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排序方式: 共有2059条查询结果,搜索用时 31 毫秒
1.
Lesley B Milgrom Jo Ann Brooks Rong Qi Karen Bunnell Susie Wuestfeld Daniel Beckman 《American journal of critical care》2004,13(2):116-125
BACKGROUND: Acute pain is common after cardiac surgery and can keep patients from participating in activities that prevent postoperative complications. Accurate assessment and understanding of pain are vital for providing satisfactory pain control and optimizing recovery. OBJECTIVES: To describe pain levels for 5 activities expected of patients after cardiac surgery on postoperative days 1 to 6 and changes in pain levels after chest tube removal and extubation. METHODS: Adults who underwent cardiac surgery were asked to rate the pain associated with various types of activities on postoperative days 1 to 6. Pain levels were compared by postoperative day, activity, and type of cardiac surgery. Pain scores before and after chest tube removal and extubation also were analyzed. RESULTS: Pain scores were higher on earlier postoperative days. The order of overall pain scores among activities (P < .01) from highest to lowest was coughing, moving or turning in bed, getting up, deep breathing or using the incentive spirometer, and resting. Changes in pain reported with coughing (P = .03) and deep breathing or using the incentive spirometer (P = .005) differed significantly over time between surgery groups. After chest tubes were discontinued, patients had lower pain levels at rest (P = .01), with coughing (P = .05), and when getting up (P = .03). CONCLUSIONS: Pain relief is an important outcome of care. A comprehensive, individualized assessment of pain that incorporates activity levels is necessary to promote satisfactory management of pain. 相似文献
2.
S V Kamat B Iwaskewycz E J Beckman A J Russell 《Proceedings of the National Academy of Sciences of the United States of America》1993,90(7):2940-2944
Supercritical fluids are a unique class of nonaqueous media in which biocatalytic reactions can occur. The physical properties of supercritical fluids, which include gas-like diffusivities and liquid-like densities, can be predictably controlled with changing pressure. This paper describes how adjustment of pressure, with the subsequent predictable changes of the dielectric constant and Hildebrand solubility parameter for fluoroform, ethane, sulfur hexafluoride, and propane, can be used to manipulate the activity of lipase in the transesterification of methylmethacrylate with 2-ethyl-1-hexanol. Of particular interest is that the dielectric constant of supercritical fluoroform can be tuned from approximately 1 to 8, merely by increasing pressure from 850 to 4000 psi (from 5.9 to 28 MPa). The possibility now exists to predictably alter both the selectivity and the activity of a biocatalyst merely by changing pressure. 相似文献
3.
Proarrhythmia: a paradoxic response to antiarrhythmic agents 总被引:2,自引:0,他引:2
Antiarrhythmic drugs may effectively terminate and prevent symptomatic tachycardias, but they may also provoke life-threatening rhythm disturbances. The electrophysiologic mechanisms responsible for proarrhythmia can be extrapolated from the existing models of reentry and abnormal automaticity. Although all antiarrhythmic drugs may cause proarrhythmia with seemingly similar frequency, the profile of the disturbance with each class of agents appears somewhat distinct. All agents may cause an increased frequency of premature beats or new or worsened ventricular tachycardia, but the classic form of proarrhythmia due to type la agents is torsades de pointes. Recent information has provided clues to the underlying mechanism of drug-induced torsades de pointes and has provided a clinical picture of patients with this adverse effect. Types lb and lc agents only rarely precipitate torsades de pointes. The latter, however, may cause a rapid, sustained, monomorphic ventricular tachycardia in certain high-risk patients that can be resistant to resuscitation efforts. Amiodarone may cause a broad variety of arrhythmias that are complicated by their extended duration and difficulty in distinguishing proarrhythmia from simple inefficacy. Proarrhythmia is a relatively common, paradoxic side effect that necessitates the clinician to make careful risk-benefit decisions in choosing antiarrhythmic drug therapy. 相似文献
4.
5.
INVOLVEMENT OF NON-NMDA AND NMDA RECEPTORS IN GLUTAMATE-INDUCED PRESSOR OR DEPRESSOR RESPONSES OF THE PONS AND MEDULLA 总被引:1,自引:0,他引:1
SY Chen WC Wu CJ Tseng JS Kuo CY Chai 《Clinical and experimental pharmacology & physiology》1997,24(1):46-56
1. Fifty-five intact and six baroreceptor denervated and vagotomized cats of either sex were anaesthetized intraperito-neally with urethane (400 mg/kg) and a-chloralose (40 mg/kg). Responses of the systemic arterial pressure (SAP), mean SAP (MSAP) and sympathetic vertebral nerve (VNA) and renal nerve activities (RNA) were recorded. 2. In intact animals, monosodium L-glutamate (Glu, 0.1 mol/L, 50 nL) was microinjected into pressor areas of the locus coeruleus (LC), gigantocellular tegmental field (GTF), rostral ventrolateral medulla (RVLM) and dorsomedial medulla (DM), and the depressor areas of caudal ventrolateral medulla (CVLM). The induced actions were compared before and after microinjection of either glutamate antagonists, glutamate diethylester (GDEE, 0.5 mol/L, 50–100nL), a competitive AMPA receptor blocker, or 2-amino-5-phosphonovaleric acid (D-AP5, 0.025 mol/L, 50–100 nL), a competitive N-methyl-D-aspartate (NMDA) receptor blocker. GDEE completely blocked the increases of SAP and VNA elicited from all pressor areas. D-AP5 only partially blocked the pressor but slightly blocked VNA and RNA responses from LC, GTF and DM, particularly those from RVLM. Neither GDEE nor D-AP5 blocked the depressor responses of SAP and two nerve activities elicited from CVLM. 3. In baroreceptor denervated animals, NMDA (2 mmol/L, 50–100 nL) and AMPA (0.2 mmol/L, 50–100 nL) were micro-injected into the same pressor areas of GTF, RVLM and DM and the depressor area of CVLM responsive to Glu activation (0.1 mol/L, 30 nL). In RVLM, DM and CVLM, the results of either NMDA or AMPA were similar to those induced by Glu. However, in GTF, microinjection of either NMDA or AMPA did not induce similar responses to Glu. This suggests that the nature of GTF may differ from RVLM and DM. 4. The above results suggest that the Glu-induced pressor responses from LC, GTF, DM and especially RVLM, are primarily mediated through AMPA receptors. The Glu-induced depressor responses from CVLM may not be predominantly mediated by either AMPA or NMDA receptors. 5. In both baroreceptor-intact and -denervated cats stimulation of the pressor areas often produced an increase of VNA and a decrease of RNA, while in the depressor CVLM decreased both VNA and RNA. The VNA, but not RNA were positively correlated with the pressor responses, while both VNA and RNA were positively correlated with the depressor responses. This may suggest that neurons of the sympathetic vertebral and renal nerves are topographically organized in the brain. 相似文献
6.
Raymond Dalgleish Timothy Francis Matthew J Beckman 《Journal of orthopaedic research》2006,24(7):1571-2; author reply 1572-4
7.
Hillmann JS; Mesgarzadeh M; Revesz G; Bonakdarpour A; Clancy M; Betz RR 《Radiology》1987,165(3):769-773
Proximal femoral focal deficiency, an uncommon congenital anomaly, necessitates early radiologic classification for surgical planning and treatment. Objective radiographic criteria, including femoral length index, acetabular depth index, acetabular angle index, and shape of the proximal femur were determined in 49 patients before cartilaginous ossification of the femoral capital epiphysis; final classification was based on follow-up radiographs or findings at arthrography or surgery. These parameters were analyzed to determine the accuracy and contributions of each in classification. Correct classification into one of three groups was possible in 86% of cases with use of three of the parameters: femoral length index, acetabular depth index, and shape of the proximal femur. The acetabular angle was found to contribute insignificantly to classification. Magnetic resonance imaging, used in only one case, depicted the nonossified cartilaginous femoral capital epiphysis, thus obviating the need for invasive diagnostic procedures and facilitating early classification. 相似文献
8.
9.
Serum ionic fluoride levels in haemodialysis and continuous ambulatory peritoneal dialysis patients 总被引:1,自引:1,他引:0
al-Wakeel JS; Mitwalli AH; Huraib S; al-Mohaya S; Abu-Aisha H; Chaudhary AR; al-Majed SA; Memon N 《Nephrology, dialysis, transplantation》1997,12(7):1420-1424
High serum fluoride (F-) in patients with chronic renal failure (CRF) and
end-stage renal disease (ESRD) is associated with risk of renal
osteodystrophy and other bone changes. This study was done to determine F-
in normal healthy controls and patients with ESRD on haemodialysis (HD) or
peritoneal dialysis (PD). Seventeen healthy controls (12 males, 5 females)
and 39 ESRD patients on dialysis (17 males, 22 females) were recruited in
the study in a community with 47.4 +/- 3.28 microM/l (range 44-51 microM/l)
of F- content in drinking water. Control subjects showed a mean serum F-
concentration of 1.08 +/- 0.350 microM/l. Males in control group showed
slightly higher F- levels (1.15 +/- 0.334, range 0.55-1.9 microM/l) than
females (0.92 +/- 0.370, range 0.6-1.5 microM/l). Mean serum F-
concentration did not correlate significantly with age and sex among
control subjects, whereas such correlation was observed in patients with
ESRD on dialysis. Mean serum F- concentration was significantly higher in
patients on dialysis (2.67 +/- 1.09, range 0.8-5.2 microM/l) than normal
controls. When grouped according to sex, the mean serum F- concentration in
males (3.05 +/- 1.04, range 1.8-5.2 microM/l) was significantly higher than
females (2.38 +/- 1.08, range 0.8-5.2 microM/l). When patients were grouped
according to age, it was observed that F- concentration was significantly
higher in patients with age groups 21-70 (2.86 +/- 1.05) than those with
age group 13-20 years (1.42 +/- 0.531). Thus F- concentration correlated
with age and sex, being higher in males and above 20 years. Despite
appreciable clearance of F- (39-90%) across the peritoneum, patients on
CAPD showed higher serum F- concentration than those on HD (3.1 +/- 1.97 vs
2.5 +/- 1.137 microM/l). Of the total 39 patients on dialysis 39% had their
serum F- concentration above 3.0 microM/l, posing the risk of renal
osteodystrophy.
相似文献
10.
Rupture of the distal biceps tendon: evaluation with MR imaging 总被引:2,自引:0,他引:2