镇痛泵在剖官产术后应用中的护理研究

目的探讨剖宫产术后应用镇痛泵对剖宫产患者术后自理能力、肛门排气、恶心呕吐的影响。方法以170例剖宫产手术后的产妇为对象，随机分为实验组（95例）和对照组（75例），实验组术后留置镇痛泵，对照组按传统方法使用镇痛剂止痛。监测2组产妇术后首次自行翻身、坐起、下床、漱洗入厕的时间和患者的恶心呕吐、肛门排气情况。结果实验组产妇术后首次自行翻身、坐起、下床、漱洗入厕的时间比无使用镇痛泵者早，P〈0．05；而恶心呕吐、肛门排气情况无差异，P〉0．05。结论镇痛泵能有效地解决了手术后切口疼痛的问题，使患者有充分的时间休息，术后自理能力恢复快，且不增加恶心呕吐和延缓肠蠕动的恢复。     

镇痛泵在剖宫产术后应用中的护理研究

目的 探讨剖宫产术后应用镇痛泵对剖宫产患者术后自理能力、肛门排气、恶心呕吐的影响.方法 以170例剖宫产手术后的产妇为对象,随机分为实验组(95例)和对照组(75例),实验组术后留置镇痛泵,对照组按传统方法使用镇痛剂止痛.监测2组产妇术后首次自行翻身、坐起、下床、漱洗入厕的时间和患者的恶心呕吐、肛门排气情况.结果 实验组产妇术后首次自行翻身、坐起、下床、漱洗入厕的时间比无使用镇痛泵者早,P＜0.05;而恶心呕吐、肛门排气情况无差异,P＞0.05.结论 镇痛泵能有效地解决了手术后切口疼痛的问题,使患者有充分的时间休息,术后自理能力恢复快,且不增加恶心呕吐和延缓肠蠕动的恢复.     

四磨汤对预防术后使用硬膜外镇痛泵产妇腹胀的效果观察

目的：探讨四磨汤对术后使用硬膜外镇痛泵剖宫产产妇腹胀的应用效果。方法：将80例剖宫产术后使用硬膜外镇痛泵的产妇随机分为实验组和对照组各40例。实验组术后6～12h开始口服四磨汤,每天3次,每次10ml;对照组采用常规治疗。观察两组产妇肛门排气时间、肠鸣音恢复时间和腹胀情况。结果：实验组术后肛门排气时间和肠鸣音恢复时间明显早于对照组（P＆lt;0.01）,腹胀发生情况明显低于对照组（P＆lt;0.01）。结论：四磨汤可促进胃肠功能恢复,有效预防剖宫产产妇术后使用硬膜外镇痛泵腹胀的发生。     

硬膜外镇痛对剖宫产术后产妇胃肠、排尿功能和阴道出血影响的研究

[目的]了解硬膜外自控镇痛泵(PCEA)对剖宫产术后产妇胃肠道功能、排尿功能和产后阴道出血的影响.[方法]选择剖宫产分娩的初产妇105例,随机分为PCEA组(47例)和对照组(58例),比较两组疼痛情况、肛门排气时间、自行排尿时间、恶心呕吐情况以及产后24 h阴道出血情况.[结果]PCEA组术后12 h、24 hVAS评分均明显低于对照组(P<0.05或P<0.01),肛门排气早,自行小便所需时间长,术后阴道出血量少.[结论]PCEA镇痛能有效缓解剖宫产术后疼痛,且能促进产妇肛门排气,但易发生呕吐、排尿困难等.需加强术后PCEA镇痛产妇的护理,减少并发症,提高围术期护理质量.     

硬膜外镇痛对剖宫产术后产妇胃肠、排尿功能和阴道出血影响的研究

[目的]了解硬膜外自控镇痛泵（PCEA）对剖宫产术后产妇胃肠道功能、排尿功能和产后阴道出血的影响。[方法]选择剖宫产分娩的初产妇105例,随机分为PCEA组（47例）和对照组（58例）,比较两组疼痛情况、肛门排气时间、自行排尿时间、恶心呕吐情况以及产后24h阴道出血情况。[结果]PCEA组术后12h、24hVAS评分均明显低于对照组（P〈0．05或P〈0．01）,肛门排气早,自行小便所需时间长,术后阴道出血量少。[结论]PCEA镇痛能有效缓解剖宫产术后疼痛,且能促进产妇肛门排气,但易发生呕吐、排尿困难等。需加强术后PCEA镇痛产妇的护理,减少并发症,提高围术期护理质量。     

中药浴足对剖宫产术后患者体能恢复的影响

目的 探讨中药浴足对剖宫产术后患者体能恢复的影响,防止术后并发症.方法 选择剖宫产手术产妇180例,按产妇病房、床号随机分为实验组和对照组各90例.实验组产妇在术后6h开始中药浴足1次,并于每日上午7:00～8:00和晚上21:00～22:00各进行1次,20 min/次,连续3～5 d;对照组执行剖宫产术后常规护理.观察2组产妇术后肛门排气时间、独立下床时间等体能恢复情况.结果 实验组产妇术后肛门首次排气时间、独立下床活动时间均显著早于对照组.结论 剖宫产术后中药浴足能有效促进产妇胃肠功能恢复和早日下床活动,改善产妇食欲和睡眠质量,减少术后并发症,促进术后体能恢复.     

剖宫产术后应用镇痛泵对产妇泌乳及胃肠功能的影响

目的：观察并探讨剖宫产术后使用镇痛泵对产妇泌乳及胃肠功能恢复的影响。方法：将200例剖宫产产妇分为两组,观察组100例应用镇痛泵镇痛,对照组100例应用肌内注射度冷丁镇痛。术后2～48h观察产后疼痛的反应、首次哺乳时间、肛门排气时间、消化道反应等情况。结果：观察组术后6～24h镇痛效果优于对照组,差异有统计学意义（P〈0.01）,观察组术后泌乳时间显著早于对照组（P〈0.01）,而术后肠鸣音恢复时间与肛门排气时间无统计学差异（P〉0.05）。结论：应用镇痛泵镇痛可以有效的解除产妇疼痛能促进泌乳,不影响胃肠功能恢复。     

静脉自控镇痛泵在剖宫产术后的应用及护理

[目的] 观察静脉自控镇痛泵镇痛与肌肉注射镇痛药的镇痛效果、不良反应和剖宫产术后48 h内母乳喂养时间、睡眠时间及第1次排气时间,总结护理对策.[方法] 将180例剖宫产术后产妇随机分为两组,实验组90例,产妇术后用自控镇痛泵镇痛,对照组90例,产妇术后实行肌肉注射镇痛药的方法镇痛,采用相应护理措施.[结果]实验组疼痛明显减轻,与对照组比较差异有统计学意义(P＜0.01);实验组恶心、呕吐、头痛、头晕、尿潴留等不良反应明显少于对照组(P＜0.05);实验组48 h内母乳喂养时间和睡眠时间明显多于对照组(P＜0.01),实验组术后第1次排气时间明显短于对照组(P＜0.01).[结论] 静脉自控镇痛泵镇痛明显优于肌肉注射镇痛法.     

新式剖宫产术后护理改进研究

为研究新式剖宫产术后护理改进的可行性和必要性 ,本文通过对 86例新式剖宫产术后护理进行改进。即 :保留尿管拔除时间由过去的大于 2 4h提前至 6～ 2 4h ,观察产妇自行排尿情况 ;术后6h进食术后流汁 ,观察肛门排气时间 ;鼓励并指导产妇早期活动 ,记录首次下床活动时间 ;指导产妇自我观察和自我照顾 ,评估产妇自理能力。与常规横切口剖宫产 45例对照研究 ,结果显示 :两组产妇尿管拔除后自行排尿成功率 (P >0 .0 5 )差异无显著性 ;术后早进食 ,产妇肛门排气时间明显缩短 (P <0 .0 1) ;观察组产妇首次下床活动时间明显提前 (P <0 .0 1)。观察组产妇自理能力明显强于对照组的产妇(P <0 .0 1)。因此认为对新式剖宫产术后护理进行改进是可行和必要的。改进后的护理措施也适合于其它术式产妇的术后护理。     

吴茱萸粉外敷配合穴位按摩对剖宫产术后胃肠功能的影响

目的探讨吴茱萸粉神阙穴外敷配合穴位按摩对剖宫产术后产妇胃肠功能的影响。方法将120例剖宫产术后产妇随机分成2组,每组60例,实验组在剖宫产术后6h给予常规护理后,采用吴茱萸粉神阙穴外敷配合穴位按摩,对照组给予常规护理。观察产妇术后首次肛门排气时间及排便时间和食欲恢复正常的时间。结果实验组首次肛门排气时间、排便时间、食欲恢复时间均早于对照组(P0.05)。结论吴茱萸粉神阙穴外敷配合穴位按摩能促进剖宫产术后产妇肛门排气排便,尽早恢复胃肠功能,增进食欲。     

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.