电话再教育对门诊结肠镜检查患者肠道准备的影响

目的:探讨电话再教育对门诊结肠镜检查患者肠道准备的影响。方法:将300例预约行结肠镜检查的门诊患者随机分为观察组和对照组各150例,观察组中途退出24例,对照组中途退出13例。对照组采取常规口头及书面教育的方式指导患者,观察组在此基础上进行电话再教育,加强对患者的指导。比较两组患者肠道准备质量、主观感觉和依从性。结果:观察组患者肠道准备质量明显优于对照组(P0.05),重复检查意愿高于对照组(P0.05),对饮食指导的依从性优于对照组(P0.05),而在睡眠质量、不良反应发生率及泻药指导依从性方面,两组比较差异无统计学意义(P0.05)。结论:对门诊结肠镜检查患者在常规指导基础上进行电话再教育,可提高肠道准备质量,增强患者忍耐力,改善患者饮食依从性。     

图示法在门诊患者肠道准备中的应用

目的分析门诊肠道准备过程中应用图示法的具体方法和效果。方法将我院门诊接受肠镜检查的230例患者按照数字随机方法平均分为两组:对照组接受常规指导,观察组接受图示法指导。对比两组的肠道准备情况。结果观察组肠道完全清洁的几率为86.08%(99/115),对照组为66.08%(76/115),两组之间差异对比存在统计学意义(P0.05);观察组发生各项不良反应的几率明显低于对照组,差异比较有统计学意义(P0.05)。结论肠道检查患者接受图示法指导能够有效提高肠道清洁度,降低不良反应几率,值得应用。     

个性化肠道准备方案联合细节护理在结肠镜检查前肠道准备中的应用

目的:探讨个性化肠道准备方案联合细节护理在结肠镜检查前肠道准备中的应用效果。方法:将138例结肠镜检查患者按随机数字表法分为对照组和观察组各69例,对照组采取个性化肠道准备,观察组采用个性化肠道准备方案联合细节护理,比较两组患者肠道准备清洁度、患者满意度及不良反应发生情况。结果:干预后观察组肠道准备清洁度高于对照组(P0.05);观察组患者舒适度、健康教育、服务态度及用药各项满意度高于对照组(P0.05);观察组恶心呕吐、腹痛、头晕、肛周不适等不良反应发生情况少于对照组(P0.05)。结论:个性化肠道准备方案联合细节护理可以有效提高肠道准备清洁度,提升患者满意度,降低不良反应发生率。     

微信小程序辅助的关键点指导对门诊结肠镜检查患者肠道准备的影响

目的探讨微信小程序辅助的关键点指导对门诊结肠镜检查患者肠道准备的作用。方法 2019年8月至2020年1月,便利抽样法选取于某三级甲等医院消化内镜中心行结肠镜检查的门诊患者224例为研究对象,按照就诊时间进行分组,2019年8-10月入选的患者为对照组(n=112),2019年11月至2020年1月入选的患者为观察组(n=112)。对照组给予常规肠道准备指导,观察组运用微信小程序辅助的关键点指导,评价并比较两组患者肠道准备清洁度、肠道准备依从性、宣教服务满意度等结局指标。结果观察组患者的肠道准备合格率及波士顿肠道清洁度评分均优于对照组(均P0.01)、饮食依从性、服药依从性及运动依从性均高于对照组(均P0.01);两组患者宣教态度满意度差异无统计学意义(P0.05),但观察组的宣教内容与宣教方式满意度均高于对照组(均P0.01)。结论微信小程序辅助的关键点指导有助于提高门诊结肠镜检查患者肠道准备依从性及肠道准备效果,提高患者对护理服务的满意度。     

电子结肠镜检查前两种肠道准备效果的对比研究

目的 评价两种不同肠道准备方法 对电子结肠镜检查结果 的影响,寻求更为安全、有效的清洁肠道的方法 .方法 将568例行结肠镜检查的患者随即分为观察组(286例)和对照组(282例),观察组口服潘泻叶煎剂、对照组口服甘露醇溶液,分别观察各组患者的肠道清洁度、药物的不良反应、并发症及检查成功率.结果 观察组肠道的清洁效果优良、电子结肠镜检查成功率100%,不良反应发生率28.67%,并发症发生率0;对照组电子结肠镜检查成功率90.07%,不良反应发生率42.55%,并发症发生率3.54%,两组结果 比较差异具有显著性意义(均P＜0.01).结论 采用潘泻叶煎剂口服清洁肠道较甘露醇更为安全、有效、检查成功率高,电子结肠镜检查前行肠道准备时可作为首选方法 .     

规范化护理操作流程在结肠镜检查前肠道准备中的应用效果

目的探讨规范化操作流程在结肠镜检查前肠道准备中的效果。方法选取2014年~2015年在本院进行结肠镜检查的280例患者,根据便利抽样法分为对照组与研究组。对照组为2014年1月~12月的140例患者(实施肠道准备规范化护理操作流程前),研究组为2015年1月~12月的140例患者(实施后),观察比较2组在肠道准备中的舒适度、肠道准备清洁度及不良反应的发生率。结果实施规范化护理操作流程的研究组应用在肠道准备中的舒适度及肠道准备清洁度优于对照组,不良反应的发生率低于对照组,差异有统计学意义(P0.05)。结论在结肠镜检查前的肠道准备中实施规范化护理操作流程,可提高患者的舒适度及肠道准备清洁度、减少不良反应的发生。     

量化运动干预方案在结肠镜检查患者肠道准备中的应用研究

目的探讨量化运动干预方案在结肠镜检查患者肠道准备中的作用,为临床制订有效的肠道准备方案提供依据。方法选择2016年2月至7月行结肠镜检查的患者220例,分为对照组和干预组,各110例。对照组给予常规结肠镜检查的健康教育;干预组在常规健康教育的基础上实施量化运动干预方案。结果干预组肠道清洁度评分、能够耐受以及愿意行相同肠道准备方案的患者比例、不良反应发生率均优于对照组,差异均具有统计学意义(P0.01或P0.05)。结论量化运动干预方案可以提高肠镜检查患者的肠道清洁度、降低不良反应发生率,从而提升患者再次接受肠道准备的意愿。     

电话随访对门诊结肠镜诊疗患者肠道准备依从性的影响

目的 探讨电话随访对门诊结肠镜诊疗患者肠道准备依从性及肠道清洁效果的影响.方法 将400例门诊结肠镜诊疗患者随机分为随访组(200例)和对照组(200例),两组患者均在预约时给予常规口头及书面肠道准备的健康教育,随访组在饮食准备和药物清洁肠道时还接受电话随访健康教育,且患者可随时咨询预约护士.通过术前问卷调查,对患者饮食和服药依从性进行评价,术后由内镜医师单盲法判定肠道清洁度.结果 两组患者饮食和服药依从性、肠道清洁度比较,差异均有显著意义(P＜0.00l),随访组优于对照组.结论 对门诊结肠镜诊疗患者实施电话随访,延续健康教育,有助于提高患者肠道准备依从性及肠道清洁度,从而有效提高结肠镜诊疗的成功率,减少并发症.     

肠道准备关键点指导方案在老年患者结肠镜检查中的应用研究*

目的旨在探讨肠道准备关键点指导方案在老年结肠镜检查患者中的应用效果,从而为临床开展科学规范的肠道准备指导工作提供参考依据。方法选取2017年2月-2017年9月行结肠镜检查的老年门诊患者206例,对照组和干预组各103例。其中对照组在预约时给予常规的肠道准备指导,干预组在常规肠道准备指导的基础上给予基于肠道准备关键点指导方案的干预措施,评价并比较两组患者的肠道清洁效果、肠道准备依从性和肠道准备期间不良反应发生率等结局指标。结果干预组患者的肠道准备合格率及渥太华肠道清洁度评分(OBPS)均优于对照组(P 0.01);干预组患者的进镜时间短于对照组(P 0.01);干预组不依从饮食、服药及运动的患者比例均低于对照组(P 0.01);干预组患者服药期间发生恶心、腹胀的情况远低于对照组(P 0.01)。此外,干预组对肠道准备的总体满意程度及愿意再次行肠镜检查的患者比例也明显优于对照组(P 0.01)。结论在肠道准备期间,根据肠道准备关键点指导方案对老年患者进行指导,不仅有利于医护人员更加科学规范地进行肠道准备指导工作,并且方案内容高度契合老年结肠镜检查患者的实际需求,便于实施推广,具有较好的临床实用价值。     

复方聚乙二醇电解质散与硫酸镁在结肠镜检查病人肠道准备中的应用效果

[目的]探讨硫酸镁与复方聚乙二醇电解质散(PEG)两种泻药在结肠镜检查肠道准备中应用的效果。[方法]选择2015年1月—2015年6月住院行结肠镜检查的407例病人,将2015年1月—2015年3月住院行结肠镜检查的196例病人作为对照组,将2015年4月—2015年6月住院行结肠镜检查的211例病人作为观察组,对照组肠道准备采用硫酸镁口服,观察组肠道准备采用复方聚乙二醇电解质散口服,比较两组病人的肠道准备清洁度、不良反应发生率、服药依从性及病人满意度。[结果]观察组肠道准备清洁合格率、病人依从性及满意度高于对照组,肠道准备不良反应发生率低于对照组,经比较差异均有统计学意义(P0.05)。[结论]复方聚乙二醇电解质散用于结肠镜检查病人行肠道准备,肠道清洁度好,不良反应发生率低,病人依从性及满意度高,效果明显优于口服硫酸镁。     

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.