细菌性肝脓肿经皮肝穿刺置管引流术中的循证护理

目的探讨循证护理在超声引导下经皮肝穿刺置管引流术治疗细菌性肝脓肿的疗效。方法选取80例患者,按照随机数字表法分为对照组和实验组,每组40例。对照组给予常规护理,实验组在对照组基础上实施循证护理干预。比较2组住院情况及并发症发生率。结果 2组患者体温恢复时间比较,差异无统计学意义(P 0.05);实验组脓腔消失时间、住院时间短于对照组,并发症率低于对照组,差异有统计学意义(P 0.05)。结论细菌性脓肿患者在超声引导下经皮肝穿刺置管引流术治疗过程中实施循证护理,能缩短脓腔消失时间和住院时间,降低并发症发生率。     

B超引导下经皮穿刺留置引流管治疗肝脓肿患者的护理

目的 探讨在B超引导下经皮穿刺留置引流管治疗肝脓肿患者的临床护理.方法 对我院2004年1月至2010年12月收治的64例脓腔直径≥5 cm的肝脓肿患者的治疗转归及护理资料进行回顾性分析.结果 64例肝脓肿患者经过B超引导下经皮穿刺留置引流管后,治愈率为100％,未发生并发症.结论 B超引导下经皮穿刺留置引流管治疗肝脓肿切实可行,而细致的护理也是提高其治愈率的一项重要措施.     

超声引导下经皮穿刺置管引流术治疗老年细菌性肝脓肿的临床效果观察

研究超声引导下经皮穿刺置管引流术治疗老年细菌性肝脓肿的临床效果。纳入老年细菌性肝脓肿患者94例,根据随机数字表法均分为切开组和超声组。切开组采用细菌性肝脓肿切开置管引流治疗,超声组采用超声引导下经皮穿刺置管引流术治疗。比较两组总有效率、体温复常时间、脓腔消失时间、血象复常时间、住院时间及并发症发生率的差异。超声组总有效率显著高于切开组(P0.05);超声组相较于切开组体温复常时间、脓腔消失时间、血象复常时间、住院时间更短(P0.05);超声组相较于切开组并发症发生率更低(P0.05)。超声引导下经皮穿刺置管引流术治疗老年细菌性肝脓肿的临床效果确切,可有效促进体温和血象恢复正常,减少并发症发生,缩短脓腔消失时间和住院时间,值得推广运用。     

超声引导下经皮穿刺置管引流术治疗老年细菌性肝脓肿的效果观察

目的探讨给予细菌性肝脓肿老年患者超声引导下经皮穿刺置管引流术治疗的临床效果。方法从本院2017年4月～2018年6月收治细菌性肝脓肿老年患者中选取68例,随机分为对照组和观察组各34例。对照组给予切开置管引流治疗,观察组予超声引导下经皮穿刺置管引流术治疗,观察两组患者治疗效果。结果术后,观察组体温、血象复常时间及脓腔消失、住院时间均显著短于对照组,差异有统计学意义(P0.05);观察组并发症总发生率为5.88%,显著低于对照组的17.65%,观察组治疗总有效率为94.12%,显著高于对照组的79.41%,差异均有统计学意义(P0.05)。结论超声引导下经皮穿刺置管引流术应用于老年细菌性肝脓肿治疗,可使患者临床症状、体征获得更快恢复,总疗效更理想,且术后并发症较少,有助于缩短患者住院时间。     

戴明循环护理模式在细菌性肝脓肿患者护理实践中的应用

目的探讨戴明循环护理模式对细菌性肝脓肿患者实施护理干预的效果。方法选择2013年1月至2015年9月来该院接受治疗的细菌性肝脓肿患者100例,按照随机数字表法平均分为两组,50例患者施行常规护理(常规护理组),50例患者施行戴明循环护理模式(循环护理组)。统计两组患者术后血象恢复、体温恢复、脓腔消失及住院时间;统计两组患者术后引流口感染、腹痛剧烈、腹腔出血、肺内感染及腹腔脓肿等并发症发生情况;应用自制调查问卷统计患者出院时护理满意率、遵医良好率。结果两组患者经过综合系统治疗和护理,均康复出院。经术后相应的护理后,循环护理组术后血象恢复、体温恢复、脓腔消失及住院时间明显短于常规护理组,差异均有统计学意义(P0.05);循环护理组并发症发生率(12.0%)明显低于常规护理组(28.0%),差异有统计学意义(P0.05);循环护理组护理满意度和遵医良好率明显高于常规护理组,差异有统计学意义(P0.05)。结论相对于常规护理模式,戴明循环护理模式能提高细菌性肝脓肿患者的治疗效果,降低治疗成本和术后并发症发生率,提高患者护理满意度和治疗依从性,是有效的护理管理模式,值得临床推广应用。     

超声介入治疗细菌性肝脓肿的临床疗效及安全性研究

目的：分析细菌性肝脓肿患者临床治疗中超声介入治疗的效果。方法：选取2021年2月—2023年2月新泰市人民医院收治的细菌性肝脓肿患者60例,对患者的分组方式为治疗方法,分别为实验组与参照组,每组各选取30例,参照组接受常规开腹脓肿切开引流术治疗,实验组接受超声介入治疗,比较两组患者的手术指标（手术时间、引流时间、体温恢复时间、白细胞数恢复时间、住院时间、脓腔消失时间、血象恢复正常时间）、并发症发生率（脓气胸、弥漫性腹膜炎、伤口感染、肝内脓腔大出血）;分析典型病例影像表现。结果：实验组手术时间、引流时间、体温恢复时间、白细胞数恢复时间、住院时间、脓腔消失时间、血象恢复正常时间均少于参照组（P <0.05）;实验组并发症发生率6.67%明显低于参照组的26.67%(P <0.05)。结论：在细菌性肝脓肿患者的临床治疗中实施超声介入治疗效果显著,对患者的应激反应比较轻微,安全性高,值得推广。     

超声引导下经皮肝穿刺治疗细菌性肝脓肿的临床价值

目的评价超声引导下经皮肝穿刺治疗细菌性肝脓肿的临床应用价值。方法对临床确诊为细菌性肝脓肿的49例患者进行超声引导下经皮肝穿刺治疗,其中22例行单纯细针抽吸术（抽吸组）,26例行置管引流术（置管组）,1例抽吸术后1周脓腔无明显缩小而行置管引流术（抽吸＋置管组）;同时配合静脉抗炎、全身支持治疗。结果超声引导下经皮肝穿刺细针抽吸或置管引流治疗后,患者体温恢复正常、白细胞计数恢复正常及脓腔消失时间分别为（2.8±0.6）d、（3.2±0.5）d、（14.6±4.2）d。所有患者均无并发症,术后3个月复查超声脓腔均消失,超声引导下经皮肝穿刺治疗细菌性肝脓肿的治愈率为100%。结论超声引导下经皮肝穿刺细针抽吸和置管引流术具有简便经济、创伤小、并发症低、治愈率高等优点,成为细菌性肝脓肿首选治疗方法。     

经皮肝穿置管引流治疗肝脓肿

目的 观察经皮肝穿置管引流治疗肝脓肿的临床疗效。方法 １０例单发肝脓肿,４例双发肝脓肿,２例多发肝脓肿患者在Ｂ超引导下行脓腔穿刺置管引流,观察其全身症状消失、脓腔消失、住院时间等,总结其临床疗效。结果 １６例患者均获得痊愈,效果良好。结论经皮肝穿置管引流治疗肝脓肿具有良好的临床疗效。     

B超下定位经皮肝穿刺引流联合康复新液治疗细菌性肝脓肿80例临床分析

80例细菌性肝脓肿患者随机分为观察组和对照组,观察组:B超下定位,行经皮肝穿刺引流术,术后每天用生理盐水、甲硝唑溶液、康复新液混合液冲洗脓腔。对照组:行剖腹探查切开引流术,术后每天以生理盐水、庆大霉素、甲硝唑混合液冲洗脓腔。所有患者术后均予以抗生素治疗,待临床症状消失或好转,2w后复查B超示脓腔缩小或消失后,即可拔除引流管。观察组40例患者7d内体温恢复正常,38例患者7¹4d治愈,2例患者因脓腔残留继续冲洗5d后痊愈,平均住院12d。对照组40例患者于术后314d治愈,2例患者因脓腔残留继续冲洗5d后痊愈,平均住院12d。对照组40例患者于术后3⁵d体温恢复正常,35例患者75d体温恢复正常,35例患者7¹4d治愈,5例患者因继发感染于1814d治愈,5例患者因继发感染于18²5(平均19)d治愈出院。B超定位下行穿刺引流术排脓,术后联合生理盐水、甲硝唑溶液、康复新液混合液冲洗脓腔,此方法操作简单、安全、成功率高、住院时间短、医疗费用少,并发症及病死率低。     

超声引导下经皮穿刺置管引流术治疗腹腔脓肿临床效果观察

目的:探讨在腹腔脓肿疾病中采用超声引导下经皮穿刺管引流术治疗的临床效果.方法:选取我院普外科2018年9月—2020年8月收治的90例腹腔脓肿患者作为此次研究对象.所有患者均采用超声引导下经皮穿刺置管引流术进行治疗,观察对比患者的临床治疗效果、住院时间、脓腔消失时间以及体温恢复时间和并发症等相关情况.结果:经超声引导下...     

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.