帕金森病患者睡眠障碍相关因素分析及其对生活质量的影响

目的探讨帕金森病(PD)患者伴发睡眠障碍(SD)的特点、影响因素、与运动症状(MS)及非运动症状(NMS)的相关性及其对患者生活质量的影响。方法收集2010年4月至2011年11月就诊于北京天坛医院神经内科的132例PD患者的人口学资料,采用匹兹堡睡眠指数量表(PSQI)、爱泼沃斯瞌睡量表(ESS)评估患者睡眠状况,完成相关MS、NMS及生活质量量表的评定。结果 (1)132例PD患者中86例(65.2%)伴发SD(PSQI评分≥5分),为SD组,PSQI平均分为(9.7±3.9)分;46例(34.8%)不伴发SD(PSQI评分<5分),为NSD组;同时完成ESS量表评定的114例患者中,15例(13.2%)有白天困倦(ESS评分≥10分),ESS平均分为(13.5±3.2)分,99例(86.8%)无白天困倦(ESS评分<10分)。(2)PD患者PSQI量表前三位因子及评测结果分别为白天功能紊乱(1.6±1.0)分,睡眠紊乱(1.3±0.5)分,主观睡眠质量(1.3±0.8)分。(3)SD组和NSD组除受教育水平(P=0.032)外,性别、年龄、起病年龄、病程、起病侧别及临床类型均无显著差异(P>0.05)。(4)SD组和NSD组除了统一帕金森病量表(UPDRS)Ⅲ评分外(P=0.007),H-Y分期、改良Webster评分、剂末现象个数、UPDRSⅣ评分均无显著差异(P>0.05)。(5)SD组NMS个数、运动症状期后NMS个数明显多于NSD组(P=0.000),而运动症状期前NMS无显著差异(P>0.05);SD组眩晕、噩梦、入睡困难、白天思睡、性生活障碍、性冷淡、焦虑、抑郁、淡漠、注意力下降、疼痛及梦游的发生率明显高于NSD组(P<0.05);SD组UPDRSⅠ、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、ESS、自主神经症状量表(SCOPA-AUT)、疲劳量表(FS-14)、疲劳严重度量表(FSS)及不宁腿综合征严重程度评定量表(RLSRS)评分均明显高于NSD组(P<0.05)。(6)SD组UPDRSⅡ、日常生活能力量表(ADL)评分明显高于NSD组(P<0.05);SD组39项帕金森病生活质量问卷(PDQL-39)量表评分明显低于NSD组(P<0.05)。(7)相关分析发现,焦虑、抑郁与PSQ     

高压氧联合康复训练治疗帕金森病非运动症状的疗效观察

目的:探讨高压氧联合康复训练对帕金森病(PD)非运动症状的影响。方法:纳入无严重痴呆的原发性PD患者91例,随机分成药物组45例,给予美多巴治疗;联合组46例,在药物组治疗基础上加用高压氧联合康复训练;治疗30 d。比较2组非运动症状的发生率;于治疗前及治疗15及30 d后,采用PD综合评分量表(UPDRS)评价患者的PD症状;于治疗前及治疗30 d后,采用简易智能精神状态检查量表(MMSE)评价患者认知功能,汉密尔顿抑郁量表(HAMD)评估患者抑郁情况,帕金森病睡眠量表(PDSS)评价患者睡眠情况,帕金森病非运动症状问卷量表(NMSQuest)评估患者非运动症状。结果:治疗后,联合组伴发抑郁、疼痛、下肢痉挛、不宁腿综合征、入睡困难、易醒的发生率明显低于药物组(P0.05);联合组伴发幻觉、嗜睡、出汗、口干、体位性低血压的发生率明显高于药物组(P0.05);治疗后,联合组UPDRS评分、NMSQuest评分及HAMD评分低于药物组;PDSS及MMSE评分高于药物组(均P0.05)。结论:高压氧联合康复训练可改善PD患者部分非运动症状。     

帕金森病患者睡眠障碍及相关因素的临床研究

目的:探讨帕金森病(PD)患者睡眠障碍的相关因素及对PD患者生活的影响。方法:应用匹兹堡睡眠指数(PSQI)评分将56例PD患者分为睡眠障碍组35例与非睡眠障碍组21例,分别应用统一PD评分量表(UPDRS)、汉密顿抑郁量表(HAMD)、汉密顿焦虑量表(HAMA)、疲劳严重度量表(FSS)、简易智能状态检查表(MMSE)和蒙特利尔认知评测量表(Mo CA)进行评分,比较2组在运动障碍、抑郁、焦虑、疲劳、认知等方面的差异。对PD患者的PSQI评分与年龄、UPDRS评分、HAMD评分、HAMA评分、FSS评分、Mo CA评分进行Spearman相关性分析。结果:睡眠障碍组年龄、起病年龄及病程均大于或长于非睡眠障碍组(P0.05);睡眠障碍组UPDRS第Ⅰ、Ⅱ、Ⅲ分量表评分、HAMD评分、HAMA评分、FSS评分均高于非睡眠障碍组(P0.05);Mo CA评分低于非睡眠障碍组(P0.05),在注意力、延迟记忆方面差异有统计学意义(P0.05)。PD患者PSQI量表评分与年龄、UPDRS第Ⅲ分量表评分总分、运动迟缓项目评分、震颤项目评分、肌强直项目评分和姿势平衡项目评分均显著相关(P0.01);还与HAMD评分、HAMA评分和Mo CA评分具有相关性(P0.05),与FSS评分显著相关(P0.01)。结论:PD患者睡眠障碍的影响因素有年龄、运动障碍、抑郁、焦虑、疲劳、认知障碍。     

帕金森病患者疲劳及其相关因素的研究

目的探讨帕金森病(PD)患者伴发疲劳的临床特点及其相关因素。方法连续收集2010年4月至2012年1月就诊于北京天坛医院神经内科神经变性疾病专业门诊及病房的176例PD患者的人口学资料,采用疲劳严重程度量表(FSS)和疲劳量表(FS-14)评价疲劳,完成相关运动症状(MS)、非运动症状(NMS)、日常生活能力和生活质量的评价。结果 (1)根据FSS量表的评测结果(4分以上为疲劳组),176例PD患者中92例有疲劳症状,占52.30%,平均评分为(5.59±0.91)分;84例无疲劳症状,占47.70%,平均评分为0.00(0.00～1.53)分;(2)疲劳组躯体疲劳、脑力疲劳及FS-14总分均明显高于非疲劳组:6.00(0.00～8.00)分vs.0.00(0.00～0.00)分;3.00(0.00～5.00)分vs.0.00(0.00～0.00)分;9.00(0.00～12.00)分vs.0.00(0.00～2.00)分(P<0.05);(3)疲劳组与非疲劳组在年龄、起病年龄、病程、性别、受教育程度及临床类型等方面均无统计学差异(P>0.05);(4)疲劳组统一帕金森病量表Ⅲ(UPDRSⅢ)评分、Hoehn-Yahr(H-Y)分期及改良的Webster量表评分均明显高于非疲劳组[(28.95±11.79)分vs.(22.96±11.14)分,(2.21±0.75)期vs.(1.97±0.78)期,(12.82±4.10)分vs.(11.08±4.70分)](P均<0.05);(5)疲劳组并发症评分(UPDRSⅣ)明显高于非疲劳组:0.00(0.00～3.00)分vs.0.00(0.00～0.00)分(P<0.05);两组剂末现象的个数无统计学差异:0.00(0.00～5.00)个vs.0.00(0.00～4.00)个(P>0.05);(6)疲劳组NMS总个数及MS期后NMS个数明显多于非疲劳组:13.00(10.00～16.00)个vs.9.00(5.00～12.00)个;11.00(8.00～15.00)个vs.7.50(3.00～11.00)个(P<0.05);MS期前NMS个数无统计学差异[0.00(0.00～2.00)个vs.1.00(0.00～2.00)个,P>0.05];(7)疲劳组精神情绪总体状况(UPDRSⅠ)、抑郁(HAMD)、焦虑(HAMA)、白天嗜睡(ESS)、睡眠质量(PSQI)、自主神经功能(SCOPA-AUT)及不宁腿综合征(RLSRS)评分均明显高于非疲劳组:4.00(3.00～5.00)分vs.2.00(1.00～4.00)分;15.00(8.00～19.00)分vs.8.00(4.00～14.75)分;13.50(8.00?     

帕金森病患者吞咽障碍的临床分析

目的：研究帕金森病（PD）患者吞咽障碍的发生情况,调查PD患者发生吞咽障碍与其基本状况及PD特征的相关性,探讨其危险因素。方法：将83例 PD患者根据吞咽X线荧光透视检查（VFSS）分为吞咽障碍组（PD-D组）63例和非吞咽障碍组（PD-ND组）20例。分析与吞咽障碍发生的有关情况,采用H-Y分期、统一帕金森运动评分量表（UPDRS）Ⅲ、非运动症状评估量表（NMSS）、自主神经症状量表（SCOPA-AUT）、匹兹堡睡眠质量指数（PSQI）、汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HAMA）、左旋多巴等效剂量（LED）、帕金森综合评分量表（UPDRS）Ⅱ及帕金森病生活质量问卷（PDQL）对患者进行评估,分析PD合并吞咽障碍的独立危险因素。结果：PD D组较PD ND组年龄更大,更容易出现吞咽障碍（P＜0.01）;PD-D组较PD-ND组病程更长（P＜0.01）,H-Y分期更严重（P＜0.05）,LED剂量更高（P＜0.01）,UPDRSⅢ、SCOPA-AUT、HAMD、HAMA、UPDRSⅡ及PDQL评分均更高（P＜0.01,0.05）;年龄、H-Y分期、UPDRSⅢ及HAMD是吞咽困难的独立影响因素。结论：吞咽障碍是PD患者常见的非运动症状;年龄、疾病分期及运动症状更严重的PD患者更容易出现吞咽障碍,合并吞咽障碍的PD患者更容易出现抑郁。     

帕金森病患者伴很可能的快速眼动睡眠行为障碍和相关因素的研究

目的探讨帕金森病伴很可能的快速眼动睡眠行为障碍（ P-RBD）患者的临床特点及相关因素。方法连续收集2012年4月至2013年1月就诊于北京天坛医院神经内科102例帕金森病患者的人口学资料,采用RBD筛查量表（RBDSQ）评估患者RBD的状况,采用相关量表完成运动症状（MS）、非运动症状（NMS）和生活质量的评价。结果（1）102例帕金森病患者中30例伴发P-RBD（RBDSQ评分≥6分）,为P-RBD组,发生率为29.41％,RBDSQ平均分为（8.23±1.89）分;72例不伴P-RBD （ RBDSQ 评分＜6分）,为NP-RBD组,平均分为（2.21±1.33）分;（2）P-RBD 组和NP-RBD 组除病程[3.50（1.13～6.75）年和2.00（1.00～3.00）年]（ P＝0.022）外,性别、年龄、起病年龄、受教育水平、起病侧别和临床类型均无显著差异（P＞0.05）;（3）P-RBD组H-Y分期明显高于NP-RBD组[2.25（1.89～3.00）期和1.50（1.50～2.50）期]（ P＝0.022）,两组UPDRSⅢ评分无显著差异;P-RBD组异动症（ UPDRSⅣ）评分[2.00（0.00～4.75）分]显著高于NP-RBD组[0.00（0.00～1.00）分]（P＝0.016）,剂末现象的个数[0.00（0.00～9.00）个]显著多于NP-RBD组[0.00（0.00～0.00）个]（P＝0.042）;（4）P-RBD组NMS总个数[（11.03±5.95）个]明显多于NP-RBD组[（7.96±5.30）个]（P＝0.032）;P-RBD组MS期后NMS个数[（8.58±5.59）个]明显多于NP-RBD组[（6.08±5.10）个]（ P＝0.012）;两组MS期前NMS个数无显著差异（ P＞0.05）。 P-RBD组UPDRSⅠ、汉密尔顿抑郁量表（ HAMD）、汉密尔顿焦虑量表（ HAMA）、爱泼沃斯瞌睡量表（ ESS）、匹兹堡睡眠指数量表（PSQI）、自主神经症状量表（SCOPA-AUT）及疲劳评定量表（FS-14）的评分均显著高于 NP-RBD 组[3.50（1.75～6.00）分和2.00（0.00～4.75）分、（17.00±8.98）分和（11.83±10.36）分、（15.45±9.94）分和（10.65±8.85）分、（6.77±4.22）分和（4.49±3.38）分、（9.22±5.68）分和（6.06±4.14）分、（41.42±9.97）分和（34.81±9.46）分、（9.87±3.09）分和（8.01±4.13）分]（ P ＜0.05）;两组简易精神状态检查量表（MMSE）、蒙特利尔认知评估量表（MoCA）、改良淡漠评定量表（MAES）和不宁腿综合征严重程度评定量表（RLSRS）的评分无显著差异（P＞0.05）;（5）病程、H-Y分期、NMS个数及UPDRSⅠ、HAMD、HAMA、SCOPA-AUT、PQSI、ESS以及FS-14评分与RBDSQ 评分均具有显著相关性（ r 分别为0.256、0.311、0.324、0.306、0.275、0.287、0.409、0.352、0.26和0.243, P ＜0.05）;（6） RBDSQ 评分与 PDQL-39评分呈显著负相关（r＝-0.203,P＜0.05）。结论帕金森病患者P-RBD发生率较高,P-RBD组病程更长,病情更重,NMS更多,与部分NMS,包括情绪、总体睡眠质量、日间过度思睡及自主神经功能障碍显著相关,严重影响帕金森病患者的生活质量。     

美多巴联合高压氧及康复运动对帕金森病患者非运动症状的影响

目的:探讨美多巴联合高压氧及康复运动对无严重痴呆的原发性帕金森病(PD)患者非运动症状的影响。方法:选取2012年3月至2015年9月我院神经内科收治的无严重痴呆的原发性PD患者86例,随机分为对照组42例和实验组44例。2组均维持服用美多巴,实验组在此基础上给予高压氧治疗和神经发育疗法(NDT)与本体感觉神经肌肉促进疗法(PNF),持续治疗30 d。观察2组患者PD症状发生率;治疗前及治疗第15、30天,使用统一帕金森病量表(UPDRS)对患者的PD症状作出评价;治疗前及治疗第30天,分别使用帕金森病非运动症状评定量表(NMSQ)、汉密尔顿抑郁量表(HAMD)、帕金森病睡眠量表(PDSS)、简易精神状态检查量表(MMSE)评价患者的非运动症状、抑郁情况、睡眠情况以及神经感觉情况。结果:实验组焦虑抑郁、疼痛、下肢痉挛、不宁腿综合征、入睡困难、易醒的发生率显著低于对照组(P0.05);实验组出现幻觉、嗜睡、出汗、口干、体位性低血压等情况的发生率显著高于对照组(P0.05);其他症状2组发生率差异无统计学意义(P0.05)。治疗后,实验组的UPDRS评分、NMSQ评分、HAMD评分低于对照组,PDSS评分和MMSE评分高于对照组(均P0.05)。结论:美多巴联合高压氧及康复运动对无严重痴呆的原发性PD患者非运动症状有一定的改善作用,并且有效提高患者的生活质量。     

伴认知障碍帕金森病患者氧化应激指标变化及意义

目的:探讨帕金森病(PD)伴发轻度认知功能障碍(MCI)患者血浆氧化应激指标水平的变化及意义。方法:选择PD患者86例为PD组,根据是否伴MCI分为MCI亚组48例和无MCI亚组38例,健康对照40例为对照组,记录PD组的性别、年龄、病程、受教育年限、HoehnYahr(H-Y)分级,采用蒙特利尔认知评估量表(Mo CA)北京版对2组认知功能进行评估。采用酶联免疫吸附法(ELISA)检测2组血浆SOD、GSH和MDA水平。结果:PD组的血浆T-SOD、T-GSH水平低于对照组(P0.01),MDA水平高于对照组(P0.05);MCI亚组的血浆T-GSH水平低于无MCI亚组(P0.01);PD患者Mo CA评分与受教育年限(β=0.721,P0.01)、血浆T-GSH水平(β=0.415,P0.01)呈正相关,与病程(β=-0.356,P0.05)和H-Y分级(β=-0.295,P0.05)呈负相关。结论:血浆抗氧化机制的受损可能参与PD患者的发病机制;血浆GSH水平的下降可能与PD患者的MCI具有相关性。     

帕金森病伴发焦虑与运动症状及非运动症状关系的研究

目的 探讨帕金森病(PD)患者伴发焦虑与运动症状及非运动症状(NMS)的关系.方法 对124例PD患者应用汉密尔顿焦虑量表(HAMA)进行评测,分为焦虑组和非焦虑组,并完成相关运动症状及NMS量表评测.结果 (1)124例PD患者焦虑发生率为33.87%,焦虑和抑郁共病率为31.45%;(2)两组患者运动症状及运动并发症相关量表评测结果分别为:Hoehn-Yahr分期:2.48.±0.80 vs.2.04±0.78;UPDRS-Ⅲ (运动):30.68 ±9.91 vs 24.70±12.25;"开-关"现象发生率:35.71%vs.17.07%,两组间具有统计学差异(PO.05);(3)焦虑组患者出现NMS个数为(14.57±3.83)个,非焦虑组患者为(1 0.03.±5.25)个,两组间均有统计学差异(P<0.05);(4)焦虑组抑郁、性生活障碍、不宁腿综合征、淡漠、白天思睡、入睡困难、眩晕、疼痛、噩梦以及体位性头晕等NMS发生率高于非焦虑组,两组均有统计学差异(P<0.05);(5)焦虑组和非焦虑组患者NMS相关量表评测结果分别为:UPDRS-I(精神、行为和情绪):4.74±1.93vs.2.93±1.84;HAMD:19.41±6.97 vs.9.82±5.83:PSQI:19.48±6.36 vs.12.37±6.47;ESS:6.69±5.62 vs.3.56±3.34;SCOPA-AUT:43.48±7.75 vs 36.76±7.33;RLSRS:21.77±6.51 vs.17.29±7.27,两组间具有统计学差异(P0.05);(6)焦虑组和非焦虑组患者UPDRS-Ⅱ(日常生活活动)以及PDQL评分结果分别为:15.29±5.85 vs.12.22±5.39、128.62±20.51 vs.149.30±20.13,具有统计学差异(P<0.05).结论 焦虑是PD常见的NMS之一,与运动障碍的程度以及运动并发症相关;PD伴发焦虑患者NMS的发生率高,个数多,精神、行为、情绪、睡眠、自主神经障碍突出,严重影响患者的日常生活活动能力,使生活质量明显下降.     

帕金森病患者发生体位性低血压的危险因素

目的探讨帕金森病(Parkinson’s disease, PD)患者发生体位性低血压(orthostatic hypotension, OH)的危险因素。方法 PD患者164例,其中50例有OH者为OH组,114例无OH者为NOH组。比较2组年龄、性别比例、病程、受教育时间、每日左旋多巴等效剂量(levodopa equivalent daily dosage, LEDD)及PD统一评分量表(Unified Parkinson’s Disease Rating Scale, UPDRS)评分、Hoehn-Yahr(H-Y)分级、自主神经症状量表(the Scale for Outcomes Parkinson’s Disease for Autonomic Symptoms, SCOPA-AUT)评分、24项汉密尔顿抑郁量表(24-item Hamilton Depression Scale, HAMD-24)评分、14项汉密尔顿焦虑量表(14-item Hamiton Rating Scale for Anxiety, HAMA-14)评分、简易智能状态检查量表(Mini-mental State Examination, MMSE)评分、蒙特利尔认知评估量表(Montreal Cognitive Assessment, MOCA)评分;多因素logistic回归分析PD患者发生OH的危险因素。结果 OH组年龄[(68.60±5.55)岁]、LEDD[(625.78±146.47)mg]较NOH组[(63.75±8.47)岁、(557.89±122.52)mg]大(P0.05),病程[(5.98±2.19)a]较NOH组[(4.57±1.84)a]长(P0.05),H-Y分级中重度比率(56.0%)、UPDRS日常生活能力评分[(16.30±4.62)分]、UPDRS运动症状评分[(30.46±8.56)分]、SCOPA-AUT[(14.50±3.64)分]较NOH组[32.5%、(14.58±3.94)分、(27.11±6.65)分、(12.85±4.35)分]高,MOCA评分[(23.36±3.79)分]、MMSE评分[(24.82±3.19)分]较NOH组[(24.60±3.23)、(25.92±2.62)分]低(P0.05);OH组性别、受教育时间、UPDRS精神行为评分、HAMA-14评分、HAMD-24评分与NOH组比较差异无统计学意义(P0.05);多因素logistic回归分析结果显示,病程5 a (OR=2.727, 95%CI:1.260～5.901,P=0.011)、年龄65岁(OR=2.773, 95%CI:1.317～5.838,P=0.007)是PD患者发生OH的危险因素。结论病程、年龄与PD患者发生OH有关。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.