孟鲁司特联合用药治疗咳嗽变异性哮喘48例临床分析

目的探讨孟鲁司特钠联合用药治疗咳嗽变异性哮喘（CVA）的临床疗效。方法将96例CVA患者,按随机数字表法分为治疗组（48例）和对照组（48例）,2组患者均予以必可酮和咳喘宁,治疗组在上述药物基础上给予孟鲁司特钠,2组疗程均为12周;观察咳嗽频率评分、咳嗽缓解时间和消失时间及治疗前、后肺功能指标（FEV1）、FEV1与用力肺活量（FVC）的比值（FEV 1/FVC）和最大通气量（MVV）。结果 2组组内治疗前后咳嗽频率评分比较,差异有统计学意义（P〈0.05或P〈0.01）;治疗后2组咳嗽缓解时间、咳嗽消失时间比较,有统计学意义（P〈0.05）。2组治疗前后FEV1、FEV 1/FVC指标各自分别比较,差异有统计学意义（P〈0.05或P〈0.01）。治疗后2组FEV1、FEV 1/FVC比较,差异有统计学意义（P〈0.05）。结论孟鲁司特钠联合必可酮和咳喘宁治疗咳嗽变异性哮喘疗效肯定,不良反应少,可作为治疗CVA的新选择。     

孟鲁司特联合布地奈德治疗咳嗽变异性哮喘的效果及对炎性介质的影响

目的探讨孟鲁司特联合布地奈德治疗咳嗽变异性哮喘的效果及对炎性介质的影响。方法选取150例咳嗽变异性哮喘患儿作为研究对象,按照用药方式将其分为对照组(75例,布地奈德)和观察组(75例,孟鲁司特联用布地奈德)。比较两组的治疗效果。结果治疗1、2个月后,观察组的FEV1%、PEF%、FEV1/FVC均优于对照组(P<0.05);治疗后,两组患儿的TNF-α、IL-4、IL-5水平均下降,且观察组明显低于对照组(P<0.05);治疗后,两组的IgE、IgG水平及咳嗽症状、LCQ评分均改善,且观察组明显优于对照组(P<0.05)。结论孟鲁司特联用布地奈德能有效改善咳嗽变异性哮喘患儿肺功能指标,减少炎性介质释放,改善免疫功能,提高生存质量,值得临床推广。     

孟鲁司特钠辅助治疗对AECOPD患者的疗效观察

目的探讨孟鲁司特钠辅助治疗对AECOPD患者肺功能、CAT评分、Borg评分以及血清炎症因子的影响。方法选取我院呼吸内科2016年4月～2017年10月收治的慢性阻塞性肺疾病急性加重期患者100例,按随机数字表法分为研究组和对照组各50例。研究组在常规治疗基础给予孟鲁司特钠联合信必可都保治疗;对照组在常规治疗基础上给予信必可都保治疗。观察两组患者治疗前后肺功能、CAT评分、Borg评分变化以及血清炎症因子水平。结果治疗后,两组患者FEV1、FVC、FEV1/FVC(%)较治疗前均明显增加,且研究组较对照组增加更为显著,差异具有统计学意义(P0.05);两组患者CAT评分和Borg评分较治疗前明显降低,且研究组较对照组降低更为显著,差异具有统计学意义(P0.05);两组患者CRP、PCT较治疗前明显降低,且研究组较对照组降低更为显著,差异具有统计学意义(P0.05)。结论孟鲁司特钠辅助治疗可显著提高AECOPD患者肺功能,降低患者CAT评分和Borg评分,改善临床症状,同时降低患者炎症因子水平,值得推广应用。     

妥洛特罗贴剂对咳嗽变异性哮喘患儿血清炎症因子的影响

目的探讨妥洛特罗贴剂对咳嗽变异性哮喘患儿血清炎症因子的影响。方法选取2015年8月至2016年11月青海省人民医院收治的咳嗽变异性哮喘患儿78例,随机分为观察组和对照组各39例。对照组给予常规对症治疗。观察组在对照组基础上,给予妥洛特罗贴剂治疗。观察两组治疗前后肺功能[最大呼气流量(PEF)、1秒用力呼气容积(FEV1)、用力肺活量(FVC)、FEV1/FVC]及炎症因子[干扰素γ(IFN-γ)、白细胞介素4(IL-4)、IFN-γ/IL-4]的变化。结果观察组的总有效率(92.31%)高于对照组(71.79%),差异有统计学意义(P0.05);两组治疗后PEF、FEV1、FVC、FEV1/FVC升高,观察组的PEF、FEV1、FVC、FEV1/FVC高于对照组,差异有统计学意义(P0.05);两组治疗后IFN-γ、IFN-γ/IL-4升高,IL-4降低,观察组的IFN-γ、IFN-γ/IL-4高于对照组,IL-4低于对照组,差异有统计学意义(P0.05)。结论妥洛特罗贴剂能减轻儿童咳嗽变异性哮喘的炎性反应,改善肺功能。     

气雾型布地奈德联合孟鲁司特治疗小儿咳嗽变异性哮喘的疗效及炎症改善效果分析

探讨气雾型布地奈德联合孟鲁司特治疗小儿咳嗽变异性哮喘的疗效及炎症改善效果。筛选2015年1月~2016年6月我院收治的小儿咳嗽变异性哮喘患儿86例,作为研究对象。采用随机数表法将其分为观察组与对照组,每组43例,对照组在常规抗感染、化痰治疗的基础上应用气雾型布地奈德吸入治疗,观察组则在对照组基础上联合应用孟鲁司特钠治疗,比较两组患儿治疗效果及炎症因子水平变化。两组治疗前肺功能指标FVC、FEV1、PEF比较无显著差异(P0.05),治疗后均明显改善,但观察组治疗后FVC、FEV1、PEF指标较对照组改善效果更为显著(P0.05);观察组治疗后IL-4、IL-6、TNF-α明显低于对照组(P0.05)。气雾型布地奈德联合孟鲁司特治疗小儿咳嗽变异性哮喘临床疗效显著,可有效改善患儿呼吸通气功能以及机体炎症程度,具有临床应用及推广价值。     

高流量湿化氧疗联合布地奈德福莫特罗粉吸入剂治疗支气管哮喘急性发作的效果

目的探讨高流量湿化氧疗联合布地奈德福莫特罗粉吸入剂(信必可都保)治疗支气管哮喘急性发作的效果。方法选取我院2016年9月～2020年9月采用常规治疗+雾化吸入信必可都保治疗的50例患者纳入对照组。选取同期采用常规治疗+高流量湿化氧疗+雾化吸入信必可都保治疗的50例患者纳入观察组。两组连续治疗2周,比较两组治疗前、治疗2周后的炎症反应[白细胞介素(IL)-6、IL-17、超敏C反应蛋白(hs-CRP)]和肺功能[用力肺活量(FVC)、最大呼气流量(PEF)]水平。结果治疗2周后,两组的hs-CRP、IL-6、IL-17水平低于治疗前,且观察组低于对照组,两组FVC、PEF高于治疗前,且观察组高于对照组(P0.05)。结论高流量湿化氧疗联合信必可都保治疗支气管哮喘急性发作,更利于缓解患者的炎症反应,提升患者的肺功能。     

苏黄止咳胶囊联合糖皮质激素吸入治疗咳嗽变异性哮喘患者的临床效果

目的分析咳嗽变异性哮喘采用苏黄止咳胶囊与吸入用糖皮质激素联合治疗,对患者症状改善及肺功能的影响。方法选取我院2016年9月~2018年10月收治的咳嗽变异性哮喘患者68例为研究对象,随机分为对照组和观察组各34例。对照组予以吸入用糖皮质激素治疗,观察组予以苏黄止咳胶囊与吸入用糖皮质激素联合治疗,比较两组治疗前后咳嗽症状改善情况、咳嗽敏感性阈值、最大呼气流量及FEV1/FVC。结果观察组治疗2周后咳嗽症状评分低于对照组,咳嗽敏感性阈值高于对照组(P<0.05);两组治疗2周后PEF、FEV1/FVC高于治疗前,且观察组PEF、FEV1/FVC高于对照组(P<0.05)。结论咳嗽变异性哮喘采用苏黄止咳胶囊联合吸入用糖皮质激素治疗,可有效改善患者咳嗽症状,提高咳嗽敏感性阈值,改善肺功能。     

疏风化痰通络汤联合穴位贴敷治疗小儿咳嗽变异性哮喘

目的:观察疏风化痰通络汤联合穴位贴敷治疗小儿咳嗽变异性哮喘的临床效果。方法:选取2017年3月～2018年8月我院收治的96例咳嗽变异性哮喘患儿为研究对象,按照随机数字表法分为对照组和观察组,每组48例。对照组在常规治疗基础上给予孟鲁司特钠联合普米克令舒治疗,观察组在对照组基础上给予疏风化痰通络汤联合穴位贴敷治疗。比较两组临床疗效、肺功能(FVC、FEV1、PEF)、炎症因子(血清EOS及IL-4、IL-5)水平差异。结果 :观察组总有效率(95.83%)显著高于对照组(77.08%),P0.05;治疗后,观察组FVC、FEV1、PEF均明显高于对照组,血清EOS、IL-4、IL-5水平明显低于对照组,P0.05。结论 :疏风化痰通络汤联合穴位贴敷治疗小儿咳嗽变异性哮喘,可明显改善患儿肺功能,减少炎症因子释放,提高临床疗效。     

咳嗽变异性哮喘与典型哮喘的肺功能比较观察

目的探讨咳嗽变异性哮喘肺功能的改变,分析肺功能检查在咳嗽变异性哮喘诊断和疗效中的意义。方法 2009年4～10月在我院呼吸科门诊及病房收集哮喘及咳嗽变异性哮喘患者各30例,检查其肺功能,对两组用力肺活量（FVC）、1秒钟用力呼气容积（FEV1）、FEV1/FVC、最大呼气峰流速（PEF）值进行统计分析。结果咳嗽变异性哮喘的FVC、FEV1、FEV1/FVC、PEF实测值较预计值差异均无统计学意义,与典型哮喘组FVC差异无统计学意义,FEV1、FEV1/FVC、PEF差异有显著性差异（P〈0.01）,咳嗽变异性哮喘与典型哮喘比较FVC差异无统计学意义,FEV1、PEF差异有显著性（P〈0.05）,FEV1/FVC差异有显著性差异（P〈0.01）。结论咳嗽变异性哮喘肺功能损伤程度相对较轻,如早诊断,早治疗,能预防肺功能的进一步发展。     

孟鲁司特在治疗小儿咳嗽变异性哮喘中的临床价值

目的:探讨孟司特治疗儿童咳嗽变异性哮喘(cough variant asthma,CVA)在临床上的应用价值.方法:将54例CVA患儿随机分为两组,A组给予口服酮替芬,B组给予口服孟鲁司特,连续治疗8周,观察疗效及复发情况.结果:B组总有效率为93.4%,A组总有效率67.2%;B组复发率明显低于A组;FEV1占预计值的百分数(FEV1/FVC)明显上升,肺功能改善(P<0.05).结论:孟鲁司特能有效治疗儿童咳嗽变异性哮喘,值得在临床推广应用.     

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.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

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.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.