人工全髋关节置换术围术期病人的护理

[目的]探讨人工全髋关节置换术病人的围术期护理。[方法]对43例人工全髋关节置换术病人做好围术期的护理及功能锻炼指导。[结果]经过完善护理后病人无明显并发症发生而康复出院。[结论]对全髋关节置换术病人进行规范的围术期护理和正确的功能锻炼指导,可提高手术成功率,减轻疼痛,改善关节活动度,减少并发症,促进髋关节功能恢复。     

人工髋关节置换术后假体松动原因分析及围术期护理干预

目的:探讨人工髋关节置换术后假体松动的原因,总结围术期护理干预的方法。方法:选取2006年1月~2012年1月人工髋关节置换术后发生假体松动患者45例,针对发生的原因进行相关分析,采取心理护理、疼痛管理、肢体康复锻炼、生活指导及并发症防治等护理干预方法。结果:45例患者中44例按照指定的康复治疗和训练方法进行功能锻炼,髋关节术后功能恢复良好,无脱位、感染发生,仅1例患者出现下肢深静脉血栓。结论:针对人工髋关节置换术后假体松动原因,并根据手术的不同采取围术期护理干预,能有效恢复髋关节功能,防止术后并发症的发生,提高患者手术满意度。     

LD-THR人工髋关节置换术16例围术期护理

目的:探讨LD-THR人工髋关节置换术患者的围术期护理方法.方法:对16例LD-THR人工髋关节置换术患者给予精心围术期护理.结果:本组均于术后2周内出院,功能恢复快,无并发症发生.结论:对LD-THR人工髋关节置换术患者进行细致的围术期护理及全面的康复指导有利于患者早日康复.     

强直性脊柱炎髋关节受累行全髋置换术11例围术期护理

目的:探讨强直性脊柱炎髋关节受累患者行人工全髋关节置换围手术期护理经验.方法:对11例(19髋)人工全髋关节置换术治疗强直性脊柱炎髋关节受累患者进行围手术期护理,包括心理护理、完善手术前准备、术后康复护理及并发症护理观察. 结果:除1例髋关节置换后出现早期脱位外,全部病例围手术期未发生皮肤压疮、肺部感染、髋关节脱位等并发症. 结论:强直性脊柱炎髋关节受累人工全髋关节置换患者,加强围手术期护理可以减轻术后疼痛、恢复肌肉力量、防止各种并发症发生.     

人工全髋关节置换术67例围术期护理

目的：探讨人工全髋关节置换术患者围术期的护理方法。方法：将133例人工全髋关节置换术患者随机分为对照组66例和实验组67例,对照组采用常规护理方法,实验组采用常规护理＋康复指导的护理方法,观察并比较两组术后3周并发症发生情况。结果：两组术后3周并发症发生情况比较均有极显著性差异（P〈0．01）。结论：对人工全髋关节置换术患者采用常规护理＋康复指导的围术期护理方法,可明显降低术后并发症的发生率,有利于提高患者生活质量。     

人工全髋关节置换术67例围术期护理

目的:探讨人工全髋关节置换术患者围术期的护理方法.方法:将133例人工全髋关节置换术患者随机分为对照组66例和实验组67例,对照组采用常规护理方法,实验组采用常规护理+康复指导的护理方法,观察并比较两组术后3周并发症发生情况.结果:两组术后3周并发症发生情况比较均有极显著性差异(P<0.01).结论:对人工全髋关节置换术患者采用常规护理+康复指导的围术期护理方法,可明显降低术后并发症的发生率,有利于提高患者生活质量.     

老年股骨颈骨折人工髋关节置换术围术期的康复护理

目的探讨老年股骨颈骨折人工髋关节置换术围术期的康复护理。方法对59例行人工髋关节置换术的老年股骨颈骨折患者的临床资料(围术期康复护理)进行回顾性分析。结果 59例患者住院时间16~18 d,均顺利出院。术后随访6~12个月,髋关节活动度达到正常、不痛者49例,髋关节活动度达到正常的3/4、微痛9例,髋关节活动度达到正常的1/2、疼痛明显1例。结论人工髋关节置换术的围术期康复护理提高了治疗效果,降低了术后的并发症的发生率。     

糖尿病股骨颈骨折行人工髋关节置换围手术期护理

目的：总结糖尿病股骨颈骨折行人工髋关节置换术围手术期的护理。方法：对33例糖尿病股骨颈骨折行人工髋关节置换术的围手术期患者进行心理护理，术前、术后观察，针对性的健康指导。结果：33例患者中除2例发生伤口表浅感染外，无其他并发症，患者均在术后3～4周出院。结论：做好围手术期的心理护理，术前、术后护理及健康教育指导是降低并发症的发生、促进疾病康复、提高手术成功率、提高患者生活质量的有效措施。     

髋关节特定位标定后侧小切口人工双极头置换术26例围术期护理

目的:探讨高龄股骨颈骨折患者行髋关节特定位标定后侧小切口人工双极头置换术围术期护理方法.方法:对26例高龄股骨颈骨折患者行髋关节特定位标定后侧小切口人工双极头置换术,围术期做好心理护理、术前准备、术后并发症观察及康复训练指导.结果:本组26例均手术成功,无一例假体脱位、感染、压疮、静脉血栓形成等并发症发生.结论:髋关节特定位标定后侧小切口人工双极头置换术治疗股骨颈骨折效果确切,良好的围术期护理可减少并发症发生,促进患者康复.     

髋关节置换术围手术期护理及康复护理研究

目的探讨髋关节置换术围手术期的护理、康复指导及训练要点。方法选取2011年8月-2014年8月本院收治的168例髋关节置换术患者,对其围手术期采取有针对性的护理、康复指导及训练。结果术后随访,168例患者均安全度过围手术期,未发生并发症,Harris评分优77例,良82例,中6例,差3例,髋关节置换术的优良率达94.6%。结论加强对髋关节置换术患者围手术期的护理、康复指导及训练,能有效预防并发症的发生,是手术成功及提高患者生活质量的关键。     

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.