老年患者肠镜检查前肠内营养支持的临床探讨

目的 探讨老年患者肠镜检查前实施肠内营养支持的方法和临床效果.方法 选取我科门诊及病房拟行电子肠镜检查的老年患者40例,随机分为传统组、改良组,每组20例.传统组采用常规方法进行肠道准备,改良组则采用口服肠内营养液,进行肠道清洁准备.结果 改良组的血糖、电解质、自我感觉问卷较传统组有统计学意义(P＜0.05),血压及肠道清洁度无明显差异.结论 老年患者肠镜检查前以口服肠内营养液辅助肠道准备可避免低血糖、电解质紊乱等不良反应及不适的发生,同时可有效地清洁肠道.     

老年患者肠镜检查前两种肠道准备方法的对比研究

目的 探讨采用不同方法对老年患者行肠镜检查前的肠道准备,对结肠镜检查效果的影响。方法将100例拟行肠镜检查前肠道准备的老年患者随机分成两组,实验组50例,采用结肠透析机进行肠道准备;对照组50例,采用口服给药法;比较两组的肠道准备效果,观察两种肠道准备方法的治疗中和治疗后的不良反应。结果采用结肠透析机进行肠道准备效果优于口服给药法（P〈0．05）,不良反应发生率与口服给药时比较无明显差异。结论采用结肠透析机进行肠镜检查前的肠道准备是适合老年患者的一种有效方法。     

便秘型患者肠镜检查前肠道准备的方法及护理

目的:探讨便秘型患者肠镜检查前肠道准备的方法及效果.方法:将肠镜检查患者100例,随机分观察组与常规组,常规组在肠镜检查前4 h口服20%甘露醇溶液清肠;观察组在常规组的基础上加次口服20%甘露醇溶液清肠.观察肠道清洁程度.结果:观察组患者肠道清浩效果好,肠镜检查顺利完成.常规组患者肠道清洁效果较差,影响肠镜检查.结论:加次口服甘露醇对便秘型患者肠镜检查前肠道清洁准备的效果好,成功率高.     

肠内营养液在老年患者行结肠镜前肠道准备中的效果

目的观察80岁以上患者在结肠镜检查前行肠道准备时口服肠内营养制剂对肠道清洁度、肠道准备的安全性的影响。方法将112例患者按随机数字表法分为A、B、C、D4组,每组各28例,肠道准备时分别给予磷酸钠盐(A组),磷酸钠盐+肠内营养液(B组),硫酸镁(C组),硫酸镁+肠内营养液(D组),记录肠道清洁度、体质量指数、血压、血糖变化及不良事件发生率。结果4种肠道准备方法清洁有效率比较,差异无统计学意义;B组、D组体质量指数、心率、血压及空腹血糖变化幅度小于A组、C组,不良反应发生率低于A组、C组。结论80岁以上老年患者行结肠镜肠道准备时加服肠内营养液,能降低不良事件的发生、不影响肠道清洁度,提高了护理工作效率。     

口服清洁肠道药物前进食对肠镜检查中肠道清洁度及患者血糖和耐受力的影响

目的 探讨经口服清洁肠道药物前进食半流食物对患者血糖、肠道清洁度及耐受力的影响.方法 将准备进行肠道检查或经肠镜行肠道治疗的88例患者随机分为进食组(A组)和禁食组(B组)各44例,A组在口服清洁肠道药物前2.5 h进食半流食物,B组在口服清洁肠道药物前禁食;在口服清洁肠道药物前及口服清洁肠道药物后6h分别监测2组患者的血糖;进行肠道检查或经肠镜行肠道治疗时评定肠道的清洁度,总结2组无法耐受而终止检查和治疗的患者数.然后对2组患者血糖、肠道清洁度、耐受力分别进行比较.结果 A、B2组口服清洁肠道药物前后血糖比较有显著差异;2组肠道清洁度比较,无显著差异;2组患者耐受力比较有显著差异.结论 经口服清洁肠道药物前2.5 h进食半流食物对肠道清洁度无影响,但能明显升高血糖,提高患者肠道检查或治疗的耐受力,使肠道检查或治疗顺利完成.     

电子结肠镜检查不同肠道准备方法的效果观察

[目的]观察电子肠镜检查不同肠道准备方法的效果.[方法] 306例行电子肠镜检查病人随机分为3组,A组100例采用传统灌肠进行肠道准备,B组102例口服电解质进行肠道准备,C组104例采用聚乙二醇电解质溶液进行肠道准备.观察并比较3组病人肠道清洁程度、肠道准备过程中的依从性和服药后不良反应发生情况.[结果]C组肠道清洁程度、肠道准备过程中的依从性均优于A组和B组;C组服药后不良反应发生率低于A组和B组.[结论]口服聚乙二醇电解质溶液进行电子结肠镜检查肠道准备效果明显.     

结肠镜肠道准备改良方法的临床效果分析

目的 评价结肠镜肠道准备改良方法的效果,探讨一种结肠镜肠道准备的新方法.方法 将200例行结肠镜检查前肠道准备的患者随机分为两组:传统法组(100例)于检查前日晚上和检查日早晨分别口服复方聚乙二醇电解质散1.0、1.5 L;改良法组(100例)分别于检查前日晚上和检查日早晨口服1.0 L复方聚乙二醇电解质散与10 mg枸橼酸莫沙必利.进行前瞻性随机对照试验,评价两组患者服药后肠道清洁效果和患者的耐受性.结果 无论是波士顿肠道准备评分(BBPS评分)、肠镜图像主观评价,还是患者的服药耐受性,改良法组均优于传统法组,差异有统计学意义(P<0.05).结论 复方聚乙二醇电解质散联合枸橼酸莫沙必利行肠道准备能提高结肠镜检查前肠道的清洁度,减轻患者不良反应.     

电子肠镜检查前3种肠道清洁方法效果比较

目的 探讨电子肠镜检查前3种肠道清洁方法 的效果比较.方法 将1236例接受电子肠镜检查与治疗的患者随机分为口服甘露醇组408例、口服复方聚乙二醇电解质散组394例和口服硫酸镁组434例,根据电子肠镜检查前肠道清洁度和肠道清洁范围评价肠道清洁效果.结果 复方聚乙二醇组肠道清洁有效率为98.7%,显著高于口服甘露醇组95.7%和口服硫酸镁组86.7%(P<0.05);肠道清洁范围最大,全结肠清洁率92.5%,显著高于口服甘露醇组86.9%和口服硫酸锾组71.5%.复方聚乙二醇不良反应发率为11%,显著低于甘露醇组34%和口服硫酸镁组41%(P<0.05).结论 口服复方聚乙二醇电解质散是比较理想的全结肠清洁方法 ,不良反应相对少,但临床中应根据患者经济能力选择最佳的肠道准备方法 .     

结肠水疗在结肠镜检查前肠道准备中的应用

目的：探讨结肠水疗在结肠镜检查前肠道准备中的效果和安全性。方法将366例行电子结肠镜检查的患者随机分为观察组和对照组,观察组218例患者使用结肠水疗仪2次清洁肠道;对照组148例患者采用口服硫酸镁清洁肠道。比较2组患者肠镜下肠道清洁的效果及不良反应。结果观察组肠道清洁效果显著优于对照组（P＜0．05）,观察组不良反应显著低于对照组（P＜0．05）。结论使用结肠水疗进行肠道准备成功率高,患者痛苦小、易耐受,值得推广。     

老年人口服电解质溶液替代清洁灌肠的临床观察

纤维肠镜检查必须清洁肠道,传统的方法是少渣饮食—流质—口服泻药—清洁灌肠,其操作繁琐,多次插入肛管灌肠易损伤直肠粘膜而引起出血,而在老年人中有时也达不到清洁肠道的目的。近几年来,我们采用了口服电解质溶液替代清洁灌肠的方法,为40例需进纤维肠镜检查的老年病人作肠道准备,并与40例采用传统方法作肠道准备老年人作对照,观察两种方法的临床效果。1　临床资料因慢性腹泻、便血、结肠息肉、需行纤维结肠镜检查的老年病人80例,随意分为对照组和观察组,对照组,男32例、女8例,年龄在61～83岁,平均72岁,观察组,男39例、女1例,年龄60～82岁,…     

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.     

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.     

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.     

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.