不同给氧方法在脑肿瘤术后气管切开患者氧疗中的应用

目的探讨脑肿瘤术后气管切开患者氧疗中实施不同给氧方法的效果。方法选取脑肿瘤术后气管切开患者60例,按照随机数字法分为鼻导管组、人工鼻组、面罩组各20例,分别实施鼻导管吸氧、人工鼻吸氧及面罩法吸氧。观察3组患者氧疗前、氧疗1 h、氧疗24 h时的血氧饱和度、痰液黏稠度(Ⅲ度)以及并发症(肺部感染与切口感染)发生情况并进行统计学分析。结果 3组患者在吸氧1 h、吸氧24 h时的血氧饱和度均比吸氧前有显著提高(P0.05),但面罩组提高幅度显著更高(P0.05);鼻导管组与面罩组吸氧1 h、吸氧24 h时的痰液黏稠(Ⅲ度)率相比吸氧前显著下降(P0.05),优于人工鼻组(P0.05);面罩组与人工鼻组的肺部感染与切口处感染发生率差异无统计学意义(P0.05),均显著低于鼻导管组(P0.05)。结论面罩吸氧应用在脑肿瘤术后气管切开患者中有良好效果,不仅可快速平稳改善血氧饱和度,而且能降低痰液黏稠度以及肺部感染与切口感染的发生率,值得借鉴。     

重型颅脑损伤患者气管切开术后早期应用持续加温湿化吸氧疗法的效果观察

目的探讨持续加温湿化吸氧疗法在重型颅脑损伤患者气管切开术后的早期应用效果。方法将70例重型颅脑损伤气管切开非机械通气患者随机分成对照组和观察组。对照组（35例）采用持续氧气雾化吸入法进行气道湿化；观察组（35例）采用持续加温湿化氧疗进行气道湿化；观察两组患者痰液粘稠度、痰痂、日均吸痰次数、血氧饱和度及肺部感染等并发症的情况。结果观察组患者痰痂、日均吸痰次数、肺部感染发生率均低于对照组。结论重型颅脑损伤气管切开术后早期采用持续加温湿化氧疗进行气道湿化，能有效保持患者的气道通畅，增加氧合，降低肺部感染发生率，值得临床推广使用。     

颅脑手术气管切开患者最佳吸氧方式的探讨

目的：探讨颅脑手术气管切开患者的最佳吸氧方式。方法：将我院2011年5月～2012年10月64例颅脑手术气管切开患者,随机等分成试验组和对照组,试验组采用气管切开吸氧面罩＋医用雾化器进行吸氧,对照组采用气管切开套管内导管进行吸氧。观察两组患者在吸氧效果、痰液黏稠度、气管切口感染、肺部感染、拔管时间方面的差异。结果：两组给氧前患者的血氧饱和度比较差异无统计学意义（P〉0.05）,而在给氧后15,30,60 min时患者的氧饱和度比较差异有统计学意义（P〈0.05）;试验组和对照组在给氧前、给氧后24 h的痰液粘稠度比较差异无统计学意义（P〉0.05）,而在给氧后48 h的痰液粘稠度比较差异有统计学意义（P〈0.05）;试验组发生气管切口及肺部感染的例数少于对照组;试验组的气管切开拔管时间短于对照组。结论：气管切开吸氧面罩＋医用雾化器的吸氧为颅脑手术气管切开患者的最佳吸氧方式。     

三种给氧方式在气管切开患者中的应用比较

气管切开术后给氧方式较多，有传统的鼻导管吸氧、人工鼻给氧等方法。为探讨气管切开术后较合适的给氧方法，2004年1月-2005年12月，我们采用鼻导管法、人工鼻法、氧气面罩法三种不同给氧方式，对神经外科73例气管切开患者进行了观察，发现3种给氧方法对病人痰液粘稠度、脉氧饱和度、气管切门处并发症、肺部感染均有一定的影响，现介绍如下。     

面罩式医用雾化器应用于气管切开患者的效果研究

目的 探讨降低气管切开术后呼吸道感染发生率的有效方法.方法 将60例气管切开术后患者随机分为实验组和对照组,实验组用面罩式医用雾化器治疗,对照组予传统方式在气管切开处覆盖双层生理盐水湿纱布并辅以雾化吸入、气管滴药,比较2种方法的效果.结果 实验组痰阻、PaO2、SPO2、痰培养及胸片结果均显著优于对照组.结论 气管切开术后采用面罩式医用雾化器比传统的在气管切开处覆盖双层生理盐水湿纱布更有利于患者痰液的排出,可提高血氧分压,有效地预防呼吸道感染的发生.     

面罩式医用雾化器应用于气管切开患者的效果研究

目的探讨降低气管切开术后呼吸道感染发生率的有效方法。方法将60例气管切开术后患者随机分为实验组和对照组，实验组用面罩式医用雾化器治疗，对照组予传统方式在气管切开处覆盖双层生理盐水湿纱布并辅以雾化吸入、气管滴药，比较2种方法的效果。结果实验组痰阻、PaO2、SPO2、痰培养及胸片结果均显著优于对照组。结论气管切开术后采用面罩式医用雾化器比传统的在气管切开处覆盖双层生理盐水湿纱布更有利于患者痰液的排出，可提高血氧分压，有效地预防呼吸道感染的发生。     

雾化面罩吸氧用于气管切开脱机后患者的疗效观察

目的 气管切开患者脱机后行雾化面罩吸氧的疗效观察.方法 47例气管切开脱机后患者按床号单、双数分组,观察组26例采用微雾喷雾器雾化面罩持续雾化吸氧,雾化液用0.45%氯化钠溶液, 每8 h再行1次药物雾化;对照组21例采用普通面罩吸氧,每8 h行1次药物雾化.分别在吸氧后第1、3、5天查血、痰培养,每天查血气分析.结果 观察组呼吸道感染率30.8%,痰痂形成率3.8%,对照组呼吸道感染率66.7%,痰痂形成率33.3%,观察组呼吸道感染及痰痂形成明显低于对照组.结论 气管切开患者脱机后行雾化面罩持续雾化吸氧能有效降低气管切开患者脱机后的呼吸道感染和痰痂形成.     

持续加温气道湿化在气管切开脱机患者吸氧中的应用效果观察

目的探讨气管切开术后脱机患者吸氧应用加温气道湿化的效果。方法将56例行气管切开术患者脱机后随机分为实验组和对照组,每组各28例,实验组患者吸氧采用持续加温气道湿化法,对照组患者吸氧采用微量泵持续滴入气道湿化法。比较两组患者舒适度、痰液粘稠度和痰痂形成情况。结果两组患者舒适度、痰液粘稠度比较,均P<0.05,差异具有统计学意义,实验组患者明显优于对照组;两组患者痰痂形成情况比较,P>0.05,差异无统计学意义。结论持续加温气道湿化在气管切开脱机患者吸氧中应用,可增加患者舒适度,降低痰液粘稠度,值得临床推广应用。     

昏迷患者气管切开后两种气道湿化方法的效果比较

目的比较两种气道湿化方法对气管切开后昏迷患者气道的湿化效果。方法将58例气管切开患者按随机数字表法随机分为研究组和对照组,研究组患者采用氧气面罩进行气道湿化,对照组采用人工鼻进行气道湿化,比较两组痰液黏稠度、湿化效果、痰培养阳性率与肺部感染率。结果研究组患者痰液黏稠Ⅰ度18例,Ⅱ度8例,Ⅲ度3例,与对照组16,9,4例比较差异无统计学意义（u=0．55,P〉0．05）。研究组患者湿化不足8例,良好20例,过度1例,与对照组9,18,2例比较差异无统计学意义（u=0．06,P〉0．05）。研究组患者痰培养阳性2例,阴性27例,对照组分别为8,21例,两组阳性率比较差异有统计学意义（χ2=4．35,P〈0．05）。研究组患者肺部感染阳性3例,阴性26例,与对照组10,19例比较,差异有统计学意义（χ2=4．86,P〈0．05）。结论两种气道湿化方法在患者痰液黏稠度和湿化效果方面的效果相同,但在降低痰培养阳性率和肺部感染率方面,氧气面罩气道湿化法优于人工鼻。     

气管切开患者脱机采用文丘里联合伺服型加热湿化器湿化给氧的效果

目的探讨文丘里联合伺服型加热湿化器应用于气管切开患者脱机期间气道湿化给氧的效果。方法选择我科2012年5月~2014年5月住院气管切开患者70例,根据设定的入选条件随机分为对照组和干预组,各35例。对照组采用常规湿化给氧方法,使用氧气湿化瓶连接气切面罩结合气切口微量注射泵泵入0.45%生理盐水。干预组采用文丘里联合伺服型加热湿化器湿化给氧。观察比较两组气切口吸入氧气温度、气道内痰液粘稠度、气管内痰痂形成、血气分析中PaO2平均值、PaCO2平均值。结果两组气切口吸入氧气温度、气道内痰液粘稠度及气管内痰痂形成、动脉血气PaO2及PaCO2平均值比较有显著性差异(P0.05)。结论气管切开患者脱机期间采用文丘里与伺服型加热湿化器联合应用湿化给氧,更有利于提高患者氧合效果及吸氧舒适度。     

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.     

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.     

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.     

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.