关节置换术后康复训练预防下肢深静脉血栓疗效分析

目的评价康复训练在预防关节置换术后下肢深静脉血栓(DVT)的作用。方法将50例髋、膝关节置换术的患者随机分成两组,实验组术后进行足踝主动运动、股四头肌等长收缩运动和深呼吸训练,对照组术后被动按摩偏瘫侧比目鱼肌和腓肠肌。比较术前和术后1周股静脉血流速度及下肢DVT的发生情况。结果经康复训练,实验组股静脉血流峰速度高于对照组(P<0.01);实验组有1例发生DVT,对照组有4例发生DVT,两组比较差异有统计学意义(P<0.05)。结论康复训练可有效预防髋、膝关节置换术后下肢DVT。     

早期活动对预防脑出血患者术后下肢深静脉血栓形成的作用

目的 制订早期活动方案,探讨其对预防脑出血患者术后深静脉血栓形成(deep venous thrombosis,DVT)的临床效果.方法 按随机数字表法将100例脑出血术后患者分成试验组和对照组各50例,试验组除给予脑出血术后常规护理外,实施系统早期活动方案,即术后进行足踝被动或主动运动,腓肠肌、股二头肌、股四头肌和臀大肌等长收缩运动和深呼吸训练;对照组给予脑出血术后常规护理.分别在干预前及干预后第7日测量两组患者股静脉血流速度及DVT的发生情况.结果 试验组股静脉血流速度明显高于对照组,而术后DVT发生率明显低于对照组.结论 系统早期活动方案能提高下肢静脉血流速度,安全、有效地预防脑出血术后患者下肢DVT的形成.     

早期运动护理对预防脑出血患者术后下肢深静脉血栓形成的作用

目的 探讨早期运动护理对脑出血患者在手术后深静脉血栓形成(DVT)的作用.方法 选取脑出血患者200例,随机分为运动组和对照组,每组100例.对照组术后进行脑出血常规护理;运动组在脑出血术后常规护理基础上进行足踝部的主动和被动运动以及股四头肌,臀大肌和股二头肌的收缩运动以及进行深呼吸训练.术后及术后第7天观察两组患者股静脉血流速度以及DVT的发生情况.结果 术后第7天运动组的股静脉血流速度与对照组相比明显升高(P＜0.05),术后的DVT的发生率较对照组明显降低(P＜0.05).结论 术后早期给予脑出血患者运动护理可以提高下肢静脉血流速度,并能够显著降低脑出血术后患者下肢DVT的发生率.     

康复训练对骨科术后深静脉血栓的预防作用

目的探讨康复训练对于骨科术后下肢深静脉血栓(DVT)的预防作用。方法选择68例骨科手术患者,术后进行下肢的被动及主动活动,包括踝关节的屈伸活动,膝关节的屈伸活动及股四头肌的等长收缩活动,应用彩色多普勒超声测定康复功能训练前与训练后下肢血流速度的变化。结果该研究中的病例均无DVT发生。踝关节、膝关节的主动、被动运动均可增加股动、静脉的血流速度,包括峰速度及平均速度,运动前后比较差异有统计学意义(P0.05),而且主动运动增加血流速度的幅度要明显高于被动运动(P0.05)。结论正规康复功能训练可促进患肢静脉回流,避免血流滞缓,达到预防下肢DVT的目的,具有简单、安全、有效、无创伤等优点,不需特殊设备,不会给患者增加经济负担,因此在临床及护理工作中有极大的应用价值。     

系统早期活动对卵巢癌患者术后下肢深静脉血栓形成的影响

目的 探讨系统早期活动方案,了解卵巢癌患者术后其预防深静脉血栓形成(deep-venous thrombosis,DVT)的临床效果.方法 采用随机分组的原则将62例卵巢癌术后患者分成实验组和对照组,实验组除给予卵巢癌术后常规护理外,实施系统早期活动方案,即术后进行足踝被动或主动运动,腓肠肌、股二头肌、股四头肌和臀大肌等长收缩运动和深呼吸训练;对照组给予卵巢癌术后常规护理及由护理人员进行简单的术后活动健康教育,未给予活动时间及形式上的具体指导.分别记录两组患者术后下肢深静脉血栓的发生情况.结果 实验组术后下肢深静脉血栓发生率明显少于对照组,差异有统计学意义(P<0.05).结论 系统早期活动能有效地预防卵巢癌术后患者下肢DVT的发生.     

早期活动对预防髋关节置换术后下肢深静脉血栓形成的效果观察

目的：探讨早期活动对预防髋关节置换术后下肢深静脉血栓形成（deep venous thrombosis,DVT）的临床效果。方法选取在本院行髋关节置换术的患者100例,随机分成观察组和对照组,观察组在给予术后常规护理的基础上,执行科室制订的早期活动计划;对照组给予术后常规护理。分别在干预前1日及干预第7日活动30min 内比较2组患者股静脉血流速度及 DVT 的发生情况。结果观察组 DVT 发生率为2．0％,明显低于对照组的12．5％,差异具有统计学意义（P ＜0．01）。结论早期活动能提高下肢股静脉血流速度,有效预防 DVT 的发生。     

综合护理干预对中老年髋、膝关节置换术后下肢深静脉血栓的预防作用

目的探讨综合护理干预在预防中老年髋、膝关节置换术后下肢深静脉血栓(DVT)发生中的效果。方法选取行髋、膝关节置换术的中老年患者101例,随机分为观察组51例和对照组50例。对照组采取常规护理方式,观察组在对照组基础上实施综合护理干预。观察2组患者术后第7天DVT、下肢肿痛、腓肠肌压痛及血流淤滞发生情况,及患者满意度。结果观察组下肢肿痛、腓肠肌压痛、血流淤滞、DVT发生率均低于对照组,差异有统计学意义(P0.05);观察组在业务水平、工作态度、病区管理、疾病普及、健康教育5个方面的护理满意度均高于对照组,差异有统计学意义(P0.05)。结论实施综合护理干预可提高中老年患者髋膝关节置换术后的护理满意度,降低DVT的发生率。     

压力泵治疗仪预防全髋置换术后患者下肢深静脉血栓形成的临床研究

目的 观察压力泵治疗仪预防全髋置换术后患者下肢深静脉血栓（deep vein thrombosis, DVT）的效果。方法 选择 2012年 1月－2012年 6月我院骨科48例全髋置换术后采用低分子肝素皮下注射治疗患者为对照组,同期40例全髋置换术后使用压力泵治疗仪辅助治疗患者为观察组。比较两组患者 DVT形成情况及静脉栓子检出率、栓子直径。结果 两组患者术后 10 d均没有发生 DVT,观察组静脉栓子检出率明显低于对照组（P＜ 0.01）,且栓子以自行吸收栓子（直径0.1 cm～0.3cm）为主。结论 全髋置换术后患者使用压力泵治疗仪能有效降低静脉栓子形成的危险,预防 DVT的发生,且经济实惠,值得临床推广应用。     

磁治疗带预防髋膝关节术后下肢深静脉血栓形成

目的：评价磁治疗带预防髋膝关节术后下肢深静脉血栓形成（DVT）的疗效。方法：48例接受髋膝周围手术的患者随机分为2组，预防组术后应用磁治疗带治疗，对照组不采用任何预防措施，术后4－7d行患侧静脉造影，了解深静脉血栓的发生情况。结果：对照组中8例发生DVT占33．3％，预防组中1例占4．2％。2组比较差异有显著性（P＜0．05）。结论：磁治疗带能安全，有效地预防髋膝关节及其周围手术后下肢深静脉血栓形成。     

规范化护理干预在髋、膝关节置换术后预防下肢DVT中的应用

目的:探讨规范化护理干预对髋、膝关节置换术后下肢深静脉血栓形成(DVT)的效果。方法:将2014年8月~2015年8月骨科收治的180例髋、膝关节置换术患者设为对照组,给予常规护理;将2015年9月~2016年8月骨科收治的180例髋、膝关节置换术患者设为观察组,在对照组基础上实施规范化的护理干预。比较两组DVT情况。结果:观察组深静脉血栓发生率明显低于对照组(P0.05)。结论:规范化的护理干预可以有效预防髋、膝关节置换术后DVT。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.