标准化康复训练对全髋关节置换术老年股骨颈骨折的影响

目的:探究标准化康复训练在全髋关节置换术治疗老年股骨颈骨折的应用效果。方法:选取2017年5月～2018年5月我院收治102例行全髋关节置换术老年股骨颈骨折患者为研究对象,按照随机数字表法分为观察组与对照组,每组51例。观察组予标准化康复训练,对照组予常规康复训练。随访3个月,比较两组康复效果、关节功能评分、日常生活活动能力评分、满意度评分及并发症发生情况。结果:随访3个月发现,观察组康复优良率明显高于对照组,P0.05;干预前,两组髋关节功能评分及日常生活活动能力评分组间比较,无显著性差异(P0.05);干预后,观察组髋关节功能评分、日常生活活动能力评分及满意度评分均明显高于对照组,P0.05;观察组并发症发生率明显低于对照组,P0.05。结论:对行全髋关节置换术老年股骨颈骨折患者实施标准化康复训练具有较佳的效果,可有效改善髋关节功能,增加其日常生活活动能力,有助于增加患者满意度。     

早期康复护理对老年股骨颈骨折患者的睡眠影响和疗效观察

目的:观察早期康复护理对老年股骨颈骨折患者的疗效以及睡眠的影响。方法:选取2017年1月至2018年1月福建中医药大学附属第二人民医院东二环院区骨科收治的老年股骨颈骨折患者78例,随机分为对照组和观察组,每组39例。对照组给予常规护理,观察组实施早期康复护理。观察2组患者的髋关节功能、并发症发生率以及睡眠质量。结果:观察组患者的Harris评分显著高于对照组,差异有统计学意义(P0.05)。观察组患者的并发症发生率为5.13%,对照组患者的并发症发生率为20.5%,差异有统计学意义(P0.05)。入院时2组患者的PSQI量表评分无显著差异,护理结束后,观察组PSQI量表评分均显著低于对照组,差异有统计学意义(P0.05)。结论:早期康复护理能够促进老年股骨颈骨折患者的功能恢复,改善其睡眠质量,对患者具有重要的应用意义。     

延续性护理对老年髋部骨折患者髋关节功能恢复的影响

目的:探讨延续性护理对老年髋部骨折患者髋关节功能恢复的影响。方法:选择2016年8月-2018年8月在我院治疗的老年髋部骨折患者70例作为观察对象,采用随机数表法分为2组,各35例。对照组使用常规护理,观察组患者在此基础上加用延续性护理。将两组髋关节恢复情况及日常生活能力展开对比分析。结果:干预前,比较两组髋关节功能、日常生活活动能力评分,差异无统计学意义(P0.05);干预1个月、3个月、6个月,观察组髋关节功能、日常生活能力与对照组相比,差异具有统计学意义(P0.05)。结论:延续性护理应用于老年髋部骨折能够促进患者髋部关节功能恢复,提高生活活动能力,促进疾病康复。     

家庭式平衡锻炼在老年股骨颈骨折手术患者中的应用效果分析

目的 研究家庭式平衡锻炼在老年股骨颈骨折手术患者中的应用效果。方法 将就诊的80例老年股骨颈骨折患者纳入研究,随机分为对照组和观察组各40例。对照组行常规护理,观察组在对照组基础上行家庭式平衡锻炼。观察两组干预前后髋关节功能评分变化及术后并发症发生情况。结果 干预后6个月,两组关节功能、关节疼痛、肢体畸形、关节活动度评分均提升,且观察组高于对照组,差异具有统计学意义(P0.05);观察组术后并发症总发生率略低于对照组,差异无统计学意义(P0.05)。结论 家庭式平衡锻炼可显著改善股骨颈骨折术后老年患者的髋关节功能,对术后并发症发生率降低具有积极影响。     

图文式功能锻炼手册对老年股骨颈骨折手术患者的影响

目的:探讨图文式功能锻炼手册对老年股骨颈骨折手术患者的影响。方法:将124例老年股骨颈骨折手术患者随机分为观察组和对照组各62例,对照组给予股骨颈骨折术后常规护理和功能锻炼指导,观察组按图文式功能锻炼手册进行功能锻炼,比较两组患者锻炼效果。结果:两组患者术后功能锻炼相关指标比较差异有统计学意义(P0.05);两组患者术后Harris髋关节指数高于术前(P0.05),观察组术后Harris髋关节指数高于对照组(P0.05);观察组患者术后并发症发生率低于对照组(P0.05)。结论:图文式功能锻炼手册可促进老年股骨颈骨折手术患者康复,提高功能锻炼依从性,减少术后并发症,改善关节功能。     

连续护理对老年髋部骨折手术患者的影响

目的:探讨连续护理对老年髋部骨折手术患者的影响。方法:将118例老年髋部骨折患者随机分为观察组和对照组各59例,对照组给予常规护理,观察组在常规护理基础上给予连续护理,比较两组护理效果。结果:两组护理后Harris髋关节功能评分、Barthel指数评分、一般效能感量表(GSES)评分、日常生活活动能力(ADL)评分及护理满意度、术后并发症发生率比较差异均有统计学意义(P0.05)。结论:连续护理能有效改善老年髋部骨折手术患者的临床效果,提高生活质量及生活自理能力。     

综合护理配合全髋关节置换术治疗老年股骨颈骨折的临床效果观察

目的研究全髋关节置换术治疗老年股骨颈骨折的临床疗效及综合护理方法。方法抽取老年股骨颈骨折患者76例,入院后均行全髋关节置换术治疗,采用抽签法将患者分为2组,对照组行常规护理,观察组行综合护理干预,分析2组患者的临床疗效以及并发症发生情况。结果观察组患者的优良率和并发症发生率分别为76.32%、5.26%,对照组患者的优良率和并发症发生率分别为55.26%、23.68%,2组差异具有统计学意义(P0.05)。2组除了在手术时间方面的差异具有统计学意义外,其余各项差异均无统计学意义(P0.05)。结论老年股骨颈骨折患者行全髋关节置换术治疗后加强综合护理,不仅能够提高临床疗效,还可降低并发症发生率,值得推广使用。     

持续被动运动锻炼联合萧氏双C护理模式对股骨颈骨折老年患者术后髋关节恢复情况及VAS评分的影响

目的:探讨持续被动运动锻炼联合萧氏双C护理模式对股骨颈骨折老年患者术后髋关节恢复情况及视觉模拟评分法(VAS)评分的影响。方法:选取2015年5月～2017年4月我院82例股骨颈骨折老年患者,随机数字表法分组。对照组41例采用常规护理,观察组41例在对照组基础上采用持续被动运动锻炼联合萧氏双C护理模式。统计对比两组干预后髋关节恢复情况与VAS评分。结果:观察组髋关节功能优良率92. 68%高于对照组75. 61%,差异有统计学意义(P 0. 05),差异有统计学意义(P 0. 05);干预2周后,观察组VAS评分低于对照组,差异有统计学意义(P 0. 05)。结论:持续被动运动锻炼联合萧氏双C护理模式可提高股骨颈骨折老年患者髋关节功能,降低VAS评分。     

预防性护理对老年股骨颈骨折患者压疮的影响

目的 探讨预防性护理对老年股骨颈骨折患者压疮的影响.方法 将我院60例股骨颈骨折手术患者分为观察组和对照组各30例,对照组术后常规护理,观察组在对照组的基础上给予预防性护理,比较两组患者压疮的发生情况、家属对压疮的护理能力、下地活动时间、髋关节功能及护理质量满意度.结果 观察组患者的压疮发生率、严重程度显著小于对照组,下地活动时间显著短于对照组,髋关节功能良好率、护理质量的满意率显著高于对照组,家属对压疮的护理能力显著优于对照组(P均＜0.05).结论 预防性护理能够有效降低老年股骨颈骨折患者压疮的发生,促进术后康复.     

综合护理干预对老年股骨颈骨折病人术后的影响

目的分析综合护理干预对老年股骨颈骨折病人术后应用效果。方法选取我院收治的60例老年股骨颈骨折患者,将其分为对照组和试验组各30例。对照组采用常规护理,试验组采用综合护理。观察对比两组患者护理前后的VAS评分和Harris评分、护理满意度和并发症发生率。结果护理前,两组患者VAS评分和Harris评分比较,差异无统计学意义(P0.05);护理后,试验组患者VAS评分和Harris评分分别为2.29±0.53分和82.88±7.74分,均显著优于对照组患者的4.47±0.85分和73.64±7.54分,差异有统计学意义(P0.05)。试验组患者护理满意度显著高于对照组,差异有统计学意义(P0.05)。试验组患者并发症发生率显著低于对照组,差异有统计学意义(P0.05)。结论对老年股骨颈骨折患者采用综合护理干预可以缓解疼痛程度,改善关节功能,降低并发症发生率,提高护理满意度。     

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.