食管癌术后并发肺部感染的危险因素分析

目的分析影响食管癌术后并发肺部感染的危险因素。方法选取本院2018年3月至2019年12月收治的100例接受手术治疗的食管癌患者。统计食管癌患者术后并发肺部感染的发生情况,并分析食管癌术后并发肺部感染的相关危险因素。结果手术治疗后,共19例患者发生肺部感染,肺部感染发生率为19.00%(19/100)。并发肺部感染的患者中,年龄≥65岁、体质量≥25 kg/m2、有长期吸烟史、术前合并肺部感染、手术路径2~3个、有喉返神经损伤、合并糖尿病、术前血清白蛋白<35 g/L、单肺通气的患者占比显著高于未并发肺部感染患者(P<0.05)。多元回归性分析显示,长期吸烟史、喉返神经损伤、糖尿病、术前血清白蛋白水平及通气方式为食管癌患者术后并发肺部感染的危险因素(P<0.05)。结论导致食管癌术后并发肺部感染的危险因素较多,临床医务人员需分析患者的身体状况于围手术期开展合理的预防措施,以促进预后改善。     

老年食管癌患者术后并发肺部感染危险因素的临床分析

目的研究老年食管癌患者术后并发肺部感染的危险因素,指导临床防治工作。方法以2013年8月至2015年1月进行手术治疗的老年食管癌患者92例为研究对象,将其术后并发肺部感染与患者的性别、长期吸烟史、糖尿病、术前血清清蛋白、一秒用力呼气量与用力肺活量的比值(FEV1/FVC)、通气方式、手术时间、术中出血、喉返神经损伤、临床分期进行对比分析研究。结果 92例老年食管癌患者术后并发肺部感染22例,感染率为23.9%,有长期吸烟史、糖尿病、术前低血清清蛋白、单肺通气、喉返神经损伤术后并发肺部感染率分别为33.3%、48.0%、35.7%、30.6%、53.3%,各组间比较,差异有统计学意义(P0.05)。长期吸烟史、糖尿病、术前血清清蛋白、通气方式、喉返神经损伤是老年食管癌患者术后并发肺部感染的高危因素。结论老年食管癌术后并发肺部感染的危险因素较多,在围术期采取积极的措施进行预防和治疗,有利于降低术后肺部感染。     

食管癌术后并发肺部感染的危险因素分析及护理对策

目的：探讨食管癌术后并发肺部感染的危险因素及护理对策。 方法：选择接受食管癌根治术治疗的食管癌合并肺部感染患者50例为感染组,以及同期未合并肺部感染的50例为对照组,对两组患者术后发生肺部感染的单因素和多因素进行比较分析。结果：感染组患者的年龄、吸烟史、合并基础疾病、手术时间、术中喉返神经损伤与对照组分别比较,差异有统计学意义（P＜0.05）;年龄≥60岁、合并糖尿病、高血压、冠心病等基础疾病,长期大量吸烟、手术时间较长是食管癌患者术后发生肺部感染的独立危险因素(P＜0.05)。结论： 食管癌患者术后发生肺部感染的危险因素较多,针对上述因素采取针对性的护理干预措施,如术前戒烟、改善肺功能,术后保持呼吸通畅、并进行心理护理、营养支持及合理的使用抗菌药物等,可以降低食管癌术后肺部感染的发生率。     

食管癌围术期肺部感染的危险因素

目的探讨食管癌围术期肺部感染发生的危险因素。方法随机选择2012年2月至2014年12月行手术治疗的食管癌患者150例,术后肺部感染50例为感染组,无肺部感染100例为非感染组,比较两组患者围术期相关情况(术前肺功能、吸烟史、手术情况、术前合并症等),对肺部感染单因素中有方差差异的变量行Logistic多因素回归分析。结果感染组年龄≥65岁、吸烟≥400支/年、中重度肺功能障碍、喉返神经损伤等发生率分别为78.0%、70.0%、46.0%、16.0%,非感染组为58.0%、52.0%、28.0%、5.0%,两组比较差异有统计学意义(P0.05)。高龄、吸烟史、肺功能严重障碍、围术期出血量多、喉返神经损伤为围术期肺部感染发生独立危险因素。结论高龄、吸烟史、肺功能严重障碍为食管癌围术期肺部感染的高危因素,需针对性的给予干预措施以预防或减少肺部感染。     

食管癌手术后喉返神经损伤的护理

由于颈段及胸上段食管癌行手术切除的增加以及随着食管癌三野清扫理论(颈、胸、腹淋巴结清扫)的提出,对食管癌的患者进行颈部操作的机会增加,使喉返神经损伤的可能性增多[1];喉返神经的生理作用是支配声带运动,损伤后会导致患侧声带外展以及内收功能消失而出现声音嘶哑,表现为进食流质呛咳,影响术后咳嗽排痰功能,严重者可引起吸入性肺炎和痰液潴留,使肺部感染难以控制[2]。而术后并发肺部感染致肺炎是胸部手术后最危险的并发症之一[3]。护理上做好患者的心理护理,呼吸道管理及饮食护理指导,对患者术后恢复起到重要作用。我院2004年1月~2006…     

食管癌术后喉返神经损伤致肺炎的预防及护理

目的探讨食管癌患者术后喉返神经损伤致肺炎的预防及其护理措施。方法本研究纳入食管癌术后喉返神经损伤的患者35例,对其实施针对性的护理措施,并观察护理后肺炎的发生率。结果 35例喉返神经的患者中,1例患者双侧喉返神经损伤患者因反复出现吸入性肺炎导致严重呼吸衰竭死亡。其余34例患者痊愈出院。结论针对性的护理干预措施能够降低术后肺部感染的发生率,有利于术后恢复。     

食管癌病人围手术期呼吸道管理的探讨

目的：探讨食管癌病人加强围手术期呼吸道管理对预防术后肺部并发症的临床效果。方法：将52例严格进行围手术期呼吸道管理的食管癌病人设为观察组，同期56例遵医嘱治疗的食管癌病人设为对照组。结果：观察组与对照组比较，痰液排出情况、吸氧时间及胸管拔除时间两组之间均有显著性差异（P〈0．05），观察组术后肺部并发症发生率低于对照组（P〈0．01）。结论：食管癌病人加强围手术期的呼吸道管理，能有效减少肺部并发症的发生。     

21例食管癌术后急性呼吸衰竭的临床观察及护理

应用临床资料分析２１例食管癌术后急性呼吸衰竭（以下简称呼衰）的特点。临床观察术前后肺通气功能血液指标变化。经调高龄，长期吸烟，慢性肺部疾患及术后有胸内感染并发症者容易发生。多出现在术后２４～７２小时内，除辅助通气，控制肺内感染，彻底清除呼吸道分泌物之外，重点阐述了术后早期发现并处理胸内其它病变是抢救成功的关键。     

21例食管癌术后急性呼吸衰竭的临床观察及护理

应用临床资料分析２１例食管癌术后急性呼吸衰竭（以下简称呼衰）的特点。临床观察术前后肺通气功能血液指标变化。强调高龄、长期吸烟、慢性肺部疾患及术后有胸内感染并发症者容易发生。多出现在术后２４～７２小时内,除辅助通气,控制肺内感染,彻底清除呼吸道分泌物之外,重点阐述了术后早期发现并处理胸内其它病变是抢救成功的关键。     

食管癌术后喉返神经麻痹12例分析

我院自1993-01～2003-01共施行食管癌手术1348例,术后因喉返神经麻痹导致患者声嘶的有 12例,发生率为 0.9％。术前有声嘶行手术者未列入其内;现就食管癌术后喉返神经麻痹发生的原因分析如下。     

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.