7例直肠阴道瘘患者围手术期的护理

总结7例直肠阴道瘘患者的围手术期护理经验。主要包括术前心理护理、局部护理、肠道准备,术后心理护理、营养支持、负压吸引护理、造口护理等措施,认为对直肠阴道瘘患者加强围手术期护理对手术成功、患者顺利康复可起到积极的促进作用。     

直肠癌手术患者的围术期全程护理作用及对睡眠状况的影响

目的：探究围术期全程护理在直肠癌手术患者中的作用及对患者睡眠状况的影响。方法：选取2021年1月至2022年1月福建省厦门大学附属第一医院结直肠肿瘤外科收治的直肠癌手术患者110例作为研究对象,按照不透明信封分组法分为对照组和观察组,每组55例。分别予以围术期常规护理、围术期全程护理。比较2组护理效果。结果：观察组术中出血量较对照组少,手术时间、术后首次排气时间、术后首次排便时间、术后下床活动时间较对照组短(均P<0.05)。观察组PSQI评分较对照组低(P<0.05)。观察组护理满意度(96.36%)较对照组(83.64%)高(χ²=4.949,P=0.026)。结论：围术期全程护理用于直肠癌手术患者中,效果显著,可改善患者睡眠状况,提高临床预后,值得临床应用。     

1例直肠癌术后并发阴道瘘病人的护理

阴道瘘是直肠癌保肛术后最严重的并发症之一,发生率4%~25%[1]。我院2006年1月为1例直肠癌病人施行手术并发阴道瘘,现将护理体会报告如下。1病例介绍病人,56岁,因大便带血1个月,肠镜提示直肠原位癌,2006年1月3日在全身麻醉下行直肠癌根治,保留肛门,术使用吻合器,术后1周开始进食。1月18日发现大便从阴道流出,腹腔引流管无液体引出,妇产科会诊后诊断为直肠阴瘘,给予禁食、高营养支持,经过肠道准备后再次在全身麻醉行肠造瘘术加阴道直肠修补术。2护理2.1术前护理2.1.1纠正营养不良癌肿病人均存在不同程度的营养不良尤其是贫血、低蛋白血症和维…     

经直肠前括约肌途径治疗早期中下段直肠癌的护理

目的 总结经直肠前括约肌途径治疗早期中下段直肠癌的围手术期护理,提高患者的生活质量.方法 回顾分析16例早期中下段直肠癌采用经直肠前括约肌途径手术切除的围手术期护理措施和要点.结果 16例患者均成功地保留了排便控制功能,无术后并发症,随访无复发.结论 对早期中下段直肠癌行经直肠前括约肌途径治疗是安全有效的,围手术期护理,尤其是术前的肠道准备,术后卧位、饮食、会阴部皮肤护理、并发症的观察及排便功能训练的护理非常重要.     

先天性肛门闭锁合并直肠阴道舟状窝瘘的护理

目的探讨先天性肛门闭锁合并直肠阴道舟状窝瘘的护理。方法总结14例先天性肛门闭锁合并直肠阴道道舟状窝瘘围术期护理。护理要点包括：术前心里护理及充分做好肠道准备,术后做好肛周、肛管护理,定期扩肛,观察排便情况,给予健康指导及出院指导。结果患者中2例术后肛门红肿明显伴有糜烂、流脓。经积极治疗和护理,所有患儿均痊愈出院。结论充分的术前准备和细致的术后护理及正确扩肛能避免术后并发症的发生,提高患儿生活质量。     

肛门失禁患者围术期的护理

目的 探讨肛门失禁患者围手术期的护理方法.方法 回顾分析31例肛门失禁患者行臀大肌移植外括约肌重建术围手术期的护理及随访.结果 本组病人术后均随访1年以上,大便次数均较术前减少.术后2例患者发生直肠伤口瘘,1例治愈,1例结肠造瘘后伤口愈合.本组患者均为肛门失禁半年到一年后行臀大肌移植外括约肌重建手术,术后1年内主观Wexner评分及客观直肠肛管测压结果均不理想.术后1年伴随臀大肌收缩功能锻炼及肛门直肠生物电刺激治疗,70％的患者控便功能有明显改善,生活质量能够达到正常或轻度控便标准,能重返学习和工作.结论 术前给予充分的肠道准备,术后加强肛门的护理和坚持正确的扩肛方法等,能改善控便功能,提高患者的生活质量.     

直肠癌手术患者实施全程优质护理体会

目的:探讨围术期全程优质护理对直肠癌手术患者的影响。方法:选取27例直肠癌患者为观察组,实施围手术期全程优质护理,另取28例直肠癌相同术式患者为对照组,接受一般护理。观察并比较两组手术时间、出血量、疼痛发生率、术后满意度及血压和心率变化。结果:两组患者手术时间、出血量、疼痛发生率、术后满意度及访视前后心率、血压变化比较均有显著性差异(P<0.05)。结论:围手术期全程优质护理能稳定患者情绪,缩短手术时间,减少出血量,减轻患者疼痛,提高术后满意度,促进患者康复。     

腹腔镜直肠癌根治术10例围术期护理

目的:探讨腹腔镜直肠癌根治术的围术期护理方法.方法:对10例行腹腔镜直肠癌根治术患者术前给予心理护理,完善各项检查,行营养支持,做好充分的肠道准备及肠造口定位;术后加强基础护理、引流管护理、饮食护理、并发症观察及护理.结果:10例患者均顺利完成手术,术后无吻合口瘘、肠梗阻等并发症发生,术后生活质量均良好.结论:加强腹腔镜直肠癌根治术的围术期护理,是提高手术成功率和降低并发症发生率的关键.     

13例直肠阴道瘘病人围术期临床观察和护理

[目的]探讨直肠阴道瘘病人的围术期观察和护理措施。[方法]对直肠阴道瘘病人围术期进行回顾性分析,通过对13例病人的术前心理护理、阴道冲洗、肠道准备以及术后病情观察、饮食休息与活动安排、抗感染药物的使用、伤口的护理、留置导尿、排便的干涉等医疗护理措施的观察与分析得出结论。[结果]12例病人手术成功,只有1例复发。[结论]全面、细致的护理有助于直肠阴道瘘修补术成功,减少复发率,提高病人生存质量。     

围手术期康复护理对髋关节置换术后恢复的影响研究

观察围手术期康复护理对髋关节置换术后恢复的影响。选择2014年9月~2016年3月期间在我院接受髋关节置换手术的患者70例作为研究对象,随机划入观察组和对照组,观察组35例,对照组35例,分别接受围手术期康复护理和常规围手术期护理,比较两组患者患者术后髋关节Harris评分。观察组术后1月患者髋关节Harris评分(73.9±3.2)分,术后3月(84.6±2.4)分,术后6月(88.9±2.4)分,术后6月(88.9±2.4)分,术后1年(95.8±2.2)分,对照组患者术后1月患者髋关节Harris评分(62.3±2.5)分,术后3月(72.1±2.3)分,术后6月(79.1±2.2)分,术后1年(86.8±1.9)分,组间差异有统计学意义(P<0.05)。围手术期康复护理在髋关节置换术术后恢复中的应用效果显著,值得临床应用和推广。     

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.     

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.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

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.     

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.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.