藻酸盐敷料治疗糖尿病足溃疡的临床观察和护理

目的探讨藻酸盐敷料对糖尿病足溃疡的疗效,总结护理方法。方法将36例糖尿病足溃疡患者随机分为两组,对照组18例,采用内科治疗加普通纱布换药治疗,观察组18例,采用内科治疗加藻酸盐敷料换药治疗,比较其在肉芽组织成熟度、创面愈合速度、换药次数、换药时间、创面愈合时间和疗效方面的差异,并对护理方法进行总结。结果观察组在第10和13天创面肉芽组织成熟度优于对照组(P<0.05);在第14、21和第28天创面愈合速度优于对照组(P<0.05);观察组换药次数、换药时间少于对照组(P=0.00),观察组创面愈合时间为(28.32±4.53)d,对照组为(35.27±4.62)d,两组比较具有显著性意义(P=0.00);治疗4周后观察组疗效优于对照组(P=0.01)。结论藻酸盐敷料对糖尿病足溃疡具有良好的治疗效果;恰当的护理方法有助于患者的康复。     

中药足浴联合湿润烧伤膏外敷治疗早期糖尿病足的疗效观察

目的观察中药足浴联合湿润烧伤膏治疗糖尿病足的临床疗效。方法将68例糖尿病足患者在知情同意且平等自愿选择的情况下分成对照组(32例)和观察组(36例),对照组在中药足浴治疗后常规换药,观察组在中药足浴治疗后常规换药的基础上使用湿润烧伤膏足部伤口外敷,记录两组患者治疗中的不良反应,同时比较两组患者溃疡创面的愈合面积、换药次数以及创面愈合所需时间。结果两组患者治疗过程中均未见药物不良反应;创面愈合面积观察组第14天、第21天、第28天与对照组比较,差异均有统计学意义(P0.05);观察组平均换药次数(15.3±0.2)次,少于对照组(21.4±0.3)次,两组比较差异有统计学意义(P0.05);观察组平均创面愈合时间(38.6±0.4)d,明显短于对照组(48.7±0.3)d,两者比较差异有统计学意义(P0.05)。结论中药足浴联合湿润烧伤膏治疗糖尿病足,可有效促进溃疡创面的愈合面积,减少换药次数,缩短创面愈合时间,有效改善了患者的生活质量。     

湿性愈合疗法治疗糖尿病足部慢性溃疡的临床疗效观察

目的探讨湿性愈合疗法治疗糖尿病足部慢性溃疡的临床效果。方法对31例糖尿病足部慢性溃疡共31处伤口,随机分为常规换药组16例和湿性换药组15例。湿性换药组采用湿性敷料和水胶体敷料进行换药治疗,常规换药组采用0.5%碘伏纱条进行换药,并观察两组临床效果。结果两组伤口愈合时间、换药次数比较有显著性差异(P<0.01)。结论湿性愈合疗法治疗糖尿病足部慢性溃疡明显优于常规换药方法。     

美皮康水胶体敷料应用于糖尿病足患者骨水泥植入术后创面换药的临床研究

目的观察美皮康水胶体敷料应用于糖尿病足患者骨水泥植入术后创面换药的效果。方法将100例Wagner 3级糖尿病足患者分为对照组(52例)和观察组(48例),对照组采用无菌纱布与3M敷贴换药,观察组采用美皮康水胶体敷料换药。统计分析两组患者治疗1个月时的创面愈合情况、换药次数、换药时疼痛评分。结果观察组术后1个月时创面愈合显效率为89.6%,对照组为7.7%,观察组高于对照组,差异有统计学意义(P0.05)。术后1个月内观察组平均换药(8.41±1.92)例次,疼痛评分为(1.02±0.71)分,对照组平均换药(21.12±1.23)例次,疼痛评分为(2.12±0.61)分,两组换药次数和疼痛评分比较,差异均具有统计学意义(P0.05)。结论应用美皮康水胶体敷料换药可提高Wagner 3级糖尿病足患者创面愈合显效率,减少换药次数,减轻换药疼痛。     

生肌象皮膏治疗糖尿病足的效果观察

目的:探讨生肌象皮膏治疗Ⅱ、Ⅲ级糖尿病足的临床效果.方法:将33例Ⅱ、Ⅲ级糖尿病足随机分为2组.对照组17例采用常规外科换药方法治疗;观察组16例采用生肌象皮膏外敷治疗.分别观察2组好转、显效,治愈时间.结果:观察组好转时间平均(3.0±0.8)天、显效时间平均(7.0±1.4)天、愈合时间平均(30.0±5.8)天,均显著少于对照组(P＜0.01).结论:生肌象皮膏对Ⅱ、Ⅲ级糖尿病足有加速伤口愈合的作用.     

银离子敷料与凡士林纱布对嵌甲根治术后甲床损伤创面愈合效果的比较

目的:比较嵌甲根治术后银离子敷料与凡士林纱布创面外敷对促进创面愈合的临床疗效。方法:将2013年1月~2014年5月收治的96例嵌甲甲沟炎患者随机等分为观察组和对照组,观察组用银离子敷料外敷,对照组外敷凡士林油纱条换药治疗。比较两组患者疼痛程度、换药次数、换药费用、单次换药所需时间、痊愈时间及创面感染情况。结果:观察组患者疼痛程度轻于对照组(P0.05),换药次数少于对照组(P0.05),创面平均痊愈时间、单次换药时间短于对照组(P0.05),两组患者换药费用差异无统计学意义(P0.05)。结论:银离子敷料有利于嵌甲根治术后创面的愈合,在嵌甲根治术后创面能促进表皮生长,加速创面愈合,达到预防感染的目的,并且可显著减少换药次数,减轻患者的痛苦。     

新型湿性敷料在脊髓损伤患者压疮创面护理中的应用

目的观察新型湿性敷料在脊髓损伤患者压疮创面护理中的应用效果。方法 58例脊髓损伤并发压疮患者分为观察组和对照组各29例,观察组采用新型湿性敷料,对照组采用传统换药、特定电磁波谱及紫外线照射治疗。比较两组患者治疗2周后的疗效及创面愈合时间。结果观察组换药2周后愈合11例,好转17例,无效1例;对照组愈合5例,好转18例,无效6例(P0.05);观察组创面愈合时间为(26.69±16.48)d,短于对照组(38.24±22.47)d(P0.05)。结论新型湿性敷料可促进脊髓损伤患者压疮创面愈合,缩短愈合时间。     

新型水凝胶敷料用于治疗放疗后湿性脱皮效果的研究

[目的]研究水凝胶敷料和传统敷料对放疗后湿性脱皮的治疗效果。[方法]选择进行放疗的恶性肿瘤病人76例,随机分为观察组和对照组,观察组创面换药应用水凝胶敷料,对照组创面换药应用无菌纱布敷料,收集病人一般指标、放疗相关指标和创面愈合率、创面愈合时间、换药费用。[结果]观察组创面愈合时间较对照组短(P0.05),但两组换药费用比较差异无统计学意义(P0.05)。[结论]放疗后湿性脱皮治疗中应用水凝胶敷料,可促进损伤皮肤生长,加速损伤皮肤的愈合。     

湿性敷料在氢氟酸烧伤手指患者中的应用

目的:探讨湿性敷料在氢氟酸烧伤手指患者中的应用方法及效果。方法:按随机数字表法将60例氢氟酸烧伤手指患者分为观察组和对照组各30例,对照组采用皮维碘外敷换药方法,观察组采用湿性敷料换药方法,比较两组换药次数、愈合时间及临床疗效。结果:两组换药次数、愈合时间及临床疗效比较差异有统计学意义(P0.05,P0.01)。结论:湿性敷料在氢氟酸烧伤手指患者中的应用效果较好,值得临床推广。     

重组人表皮生长因子凝胶在烧伤创面中的应用效果

[目的]探讨重组人表皮生长因子凝胶在烧伤创面中的应用效果。[方法]将84例烧伤病人按住院号随机分为观察组和对照组各42例,对照组采用硅酮凝胶膏湿敷创面,观察组采用重组人表皮生长因子凝胶敷创面,比较两组病人换药时的疼痛程度、换药次数、愈合时间以及渗液情况。[结果]观察组在第4天、第7天换药时的疼痛程度轻于对照组(P0.05);观察组在第3次换药、第4次换药渗出液少于对照组(P0.05);观察组的换药次数少于对照组,创面愈合时间短于对照组(P0.05)。[结论]重组人表皮生长因子凝胶能够减少烧伤病人创面的渗出液,减少换药次数,促进表皮生长,加速创面愈合。     

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.     

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.