体表骶神经电刺激结合盆底肌肉电刺激治疗脊髓损伤后神经源性膀胱

目的观察体表骶神经电刺激结合盆底肌肉电刺激治疗脊髓损伤后神经源性膀胱的疗效。 方法选取脊髓损伤后神经源性膀胱患者17例,其中男15例,女2例;平均年龄（32.9±11.5）岁,脊髓损伤时间（85.0±51.4）d。给予体表骶神经电刺激结合盆底肌肉电刺激治疗,每次20 min,每日 1次,每周5 d,连续治疗4周。比较治疗前、后的排尿日记、脊髓损伤神经学分类国际标准评分和尿流动力学检查结果。 结果经4周治疗后,患者24 h尿失禁次数减少（P<0.05）,24 h排尿次数减少（P<0.05）,每次排尿量增加（P<0.05）,残余尿量减少（P<0.05）;尿流动力学检查结果显示,最大膀胱容积增加（P<0.05）,充盈期逼尿肌压力下降（P<0.05）,最大尿道压增加（P<0.05）。 结论体表骶神经电刺激结合盆底肌肉电刺激对脊髓损伤后神经源性膀胱治疗有效。     

盆底肌电刺激治疗脊髓损伤后神经源性膀胱的疗效观察

目的:探讨盆底肌电刺激(PES)对脊髓损伤(SCI)后膀胱功能障碍的疗效。方法:60例完全性SCI患者随机分为常规治疗组和PES组,每组30例。常规治疗组采用间歇导尿、激发排尿技术或Crede手压法、Valsalva屏气法;PES组采用PES联合常规康复治疗。治疗前、治疗后分别评定患者日排尿次数、平均膀胱容量、最大排尿量、残余尿量、生存质量评分和国际下尿路症状(LUTS)评分等。结果:2个月的疗程结束后,两组患者日排尿次数减少、平均膀胱容量增加、最大排尿量、残余尿量减少,排尿症状有显著改善(P<0.05),生存质量评分和国际LUTS症状评分差异有显著性意义(P<0.05),PES组明显优于常规治疗组(P<0.05)。结论:PES联合常规膀胱功能训练对治疗SCI患者神经源性膀胱的疗效优于常规的膀胱功能训练。     

骶神经电刺激治疗顽固性排尿功能障碍

目的：观察骶神经电刺激(sacral nerve stimulation，SNS)治疗顽固性排尿功能障碍的临床效果。方法：对1例确诊为顽固性排尿功能患者行骶3孔神经电刺激治疗。结果：电刺激治疗8d后及拔除电极后第1，4，8周，B超测定剩余尿量为0，尿失禁、尿频、尿急等临床症状均明显改善，每次排尿量正常。结论：骶神经电刺激能有效地治疗顽固性排尿功能障碍。     

功能性磁刺激对神经源性膀胱患者的疗效追踪

目的：追踪观察功能性磁刺激(FMS)治疗神经源性膀胱的疗效。方法：20例神经源性膀胱患者采用MagLite型磁刺激仪，经S3神经根和膀胱区行FMS治疗，每日2次，5d／周，4—6周1个疗程。以生活质量评分和国际下尿路综合征症状评分评价治疗前后及停止治疗第1、3个月时排尿次数、平均尿量及单次最大排尿量。结果：治疗后，20例中17例症状显著改善，日排尿次数显著减少，平均尿量增加，尿急程度减轻，其中3例治愈；3例无效。结论：FMS可显著改善部分神经源性膀胱患者的排尿功能，提高生活质量。     

心理干预治疗脊髓损伤后神经源性膀胱的疗效观察

目的观察心理干预对脊髓损伤（SCI）后神经源性膀胱的患者的疗效。 方法将60例SCI后神经源性膀胱的患者按随机数字表法分为治疗组（30例）和对照组（30例）。2组患者均给予常规的膀胱功能训练,治疗组在常规训练的基础上增加心理干预。2组患者均于治疗前和治疗8周后检测膀胱容量、最大排尿量、残余尿量、日排尿次数等指标,同时采用7级日常生活质量评分和国际下尿路症状（LUTS）评分进行疗效评定。 结果治疗8周后,2组患者的膀胱容量、最大排尿量、日排尿次数和残余尿量均显著改善(P<0.05),且治疗组上述各项指标较对照组改善更为显著,组间差异均有统计学意义(P<0.05）。治疗8周后,治疗组的生活质量评分和LUTS评分分别为（1.75±0.86）分和（14.60±8.87）分,与组内治疗前和对照组治疗后比较,差异均有统计学意义(P<0.05)。 结论在常规膀胱功能训练的基础上联合心理干预治疗,可显著改善SCI后神经源性膀胱的排尿功能,提高患者的生活质量。     

骶神经电剌激治疗顽固性排尿功能障碍(英文)

目的:观察骶神经电刺激(sacralnervestimulation,SNS)治疗顽固性排尿功能障碍的临床效果。方法:对1例确诊为顽固性排尿功能患者行骶3孔神经电刺激治疗。结果:电刺激治疗8d后及拔除电极后第1,4,8周,B超测定剩余尿量为0,尿失禁、尿频、尿急等临床症状均明显改善,每次排尿量正常。结论:骶神经电刺激能有效地治疗顽固性排尿功能障碍。     

骶神经电刺激治疗顽固性排尿功能障碍

目的观察骶神经电刺激(sacral nerve stimulafion,SNS)治疗顽固性排尿功能障碍的临床效果.方法对1例确诊为顽固性排尿功能患者行骶3孔神经电刺激治疗.结果电刺激治疗8 d后及拔除电极后第1,4,8周,B超测定剩余尿量为0,尿失禁、尿频、尿急等临床症状均明显改善,每次排尿量正常.结论骶神经电刺激能有效地治疗顽固性排尿功能障碍.     

不同时长任脉灸对骶上脊髓损伤后神经源性膀胱患者排尿功能的影响

目的:观察不同时长任脉灸对骶上脊髓损伤(SSCI)后神经源性膀胱(NB)患者排尿功能的影响。方法:选择2016年12月—2018年12月在山东中医药大学第二附属医院康复医学科治疗的SSCI后NB患者60例,采用随机数字表法分为对照组和观察组,每组30例。对照组在患者鸠尾穴至中极穴的任脉段给予任脉灸,每次灸治1 h,3次/周,共治疗4周;观察组每次灸治时间改为2 h,其余治疗操作同对照组,3次/周,共治疗4周。于治疗前、治疗4周后分别采用24 h排尿日记(单次排尿量、24 h排尿次数、24 h漏尿次数)、最大膀胱安全容量和残余尿量评价患者的排尿功能。结果:治疗4周后,对照组排尿次数、漏尿次数、单次排尿量、最大膀胱安全容量、残余尿量分别为(11.25±0.43)次/d、(5.30±0.37)次/d、(148.55±17.81)mL、(301.90±14.73)mL、(72.50±7.21)mL,观察组排尿次数、漏尿次数、单次排尿量、最大膀胱安全容量、残余尿量分别为(9.80±1.51)次/d、(4.45±0.31)次/d、(159.40±10.97)mL、(314.90±16.33)mL、(67.05±7.18)mL。与治疗前比较,2组治疗4周后每日排尿次数、漏尿次数、残余尿量均明显降低,单次尿量、膀胱安全容量均明显升高(P<0.05)。与对照组比较,观察组每日排尿次数、漏尿次数、残余尿量降低更加明显,单次排尿量、最大膀胱安全容量改善更加明显(P<0.05)。结论:长时程任脉灸可以更有效改善SSCI后NB患者排尿功能,减少尿失禁。     

生物反馈联合电刺激治疗脊髓损伤后神经源性膀胱的疗效观察

目的:观察生物反馈联合电刺激对脊髓损伤后神经源性膀胱患者膀胱功能的影响。方法:将80例神经源性膀胱患者随机分为2组各40例。2组采用常规间歇式导尿技术并制定饮水计划,观察组加用生物反馈联合电刺激治疗。治疗前后评定2组患者膀胱功能及国际下尿路症候群症状(LUTS)评分。结果:治疗4周后,2组患者每日最大排尿量均较治疗前明显增加(P<0.05),且观察组更高于对照组(P<0.05);2组每日平均排尿次数、残余尿量、平均漏尿次数及LUTS评分均较治疗前明显下降(P<0.05),且观察组更低于对照组(P<0.05)。结论:生物反馈联合电刺激治疗方法对SCI患者神经源性膀胱功能康复的疗效优于常规的膀胱功能治疗训练。     

体表膀胱及骶神经电刺激联合冷热交替膀胱冲洗法对脊髓损伤后神经源性膀胱功能恢复的影响

目的：观察体表膀胱及骶神经电刺激联合冷热交替膀胱冲洗对脊髓损伤（SCI）后神经源性膀胱功能恢复的影响。方法将45例SCI后膀胱功能障碍患者按随机数字表法分为体表电刺激＋冷热冲洗组、体表电刺激组和常规组3组,每组15例。常规组采用常规无菌性间歇导尿和膀胱功能训练;体表电刺激组在常规组治疗的基础上给予患者体表膀胱及骶神经电刺激;体表电刺激＋冷热冲洗组在体表电刺激组治疗基础上加用冷热交替膀胱冲洗。对3组患者治疗前、治疗2个月后的膀胱容量、残余尿量、泌尿系感染发生率及停止导尿时间进行比较。结果3组患者治疗2个月后膀胱容量多于治疗前、残余尿量少于治疗前（均P＜0.05）;体表电刺激＋冷热冲洗组及体表电刺激组的膀胱容量明显多于常规组、残余尿量明显少于常规组（均P＜0.05）;体表电刺激＋冷热冲洗组的膀胱容量明显多于体表电刺激组、残余尿量明显少于体表电刺激组、停止导尿时间短于体表刺激组（均P＜0.05）。体表电刺激＋冷热冲洗组泌尿系统感染发生率为6.7%,体表电刺激组泌尿系统感染发生率为40.0%,常规组泌尿系统感染发生率为46.7%,体表电刺激组及常规组的感染发生率明显高于体表电刺激＋冷热冲洗组（均P＜0.05）。结论体表膀胱及骶神经电刺激联合冷热交替膀胱冲洗法能有效地减少SCI后膀胱功能障碍患者残余尿量,增加膀胱容量,减少泌尿系统感染发生率并缩短导尿时间,有效地促进了SCI后神经源性膀胱功能的恢复。     

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.