不同方法治疗感染伤口的换药体会

[目的]寻找好的治疗感染伤口的换药方法。[方法]将60例感染伤口病人随机分为观察组和对照组各30例。两组病人均先用3%过氧化氢和生理盐水彻底清洗伤口后,对照组用0.1%依沙吖啶纱布湿敷;观察组用庆大霉素、维生素C直接涂在创面上,并用红外线照射20min～30min后,再外敷湿润烧伤膏。[结果]观察组的换药次数和愈合天数比对照组要少,治愈率和有效率比对照组高。[结论]采用庆大霉素、维生素C、湿润烧伤膏辅以红外线照射治疗感染伤口,可缩短伤口愈合时间,提高换药效果。     

美宝湿润烧伤膏联合红外线照射对大便失禁后肛周皮肤损伤的疗效观察

[目的]观察美宝湿润烧伤膏联合红外线照射治疗大便失禁后肛周皮肤损伤的效果。[方法]将60例因大便失禁肛周皮肤损伤的病人随机分为观察组、对照组各30例,观察组采用美宝湿润烧伤膏换药,对照组采用氧化锌换药,之后两组病人均给予红外线灯照射20 min,比较两组病人的治疗效果。[结果]观察组病人总有效率高于对照组、治愈时间短于对照组,经比较差异有统计学意义(P<0.05)。[结论]应用美宝湿润烧伤膏联合红外线照射治疗大便失禁所致肛周皮肤损伤效果优于氧化锌联合红外线照射。     

烧伤三号用于腹部手术后伤口感染换药的效果观察

[目的]探讨烧伤三号用于腹部手术后感染性伤口换药的临床疗效。[方法]将64例腹部手术后伤口感染病人随机分为观察组和对照组,观察组采用烧伤三号敷料换药,对照组采用庆大霉素敷料换药。观察两组伤口愈合情况。[结果]观察组伤口脓性分泌物减．少,换药次数、换药时间少于对照组.[结论]采用烧伤三号换药可减少伤口换药次数,缩短其愈合时间。     

烧伤三号用于腹部手术后伤口感染换药的效果观察

[目的]探讨烧伤三号用于腹部手术后感染性伤口换药的临床疗效.[方法]将64例腹部手术后伤口感染病人随机分为观察组和对照组,观察组采用烧伤三号敷料换药,时照组采用庆大霉素敷料换药.观察两组伤口愈合情况.[结果]观察组伤口脓性分泌物减少,换药次数、换药时间少于对照组.[结论]采用烧伤三号换药可减少伤口换药次数,缩短其愈合时间.     

高频电火针治疗腋臭后应用湿润烧伤膏疗效分析——附392例高频电火针治疗腋臭疗效

目的观察高频电火针治疗腋臭后应用湿润烧伤膏创面的愈合疗效。并设对照组。方法观察组：术毕196例直接应用湿润烧伤膏涂抹双侧腋窝创面。对照组：196例作对照组用常规消毒创面，然后均无菌纱布包扎，1次／d，连续换药1周．结果观察纽：应用湿润烧伤膏涂抹5—7d，195例局部完全愈合，愈合率99．49％．对照组：经常规消毒换药5—7d，172例局部完全愈合，15例换药7—10d局部完全愈合，总愈合率95．41％。结论湿润烧伤膏，具有清热解毒、消肿止痛、化瘀生肌、抗感染及防止瘢痕形成等功能，促进烧伤创面愈合。明显优于常规消毒换药组。湿润烧伤膏是促进高频电火针治疗后创面愈合的有效防治性药物。能明显减轻局部的渗出、水肿、疼痛，无感染、无癍痕形成，     

换药加红外线理疗治疗难愈合伤口的效果观察

[目的]探讨常规换药配合红外线理疗对难愈合胫骨前皮肤软组织损伤的治疗效果。[方法]将60例小腿胫前皮肤损伤病人随机分为观察组与对照组。观察组先清洗伤口或清创,在理疗20min后根据伤口情况使用换药材料及包扎。对照组先清洗伤口或清创,根据伤口情况使用换药材料及包扎。[结果]观察组病人伤口愈合时间短于对照组,伤口愈合疗效优于对照组,差异均有统计学意义(P<0.05)。[结论]常规换药配合红外线理疗能促进胫前伤口早日愈合。     

湿润烧伤膏外敷加红外线照射治疗糖尿病足的疗效观察

目的观察湿润烧伤膏外敷加红外线照射治疗糖尿病足的疗效。方法随机将60例糖尿病足病人分为两组各30例,观察组采用湿润烧伤膏外敷加红外线照射;对照组采用0.1%醋酸洗必泰湿敷,并观察两组治愈情况。结果观察组治愈率为80.0%,对照组治愈率为10.0%,两组比较,P<0.01,差异有统计学意义。结论湿润烧伤膏加红外线照射对糖尿病足具有抗炎、止痛、通经活络、生肌之功效,能有效改善局部血液循环,促进溃疡愈合,从而提高糖尿病足治疗的效果。     

美宝湿润烧伤膏联合龙血竭治疗糖尿病足的疗效观察

[目的]观察美宝湿润烧伤膏联合龙血竭治疗糖尿病足的临床疗效。[方法]将113例糖尿病足病人按照匹配抽样方法分成对照组(54例)和治疗组(59例),对照组在糖尿病综合治疗基础上使用美宝湿润烧伤膏足部伤口外敷治疗,治疗组在糖尿病综合治疗基础上采用美宝湿润烧伤膏联合龙血竭足部伤口外敷治疗,记录两组治疗中的不良反应,同时比较两组治疗的有效性及换药次数、伤口愈合所需时间以及住院天数。[结果]两组病人治疗过程中均未见足部外敷药物不良反应;治疗组总有效率(96.61%)优于对照组(83.33%);治疗组换药次数(22.05次±1.83次)少于对照组(34.28次±2.62次);治疗组住院时间(14.00d±3.24d)明显短于对照组(23.00d±2.76d),差异有统计学意义(P0.01)。[结论]美宝湿润烧伤膏联合龙血竭治疗糖尿病足可提高糖尿病足的治愈率,缩短住院时间。     

微波治疗腹部伤口脂肪液化的效果观察

[目的]探讨病人腹部手术后伤口脂肪液化应用微波照射治疗促进伤口愈合的效果。[方法]将152例腹部手术后伤口脂肪液化的病人随机分为观察组80例和对照组72例。对照组应用碘伏换药治疗;观察组在碘伏换药治疗基础上行微波照射治疗;比较两组切口的渗液、感染及愈合情况。[结果]观察组伤口渗液情况、伤口疼痛缓解情况、伤口愈合时间、伤口愈合情况均明显优于对照组。[结论]腹部手术后伤口脂肪液化应用微波照射可减轻病人疼痛,促进伤口愈合。     

微波治疗腹部伤口脂肪液化的效果观察

[目的]探讨病人腹部手术后伤口脂肪液化应用微波照射治疗促进伤口愈合的效果。[方法]将152例腹部手术后伤口脂肪液化的病人随机分为观察组80例和对照组72例。对照组应用碘伏换药治疗;观察组在碘伏换药治疗基础上行微波照射治疗;比较两组切口的渗液、感染及愈合情况。[结果]观察组伤口渗液情况、伤口疼痛缓解情况、伤口愈合时间、伤口愈合情况均明显优于对照组。[结论]腹部手术后伤口脂肪液化应用微波照射可减轻病人疼痛,促进伤口愈合。     

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。