组织多普勒超声心动图对扩张型心肌病患者急性左心功能衰竭的研究

目的 应用组织多普勒超声心动图定量分析心肌运动状态与扩张型心肌病患者急性左心功能衰竭的关系.方法 25例扩张型心肌病患者分为急性左心功能衰竭组(Ⅰ a组)与慢性左心功能不全组(Ⅰ b组),正常对照组20例.频谱多普勒超声心动图测量二尖瓣舒张早期血流速度(E峰)与舒张晚期血流速度(A峰)及E峰减速时间、E/A比值.组织频谱多普勒超声心动图测量二尖瓣环收缩期心肌运动速度(s峰)、舒张早期心肌运动速度(e峰)及舒张晚期心肌运动速度(a峰)与s/e比值.结果 在正常对照组中,Ve大于Vs;在伴有急性左心衰竭扩心病患者中,Vs减低不明显,而Ve、Va则明显减低,Vs/Ve比值增高.且随着临床症状改善,Ve值明显增高.在慢性左心功能衰竭扩心病患者组中,Ve、Va明显高于Vs,Vs/Ve比值小于1.结论 在扩张型心肌病患者中,导致急性左心功能衰竭的原因是由于心肌舒张功能损害,而不是心肌收缩功能减低.     

彩色多普勒超声检查在急性肺栓塞诊断与治疗中的价值

目的探讨彩色多普勒超声在急性肺栓塞诊断与治疗中的价值。方法对临床综合诊断(包括核素肺灌注扫描、MRI及肺动脉造影)为急性肺栓塞患者30例所进行的彩色多普勒超声心动图及周围血管彩色多普勒超声检查。结果超声心动图检出肺动脉分叉处血栓2例,右心异常改变者21例,其中右室增大伴右室收缩功能减退17例,右室肥厚15例,室间隔运动幅度减低17例,右房增大15例,肺动脉扩张6例。彩色多普勒血流显像在16例患者取得中度至重度三尖瓣反流,用连续多普勒测量三尖瓣反流速度,估测肺动脉收缩压,16例患者肺动脉压升高,范围32～105mmHg(63.5±21.09)mmHg,治疗后肺动脉压明显下降,25.0～55.7(39.6±12.16)mmHg。下肢深静脉彩色多普勒超声检查12例患者检出深静脉血栓,6例血流缓慢伴自发性云雾样回声。结论系统全面、动态的彩色多普勒超声心动图及周围血管彩色多普勒超声检查,对于急性肺栓塞患者的诊断的确立、疗效的评估均有重要价值。     

多普勒超声心动图对胎儿心功能的研究

我们利用多普勒超声心动图记录76例孕龄从21周到42周的正常胎儿心脏各瓣膜血流频谱,测量 1.最大血流速度;2.血流频谱积分;3.主动脉、肺动脉血流的加速时间、射血时间;4.二尖瓣、三尖瓣血流的E峰、A峰;计算通过各瓣口的每搏量、心排量。结果显示了多普勒超声心动图研究胎儿心功能的可行性,并进一步证实胎儿循环右心占优势,胎儿循环处于高阻力状态及胎儿心室肌舒张功能减低。     

正常胎儿彩色多普勒超声心动图分析

目的获得正常胎儿心脏彩色多普勒超声心动图的各种参数。方法应用彩色多普勒超声诊断仪,对胎龄２０～４０周３００例正常胎儿的四腔室内径和各瓣口峰值血流速度进行了检测。结果胎儿心脏内径的大小与胎龄呈正相关,右心系统占优势。各瓣口峰值血流速度随胎龄的增加而升高,左室低于右室;房室瓣口呈双峰型频谱,Ｅ峰小于Ａ峰,而主、肺动脉瓣口呈单峰型频谱伴峰值前移,主动脉瓣口血流高于肺动脉。结论彩色多普勒超声心动图对于胎儿心脏的解剖结构和血流动力学检测具有很高的价值。     

心肌组织多普勒技术结合M型超声评价急性下壁及前壁心肌梗死的右心室功能

目的　应用心肌组织多普勒 (TDI)技术结合M型超声测定三尖瓣环运动评价急性下壁及前壁心肌梗死 (心梗 )患者右心室整体功能。方法　正常对照组 2 5例 ,急性下壁心梗 2 5例 ,急性前壁心梗 2 3例。在标准心尖四腔心观二维图像指引下 ,采用M型超声记录三尖瓣环右室游离壁处运动曲线 ,测量收缩期、舒张早晚期运动幅度 ,采用TDI的频谱多普勒技术记录该处速度曲线 ,测量各期最大运动速度。结果　与对照组相比 ,急性下壁与前壁心梗患者三尖瓣环右室游离壁处收缩期及舒张早期运动幅度显著降低 ,最大收缩速度在下壁心梗显著降低 [(12 .9± 2 .7)cm /svs (15 .9± 2 .6)cm/s ,P <0 .0 1] ,在前壁心梗无下降 [(14 .5± 4.0 )cm/svs (15 .9± 2 .6)cm /s ,P >0 .0 5 ] ,两者舒张早期速度均显著降低 ,分别为 (12±3 .1)cm/s和 (13 .2± 3 .1)cm/s ,舒张早期与晚期速度比值也明显降低。结论　TDI频谱多普勒技术能反映急性心梗导致的右室舒缩功能减低 ,其与M型超声结合测定三尖瓣环运动有利于全面评价心梗后右室整体功能。     

彩色多普勒超声在扩展先天性室间隔缺损合并重度肺动脉高压患者手术适应证中的研究

目的 彩色多普勒超声在扩展先天性室间隔缺损(VSD)合并重度肺动脉高压(PH)患者手术适应证中的应用价值.方法 选取先天性VSD并重度PH患者30例,肘静脉注射腺苷75 μg·kg-1·min-1,应用彩色多普勒超声心动图检测主动脉平均压、肺动脉平均压、肺动脉收缩压、肺动脉舒张压、肺循环阻力、体循环阻力、肺循环阻力/体循环阻力比值、肺动脉/主动脉收缩压比值、肺循环/体循环血流量比值,注射5分钟后肺血管阻力下降>30%和肺动脉平均压下降>10%为急性血管扩张试验阳性.结果 17例急性血管扩张试验阳性者,通过临床药物降压治疗有效后成功手术;13例药物试验阴性者继续降压治疗无效.结论 通过腺苷急性血管扩张试验,可以判断肺动脉高压的可逆性,彩色多普勒超声心动图在扩展先天性室间隔缺损合并重度肺动脉高压患者手术适应征中起到初步筛选的作用.     

正常胎儿心脏肺循环血流的超声心动图特征

目的 :应用彩色多普勒超声心动图检测正常胎儿心脏肺循环血流 ,观察肺动脉及分支血流形态特点并探讨其意义。方法 :入选妊娠 2 0～ 4 1周的正常胎儿 339例。并按孕周分组 ,<2 8周为 组 ;2 8～ 36周为 组 ;>36周为 组 ;应用多普勒超声心动图观察肺动脉主干及分支血流形态 ,测量参数包括 :血流最大流速 (Vmax)、血流速度积分 (VTI)、血流加速时间 (ACT)、减速时间 (DT)及射血时间 (ET)、并计算瓣口血流量。结果 :1.正常胎儿心脏主动脉及肺动脉内径随孕周增加而增大 ,各孕周肺动脉内径均明显大于主动脉内径 ;2 .肺动脉瓣口血流速度低于主动脉瓣口血流速度 ,但肺动脉流量大于主动脉流量 ,且肺动脉流量与主动脉流量比值不随孕周而改变 ,始终保持恒定 ;3.动脉导管血流呈连续单向双期双峰血流 ,其收缩期流速始终明显高于主动脉瓣口及肺动脉瓣口流速。收缩期血流速度及收缩期与舒张期血流速度比值随孕周增加而增大 ;4 .肺动脉分支血流呈单向双峰 ,流速明显低于肺动脉瓣口流速 ,其血流形态表现为高阻力低灌注的特点。此形态孕早期即可出现 ,且不随孕龄的增加而改变。结论 :正常胎儿肺动脉循环系统的固有特点在孕早期即出现 ,并不随孕龄改变。因此早期应用彩色多普勒超声心动图检查 ,对判定胎儿心脏发育情况具     

肺栓塞肺动脉血流波形的观测

目的了解肺动脉血流波形的变化在肺栓塞诊治中的应用意义。方法利用多普勒超声检测了21例经CT、ECT及肺动脉造影证实的肺动脉栓塞患者的肺动脉血流,并对这些患者治疗前后的肺动脉血流波形的改变进行了比较分析。结果轻中度肺动脉高压17例,重度4例;多普勒超声检出了收缩早期突然加速、加速肢上升陡直、流速峰值前移、而后提前减速的肺动脉血流频谱15例,即频谱波形呈“拳指状”,2例可见收缩晚期第二个较低的峰;峰值流速明显减低<80cm/s14例,7例患者的流速在正常范围;溶栓治疗48h后,“手指状”肺动脉频谱波形逐渐消失,1周后恢复正常倒等腰三角形肺动脉血流波形14例,7例的肺动脉血流波形治疗前后变化不明显,但患者的肺动脉内栓子明显缩小。结论多普勒超声观测肺动脉血流波形的变化,不单可用于肺栓塞的诊断,在肺栓塞治疗疗效评价方面也可成为客观的影像学指标。     

超声心动图技术测定心输出量观察原发性肺动脉高压疗效的价值

目的与心导管测量结果对比,探讨超声心动图技术在原发性肺动脉高压(PPH)患者疗效观察中心输出量测定的应用价值和可靠性.方法临床诊断为PPH并同时有热稀释法和超声心动图法心输出量资料的患者43例,平均年龄(43.2±12.5)岁.在右心插管15min内同时进行超声心动图检查,于左室长轴观测量主动脉瓣环处直径(D),计算其面积[A=π×(D/2)2];于心尖五腔观主动脉瓣环水平记录多普勒血流频谱,测量血流速度时间积分(VTI),计算心输出量(CO=VTI×A×心率),并与热稀释法测量结果进行相关性分析,观察长期用前列环素治疗患者CO的变化情况.结果热稀释法测定CO为(3.83±0.88)L/min,多普勒超声心动图法为(3.62±0.94)L/min.两组测量结果呈显著正相关,r=0.74(P<0.0001).结论多普勒超声心动图法可无创、准确地测量PPH患者的CO,与心导管测量结果有显著的相关性.同时,超声法显示长期前列环素治疗可使PPH患者CO升高.     

弥漫性颅内压升高患者经颅多普勒超声频谱与参数的变化

目的:观察弥漫性颅内高压患者的经颅多普勒超声(TCD)频谱和参数的变化.方法:对66例弥漫性颅内高压患者进行TCD检测,同时测血压并腰穿测颅内压.结果:颅内压升高时,出现典型的TCD频谱(高阻力血流频谱、舒张期血流消失频谱).随着颅内压升高,舒张末期血流速度减慢(16.39±3.56)cm/s,血管脉动指数(2.25±0.45)及阻力指数(0.89±0.098)增大,与正常对照组比较差异有显著性(P＜0.05).颅内高压治疗后,舒张末期血流速度升高(26.36±4.26)cm/s,血管脉动指数(1.15±0.23)及阻力指数(0.62±0.088)降低,与治疗前及正常对照组比较差异有显著性(P＜0.05).结论:根据特征性TCD频谱和参数改变可间接推断颅内压变化.     

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.     

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.     

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.     

Clinical Trial Updates and Hotline Sessions presented at the European Society of Cardiology Congress 2007

This article provides information and commentaries on trials which were presented at the Hotline and Clinical Trial Update Sessions at the European Society of Cardiology Congress 2007 in Vienna. The key presentations were performed by leading experts in the field with relevant positions in the trials or registries. It is important to note that unpublished reports should be considered as preliminary data, as the analysis may change in the final publications. The comprehensive summaries have been generated from the oral presentation and the webcasts of the European Society of Cardiology and should provide the readers with the most comprehensive information of relevant publications.     

Balance and Boundaries in Grief Counseling: An Intervention Framework for Volunteer Training

Volunteers or paraprofessional counselors are commonly used to provide supportive care to the bereaved. These counselors generally are trained in basic listening skills, providing a generic, nonspecific approach to intervention that remains to be proven effective. The present paper outlines a framework that provides paraprofessionals with a broader model for intervention with the bereaved. Attention to boundaries as a helper and balance in the grief recovery are central to the model. Interventions are described that provide the paraprofessional counselor with more options for tailoring their counseling strategy to the individual. These include techniques that are presumed to be more specific to the enhancement of grief recovery.     

A new method for the simultaneous analysis of unmodified and modified urinary nucleosides and nucleobases by high performance liquid chromatography

Details are given of a new, rapid and simple pre-fractionation method and an isocratic high performance liquid chromatography system suitable for parallel analysis of nucleosides and nucleobases from urine and other biological fluids. The quantitative recovery and excellent reproducibility of the method is demonstrated by analysis of representative standard RNA catabolites. The advantage of this new method for application to biological samples is discussed.     

Adsorption of Charged Non-albumin Bound Drugs by Amorphous Silica

We investigated the in vitro drug adsorption of PQ 10150 sodium silicate gel (AIS, Santa Clara, CA) with particle size of 230 um and surface area of 400 nr/g. We observed 99% to 88% adsorption of gentamicin; a mean 91 % of disopyramide; a mean 89% of quinidine at low concentration, falling to 75% at higher concentration. Insulin was 88% adsorbed at low concentrations but less so (65%) at higher concentrations. We observed a mean 83 % adsorption of procainamide, a mean 84% of N-acetyl procainamide, 74% oflidocaine, 73% of amitriptyline; and 44% of desipramine. We found an average 14% reduction of total digoxin concentration when serum containing digoxin (2 to 33 ng/mL) was exposed to sodium silicate, while the reduction in free digoxin concentration was 16%. Five percent ethosuximide was also removed. The adsorption of theophylline, phenobarbital, acetaminophen, phenytoin, ethylene glycol, methotrexate, salicylate, thiocyanate and diazepam was minimal and not significant. We conclude that significant amounts of charged, non-albumin bound drugs can be removed by PQ 10150 sodium silicate gel.     

自动化酸碱平衡图在急诊社区获得性肺炎诊治中的应用

目的 探讨自动化酸碱平衡图在急诊科社区获得性肺炎(CAP)患者诊断中的价值.方法 根据病史、肺功能测定结果、慢性阻塞性肺疾病(COPD)诊断标准,将111例CAP患者分为单纯CAP组(56例)和COPD合并CAP组[即慢性阻塞性肺疾病急性加重(AECOPD)组,55例].询问患者病史后即刻抽取动脉血测血气并进行自动化酸碱平衡图分析.结果 血气分析结果显示,AECOPD组动脉血二氧化碳分压(PaCO2,kPa)、HCO3- (mmol/L)、剩余碱(BE,mmol/L)均显著高于CAP组(PaCO2:7.714±2.414比5.896±1.308,HCO3-:30.767±7.185比25.014±3.043,BE:4.345±5.371比-0.354±3.180,均P＜0.01).自动化酸碱平衡图分析结果显示,AECOPD组患者酸碱平衡紊乱高达89.1％,CAP组为66.1％.将AECOPD组和CAP组患者中正常(10.9％、33.9％)、急性呼吸性酸中毒(急性呼酸,12.7％、14.3％)、慢性呼吸性酸中毒(慢性呼酸,49.1％、10.7％)、呼吸性碱中毒(呼碱,7.3％、14.3％)、代谢性酸中毒(代酸,12.7％、17.9％)、代谢性碱中毒(代碱,12.7％、8.9％)综合进行x2分析,差异有统计学意义(x2=24.421,P=0.001),而将正常、急性呼酸、呼碱、代酸及代碱进行x2分析,差异无统计学意义(x2=5.280,P=0.260),提示AECOPD患者慢性呼酸的发生率较单纯CAP患者显著增加.结论 自动化酸碱平衡图能帮助急诊科医师快速识别CAP患者是否存在多重酸碱平衡紊乱,并可快速识别急、慢性呼吸系统疾病.