银离子藻酸盐敷料在糖尿病合并压疮患者中的应用效果

目的观察银离子藻酸盐敷料在糖尿病合并压疮患者中的应用效果。方法将2013年1月至2015年3月在上海交通大学附属第六人民医院诊治的60例糖尿病合并Ⅱ-Ⅲ期压疮患者采用随机数字表法分为两组,对照组使用普通棉纱布换药(n=30),观察组使用银离子藻酸盐敷料(n=30)。比较两组患者治疗6周后压疮愈合率、愈合时间、换药次数及床单污染次数。结果观察组Ⅱ期压疮患者创面愈合率高于对照组(57.1%vs 92.3%,χ~2=4.340,P0.05),Ⅲ期压疮患者创面愈合时间短于对照组[(27.1±3.8)d vs(35.6±3.2)d,t=2.964,P0.05)];观察组中Ⅱ、Ⅲ期压疮患者创面换药和床单污染次数均少于对照组,差异有统计学意义(均P0.05)。结论银离子藻酸盐敷料能显著提高糖尿病合并Ⅱ期压疮患者的创面愈合率、缩短Ⅲ期压疮的愈合时间,减少换药和床单污染次数,减轻患者的痛苦。     

压疮的湿性愈合疗法与成本效益分析

目的:探讨湿性愈合敷料对压疮的疗效和成本效益。方法:将74例压疮患者随机分为两组,一组为湿性敷料治疗组(实验组),一组为常规治疗组(对照组)。比较两组患者的治愈率、愈合时间、换药次数、换药所花的时间和费用。结果:实验组各期创面治疗的治愈率明显高于对照组,平均愈合时间、换药次数、换药时间明显少于对照组(均P<0.05),而两组压疮各期的换药费用比较,均P>0.05,说明两组换药方法费用相当,湿性愈合敷料没有增加换药费用。结论:湿性愈合敷料治疗压疮效果明显优于传统干性疗法,具有治愈率高、伤口愈合快、总体费用降低、护理总时数少及患者舒适等优点。     

湿性愈合理论在压疮治疗中的应用

目的探讨湿性愈合理论对治疗压疮创面的临床意义。方法Ⅱ～Ⅲ期压疮患者38例,将其随机分为传统治疗法组18例及湿润疗法组20例,分别应用普通无菌敷料及湿性敷料换药治疗压疮创面并行临床观察及对照分析。结果与传统换药组相比,湿润疗法组创面水肿消退时间由(5.5±0.4)d减少至(3.2±0.3)d、创面愈合时间由(13.3±0.6)d减少至(9.6±0.5)d、感染率由9.5%减少至4.3%,换药次数由(12±0.6)次减少至(7±0.7)次;创面治愈率由44.4%提高到65%,治愈及显效率由66.6%提高到85%;湿润疗法组与传统换药组各组数据对比,P0.05,差异有显著意义。结论湿润疗法对于Ⅱ～Ⅲ期压疮疗效显著,值得临床推广使用。     

湿性伤口敷料应用于不可分期压疮的护理方法探讨

目的：探讨湿性伤口敷料应用于不可分期压疮的护理效果,为临床护理提供参考。方法选取本院在2013年2月至2015年3月收治不可分期压疮患者55例为研究对象,按照不同护理方法分为观察组30例和对照组25例,对照组患者给予无菌纱块护理,观察组患者给予湿性伤口敷料护理,分析护理效果。结果观察组患者护理总有效率(96.7%)显著高于对照组(68.0%),(P<0.05),研究组患者肉芽生长时间(9.4±3.8)d、直径缩小时间(10.2±4.6)d 和愈合时间(22.8±7.4)d 显著短于对照组肉芽生长时间(13.8±4.0)d、直径缩小时间(15.7±5.9)d 和愈合时间(38.9±8.1) d,(P<0.05),研究组患者创面感染率(0)显著低于对照组(24.0%),(P<0.05)。结论不可分期压疮患者采用湿性伤口敷料护理能够提高护理效果,促进肉芽组织的生长,缩短愈合时间,具有推广价值。     

艾灸联合湿性愈合方法治疗四肢难愈合性创面的效果分析

目的探讨艾灸联合湿性愈合疗法治疗四肢难愈合性创面的疗效。方法选取48例四肢难愈合性创面患者,随机分为实验组26例和对照组22例。实验组患者创面清创后采用悬灸法将艾条距离患处皮肤3cm左右施灸20min,再使用藻酸盐敷料、水凝胶敷料等填塞并用水胶体敷料覆盖。对照组采取常规换药措施,创面清创后凡士林纱布覆盖创面并加盖无菌纱布。比较2组换药次数、4周后创面愈合效果、创面愈合时间、渗液酸碱度等。结果实验组换药次数为(14.88±4.02)次,对照组(24.5±4.926)次;实验组换药4周后显效为100%,对照组为90.9%;实验组创面愈合时间为(29.5±8.56)d,对照组为(39.32±8.17)d,2组以上指标差异均有统计学意义(P0.05)。结论艾灸联合湿性愈合疗法可促进四肢难愈合性创面愈合,减少换药次数,缩短换药时间,值得临床推广。     

金因肽联合水胶体敷料治疗晚期肿瘤病人Ⅲ期压疮的疗效观察

目的 观察金因肽与水胶体敷料联合应用治疗晚期肿瘤病人压疮的治疗效果.方法 将20例24处晚期肿瘤Ⅲ期压疮病人分为实验组(9例,13处)和对照组(11例,11处).实验组患者采用金因肽联合水胶体敷料治疗,对照组患者采用碘伏与凡士林油纱常规换药治疗.观察两组创面愈合时间和治疗的效果.结果 实验组的创面愈合时间为(9.00±2.25)d;对照组的创面愈合时间为(15.82±4.26)d,实验组比对照组的创面愈合时间明显缩短(P＜0.01);实验组的治疗有效率明显高于对照组(P＜0.05).结论 金因肽能够促进压疮创面愈合,水胶体敷料能够为创面提供一个湿润环境,二者联合应用可明显缩短压疮愈合时间,提高疗效.     

云南白药治疗Ⅱ~Ⅲ期压疮20例疗效观察

目的观察云南白药外敷治疗Ⅱ~Ⅲ期压疮的效果。方法将40例各种原因引起的压疮患者随机分为对照组和观察组各20例,两组的创面处理分别采用常规换药治疗(对照组20例)和云南白药外敷治疗(观察组20例),观察两组患者2周时压疮治疗的疗效和最终愈合时间。结果观察组治疗2周时压疮愈合17处,显效8处,有效5处,无效2处,总有效率为93.75%,愈合时间为(10.9±3.4)d;对照组治疗2周时压疮愈合9处,显效6处,有效4处,无效10处,总有效率为65.52%,愈合时间为(13.2±4.1)d。两组在疗效上差异有统计学意义(P0.05)。结论云南白药外敷压疮能较快促进创面愈合,显著提高治愈率。     

新型伤口敷料在压疮患者中的应用

目的:探讨新型伤口敷料在压疮患者中的应用效果。方法:将200例压疮患者随机分为对照组和观察组各100例,对照组采用传统的压疮治疗换药方法,观察组使用新型伤口敷料治疗,比较两组换药次数、住院时间及愈合时间。结果:观察组换药次数、住院时间和愈合时间均少于对照组(P0.05)。结论:对压疮患者使用新型伤口敷料能缩短伤口愈合时间,减轻患者的痛苦和缩短住院时间。     

压疮的湿性愈合疗法与成本效益分析

目的：探讨湿性愈合敷料对压疮的疗效和成本效益。方法：将74例压疮患者随机分为两组，一组为湿性敷料治疗组（实验组），一组为常规治疗组（对照组）。比较两组患者的治愈率、愈合时间、换药次数、换药所花的时间和费用。结果：实验组各期创面治疗的治愈率明显高于对照组，平均愈合时间、换药次数、换药时间明显少于对照组（均P〈0．05），而两组压疮各期的换药费用比较，均P〉0．05，说明两组换药方法费用相当，湿性愈合敷料没有增加换药费用。结论：湿性愈合敷料治疗压疮效果明显优于传统干性疗法，具有治愈率高、伤口愈合快、总体费用降低、护理总时数少及患者舒适等优点。     

压疮的湿性愈合疗法与成本效益分析

目的：探讨湿性愈合敷料对压疮的疗效和成本效益。方法：将74例压疮患者随机分为两组，一组为湿性敷料治疗组（实验组），一组为常规治疗组（对照组）。比较两组患者的治愈率、愈合时间、换药次数、换药所花的时间和费用。结果：实验组各期创面治疗的治愈率明显高于对照组，平均愈合时间、换药次数、换药时间明显少于对照组（均P〈0．05），而两组压疮各期的换药费用比较，均P〉0．05，说明两组换药方法费用相当，湿性愈合敷料没有增加换药费用。结论：湿性愈合敷料治疗压疮效果明显优于传统干性疗法，具有治愈率高、伤口愈合快、总体费用降低、护理总时数少及患者舒适等优点。     

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.     

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.