急性脑出血和脑梗死患者血液流变学指标变化情况探讨

目的：探讨急性脑出血和脑梗死患者血液流变学指标变化情况,为临床诊断提供依据。方法观察86例急性脑出血患者（急性脑出血组）,83例脑梗死患者（脑梗死组）和120例健康人群（对照组）的血液流变学指标,对结果进行对比分析。结果急性脑出血组和脑梗死组的血浆黏度均高于对照组（P＜0．05）。急性脑出血组全血黏度（低、中、高切）和红细胞沉降率均明显高于脑梗死组和对照组（P＜0．05）,脑梗死组红细胞沉降率高于对照组（P＜0．05）。急性脑出血组血小板计数、平均血小板体积、血小板分布宽度和大血小板百分率4项指标均低于脑梗死组（P＜0．05）;急性脑出血组和脑梗死组血小板计数均明显低于对照组（ P＜0．05）。急性脑出血组血浆D-二聚体水平为（785±332）μg/L ,明显高于脑梗死组[（365±234）μg/L ]和对照组[（163±79）μg/L ],差异有统计学意义（ P＜0．05）。血浆D-二聚体水平与高切全血黏度（ r＝0．812,P＜0．01）,中切全血黏度（ r＝0．917, P＜0．01）,血浆黏度（ r＝0．893,P＜0．01）呈正相关。结论血液流变学指标异常可作为急性脑出血和脑梗死的诊断依据之一,脑出血患者血液流变学指标异常情况更加突出。     

悦安欣注射液治疗急性脑梗死及对血液流变性的影响

目的：观察悦安欣注射液治疗急性脑梗死的疗效及其对患者血液流变性的影响。方法：将62例急性脑梗死患者随机人灵悦安欣注射液治疗 31例和种芎嗪注射液对照组31例,均为每日1次,30日为1疗程,观察疗效及血液流变学指标的变化。结果：悦安欣注射液的显效率（74．2％）和总有效率（96．8％）均明显优于对照组（38．7％和67．7％）,P＜0．05或P＜0．01。血液流变学指标（全血低切粘度、血浆粘度、血细胞比容和血小板粘附率）治疗组的改善明显好于对照组（P＜0．05和P＜0．01）。结论：悦安欣注射液治疗急性脑梗死疗效满意。     

血清C反应蛋白水平与脑卒中的病情及预后关系探讨

目的：探讨急性脑卒中患者发病早期血液中C反应蛋白（CRP）含量高低与病情严重程度及预后的影响。方法：对155例患者血清CRP含量进行测定，其中脑梗死41例（脑梗死组），脑出血40例（脑出血组），腔隙性梗死33例（脑隙性梗死组）及非脑卒中41例（对照组）。结果：（1）脑卒中患者CRP阳性率明显较对照组升高（P〈0．01）；其中脑出血组较脑梗死组CRP水平高（P〈0．05），脑梗死组较腔隙性梗死组水平高（P〈0．05），而腔隙性梗死组与对照组比较无明显升高（P〉0．05）。结论：急性脑卒中患者早期血清CRP升高提示病情严重且预后不良     

心脑血管病与氧化低密度脂蛋白及血流变指标关系的分析

目的：探讨心脑血管病患者血浆ox-LDL和血液流变学指标的变化及其相关关系。方法：用ELISA法测20例冠心病、30例脑梗死患者和50例健康对照组血浆ox-LDL;平行测定血液流变学指标,并对OX－LDL与血流变指标进行两者的相关分析。结果：心脑血管病患者血浆ox-LDL浓度明显高于对照组（P＜0．01）;血液流变学指标与正常对照组比较：高切全血粘度、低切全血粘度、红细胞压积和红细胞变形指数均有较显著性差异（P＜0．05或P＜0．01）;心脑血管病患者血浆ox-LDL浓度与血流变异常指标呈正相关（P＜0．05或P＜0．01）。结论：血浆ox-LDL与血液流变学可能与心脑血管病发病有关;血浆ox-LDL与血液流变学检测有助于心脑血管病的诊断和治疗。     

高脂蛋白（A）水平与脑卒中发病危险因素的关系

背景：流行病学及临床观察表明，脂蛋白（A）是一个新的脑血管病危险因素，与缺血性脑卒中关系较大。 目的：探讨高脂蛋白（A）水平与脑卒中的关系。设计：病例一对照分析。单位：中南大学湘雅医院神经病学研究所. 对象：选择1999-09／2002-03在中南大学湘雅医院神经内科住院的294例脑卒中患者。294例脑卒中患者分为脑梗死组159例，急性高血压性脑出血组135例。脑梗死组中动脉粥样硬化性脑梗死者109例，腔隙性脑梗死者50例。并选择来自门诊连续健康体检人员94例为健康体检组。 方法：采用夹心酶联免疫吸附法测定各组的血浆脂蛋白（A），并将动脉粥样硬化性脑梗死患者及急性高血压性脑出血患者分别按血脂各项正常与否（脂蛋白（A）除外）分成两组，血脂正常组与血脂异常组脂蛋白（A）水平比较采用独立样本t检验，采用多元线性回归法分析性别、高血压及血脂各项与脂蛋白（A）血清水平有无相关性。 主要观察指标：①动脉粥样硬化性脑梗死组、腔隙性脑梗死组和急性高血压性脑出血组及健康对照组间脂蛋白（A）的比较。②血浆脂蛋白（A）水平与血脂各项的相关性分析。 结果：所纳入的294例患者及94例正常对照组均进入结果分析。①动脉粥样硬化性脑梗死组、腔隙性脑梗死组和急性高血压性脑出血组及健康对照组间脂蛋白（A）的比较：动脉粥样硬化性脑梗死、脑出血组患者脂蛋白（A）水平均较健康对照组增高（P〈0．05）。动脉粥样硬化性脑梗死组脂蛋白（A）浓度较急性高血压性脑出血组高（P〈0．05）；腔隙性脑梗死患者的脂蛋白（A）水平稍高于对照组，但差异无显著性意义（P〉0．05）。②血浆脂蛋白（A）水平与血脂各项的相关性分析：血脂正常组与血脂异常组脂蛋白（A）水平比较采用独立样本t检验，显示两组脂蛋白（A）水平接近（P〉0．05）。采用多元线性回归法分析亦显示性别、高血压及血脂各项与脂蛋白（A）血清水平无相关性。 结论：高脂蛋白（A）可能是脑出血及动脉粥样硬化性脑梗死的独立危险因素。     

急性出血性脑血管病WBC、血液流变性变化的意义

目的　探讨外周血白细胞 (WBC)、血液流变性在急性出血性脑血管病的病因、病理中的作用及其关系。方法　对 46例脑出血患者、5 0例脑梗塞患者和 40例正常人 ,测定外周血WBC计数、血液流变学指标并作相关分析。结果　脑出血组WBC、血液流变学指标明显高于脑梗塞组 ,同时亦显著高于正常组 (P <0 .0 5或P <0 .0 1)。结论　急性出血性脑血管病存在WBC增多及血液流变性异常 ,后者是出血性和缺血性脑血管病二者发病的共同危险因素之一。     

β-七叶皂甙钠对急性脑出血的临床治疗研究

目的：观察β—七叶皂甙钠治疗急性脑出血的疗效和对患者血液流变学的影响。方法：对确诊为急性脑出血患者187例随机分为β—七叶皂甙钠治疗组及对照组，比较治疗效果和血液流变学的变化。结果：治疗组总有效率为86．2％，对照组总有效率为67．2％(P＜0．05)；两组血液流变性均有明显改变，但以β—七叶皂甙钠组为佳。结论：β—七叶皂甙钠对急性脑出血有较好治疗效果。     

新正天丸对偏头痛患者血液流变性和甲襞微循环的影响

目的：探讨偏头痛患者血液流变学，甲襞微循环的改变及新正天丸对其的影响。方法：偏头痛患者１００例，随机分为２组，观察组５０例，口服新正天丸对照组５０例，口服氟桂嗪，疗程均为３０天。并进行治疗前后血液流变学和甲襞微循环的检测。结果：观察组血液流变性各项指标中除红细胞压积变化不明显外，其它各项均有显著改善（Ｐ＜０．０５或Ｐ＜０．０１），而对照组中只有血小板聚集率和血沉改变明显（Ｐ＜０．０５），观察组对甲襞四项积分示明显改善（Ｐ＜０．０５或Ｐ＜０．０１），而对照组改善不明显（Ｐ＞０．０５）。结论：血液流变性及甲襞微循环的改变是偏头痛的重要病理特征，新正天丸对偏头痛血瘀障碍可能有改善作用。     

补阳还五汤合用维生素E对急性脑梗死患者自由基及血液流变性的影响

目的：观察补阳还五汤合用维生素Ｅ治疗急性脑梗死的疗效及对患者血中自由基和血液流变性的影响。方法：将５６ 例患者随机分为治疗组（３４ 例）和对照组（２２ 例）,２ 组患者常规治疗相同,治疗组加用口服补阳还五汤,每日１剂,维生素Ｅ１００ ｍ ｇ,每日１ 次。２ 组均于治疗１４ 日后观察血中自由基及血液流变学指标变化。结果：治疗组总有效率８８．２％ ,对照组总有效率５９．１％ ,治疗组疗效显著优于对照组（Ｐ＜ ０．０５）;治疗组治疗后血中自由基和血液流变学指标与治疗前及对照组治疗后比较均有显著改善（Ｐ＜ ０．０１ 或Ｐ＜ ０．０５）。结论：补阳还五汤合用维生素Ｅ治疗急性脑梗死可清除血中自由基,增强抗自由基物质的活力,改善血液流变性,降低血粘度。     

降纤酶治疗急性脑梗死临床研究

目的 观察降纤酶治疗急性脑梗死的疗效、血液纤溶功能变化和治疗时间窗。方法 选32例急性脑梗死患者予以降纤酶治疗。另选30例急性脑梗死患者予以706代血浆加葛根素作对照组。结果 2周末治疗组显效率60％，极高于对照组17％（P＜0．01）。纤溶功能检查：除发病49小时－1周内用药者PAI无变化外，余均有显著或极显著差异（P＜0．05或P＜0．01）。结论 降纤酶治疗脑梗死的疗效极显著高于对照组，并提高纤溶活性。     

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.