骨关节术后急性疼痛规范化镇痛护理干预的临床分析

目的 探讨规范化镇痛护理干预对骨科术后患者急性疼痛治疗的效果.方法 将40例骨关节手术治疗的患者随机分为观察组和对照组各20例.对照组患者根据疼痛主诉,给予常规镇痛护理.观察组患者在围手术期准确评估疼痛,给予规范化镇痛护理干预.观察并比较两组患者术后72 h的疼痛程度及住院天数的差异.结果 观察组患者术后72 h疼痛程度显著低于对照组(P＜0.05);观察组患者平均住院天数明显少于对照组(P＜0.05).结论 对骨科术后急性疼痛患者进行规范化镇痛护理干预能有效控制术后疼痛,减轻痛苦,缩短住院天数,促进康复.     

中医护理临床路径在胆囊切除术患者术后镇痛中的应用研究

【目的】 探讨中医护理临床路径在胆囊切除术患者术后镇痛的效果。方法 选取我院外科胆囊手术患者120例,随机分为观察和对照两组各60例。对照组术后给予常规的护理干预,观察组在常规护理干预的基础上,实施中医护理临床路径。观察2组患者术后镇痛效果、住院天数、住院费用及患者镇痛满意度。结果 两组术后患者疼痛均有改善。观察组在镇痛效果、住院时间、住院费用和满意度等方面优于对照组,两组之间具有统计学意义(P＜0.05)。结论 对胆囊切除术患者术后实施中医护理临床路径,镇痛效果明显,可提高患者对术后镇痛的满意度,缩短患者的住院时间,减少住院费用,值得推广。     

Orem自理模式对剖宫产术后患者自控镇痛健康教育的效果分析

目的 探讨Orem自理模式在患者剖宫产术后自控镇痛健康教育中的作用.方法 选取行剖宫产术后产妇160例,随机分为对照组和实验组,每组80例.对照组术后给予一般常规健康教育护理指导,实验组术后给予orem自理模式行针对性健康教育指导.观察两组产妇的术后6、12、24、48 h的疼痛状况,术后下床时间,Barthel指数,住院天数及术后回叫次数,肛门排气时间等情况.结果 术后6、12、24、48 h疼痛评分,实验组和对照组比较有显著差异(P＜0.05).两组患者下床时间、Barthel指数、住院天数、回叫次数、肛门排气时间等指标比较均有显著显著差异(P＜0.05).结论 Orem自理模式在运用于剖宫产术后自控镇痛临床疗效确切,值得在护理工作中推广应用.     

术前疼痛教育对结直肠癌手术患者术后康复的影响

目的观察术前疼痛教育对结直肠癌手术患者术后康复的影响。方法将50例结直肠癌手术患者按随机数字表分为对照组和观察组各25例。对照组行常规肛肠外科术前宣教,观察组在常规宣教基础上强化疼痛知识及评分方法教育。术后3d进行镇痛需求、镇痛治疗满意度、睡眠时间及首次肛门排气时间、首次下床时间的评估。结果观察组术后镇痛需求及镇痛治疗满意率明显高于对照组,术后睡眠时间多于对照组,术后首次下床活动时间、首次肛门排气时间及住院天数少于对照组。结论术前疼痛教育能提高结直肠癌手术患者术后镇痛治疗满意度及疗效,有利于术后康复。     

疼痛规范管理对开胸术患者术后早期疼痛控制的效果观察

目的探讨疼痛规范管理对开胸术患者术后早期疼痛的控制效果。方法将本院2011年1月—2012年8月收治的200例开胸患者随机分为对照组和观察组,每组100例。观察组予以疼痛规范管理,对照组给予传统的疼痛护理管理,对比2组的疼痛控制效果并总结分析。结果经过疼痛规范管理后,观察组将术后24 h伤口疼痛分数>3分患者的疼痛分值均小于对照组;观察组重度以上疼痛患者明显少于对照组。结论疼痛规范管理可以提高开胸患者术后的疼痛控制效果,有利于患者术后的早期康复。     

知信行健康教育对剖宫产产妇术后疼痛管理的作用

目的：探讨知信行健康教育在剖腹产产妇术后疼痛管理中的作用。方法选取我院收治的行剖宫产手术的产妇300例,随机分为对照组给予常和观察组,每组150例。对照组产妇给予常规健康教育方式,观察组产妇给予知信行健康教育护理管理。比较两组产妇术后镇痛自我管理行为的评分、疼痛程度评分、自控镇痛泵（ PCA）的使用量及患者满意度。结果术后观察组患者术后镇痛自我管理行为评分显著低对照组（P＜0.01）,术后48 h内疼痛程度评分评分显著低于对照组（P＜0.01）,术后PCA消耗量方面明显高于对照组（P＜0.01）,产妇术后满意度评分明显高于对照组（P＜0.01）。结论知信行健康教育在一定程度上能够提高患者术后镇痛的自我管理能力,增强了产妇术后疼痛的控制效果,并提高了产妇满意度。     

思维导图在乳腺癌术后伤口换药中的应用

目的探讨将思维导图应用于乳腺癌术后伤口换药中的效果。方法将80例乳腺癌术后患者随机分成对照组及观察组,每组各40例。对照组给予常规换药,观察组在对照组基础上运用思维导图进行换药。比较两组患者的并发症发生率、换药时间、住院天数、患者满意度。结果观察组在并发症发生率、换药时间、住院天数、患者满意度等方面都明显优于对照组,差异有统计学意义(P0.05)。结论在乳腺癌术后伤口换药中应用思维导图能有效提高患者满意度,减少术后伤口并发症的发生。     

消肿止痛膏外敷对缓解桡骨远端骨折术后患肢胀痛的效果研究

目的探讨消肿止痛膏外敷对缓解桡骨远端骨折术后患肢肿胀、疼痛的效果。方法将70例桡骨远端骨折行切开复位内固定术的术后患者随机分为对照组和观察组,每组35例。对照组给予骨折术后常规治疗与护理,观察组在骨折术后常规治疗与护理的基础上给予消肿止痛膏中药外敷,观察患者术后患肢的肿胀消退程度、疼痛情况,观察患者住院天数及满意度。结果观察组患者肿胀消退效果明显优于对照组,疼痛数字评价量表(NRS)评分低于对照组,住院天数少于对照组,患者满意度高于对照组,差异均有统计学意义(P0.05)。结论消肿止痛膏外敷可有效缓解桡骨远端骨折术后患者患肢的肿胀、疼痛程度,有助于提高治疗疗效,缩短住院天数,提高患者的满意度,值得临床推广应用。     

腹部手术患者疼痛评估管理的效果观察

目的 探讨对腹部手术患者实施疼痛评估管理的效果.方法 将251例择期腹部手术患者随机分为对照组(n=116)和观察组(n=135),对照组患者采用传统的临床经验法对疼痛进行护理,即患者在术后主诉疼痛难忍和要求药物镇痛时才被动地给予镇痛治疗;观察组在常规围术期护理基础上实施疼痛评估管理,要求护理人员统一掌握使用视觉模拟疼痛量表(Visual Analogue Scale,VAS):护士从患者入院即开始运用规范的语言对患者和家属进行疼痛知识及疼痛治疗观念教育,介绍使用VAS线性标尺表达疼痛的方法,使其对术后疼痛有较全面的认识,能正确地表达术后疼痛,当VAS评分≥5分即报告医生进行镇痛治疗.术后72 h对两组患者进行问卷调查,评估镇痛治疗效果及其满意度.结果 两组患者接受镇痛治疗态度、术后72 h内镇痛治疗频率、疼痛治疗满意度差异均有统计学意义(P＜0.001).结论 规范化疼痛评估管理增强了患者镇痛治疗的依从性,减轻了患者术后疼痛,有利于术后康复.     

骨科术后镇痛护理对患者康复的影响

目的：探讨骨科术后镇痛护理对患者康复的影响。方法选取我院诊治的骨科手术患者166例,根据护理方案分为对照组和观察组,每组83例。对照组患者术后实施常规护理,观察组患者术后实施镇痛护理。采用视觉模拟评分法评定患者的疼痛程度,比较两组患者的疼痛缓解情况、治疗效果及患者满意度。结果护理后两组患者疼痛评分均明显降低。观察组患者护理后疼痛评分明显低于对照组（P＜0.05）,患者疼痛缓解明显好于对照组（P＜0.05）,患者术后住院时间明显少于对照组（P＜0.05）,患者满意度明显高于对照组（P＜0.05）。结论骨科术后镇痛护理可明显缩短患者的治疗时间,缓解患者的疼痛状况,提高患者满意度,对加速患者的康复进程具有重要意义。     

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.