晋中市榆次区孕妇唐氏综合征产前筛查现状及影响因素分析

目的：了解晋中市榆次区孕妇唐氏综合征产前筛查工作的现状,探讨其影响因素。方法对2012年10月—2013年9月到榆次区妇幼保健院产前检查且孕14～21周的4503名孕妇进行唐氏综合征产前筛查的健康宣教,填写“孕中期唐氏综合征产前筛查知情同意意愿书”,选择筛查意愿。结果4503名孕妇均填写了知情同意书,但知情筛查率仅有29．2％;孕妇的户籍、学历、家庭月收入是影响唐氏综合征产前筛查的主要因素。结论应加强健康宣教,加快唐氏综合征产前筛查机构的建设,提高社会保障,以推进和提高唐氏筛查工作的开展和效果。     

新生儿疾病筛查血样采集的护理管理体会

目的 总结473例活产新生儿疾病筛查血样采集的护理管理体会,提高采血成功率及血标本合格率,杜绝漏登记、漏筛查.方法 分析东南大学医学院附属江阴医院产科473例采血情况.存在问题主要有采血片填写不正确;采集血标本不规范;采血流程有欠缺;家属不配合,初筛阳性时召回困难.针对存在问题采取了相应措施,包括加强对采血人员的培训和考核;调整护理工作流程;改进采血方法;加强血标本的管理;做好健康宣教,取得家属的理解和支持.结果 采血片合格率99.57％,一次采血成功率98.7％,筛查率99.57％,先天性甲状腺功能低下初4例阳性,确诊2例,阳性率0.42％,召回率99％.结论 有效提高了新生儿疾病筛查血样采集的成功率,保证了血片质量.     

胎儿外生殖器畸形超声诊断病例分析

目的探讨超声在胎儿外生殖器异常产前诊断中的临床意义。方法对2014年1月至2016年1月北京大学第三医院超声诊断和疑诊14例外生殖器异常胎儿的产前超声表现、产后生殖器形态特征及病理结果进行分析。结果 14例外生殖器异常胎儿产前超声表现及临床结局:(1)部分性阴茎阴囊转位4例(28.6%,4/14),产前胎儿外生殖器共同的声像图表现为短小的阴茎位于分裂的阴囊之间,呈"花瓣"征,均合并阴茎短小、尿道下裂,其中2例终止妊娠(1例合并一侧输尿管扩张、肾积水、肛门闭锁;1例合并室间隔缺损),1例未合并其他异常,足月自然分娩,1例合并隐性脊柱裂,足月自然分娩。(2)完全性阴茎阴囊转位2例(14.3%,2/14),产前超声表现为阴茎与阴囊的位置完全颠倒,即阴茎在阴囊之后,阴茎指向尾侧;其中1例合并肛门闭锁、小眼球畸形,1例合并法洛四联症、十二指肠闭锁、肛门闭锁,超声检查后孕妇均选择终止妊娠。(3)阴茎短小4例(28.6%,4/14),产前超声表现为阴茎形态结构显示困难或仅呈点状中等回声,其中2例胎儿宫内生长受限;1例生后不明原因死亡,1例生后存在尿道下裂;另2例胎儿中1例染色体核型为18-三体,1例9号染色体微缺失,超声检查后孕妇均选择终止妊娠。(4)阴茎缺如2例(14.3%,2/14),产前超声仅探及胎儿阴囊结构,阴茎缺如,均合并膀胱外翻,超声检查后孕妇均选择终止妊娠。(5)外生殖器性别不明2例(14.3%,2/14),1例染色体核型为46xy,出生后呈女性生殖器外观,1例染色体为46xx,出生后随访患者自诉阴蒂肥大,患先天性肾上腺皮质增生症。结论产前超声检查是诊断胎儿外生殖器畸形有效、可行的检查方法,阴茎阴囊转位、阴茎缺如可产前诊断;在超声检查中胎儿性别难以明确时,应结合染色体检查以识别是否存在外生殖器畸形。因声像图不典型而诊断困难者,在不合并其他异常时应慎重诊断,可于中晚孕期再次超声检查而明确诊断。     

健康宣教与护理干预在两癌筛查中的实施效果分析

目的 探讨健康宣教与护理干预在两癌筛查中应用的护理效果.方法 选择2021年1月至2022年5月时间段在我院接受两癌筛查的女性抽取400例为研究对象.依据抽签法将患者分成对照组和观察组,每组各200例.对照组采用常规指导护理方法,观察组采用健康宣教与护理干预的方法.分析比较两组的两癌知识掌握水平、两癌筛查参与率、检查满意度.结果 观察组对两癌知识掌握水平各维度评分显著高于对照组(P＜0.05).观察组女性接受两癌筛查参与率显著高于对照组(P＜0.05)观察组接受筛查的受检者对检查满意度显著高于对照组(P＜0.05).结论 两癌筛查工作实施健康宣教与护理,可以显著提升两癌知识掌握水平,筛查受检率和检查满意度.     

筒式男童阴茎睾丸测量尺的研制

目的设计一种操作简单、测量方便、结果精准的男童阴茎睾丸测量尺,以提高临床上男童阴茎睾丸测量与评估的准确率。方法筒式男童阴茎睾丸测量尺由卡座和游标尺组成,卡通外形。卡座分成卡槽、筒尺和套环3部分,游标尺的底端设置指示条,指示条的末端装有指向刻度区的指示板,游标尺的左侧设有刻度区,用于测量阴茎睾丸大小。结果筒式男童阴茎睾丸测量尺用于男童阴茎睾丸测量,一人一尺,测量误差小,测量过程无不适,儿童配合程度高。结论筒式男童阴茎睾丸测量尺设计合理,使用方便,测量男童阴茎睾丸更准确,更客观,可提高男童阴茎睾丸发育评估的准确率。     

健康教育对提高糖尿病患者的认识与自控能力的效果研究

目的研究健康教育对提高糖尿病患者的认识与自控能力的价值.方法将95例DM患者随机分为A、B两组,A组进行"传统卫生宣教",B组进行健康教育.结果健康教育组的认识和自控能力均较传统卫生宣教组提高.结论健康教育是DM患者学习DM知识、提高自我控制能力的有效途径.     

出生缺陷分析及健康教育对策

目的：对出生缺陷相关因素进行分析,提出针对性的健康教育对策及干预措施.方法：按照2006年卫生部妇幼保健与社区卫生司制定的〈中国出生缺陷监测工作手册〉标准,对2009年第一季度住院分娩的围产儿逐一筛查.结果：在92例出生缺陷儿中,缺陷原因位居前两位的分别为先天性心脏病、唇腭裂;出生缺陷相关因素分析显示城乡有很大差别;致畸因素分析与孕早期感冒或发烧、早孕出血等因素有关.结论：对育龄人群广泛开展优生优育健康教育,加强孕期保健和孕早期健康教育,特别是加大乡村的孕期保健和卫生宣教,普及产前筛查,做好产前筛查的咨询与指导,加大对出生3个月至1岁以内婴儿先天性心脏病筛查力度是必要的.     

食疗配合拔罐改善湿热体质人群痤疮症状的疗效观察

目的 观察食疗配合拔罐及宣教改善湿热体质人群痤疮症状的疗效.方法 选取湿热体质痤疮患者75例,随机分为治疗组39例,宣教组23例和对照组13例.治疗组采用自拟养生茶(薄荷、麦冬、玫瑰花、陈皮)配合拔罐,并进行健康宣教；宣教组患者接受健康教育；对照组仅接受随访,不予特殊处理.比较3组的临床疗效.结果 治疗组、宣教组和对照组的临床有效率分别为92.31％、30.43％和15.38％,差异有统计学意义.结论 食疗配合拔罐及宣教能够有效改善湿热体质痤疮症状.     

多种形式健康宣教在脑卒中患者中应用的效果评价

目的 探讨多形式健康宣教对脑卒中患者的应用效果.方法 将128例脑卒中患者随机分为观察组和对照组各64例,2组在常规护理的基础上,对照组采用传统的健康宣教方法,观察组采用多形式健康宣教方法.比较2组患者健康宣教知识掌握情况及患者满意度.结果 观察组患者健康宣教知识掌握情况及满意度均优于对照组.结论 对脑卒中患者应用多形式健康宣教,可提高患者的健康知识掌握度和患者满意度.     

多元化健康教育在ROP筛查护理中对家属筛查意识和护理满意度的影响

目的 分析多元化健康教育在早产儿视网膜病变(ROP)筛查护理中对家属筛查意识和护理满意度的影响.方法 选取2018年12月至2020年12月在我院开展ROP筛查的84例早产儿及其家属作为研究对象,将其随机分为对照组(42例,常规健康宣教)和试验组(42例,多元化健康教育).比较两组患儿家属的疾病知晓情况、遵医行为及护理...     

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.     

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.     

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.     

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.