儿童功能性便秘的护理干预效果观察

[目的 ]探讨护理干预对 3岁～ 7岁儿童功能性便秘的效果。 [方法 ]将72例功能性便秘患儿随机分成两组 ,干预组接受问卷调查和排便习惯训练的护理干预 ,对照组只接受问卷调查 ,观察两组的膳食结构和排便情况。[结果 ]在膳食结构基本相似的情况下 ,两组的排便情况比较有统计学意义 (P <0 .0 5 ) ,而且干预组粪便性状有显著性改善。 [结论 ]以护理干预主导的排便习惯训练 ,对治疗 3岁～ 7岁儿童功能性便秘有重要的作用     

针对性护理干预在预防强阿片类药物致便秘中的疗效探讨

目的 探究针对性护理干预方法对阿片类药物引起便秘的预防护理效果。方法 选取 2021 年 6 月至 2022 年 12 月期间我 院收治的 64 例癌痛患者作为研究对象。采用电脑随机分组的方法将患者分为对照组和研究组，每组各 32 例。对照组采用常规 护理方法，研究组采用针对性护理干预方法。分析对比两组的护理效果、便秘症状、心理状态、排便顺畅程度及不良反应。结 果 研究组的护理总有效率显著高于对照组（P<0.05）。研究组护理后的便秘症状评分显著低于对照组（P<0.05）。研究组护理后 的排便心理状态和排便积分情况均显著优于对照组（P<0.05）。研究组护理后的排便顺畅程度显著高于对照组（P<0.05）。研究 组护理后的不良反应发生率显著低于对照组（P<0.05）。结论 针对性护理干预方法应用于阿片类药物引起便秘的癌痛患者的护 理中，能提高护理效果，改善便秘症状和心理状态，提升排便顺畅程度，减少不良反应。     

排便护理干预对急性心肌梗死合并便秘患者疗效及症状评分指标影响

目的 观察排便护理干预对急性心肌梗死(AMI)合并便秘患者疗效及症状评分指标影响。方法 连续选择 近期在中国医科大学附属第一医院急诊科救治的AMI合并便秘患者77例,并按随机数字表和住院顺序分为干预 组（34例）和对照组（33例）,病情平稳后,干预组接受了排便专项护理干预,并使用便秘症状及疗效评估问卷与对 照组比较。结果干预组进行排便专项护理干预后排便困难、粪便性状、排便时间、下坠感、排便频度、腹胀和便秘 症状总分均明显少于对照组（P均<0. 01）。结论排便护理干预可明显改善AMI合并便秘患者的疗效及症状评 分指标.     

剖宫产术前留置导尿管时机的临床研究

目的：探讨临床护理路径在预防老年急性心肌梗死患者便秘中的应用。方法：将130例老年急性心肌梗死患者随机分为观察组和对照组各65例，对照组给予常规护理，观察组采用临床护理路径系统护理，即按照路径图采取心理支持、早期预防、饮食护理、促进排便练习、首次排便监护等护理干预措施。观察两组患者便秘及心肌梗死面积再增大的发生情况。结果：观察组患者接受护理干预后排便情况、便秘的发生情况。便秘的症状及心肌梗死面积再增大的发生与对照组比较差异有显著性意义（P〈0．05）。结论：应用临床护理路径进行护理干预能显著降低老年急性心肌梗死患者便秘的发生率，提高患者的救治成功率和生活质量。     

手部全息刮痧联合心理护理对老年慢性便秘患者的临床护理效果

目的 探究分析手部全息刮痧联合心理护理对老年慢性便秘患者的护理效果。方法 2022 年 1 月至 2022 年 12 月我院收治 的脑卒中后便秘患者 70 例，根据入院时间分为对照组以及观察组。对照组采用常规护理模式进行干预。观察组采用手部全息 刮痧联合心理护理模式对患者进行干预。对比两组的粪便性状和排便情况。结果 观察组优于对照组，P<0.05。结论 对脑卒中 后便秘患者采用手部全息刮痧联合心理护理模式，能够改善粪便性状和排便情况。     

饮食干预与指压按摩对AMI患者稳定期排便情况的效果评价

目的 探讨饮食干预加指压按摩对急性心肌梗死（AMI）患者稳定期排便情况的影响。方法 将60例患者分为干预组（n=30）和对照组（n=30）,对照组给予常规护理,干预组在常规护理基础上给予饮食干预与指压按摩。结果 干预组发生便秘5例,便秘发生率16.7%,对照组发生便秘者17例,便秘发生率56.7%,两组比较差异有显著意义（χ2=10.33,P〈0.05）;干预组发生心力衰竭者1例,发生率3.3%,对照组发生心力衰竭者8例,发生率26.6%,两组比较差异有显著意义（χ2=6.41,P〈0.05）;干预组没有死亡患者,对照组发生2例死亡,两组比较差异无显著意义（χ2=2.07,P〉0.05）;干预组患者住院期间满意度优于对照组（χ2=5.46,P〈0.05）。评估两组患者出院前1～3d排便症状（排便困难、粪便性状、排便时间、排便频度、腹胀）,各条目得分及总分比较差异有显著意义（P〈0.05）,下坠、不尽感此条目显示无显著意义。结论常规护理基础上给予饮食干预、指压按摩,可改善AMI患者排便情况,降低便秘与心力衰竭的发生率,提高住院患者满意度,干预效果显著。     

护理干预对围手术期伴便秘患者的效果

目的观察护理干预对围手术期伴有便秘患者的护理效果。方法将围手术期伴有便秘的患者随机分为3组,对照组、药物组及干预组各50例,疗程8周。观察各组患者腹胀、排便次数、排便形状等症状改善情况。结果干预组采用护理干预后患者腹痛、排便次数及排便形状均有所改善,与其他两组相比差异均有统计学意义（p〈0．05）。结论护理干预可有效缓解围手术期患者便秘的情况。     

化疗患者应用止吐剂所致便秘的护理干预效果观察

目的针对止吐剂所致化疗患者便秘采取相应护理对策的研究。方法将40例患者随机分组，试验组接受心理护理和饮食、生活方式、排便习惯功能训练、问卷调查等系统护理。对照组只接受问卷调查，观察两组的排便情况。结果干预后预防便秘效果两组比较差异有显著统计学意义（P〈0．01）。结论以护理干预为主导的心理、饮食、生活方式、排便习惯的功能训练，效果确切，对患者无不良反应，而且可以明显改善排便功能，减轻腹胀，减少患者的痛苦，提高生活质量。     

腹部按摩联合肛提肌运动预防脊柱外科术后患者便秘的效果观察

目的观察腹部按摩联合肛提肌运动护理干预对预防脊柱外科术后患者便秘的效果。方法将79例脊柱外科术后患者随机分为对照组与干预组，对照组40例给予常规护理，即心理护理，排便、饮食和运动指导；干预组39例给予常规护理，同时给予腹部按摩和肛提肌运动的护理干预措施，观察两组脊柱外科术后患者的排便情况。结果脊柱外科术后患者恢复正常排便的时间干预组为（2．38±0．99）d，对照组为（3．68±1．73）d，两组比较差异有显著意义（P-〈0．01）；便秘发生率对照组65．00％，干预组41．02％，两组比较差异有显著意义（P〈0．05）。结论腹部按摩联合肛提肌运动护理干预，可缩短脊柱外科术后患者恢复正常排便的时间，降低术后患者便秘的发生率。     

消胀散巴布剂外敷神阙穴治疗中风后遗症患者便秘的效果观察

目的观察消胀散巴布剂外敷神阙穴治中风后遗症患者便秘的效果。方法选择住院治疗的中风并便秘的患者40例,按就诊先后分成观察组和对照组各20例。对照组采用饮食调整、排便习惯指导、运动指导等护理方法,观察组在对照组的基础上采用消胀散巴布剂敷神阙穴。观察比较干预后第1次排便时间,干预前及干预后第12天患者便秘症候积分情况。结果干预后两组患者首次自主排便时间比较差异有统计学意义（P<0.01）,观察组干预后3 d内首次自主排便情况明显好于对照组;观察组便秘症候总积分及5个条目评分均低于对照组（P<0.01或 P<0.05）。结论消胀散巴布剂敷神阙穴脐外治中风后遗症患者便秘的效果显著,值得临床借鉴和进一步推广应用。     

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.     

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.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.