固定术,全髋关节置换术治疗股骨颈骨折近期疗效满意,术后并发症明显降低,利于功能恢复。     

优质护理干预在老年股骨颈骨折中的应用效果分析

目的:分析优质护理干预在老年股骨颈骨折患者中的应用效果。方法:选取2016年9月～2018年4月收治的104例老年股骨颈骨折患者,随机分为对照组和观察组各52例。对照组采用常规护理,观察组采用优质护理,对比两组髋关节功能恢复情况、并发症发生情况以及对护理工作的满意度。结果:观察组对护理工作的满意度高于对照组(P0.05);观察组髋关节功能恢复优良率高于对照组(P0.05);观察组并发症发生率明显低于对照组(P0.05)。结论:老年股骨颈骨折患者采用优质护理干预,能够提升患者髋关节功能,提高患者对护理工作的满意度,降低患者并发症发生率,效果显著。     

临床护理路径对股骨颈骨折人工髋关节置换术病人就医成本、治疗效果及护理满意度的影响

[目的]探讨临床护理路径对股骨颈骨折人工髋关节置换术病人就医成本、治疗效果及护理满意度的影响。[方法]通过对本院2015年2月—2017年4月骨科就诊治疗的80例行人工髋关节置换术治疗的股骨颈骨折病人临床资料做回顾性分析,并根据护理方式的不同分为观察组和对照组各40例。其中观察组给予临床护理路径护理,对照组给予常规护理。比较并分析两组病人的治疗疗效、住院时间、住院经费、健康教育评分及护理满意度等。[结果]两组病人经各自方案护理后,观察组的住院时间、住院总费用、SCL-90量表各因子评分均明显少于对照组(P0.05),观察组的护理满意度(95.00%)、出院当天及术后1个月Harris髋关节功能评分、健康教育评分均明显高于对照组(77.50%,P0.05)。观察组的术后并发症发生率(7.50%)明显低于对照组(25.00%,P0.05)。[结论]临床护理路径在应用股骨颈骨折人工髋关节置换术病人中,可提高其髋关节功能恢复效果、生活质量、健康教育效果及护理满意度,还可缩短病人的住院时间、减少就医成本、降低术后并发症的发生。     

临床康复护理路径在老年股骨颈骨折术后的应用效果观察

目的:探讨临床康复护理路径在老年股骨颈骨折术后中的应用效果。方法:选择2014年1月~2016年5月于我科行股骨颈骨折术后的80例老年患者并随机等分为对照组和观察组,对照组在术后仅给予骨科常规护理;观察组则采用临床康复护理路径。比较两组患者的住院时间、术后并发症、康复效果及护理满意度。结果:与对照组比较,观察组住院时间明显缩短、术后DVT并发症发生率明显减低、髋关节恢复效果明显提高,且护理满意度高于对照组(P0.05)。结论:老年股骨颈骨折术后实施临床护理路径不仅有效缩短住院时间,降低术后并发症发生率,提高髋关节功能恢复程度及患者和家属的满意度。     

优化中医护理临床路径对股骨颈骨折患者术后并发症、康复进程及生活质量的影响

目的:探讨优化中医护理临床路径对股骨颈骨折患者术后并发症、康复进程及生活质量的影响。方法:选取2015年1月~2016年12月我院收治的股骨颈骨折患者100例为研究对象,随机等分为观察组和对照组,对照组给予常规护理,观察组在此基础上采用优化中医护理临床路径进行干预,对比两组术后一般情况及骨折愈合情况、髋关节功能、生活质量及舒适度,并记录并发症发生情况。结果:观察组住院时间、康复时间与对照组比较明显较短,观察组住院费用低于对照组,而其护理满意度评分较对照组高(P0.05);观察组骨折愈合总有效率明显高于对照组(P0.05);干预后观察组Harris评分、SF-36评分与对照组比较明显较高(P0.05),观察组舒适度评分低于对照组(P0.05);观察组干预后并发症发生情况明显低于对照组(P0.05)。结论:优化中医护理临床路径可促进股骨颈骨折患者术后髋关节功能恢复,能明显提高生活质量,降低并发症,且患者满意度高,值得在临床推广应用。     

基于影视素材的疼痛健康教育对髋关节置换术患者的应用效果

目的 探讨基于影视素材的疼痛健康教育对髋关节置换术患者的应用效果。方法 选取2019年1月-12月在我院行全髋关节置换术的患者158例,随机分为两组各79例,对照组给予常规护理,观察组在常规护理的基础上实施基于影视素材的疼痛健康教育,对比两组疼痛程度、髋关节功能恢复状况、负性情绪与护理满意度。结果 观察组术后1d、术后3d疼痛评分均低于对照组(P＜0.05);观察组术后7d、术后2个月 Harris髋关节评分高于对照组(P＜0.05);干预后观察组焦虑、抑郁评分明显低于对照组(P＜0.05);观察组并发症发生率低于对照组(P＜0.05);观察组护理满意度高于对照组(P＜0.05)。结论 在髋关节置换术患者中应用基于影视素材的疼痛健康教育能够减轻患者疼痛、促进髋关节功能恢复、改善负性情绪、提高护理满意度。     

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.     

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.     

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.