阶段式康复护理对颅脑外伤患者术后肢体运动及神经功能的影响

目的探讨阶段式康复护理对颅脑外伤患者术后功能恢复的影响。方法将80例颅脑外伤手术患者随机分为2组各40例,对照组术后给予常规护理,观察组在常规护理基础上采用阶段式康复护理,比较2组术后肢体运动功能、神经功能的恢复情况,统计并发症、住院时间及预后。结果观察组1个月后NIHSS评分低于对照组,上肢Fugl-Meye、下肢FuglMeye评分均高于对照组(P0.05);观察组术后并发症少于对照组,住院时间短于对照组,预后优良率高于对照组(P0.05)。结论阶段式康复护理遵循颅脑外伤术后恢复的特点,能够显著促进患者术后的肢体运动功能和神经功能康复。     

综合性护理在重症颅脑损伤患者术后的价值

目的 分析重症颅脑损伤患者术后护理中应用综合性护理的作用。方法 选取 2020 年 1 月至 2022 年 10 月本院收治的 60 例重症颅脑损伤患者作为研究对象。按照双盲对照原则进行分组，将患者分为对照组和观察组，每组各 30 例。术后护理中， 对照组实施基础护理，观察组采用综合性护理。分析对比两组的平均住院时间、重症加强护理病房时间、术后并发症、护理认 可度。结果 观察组的平均住院时间和重症加强护理病房时间均显著短于对照组（P<0.05）。观察组术后并发症发生率显著低于 对照组（P<0.05）。观察组的护理认可度显著高于对照组（P<0.05）。结论 在重症颅脑损伤患者术后护理中应用综合性护理，能 加快患者的康复、减少术后并发症、提高患者亲属的护理认可度。     

综合性护理在重症颅脑损伤患者术后护理中的应用

目的:探讨综合性护理在重症颅脑损伤患者术后护理中的应用价值。方法:将60例重症颅脑损伤的患者用随机数字表法分为观察组和对照组,对照组围手术期采用常规护理,观察组术后采用综合护理,比较两组患者的并发症、生命体征、住院时间以及护理满意度。结果:观察组护理后的SOFA、APACHEII评分低于对照组,GCS评分高于对照组,有统计学意义(P0.05)。观察组的并发症少于对照组,焦虑评分低于对照组,入住ICU、住院时间短于对照组,护理满意度高于对照组,有统计学意义(P0.05)。结论:综合性护理能减少重症颅脑手术患者术后并发症,改善预后。     

重型颅脑损伤合并脑疝患者的护理措施改进及效果分析

目的探讨重型颅脑损伤合并脑疝患者的护理措施改进及应用效果。方法选取本院2014年1月~2015年6月收治的40例重症颅脑损伤合并脑疝患者为研究对象,采用改进的护理措施,主要有强化急救护理、加强气道护理、预防并发症等,设为观察组;选取本院2012年12月~2013年12月收治的40例重症颅脑损伤合并脑疝患者为研究对象,采用常规护理,设为对照组。比较两组的预后、并发症、住院时间以及患者家属的满意度。结果两组的预后良好或中残的情况比较,差异无统计学意义(P0.05)。观察组的重残或植物生存率高于对照组,死亡率低于对照组,并发症少于对照组,住院时间短于对照组,差异均有统计学意义(P0.05)。观察组家属在护理技术、服务态度、健康教育等方面的护理满意度高于对照组,差异有统计学意义(P0.05)。结论改进护理措施能够减少重型颅脑损伤合并脑疝患者的并发症,改善预后,提高家属对护理工作的满意度。     

探讨集束化护理对ICU重症颅脑损伤患者的影响

目的 探究在 ICU 重症颅脑损伤患者的护理过程中实施集束化护理模式对患者的影响。方法 选取我院 2021 年 4 月至 2022 年 7 月收治的 49 例 ICU 重症颅脑损伤患者，按照组间资料均衡可比的原则分为对照组和观察组。对照组（24 例）给予常规护 理，观察组（25 例）在常规护理的基础上实施集束化护理。比较两组临床指标用时、并发症、神经功能缺损程度、预后情况和 护理满意度。结果 观察组的 ICU 停留、机械通气、住院时间均低于对照组。观察组治疗费用使用少于对照组（P<0.05）。观 察组并发症发生率低于对照组（P<0.05）。观察组的神经功能缺损程度、预后情况优于对照组（P<0.05）。观察组护理满意度 高于对照组（P<0.05）。结论 对 ICU 重症颅脑损伤患者实施集束化护理模式，能够缩短机械通气时间，降低并发症发生率， 提高患者护理满意度。     

预防性护理对颅脑手术患者术后并发症的影响

目的探讨预防性护理在预防颅脑手术患者术后并发症中的应用。方法 70例颅脑损伤手术的患者采用随机数字表法分为观察组和对照组,对照组采用常规护理,观察组在对照组的基础上采用预防性护理,比较两组患者的术后并发症及预后情况。结果观察组的并发症、死亡率少于对照组,GCS评分、Karnofsky预后评分高于对照组,住院时间少于对照组,差异有统计学意义（P〈0.05）。结论预防性护理能够起到前瞻性护理的作用,减少颅脑术后并发症,改善预后。     

保护动机理论的综合护理在重症颅脑损伤患者术后中的应用效果观察

目的观察保护动机理论的综合护理在重症颅脑损伤患者术后中的应用效果。方法选取2014年3月~2016年2月我院收治重症颅脑损伤患者74例。采用随机数表法分为对照组和观察组各37例。对照组实施常规护理干预,观察组在对照组基础上实施保护动机理论的综合护理干预。对比两组术后并发症发生率及生存质量。结果观察组术后并发症发生率为8.11%,显著低于对照组的29.73%,差异有统计学意义(P0.05);观察组生理功能、心理功能、社会功能、物质功能评分均显著高于对照组,差异有统计学意义(P0.05)。结论基于保护动机理论为框架的综合护理干预,可降低重症颅脑损伤患者术后并发症发生率,提高患者生存质量。     

医护康一体化护理模式在重症颅脑损伤患者人工气道管理中的应用

目的：探讨医护康一体化护理在重症颅脑损伤患者人工气道管理中的应用效果。方法：选取2019年1月1日～12月31日神经外科收治的60例重症颅脑损伤并行气管切开术患者为研究对象,采用区组随机化方法,借助SPSS 21.0统计软件编号分为对照组和观察组各30例;对照组采用常规护理,观察组采用医护康一体化护理。比较两组痰液黏稠程度,并发症发生情况,恢复情况等。结果：护理7 d,观察组痰液黏稠程度轻于对照组(P<0.05),临床肺部感染风险评分低于对照组(P<0.05);观察组气管切开拔管时间、住院时间均短于对照组(P<0.05,P<0.01);护理后,观察组格拉斯哥昏迷指数(GCS)评分高于对照组(P<0.05);观察组呼吸道相关并发症发生率低于对照组(P<0.05)。结论：医护康一体化护理能够减轻重症颅脑损伤并行气管切开术患者痰液黏稠程度,缩短气管切开拔管时间,减少并发症的发生,改善预后。     

围术期综合护理干预在颅脑损伤行开颅手术患者中的应用

目的:探讨围术期综合护理干预在颅脑损伤行开颅手术患者中的应用效果。方法:将80例颅脑损伤行开颅手术治疗患者按护理方法不同分为对照组和观察组各40例,对照组实施常规护理,观察组在此基础上实施围术期综合护理干预,比较两组护理效果。结果:两组护理后神经功能缺损量表(NIHSS)评分低于护理前(P0.05),观察组护理后NIHSS评分低于对照组(P0.05);两组护理后Barthel指数(BI)评定量表评分高于护理前(P0.05),观察组护理后BI指数高于对照组(P0.05);两组护理后上肢、下肢Fugl-Meyer运动量表(FMA)评分高于护理前(P0.05),观察组护理后上肢、下肢FMA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)。结论:围术期综合护理干预可改善颅脑损伤行开颅手术患者的肢体功能,降低并发症发生率。     

综合护理干预对重症颅脑损伤患者功能恢复效果研究

目的研究护理干预对重症颅脑损伤患者的功能恢复的影响。方法选取2017年2月～2018年3月我院收治的重症颅脑损伤患者100例,采用随机抽签法将患者分为对照组和观察组各50例。对照组患者实施常规护理,观察组实施综合护理干预,对比两组患者护理前后肢体运动功能量表(FM)、格拉斯哥昏迷量表(GCS)、生活能力指数(BI)评分,对比两组患者并发症的发生率。结果两组患者护理后的FM、GCS、BI评分较护理前均明显增高,且观察组变化幅度明显高于对照组(P0.05);观察组并发症的发生率明显低于对照组(P0.05)。结论对重症颅脑损伤患者实施综合护理干预的效果显著,对患者的各项功能恢复具有积极的意义。     

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.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.