皮肤软组织扩张器治疗瘢痕秃发畸形的护理41例

目的探讨外伤性颈脊髓损伤的急救护理。方法现场对伤情做出初步评估后采取以下急救护理措施：保持呼吸道通畅，给氧，颈部制动，正确的搬运方法及转送途中给予心理护理。结果39例患者中37例安全送达医院，2例途中死亡。结论正确的急救护理措施可避免加重脊髓损伤并保证患者安全送达医院。     

外伤性颈脊髓损伤的急救护理39例

目的：探讨外伤性颈脊髓损伤的急救护理。方法：现场对伤情做出初步评估后采取以下急救护理措施：保持呼吸道通畅，给氧，颈部制动，正确的搬运方法及转送途中给予心理护理。结果：39例患者中37例安全送达医院，2例途中死亡。结论：正确的急救护理措施可避免加重脊髓损伤并保证患者安全送达医院。     

外伤性颈脊髓损伤的急救护理

目的 探讨外伤性颈脊髓损伤的急救护理。方法 现场对伤情做出初步评估后，保持呼吸道通畅与给氧，采用颈部制动、正确的搬运方法；转送途中给予心理护理。结果 39例患者中37例安全送达医院，2例途中死亡。结论正确的急救护理可避免加重脊髓损伤并保证患者安全送达医院。     

急性颈髓损伤40例的急救护理

目的探讨急性颈髓损伤的急救护理方法。方法 40例急性外伤性颈髓损伤患者,在现场及急诊科进行急救护理,包括保持呼吸道通畅、给氧,颈部制动,正确地搬动及途中必要的护理措施等。结果 40例患者除1例途中死亡外,余均安全送达医院。结论急性颈髓损伤患者需要采取正确的护理措施,以减少途中死亡。     

重视急性脊髓损伤11例的院前急救

目的探讨脊髓损伤院前救治的方法及临床效果。方法对11例脊髓损伤患者进行伤情评估,维持生命体征,进行各项生命体征的监护并药物救治。结果院前急救11例患者中,7例经上述处理后病情好转安全转运达院内,3例经抢救后不缓解,转送医院途中病情加重,1例抢救过程中死亡。结论急救急性脊髓损伤进行伤情评估后,及时实施确定性救治方案,能够有效降低死亡率。     

长途安全转运的护理体会

通过对286例长途转运患者转运过程中风险因素评估和实施途中急救护理措施,286例长途转运患者中284例安全转运返院.转运前病情风险评估,途中监测,完善急救转运措施流程,改善交接班制度,备好急救设备及药品,提高安全意识性,能确保患者安全转运,提高转运成功率.     

长途安全转运的护理体会

通过对286例长途转运患者转运过程中风险因素评估和实施途中急救护理措施,286例长途转运患者中284例安全转运返院.转运前病情风险评估,途中监测,完善急救转运措施流程,改善交接班制度,备好急救设备及药品,提高安全意识性,能确保患者安全转运,提高转运成功率.     

急性脑血管意外的院前急救及护理体会

目的探讨院前急救对急性脑血管意外的作用。方法回顾分析96例急性脑血管意外患者在院前急救中的处理措施和护理。结果通过实施有效复苏，重视搬运技术和注意运输途中的安全及运送时的护理减少了脑血管意外患者的死亡率和伤残率。结论急性脑血管意外患者在院前急救中采取正确有效的急救措施和护理是有效的，值得推广。     

颅脑损伤病人的院前及院内急救护理

[目的]总结颅脑损伤病人的院前及院内急救护理措施。[方法]回顾性分析90例急救颅脑损伤病人的临床资料。[结果]本组病人途中死亡3例,急诊室救治中死亡2例,转院治疗5例,治愈或住院进一步治疗80例。[结论]加强颅脑损伤病人的院前及院内急救护理有利于预后。     

急诊冠状动脉介入治疗术后患者安全转运的护理

总结150例急诊冠状动脉介入治疗术后患者的安全转运。主要措施是制定急诊冠状动脉介入治疗术后患者转运制度和转运流程,加强人员培训和安排,转运前准确评估患者病情,正确选择转运途径、方法,备好急救仪器、药物和物品,途中严密观察病情,做好心律失常、心力衰竭患者的途中急救,完善患者的交接班等,减少转运交接过程中的意外事件发生。150例患者转运途中出现低血压25例、急性左心衰1例、心律失常27例,经处理后均恢复正常,途中无意外死亡发生。     

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.