盐酸利多卡因胶浆用于男性导尿术的研究

目的探讨盐酸利多卡因胶浆用于男性导尿患者尿道表面麻醉的效果及安全性。方法103例患者随机分为:试验组53例和对照组50例。试验组在插管前用2%利多卡因胶浆浸湿棉球润滑导尿管前段,插入尿道约7~8 cm时,向尿管(16 F)内注入盐酸利多卡因胶浆6~8 ml,待2~3 min药液扩散吸收后再继续插入尿管。对照组用传统的石蜡油润滑导尿法。用疼痛视觉模拟评分(VAS)、疼痛行为反应评级评估患者导尿时疼痛的程度,同时监测患者的血压和心率变化。结果2组患者中,VAS评分、疼痛行为反应评级差异有显著性(P<0.01),但心率、血压差异无显著性(P>0.05)。结论在男患者导尿时,于尿管注入盐酸利多卡因胶浆,可起表面麻醉和润滑作用,对尿道黏膜创伤小、无副作用,能明显减轻患者疼痛。     

盐酸丁卡因胶浆在导尿操作中的应用

目的探讨盐酸丁卡因胶浆在导尿操作中应用的临床效果。方法选择需要导尿的患者100例,按就诊次序单双号分为观察组和对照组,每组50例,分别使用盐酸丁卡因胶浆和无菌石蜡油润滑尿管后进行导尿,观察两组患者自述的疼痛感觉。结果观察组自述疼痛感觉较对照组减轻,两组比较差异有统计学意义（P〈0.05）。结论在导尿过程中使用盐酸丁卡因胶浆尿道局部使用和润滑尿管后导尿的方法 ,可起到较好的局部麻醉和润滑作用,明显减轻患者在导尿过程中的疼痛,值得推广应用。     

全身麻醉男性手术病人留置导尿时间及方法的探讨

[目的]探讨全身麻醉男性手术病人术前最佳的留置导尿方法,提供更优质的护理.[方法]将120例男性择期手术病人随机分为3组,A组采用全身麻醉后导尿法,B组采用全身麻醉前从尿道注入利多卡因胶浆后再实施导尿法,C组在全身麻醉后加尿道注入利多卡因胶浆后再实施导尿.比较3组在插尿管时、麻醉苏醒期、回病房后的尿道疼痛刺激反应情况.[结果]A组麻醉苏醒期有疼痛刺激反应者59.0%,回病房后占87.5%;B组插管时、麻醉苏醒期、回病房后有疼痛刺激反应者占92.5%、45.0%、17.5%;C组有疼痛反应刺激者仅2.5%.[结论]采用全身麻醉后尿管注入利多卡因胶浆再插尿管的方法,有效地减轻了病人由于导尿造成的尿道刺激反应,缩短了导尿时间.     

男性手术全身麻醉患者留置导尿时机及方法的探讨

目的探讨全身麻醉男性手术患者留置导尿的最佳时机和方法。方法选取男性择期全身麻醉手术患者,随机分为3组各30例。A组全身麻醉诱导前从尿道注入利多卡因胶浆后再实施导尿;B组全身麻醉诱导后实施导尿;C组全身麻醉诱导后尿道注入利多卡因胶浆后再实施导尿。观察并比较3组患者在导尿前、中、后的心率和血压变化,比较3组患者在插尿管时、麻醉苏醒期、回病房后的尿道刺激反应及躁动评分情况,比较各组之间的差异。结果 A组患者导尿后术中、术后心率和血压较术前升高(P0.05),B组、C组患者导尿后与术前比较差异无统计学意义(P0.05)。A组患者插尿管时尿道刺激明显,而B组和C组无刺激,而苏醒期和回病房后,B组患者尿道刺激反应较A组、C组高(P0.05)。与A组、C组相比,B组苏醒期躁动评分升高(P0.05),而C组与A组比较差异无统计学意义(P0.05)。结论全身麻醉诱导后采用尿道注入利多卡因胶浆再实施留置导尿有效减轻了男患者因隐私、尿道刺激而导致的血压和心率升高,降低了全身麻醉男患者苏醒期躁动的发生率。     

全身麻醉男性手术病人留置导尿时间及方法的探讨

[目的]探讨全身麻醉男性手术病人术前最佳的留置导尿方法,提供更优质的护理。[方法]将120例男性择期手术病人随机分为3组,A组采用全身麻醉后导尿法,B组采用全身麻醉前从尿道注入利多卡因胶浆后再实施导尿法,C组在全身麻醉后加尿道注入利多卡因胶浆后再实施导尿。比较3组在插尿管时、麻醉苏醒期、回病房后的尿道疼痛刺激反应情况。[结果]A组麻醉苏醒期有疼痛刺激反应者59.0%,回病房后占87.5%;B组插管时、麻醉苏醒期、回病房后有疼痛刺激反应者占92.5%、45.0%、17.5%;C组有疼痛反应刺激者仅2.5%。[结论]采用全身麻醉后尿管注入利多卡因胶浆再插尿管的方法,有效地减轻了病人由于导尿造成的尿道刺激反应,缩短了导尿时间。     

老年男性脑卒中患者导尿管置管新方法

目的:探讨老年男性脑卒中患者导尿管置管新方法。方法:选择2013年6月~2014年2月在我科住院治疗的老年男性脑卒中患者80例,将其随机等分为对照组和试验组,对照组采用传统的导尿方法,观察组用石蜡油润滑尿道口,将尿管插入约10 cm后,向尿管内注入0.1%盐酸利多卡因10 ml,约3 min,再继续插入尿管。比较两组患者一次置管成功率和疼痛程度。结果:观察组患者一次置管成功率明显高于对照组(P0.05),痛疼程度轻于对照组(P0.05)。结论:用石蜡油润滑尿道口,向尿道内注入0.1%的盐酸利多卡因注射液,提高了一次置管成功率,减轻了患者疼痛程度,减少尿道感染的机会,值得临床推广应用。     

盐酸利多卡因胶浆在前列腺增生患者导尿中的临床应用

对我院住院的50例排尿困难、小便不尽的前列腺增生患者采用盐酸利多卡因胶浆术辅助导尿。用注射器抽取盐酸利多卡因胶浆缓慢注入患者尿道,2~3min后,插尿管至有尿液流出。所有患者均一次插管成功。采用盐酸利多卡因胶浆导尿,减轻了患者的痛苦,减少了插管次数,提高了导尿成功率,减少了反复插管所致的损伤、出血、尿道感染的机会。     

盐酸丁卡因胶浆在男性患者术前留置导尿中的应用

目的探讨盐酸丁卡因胶浆在术前导尿中的应用效果。方法将70例需术前留置尿管的男性患者随机分为对照组（35例）和实验组（35例）。对照组采用石蜡油棉球润滑导尿管前端,实验组采用盐酸丁卡因胶浆润滑导尿管前端和尿道。观察两组患者插管一次成功率,插尿管时患者的疼痛等级及插管后10min尿道刺激反应程度。结果实验组插管一次成功率为85．7％,对照组为54．3％,差异有统计学意义（x2=8．231,P〈0．01）;两组患者插管时疼痛程度及插管后10min尿道刺激反应程度差异均有统计学意义（x2=17．437,9．69;P〈0．05）。结论男性患者导尿时,用盐酸丁卡因胶浆润滑尿管和尿道能明显减轻插管时的疼痛,降低患者插管后10min尿道刺激反应程度,提高了一次性插管成功率。     

经尿管注入利多卡因和石蜡油导尿法

前列腺增生病人需从尿管注入石蜡油、利多卡因用于导尿 ,选择 10 0例患者 ,年龄 67～ 88岁 ;结果无 1例尿道损伤 ,导尿均一次成功。在常规导尿过程中 ,当插管遇到阻力 ,病人疼痛难以忍受 ,致使尿管无法插入时 ,保持尿管位置不动 ,请助手用5ｍｌ注射器抽取 2 %利多卡因 3～ 4ｍｌ,由尿管尾端开口处 ,向尿管内注入 ,1～ 3ｍｉｎ再抽取 2～ 3ｍｌ无菌石蜡油 ,由尿管尾端注入后再将尿管插入。在此操作过程中 ,石蜡油注入后起到润滑剂的作用 ,可减少尿管插入时的阻力。而利多卡因能麻醉感觉神经 ,解除病人由插管时引起的疼痛 ,并松弛尿道前列腺部…     

盐酸丁卡因胶浆在男性患者全麻后留置导尿术中的应用

目的：探讨盐酸丁卡因胶浆预防男性患者全麻后留置导尿管复苏期间躁动的效果。方法将120例术前留置导尿管的男性患者随机分为观察组和对照组,每组各60例,其中观察组将盐酸丁卡因胶浆软管前端插入尿道,将胶浆挤入约2g,提高阴茎,余下3g 涂抹于尿管前段,2min 后将导尿管插入尿道;对照组用无菌液体石蜡油涂抹于尿管前段,全麻苏醒期间观察并记录患者血压、心率、躁动程度。结果2组患者苏醒期复苏良好,对照组血压、心率变化均高于观察组（P ＜0．05）,发生躁动的例数、程度均高于观察组（P ＜0．05）。结论盐酸丁卡因胶浆对男性患者全麻后留置导尿复苏期躁动有良好的预防作用。     

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.