日光早期干预对新生儿高胆红素血症倾向的效果观察

目的:探讨日光早期干预对新生儿高胆红素血症倾向的效果。方法:将2009年5～8月我院产科足月产新生儿560例随机分为实验组和对照组各280例,两组新生儿开奶时间相同,均为母乳喂养。对照组按新生儿护理常规护理,实验组在此基础上每天进行日光干预2h,每天2次。结果:实验组新生儿高胆红素血症发病率明显低于对照组,两组差异具有极显著意义(P0.01)。结论:对新生儿高胆红素血症倾向者进行日光早期干预能显著降低新生儿高胆红素血症的发病率,提高产科质量。     

畏养方式与新生儿高胆红素血症的相关性研究及护理对策

目的 探讨喂养方式对新生儿高胆红素血症的影响。方法 采用SDS对206例产妇产后1周内的新生儿高胆红素血症发生情况进行调查分析，分为纯母乳喂养组及混合喂养组。结果 纯母乳喂养组的高胆红素血症发生率高于混合喂养组，混合喂养组的新生儿高胆红素血症恢复情况明显好于纯母乳喂养组。提示 产妇产后泌乳量不足时，适当添加辅食，待母乳足量时再行纯母乳喂养，可降低新生儿高胆红素血症发生率。     

新生儿游泳＋抚触疗法对新生儿胆红素的影响

目的：探讨新生儿游泳＋抚触疗法对新生儿胆红素的影响。方法：对200例生理产出生的足月正常新生儿随机分为两组，对照组100例给予单纯沐浴护理，研究组100例给予游泳＋抚触疗法。观察两组新生儿胆红素的动态变化及24h后母乳喂养次数、新生儿体重、睡眠时问。结果：研究组新生儿胆红素指数明显低于对照组，研究组有2例出现高胆红素血症，对照组13例出现高胆红素血症；研究组新生儿母乳喂养次数、新生儿体重、睡眠时问明显优于对照组。结论：新生儿游泳＋抚触疗法可减少“肠一肝”循环，降低高胆红素血症的发生率，促进新生儿生长发育。     

苯巴比妥预防新生儿高胆红素血症的临床研究

目的：苯巴比妥预防新生儿高胆红素血症的效果。方法：以出生后1天内住院的180新生儿为研究对象，预防组于生后24小时内给予苯巴比妥5mg(kg.d)，每日2次口服，疗程3天，对照组不同苯巴比妥，用经皮胆红素测定仪测定胆红素，比较两组胆红素的变化。结果：预防组总红素均值明显低于对照组，预防组高胆红素血症的发病率为27．8％，明显低于对照组的68．9％（P＜0．01）。结论：生后预防口服苯巴比妥可降低新生儿胆红素浓度和新生儿高胆红素血症的发病率。     

益生菌对足月新生儿高胆红素血症的预防效果分析

目的：探讨益生菌预防足月新生儿高胆红素血症的效果及对血清总胆红素水平的影响。方法：选取2018年2月~2020年2月出生的足月新生儿96例,按随机数字表法分为对照组和观察组,各48例。对照组采用母乳喂养,观察组在母乳喂养基础上加服益生菌。比较两组血清总胆红素水平、大便频率、胆红素峰值、黄疸持续时间和高胆红素血症发生情况。结果：日龄5 d时,两组血清总胆红素水平均较日龄1 d时升高,但观察组低于对照组,差异有统计学意义（P＜0.05）;观察组大便频率高于对照组,胆红素峰值低于对照组,黄疸持续时间、胎便排空时间均短于对照组,差异有统计学意义（P＜0.05）;观察组高胆红素血症发生率低于对照组,差异有统计学意义（P＜0.05）。结论：益生菌可加快足月新生儿胎便排出,缩短黄疸持续时间,降低血清总胆红素水平,利于降低高胆红素血症发生率。     

抚触对新生儿黄疸影响的研究

目的 :探讨抚触能否降低新生儿黄疸指数和新生儿高胆红素血症。方法 :新生儿出生满 2 4h后连续 5d行新生儿抚触及皮测黄疸指数 ,并观察新生儿高胆红素血症的发生情况。结果 :第 2日至第 6日抚触组新生儿皮测黄疸指数均明显低于对照组 ,两者之间差别均有统计学意义 (P <0 .0 1) ;抚触组新生儿高胆红素血症明显低于对照组 ,差别有统计学意义 (P <0 .0 5 )。结论 :尽管新生儿黄疸的发生原因比较复杂 ,但抚触有明显降低新生儿黄疸指数和新生儿高胆红素血症发生的作用。     

新生儿口服苯巴比妥预防高胆红素血症的临床观察

目的：探讨口服苯巴比妥对预防新生儿高胆红素血症的作用。方法：选择80例母婴同室的新生儿，随机分成服药组和对照组各40例，于生后1天在服药组开始口服苯巴比妥5mg/kg，每日2次，共3天。对照组不服用药物。结果：服药组新生儿高胆红素血症发病率和胆红素整体水平明显低于对照组（P＜0．01）。结论：口服苯比妥 生儿高胆红素血症疗效明显。     

综合预防性护理干预对新生儿高胆红素血症发病率的影响

目的探讨综合预防性护理干预对新生儿高胆红素血症发病率的影响。方法选择2016年7月至2017年12月在我院出生的新生儿80例,将其随机分为对照组37例和观察组43例。对照组采取新生儿常规护理,观察组采取综合预防性护理干预,包括健康教育、预测评估、喂养护理、早期药物干预、预防性光疗、出院随访。比较两组新生儿不同日龄的经皮胆红素值、首次排胎便时间、首次排黄便时间、高胆红素血症发病率、家长护理满意度。结果观察组新生儿出生第3,4,5天的经皮胆红素值均低于对照组(P0.05),观察组首次排胎便时间、首次排黄便时间均早于对照组(P0.05),高胆红素血症发病率低于对照组(P0.05),患儿家长护理满意度高于对照组(P0.05)。结论综合预防性护理干预有助于降低新生儿高胆红素血症发病率,与早期评估、干预有关,对促进血清胆红素分解具有积极作用。     

抚触配合穴位按摩对新生儿黄疸影响的研究

[目的 ]探讨抚触配合穴位按摩对新生儿黄疸的影响。 [方法 ]选取足月分娩新生儿 2 10例 ,随机分成对照组、抚触组和穴位按摩抚触组各 70例。对照组予以新生儿常规护理 ,抚触组在常规护理基础上给予传统正规的标准抚触方法 ;穴位按摩抚触组除给予新生儿常规护理外 ,将穴位按摩手法融入标准抚触方法中进行按摩 ,观察并记录新生儿出生后 7d内的经皮胆红素变化及高胆红素血症发生率。 [结果 ]在降低黄疸指数和新生儿高胆红素血症发生方面 ,穴位按摩抚触组与抚触组有统计学意义(P <0 .0 1) ,抚触组与对照组有统计学意义 (P <0 .0 1)。 [结论 ]抚触有降低新生儿黄疸指数和新生儿高胆红素血症的作用 ,抚触配合穴位按摩效果更优于单纯抚触法。     

新生儿高胆红素血症相关因素分析

目的探讨非病理因素对新生儿高胆红素血症的影响。方法回顾性分析47例不明原因的新生儿高胆红素血症（观察组）和56例同期分娩健康新生儿（对照组）的临床资料。结果观察组和对照组新生儿性别、胎龄、产次、出生体重差异无显著性（P均〉0．05）。观察组和对照组出生后第4天的体重下降率、开奶时间、母乳喂养率、排便次数分别为（2．87±0．94）％和（2．10±0．70）％、（4．012±1．01）h和（3．07±0．81）h、66．07％和23．40％、（2．34±0．94）次／d和（3．82±1．32）次／d，两组比较差异均有显著性（P均〈0．01）。结论新生儿高胆红素血症的发生可能与新生儿生理性体重下降的程度、开奶时间、喂养方式、排便次数有关。加强指导新生儿早期合理喂养，避免新生儿高胆后素血症发生的风险因素，动态监测胆红素，对及早预防、适时干预新生儿高胆红素血症有重要的临床意义。     

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.