改良婴儿肠造口袋粘贴方法的效果观察

目的探讨改良造口袋粘贴法在婴儿肠造瘘口护理中的应用效果。方法选取2008年6月—2012年8月在本院行结肠双腔造瘘术住院患儿64例,根据抽签法分为观察组和对照组各32例,对照组采用常规方法粘贴肠造瘘袋,观察组应用水胶体敷料和3M敷贴改良粘贴肠造瘘袋方法,比较两组造口袋保留天数、造口袋松脱例数、肠液外漏例数、造瘘口周围皮肤潮红糜烂例数。结果两组患儿造瘘口均正常排气排便,观察组造口袋保留天数大于对照组,造口袋松脱例数、肠液外漏例数、瘘口皮肤潮红糜烂例数少于对照组,差异均有统计学意义(P0.05)。结论改良造口袋粘贴法在婴幼儿肠造瘘护理应用中有造口袋不易松脱,保留时间长,肠液外漏、造口周围皮潮红糜烂发生减少的优势,可提高婴儿肠造瘘护理质量。     

二件式造口袋预热装置在婴幼儿造口护理中的应用效果

目的 探讨二件式造口袋预热装置在婴幼儿造口护理中的应用效果。方法 采用方便抽样法选取我院2019年7月1日—2021年6月30日儿科医学部肠造口89例患儿为研究对象,按入院时间先后分为对照组44例(2019年7月1日—2020年6月30日)与观察组45例(2020年7月1日—2021年6月30日)。对照组实施造口常规护理;观察组佩戴造口袋前采用二件式造口袋预热装置预热。比较2组患儿造口潮湿相关性皮炎发生率、造口周围皮肤受损程度、造口袋留置时间、造口相关总费用以及照顾者满意度。结果 观察组患儿第1、第2周造口潮湿相关性皮炎发生率以及总发生率均低于对照组(P<0.05);观察组造口周围皮肤受损程度低于对照组。造口袋留置时间长于对照组,照顾者满意度高于对照组,造口相关总费用低于对照组,差异均有统计学意义(P<0.05)。结论 婴幼儿造口护理时使用二件式造口袋预热装置对造口袋进行预热,可有效降低造口潮湿相关性皮炎发生率,减轻皮肤受损严重程度,为照顾者减轻经济负担。     

小儿肠造瘘口及更换造口袋的护理

目的 研究不同小儿肠造瘘口皮肤护理方法和最佳更换造口袋频率对小儿肠造瘘口皮肤病变的影响.方法 通过前瞻性研究将28例肠造瘘患儿分为实验组和对照组,实验组采用造口护理系列产品进行护理,对照组使用传统护理方法进行护理,同时比较不同更换造口袋频率对小儿肠造瘘口周围皮肤病变的差异.结果 实验组在造瘘口周围皮肤湿疹和溃疡的发生率均明显少于对照组(P＜0.05),每7天更换造口袋发生的造瘘口周围皮肤病变是最低(P＜0.05).结论 以造口护理系列产品的护理方法在造口周围皮肤病变防治优于传统护理方法,每7天更换一次造口袋对患儿较为合适.     

改良型造口袋裁剪技术在特殊肠造口中的应用效果观察

目的:探讨改良型造口袋裁剪技术在袢式肠造口、蘑菇形肠造口两类特殊肠造口维护中的效果观察.方法:将126例肠造口病人随机分为对照组和观察组各63例,对照组与观察组均采用ARC标准护理方法,而观察组在造口袋裁剪上采用改良型造口袋裁剪方法,比较两组造口底盘发生渗漏率、造口周围皮肤损伤发生率及造口袋更换时间的差异.结果:观察组粪水性皮炎发生率为12.7％,低于对照组38.1％(P<0.05).术后第1天、术后第4天、术后第7天、术后第10天对照组底盘渗漏发生率为7.9％、36.5％、41.2％和20.6％高于观察组的6.3％、7.9％、11.1％和6.3％,除了术后第1天外,其他均有统计学意义(P<0.001).观察组造口袋更换时间分别为22.49 min、17.13 min、14.52 min和11.22 min,对照组为20.29 min、19.24 min、18.26 min和16.25 min,除术后第1天外,观察组时间均较对照组缩短(P<0.001).结论:采用改良型造口袋裁剪方法在袢式及蘑菇形肠造口中运用时能够有效减少造口底盘发生渗漏,降低粪水性皮炎的发生率,同时后期可缩短造口装更换时间,是可行、有效的造口护理方法.     

2种肠造口袋更换方法的比较

目的：采用2种肠造口袋更换方法对肠造口袋使用时间、并发症发生率进行比较,方法：41例肠造口术后病人,按更换方法不同分成改良组、常规组,改良组更换造口袋时,用测量板、防漏膏、常规组则用目测法,结果和常规组相比,改良组造口袋使用时间延长,造口周围皮肤炎发生率低,结论：更换造口袋应推使用造口测量板确定造口大小,胶板圈不宜过大,对不平整皮肤应使用防漏膏。     

2种肠造口袋更换方法的比较

目的采用2种肠造口袋更换方法对肠造口袋使用时间、并发症发生率进行比较。方法41例肠造口术后病人,按更换方法不同分成改良组、常规组。改良组更换造口袋时,用测量板、防漏膏,常规组则用目测法。结果和常规组相比,改良组造口袋使用时间延长,造口周围皮肤炎发生率低。结论更换造口袋应推广使用造口测量板确定造口大小,胶板圈不宜过大,对不平整皮肤应使用防漏膏。     

负压联合造口袋用于小儿回肠造口底盘渗漏

目的 总结使用负压收集造口排泄物在治疗造口周围皮肤损伤的效果。方法 回顾分析2011年8月－2013年6月治疗的10例造口周围皮肤损伤导致造口袋难以粘贴患儿的临床资料,总结采用负压收集造口排泄物对造口周围皮肤损伤的疗效及安全性。结果 10例患儿造口袋粘贴时间均＞3 d。3 d后造口周围皮肤损伤均明显好转。9例粪性皮炎6 d愈合,1例造口周围皮肤缺损患者9 d愈合。结论 在造口袋中加用负压吸引是院内处理回肠造口周围大面积粪性皮炎的有效大便收集方法,可促进造口周围皮损愈合。     

改良造口袋更换法在高流量肠外瘘患者中的应用

目的:探讨应用改良造口袋更换法改善高流量肠外瘘患者肠液管理、提高患者舒适度的效果。方法:将40例高流量肠外瘘患者随机分为观察组与对照组,对照组采用常规的造口袋更换方法粘贴底盘,观察组采用中心负压吸引管理肠液的同时更换造口底盘,评估两组患者每次更换造口袋的护理时间、肠瘘瘘口周围皮肤重复污染次数、患者的舒适度。结果:观察组与对照组比较,每次更换造口袋的护理时间缩短、肠瘘周围皮肤重复污染次数减少、患者的舒适度提高(P0.05)。结论:改良造口袋更换法可有效减少医护人员更换造口袋的护理时间、减少肠瘘液体污染皮肤次数,提高患者的舒适度。     

膀胱全切术后造口袋固定方式改进的效果

目的 探讨膀胱全切术后改进造口袋固定方式的效果.方法 选取膀胱癌患者75例,按住院日期单双号分为观察组(37例,单号)和对照组(38例,双号).对照组采用常规造口粘贴方法;观察组在此基础上采用改进的造口袋粘贴方法,剪断底盘保护纸、用条形防漏条环绕造口底盘内口、利用胶布撕离保护纸、用手捂热造口袋.观察两组患者造口部位皮肤损害程度、造口部位皮肤消毒情况、造口袋粘贴时间及更换次数.结果 观察组患者皮肤损伤程度、皮肤消毒合格率、更换敷料次数明显较对照组低,且造口袋使用时间较对照组长(P＜0.05).结论 采用正确的更换粘贴造口袋方法能延长有效造口袋使用时间,能够减轻医护人员工作量,有利于减少造口皮肤损伤度.     

康乐保造口袋结合人文关怀护理对小儿肠造瘘口患儿并发症的影响

目的:探讨康乐保造口袋结合人文关怀护理对小儿肠造瘘口患儿并发症的影响。方法:选择2018年6月1日～2019年12月31日收治的85例肠外瘘患儿进行回顾性分析,根据术后不同护理方案分为观察组38例和对照组47例;患儿均行肠造瘘术并应用康乐保造口袋,对照组实施常规肠造瘘术后护理,观察组在对照组基础上实施人文关怀护理;比较两组康复期间黏膜出血、造口周围皮炎、皮肤黏膜分离、腹泻等并发症发生情况。结果:观察组黏膜出血、造口周围皮炎、皮肤黏膜分离发生率均低于对照组(P0.05)。结论:康乐保造口袋结合人文关怀护理可有效降低小儿肠造瘘口并发症发生率。     

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.     

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.     

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.     

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.