老老年人24h动态血压特征分析

目的探讨老老年人24h动态血压参数变化的临床意义。方法选择122例老老年人进行24h动态血压监测,分析其24h、白天、夜间平均血压和平均脉压及血压变异性。结果血压节律呈非杓型者112例(91.80%,112/122),杓型者10例(8.20%,10/122)。24h平均收缩压(126.37±14.78)mmHg,平均舒张压(66.35±8.32)mmHg;白天平均收缩压(127.69±14.72)mmHg,平均舒张压(67.75±8.58)mmHg;夜间平均收缩压(123.72±17.96)mmHg,平均舒张压(63.54±9.29)mmHg。24h动态脉压60.02mmHg。夜间血压下降百分率分别为:收缩压3.11%,舒张压6.21%。昼夜血压变化规律在男女间无明显差别。结论老老年人血压昼夜节律呈非杓型改变,血压昼夜节律消失,24h动态脉压远大于正常脉压。     

2型糖尿病合并高血压患者24小时动态血压分析

目的观察2型糖尿病合并高血压患者24h动态血压昼夜节律的变化。方法选取60例住院患者,按诊断标准分为2型糖尿病合并高血压组和单纯高血压组,对所有患者进行24h动态血压监测,比较24h平均收缩压、24h平均舒张压、白天平均收缩压、夜间平均收缩压、白天平均舒张压、夜间平均舒张压、24h平均脉压、白天平均脉压、夜间平均脉压及血压昼夜节律。结果 24h平均舒张压、白天平均收缩压、白天平均舒张压、白天平均脉压2组比较差异无统计学意义(P均>0.05),24h平均收缩压、夜间平均收缩压、24h平均脉压、夜间平均脉压及血压昼夜节律2组比较差异有统计学意义(P均<0.05)。结论 2型糖尿病合并高血压患者建议尽早进行24h动态血压监测,同时降压和降血糖,纠正异常的昼夜血压节律,对于减少心脑血管并发症、防止靶器官的损害具有积极意义。     

原发性高血压病患者动态血压参数与颈动脉内膜-中膜厚度的关系

目的:探讨原发性高血压病患者的动态血压各参数与颈动脉内膜-中膜厚度的关系。方法:对89例原发性高血压患者进行颈动脉超声检查和24h动态血压监测。根据颈动脉超声检查结果分成颈动脉正常组(CAN组)和颈动脉粥样硬化组(CAS组),对两组动态血压各参数进行比较。结果:CAS组的24h平均收缩压(24hSBP)、白天平均收缩压(dSBP)、夜间平均收缩压(nSBP)明显高于CAN组(P<0.01),CAS和CAN两组患者的24h平均舒张压(24hDBP)、白天及夜间平均舒张压(dDBP、nDBP)差异无显著性(P>0.05);CAS组的非杓型血压节律检出率高于CAN组(P<0.05)。结论:高血压患者动脉粥样硬化与24hSBP、血压昼夜节律异常的关系密切。提示高血压病降压治疗的同时还需要纠正紊乱的血压昼夜节律。     

老年高血压病患者动态血压参数与颈动脉粥样硬化的关系

目的：探讨老年高血压病患者的动态血压各参数与颈动脉粥样硬化的关系。方法：82例老年高血压病患者均行颈动脉超声检查和24 h动态血压监测,根据颈动脉超声检查结果分为两组：颈动脉正常组（CAN组）40例和颈动脉粥样硬化组（CAS组）42例,并对两组的动态血压各参数进行比较。结果：CAS组的24 h平均收缩压（24hSBP）,白天平均收缩压（dSBP）,夜间平均收缩压（nSBP）均明显高于CAN组（P均〈0.01）;24 h平均舒张压（24hDBP）,白天平均舒张压（dDBP）,夜间平均舒张压（nDBP）,两组之间差异均无统计学意义（P均〉0.05）;CAS组的非杓型血压节律检出率高于CAN组（P〈0.05）。结论：老年高血压病患者颈动脉粥样硬化与血压昼夜节律异常及24 h平均收缩压（24 hSBP）关系密切,高血压病降压治疗的同时还需要纠正紊乱的血压昼夜节律。     

2型糖尿病合并高血压病患者的动态血压特点

目的了解2型糖尿病合并高血压病患者动态血压的特点.方法对2型糖尿病合并高血压病患者40例及单纯高血压病患者45例进行动态血压监测,并探讨合理的护理措施.结果两组患者比较,昼夜血压节律消失、夜间平均收缩压、白天收缩压负荷值、夜间收缩压负荷值糖尿病合并高血压病组高于单纯高血压病组,差异有显著性意义;24h平均收缩压及24h平均舒张压、白天平均舒张压、白天平均收缩压、白天舒张压负荷值、夜间舒张压负荷值两组间差异无显著性意义.结论糖尿病合并高血压病患者失去正常昼高夜低的血压波动规律,尤以收缩压负荷、夜间收缩压升高为明显.24h平稳降压是治疗2型糖尿病合并高血压病患者的有效治疗方法.     

老年高血压患者的动态脉压与冠心病并发症及颈动脉粥样硬化的关系

【目的】探讨老年高血压患者的动态脉压与冠心病并发症及颈动脉粥样硬化的关系。【方法】2010年5月至2013年6月在本院就诊的年龄≥60岁的老年性高血压患者328例,其中单纯性老年高血压患者168例,为高血压组;合并有冠心病的老年性高血压患者160例,为高血压合并冠心病组。根据颈动脉内膜中层厚度（IM T）增厚与正常将高血压组分为IM T增厚组（94例）和IM T正常组（74例）,对其动态血压及IM T进行测定。【结果】与高血压组相比,高血压合并冠心病组的24 h平均脉压（24hAPP）、白昼平均脉压（dPP）、夜间平均脉压（nPP）等指标以及24 h平均收缩压（24hASBP）、夜间平均收缩压（nSBP）等指标均显著升高;而24 h平均舒张压（24hADBP）、白昼平均舒张压（dDBP）、夜间平均舒张压（nDBP）等指标则明显下降;IM T增厚组患者的24hAPP、dPP及 nPP水平均明显高于 IMT 正常组;≥60 mmHg 组共89例,IMT 为（1．14±0．23）mm ,明显高于＜60 mmHg组79例的平均厚度（0．93±0．12）mm。差异均有统计学意义（P＜0．05）。【结论】老年高血压患者的动态脉压在冠心病并发症及颈动脉粥样硬化预测方面具有重要的意义。     

高血压患者血压变异性与颈动脉硬化的关系研究

目的探讨原发性高血压患血压变异性(BPV)与颈动脉硬化的关系。方法选择中老年高血压病患者共154例,同期进行24 h动态血压监测及颈动脉血管超声检查,根据颈动脉内膜中层厚度(IMT)将其分为IMT正常组(69例)及颈动脉硬化组(85例),以24 h收缩压变异性中位数为分界点,分为低BPV组(77例)和高BPV组(77例)。结果颈动脉硬化组较颈动脉IMT正常组相比,颈动脉硬化组24 h平均收缩压、24 h平均舒张压、24 h收缩压变异性、24 h舒张压变异性、IMT均显著增高(P0.05);相对于低BPV组患者,高BPV组患者有更高的颈动脉IMT值及斑块检出率(P0.05);24 h平均收缩压变异性与颈动脉IMT(r=0.64,P0.05)呈正相关。结论高血患者颈动脉硬化及斑块的形成与血压变异性密切相关。     

老年高血压患者24h动态血压和脉压分析与护理启示

目的 了解老年高血压患者动态血压特点,分析其与心脑血管疾病相瓦关系,指导制定相应护理预防对策.方法 回顾分析80例高龄老年高血压患者的24 h动态血压,并按年龄、脉压分组,比较不同年龄组动态血压特点,比较不同脉压组的心脑血管疾病发病率.结果 与高龄老年组相比,长寿老年组患者24 h平均动脉压(135.62±8.21)mmHg(1 mmHg=0.133 kPa)vs(110.46±6.98)mmHg,平均收缩压(159.89±9.76)mmHg vs(140.56±6.32)mmHg,平均脉压(75.78±5.14)mmHg vs(60.45±4.76)mmHg均明显高于高龄老年组,P<0.05.而长寿老年组患者24 h平均舒张压明显低于高龄老年组,(65.56±4.78)mmHg vs(74.33±6.56)mmHg,P<0.05.24 h平均脉压≥60mmHg组患者冠心病、心力衰竭、心肌梗死、脑卒中发生率均明显高于24 h平均脉压<60mmHg组,P<0.05.结论 长寿老年高血压患者的收缩压、脉压高于高龄老年患者,舒张压较之低.提示观察到老年高血压患者脉压水平过高时,提前做好预见性的治疗和护理,减少心脑血管事件的发生.     

动态血压监测在心力衰竭患者病情评估中的价值

目的 研究动态血压监测在心力衰竭患者病情评估中的价值.方法 92例心力衰竭患者,均行动态血压监测(ABPM),并准确记录监测时的心功能分级.分别按基础心脏病病因和纽约心脏病协会(NYHA)心功能分级分组.选取同时期门诊及住院的72例有基础心脏病但无心力衰竭的患者作为对照组.观察动态血压参数与心功能分级关系.结果 与对照组比较,心力衰竭组的白昼平均收缩压(DSBP)、白昼平均舒张压(DDBP)、24小时平均压(24hMBP)、白昼平均压(DMBP)、白昼舒张压变异(DDBPV)水平明显低于对照组,DSBP(116.2±17.8) mmHg vs (123.9±14.5) mmHg,DDBP(69.5±10.2) mmHg vs (75.9±9.7) mmHg,24hMBP(89.4±12.5) mmHg vs (95.9±11.4) mmHg,DMBP(90.4±13.5) mmHg vs (100.2±11.5) mmHg,DDBPV(8.5±2.4) mmHg vs (10.4±2.4) mmHg(P<0.01).心力衰竭Ⅳ级组24小时平均收缩压(24hSBP)、DSBP、夜间平均收缩压(NSBP)、DDBP、24hMBP、DMBP、夜间平均压(NMBP)、24小时平均脉压(24hPP)、白昼平均脉压(DPP)、夜间平均脉压(NPP)均明显低于Ⅱ级组和(或)Ⅲ级组(P<0.01).相关分析表明,24hSBP、24hDBP、24hMBP、24hPP、24小时收缩压变异(24hSBPV)与NYHA分级呈负相关(P<0.05或<0.01).结论 心力衰竭患者DSBP、DDBP、24hMBP、DMBP、DDBPV较对照组明显降低,且随着心力衰竭程度加重,血压均值有下降趋势,心功能Ⅳ级患者24hSBP、DSBP、NSBP、DDBP、24hMBP、DMBP、NMBP、24hPP、DPP、NPP均低于Ⅱ级和Ⅲ级患者.     

高血压病患者动态血压与左室肥厚的相关性研究

目的探讨高血压病患者动态血压与左室肥厚的相关性。方法对120例高血压病患者行超声心动图、动态血压监测检查。根据左室质量指数将患者分成左室肥厚组38例和非左室肥厚组82例。结果左室肥厚组24h收缩压负荷(24h SBPL)、24h舒张压负荷(24h DBPL)、夜间收缩压负荷(nSBPL)、夜间舒张压负荷(nDBPL)、白天收缩压负荷(dSB-PL)显著高于非左室肥厚组(P0.01)。结论高血压病动态血压负荷异常者左室肥厚的发生率增多。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

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.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.