人工全髋关节置换翻修术后的康复

目的探讨人工全髋关节置换翻修术后康复训练的有效方法。方法对24例不同病因行各类人工全髋关节置换翻修术后患者,给予有异于初次人工全髋关节置换术后患者的特殊康复治疗,于手术前和手术后1、3个月进行Harris评分并判定疗效。结果全髋关节翻修手术后1、3个月患者疼痛、活动度、步行能力、日常生活能力比术前均有所提高（P〈0.05或P〈0.001）。术后3个月疗效评定：优4例,良13例,中6例,差1例,优良率70.83%。结论 1）全髋关节翻修术后的早期康复对髋关节功能的恢复有重要的作用;2）由于人工全髋关节置换翻修手术的复杂性,其术后的康复训练需从髋关节骨骼的完整性（是否骨质疏松、骨缺损的程度）、内植物相对的稳定性（选择何种类型的假体固定）、关节周围的软组织条件3个方面进行评定;3）术后康复训练遵循个体化、渐进性、全面性的原则,重点是增加肌力,尤其是髋外展肌肌力的训练。     

老年全髋关节置换翻修术患者术后早期康复训练的效果观察

目的:探讨康复训练在老年全髋关节置换翻修术后的效果。方法:对17例全髋关节置换翻修术患者进行相应的系统性康复功能训练,比较每位患者术前术后髋关节功能改善的程度。结果:17例全髋置换术后翻修患者经过康复训练后,Harris髋关节功能评分与术前比较,具有显著性差异,训练后髋关节功能较训练前有明显改善。结论:术后进行系统化的康复训练能明显改善患者髋关节功能。     

人工全髋关节置换后33例翻修原因解析

背景：人工髋关节置换后出现感染、假体松动、假体磨损断裂、骨溶解、复发性脱位等并发症的数量逐渐增多,最终导致行全髋关节翻修。 目的：分析人工全髋关节置换后进行翻修的原因和治疗措施。 方法：对33例患者全髋关节翻修的原因、假体选择、骨缺损处理及康复进行分析研究。其中髋臼有21例行普通金属杯加内衬置换、8例行大头臼杯置换、4例行聚乙烯臼杯置换。股骨柄有15例行普通柄（11例应用骨水泥固定）置换、18例行加长柄置换（9例应用骨水泥、6例为组合型柄）。 结果与结论：33例患者全部获得随访,翻修后随访24-60个月,平均随访36.5个月;翻修后伤口愈合良好,假体固定可靠,未再次出现感染脱位患者;髋关节功能均得到了较大的改善,Harris评分：翻修前平均为37.1分,翻修后平均为91.3分。中短期临床随访结果示,若翻修手术指征正确,骨缺损处理得当,翻修假体选择正确,行一期人工全髋关节翻修可以获得良好的临床疗效。     

预防接种训练降低人工全髋关节翻修术患者焦虑水平的研究

目的探讨预防接种训练对降低人工全髋关节嵌压植骨翻修术患者的焦虑水平的作用。方法将接受人工全髋关节翻修术患者94例随机分为观察组和对照组,对观察组实施预防接种训练。采用汉密尔顿焦虑量表(HAMA)对两组患者术前3d、术前1d和术后1d的焦虑状况进行评定。结果术前3 d两组患者HAMA评分差异无统计学意义(P>0.05);术前1d两组HAMA评分分别为(25.37±7.81)分和(10.78±5.03)分,经检验,P<0.01;术后1d两组HAMA评分分别为(19.09±2.46)分和(8.91±2.77)分,经检验,P<0.01。结论两组全髋关节翻修术患者术前HAMA得分均大于21分,提示存在明显焦虑;观察组采取预防接种训练进行心理干预后,在术前1d和术后1d,与对照组比较,HAMA得分显著降低,提示此种干预方法可缓解患者术前和术后的焦虑情绪,有利于患者的身心康复。     

人工髋关节置换术后的阶段康复训练

总结60例人工髋关节置换术后的阶段康复训练。依据术后病程,循序渐进进行卧位管理、肌力训练、不同体位转换训练、步行训练,做好出院后康复训练指导。通过康复训练,出院3月髋关节功能评分平均(85.77±5.72)分,优良率为86.4%,康复效果满意,说明人工髋关节置换术后实施阶段康复训练有利于恢复关节功能,提高手术疗效。     

康复训练程序在人工髋关节置换术患者中的应用

目的探讨康复训练程序在人工髋关节置换术患者中的应用效果。方法对418例行人工全髋关节置换患者进行个性化、渐进性和全面性的康复训练。结果本组病例经随访结果表明，术后髋关节功能恢复良好，至术后6个月髋关节功能基本恢复正常（Harris评分：平均95分）。结论该训练程序具有使患者康复快、关节功能恢复效果好、并发症少的特点。     

一期双侧全髋关节置换术后的康复护理

目的探讨一期双侧全髋关节置换术后的康复护理.方法对15例一期双侧髋关节置换病人,给予以护士指导下的患者自身训练为主体的规范的康复护理和康复程序治疗.结果经过规范的康复护理和康复程序治疗,术后随访6个月～3年,平均1.2年,无1例深静脉血栓、脱位、假体周围骨折、感染、死亡等并发症发生.按Harris髋关节功能评定,术前Harris评分(39.5±14.5),术后Harris评分(89.5±18.5),术后与术前Harris评分比较t=23.726,p＜0.05.髋关节功能、关节活动度均明显改善.结论合理的康复训练和康复护理有助于一期双侧全髋关节置换术后髋关节恢复到正常功能.     

全髋置换患者术后康复训练恢复关节功能的效果观察

目的探讨全髋置换患者术后康复训练恢复关节功能的效果。方法30例全髋置换患者,根据髋关节假体类型不同分为骨水泥组和生物型组,分别进行相应的康复治疗程序,比较每位患者术前、术后髋关节功能改善程度。结果30例全髋置换患者经过系统的康复训练后,Harris髋关节功能评分与术前比较经t检验,具有显著性差异,P<0.01,训练后髋关节功能比训练前明显改善;骨水泥组与生物型组经康复训练后,髋关节功能评分分别与训练前比较,均具有显著性差异,P<0.01,两组髋关节功能训练后均比训练前明显改善;训练前、后两组间髋关节功能评分均无显著性差异,P>0.05,说明全髋置换术患者采用不同人工关节不影响康复训练后髋关节功能评分。结论根据髋关节假体类型不同,采用相应的康复训练程序,能明显改善患者髋关节功能。     

全髋置换后康复干预时间与效果的比较

背景:观察全髋置换后康复干预开始时间对临床效果的影响.方法:回顾性分析2000-07/2008-03湘南学院附属医院骨科收治的行全髋关节置换后康复治疗的患者165例,根据置换后行康复治疗时间的不同分为3组,早期康复组(n=56):男27例,女29例;年龄44～79岁.置换前患患髋Harris评分为(47.4±1.3)分,全髋置换后3 d行康复治疗.中期康复组(n=63):男37例,女26例;年龄48～80岁,置换前Harris评分(45.6±2.1)分,全髋置换4-21 d后行康复治疗.延迟康复组(n=46):男24例,女22例;年龄47～81岁,置换前Harris评分(46.3±1.5)分,伞髋置换21 d后行康复治疗.3组按统一制定的康复训练计划实施功能锻练.于置换前,置换后1,2,3个月行Harris评分比较.结果:行康复治疗的患者165例均进入结果分析.置换前3组髋关节Harris评分差异无显著性意义(P>0.05);康复治疗后,置换后1个月Harris评分早期康复组平均(89.1±6.3)分,中期康复组平均(60.1±3.7)分,延迟康复组平均(54.6±3.5)分,早期康复组得分高于中期康复组及延迟康复组(P<0.05).置换后2个月Harris评分早期康复组平均(90.1±4.3)分,中期康复组平均(85.7±5.3)分,延迟康复组平均(69.8±3.8)分,早期康复组、中期康复组与延迟康复组之间相比,差异有显著性意义(P<0.05).置换后3个月Harris评分早期康复组平均(94.8±2.3)分,中期康复组平均(92.2±3.2)分,延迟康复组平均(90.5±3.1)分,3组之间相比,差异无显著件意义(P>0.05).结论:早期系统康复治疗有利于全髋置换后髋关节功能的恢复.     

高位先天性髋关节脱位行人工全髋关节置换术13例围术期护理

目的:探讨高位先天性髋关节脱位行人工全髋关节置换术的围术期护理及康复指导方法。方法:术前评估患者病情,做好心理护理、术前准备;术后做好体位护理、心理护理、用药护理,积极预防并发症;制订分时间段的康复训练计划,指导患者加强训练。结果:术后随访6～12个月,患者Harris评分为75～88分,异常步态经过手术治疗均能得到改善或纠正,髋关节功能均恢复。结论:人工全髋关节置换术治疗高位先天性髋关节脱位患者效果满意,配合围术期护理及康复训练,患者生活质量均得到较大的改善。     

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。