三七提取物并早期康复对脑梗死患者微循环及血液流变学的影响

背景：三七总皂甙具有活血化瘀，增加脑血管和冠状动脉血流量，改善微循环等作用，应用中医药方法和采用易化技术进行早期康复是否对脑卒中患者的康复有明显促进作用?目的：观察中药三七提取物血塞通并早期康复对脑梗死患者微循环、血液流变学的影响，探讨其治疗作用的机制。设计：以诊断为依据的随机对照试验。方法：对经头颅CT或MRI确诊的高血压动脉硬化性脑梗死患者200例，按入院次序采用随机数字表法分为两组，研究组100例给予血塞通每次200mg加50g／L葡萄糖或生理盐水250～500mL静脉滴注，1次／d，当生命体征稳定后采用易化技术进行早期康复治疗；对照组100例，按传统方法治疗。两组治疗前后采用临床神经功能缺损程度评分标准评定疗效、Brunstrom分级评定偏瘫恢复程度、Barthel指数(BI)评定日常生活活动(ADL)能力。同时观察两组治疗前后甲襞微循环、血液流变学的变化。主要观察指标：①两组患者ADL恢复情况。②两组患者偏瘫恢复程度。③两组患者临床疗效。④两组患者甲襞微循环变化。⑤两组患者血液流变学变化。结果：研究组患者ADL能力的恢复、偏瘫的功能恢复比对照组的效果要好；其有效率为93％，显效率52％，与对照组比较差异有显著性意义(χ^2=19．46，P&;lt;0．005)，通过对实验室各项观察指标结果的对比分析看出，研究组患者治疗后其微循环、血液流变性有明显的改善。结论：中药三七提取物血塞通并早期康复是通过改善微循环、血液流变性等机制，而达到较好的临床治疗效果，是脑梗死急性期治疗的优选方法。     

三七提取物并早期康复对脑梗死患者微循环及血液流变学的影响

背景三七总皂甙具有活血化瘀,增加脑血管和冠状动脉血流量,改善微循环等作用,应用中医药方法和采用易化技术进行早期康复是否对脑卒中患者的康复有明显促进作用?目的观察中药三七提取物血塞通并早期康复对脑梗死患者微循环、血液流变学的影响,探讨其治疗作用的机制.设计以诊断为依据的随机对照试验.方法对经头颅CT或MRI确诊的高血压动脉硬化性脑梗死患者200例,按入院次序采用随机数字表法分为两组,研究组100例给予血塞通每次200mg加50 g/L葡萄糖或生理盐水250～500mL静脉滴注,1次/d,当生命体征稳定后采用易化技术进行早期康复治疗;对照组100例,按传统方法治疗.两组治疗前后采用临床神经功能缺损程度评分标准评定疗效、Brunstrom分级评定偏瘫恢复程度、Barthel指数(BI)评定日常生活活动(ADL)能力.同时观察两组治疗前后甲襞微循环、血液流变学的变化.主要观察指标①两组患者ADL恢复情况.②两组患者偏瘫恢复程度.③两组患者临床疗效.④两组患者甲襞微循环变化.⑤两组患者血液流变学变化.结果研究组患者ADL能力的恢复、偏瘫的功能恢复比对照组的效果要好;其有效率为93%,显效率52%,与对照组比较差异有显著性意义(x2=19.46,P＜0.005),通过对实验室各项观察指标结果的对比分析看出,研究组患者治疗后其微循环、血液流变性有明显的改善.结论中药三七提取物血塞通并早期康复是通过改善微循环、血液流变性等机制,而达到较好的临床治疗效果,是脑梗死急性期治疗的优选方法.     

康复训练加中药三七对脑出血的早期康复

目的 :探讨康复训练加中药三七 (血塞通 )对脑出血患者肢体运动功能及ADL的影响。方法 :脑出血患者 6 4例随机分为 2组 ,均采用常规康复治疗 ;血塞通组同时加用血塞通注射液静脉滴注 10～ 15d。结果 :治疗 3及 6周时肢体运动功能、ADL能力评分 ,血塞通组明显好于对照组 (P <0 .0 1或P <0 .0 0 1)。结论 :康复训练配合血塞通治疗更能有效促进脑出血患者早期全面康复。     

血塞通注射液治疗急性脑梗死临床观察

目的：观察血塞通注射液治疗急性脑梗死的疗效。方法：150例急性脑梗死随机分为研究组(血塞通注射液组)80例，对照组(丹参注射液组)70例，作疗效比较。结果：研究组的轻、中型急性脑梗死，基本治愈率分别为72．2％和32．5％，明显优于对照组；研究组的重型急性脑梗死，有效率为91％，明显优于对照组，但基本治愈率与对照组比较无明显差异。研究组的血液流变学和P选择素(CD62P及CD41)，治疗后较治疗前有明显进步。结论：对于轻、中型急性脑梗死的治疗，血塞通注射液是一理想的药物；而对于重型急性脑梗死的治疗尚无明显优势。     

早期康复加体外反搏治疗脑梗死偏瘫

目的：观察早期康复加体外反搏对脑梗死偏瘫患运动功能的影响。方法：123例急性脑梗死患随机分为早期康复加体外反搏组（30例），早期康复组（32例），体外反搏组（30例），对照组（31例）。应用Bobath疗法、Carr的运动再学习和体外反搏治疗，以临床神经功能缺损程度评分（NFI），简式FugI-Meyer评分（FMA），BartheI指数评定（MBI）为观察疗效指标。结果：早期康复加体外反搏组疗效明显优于早期康复组、体外反搏组和对照组。结论：急性脑梗死早期介入康复治疗和体外反搏治疗，两种治疗联合应用优于单一治疗。     

Vocastim—Master吞咽言语诊断治疗仪联合吞咽训练治疗脑梗死合并吞咽障碍的疗效

目的探讨Vocastim—Master吞咽言语诊断治疗仪联合康复吞咽功能训练对脑梗死后吞咽功能障碍患者的疗效。方法将118例脑梗死合并吞咽功能障碍的患者按随机数字表法分为对照组（56例）及研究组（62例）。2组患者在常规药物治疗的基础上,对照组进行康复吞咽功能训练,研究组采用康复吞咽功能训练＋Vocastim—Master吞咽言语诊断治疗仪治疗。2组均2周为1个疗程。根据洼田吞咽能力评定标准对2组患者治疗前后的吞咽功能（吞咽能力等级评定）及疗效进行比较。结果治疗前2组患者洼田吞咽能力评定等级比较差异无统计学意义（P〉O．05）;治疗后2组洼田吞咽能力评定等级较治疗前升高,研究组较对照组升高更明显（均P〈O．01）。研究组总有效率为90．3％,对照组总有效率为67．9％,2组比较差异有统计学意义（P〈0．01）。结论应用Vocastim—Master吞咽言语诊断治疗仪治疗联合康复吞咽功能训练对脑梗死合并吞咽障碍患者的吞咽功能恢复有明显的疗效。     

丁苯酞联合银杏叶提取物片治疗脑梗死恢复期患者疗效观察

目的 探讨丁苯酞联合银杏叶提取物片治疗脑梗死恢复期患者的临床疗效.方法 将139例脑梗死恢复期患者按照随机数字表法分为研究组70例,对照组69例.两组均给予丁苯酞软胶囊治疗,研究组在此基础上联合银杏叶提取物片治疗.比较两组临床疗效,治疗前后采用美国国立卫生研究院卒中量表评定两组神经功能,采用简易智力状态检查量表评定两组...     

血塞通注射液治疗脑梗死120例疗效观察

目的：观察血塞通注射液治疗脑梗死的疗效。方法；将180例脑梗死患者随机分为治疗组120例和对照组60例，治疗组在常规脱水、控制感染的基础上加用血塞通注射液静漓，对照组采用常规西药治疗，2组均以15d为1个疗程。结果：治疗组有效率93.33％，对照组有效率78.33％，经X~2检验，有显著性差异(P＜0.01)。结论：血塞通注射液治疗脑梗死，有助于脑缺血的神经功能恢复，疗效明显优于单纯西药治疗。     

急性脑梗死的早期康复和防治的临床研究

目的：根据临床研究和循证医学的证据，探讨脑梗死早期康复及一级预防和二级预防的作用。方法：将诊断为急性脑梗死患者分为治疗组和对照组，对照组行常规内科治疗，治疗组除常规治疗外加早期康复，包括心理康复，以Barthel指数作疗效评定．治疗4周后两组进行疗效比较．结果：Barthel指数和Fugl—Meyer评分治疗组明显好于对照组（P〈0．01）．结论：急性脑梗死的早期康复可降低致残率，而一级预防及二级预防可降低发病率。     

中西医结合治疗出血性脑梗死临床观察

目的观察早期使用活血化瘀中药的中西医结合方法治疗出血性脑梗死的临床疗效.方法将59例出血性脑梗死患者随机分为治疗组31例和对照组28例.2组基础疗法相同,治疗组早期加用复方丹参注射液和活血化瘀中药;2组治疗前后分别评定神经功能缺损评分,并比较疗效.结果治疗组总有效率(90.3%)明显高于对照组(67.9%),2组比较有显著性差异(χ2=4.58,P<0.05);治疗组复查颅脑CT显示,血肿吸收完全,且无不良反应.结论中西医结合疗法早期使用活血化瘀中药治疗出血性脑梗死可降低病死率和致残率.     

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.