适度松解弹力绷带减少肾病综合征患儿静脉留置针皮损的观察

目的探讨适度松解弹力绷带，减少肾病综合征患儿静脉留置针的效果。方法将经静脉途径治疗的178例肾病综合征患儿，按入院时间随机分为观察组与对照组各89例，根据水肿程度，采用适度松解弹力绷带固定静脉留置针。结果观察组患儿局部皮肤完好率明显高于对照组，差异有显著性（P〈0．01），适度松解弹力绷带，降低了局部皮肤并发症，减轻息儿痛苦，提高了护理质量。结论适度松解弹力绷带可减少肾病综合征患儿静脉留针皮损的发生。     

3M弹力绷带联合不同敷料对脑血管造影术后股动脉穿刺部位周围皮肤的影响

目的 观察3M弹力绷带联合不同敷料对脑血管造影术后股动脉穿刺部位周围皮肤的影响.方法 选取神经内科经股动脉入路行脑血管造影检查患者90例,按简单随机方法分为A、B、C三组各30例,造影结束后A组仅采用3M弹力绷带包扎;B组采用3M弹力绷带加3M透明敷料包扎;C组采用3M弹力绷带加3M液体敷料包扎.比较三组患者舒适度、疼痛程度、皮肤瘙痒情况、皮肤损伤程度及满意度.结果 C组患者在舒适度上明显优于其他两组患者,差异具有统计学意义;C组患者疼痛评分、局部瘙痒情况优于A组,差异具有统计学意义.结论 股动脉穿刺处周围皮肤采用3M弹力绷带辅以3M液体敷料包扎可增加患者舒适度、降低疼痛感及局部瘙痒.     

利用湿毛巾巧除弹力绷带

患者行冠状动脉介入术后,穿刺点一般采用弹力绷带加压包扎8h,制动24h的方法来止血。由于弹力绷带黏性强,包扎时间长,皮肤长时间受到化学性的刺激,所以在撕除绷带时极易造成局部皮肤的破损,给患者带来极大的痛苦,故用正确的、技巧性的方法来去除绷带尤为重要。现介绍一种去除弹力绷带的小方法。     

弹力绷带松解时间提示牌在经桡动脉行冠脉介入治疗后的应用

目的探讨减少经桡动脉途径行冠状动脉介入治疗术后弹力绷带局部松解时间的研究,减少患者手腕部加压包扎的不适。方法选择我院120例行冠状动脉造影及冠状动脉支架术的患者为研究对象,将入选患者随机分为观察组和对照组各60例。两组患者在术后应用弹力绷带加压包扎穿刺部位,观察组为包扎后予床边应用弹力绷带松解时间提示牌,分别予30min,1h,2h,4h松解绷带,12h拆除绷带;对照组予传统法加压包扎2h,4h松解、12h后拆除绷带。观察两组止血成功率、并发症发生率、舒适度等。结果两组患者并发症发生率组间比较差异无统计学意义（P〉0．05）,两组患者舒适度比较差异具有统计学意义（P〈0．05）。结论经桡动脉途径行冠状动脉介入治疗术后应用弹力绷带松解时间提示牌,并按照提示时间予定时松解弹力绷带,减少患者手腕部不适感且止血效果安全可靠,并发症发生率低。     

美皮康预防股动脉介入术后压迫止血导致皮肤损伤的效果观察

目的探讨美皮康敷料预防介入术后皮肤损伤的效果。方法将符合冠心病介入治疗患者200例随机分为观察组、对照组各100例。观察组术后穿刺处应用美皮康无边形吸收性软聚硅酮泡沫敷料覆盖伤口,再用弹力绷带加压包扎。对照组穿刺处直接用弹力绷带加压包扎。观察去除弹力绷带后,两组患者穿刺处周围皮肤损伤的发生率。结果观察组皮肤损伤发生率为1.0%,对照组皮肤损伤发生率为12.0%,差异有统计学意义(P0.05);观察组疼痛程度显著低于对照组(P0.01)。结论使用美皮康无边形吸收性软聚硅酮泡沫敷料,可显著降低介入术穿刺处周围皮肤损伤发生率,有效减轻患者穿刺口局部疼痛。     

老年患者介入术后穿刺部位使用弹力绷带加压时间的探讨

目的:探讨经股动脉穿刺行冠脉造影及冠脉介入手术后应用弹力绷带的加压包扎时间。方法:选择我院352例行冠状动脉造影及冠状动脉支架术的老年患者,随机分为观察组和对照组各176例。两组在术后行徒手压迫止血20min后,应用弹力绷带8字交叉加压包扎穿刺部位,观察组冠脉造影加压包扎8h、支架植入术后12h拆除绷带;对照组冠脉造影加压包扎12h、支架植入术后24h后拆除绷带,观察两组患者股动脉穿刺处渗血、血肿、皮下淤斑、假性血管瘤等并发症及患者舒适度情况。结果:观察组和对照组的并发症发生率无显著差异性(P0.05),两组患者舒适度情况比较具有显著性差异(P0.05)。结论:应用弹力绷带加压包扎止血,冠脉造影术后8h,支架植入术后12h拆除弹力绷带能减少患者的不适感且安全有效。     

输液敷贴在预防弹力绷带致皮肤受损中的应用

弹力绷带在儿科浅静脉套管针中的固定效果较常规胶布满意,套管针保留时间长,且无副作用[1].本科在使用弹力绷带固定小儿四肢浅静脉套管针过程中,却发现弹力绷带压迫套管针针柄及肝素帽,产生压疮,使小儿局部皮肤受损,增加了患儿的痛苦.2005年6月本科在使用弹力绷带固定套管针的基础上加用一次性输液敷贴保护局部受压皮肤,明显减少了小儿局部皮肤受损的发生率.现报告如下.     

棉袜辅助固定法在婴幼儿手足静脉留置针中的应用效果

目的：探讨棉袜辅助固定法在婴幼儿手足静脉留置针中的应用效果。方法选取2015年1—7月的150例婴幼儿接受手足静脉留置针穿刺370例次,按入院先后顺序分为3组,2015年1—3月选择静脉留置针穿刺50例婴幼儿为棉袜辅助固定组,共穿刺125例次;2015年4—5月选择静脉留置针穿刺50例婴幼儿为丝袜辅助固定组,共穿刺126例次;2015年6—7月选择静脉留置针穿刺50例婴幼儿为弹力绷带辅助固定组,共穿刺119例次。观察比较3组婴幼儿手足静脉留置针留置过程中并发症发生率及药液外渗程度。结果棉袜辅助固定组和弹力绷带辅助固定组在局部渗血方面低于丝袜辅助固定组（P<0.05）;棉袜辅助固定组在意外拔管方面低于丝袜辅助固定组和弹力绷带辅助固定组（P<0.05）;棉袜辅助固定组和丝袜辅助固定组在局部皮肤不良反应（发红、压痕）发生率方面低于弹力绷带辅助固定组（P<0.05）;棉袜辅助固定组和丝袜辅助固定组药液外渗程度低于弹力绷带辅助固定组（P<0.05）。结论婴幼儿手足静脉留置针穿刺成功后,采用棉袜辅助固定法,可减少局部渗血、意外拔管及局部皮肤不良反应发生率,减轻药液外渗程度,值得临床借鉴使用。     

明胶海绵联合网状弹力绷带在肿瘤病人 PICC 置管后止血效果的观察

[目的]观察明胶海绵联合网状弹力绷带在肿瘤病人经外周静脉穿刺置入中心静脉导管(PICC)后的止血效果。[方法]将364例进行 PICC 的肿瘤病人随机分为观察组和对照组,每组182例,观察组穿刺后病人穿刺点覆盖明胶海绵,对照组病人穿刺点覆盖无菌小纱布块,两组病人均在无菌敷贴外套以网状弹力绷带加压固定。观察并比较两组病人穿刺后至穿刺1周后局部穿刺点渗血情况。[结果]观察组穿刺点渗血程度少于对照组,两组差异有统计学意义(P <0.05)。[结论]PICC 置管后穿刺点采用明胶海绵覆盖并辅以网状弹力绷带局部加压固定可预防 PICC 置管后穿刺点出血。     

明胶海绵联合网状弹力绷带在肿瘤病人PICC置管后止血效果的观察

[目的]观察明胶海绵联合网状弹力绷带在肿瘤病人经外周静脉穿刺置入中心静脉导管(PICC)后的止血效果。[方法]将364例进行PICC的肿瘤病人随机分为观察组和对照组,每组182例,观察组穿刺后病人穿刺点覆盖明胶海绵,对照组病人穿刺点覆盖无菌小纱布块,两组病人均在无菌敷贴外套以网状弹力绷带加压固定。观察并比较两组病人穿刺后至穿刺1周后局部穿刺点渗血情况。[结果]观察组穿刺点渗血程度少于对照组,两组差异有统计学意义(P0.05)。[结论]PICC置管后穿刺点采用明胶海绵覆盖并辅以网状弹力绷带局部加压固定可预防PICC置管后穿刺点出血。     

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.