早期康复护理干预在颅脑损伤患者中的应用

目的:探讨早期康复护理干预对颅脑损伤患者昏迷清醒时间、日常生活活动(ADL)能力恢复的影响.方法:将80例颅脑损伤患者随机分为实验组和对照组各40例,对照组给予常规护理,实验组在此基础上给予早期康复护理干预.结果: 实验组苏醒时间、ADL评分明显优于对照组(P<0.05).结论:颅脑损伤患者实施早期康复护理干预,能明显缩短昏迷清醒时间,降低并发症发生率.     

早期呼唤式护理在重型颅脑损伤昏迷患者中的应用

目的探讨早期呼唤式护理干预对重型颅脑损伤患者促醒效果及出院后生活自理能力的影响。方法将44例重型颅脑损伤患者随机分为实验组23例和对照组21例,对照组采用神经外科的常规治疗和护理,实验组除神经外科的常规治疗和护理外,尝试采用早期呼唤式护理干预,对2组患者治疗后的格拉斯哥(GCS)昏迷量表评分和出院后1个月自理能力恢复进行比较分析。结果实验组呼唤式护理后的GCS评分显著高于对照组,且出院后自理能力显著高于对照组(P0.05)。结论早期呼唤式护理干预对重型颅脑损伤昏迷患者的意识恢复,提高生活自理能力具有明显的积极作用。     

重型颅脑损伤昏迷病人的呼唤式护理

[目的]探讨呼唤式护理干预对重型颅脑损伤昏迷病人中的恢复效果。[方法]将80例重型颅脑损伤昏迷病人随机分为实验组和对照组。对照组行神经外科常规护理,实验组在对照组基础上加入呼唤式护理。[结果]实验组苏醒时间与对照组比较差异有统计学意义(P<0.05)。[结论]呼唤式护理干预应用于重型颅脑损伤昏迷病人,有显著的催醒作用。     

刺激性康复护理对颅脑损伤致昏迷患者的促醒作用研究

目的:探讨刺激性康复护理对颅脑损伤致昏迷患者的促醒作用及预后的影响.方法:选择格拉斯哥昏迷评分(GCS)≤8分的颅脑损伤昏迷患者64例,随机分为观察组(刺激性康复护理组)及对照组(常规护理组)各32例,对照组采用常规护理方法,观察组在常规护理的基础上,同时给予刺激性康复护理.于住院2个月后比较两组的清醒率、清醒时间及临床疗效.结果:观察组患者昏迷转清醒率较对照组明显增高(P<0.05),清醒时间较对照组明显缩短(P<0.01),临床疗效优于对照组(JP<0.05).结论:刺激性康复护理应用于颅脑损伤患者,能促进患者早日清醒,减少致残率和病死率,改善预后.     

呼唤式护理对脑卒中昏迷患者的影响

目的 观察呼唤式护理对脑卒中昏迷患者的影响.方法 选择GCS≤8分的脑卒中昏迷患者92例,随机分为实验组及对照组各46例,对照组采用常规护理方法,实验组在常规护理的基础上,增加呼唤式护理,比较两组患者的GCS评分及NFI评分情况.结果 30d后,实验组患者GCS评分较对照组明显提高(P＜0.05),神经功能缺损评分较对照组明显降低,两者比较(P＜0.01),差异有统计学意义.结论 呼唤式护理能促进患者恢复,减少致残率,提高其生活质量.     

护理干预对重型颅脑损伤昏迷患者的促醒作用

目的探讨临床综合性呼唤式护理干预对重型颅脑损伤昏迷患者的促醒作用。方法对照组60例患者采用常规性护理方法,研究组60例患者采用综合性呼唤式护理方法,分别对患者治疗前及治疗后10d、20d、30d的格拉斯哥昏迷评分(GCS)和清醒情况进行记录和比较分析。结果两组患者于治疗后经护理GCS评分逐渐升高,治疗后20d和30d时,研究组评分(8.37±2.74,12.50±2.98)明显高于对照组(6.58±2.66,9.02±2.91),差异有统计学意义(P<0.05)。结论采用综合性呼唤式护理方法对于重型颅脑损伤昏迷患者具有较好的临床护理疗效,能够有效提高觉醒率,适合于临床推广应用。     

呼唤式护理联合肠内营养支持对重型颅脑损伤致昏迷的研究

目的:探讨呼唤式护理干预联合肠内营养支持应用于重型颅脑损伤致昏迷患者的临床效果。方法:选取2014年12月~2017年1月洛阳市第一人民医院收治的重型颅脑损伤致昏迷患者128例,随机分为对照组和研究组各64例。对照组实施常规护理联合肠外营养支持,研究组实施呼唤式护理联合肠内营养支持。比较两组患者GCS评分,血清白蛋白、总蛋白及血红蛋白的含量,护理满意度及并发症发生率。结果:出院时,研究组GCS评分及血清白蛋白、总蛋白、血红蛋白含量均高于对照组,并发症发生率低于对照组,护理满意度明显高于对照组(P<0.05)。结论:呼唤式护理干预联合肠内营养支持应用于重型颅脑损伤致昏迷患者可有效改善其昏迷状态及营养状况,降低并发症发生率,有利于患者康复,提高护理满意度,缓解家属焦虑等负性情绪,减少住院费用。     

呼唤护理对重型颅脑损伤迁延性昏迷患者预后的影响

目的探讨呼唤护理对重型颅脑损伤迁延性昏迷患者预后的影响。方法将66例重型颅脑损伤迁延性昏迷患者随机分为干预组34例和对照组32例。对照组采用神经外科综合治疗常规护理方法,干预组在此基础上增加系统、有效的呼唤护理。观察患者住院各个阶段GCS评分和昏迷恢复情况以及住院天数。结果干预组住院1个月时GCS评分、昏迷恢复情况明显优于对照组;2个月时清醒率明显高于对照组;出院时意识恢复情况明显优于对照组,住院天数明显少于对照组。结论呼唤护理对促进重型颅脑损伤迁延性昏迷患者的恢复、改善其预后有积极的影响。     

呼唤式护理干预在重型颅脑损伤昏迷患者中的应用

目的探讨呼唤式护理干预在重型颅脑损伤昏迷患者中的应用效果。方法本文对75例重型颅脑损伤昏迷患者随机分为观察组39例和对照组36例。对照组按神经外科护理常规进行护理，观察组在常规护理的基础上加用呼唤式护理干预。结果观察组患者转清醒时间明显缩短（P〈0．01），转清醒例数明显增多（P〈0．05），家属的满意度提高（P〈0．05），COS评分优于对照组（P〈0．01）。结论呼唤式护理干预在重型颅脑损伤昏迷患者的应用，不仅起到很有效的催醒作用，减少了致残率，提高生存质量；而且体现了人文关怀，提高了家属的满意度，促进了家属的参与，有利于营造共同参与型医学模式。     

触听光刺激呼唤法在颅脑损伤昏迷患者中的应用效果

目的观察触听光刺激呼唤法在颅脑损伤昏迷患者中的应用效果。方法将88例患者根据随机数字表分为观察组和对照组各44例,对照组接受常规护理,观察组在常规护理基础上加用触听光刺激呼唤法,比较两组昏迷程度、清醒率和清醒时间。结果观察组格拉斯哥昏迷评分、清醒率显著高于对照组,清醒时间短于对照组,差异有统计学意义(P<0.05)。结论触听光刺激呼唤法可减轻颅脑损伤昏迷患者的昏迷程度,缩短昏迷时间,提高清醒率。     

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.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.