负压进针在心血管内科病人中的应用

[目的]探讨负压进针在心血管内科病人的静脉输注中是否优于常规进针法.[方法]将2004年1月-2005年6月我科收治且静脉穿刺难度大的病人随机分为实验组和对照组,实验组150例应用负压进针法,对照组150例应用常规进针法,比较两组的穿刺成功率和回血率.[结果]负压进针法比常规进针法的穿刺成功率提高了12%,回血率提高了13%,两组间穿刺成功率和回血率的差异有统计学意义(P＜0.01).[结论]负压进针大大提高了穿刺成功率和回血率,减少了病人的痛苦,提高护理人员的工作效率和住院病人满意度.     

负压进针在心血管内科病人中的应用

[目的]探讨负压进针在心血管内科病人的静脉输注中是否优于常规进针法.[方法]将2004年1月-2005年6月我科收治且静脉穿刺难度大的病人随机分为实验组和对照组,实验组150例应用负压进针法,对照组150例应用常规进针法,比较两组的穿刺成功率和回血率.[结果]负压进针法比常规进针法的穿刺成功率提高了12%,回血率提高了13%,两组间穿刺成功率和回血率的差异有统计学意义(P＜0.01).[结论]负压进针大大提高了穿刺成功率和回血率,减少了病人的痛苦,提高护理人员的工作效率和住院病人满意度.     

负压进针法在老年患者静脉留置针中的应用

目的:探讨负压进针法在老年患者静脉留置针中的应用.方法:将480例需行静脉留置针穿刺的患者随机分为对照组和实验组各240例,对照组按常规穿刺,实验组采用负压进针法穿刺.结果:两组静脉穿刺一次成功率、回血率、回血速度比较差异具有统计学意义(P<0.01).结论:负压进针法可提高静脉留置针穿刺一次成功率、回血速度、回血率.     

离心方向静脉穿刺在静脉穿刺困难病人中的应用

[目的]探讨离心方向静脉穿刺在静脉穿刺困难病人中的应用。[方法]将300例静脉穿刺难度大的病人随机分为观察组和对照组，每组150例，对照组采用常规向心方向静脉穿刺，观察组采用离心方向静脉穿刺。比较两组病人一次性静脉穿刺成功率、输液成功率和回血率。[结果]观察组病人一次性静脉穿刺成功率、输液成功率和回血率均高于对照组（P〈O．05）。[结论]穿刺困难静脉行离心方向静脉穿刺输液，回血快，一次性穿刺成功率和输液成功率高。     

负压进针法在早期休克患者静脉输液中的应用

目的提高早期休克患者静脉输液穿刺成功率。方法200例早期休克的静脉输液患者,随机分为观察组和对照组各100例,观察组使用负压进针法,即关键在于进针前将输液器前端反折,进针后将反折松开形成负压,利于快速回血;对照组采用传统静脉输液法。结果观察组比对照组的回血时间快,回血量大,差异有统计学意义（P〈0．01）,提高了一针见血成功率,但无统计学意义（P〉0．05）。结论负压进针法可以提高早期休克患者的静脉穿刺成功率,为抢救赢得了时间和机会。     

外周浅静脉留置针一步到位进针法效果观察

[目的]寻求提高外周浅静脉留置针穿刺成功率的办法。[方法]2006年4月—2008年4月选择住院输液病人196例,随机分为对照组和观察组,对照组采用留置针常规进针方法行外周浅静脉留置针穿刺,观察组采用一步到位进针法行外周浅静脉留置针穿刺,对两组穿刺成功率进行比较。[结果]观察组穿刺成功率明显高于对照组,经比较差异有统计学意义（P〈0.01）。[结论]一步到位进针法可提高外周浅静脉留置针穿刺成功率。     

外周浅静脉留置针一步到位进针法效果观察

[目的]寻求提高外周浅静脉留置针穿刺成功率的办法.[方法]2006年4月-2008年4月选择住院输液病人196例,随机分为对照组和观察组,对照组采用留置针常规进针方法行外周浅静脉留置针穿刺,观察组采用一步到位进针法行外周浅静脉留置针穿刺,对两组穿刺成功率进行比较.[结果]观察组穿刺成功率明显高于对照组,经比较差异有统计学意义(P＜0.01).[结论]一步到位进针法可提高外周浅静脉留置针穿刺成功率.     

负压穿刺在小儿头皮静脉穿刺中的应用效果观察

[目的]观察负压穿刺在小儿头皮静脉穿刺中的应用效果.[方法]将620例行小儿头皮静脉穿刺的患儿随机分为观察组和对照组,每组310例,对照组采用常规穿刺法,观察组利用负压原理,采取负压穿刺.比较两组的穿刺效果.[结果] 观察组一次穿刺成功率高于对照组(P＜0.05);观察组有回血295例,对照组有回血260例,观察组高于对照组(P＜0.05). [结论] 在小儿头皮静脉穿刺中利用负压原理,采取负压穿刺优于常规穿刺.     

负压穿刺在小儿头皮静脉穿刺中的应用效果观察

[目的]观察负压穿刺在小儿头皮静脉穿刺中的应用效果。[方法]将620例行小儿头皮静脉穿刺的患儿随机分为观察组和对照组,每组310例,对照组采用常规穿刺法,观察组利用负压原理,采取负压穿刺。比较两组的穿刺效果。[结果]观察组一次穿刺成功率高于对照组（P〈0.05）;观察组有回血295例,对照组有回血260例,观察组高于对照组（P〈0.05）。[结论]在小儿头皮静脉穿刺中利用负压原理,采取负压穿刺优于常规穿刺。     

静脉穿刺见回血后再进针长度探讨

[目的 ]探讨静脉穿刺见回血后再进针的长度。 [方法 ]通过对 10 0例病人采取穿刺见回血后再进针 >4mm和见回血后再进针约 3mm两种方法进行对照观察。 [结果 ]静脉穿刺见回血后再进针约 3mm静脉穿刺成功率较高 ( χ2 =7.0 86,P <0 .0 1) ;两组输液中断率比较有统计学意义 ( χ2 =6.60 9,P <0 .0 1)。 [结论 ]静脉穿刺见回血后再进针约 3mm较妥     

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.     

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.