《护理学报》第6B期继续教育思考题

1作者黄家莲等报道:远红外线照射联合马铃薯外敷治疗动静脉内瘘皮下血肿,较50%硫酸镁湿敷和喜疗妥乳膏外擦具有明显优势,具体体现在:A有效治疗动静脉内瘘皮下血肿伴疼痛     

外敷马铃薯与喜辽妥联合远红外线理疗治疗糖尿病肾病动静脉内瘘血肿的效果观察

目的 探讨马铃薯与喜疗妥联合远红外线理疗治疗糖尿病肾病血液透析患者动静脉内瘘皮下血肿的临床效果.方法 将60例内瘘皮下血肿患者随机分为对照组1、对照组2和观察组,每组20例.对照组1采用50%硫酸镁溶液湿敷,对照组2采用喜辽妥配合湿热敷,观察组采用外敷马铃薯与喜辽妥联合远红外线理疗.结果 观察组疗效显著优于对照组1和对照组2.结论 马铃薯外敷与喜辽妥外涂联合远红外线理疗科可有效治愈糖尿病肾病动静脉内瘘血肿,应用简便安全,值得临床推广.     

三七粉加金黄膏外敷在动静脉内瘘穿刺后皮下血肿中的应用

目的:探讨三七粉加金黄膏外敷在动静脉内瘘穿刺后皮下血肿中的应用效果.方法:将60例在血液透析过程中出现动静脉内瘘皮下血肿的患者随机分为试验组、对照A组、对照B组各20例,试验组应用三七粉加金黄膏,对照A组应用喜辽妥,对照B组应用50％硫酸镁外敷皮下血肿处.结果:试验组动静脉内瘘皮下血肿的疼痛持续时间、血肿消退时间、第一疗程前后疼痛程度、第一疗程前后瘀斑面积均低于对照A组和对照B组(P＜0.05).结论:三七粉加金黄膏外敷治疗动静脉内瘘皮下血肿的疗效优于喜辽妥及50％硫酸镁外敷的治疗方法.     

喜疗妥外敷结合远红外线照射对血液透析患者自体动静脉内瘘的护理体会

目的 探究血液透析患者自体动静脉内瘘采取喜疗妥外敷结合远红外线照射护理的效果。方法 选取 2022 年 2 月至 2023 年 2 月期间本院收治的 50 例血液透析患者作为研究对象。随机将患者分为对照组和观察组,每组各 25 例。对照组采取常规喜 疗妥外敷护理;观察组采取喜疗妥外敷结合远红外线照射护理。分析对比两组的穿刺成功率、透析血流量、疼痛情况以及并发 症发生率。结果 观察组的穿刺成功率及透析血流量均显著高于对照组（P<0.05）。观察组疼痛评分显著低于对照组（P<0.05）。 观察组的并发症发生率显著低于对照组（P<0.05）。结论 在血液透析患者自体动静脉内瘘中采取喜疗妥外敷结合远红外线照射 护理干预,能提升穿刺成功率,提高患者透析血流量,缓解患者疼痛,减少不良反应。     

远红外线照射结合木瓜酒湿敷对维持性血液透析病人动静脉内瘘并发症的影响

[目的]观察远红外线照射结合木瓜酒湿敷对维持性血液透析病人动静脉内瘘(AVF)并发症的影响。[方法]选择经AVF穿刺维持血液透析3个月以上的维持性血液透析病人86例,采用隐匿数字随机法分为对照组和观察组,每组43例,对照组给予喜疗妥外涂及常规护理,观察组给予远红外线照射结合木瓜酒湿敷及针对性护理,观察两组内瘘近期和远期并发症发生情况。[结果]观察组血肿吸收时间短于对照组、透析血流量大于对照组(P0.05);观察组内瘘穿刺后皮下血肿、疼痛、针眼处渗血发生率分别为4.65%、6.98%、16.28%,均低于对照组(P0.05);观察组远期并发症血管硬化、内瘘闭塞、内瘘狭窄和动脉瘤发生率分别为4.65%、2.33%、4.65%和23.26%,对照组远期并发症发生率分别为25.58%、16.28%、32.56%和44.19%,经比较差异均有统计学意义(P0.05)。[结论]远红外线照射结合木瓜酒湿敷可促进内瘘血肿吸收,减轻疼痛,提高透析血流量,还可预防血管硬化、内瘘闭塞等远期并发症;做好针对性护理可确保预防效果。     

三七合剂联合微波防治动静脉内瘘并发症的临床研究

[目的]观察三七合剂联合微波理疗对延长动静脉内瘘寿命的临床效果。[方法]选取2013年6月—2014年12月在肾病内科行血液透析且符合纳入标准的病人120例,将其随机分成3组:A组采用50%硫酸镁溶液湿敷治疗,B组使用喜疗妥乳膏外擦治疗,C组采用三七合剂联合微波疗法治疗。评价病人治疗前和治疗后24h疼痛缓解、皮下血肿消退情况;随访病人规律治疗2个月,追踪发生动静脉内瘘血管狭窄及闭塞状况,比较透析前后3组病人血液中炎性因子水平。[结果]治疗后24h视觉模拟评分法(VAS)评分及疼痛消退平均时间比较,差异有统计学意义(P0.05);C组治疗后24h血肿直径较治疗前及A组、B两组显著减小,差异有统计学意义(P0.05);C组动静脉内瘘血管狭窄发生率明显低于A组和B组,差异有统计学意义(P0.05);3组病人透析后血液中炎性因子水平比较,C组明显低于其他两组(P0.05)。[结论]三七合剂联合微波理疗能有效降低动静脉内瘘并发症,可延长动静脉内瘘病人寿命。     

喜疗妥软膏联合远红外线照护对血液透析患者自体动静脉内瘘功能影响的研究

目的探讨喜疗妥软膏联合远红外线照护对血液透析的患者自体动静脉内瘘功能的影响。方法将180例采用自体动静脉内瘘进行长期血液透析患者随机分为对照组和观察组,每组90例,对照组采用局部喜疗妥软膏外涂,观察组采用局部喜疗妥外涂联合远红外线照护。比较两组患者治疗3个月后血管情况。结果观察组患者治疗3个月后,在改善内瘘血管弹性、提高血液透析患者自体动静脉内瘘透析时的血流量等方面均优于对照组,两组比较差异有显著意义（P〈0．05）。结论血液透析患者自体动静脉内瘘护理,局部用喜疗妥外涂联合远红外线照护,效果优于局部单纯用喜疗妥外涂。     

喜疗妥涂搽加冰片食醋湿敷治疗动静脉内瘘早期并发症95例效果观察

目的:探讨喜疗妥涂搽加冰片湿敷治疗动静脉内瘘早期并发症的疗效观察。方法:将185例动静脉内瘘早期并发症的患者随机分为观察组95例和对照组90例,透析结束后24 h,观察组患处用喜疗妥涂搽加冰片食醋湿敷,对照组用50%硫酸镁溶液湿热敷,观察两组并发症消退时间、疼痛持续时间。结果:观察组大小血肿消退时间、血栓消失时间、复原时间、疼痛持续时间显著短于对照组(P<0.01,P<0.05)。结论:喜疗妥涂搽加冰片食醋能明显促进并发症的痊愈,其临床效果优于硫酸镁湿敷。     

木瓜酒湿敷改善血液透析患者动静脉内瘘血流量不足的效果观察

目的探讨木瓜酒湿敷改善血液透析患者动静脉内瘘血流量不足的效果。方法选择本院维持血液透析自体动—静脉内瘘发生血流量下降的患者65例,随机分为观察组(木瓜酒湿敷法)34例与对照组(喜疗妥热敷法)31例。治疗1周后通过内瘘物理检查方法和超声多普勒检测患者血流改善、血管杂音增强及血管狭窄、硬结软化改善情况。结果观察组患者在改善瘘管狭窄、血流量、增强血管杂音方面明显优于对照组,组间比较,均P<0.05,差异具有统计学意义。结论 木瓜酒湿敷法对改善自体动静脉内瘘泵控血流量不足效果优于喜疗妥热敷法,而且价格低廉、操作简单易行、起效快,值得临床推广应用。     

红外线照射联合喜疗妥外涂对动静脉内瘘并发症的影响

目的：探讨血液透析患者动静脉内瘘并发症的预防。方法：选择100例采用自体动静脉内瘘进行长期血液透析的尿毒症患者,随机分为对照组和实验组,每组50例。对照组采用喜疗妥软膏外涂,实验组采用红外线照射加喜疗妥软膏外涂。比较两组患者透析12个月后动静脉内瘘情况。结果：实验组治疗12个月后内瘘情况优于对照组。两组比较差异有统计学意义（P〈0．05）。结论：在血液透析患者动静脉内瘘护理中,应用红外线照射联合喜疗妥软膏外涂,可有效减少硬结、红肿、血管狭窄等静脉炎发生率。     

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.     

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.