注射用白眉蛇毒血凝酶在普通外科手术中的应用研究

目的 研究注射用白眉蛇毒血凝酶在普通外科手术中止血的有效性及安全性.方法选取行手术治疗的住院患者90例,随机分为两组.实验组于术前30 min及术后第1～3天分别应用注射用白眉蛇毒血凝酶,对照组在相同时期给予常规止血药物,观察两组术中及术后渗血情况.结果实验组患者术中伤口渗血量较对照组少[(9.45±2.90)ml与(13.35±5.73)ml,P<0.01],术后引流血量也较少.实验组患者45例均未出现用药相关并发症.结论注射用白眉蛇毒血凝酶能减少普通外科手术伤口术中及术后的渗血,疗效确切,临床应用安全.     

神经外科手术应用注射用血凝酶止血的临床效果观察

目的 观察注射用血凝酶在神经外科手术中局部应用的止血效果及对凝血功能的影响.方法 选取我院诊治的60例神经外科手术患者,美国麻醉医师协会（ASA）分级Ⅰ、Ⅱ级,随机分为用药组30例和空白对照组30例.两组术前一天给予注射用血凝酶2U肌肉注射;术前30 min注射用血凝酶2U静脉注射;术后注射用血凝酶2U静脉注射,每天2次,连续用药3d.用药组术中应用注射用血凝酶4U＋生理盐水10 ml局部喷洒.比较两组患者的手术视野清晰度、手术出血量、术中输血量、术后引流量,并检测术前及术后凝血酶原时间（PT）、部分凝血活酶时间（APTT）、纤维蛋白原（FIB）定量、纤维蛋白原降解产物（FDP）、D-二聚体和血小板计数（PLT）,并于术后进行随访.结果 用药组手术视野有效改善率为70.0％ （21/30）,空白对照组手术视野有效改善例数为0,两组比较差异有统计学意义（P＜0.05）;用药组术中手术出血量[（680.00±95.22） ml],少于空白对照组[（790.00±47.00） ml],两组比较差异有统计学意义（P=0.034）;两组患者术后PLT计数与术前相比均明显减少（P＜0.05或P＜0.01）,但两组间相比差异无统计学意（P＞0.05）.术后随访两组患者术后恢复好,无不良事件发生.结论 注射用血凝酶局部喷洒用于神经外科手术可改善手术术野清晰度,减少手术出血量;不会影响患者凝血功能,不会增加血栓形成的危险.     

注射用白眉蛇毒血凝酶联合奥美拉唑钠对急性上消化道出血预后的影响观察

目的观察注射用白眉蛇毒血凝酶联合奥美拉唑钠对急性上消化道出血预后的影响。方法选取2016年8月～2017年8月收治的50例急性上消化道出血患者为研究对象,采用随机数字表法分为试验组和对照组各25例,对照组给予美拉唑钠治疗,试验组在对照组基础上给予注射用白眉蛇毒血凝酶治疗,比较两组疗效、生活质量及药物不良反应。结果治疗前两组生活质量评分无明显差异(P0.05),治疗后,试验组生活质量评分明显高于对照组,差异有统计学意义(P0.05);试验组有效率为88.00%,明显高于对照组的64.00%,差异有统计学意义(P0.05);两组不良反应无明显差异。结论注射用白眉蛇毒血凝酶联合奥美拉唑钠治疗急性上消化道出血的疗效显著,且能提高患者生活质量,值得进一步推广。     

注射用白眉蛇毒血凝酶细菌内毒素检测

目的 建立注射用白眉蛇毒血凝酶细菌内毒素检测方法.方法 按〈中国药典〉（2005版）收载的细菌内毒素检测法,计算注射用白眉蛇毒血凝酶的细菌内毒素限值,通过干扰试验确定其最大无干扰质量浓度.结果 注射用白眉蛇毒血凝酶经4倍稀释后,注射用白眉蛇毒血凝酶质量浓度为0.05KU·mL-1时对细菌内毒素无干扰.结论 注射用白眉蛇毒血凝酶的热原检查采用细菌内毒素检查方法是可行的.     

白眉蛇毒血凝酶联合奥曲肽在肝硬化上消化道出血患者中的应用

目的探讨白眉蛇毒血凝酶联合奥曲肽在肝硬化上消化道出血患者中的应用效果。方法回顾性分析,选择2018年4月～2020年7月我院收治的82例肝硬化上消化道出血患者,根据不同治疗方式分为两组各41例。两组均进行常规治疗,在此基础上,对照组采用奥曲肽进行治疗,观察组在对照组基础上加用白眉蛇毒血凝酶进行治疗,两组均连续治疗5d。比较两组患者治疗5d后的临床疗效,治疗前、治疗5d后的凝血功能。结果治疗5d后,两组治疗总有效率对比,观察组更高(P0.05);两组患者凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)均缩短,血小板计数(PLT)水平升高、纤维蛋白原(FIB)水平降低,且观察组改善更多(P0.05)。结论肝硬化上消化道出血患者采用白眉蛇毒血凝酶与奥曲肽联合治疗,可有效改善其凝血功能,提高治疗效果。     

蛇毒血凝酶在食道癌手术中的止血效果观察

目的 评价蛇毒血凝酶在食道癌手术中的止血效果和对患者凝血功能的影响。方法 将60例食道癌手术患者分为蛇毒血凝酶组（Ⅰ组）、立芷血组（Ⅱ组）和生理盐水组（Ⅲ组）各20例。均采用全身麻醉，诱导插管后各组分别静脉注射2kU蛇毒血凝酶、2kU立芷血或2ml生理盐水。分别观察患者切口长度、失血量，术前、术中30分钟、术毕30分钟的凝血功能指标以及手术前后的血红蛋白、血球压积、血小板。结果 3组凝血功能指标比较。差异均无显著性意义（P〉0．05）；Ⅰ、Ⅱ组术毕30分钟的血红蛋白、血球压积、血小板高于Ⅲ组（P〈0．05），切口失血量低于Ⅲ组（P〈0．05）。结论 蛇毒血凝酶对机体凝血功能无影响，蛇毒血凝酶和立芷血都可减少切口出血。     

甲状腺切除术应用尖吻蝮蛇血凝酶的止血效果

目的探讨尖吻蝮蛇血凝酶对甲状腺切除患者的止血作用及安全性。方法 2013年1月至2014年6月采用前瞻、随机、盲法、对照研究设计,满足方案入选标准并获得知情同意的甲状腺疾病患者共60例,按随机数字表法分为两组,均行甲状腺部分切除术。观察组(30例)于术前20 min静脉注射尖吻蝮蛇血凝酶2 U,术后4 h再次注射2 U;对照组(30例)在相同时间给予生理盐水。观察记录术中出血量和术后24 h创面引流量;同时观察凝血功能变化和安全性。结果观察组术中出血量(40.6±19.5)g少于对照组的(54.1±22.3)g(t=2.496,P=0.015);术后24 h创面引流量(56.4±24.8)g少于对照组的(73.0±31.5)g(t=2.268,P=0.027);凝血功能指标两组相近(P均>0.05)。两组患者均未出现血栓等并发症,未出现研究药物相关的不良事件。结论尖吻蝮蛇血凝酶对甲状腺切除手术创面有较好的止血作用,且未增加血栓形成的风险,有较好的安全性。     

临床常用蛇毒类凝血酶制剂对凝血指标的影响

目的观察临床常用蛇毒类凝血酶(SVTLE)制剂对凝血指标的影响,为临床判断可能发生的出血风险作出提示。方法选取2017年1—10月空军军医大学附属西京医院泌尿外科患者102例(泌尿外科组)和耳鼻咽喉头颈外科患者80例(耳鼻喉科组)。泌尿外科组患者均为泌尿系统相关疾病术后使用注射用白眉蛇毒血凝酶止血的患者,耳鼻喉科组均为突发性耳聋使用巴曲酶注射液改善微循环的患者。比较泌尿外科组与耳鼻喉科组治疗前后凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fib)、凝血酶时间(TT)、D-二聚体(DD)、纤维蛋白/纤维蛋白原降解产物(FDP)的变化。结果泌尿外科组注射用白眉蛇毒血凝酶治疗后Fib水平较治疗前降低,FDP水平较治疗前升高(P0.05)。耳鼻喉科组巴曲酶注射液治疗后Fib水平较治疗前降低,FDP水平较治疗前升高(P0.05)。结论 SVTLE制剂可对Fib与FDP水平产生影响,应及时检测用药患者的凝血指标,观察其变化,避免因低纤维蛋白血症引起的出血。     

血液回收器在减少心脏手术用血中的应用

目的:探讨自体血液回收器在减少心脏手术用血中的应用效果。方法:选取我院手术室2013年9月~2016年2月收治的88例手术患者,并随机等分为研究组和对照组,其中对照组采取负压吸引器回抽血液,再将"机器余血"回输至患者体内;研究组则利用血液回收器将术野出血回抽,再予以洗涤处理,并将血液回输给患者。记录两组患者活化部分凝血活酶时间、凝血酶原时间、体外循环事件、术后24 h血浆输入量、留置气管导管时间、红细胞输入量、术中血浆输入量、术后24 h引流量及术后24 h红细胞输入量。结果:两组患者在体外循环时间、术后24 h血浆输入量及留置气管导管时间方面差异无统计学意义(P0.05);研究组患者术中红细胞输入量、术中血浆输入量、术后24 h引流量、术后24 h红细胞输入量均小于对照组(P0.05)。两组患者术前的凝血酶原时间和活化部分凝血活酶时间差异无统计学意义(P0.05);术后,研究组凝血酶原时间长于对照组,活化部分凝血活酶时间短于对照组,差异均有统计学意义(P0.05)。结论:对于手术治疗患者,采取血液回收器进行自体供血能有效减少围手术期用血量,有助于降低用血相关不良事件的发生率。     

巴曲亭对股骨颈骨折全髋关节置换术患者术中出血量及凝血功能的影响

目的探讨巴曲亭对股骨颈骨折全髋关节置换术患者术中出血量及凝血功能的影响。方法我院骨科就诊治疗的86例择期行单侧全髋关节置换术患者,根据有无应用巴曲亭分为观察组、对照组各43例。比较两组术中出血量、术后24 h引流量、住院时间、并发症发生情况及不同时间段凝血功能指标与血常规水平。结果观察组术中出血量、术后24 h引流量均少于对照组(P 0. 05);对照组手术完成时、术后24 h APTT、PT、TT均较术前延长,且PT、TT时间长于观察组,FIB均较术前降低,且低于观察组(P 0. 05);两组在手术完成时与术后24 h RBC、Hb、HCT、Plt水平均呈下降趋势,观察组RBC、HCT在同一时间段明显高于对照组(P 0. 05);两组并发症总发生率比较差异无统计学意义(P=0. 397)。结论在行全髋关节置换术的股骨颈骨折患者中,巴曲亭可有效的减少术中及术后出血量,且降低低分子肝素对凝血功能的影响,维持患者正常凝血功能,安全性较高。     

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.