直肠癌结肠造口病人生活质量的调查分析

目的 了解直肠癌结肠造口病人的生活质量,分析其影响因素,为提高直肠癌结肠造口病人生活质量提供依据.方法 对40例直肠癌结肠造口病人进行问卷调查,收集资料进行分析.结果 本组造口病人生活质量总体评分仅为56.87,生活质量影响因素主要有年龄、婚姻状况、文化程度、自理能力、排便是否规律、造口时间、是否参加造口联谊会等.结论 应根据病人的具体情况,加强院外健康教育,提高自理能力,建立规律排便,以改善病人生活质量.     

直肠癌结肠造口病人生活质量的调查分析

目的了解直肠癌结肠造口病人的生活质量，分析其影响因素，为提高直肠癌结肠造口病人生活质量提供依据。方法对40例直肠癌结肠造口病人进行问卷调查，收集资料进行分析。结果本组造口病人生活质量总体评分仅为56．87，生活质量影响因素主要有年龄、婚姻状况、文化程度、自理能力、排便是否规律、造口时间、是否参加造口联谊会等。结论应根据病人的具体情况，加强院外健康教育，提高自理能力，建立规律排便，以改善病人生活质量。     

直肠癌结肠造口病人生活质量的研究

目的 :了解直肠癌结肠造口病人的生活质量 ,分析其影响因素 ,为提高直肠癌结肠造口病人生活质量提供依据。方法 :对 40例直肠癌结肠造口病人进行问卷调查采集资料。结果 :本组造口病人生活质量总体评分仅为 56 .87,生活质量影响因素主要有年龄、婚姻状况、文化程度、自理能力、排便是否规律、造口时间、是否参加造口联谊会等。结论 :应根据病人的具体情况 ,加强院外健康教育 ,鼓励参加造口联谊会 ,提高自理能力 ,建立规律排便 ,以改善病人生活质量。     

永久性结肠造口病人生活质量现状及影响因素分析

[目的]了解永久性结肠造口病人生活质量现状,分析其影响因素,为提高该人群生活质量提供依据.[方法]对2014年6月-2015年12月西安交通大学第一附属医院造口专科门诊随访的120例永久性结肠造口病人进行问卷调查,收集资料,统计分析.[结果]120例永久性结肠造口病人生活质量总体评分均值为58.97分,心理状态、健康教育和排便是否规律与生活质量各维度之间呈显著正相关.[结论]根据具体情况针对性采取护理措施,对病人的躯体、精神、心理等方面加以关注,以提高病人的生活质量.     

结肠造口病人并发症危险因素及知识需求的研究

[目的]探讨直肠癌永久性结肠造口术(Miles术)后结肠造口并发症发生的危险因素及病人的知识需求情况。[方法]回顾分析145例Miles术后病人造口并发症的发生情况及危险因素,同时调查并发症病人的知识需求情况。[结果]调查对象中,59例发生了造口并发症,占40.7%;经单因素分析排便不规律、未接受电话随访、术后时间短、造口位置不合适、造口自护能力差、经济状况差和未参加造口联谊会是造口并发症发生的危险因素(P<0.05);多元回归分析显示,造口位置、排便规律性和是否接受电话随访是并发症发生的危险因素,均与造口并发症呈负相关;知识需求调查结果显示,并发症病人最需要的知识为训练规律排便,其次为并发症的观察与处理。[结论]医护人员术前定位应保证造口位置合适,术后加强随访和训练病人规律排便,采取各种途径满足并发症病人规律排便及并发症观察与处理的知识需求,减少造口周围皮肤炎症等并发症的发生,提高生活质量。     

直肠癌结肠造口患者的排便现状分析

目的探讨直肠癌术后结肠造口患者的排便现状,以便为结肠造口患者提供针对性的护理措施,早期促进患者排便规律形成,提高生活质量。方法采用自行设计的调查问卷对75例本院自2002年1月～2007年12月收治的直肠癌结肠造口患者,从排便规律情况、排便感知情况、规律排便相关知识掌握情况等方面进行调查。结果75例患者中有48例排便不规律,73例患者自然排便,仅2例患者进行过结肠灌洗,74例患者没有接受过系统的规律排便训练及指导。随造口时间的延长,排便时间固定人数增加,而排便时有感觉人数明显增加,排便时不适人数减少（P〈0．05）。结论应采取多种形式的健康教育,加强规律排便训练,尽快促进患者规律排便。正确的结肠造口护理及护理指导是确保患者早日恢复正常的生活、工作,提高生活质量的关键。     

直肠癌结肠造口患者生活质量及影响因素研究

目的 了解西安市直肠癌结肠造口患者的生活质量现状及其影响因素,为提高永久性结肠造口患者的生活质量提供依据.方法 使用欧洲癌症研究与治疗组织生活质量核心问卷对145例在西安市4所三级甲等医院行直肠癌结肠造口患者的生活质量进行问卷调查,将所得资料进行统计学分析.结果 结肠造口患者总体生活质量得分为(60.31±23.19)分,角色功能和社会功能得分显著低于常模(P＜0.01),腹泻和经济困难得分显著高于常模(P＜0.01),相关分析结果显示心理状态和造口并发症是影响总体生活质量及各功能维度的主要因素;多元逐步回归分析结果显示心理状态、术后时间、造口并发症是进入回归方程的因素,心理状态、术后时间与生活质量呈正相关,造口并发症与生活质量呈负相关.结论 结肠造口患者角色功能和社会功能显著受影响,腹泻症状和经济困难严重.造口专科护士应为患者提供精神心理支持,训练患者规律排便,采取多种方式重点指导患者正确认识、预防、处理造口并发症,以改善其生活质量.     

生大黄脐疗对结肠造口病人排便管理的影响

[目的]探讨生大黄脐疗对直肠癌术后结肠造口病人排便管理及其生活质量的影响。[方法]将2011年2月—2011年10月住院的68例直肠癌术后结肠造口病人随机分为两组,对照组行常规护理,观察组在常规护理基础上于术后15d开始给予生大黄脐疗30d,比较两组干预效果。[结果]两组病人术后3个月排便规律、对人工肛门功能(除问题4)评价、每月使用造口袋的数量及费用比较差异均有统计学意义(P<0.05);两组躯体功能、角色功能、社会功能、疲倦、总健康状况、人工肛门有关问题评分比较差异有统计学意义(P<0.05)。[结论]生大黄脐疗能促进直肠癌术后结肠造口病人排便规律的形成,帮助病人节约造口袋的使用数量及费用,改善腹壁人工肛门的功能,提高直肠癌结肠造口病人的生活质量。     

直肠癌Miles术后结肠造口患者生活质量及影响因素研究

目的了解淮南市直肠癌结肠造口患者的生活质量现状及其影响因素,为提高永久性结肠造口患者的生活质量提供依据。方法使用欧洲癌症研究与治疗组织生活质量核心问卷对120例在淮南市3所二级甲等医院行直肠癌结肠造口患者的生活质量进行问卷调查,将所得资料进行统计学分析。结果结肠造口患者总体生活质量得分为60.4±22.8分,角色功能和社会功能得分显著低于常模(P<0.01),腹泻和经济困难得分显著高于常模(P<0.01)。相关分析结果显示,心理状态和造口并发症是影响总体生活质量及各功能维度的主要因素;多元逐步回归分析结果显示,心理状态、术后时间、造口并发症是进入回归方程的因素,心理状态、术后时间与生活质量呈正相关,造口并发症与生活质量呈负相关。结论结肠造口患者角色功能和社会功能显著受影响,腹泻症状和经济困难严重。造口专科护士应为患者提供精神心理支持,训练患者规律排便,采取多种方式重点指导患者正确认识、预防、处理造口并发症,以改善其生活质量。     

结肠造口灌洗对提高结肠造口病人生活质量的影响

目的:探讨结肠造口灌洗对提高行结肠造口病人生活质量的影响。方法:2001年1月~2009年1月因低位直肠癌行M ile’s手术住院病人109例。行永久性降结肠或乙状结肠造口,并且大肠功能正常,排除合并有其他严重躯体性疾病、精神症状和精神病家族史者,符合上述要求的病人57例。随机将其分为观察组31例,采用结肠造口灌洗法;对照组26例,采用自然排便法。结果:观察组规律性排便效果明显优于对照组(P0.001),生活质量明显优于对照组(P0.005)。两组比较有显著性差异。结论:结肠造口灌洗可促进结肠造口病人有规律性排便,提高病人的生活质量。     

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.     

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.