超声引导下PICC置管在乳腺癌术后化疗患者中的应用

目的：探讨乳腺癌术后化疗超声引导下PICC置管的应用。方法：将60例需行PICC置管的乳腺癌患者分为盲穿组和超声组，分别在盲穿和超声引导下置管，对两组置管成功率、局部组织损伤发生率进行比较。结果：超声组置管成功率高于盲穿组，局部组织损伤发生率低于盲穿组，差异有统计学意义（P〈0．05）。结论：超声技术有效克服了盲穿置管的局限性，提高了穿刺置管成功率．减少了局部组织损伤的发生。     

彩超及二维血流显像技术在PICC置管中的应用及效果

目的探讨彩色多普勒血流显像技术(简称彩超技术)及二维血流显示技术(简称B-Flow技术)在PICC置管的应用及效果。方法将87例需行PICC置管的患者分为对照组和试验组,分别在彩超引导和彩超及B-Flow引导下置管,对两组的置管成功率、操作时间、局部组织损伤、术后血栓发生率进行比较。结果试验组置管成功率、局部组织损伤、术后血栓发生率与对照组比较,差异有统计学意义。结论彩超及B-Flow引导下PICC置管是一种实用、安全的置管方法,它使彩超引导下置管变得更加容易,对局部血管状况差的患者更突显其优势。     

彩超引导下中心静脉导管术置管成功50例

目的:研究彩超引导下行外周静脉植进的中央静脉导管术(peripherally insened central catheter,PICC)操作方法及临床应用.方法:利用彩色多普勒引导技术行PICC穿刺患者50例为观察组,床边穿刺置管患者50例为对照组.结果:观察组穿刺成功率、皮肤穿刺点异化情况、感染发生率、静脉炎发生率、患者满意度、舒适度均优于对照组.结论:彩超引导下中心静脉置管术提高了穿刺的成功率,减少了穿刺针在组织间潜行对周围组织的损伤和局部刺激,降低置管并发症,提高患者的满意度.     

Site-Rite 5型超声导引下结合改良塞丁格技术置入PICC的应用效果评价

[目的]评价 Site-Rite 5型超声导引下结合改良塞丁格技术经外周置入中心静脉导管（PICC）的临床应用效果。[方法]将140例肿瘤病人肘部血管条件良好者作为对照组（85例）,差者为观察组（5 5例）,对照组采用常规盲穿式PICC置管法,观察组采用 Site-Rite 5型超声导引下结合改良塞丁格技术行 PICC 置管。比较两组一次性穿刺成功率、一次性置管成功率以及术后组织损伤、机械性静脉炎、血栓、误入动脉发生率。[结果]观察组一次性置管成功率高于对照组（P〈0.05）,组织损伤、机械性静脉炎发生率低于对照组（P〈0.05）,误入动脉发生率高于对照组（P〈0.05）。[结论]Site-Rite 5型超声导引下结合改良塞丁格技术置入PICC的置管成功率高、术后总体并发症低于常规盲穿式PICC置管法,但存在误穿动脉的风险。     

三种经外周静脉穿刺置入中心静脉导管置管方法临床应用效果的比较

目的探讨三种经外周静脉穿刺置入中心静脉导管(periperally inserted central catheter,PICC)置管方法的临床应用效果。方法便利抽样法选择2014年1月至2016年7月盐城市第一人民医院肿瘤科收治的需要PICC置管的90例患者为研究对象,按入院先后将其分为传统的PICC置管组、改良塞丁格技术的盲穿组、血管超声引导下结合改良塞丁格技术组,每组各30例,分析并比较三组患者一次性置管成功率、置管期间的穿刺点局部渗血、静脉炎、静脉血栓的发生率,置管使用的时间等。结果血管超声引导下的结合改良塞丁格技术的PICC置管的一次性置管成功率、穿刺点局部渗血、静脉炎、静脉血栓的发生率及置管时间等均优于传统的PICC置管组和改良的塞丁格技术盲穿组(均P0.05)。结论血管超声引导下的结合改良塞丁格技术的PICC置管极大地提高了一次性穿刺的成功率、减少了局部组织损伤和出血等并发症的发生、在预防机械性静脉炎和静脉血栓方面有着显著的效果,缩短了置管使用的时间,有利于提高患者的满意度,是临床上目前值得推广应用的一种PICC置管方法。     

超声血流显像技术在儿童经外周静脉置入中心静脉导管中的应用

目的探讨超声血流显像技术在儿童经外周静脉置入中心静脉导管中的运用。方法将90例需要行PICC置管的患儿,分为对照组和试验组各45例,对照组采用传统的盲穿法,试验组在超声显像技术引导下置管,比较2组穿刺成功率、操作时间、局部组织损伤率。结果试验组的穿刺成功率、操作时间和局部组织损伤率明显优于对照组。结论超声血流显像技术引导下行PICC置管可提高穿刺成功率,缩短操作时间,降低局部组织损伤发生率,此方法安全、可靠、有效,具有可行性。     

超声引导结合改良塞丁格技术实施颈内静脉置管的效果

目的通过对超声引导结合改良塞丁格技术(modified seldinger technique,MST)经颈内静脉置入中心静脉导管(PICC)与盲穿置管的效果比较,评价超声引导结合MST经颈内静脉置入PICC的安全性与实用性。方法选择2009年5月—2012年1月,在山东省青岛市市立医院实施颈内静脉置入PICC的患者60例。随机分为观察组和对照组各30例,观察组采用超声引导结合MST,对照组采用盲穿置管,比较两组一针穿刺成功率、穿刺后并发症发生率、一次送入成功率、穿刺时间和置管成功率等情况。结果两组在一针穿刺成功率、穿刺后并发症、一次送入成功率和穿刺时间比较,差异有统计学意义(P<0.05);而置管成功率比较差异无统计学意义。结论采用超声引导结合MST实施颈内静脉置入PICC能有效提高穿刺的成功率,减少不良反应的发生率,提高PICC的安全性。     

B超引导下MST在经外周静脉置入PICC中的应用效果

目的 探讨B超引导下改良Seldinger技术(MST)在经外周静脉置入中心静脉导管(PICC)中的应用效果.方法 选取该院甲乳胃肠外科2015年5月～2016年5月收治的MST经外周静脉置入PICC患者80例为研究对象,依据MST经外周静脉置入PICC方法分为B超引导组和传统盲穿组各40例.B超引导组患者接受B超引导下MST经外周静脉置入PICC治疗,传统盲穿组患者接受传统盲穿MST经外周静脉置入PICC治疗,对两组患者的一次穿刺成功和置管成功及并发症发生情况、置管时间、疼痛程度及满意度进行分析.结果 B超引导组患者的一次穿刺成功率、置管成功率分别为80.0％、100.0％均显著高于传统盲穿组的52.5％、87.5％(均P<0.05),并发症发生率22.5％显著低于传统盲穿组的35.0％(P<0.05),置管时间显著短于传统盲穿组(P<0.05),疼痛程度评分显著低于传统盲穿组(P<0.05),满意度评分显著高于传统盲穿组(P<0.05).结论 B超引导下MST用于经外周静脉置入PICC的效果显著,值得在临床推广.     

彩超引导结合改良塞丁格技术在经外周中心静脉置管困难患者中的应用

目的探讨使用彩超引导结合改良塞丁格技术(MST)在经外周中心静脉置管(PICC)困难患者中的应用效果。方法选择本院2014年1月至2015年12月进行盲穿置管的93例患者为对照组,同期79例彩超引导结合MST进行PICC置管患者为观察组,比较两组患者一次性置管成功率、留置时间和置管后并发症发生率。结果观察组一次性置管成功率明显高于对照组,留置时间长于对照组,置管后并发症发生率均低于对照组,差异均有统计学意义(P0.05)。结论彩超引导结合MST应用于PICC置管困难的患者,能提高置管成功率,延长带管时间,减轻置管后并发症的发生。     

不同PICC置管方式对肿瘤化疗患者常见并发症的影响

目的:探讨不同经外周静脉穿刺中心静脉置管(PICC)置管方式对肿瘤化疗患者常见并发症的影响。方法:回顾性分析2017年1月～2018年10月我院PICC置管的158例肿瘤化疗患者,分为盲穿组36例,改良组52例,超声组70例。盲穿组采用传统盲穿法PICC置管,改良组采用改良塞丁格尔技术PICC置管,超声组采用超声引导下PICC置管。比较三组患者PICC的一次置管成功率,置管1个月内的导管相关并发症情况、非计划拔管情况。结果:三组患者一次置管成功率比较,超声组最高,改良组次之,盲穿组最低(P0.05);超声组和改良组的导管堵塞、导管相关性血栓、导管相关性血流感染发生率和非计划拔管率均低于盲穿组(P0.05)。结论:肿瘤化疗患者采用改良塞丁格尔技术和超声引导下PICC置管,能提高置管成功率,减少导管相关并发症,值得临床推广。     

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.     

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.     

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.     

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.