丙泊酚用于人工流产术的观察及护理

[目的]探讨丙泊酚在人工流产手术中的无痛效果及护理方法。[方法]将门诊行人工流产300例病人随机分为两组,其中150例术前应用丙泊酚静脉麻醉注射为实验组,150例应用宫术凝胶棒置于宫颈内口麻醉为对照组,观察两组术中疼痛效果。[结果]实验组病人均达到无痛效果,满意率100%;麻醉效果明显优于对照组。[结论]丙泊酚为人工流产麻醉的理想选择,积极有效的护理是保证无痛人流术成功的重要因素。     

宫颈局部麻醉实施无痛人工流产的护理及护理配合

[目的]观察宫颈局部麻醉实施无痛人工流产的效果.[方法]对475例宫颈局部麻醉下行无痛人工流产的病人实施术前心理护理,术中配合局部用药、护理及术后健康指导.[结果] 结果显效394例,有效69例,无效12例.[结论] 宫颈局部麻醉实施无痛人工流产是一种较好的方法.     

丙泊酚联合芬太尼用于无痛人工流产术临床效果观察

目的通过对680例应用丙泊酚联合芬太尼施行无痛人工流产术的临床效果观察,进一步确定丙泊酚联合芬太尼用于无痛人工流产术是目前终止早期妊娠的安全、有效的手术方式。方法选择680例要求无痛人工流产术的早孕妇女作为观察组,术中给予芬太尼、丙泊酚进行静脉麻醉,并与同期要求传统人工流产术的早孕妇女进行对比观察。观察两组患者的疼痛程度、出血量、人工流产综合征的发生率,并记录观察组麻醉前、手术中及手术后血压、心率和血氧饱和度的变化,麻醉恢复时间及不良反应。结果观察组疼痛程度明显轻于对照组,无一例人工流产综合征的发生,两组患者在出血量方面比较差异无统计学意义。观察组麻醉恢复快、不良反应小,麻醉和手术期间血压和心率下降较明显,术后可迅速恢复。结论丙泊酚联合芬太尼用于无痛人工流产术,起效快,恢复快,镇痛效果好,麻醉不良反应小,可预防人工流产综合征的发生,是目前终止早期妊娠的安全、有效的手术方式。     

463例无痛人工流产术病人麻醉复苏期的观察及护理

[目的]总结无痛人工流产术病人麻醉复苏期的观察及护理。[方法]对463例早孕病人行无痛人工流产手术,均采用丙泊酚进行麻醉,术后麻醉复苏期密切观察病情、积极预防并发症等。[结果]麻醉复苏期,出现低血压82例,低氧血症165例,变态反应5例,经及时处理,病人均顺利复苏,无严重并发症发生。[结论]加强无痛人工流产术病人麻醉复苏期的观察及护理,可减少并发症的发生,使病人顺利复苏。     

丙泊酚复合芬太尼静脉麻醉在人工流产中的应用与护理

目的：探讨丙泊酚复合芬太尼静脉麻醉下行人工流产的效果与护理。方法：选取100例人工流产患者为观察组,给予丙泊酚复合芬太尼静脉滴注,选取100例人工流产患者为对照组,给予单纯丙泊酚静脉注射,记录两组患者诱导前后平均动脉压、心率和血氧饱和度,观察麻醉期间患者有无不良反应及呼吸循环状态,实施相应护理方法,并对观察结果进行比较。结果：观察组诱导期丙泊酚用量明显少于对照组（P〈0.01）,诱导前两组平均动脉压、心率和血氧饱和度比较均无显著性差异（P〉0.05）,诱导后两组平均动脉压、心率和血氧饱和度比较均有显著性差异（P〈0.01）,手术结束后两组平均动脉压、心率和血氧饱和度比较均无显著性差异（P〉0.05）。观察组麻醉镇痛效果明显优于对照组。结论：应用丙泊酚静脉复合芬太尼行人工流产术麻醉效果可靠,加强镇痛作用的同时未见加深丙泊酚的呼吸循环抑制作用,显著减少了丙泊酚的用量。     

526例丙泊酚麻醉下无痛人工流产术病人的护理

无痛人工流产术是近年发展起来的一种使用全身麻醉技术,使病人在手术操作过程中处于短暂睡眠,手术完毕立即清醒如常,并对整个手术过程无记忆、无痛苦感觉的手术[1,2]。2008年3月—2009年2月我院妇产科与手术室、麻醉科合作开展了在丙泊酚静脉麻醉下行无痛人工流产术526例,同时加强术前准备、术中监护、术后护理及医护间的密切配合,效果满意。现     

丙泊酚与利多卡因在无痛人工流产中的应用

近年来无痛术在人工流产中的应用日益增多 ,可使患者在术中无痛感觉 ,体现现代人文关怀 ,而且使手术更具安全。我院妇产科于1999年10月以来开展应用丙泊酚静脉麻醉、利多卡因宫颈旁阻滞麻醉两种方法进行无痛人工流产效果研究并与对照组进行比较。现将结果报道如下。1资料与方法1.1研究对象选择1999年10月～2001年6月门诊行人流的早孕妇女400例 ,年龄19～42岁 ,孕期40～70天 ,所有病人均无心血管疾病及过敏史。随机分为3组 :Ⅰ组为丙泊酚组150例 ;Ⅱ组为利多卡因组150例 ;Ⅲ组为对照组100例。各组的年龄、孕次、产次、孕龄均无显著差异。1.2…     

氯诺昔康联合丙泊酚用于无痛人工流产术的观察及护理

[目的]探讨提高无痛人工流产术安全性的方法。[方法]选择妊娠1月～2月自愿施行人工流产术的孕妇60例,随机分为治疗组和对照组,每组各30例,对照组为单纯丙泊酚静脉麻醉,治疗组先静脉注射氯诺昔康8mg后行丙泊酚静脉麻醉。[结果]丙泊酚用量治疗组少于对照组,呼吸抑制发生率治疗组少于对照组,术后缩宫痛治疗组明显少于对照组;两组术中血压、心率、脉搏氧饱和度比较无显著性差异。[结论]氯诺昔康能提高丙泊酚静脉麻醉无痛人工流产术的安全性。     

氧化亚氮联合利多卡因并给予心理护理在人工流产中的效果观察

[目的]观察氧化亚氮联合利多卡因并给予心理护理在人工流产中的效果.[方法]选择160例行人工流产术病人,随机分为观察组和对照组,每组80例,观察组采用氧化亚氮吸入及2%利多卡因宫颈旁阻滞麻醉并给予心理护理,对照组采用传统人工流产术.观察并比较两组镇痛效果、术中出血量、宫颈松弛情况、人工流产综合征发生情况.[结果]现察组镇痛及宫颈松弛效果明显高于对照组(P<0.05),人工流产综合征的发生明显低于对照组(P<0.05),手术出血量两组差异无统计学意义(P>0.05).[结论]氧化亚氮联合利多卡因并给予心理护理应用于人工流产术镇痛效果好,宫颈松弛满意,人工流产综合征发生率低,病人术中配合好.     

氯诺昔康联合丙泊酚用于无痛人工流产术的观察及护理

[目的]探讨提高无痛人工流产术安全性的方法。[方法]选择妊娠1月～2月自愿施行人工流产术的孕妇60例,随机分为治疗组和对照组,每组各30例,对照组为单纯丙泊酚静脉麻醉,治疗组先静脉注射氯诺昔康8mg后行丙泊酚静脉麻醉。[结果]丙泊酚用量治疗组少于对照组,呼吸抑制发生率治疗组少于对照组,术后缩宫痛治疗组明显少于对照组;两组术中血压、心率、脉搏氧饱和度比较无显著性差异。[结论]氯诺昔康能提高丙泊酚静脉麻醉无痛人工流产术的安全性。     

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.