三种清肠方法在小肠胶囊内镜检查中的比较研究

目的比较三种肠道准备方法在小肠胶囊内镜检查中的清肠效果。方法分析2012年12月—2018年12月在我院行小肠胶囊内镜检查的96例患者的临床资料,随着时间的推进,不断学习更新知识,改进清肠工艺,根据用药方案的不同,分为A组(32例,甘露醇清肠)、B组(28例,3袋和爽清肠)、C组(36例,1袋和爽清肠)。比较各组清肠后的小肠内总体清肠效果,对小肠内消化液量、气泡量、清洁度、图片效果进行定量分析。结果 C组肠道清洁度效果优于A组,差异具有统计学意义(P0.05),C组肠道清洁度效果略优于B组,差异无统计学意义(P0.05);C组消化液量均少于A、B组,差异具有统计学意义(P0.05);C组气泡量明显少于A组,但差异具有统计学意义(P0.05),C组气泡量略少于B组,但差异无统计学意义(P0.05);C组观察效果明显优于A组,差异具有统计学意义(P0.05),C组观察效果略优于B组,但差异无统计学意义(P0.05)。结论 C组清肠方法效果优于A组和B组,能明显减少小肠内的消化液量,而且气泡量少、清洁度佳,能得到更加清晰的图片效果。认为C组清肠方法简单易被患者接受且经济实用,值得临床推广。     

莫沙必利联合聚乙二醇电解质散在胶囊内镜肠道准备中的效果评价

目的:探讨莫沙必利联合聚乙二醇电解质散在胶囊内镜检查肠道准备中的应用价值.方法:将进行胶囊内镜检查的130例患者随机分为对照组(仅服聚乙二醇电解质散)和研究组(莫沙必利+聚乙二醇电解质散),各65例.将每例胶囊所获得的小肠图像资料按照小肠通过时间平均分成A、B二段,对两组胶囊内镜图像的气泡量、肠液量等进行定量分析,并统计胶囊内镜通过情况及患者肠道准备过程中的不良反应.结果:两组患者胶囊在小肠的停留时间和排出时间差异均无统计学意义(P>0.05),研究组A段肠道气泡及肠液量较对照组明显改善(P值分别为0.01、0.031),而B段则与对照组无明显差异(P值分别为0.337、0.200);研究组出现的恶心、呕吐等不良反应也明显低于对照组(P=0.029).结论:莫沙必利联合聚乙二醇电解质散可提高上段小肠黏膜观察清晰度,从而提高胶囊内镜观察效果,且可减少肠道准备过程中不良反应的发生.     

不同肠道准备方法对胶囊内镜检查的效果研究*

目的探寻胶囊内镜(CE)检查的最佳肠道准备方法。方法 102例拟行CE检查的患者随机分为3组,A组(n=40):检查前1天21:00口服聚乙二醇电解质散137.12 g,溶于2 000 ml水中,检查前4 h口服聚乙二醇电解质散68.56 g,溶于1 000 ml水中;B组(n=32):检查前4 h口服聚乙二醇电解质散205.68 g,溶于3 000 ml水中;C组(n=30):检查前4 h口服20%甘露醇500 ml,后饮水2 500 ml。3组患者均吞服胶囊后立即吞服二甲基硅油120 mg,比较各组患者副反应发生率、小肠清洁度和小肠通过时间。结果 3组副反应发生率分别为15.00%、15.63%及16.67%,差异无统计学意义(P0.05);B、C两组小肠清洁度均优于A组,差异具有统计学意义(均P0.05),C组略优于B组,差异无统计学意义(P0.05);A组小肠通过时间明显长于B、C两组(均P0.05),而B、C两组间比较差异无统计学意义(P0.05)。结论清肠剂顿服效果优于分次口服,20.00%甘露醇500 ml顿服是一种清肠效果好、副反应较少且经济的肠道准备方法,值得临床推广。     

使用磷酸钠盐口服液进行肠道准备的效果观察

目的 探讨磷酸钠盐口服液作为清肠剂在电子结肠镜检查患者进行肠道准备中应用的效果.方法 将120例行电子结肠镜检查的患者按抽签法随机分为磷酸钠盐组与聚乙二醇组各60例,磷酸钠盐组于检查当日上午8:00口服磷酸钠盐原液45 mL加温开水750 mL稀释后30 min内喝完,11:00按同样的方法重复口服1次;聚乙二醇组于检查当日上午9:00将聚乙二醇电解质散137.12 g倒入2 000 mL温开水中,充分溶解后首次服用1 000 mL,1 h内喝完,全部2 000 mL溶液在1.5～2.0 h内喝完.比较两组患者不良反应发生率及清肠效果.结果 磷酸钠盐组恶心、呕吐、腹痛、腹胀等不良反应发生率低于聚乙二醇组(P＜0.05),肠道清洁效果优于聚乙二醇组(P＜0.05).结论 采用磷酸钠盐口服液进行肠道清洁效果显著,不良反应较少,值得临床推广.     

25例结肠胶囊内镜检查的护理

[目的]总结结肠胶囊内镜检查的护理。[方法]对25例行结肠胶囊内镜检查,同时加强护理,主要对病人宣教检查前注意事项及进行肠道准备,观察病人胶囊胃、小肠通过时间、结肠检查时间、胶囊排出率、肠道清洁度、检查过程中副反应。[结果]25例检查者均顺利完成结肠胶囊内镜检查,90.4%检查者胶囊在480min内排出;结肠检查时间360min±85min,胃通过时间85min±43min,小肠通过时间为142min±83min;肠道清洁度良好为95%,检查过程中未出现严重不良反应。[结论]对结肠胶囊内镜检查病人行护理指导可使检查者顺利完成检查,使结肠胶囊内镜用于肠道疾病临床筛查和诊断。     

结肠镜检查采用不同药物行肠道准备的效果比较

目的比较不同药物用于结肠镜检查肠道准备的效果。方法行结肠镜检查和治疗患者120例,随机分为A组和B组,各60例。A组口服磷酸钠盐口服液行肠道准备。B组口服甘露醇行肠道准备。比较两组内镜下的肠道清理效果、耐受性和顺应性。结果A组肠道清洁度明显高于B组（P〈0．05）,A组口服清肠剂后耐受性和顺应性优于B组（P〈0．05）。结论磷酸钠盐口服液是安全、方便、清肠效果理想的药物。     

二甲硅油的不同配伍方案在胶囊内镜肠道准备中的随机对照研究

目的 比较二甲硅油与肠道清洁剂的不同配伍方案在胶囊内镜肠道准备中的效果,以探寻最佳的肠道准备方法。方法 将90例拟行胶囊内镜的患者随机分为3组,每组均于检查前4 h常规服用2 L的复方聚乙二醇电解质散导泻清肠。A组（n = 30）检查前30 min口服二甲硅油2.5 g;B组（n = 30）检查前30 min口服二甲硅油5.0 g;C组（n = 30）检查前30 min口服二甲硅油2.5 g,确认胶囊进入小肠后再口服2.5 g。主要评价指标为小肠清洁度和气泡量评分;次要指标为阳性病变诊断率、全小肠检查完成率、胃/小肠通过时间和不良反应发生率。结果 3组患者小肠清洁度比较,差异无统计学意义（P > 0.05）;3组患者小肠上段的气泡量比较,差异无统计学意义（P > 0.05）;当胶囊进入小肠中下段后,B组和C组的气泡量较A组减少（P < 0.05）;且C组的气泡量在小肠下段较B组进一步减少（P < 0.05）;C组阳性病变诊断率较A组和B组高,差异均有统计学意义（P < 0.05）;3组患者全小肠检查完成率、胃/小肠通过时间和不良反应发生率比较,差异均无统计学意义（P > 0.05）。结论 使用二甲硅油5.0 g去泡效果更佳;且在检查前30 min及确定胶囊进入小肠后分次口服较检查前30 min顿服,可增强小肠的去泡效果,改善视野清晰度,提高阳性病变诊断率,值得临床推广。     

妇科择期手术病人两种不同方法肠道准备的效果对比研究

目的 探讨妇科择期手术术前肠道准备中提高肠道清洁率、减轻病人痛苦,术后肠蠕动尽快恢复的方法.方法 对2011年收治的358例妇科择期手术病人,按手术时间的单双号分为观察组和对照组,观察组患者采用磷酸钠盐口服液加番泻叶进行围手术期肠道准备,对照组患者口服聚乙二醇电解质溶液进行围手术期肠道准备.结果 观察组患者的肠道清洁度、不良反应、排便次数、术后排气情况等均好于对照组,差异有极显著意义(P＜0.01).结论 磷酸钠盐口服液加番泻叶溶液口感好,肠道清洁度高,排便次数减少,术后排气早、无腹胀、肠道功能恢复早,其效果优于单纯口服聚乙二醇电解质溶液.     

不同时间口服西甲硅油在胶囊内镜检查中的祛泡效果观察

目的探讨不同时间口服西甲硅油在胶囊内镜检查中的祛泡效果。方法将60例胶囊内镜检查患者随机分为实验组和对照组:实验组检查前30min口服10%西甲硅油15ml,对照组在口服复方聚乙二醇时加入西甲硅油(复方聚乙二醇200g溶于温开水2000ml中,加10%西甲硅油15ml口服),比较2组小肠肠道内所含气泡量以及图像清晰度,同时观察有无不良反应。结果与对照组相比,实验组小肠肠道内的气泡较少、图像清晰度较好,2组差异有统计学意义(P0.05)。2组均没有出现明显不良反应。结论不同时间口服西甲硅油对祛除肠道内的气泡及提高胶囊内镜检查的图像清晰度有影响。检查前30min口服西甲硅油的祛泡效果比西甲硅油与复方聚乙二醇同服效果好,是值得临床推广使用的祛泡方法。     

结肠镜检查及治疗前肠道准备用药探讨

目的 探讨一种安全、有效的肠道准备方法以提高肠镜检查及治疗的成功率,减少并发症.方法 将216例行结肠镜检查的患者随机分为3组.A组70例口服聚乙二醇电解质散剂,B组74例口服甘露醇,C组72例口服番泻叶,分别观察3组患者服药后的肠道清洁程度、药物不良反应及肠道准备中患者紧张、恐惧心理状态.结果 A组患者的肠道清洁度与B组比较,差异无显著性,P>0.05,但不良反应及患者出现紧张、恐惧心理A组明显少于B组C组,差异有显著性,P<0.05.结论 口服聚乙二醇电解质溶液清洁肠道效果好、清肠过程中不良反应及患者出现紧张、恐惧心理少,且发现息肉的同时可行电凝电切治疗.     

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。