康惠尔透明贴预防小儿静脉留置针压疮的效果观察

目的观察康惠尔透明贴预防小儿静脉留置针压疮的效果。方法按随机数字表将1 200例儿科门急诊留置静脉留置针患儿分为对照组和观察组,每组600例。对照组采用3M敷料无张力固定留置针,其Y型鲁尔接头以3M透气胶布固定;观察组采用康惠尔透明贴贴在针柄和Y型鲁尔接头下方皮肤处,再用3M敷料和胶布固定。比较两组患儿留置针针柄和Y型鲁尔接头处压疮的发生率。结果观察组发生Ⅰ期压疮9例、Ⅱ期压疮0例,压疮发生率1.50%;对照组发生Ⅰ期压疮72例、Ⅱ期压疮12例,压疮发生率14.00%,经比较,差异有统计学意义(P0.05)。结论康惠尔透明贴能预防小儿静脉留置针针柄、Y型鲁尔接头肝素帽和端帽处的压疮。     

门诊小儿头皮静脉留置针规范化固定的效果观察

目的探讨门诊小儿头皮静脉留置针规范化竖向贴膜加自粘性弹力绷带固定的应用效果。方法将2017年10月～2018年3月在我院门诊输液室126例使用头皮静脉留置针输液的患儿随机分为观察组66例、对照组60例,对照组使用横向无张力贴膜固定,观察组使用竖向无张力贴膜加弹力绷带固定。观察比较两组使用效果及患儿家长对静脉留置针固定的满意度。结果观察组使用效果患儿家长对静脉留置针固定的满意度高于对照组(P0.05)。结论门诊小儿头皮静脉留置针规范化竖向贴膜加弹力绷带固定,可明显减少头皮留置贴膜发生卷边、松脱和留置针脱出的现象,解决小儿头皮留置针的固定问题,避免患儿反复穿刺、减轻患儿痛苦,提高患儿家长对静脉留置针的接受度,操作方便、简单、易行。     

水胶体敷料预防婴幼儿头皮静脉留置针压疮的效果评价

目的探讨水胶体敷料在预防婴幼儿头皮静脉留置针压疮中的应用。方法将180例头皮静脉留置针患儿随机分为对照组和观察组,各90例,对照组留置针针梗下垫一次性输液贴,观察组留置针针梗下垫水胶体敷料预防压疮,观察2组患儿压疮发生情况、留置针留置时间、患儿家长的满意度。结果观察组静脉留置针压疮发生情况明显低于对照组(P0.05),观察组留置针留置时间明显长于对照组(P0.05),观察组患儿家长满意度明显高于对照组(P0.05)。结论水胶体敷料预防婴幼儿头皮静脉留置针压疮的效果明显优于棉垫预防压疮的效果。     

两种小儿留置针固定方法比较

[目的]探讨小儿留置针固定的稳定性,延长留置针留置时间。[方法]将270例应用小儿留置针的患儿随机分为观察组和对照组,对照组穿刺成功后常规使用圣纳愈敷膜贴住针眼及针柄,再加以胶布固定;观察组穿刺成功后先用圣纳愈敷膜内附有的纸胶贴进行固定针眼及针柄,再用圣纳愈敷膜进行固定。[结果]观察组静脉留置针固定时间明显长于对照组(P<0.05)。[结论]改进后的留置针固定方法可延长留置时间,任何部位穿刺固定。     

V形交叉固定法在小儿头皮针连接留置针中的应用

目的 探讨V形交叉固定法在小儿头皮针连接留置针中的应用效果.方法 将100例住院需要静脉输液的患儿随机均分为观察组和对照组,对照组采用一次性输液敷贴固定连接小儿静脉留置针的头皮针.观察组采用V形交叉固定法固定连接小儿静脉留置针的头皮针.比较两种方法对头皮针从留置针肝素帽中脱出情况的影响.结果 观察组头皮针从留置针肝素帽中脱出情况明显低于对照组(P＜0.05).观察组无一例头皮针从留置针肝素帽中脱出情况.对照组因患儿不配合,活动度大,头皮针脱出4例;患儿烦躁不安、哭闹用手抓针头,头皮针脱出10例;家长抱孩子晃动,头皮针脱出14例.结论 采用V形交叉固定法固定连接静脉留置针的头皮针,可有效防止头皮针从留置针肝素帽中脱出,避免了浪费药液,扎伤患儿,减少了感染的机会,减轻护理工作量.     

两种手术患儿静脉留置针固定方法的效果观察

目的探索手术患儿外周静脉留置针的有效固定方法。方法将120例使用外周静脉留置针的手术患儿随机分为观察组和对照组,每组60例。对照组穿刺成功后使用3M透明贴粘贴固定针眼及针柄,塑料胶布2条U型固定留置针及输液器;观察组穿刺成功后先使用3M透明贴粘贴针眼及针柄,塑料胶布2条U型固定留置针及输液器,再采用弹力绷带缠绕固定留置针。观察两组手术患儿静脉留置针的脱管、移位打折、液体外渗及静脉炎发生情况。结果观察组静脉留置针移位打折及静脉炎发生情况均低于对照组,两组差异有统计学意义(P0.05)。结论使用改进的弹力绷带加固方法固定留置针提高了手术患儿的静脉留置针管理质量,增加了手术患儿围术期护理安全质量。     

改良桡动脉留置针固定技术在先天性心脏病患儿中的效果观察

[目的]观察改良桡动脉留置针固定技术在先天性心脏病患儿中的应用效果。[方法]选取收治的先天性心脏病术后均需要留置桡动脉留置针的患儿240例,随机分为对照组和观察组各120例,对照组采用传统的桡动脉留置针固定技术,观察组采用自制小夹板和水胶体敷料康惠尔透明贴方法联合固定。对比两组患儿重新固定、留置时间、针柄处压疮情况等。[结果]对照组中有85例患儿需要重新固定留置针,而观察组中仅有26例患儿需要重新固定,两者比较差异有统计学差异(χ~2=58.354,P0.001)。观察组需要2次固定和3次～5次固定的分别为24例次和2例次,多次固定率(2次或2次以上)显著低于对照组(χ~2=8.938,P=0.003)。在保留时间的比较中,观察组与对照组保留时间1d、2d～3d、3d～5d的分别为9例、26例、85例和39例、47例、34例,差异有统计学意义(χ~2=46.648,P0.001)。观察组患儿压疮发生率为3.33%,显著低于对照组压疮发生率(29.17%)(χ~2=29.422,P0.001)。[结论]改良桡动脉留置针固定技术在先天性心脏病患儿中的留置效果显著,不仅能良好地固定,而且可以延长动脉留置针留置时间,降低针柄处压疮的发生风险。     

康惠尔水胶体敷料在小儿留置针压疮预防中的应用

目的:探讨康惠尔水胶体敷料在小儿留置针压疮预防中的应用方法及效果。方法:将386例静脉留置针输液患儿随机分为对照组和实验组各193例。对照组在严格无菌技术操作下穿刺送管成功后常规用3M透明敷贴固定。实验组采用康惠尔水胶体敷料垫于针柄下,再常规用3M透明敷贴固定。比较两组压疮发生率及压疮面积。结果:两组压疮发生率及压疮面积比较差异有统计学意义(P0.05)。结论:康惠尔水胶体敷料可有效预防小儿静脉留置针所致压疮。     

两种小儿头皮静脉留置针固定方法的效果比较

目的探讨网帽固定小儿头皮静脉留置针的效果。方法120例婴幼儿接受头皮静脉留置针穿刺280例次,按穿刺的先后顺序单双号分为两组,对照组140例次采用自粘性弹力绷带固定,观察组140例次采用弹力网帽固定,观察两组静脉留置针保留时间的长短,药液外渗、静脉炎、压疮的发生情况及程度,并选取不同固定方法留置2次以上的患儿74例,出院时调查家长对2种固定方法的支持率。结果2种固定方法,留置时间、药液外渗和静脉炎的发生率差异无统计学意义,但液体外渗与静脉炎的程度不同,网帽固定明显轻于弹力绷带固定,同时网帽固定压疮的发生率比绷带固定低,其程度也明显轻于绷带固定;患儿家属对采用网帽固定法支持率高。结论弹力网帽固定婴幼儿头皮静脉留置针的效果明显优于弹力绷带固定法,值得临床推广使用。     

弹力网状绷带帽在小儿头皮静脉留置针固定中的应用

目的:探讨使用弹力网状绷带帽小儿头皮静脉留置针固定的方法及效果.方法:将317例使用头皮静脉留置针住院患儿随机分为观察组165例和对照组152例,观察组采用弹力网状绷带帽进行辅助固定,对照组采用传统医用胶带绕头1周固定法.观察比较两组患儿静脉留置针固定效果及拔针时患儿反应情况等.结果:观察组留置针固定效果及患儿拔针配合度均优于对照组(P<0.05).结论:使用弹力网状绷带帽进行小儿头皮静脉留置针辅助固定可减少留置针意外脱出和患儿皮肤过敏,增加患儿舒适度与配合度,减轻护士工作量,节约医疗成本,值得推广应用.     

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.     

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.