新生儿游泳联合开塞露早期干预对减轻新生儿黄疸的临床研究

目的探讨新生儿游泳联合开塞露早期干预对减轻新生儿黄疽的疗效。方法将100例足月新生儿按随机数字表法分为对照组和研究组。每组50例。对照组按新生儿常规护理;研究组给予游泳联合开塞露对新生儿进行早期干预。对2组新生儿的黄疸指数、胎便初排时间进行比较。结果研究组4h内排出胎便48例;对照组4h内排出胎便18例。研究组4h内排出胎便例数明显高于对照组（X^2=-56．80,P〈0．05）。2组新生儿第1天的黄疸指数比较差异无统计学意义（P〉0．05）。研究组新生儿出生后第2天的黄疸指数较对照组有所降低,第5天降低程度更加明显（均P〈0．01）。结论新生儿游泳联合开塞露能使新生儿胎便初排时间及胎便转黄时间明显提早,减少了胆红素的肠肝循环．减轻了新生儿生理性黄疸程度,降低了病理性黄疸的发生。     

早期综合护理干预对新生儿黄疸的影响

目的:探讨早期综合护理干预对新生儿黄疸的影响.方法:将200例择期剖宫产足月正常新生儿随机分为观察组和对照组各100例,对照组给予新生儿常规护理,观察组给予早期综合护理干预.观察两组新生儿胎便初排时间、胎便转黄时间、高胆红素血症发生例数、每日黄疸指数.结果:观察组在胎便初排时间、胎便转黄时间、高胆红素血症发生率、新生儿黄疸指数方面与对照组比较差异均有统计学意义(P<0.05,P<0.01).结论:早期综合护理干预可明显减轻新生儿生理性黄疸的程度,减少高胆红素血症的发生.     

护理干预降低新生儿黄疸的效果观察

目的探讨护理干预对降低新生儿黄疸的效果。方法将160例剖宫产正常足月新生儿随机分为干预组和对照组,每组80例,对照组实施常规护理,干预组在此基础上生后第1天即进行游泳和抚触护理,比较2组第1次排胎便时间、胎便转黄时间、出生后1～6d黄疸指数及病理性黄疸发生率。结果干预组新生儿第1次排胎便时间及胎便转黄时间较对照组提前(p0.01);干预组新生儿出生后2～6d黄疸指数及病理性黄疸发生率明显低于对照组,差异均有显著性(p0.05)。结论护理干预可促进新生儿胎便早排出,使胎便转黄时间提前,从而降低新生儿黄疸的程度,并可减少病理性黄疸的发生。     

早期综合护理干预在新生儿黄疸中的应用

目的:探讨早期综合护理干预在新生儿黄疸中的应用效果。方法:将150例新生儿随机分为观察组和对照组各75例,观察组给予早期综合护理干预措施,对照组给予常规护理,比较两组新生儿黄疸指数、胎便转黄时间及护理满意度。结果:观察组在黄疸指数、胎便转黄时间和护理满意度等方面均优于对照组(P<0.05)。结论:早期综合护理干预措施能有效减轻新生儿黄疸程度,减少高胆红素血症的发生,值得临床广泛应用。     

早期护理干预对新生儿黄疸的影响研究

目的 探讨早期护理干预对新生儿黄疸多项指标的影响。方法 将本科室收治的80例新生儿采用随机数字表法分为两组。观察组实施早期护理干预措施,对照组实施常规护理。比较两组新生儿的初次胎便排出及转黄时间,新生儿经皮胆红素测定指数及高胆红素血症的发生率。结果 经过早期护理干预观察组黄疸指数低于对照组(P<0.05) ,观察组第一次排胎便时间及转黄时间早于对照组(P<0.05)。结论 早期护理干预可降低新生儿黄疸发生率,减轻新生儿黄疸的程度,缩短持续时间,从而减少新生儿高胆红素血症的发生率。     

多元化早期综合护理干预对新生儿黄疸的影响

目的:探讨早期实施综合护理干预对降低新生儿黄疸指数的效果.方法:选择130例剖宫产正常足月新生儿,按出生顺序随机分为干预组和对照组各65例,两组新生儿均进行母乳喂养,常规护理,干预组在母乳充足前按需添加配方奶、促进胎便排除、结合抚触、游泳护理、日光照射,直至出院.每日经皮测黄疸指数值,并观察记录新生儿第一次排胎便时间及转黄时间.结果:干预组新生儿黄疸指数低于对照组(P<0.05),新生儿第一次排胎便时间及转黄时间提前,两组比较差异有极显著性(P<0.01).结论:早期综合护理干预能减轻生理性黄疸的程度,减少病理性黄疸的发生.     

游泳及抚触对新生儿黄疸的影响

目的探讨游泳及抚触对新生儿黄疸的影响.方法选择正常足月新生儿357例,随机分组,其中203例在出生24h内给予游泳及抚触作为研究组,154例给予单纯沐浴作为对照组,比较2组新生儿第1次排便时间、胎便转黄时间、高胆红素血症发生率的差别.结果研究组第1次排便时间较对照组明显提前(p＜0.01),胎便转黄时间较对照组明显提前(p＜0.01),高胆红素血症发生率明显低于对照组(p＜0.05).结论新生儿游泳及抚触能加速胎便排出,使胎便转黄时间提前,减少胆红素重吸收,降低黄疸发生率.     

早期护理干预对早产儿黄疸的影响

[目的]探讨早期护理干预对早产儿黄疸的影响.[方法]将100例早产儿按出生日期单双号分为干预组和对照组,对照组按照早产儿护理常规护理,干预组入院后即给予鸟巢护理、非营养性吸吮、尽早开奶,腹部按摩;对超过24h未排胎便和超过72h胎便未转黄的早产儿给予干预,用棉签蘸取液状石蜡插入肛门刺激排便或用温生理盐水早期灌肠.观察两组早产儿胎便排出时间、胎便转黄时间、黄疸指数、血清总胆红素和直接胆红素水平及光疗次数.[结果]两组早产儿胎便排出时间、胎便转黄时间、黄疸指数、生后第7天血清胆红素水平、光疗次数比较,差异有统计学意义(P＜0.01).[结论]早期护理干预可有效降低早产儿黄疸发生率,预防胆红素脑病的发生.     

早期多元化护理对新生儿黄疸指数和排便情况的影响

目的探讨早期多元化护理对新生儿黄疸指数及排便情况的影响。方法选取2017年6月至2018年5月我院收治的110例新生儿为研究对象,随机等分为对照组和观察组。对照组实施常规新生儿护理,观察组在对照组基础上实施早期多元化护理。比较两组新生儿出生后不同时间的黄疸指数、首次排便时间、胎便转黄时间及胎便退黄时间。结果观察组新生儿出生后不同时间的黄疸指数均低于对照组,差异有统计学意义(P 0. 05);观察组新生儿首次排便时间、胎便转黄时间及胎便退黄时间均优于对照组,差异有统计学意义(P 0. 05)。结论早期多元化护理对新生儿黄疸指数及排便情况的影响更为积极,应用价值较高。     

早期综合护理干预对新生儿生理性黄疸的影响

目的:探讨早期综合干预对新生儿生理性黄疸的影响。方法:将64例健康新生儿随机分为干预组和对照组,对照组给予常规新生儿护理,干预组在此基础上给予抚触、早开奶、日光浴、缩短脐带结扎时间等护理干预。观察两组首次排便时间、胎便转黄时间、经皮胆红素值测量情况。结果:干预组首次排便时间、胎便转黄时间、经皮胆红素值测量情况与对照组比较差异均有统计学意义(P0.01)。结论:新生儿的早期综合护理干预能够缩短首次排便时间,减轻黄疸程度,减少新生儿高胆红素血症的发生。     

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.     

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.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.