2种方法预防乳腺癌术后患肢淋巴水肿的效果比较

目的 探讨不同方法在预防乳腺癌术后患侧上肢淋巴水肿的效果。方法将100例患者随机分成常规组（常规护理＋临床路径）和实验组（常规护理＋临床路径＋压力治疗仪），每组50例，比较2组患者在术后第2个月末淋巴水肿发生率、发展程度及患侧上肢功能康复情况。结果实验组患者淋巴水肿发生率和发展程度明显低于常规组（p〈0．01），患者治疗后自觉肢体轻松舒适，无肿胀、沉重感，并且实验组患者患肢功能康复情况优于常规组（P〈0．05）。结论乳腺癌根治术后患者应用梯度压力治疗仪，配合积极有效的护理，能有效预防乳腺癌术后淋巴水肿的发生，促进患侧上肢的功能恢复。     

空气波压力治疗仪治疗乳腺癌术后患肢淋巴水肿的效果观察

目的探讨空气波压力治疗仪配合常规护理方法治疗乳腺癌术后患肢淋巴水肿的效果。方法 2009年6月-12月对58例出现患肢水肿的乳腺癌术后患者,按抛硬币法随机分为两组,试验组30例在常规护理治疗基础上接受空气波压力治疗,对照组28例仅按传统的常规护理方法治疗,1个月后,比较两组患者患肢淋巴水肿治疗后的转归情况。结果试验组患者患肢淋巴水肿的治疗效果,其总有效率达100%,明显优于对照组(57.1%),差异有统计学意义(χ2=16.211,P=0.000)。结论应用空气波压力治疗仪配合传统的常规护理方法,能近期改善乳腺癌术后淋巴水肿的转归,促进患肢的功能恢复,提高患者的生活质量。     

功能康复锻炼联合梯度压力辅助治疗对乳腺癌患者术后恢复的影响

目的:探讨功能康复锻炼联合梯度压力辅助治疗对乳腺癌患者术后恢复的影响。方法:将2016年5月~2017年5月收治的80例乳腺癌手术患者随机分为研究组和对照组各40例。对照组给予常规护理基础及功能康复锻炼干预,研究组在对照组基础上给予梯度压力辅助治疗干预。比较两组术后淋巴水肿及肩关节活动度。结果:术后第4周,两组淋巴水肿发生率比较差异无统计学意义(P0.05);术后第12周,研究组低于对照组(P0.05)。术后第4周,研究组患肢后伸、前屈上举、外展以及内收角度均高于对照组(P0.05);术后第12周,两组比较差异均无统计学意义(P0.05)。结论:功能康复锻炼联合梯度压力辅助治疗可显著提高乳腺癌患者术后患肢功能,减少淋巴水肿的发生,促进患者早期康复,值得临床推广。     

乳腺癌术后患肢淋巴水肿患者实施循证护理的作用研究

目的 探讨循证护理对乳腺癌术后患肢淋巴水肿患者的效果。方法 选取我院 2021 年 10 月至 2022 年 12 月收治的乳腺癌 术后患肢淋巴水肿的 80 例患者作为研究对象。按照抽签法将患者分为对照组和试验组，每组各 40 例。对照组给予常规护理， 试验组给予循证护理。比较两组的水肿程度、康复时间、住院时间、护理满意度以及负性情绪。结果 试验组水肿改善情况优 于对照组（P<0.05）。试验组患肢恢复时间以及住院时间均短于对照组（P<0.05）。试验组护理满意度高于对照组（P<0.05）。试 验组 SAS、SDS 评分较对照组更低（P<0.05）。结论 乳腺癌术后患肢淋巴水肿患者实施循证护理，能够改善患肢水肿程度，缩 短恢复时间和住院时间，提升护理满意度，减轻焦虑抑郁情绪。     

有氧恢复操对乳腺癌术后预防患肢淋巴水肿及促进上肢功能恢复的影响

目的通过有计划的指导训练乳腺癌术后患者的患肢功能锻炼,使她们在短时间内恢复手臂正常功能,降低患肢淋巴水肿的发生率,让其尽早恢复正常的生活和工作。方法将120例乳腺癌改良根治术后患者随机分为对照组和实验组。2组均在术后第6天开始指导功能锻炼,对照组行常规乳腺癌术后护理并嘱其按时功能锻炼,实验组除行常规乳腺癌术后护理外并教其做有氧恢复操[1]。结果实验组恢复时间平均43.3d,淋巴水肿轻度3例,中度0例,自我评价满意。对照组恢复时间平均61.7d,其中淋巴水肿轻度17例,中度6例。结论通过有氧恢复操可以帮助患者尽早恢复患肢功能,降低淋巴水肿的发生,还可增强身体免疫力,使身体尽早恢复健康,提高生活质量。     

系统早期活动方案对乳腺癌根治术患者的影响

目的 探讨系统早期活动方案对乳腺癌根治术后患者的影响.方法 选择98例乳腺癌根治术后的患者,随机分为实验组和对照组,实验组术后当天即开始实行系统早期活动方案;对照组采用传统方法,即术后3～5 d才开始康复护理和功能锻炼,术后分别评价两组患者的患侧上肢功能及上肢淋巴水肿发生率.结果 实验组患者术后21 d患肢功能恢复较对照组明显提高(P＜0.01);实验组患肢淋巴水肿发生率较对照组明显减少(P＜0.05).结论 乳腺癌根治术后进行系统早期活动方案可大大改善患肢的功能,提高患者的生活质量.     

不同护理干预方法在乳腺癌术后上肢淋巴水肿的应用价值

目的探讨不同的护理干预方法对乳腺癌术后上肢淋巴水肿的应用价值。方法对180例乳腺癌术后患者进行护理干预,分为三组,每组60例。即常规组（常规护理及心理护理）、按摩组（在常规组的基础上,增加手法按摩）和加压组（在按摩组的基础上,增加空气波压力治疗仪）。观察术后3个月,6个月,9个月,12个月患肢水肿的护理效果。结果3～12个月加压组明显降低了上肢淋巴水肿发展程度及发生率,并提高了上肢功能康复的程度,且在常规组的基础上增加手法按摩和＼或空气波压力治疗仪后,患者的上肢淋巴水肿发展程度及发生率下降,上肢功能康复提高。结论采用手法按摩加空气波压力治疗仪的护理干预方式,能够更好地预防及治疗术后上肢淋巴水肿,提高疗效及患者生活质量。     

有氧恢复操对乳腺癌术后预防患肢淋巴水肿及促进上肢功能恢复的影响

目的 通过有计划的指导训练乳腺癌术后患者的患肢功能锻炼,使她们在短时间内恢复手臂正常功能,降低患肢淋巴水肿的发生率,让其尽早恢复正常的生活和工作.方法 将120例乳腺癌改良根治术后患者随机分为对照组和实验组.2组均在术后第6天开始指导功能锻炼,对照组行常规乳腺癌术后护理并嘱其按时功能锻炼,实验组除行常规乳腺癌术后护理外并教其做有氧恢复操[1].结果 实验组恢复时间平均43.3 d,淋巴水肿轻度3例,中度0例,自我评价满意.对照组恢复时间平均61.7 d,其中淋巴水肿轻度17例,中度6例.结论 通过有氧恢复操可以帮助患者尽早恢复患肢功能,降低淋巴水肿的发生,还可增强身体免疫力,使身体尽早恢复健康,提高生活质量.     

梯度压力治疗对乳腺癌患者术后淋巴水肿肢功能康复和生活质量的影响

目的 探讨梯度压力治疗对乳腺癌患者术后淋巴水肿肢功能康复和生活质量的影响.方法 2018年3月—2019年3月选取本院收治的乳腺癌根治手术患者85例,根据随机数字表将患者分为观察组(n=43)及对照组(n=42),对照组术后行早期患肢功能锻炼,观察组在对照组基础上进行梯度压力治疗,干预时间为3个月,比较两组淋巴水肿发生率、肩关节活动度及生活质量情况.结果 观察组淋巴水肿发生率显著低于对照组(P<0.05).观察组干预后肩关节前屈上举、外展、后伸及内收等范围肩关节活动度优于对照组(P<0.05).干预后观察组生理状况、情感状况、社会或家庭状况、功能状况、附加关注得分及生活质量总评分均高于对照组(P<0.05).结论 梯度压力治疗能有效预防乳腺癌根治手术患者术后淋巴水肿,从而提高患者术后生活质量.     

患肢功能锻炼联合预防水肿康复护理对乳腺癌患者的影响

目的:探讨患肢功能锻炼联合预防水肿康复护理对乳腺癌患者的影响。方法:将62例乳腺癌患者随机分为对照组和观察组各31例,对照组给予患肢功能锻炼,观察组给予患肢功能锻炼联合预防水肿康复护理,比较两组护理效果。结果:两组淋巴水肿情况、肢体功能恢复情况及肢体功能恢复时间比较差异有统计学意义(P0.05)。结论:患肢功能锻炼联合预防水肿康复护理可有效改善乳腺癌患者的预后,促进功能恢复。     

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.