集束化护理在髋关节置换术后并发症及功能恢复的作用分析

目的：探讨分析集束化护理在髋关节置换术后并发症及功能恢复中的作用。方法选取2011年至2013年我院骨科收诊的经髋关节置换手术治疗的患者100例为研究对象,随机分为研究组和对照组,每组50例,对照组给予常规护理模式,研究组给予集束化护理干预,观察比较两组患者术后并发症发生率,并对患者术后髋关节功能恢复情况进行髋关节功能评分（ Harris评分）。结果研究组泌尿系感染、肺部感染、髋关节脱位、深静脉血栓、下肢肿胀、压疮等发生率明显低于对照组;术后早期,研究组患者在护理人员指导下积极完成康复训练内容,其在术后1、3、6个月的 Harris评分明显高于对照组,两组比较差异均有统计学意义（ P＜0.05）。结论集束化护理可减少髋关节置换术后并发症的发生率,有利于术后髋关节功能恢复。     

早期综合康复护理预防老年髋部骨折患者术后下肢深静脉血栓形成的效果

目的 观察早期综合康复护理预防老年髋部骨折患者术后下肢深静脉血栓形成的临床效果。方法 选取2017年9月～2018年9月我院收治的老年髋部骨折患者98例,按照护理方法不同分为对照组和观察组各49例。对照组术后给予常规护理,观察组术后给予早期综合康复护理,比较两组患者住院时间、下肢肿胀发生率、下肢深静脉血栓发生率,随访3个月,观察髋关节功能。结果 观察组住院时间、下肢肿胀发生率、下肢深静脉部分栓塞发生率、明显低于对照组(P0.05);两组下肢深静脉完全栓塞发生率比较无明显差异(P0.05);术后3个月,观察组功能、关节活动度评分优于对照组(P0.05);两组术后3个月疼痛、畸形评分比较,无明显差异(P0.05)。结论 早期综合康复护理可有效促进老年髋部骨折患者术后较快恢复,降低下肢深静脉血栓形成发生风险,促进髋关节功能较快改善,临床价值显著。     

护理干预对老年患者全髋关节置换术后并发症及康复的影响

将90例老年全髋关节置换术后患者随机分为两组,对照组42例给予全髋关节置换术后常规治疗及护理;观察组48例,在对照组治疗及护理的基础上,针对老年人全髋关节置换术后重要并发症进行护理干预.比较两组患者术后并发症发生率及术后3个月髋关节功能.结果观察组术后感染、髋关节脱位、下肢深静脉血栓形成、压疮的发生率均低于对照组(P＜0.05),术后3个月髋关节功能恢复优良率高于对照组(P＜0.05).认为有效护理干预可降低老年患者全髋关节置换术后并发症的发生率,有利于髋关节的功能恢复,可提高老年患者的生活质量.     

Caprini血栓风险评估联合集束化护理对腹腔镜下广泛性全子宫切除术病人术后下肢深静脉血栓形成的影响

目的:探讨Caprini血栓风险评估联合集束化护理对腹腔镜下广泛性全子宫切除术病人术后下肢深静脉血栓形成的影响。方法:将80例腹腔镜下广泛性全子宫切除术病人采用随机数字表法分为观察组和对照组各40例,对照组病人给予常规护理,观察组病人在对照组病人基础上给予Caprini血栓风险评估联合集束化护理,比较两组病人术后下肢深静脉血栓形成情况、术后肠胃功能恢复情况以及术后并发症。结果:干预后观察组病人的术后下肢深静脉血栓形成情况风险及发生率低于对照组(P<0.05);观察组病人肠胃功能恢复情况优于对照组(P<0.05);观察组病人术后并发症发生率低于对照组(P<0.05)。结论:Caprini血栓风险评估联合集束化护理可减少腹腔镜下广泛性全子宫切除术病人术后下肢深静脉血栓的形成,促进病人术后胃肠功能恢复,降低病人术后并发症风险和发生率,加快病人康复进程,从而提高病人生活质量。     

医护一体化护理在预防老年髋部骨折术后深静脉血栓形成中的应用讨论

目的 探究医护一体化护理在预防老年髋部骨折术后深静脉血栓形成中的应用效果。方法 2021 年 1 月至 2022 年 12 月我 院收治的老年髋部骨折患者 86 例,随机分为对照组和观察组,每组各 43 例。对照组给予常规护理,观察组给予医护一体化护 理。比较两组深静脉血栓与下肢疼痛、肿胀情况、血栓预防知识掌握程度及髋关节功能。结果 观察组的深静脉血栓发生率、 下肢疼痛、肿胀率均低于对照组（P<0.05）。观察组的血栓预防知识掌握程度高于对照组（P<0.05）。观察组的髋关节功能优于 对照组（P<0.05）。结论 老年髋部骨折术后患者实施医护一体化护理,可有效避免深静脉血栓的形成,减轻患肢的疼痛与肿胀, 提高患者对血栓预防相关知识的了解,促进其髋关节功能的改善。     

集束化护理在预防乳腺癌术后下肢深静脉血栓中的应用

目的 探讨集束化护理在乳腺癌术后下肢深静脉血栓预防中的应用效果.方法 将2014年6～12月收治该科行乳腺癌改良根治术的患者40例为对照组,实施常规护理.2015年1～7月收治该科行乳腺癌改良根治术的患者40例为观察组,采用集束化护理措施,比较两组患者下肢深静脉血栓发生率.结果 观察组患者下肢深静脉血栓的发生率明显低于对照组(χ2=3.914,P=0.048).结论 集束化护理措施可有效降低乳腺癌患者改良根治术后下肢深静脉血栓的发生率.     

电刺激治疗联合等速肌力训练在全髋关节置换术患者阶段化康复护理中的应用

目的探究电刺激治疗联合等速肌力训练在股骨头坏死全髋关节置换术患者阶段化康复护理中的应用效果。方法选取2018年1月~2019年6月我院收治的行全髋关节置换术的股骨头坏死患者80例,随机分为对照组和观察组,各40例。对照组采取阶段化康复护理。观察组在对照组的基础上加以电刺激治疗联合等速肌力训练。比较两组深静脉血栓发生率、功能恢复状况。结果观察组深静脉血栓发生率显著低于对照组(P<0.05);观察组术后1个月髋关节功能Harris各维度评分显著高于对照组(P<0.001)。结论电刺激治疗联合等速肌力训练在股骨头坏死全髋关节置换术患者阶段化康复护理中的应用,能有效防控术后深静脉血栓,可促进功能恢复。     

基于Caprini量表的预防干预对全髋关节置换术后深静脉血栓发生率的影响

目的:探讨基于Caprini量表的预防干预对全髋关节置换术后深静脉血栓发生率的影响.方法:将2018年12月—2020年12月收治的114例行全髋关节置换术病人随机分为对照组和观察组各57例,对照组行常规干预,观察组行基于Caprini量表的干预.两组病人术后第3天行患肢超声多普勒检查,统计下肢深静脉血栓发生率,采用视觉模拟评分法(VAS)评价两组病人术后第1天、第2天、第3天、第7天、第10天患肢疼痛程度,采用专用医用卷尺测量两组病人术后第2天、第4天、第6天、第8天、第10天肿胀程度,采用Harris髋关节功能评分法评价两组病人出院时、出院1个月、出院3个月的髋关节功能恢复情况.结果:观察组病人术后下肢深静脉血栓发生率低于对照组(P<0.05);观察组病人术后第1天、第2天、第3天、第7天VAS评分均低于对照组(P<0.05);观察组病人术后第2天、第4天、第6天、第8天、第10天患肢肿胀程度轻于对照组(P<0.05);观察组病人出院时、出院1个月、出院3个月Harris髋关节功能评分均高于对照组(P<0.05).结论:基于Caprini量表的干预应用于全髋关节置换术病人可降低下肢深静脉血栓发生率,减轻患肢疼痛程度及肿胀程度,促进髋关节功能恢复.     

集束化护理模式在预防缺血性脑卒中患者DVT中的应用价值

目的:评价集束化护理模式在预防缺血性脑卒中患者下肢深静脉血栓中应用的效果。方法:选取2016年10月～2018年10月收治的缺血性脑卒中患者60例,随机分为对照组和观察组,各30例,对照组采用常规护理,观察组采用集束化护理,比较两组下肢深静脉血栓发生率及凝血功能。结果:观察组下肢深静脉血栓发生率3.33%低于对照组的33.33%,凝血酶原时间、凝血酶时间短于对照组,纤维蛋白原含量高于对照组,差异有统计学意义(P0.05)。结论:采用集束化护理干预缺血性脑卒中患者,可改善患者凝血功能,减少患者下肢深静脉血栓发生。     

集束化护理对宫外孕失血性休克术后下肢运动及深静脉血栓的影响

目的:探讨集束化护理对宫外孕失血性休克术后下肢运动及深静脉血栓的影响。方法:选择2013年1月~2016年3月本院收治的宫外孕失血性休克患者80例,并随机等分为对照组和观察组,观察组实施集束化护理干预;对照组实施常规护理,比较两组患者住院期间并发症发生情况,两组术后下床时间及住院时间,并观察两组患者股静脉峰值流速。结果:观察组并发症发生少于对照组(P0.05);观察组术后下床时间早于对照组(P0.05),住院时间短于对照组(P0.05);观察组股静脉峰值流速和平均流速快于对照组(P0.05)。结论:针对宫外孕失血性休克患者实施集束化护理,有利于促进肢体运动功能恢复,降低下肢深静脉血栓发生率。     

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.