腹腔镜辅助食管癌剥脱术的护理配合

[目的]探讨腹腔镜辅助食管癌剥脱、食管胃左颈吻合术的护理配合要点。[方法]回顾性分析6例行腹腔镜辅助食管癌剥脱、食管胃左颈吻合术病人的临床资料,总结围术期术前访视,巡回护士、器械护士术前仪器物品准备和术中护理配合。[结果]6例手术病人术后均常规行空肠造瘘,手术时间150 min~225 min,平均170 min。术中失血100 mL~200 mL,平均150 mL。手术过程顺利,术后愈合良好。[结论]器械护士和巡回护士掌握配合要点、准备充分、有良好的术中应变能力是手术顺利进行的重要保证。     

12例单孔胸腔镜肺叶切除手术的术中配合与护理

[目的]总结单孔胸腔镜下肺叶切除手术的术中配合和护理经验。[方法]回顾性分析在胸外科行单孔胸腔镜下肺叶切除手术的12例病人临床资料,总结术中配合体会与护理要点。[结果]所有病人术程顺利,无中转开胸手术,手术切口长度4cm~5cm,手术时间110min~270min(175min±58.8min),术中出血量50mL~200mL(100mL±24.5mL)。术后无相关并发症发生。[结论]单孔胸腔镜下肺叶切除手术不但对外科医生的手术技术提出了新的要求,也对手术室护士专业知识掌握程度以及手术配合与护理提出了更严格的要求。手术室专科腔镜护士术中熟练配合是单孔胸腔镜肺叶切除成功的重要保证。     

腹腔镜辅助全胃切除并D2淋巴结清扫术的手术配合

目的 探讨腹腔镜辅助全胃切除并D2淋巴结清扫术的手术配合技巧.方法 总结了172例腹腔镜辅助全胃切除并D2淋巴结清扫术的手术配合.结果 术前做好患者心理护理和手术间及各种特殊器械的准备工作;术中巡回护士实施有效安全的体位管理、胃管护理及仪器摆放,器械护士熟悉手术步骤、密切配合医生,严格无菌无瘤技术操作.患者平均手术时间170 min,平均术中失血量48 ml,手术过程顺利.结论 良好的专科护士的配合,尤其器械护士熟悉手术步骤和细节能够使腹腔镜辅助全胃切除并D2淋巴结清扫术更顺利地完成.     

后腹膜入路腹腔镜肝肿瘤切除术的护理配合

[目的]总结后腹膜入路腹腔镜肝肿瘤切除术的护理配合。[方法]对10例经后腹膜入路腹腔镜肝肿瘤切除术病人加强手术配合,巡回护士术前访视,针对新术式对病人进行心理指导,做好该术式仪器及特殊器械的准备工作,实施该术式特殊体位的管理,术中预防低体温的发生,正确摆放及操作各种仪器设备。[结果]10例手术均顺利完成,围术期无严重并发症,术后恢复良好。手术时间平均148min,出血量平均186mL,住院时间平均6.9d。[结论]加强后腹膜入路腹腔镜肝肿瘤切除手术的护理配合是手术成功的保证。     

腹腔镜下脾切除术的手术配合体会

[目的]探讨基层医院用普通腹腔镜器械进行腹腔镜下脾切除术手术的可行性及手术护理配合。[方法]对6例肝炎后肝硬化脾功能亢进、脾外伤、门脉高压伴脾脏肿大病人在无先进设备情况下用普通腹腔镜器械实施腹腔镜下脾切除,做好术前心理护理、器械准备、术中手术配合、术后护理。[结果]6例病人均顺利完成手术,显示基层医院用普通腹腔镜器械进行腹腔镜下脾切除手术的可行性。[结论]术前做好充分的准备,巡回护士、器械护士熟练默契的配合,手术医生良好的操作技能,术中医护的协调配合是手术成功的关键。     

RMAST微创通道入路下椎管内肿瘤切除术的术中护理配合

[目的]探索RMAST微创通道入路下椎管内肿瘤切除术术中有效护理配合流程及要点。[方法]回顾性分析我院神经外科2016年3月—2016年12月我院神经外科采用RMAST微创通道入路下切除椎管内肿瘤的6例椎管内肿瘤病人的病人资料、手术方式及术中护理配合情况。[结果]6例病人手术过程均顺利,术后恢复良好,手术时间90 min~120 min,平均95 min;术中出血量50m L~100 m L,平均55 m L,均未输血;术后住院天数4 d~8 d,平均6.6 d。[结论]术中有效配合能够提升RMAST微创通道入路下椎管内肿瘤切除术成功率,促进病人康复,提升整体医疗服务质量。     

腹腔镜下子宫肌瘤剔除术的手术配合

[目的]总结腹腔镜下子宫肌瘤剔除术的手术配合,进一步提高护理配合水平.[方法]对126例腹腔镜下子宫肌瘤剔除术的护理配合要点作回顾性分析.[结果]手术过程顺利,无并发症发生.[结论]重视手术室人员培训,术前各项准备齐全,熟练掌握仪器、器械性能,熟悉手术步骤,术中配合熟练默契,严密观察患者病情变化,专人配合手术和管理仪器等是确保病人安全和手术成功的重要环节.     

脾切除合并自体脾移植手术的护理配合

[目的]探讨脾切除合并自体脾移植手术的护理配合。[方法]对2005年1月—2016年9月25例行脾切除合并自体脾移植手术病人的护理配合进行分析总结,器械护士必须熟悉手术步骤,精准的传递器械,提前准备好台上所需的各类物品;巡回护士要熟悉各种仪器的性能,正确地安置体位,及时更换体位。[结果]本组病人的手术时间为2h~4h,手术过程顺利,切口愈合好,术后病人恢复良好。[结论]加强脾切除合并自体脾移植手术的护理配合是手术顺利完成的保证,能为病人提供安全、舒适的手术护理,预防和避免并发症的发生。     

65例腹腔镜全子宫切除术的术中配合与护理

[目的]讨论腹腔镜下全子宫切除术的术中配合和护理措施,为临床护理配合提供依据。[方法]回顾性分析65例腹腔镜下全子宫切除术病人的临床资料,总结有效的术中配合和护理措施。[结果]经过护理人员的积极配合和有效护理,腹腔镜下全子宫切除手术过程顺利,术后5d～7d均痊愈出院,术后回访恢复良好。[结论]术前充分准备、术中密切配合、术后精心护理是保证腹腔镜下全子宫切除手术成功的重要因素,可减少术后并发症的发生,提高病人护理满意度。     

胸腔镜肺叶切除手术配合体会

[目的]总结胸腔镜肺叶切除术护理配合要点。[方法]2010年3月—2012年12月利用胸腔镜对49例肺叶病变的病人实施了手术,在术前注重病人的心理护理,使病人保持良好的心态接受手术;根据手术进程与手术医生和麻醉医生默契配合,密切观察病人病情变化,保证病人安全及手术顺利进行。[结果]49例病人除3例中转外,其余病人手术顺利,平均术中出血量为75mL,平均手术时间为162min,术后引流量为630mL,平均住院日为6.5d。[结论]胸腔镜肺叶切除术具有创伤小、术中术后痛苦轻、术后恢复快等特点,手术室护理人员熟练掌握该手术的配合要点对今后开展胸腔镜肺叶切除手术具有重要意义。     

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.     

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.     

Molecular characterization of virulence and antimicrobial resistance profile of Shigella species isolated from children with moderate to severe diarrhea in northeastern Brazil

Molecular characterization of virulence and antimicrobial resistance profiles were determined for Shigella species isolated from children with diarrhea in Fortaleza, Brazil. Fecal specimens were collected along with socioeconomic and clinical data from children with moderate to severe diarrhea requiring emergency care. Shigella spp. were isolated by standard microbiological techniques, and we developed 4 multiplex polymerase chain reaction assays to detect 16 virulence-related genes (VRGs). Antimicrobial susceptibility tests were performed using disk diffusion assays. S. flexneri and S. sonnei were the predominant serogroups. S. flexneri was associated with low monthly incomes; more severe disease; higher number of VRGs; and presence of pic, set, and sepA genes. The SepA gene was associated with more intense abdominal pain. S. flexneri was correlated with resistance to ampicillin and chloramphenicol, whereas S. sonnei was associated with resistance to azithromycin. Strains harboring higher numbers of VRGs were associated with resistance to more antimicrobials. We highlight the correlation between presence of S. flexneri and sepA, and increased virulence and suggest a link to socioeconomic change in northeastern Brazil. Additionally, antimicrobial resistance was associated with serogroup specificity in Shigella spp. and increased bacterial VRGs.     

护理干预对面部中重度寻常型痤疮的临床疗效影响分析

目的研究护理干预对面部中重度寻常型痤疮的临床疗效影响。方法选取本院在2014年4月~2016年7月诊治的136例面部中重度寻常型痤疮患者,随机分为研究组与对照组,每组68例;所有患者均依据其情况给予对应的治疗,其中对照组在治疗期间给予常规护理,研究组在对照组的基础上再给予综合性护理干预,比较两组的治疗效果及护理满意度情况等。结果患者在接受治疗和护理后,研究组中度与重度患者的治疗效果较对照组均明显提高(P0.05),研究组护理满意度较对照组明显增高(P0.05)。结论对面部中重度寻常型痤疮患者在其治疗期间给予综合性护理干预,具有良好的效果。