水疗对新生儿黄疸的影响

目的探讨水疗对新生儿黄疸的影响。方法将400例正常新生儿随机分为水疗组与对照组各200例，对水疗组新生儿于出生后24h～30d连续水疗，1次/d，15min／次。对照组单纯沐浴，于生后24h及第5，10，30天比较2组新生儿的胎便初排时间、胎便转黄时间、黄疸指数及高胆红素血症发生情况。结果水疗组新生儿胎便初排时间，胎粪转黄时间较对照组显著提前（P〈0．01）；生后第5，10，30天黄疸指数明显低于对照组，差异有统计学意义（P〈0．01）；水疗组高胆红素血症发生率也显著低于对照组（P〈0．01）。结论水疗可有效降低新生儿黄疸，预防核黄疸的发生。     

游泳抚触操对剖宫产新生儿生长发育的影响

目的探讨游泳抚触操对剖宫产新生儿神经功能和生长发育的影响。方法将188例剖宫产出生的正常足月新生儿按出生时间先后分为观察组98例和对照组90例。观察组新生儿出生6 h～14 d连续给予游泳抚触操训练1次/d;对照组出生后6 h￣14 d单纯给予游泳1次/d。分别于生后第1天、第14天评估新生儿神经行为及第4天评估其睡眠情况,同时监测胎便初排时间、胎便转黄时间、黄疸指数和出入院时头围、身长、体质量变化。结果观察组新生儿神经行为、睡眠时间、胎便初排时间、胎便转黄时间、黄疸指数和头围、身长、体质量与对照组相比,差异均有统计学意义(P<0.05或P<0.01)。观察组新生儿神经功能和生长发育情况比对照组好。结论游泳抚触操可促进剖宫产新生儿神经行为发育及正常睡眠节律建立,减低病理性黄疸的发生率,并能增加头围、身长、体质量,促进其生长发育。     

蒙脱石治疗母乳性黄疸的疗效观察

目的 观察蒙脱石治疗新生儿母乳性黄疸的临床疗效.方法 选取新生儿母乳性黄疸患儿84例,分为蒙脱石治疗组、蓝光照射治疗组、苯巴比妥治疗组.观察疗效.结果 蒙脱石治疗组新生儿母乳性黄疸平均每日胆红素降低值为(38.43±10.24)μmol/L,与蓝光治疗组(48.87±13.11)μmol/L及苯巴比妥治疗组(26.07±7.92)μmol/L比较均有统计学意义(均P<0.01).蒙脱石组平均疗程为(4.25±1.20)d,与蓝光治疗组(3.86±0.85)d比较无统计学意义(P>0.05),与苯巴比妥治疗组(6.93±1.75)d比较差异有统计学意义(P<0.05).结论 蒙脱石治疗新生儿母乳性黄疸效果较好,值得推广应用.     

短时多次蓝光疗法在新生儿黄疸治疗中的价值分析

目的探讨短时多次蓝光疗法在新生儿黄疸治疗中的价值。方法选取我院2013年3月~2015年3月收治的106例黄疸新生儿。在患儿家属知情同意的情况下将其分为治疗组和对照组各53例,治疗组采取短时多次蓝光疗法,对照组采取传统的长时间蓝光疗法,对比两组治疗效果。结果治疗组患儿的治愈率为88.68%较对照组的60.38%比较差异显著,具有统计学意义(P<0.05);治疗组患儿治疗2、4d后的血清胆红素浓度分别为220.48±41.38μmol/L、71.85±30.94μmol/L,对照组为224.93±42.59μmol/L、93.48±28.78μmol/L,两组比较差异显著,具有统计学意义(P<0.05);治疗组不良反应发生率为16.98%,对照组为7.55%,两组比较差异显著,具有统计学意义(P<0.05)。结论采取短时多次蓝光治疗效果较好,患儿的不良反应小,血清胆红素改善显著,值得应用。     

钩藤茶对预防足月新生儿黄疸的疗效评价

目的评价钩藤茶对正常足月新生儿黄疸的预防疗效。方法将240例正常足月新生儿随机分为2组：对照组和治疗组,每组120例。对照组常规喂养（8-12次/d）,不给与任何黄疸预防措施;治疗组常规喂养（8-12次/d）,并且在生后开始服用钩藤茶5 mL,3次/d,共4 d。分别在48、72、96 h 3个时间点经皮测胆红素,比较2组的胆红素结果。结果治疗组在48、72、96 h 3个时间点均值分别为（125.8±28.9）（、163.2±42.5）（、190.4±56.1）μmol/L;对照组分别为（122.4±30.6）（、170.3±32.3）、（197.2±42.5）μmol/L,2组比较差异均无统计学意义（P均〉0.05）。结论足月新生儿生后开始服用钩藤茶对预防足月新生儿黄疸疗效不明显。     

抚触对新生儿睡眠及生长发育的影响

目的探讨抚触对新生儿睡眠及生长发育的影响。方法将600例正常足月新生儿随机分为抚触组和对照组各300例,抚触组采用双手对婴儿全身各部位皮肤、肌肉进行抚触1个月,比较两组新生儿的发育指标及睡眠情况。结果抚触组新生儿睡眠时间平均延长2h;出生后第5天黄疸指数明显低于对照组;出生后30d头围、身高、体重与对照组比较,差异非常显著（P〈0．01）。结论通过对新生儿皮肤抚触,使新生儿入睡快、睡眠时间延长,睡眠质量提高;头围、身高、体重增加明显,加快了新生儿的生长发育;增加新生儿肠蠕动,促进胎粪排泄,降低黄疸指数。     

多中心协作实施新生儿抚触联合捏脊延伸护理在预防新生儿黄疸中的效果研究

目的 探讨多中心协作实施新生儿抚触联合捏脊延伸护理预防新生儿黄疸的效果。方法 便利抽样选取2021年8月-2022年1月天津市第一中心医院、天津市中心妇产科医院、天津市水阁医院符合研究标准且自愿参加本研究的100例新生儿为研究对象，采用随机数字表法分为观察组和对照组，各50例。对照组实施常规护理。观察组在对照组的基础上，实施新生儿抚触联合捏脊的延伸护理。观察2组新生儿出生后1 d、2 d、3 d、4 d、5 d、7 d、10 d及14 d的黄疸指数，抚触联合捏脊延伸护理对黄疸消退、胎便转黄、新生儿睡眠时间及喂养方式与体重变化情况，比较2组患儿家属对责任护士的满意度。结果 2组新生儿出生后1 d TcB指数差异无统计学意义(P>0.05)。观察组新生儿出生后2 d至出生后14 d TcB指数明显低于对照组，新生儿黄疸消退时间、胎便转黄时间较对照组均明显缩短观察组新生儿出生后7 d和14 d体重较对照组明显。增长(P<0.05)。观察组患儿家属对责任护士满意度明显优于对照组(P<0.05)。新生儿出生后至出生后第14天的平均睡眠时间较对照组延长，新生儿纯母乳喂养率明显高于...     

恶性梗阻性黄疸患者术后营养支持治疗的对照研究

目的 探讨恶性梗阻性黄疸患者术后理想的营养支持治疗方法,以改善肝功能,减少术后并发症.方法 回顾分析2007年3月至2010年3月我院收治的恶性梗阻性黄疸患者120例,随机分为对照组(58例)与观察组(62例),2组围手术期前3 d至手术后10 d常规静脉滴注极化液、维生素K、复方氨基酸治疗,观察组除此之外术后3 d使用绿甘氨及早期肠内营养治疗.观察2组手术后不同营养支持治疗方法对肝功能改善的变化情况.结果 观察组及对照组在手术后3 d白蛋白均下降,分别为(32.13±15.21)、(31.93±13.14)g/L,2组差异无统计学意义(t=0.09,P＞0.05),以后逐渐回升.观察组及对照组术后10 d检测白蛋白分别为(36.70±10.23)、(33.63±8.18)g/L,2组差异有统计学意义(t=2.39,P＜0.05),观察组血清胆红素[总胆红素(128.47±86.34)μmol/L,结合胆红素(192.50±80.36)μmol/L]、碱性磷酸酶[(138.67±65.38)U/L]及丙氨酸氨基转移酶[(66.23±18.26)U/L]恢复明显,较对照组[(134.26±82.56)、(233.27±132.43)μmol/L,(276.33±108.41)、(77.33±20.27)U/L]差异有统计学意义(t值分别为15.44、2.14、8.48、3.15,P均＜0.05).结论 绿甘氨配合术后早期进行肠内营养治疗对恶性梗阻性黄疸患者肝功能恢复有较好的治疗效果.     

中医辨证施治在新生儿药浴中的应用

目的探讨中医辨证法加减制成药浴水疗方进行水疗对新生儿血糖、经皮胆红素、呕吐、湿疹情况的影响。方法将396例新生儿（伴呕吐新生儿120例、早产儿或低体重儿76例、足月儿200例）随机分为对照组和药浴组各198例,对照组采用常规沐浴,药浴组在常规沐浴的基础上增加药浴水疗。比较新生儿药浴前后血糖值、两组出生后经皮胆红素值、新生儿发生呕吐、湿疹的变化情况。结果药浴后15min38例早产儿或低体重儿足跟血糖第1,3天分别为（4．448±0．266）,（4．457±0．314）mmol/L,与药浴前15min[（4．509±0,274）,（4,624±0．305）mmol／L]比较差异有统计学意义（t值分别为2．854,2．463;P〈0．05）;出生后96,144h胆红素值药浴组38例早产儿或低体重儿分别为（158．12±36．81）,（166．05±20．18）μmol／L,与对照组[（199．08±35．68）,（189．16±7．98）μmo]／L]比较,差异有统计学意义（t值分别为4．925,6．565;P〈0．01）。伴呕吐新生儿药浴组总有效率91．7％,对照组为65．0％,差异有统计学意义（Z=3．619,P〈0．01）。正常足月儿药浴组发生湿疹2例,对照组16例,差异有统计学意义（x2=11．966,P〈0．01）。结论药浴疗法可减少早产儿和低体重儿病理性黄疸的发生,降低黄疽程度,对新生儿呕吐和湿疹疗效显著,不失为一种值得推广的医疗保健方法。     

窒息缺氧与新生儿黄疸的关系

目的观察窒息缺氧与新生儿黄疸的关系。方法测定 10 6例足月新生儿的血清胆红素值 ,并按轻度窒息缺氧组、重度窒息缺氧组和无窒息缺氧组分组进行比较。结果高胆红素血症发生率 3组分别为 2 8.6%、14 .7%、46.7% ,有显著性差异 (P<0 .0 5 ) ,其中重度窒息缺氧组明显低于无窒息缺氧组 (P<0 .0 1) ;血清胆红素 3组分别为 (184.7± 48.3 )μmol/L、(15 3 .2± 48.9)μmol/L、(2 0 9.6± 49.7)μmol/L,轻度窒息缺氧组低于无窒息缺氧组 (P<0 .0 5 ) ,重度窒息缺氧组明显低于轻度窒息缺氧组 (P<0 .0 1)和无窒息缺氧组 (P<0 .0 1)。结论窒息缺氧时氧自由基的产生可能使新生儿黄疸减轻、高胆红素血症发生率降低     

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.