西安地区1 106例体检人群血脂水平分析

目的调查西安地区人群血脂水平和血脂谱现状，为血脂水平划分和血脂异常防治提供客观依据。方法选取西安地区1106例体检人群为调查对象，男性615例，女性491例，分为青年组（18～39岁）、中年组（40～49岁）、老年前期组（50～59岁）及老年组（60岁以上）共4纽。按血脂测定标准化方法测定总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDI，）和低密度脂蛋白胆固醇（LDL）4项血脂水平。结果TC升高比例较小，男女分别为1．6％、1．2％，但是TC边缘升高占有较大比例，分别为12．5％和10．0％。男性最高为中年组，女性最高为老年组。TG男性明显高于女性，男性最高为中年组，女性最高为老年前期组。HDL女性总体高于男性。LDL男性高于女性。调查结果显示，血脂谱异常以高TG和低HDL血症为主，男性分别为17．7％和24．2％，女性分别为6．5％和7．9％，男性高于女性。结论按异常发生率10％估算，西安城市居民男性TC、TG、HDL、LDL安全水平可能以〈5．34、〈2．75、〉0．92、〈3．72mmol／L为宜，女性TC、TG、HDL、LDI。安全水平可能以〈5．23、〈1．96、〉1．08、〈3．61mmol／L为宜。西安当地居民血脂异常水平在全国处于中等水平，并且有年轻化的趋势，应当引起足够的重视。     

11559例健康体检者血脂分析及对策

目的：了解芜湖市健康体检人群血脂水平情况，并提出相应的对策。方法：选择2005年度在我院体检中心进行健康体检人员11559例，其中男7125例，女4434例。年龄25—95岁，每10岁1个年龄组共分为5组，其中65岁以上归入同一组。结果：在11559例体检人群中血脂异常5076例，占体检人数的43．9％。其中男性血脂异常3519例，占男性体检人数的49．38％。男女间血脂成分的总平均水平中TC水平和我国其他地区相似．TC和LDL—c水平45岁以前男性高于女性，45岁以后女性则迅速增加．高于男性组（P〈0．01）。TG和LDL—C男性高于女性，有明显差异（P〈0．05）。TG、TC和LDL—C水平男女均随年龄升高，到55—64岁组为高峰。结论：芜湖市人群的血脂异常，远高于我国成人血脂异常总患病率18，6％．和患病率最高的广州、天津相似。血脂异常已对这一人群的健康构成威胁，对健康从业人员在体检的同时适时开展健康教育，任重道远。     

北京地区13 336例成人空腹血脂水平分析

目的 通过检测健康查体者空腹血脂水平来了解北京地区人群血脂水平现状及其血脂异常患病率.方法 应用日立7 170全自动生化分析仪检测北京地区13 336例成人空腹血脂,血脂指标包括甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C),比较不同性别和年龄组间血脂水平差别及血脂异常患病率的差异.结果 总体血脂异常患病率59.9%,男性71.6%,女性47.2%.男性TC平均(4.89±0.87)mmol/L、LDL-C平均(3.33±0.84)mmol/L、HDL-C平均(1.28±0.30)mmol/L、TG中位数1.32 mmol/L;女性TC平均(4.79±0.94)mmol/L、LDL-C平均(2.99±0.89)mmol/L、HDL-C平均(1.53±0.34)mmol/L、TG中位数0.9mmol/L.男性和女性4种血脂成分异常患病率均随年龄增加而增高(P＜0.01).TC、LDL-C、TG水平随年龄增加而增高(P＜0.01),HDL-C水平随年龄的增加有降低趋势(P＜0.01).TC在25～44岁间男性高于女性(P＜0.01),在55岁以上女性显著高于男性(P＜0.05).LDL-C在18～44岁间男性高于女性(P＜0.01),在45～74岁女性显著高于男性(P＜0.01).HDL-C水平各年龄组女性明显高于男性(P＜0.01).TG在18～54岁男性显著高于女性(P＜0.01),在55～64岁组两性间无差异,64岁以上女性高于男性(P＜0.05).结论 北京地区成人中血脂异常患病率较高,并且随年龄增大而增高,男女性别间血脂异常患病率差异有统计学意义.     

闽东地区5485例健康体检人群血脂四项水平的调查研究

目的通过检测闽东地区5485例健康体检人群血脂四项（甘油三酯TG、血清总胆固醇TC、高密度脂蛋白胆固醇HDL—C和低密度脂蛋白胆固醇LDL—C）,研究闯东地区人群血脂四项的现状,供临床诊断和防治血脂异常时参考。方法采用美国Beckman DXC800全自动生化分析仪进行检测,检测结果用SPSS13．0统计软件进行统计学分析。结果闽东地区的男女血脂四项的水平有显著性差异,P均小于0．001,男性TG、TC、LDL—C水平高于女性,而HDL—C水平低于女性,且闽东地区男性和女性的高TC血症、高TG血症、高LDL—C血症分别为24．7％和22．2％、33．7％和17．2％、17．0％和14．3％;闽东地区人群的血脂水平与年龄呈正相关,但相关不密切（相关系数均小于0．5）;同年龄组男性和女性之间大多有显著性差异,且女性高年龄纽TC、TG和LDL—C水平均高于男性,而同性别不同年龄组间男性TG水平随年龄增高而增高,至50岁以后下降;女性TG水平40岁以后增高较明显,其他三项指标（TC、HDL—C、LDL—C）男女均随年龄组的增高测定的均值都略有增高。结论闽东地区人群的血脂状况令人担忧,应重视和加强健康教育指导,预防心脑血管疾病的发生;临床上对男性和女性的血脂检测应分别设立正常参考范围;本文作者认为不易按不同年龄组设立参考范围,《中国成人血脂异常防治指南》制定的血脂异常危险分层方案也无年龄上的划分。     

杭州市健康人群血液流变学及血脂测定结果分析

目的 了解血流变学及血脂结果 在健康人群中的关系.方法 547例健康体检者男322例,女225例,女性平均年龄为(45.96±11.51岁),男性平均年龄为(44.27±11.35)岁,并按年龄段分为五组;分别用全自动血流变仪测定血液流变学指标及全自动血生化仪测定总胆固醇(TC)、甘油三酯(TG)、高密度胆固醇(HDL)、低密度胆固醇(LDL)、载脂蛋白Al(APOA)、载脂蛋白B(APOB)指标.结果 男性组与女性组血流变指标LBV、MBV、HBV、HBVI、LBVI、CV比较,差异均有统计学意义(t=3.20～11.73,P均＜0.05),男性组与女性组血脂指标除总胆固醇外,TC、TG、HDL、LDL、APOA1、APOB差异均有统计学意义(t=2.34～11.12,P均＜0.05).年龄段在4l～50岁的男性血液流变学与血脂结果 比较,差异均有统计学意义(r=-0.33～0.25,P均＜0.05).结论 322例男性体检41岁以上组血液流变学与血脂检测结果 呈显著相关性,对此类人群应在健康体检中引起重视.     

邢台县20025例健康体检者血脂水平调查

目的：了解邢台县健康体检人群血脂水平情况。方法：选择2007-01／2008—11在邢台县医院进行健康体检者20025例，统计不同性别及年龄组的血脂水平。结果：在20025例体检人群中血脂异常8044例，其中男性5516例，女性血脂异常2528例。TG、TC和LDL—C水平男女均随年龄升高。结论：邢台县人群的血脂异常比例，远高于我国成人血脂异常总患病率18．6％，已对人群的健康构成威胁。     

甘肃省东乡族人群血脂异常流行病学特点及危险因素分析

目的了解甘肃省东乡县血脂异常人群流行病学特征,通过对血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL C)、低密度脂蛋白胆固醇(LDL C)的检测、并结合相关的流行病学调查,以期为血脂异常的预防和其风险因素的控制提供参考。方法分层整群随机抽样法对甘肃省东乡县1 000例常住居民进行了包括问卷调查、体格检查以及血脂、血糖水平检查在内的综合评估。以血脂异常为因变量,以民族、性别等为自变量进行Logistic回归分析。结果东乡族血脂TC、LDL C明显高于汉族,60岁以上老年人血脂TC、TG和LDL C明显高于45~59岁中年人群。东乡族血脂异常率明显高于汉族,其中血脂TG、LDL C异常率差异具有统计学意义（P<0.05）;60岁以上老年人血脂异常率高于45~59岁中年人群,其中血脂TG、LDL C异常率差异具有统计学意义（P<0.05）。在不同民族人群中,东乡族和汉族60岁以上老年人血脂异常率均明显高于45~59岁中年人群。东乡族老年人血脂TG、HDL C、LDL C异常率明显高于中年人;汉族老年人血脂TG、HDL C异常率明显高于中年人。 在不同年龄段中,60岁以上老年人群东乡族血脂异常率明显高于汉族,以血脂TC、TG、LDL C异常为主;45~59岁中年人群东乡族血脂异常率明显高于汉族,以血脂TG、LDL C异常为主。对可能造成血脂异常的15个因素分析,结果显示：年龄、民族为血脂异常的危险因素。结论甘肃东乡县中老年居民血脂异常发生率处于较高水平, 其中东乡族中老年人血脂异常率明显高于汉族,60岁以上老年人群明显高于45~59岁中年人群。甘肃省东乡县常住居民血脂异常与当地人群年龄、民族、吸烟、高血压和体质量指数（BMI）关系密切,其中民族和年龄因素对血脂异常的影响比较大。     

石家庄市4755例公务员血脂流行病学调查

目的通过研究4 755例公务员的血脂情况,探讨我市公务员血脂异常分布及处理对策,为公务员人群冠心病的一级预防提供依据。方法选择在我院体检的公务员4 755例,采用酶法-终点法检测其血脂水平并进行分析。结果男性20~40岁年龄组的总胆固醇(TC)及甘油三酯(TG)平均值最高,分别为(5.9±6.2)mmol/L、(2.4±3.7)mmol/L,女性>60~70岁年龄组的TC、TG平均值最高,分别为(5.8±1.0)mmol/L、(1.7±1.0)mmol/L;60岁以前男性TG明显高于女性,而60岁以后女性高于男性;男性以TG升高为主(35.7%),女性以TC升高为主(36.3%)。结论我市公务员血脂异常人群主要分布在20~40岁男性,>50~70岁女性,应加强对这一人群的宣传教育,预防心血管疾病的发生。     

安宁地区成人空腹血脂水平调查

目的通过对体检人群空腹血脂水平的调查,了解安宁地区人群血脂水平及高血脂的患病率。方法应用罗氏P800全自动生化分析仪检测体检人群的空腹血脂[包括三酰甘油（TG）、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL—C）]水平,比较不同性别和年龄组间血脂水平及血脂异常的患病率。结果TG、TC、LDL-C随年龄增长有增高趋势。结论安宁地区成人血脂异常患病率较高,男女性血脂异常患病率有差异。     

南京市秦淮区4510名干部体检血脂水平的结果分析

目的通过对南京市秦淮区4 510名干部体检血脂四项的调查,得出干部人群中的血脂水平,分析血脂水平的影响因素。方法以2010年来体检的4 510名南京市秦淮区干部为对象,检测其血清中胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)及低密度脂蛋白胆固醇(LDL-C)的含量。结果总体上:男性血脂异常检出率明显高于女性;女性在51岁以后血脂异常检出率明显增高,并随着年龄的增长而升高,61岁以后女性血脂异常检出率高于男性。结论该人群血脂水平较高,血脂异常检出率与年龄、性别有关,尤其是中老年女性血脂明显增加,动脉粥样硬化的患病率明显增加。应注意通过改变不良的生活方式,控制血脂水平,预防高血压,冠心病的发生。     

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.