^153Sm—EDTMP联合热疗治疗骨转移癌骨痛28例疗效观察

目的：探讨^153Sm—EDTMP联合热疗治疗骨转移癌骨痛的疗效。方法：根据患者对治疗方法的选择，将54例骨转移癌患者分为对照组26例和治疗组28例，对照组仅给予^153Sm—EDTMP静脉注射；治疗组在静脉注射^153Sm—EDTMP的基础上给予热疗，比较两组疗效。结果：治疗组发生1级、2级、3级疼痛人数多于对照组，发生4级、5级、6级疼痛的人数较对照组明显减少，两组比较有显著性差异（P〈0．05）。治疗组骨痛治疗有效率为75．0％，好转率为17．9％，无效率为7．1％；对照组骨痛治疗有效率为34．6％，好转率为23．1％，无效率为42.3％，两组疗效比较有极显著性差异（P〈0．01）。结论：^153Sm—EDTMP联合热疗或单独静脉注射^153Sm—EDTMP都是治疗骨转移癌患者骨痛的有效方法，而^153Sm—EDTMP联合热疗效果更佳。     

钐^153-乙二胺四撑膦酸改善骨转移患者癌性疼痛

目的：对钐^153-乙二胺四撑膦酸治疗的转移性骨肿瘤患者进行随访调查，探讨其治疗骨转移性癌痛的效果，并分析年龄、性别、原发肿瘤的类型以及治疗前Karnofasky评分、疼痛严重程度和止痛剂使用分级的相关性。方法：在接受钐^153-乙二胺四撑膦酸治疗的转移性骨肿瘤患者中，选取158例进行16周的随访。该组患者具有不同程度的癌痛，并能够合作汇报、记载癌痛的症状；预期寿命&;gt;6个月；接受治疗前至少4周未行放射治疗和抗肿瘤药物治疗；无肝、肾及其他重要器官功能障碍；无病理性骨折或其他机械性失稳的临床和放射学表现；白细胞&;gt;4、0&;#215;10^9L^-1，血小板&;gt;100&;#215;10^9L^-1。随访内容包括：疼痛程度、止痛剂的使用、Karnofsky评分、血常规及血生化学变化。用骨痛缓解情况和止痛剂使用的变化评价治疗效果。同时分析疗效与年龄、性别、原发肿瘤的类型以及治疗前Karnofasky评分、疼痛严重程度和止痛剂使用分级的相关性。结果：158例患者均进入结果分析。①127例骨痛减轻，125例止痛剂使用减少。Karnofsky评分治疗前为57．8&;#177;27．6，治疗后增加为66．4&;#177;24．4。②最常见副反应为可逆性骨髓抑制。③Binary Logistic回归分析示仅原发肿瘤的类型可能是影响钐^153-乙二胺四撑瞵酸疗效的主要因素(DR=1．8)，对肺癌性性疼痛的止痛效果低于乳腺癌和前列腺癌性疼痛，而后者之间止痛效果比较基本接近。结论：钐^153-乙二胺四撑膦酸对各种骨转移癌引起的疼痛有不同程度的止痛效果，原发肿瘤的类型是影响止痛效果的主要因素。     

钐153-乙二胺四撑膦酸改善骨转移患者癌性疼痛

目的对钐153-乙二胺四撑膦酸治疗的转移性骨肿瘤患者进行随访调查,探讨其治疗骨转移性癌痛的效果,并分析年龄、性别、原发肿瘤的类型以及治疗前Karnofasky评分、疼痛严重程度和止痛剂使用分级的相关性.方法在接受钐153-乙二胺四撑膦酸治疗的转移性骨肿瘤患者中,选取158例进行16周的随访.该组患者具有不同程度的癌痛,并能够合作汇报、记载癌痛的症状;预期寿命＞6个月;接受治疗前至少4周未行放射治疗和抗肿瘤药物治疗;无肝、肾及其他重要器官功能障碍;无病理性骨折或其他机械性失稳的临床和放射学表现;白细胞＞4.0×109L-1,血小板＞100×109 L-1.随访内容包括疼痛程度、止痛剂的使用、Kamofsky评分、血常规及血生化学变化.用骨痛缓解情况和止痛剂使用的变化评价治疗效果.同时分析疗效与年龄、性别、原发肿瘤的类型以及治疗前Kamofasky评分、疼痛严重程度和止痛剂使用分级的相关性.结果158例患者均进入结果分析.①127例骨痛减轻,125例止痛剂使用减少.Kamofsky评分治疗前为57.8±27.6,治疗后增加为66.4±24.4.②最常见副反应为可逆性骨髓抑制.③Binary Logistic回归分析示仅原发肿瘤的类型可能是影响钐153-乙二胺四撑膦酸疗效的主要因素(OR=1.8),对肺癌性性疼痛的止痛效果低于乳腺癌和前列腺癌性疼痛,而后者之间止痛效果比较基本接近.结论钐153-乙二胺四撑膦酸对各种骨转移癌引起的疼痛有不同程度的止痛效果,原发肿瘤的类型是影响止痛效果的主要因素.     

153Sm-EDTMP联合热疗治疗骨转移癌骨痛28例疗效观察

目的:探讨153 Sm-EDTMP联合热疗治疗骨转移癌骨痛的疗效.方法:根据患者对治疗方法的选择,将54例骨转移癌患者分为对照组26例和治疗组28例,对照组仅给予153 Sm-EDTMP静脉注射;治疗组在静脉注射153 Sm-EDTMP的基础上给予热疗,比较两组疗效.结果:治疗组发生1级、2级、3级疼痛人数多于对照组,发生4级、5级、6级疼痛的人数较对照组明显减少,两组比较有显著性差异(P＜0.05).治疗组骨痛治疗有效率为75.0%,好转率为17.9%,无效率为7.1%;对照组骨痛治疗有效率为34.6%,好转率为23.1%,无效率为42.3%,两组疗效比较有极显著性差异(P＜0.01).结论:153 Sm-EDTMP联合热疗或单独静脉注射153 Sm-EDTMP都是治疗骨转移癌患者骨痛的有效方法,而153 Sm-EDTMP联合热疗效果更佳.     

153Sm-EDTMP治疗多发性骨转移癌骨痛89例临床护理

目的:探讨153钐-乙二胺四甲基膦酸(153Sm-EDTMP)治疗多发性骨转移癌骨痛的疗效及护理.方法:对89例多发性骨转移癌患者静脉注射153Sm-EDTMP18.5～37 MBq/kg,每月治疗1次,3次为1疗程.结果:本组153Sm-EDTMP治疗后骨痛完全缓解57例,部分缓解19例,无效13例,总缓解率85.4%.153Sm-EDTMP对轻、中、重度骨痛均有效,与疼痛级别无关(P>0.05).结论:153Sm-EDTMP对治疗多发性骨转移癌有良好的止痛效果,积极实施各项护理操作,引导患者摆脱疼痛意识,减少不良反应的发生,可明显提高骨转移癌患者的生活质量.     

云克联合~(153)Sm-EDTMP治疗多发性骨转移癌骨痛49例疗效分析及护理

目的:探讨云克联合153Sm-EDTMP治疗多发性骨转移癌骨痛的疗效及护理方法.方法:将102例患者分为对照组(行单纯153Sm-EDTMP治疗)53例及观察组(行云克联合153Sm-EDTMP治疗)49例.结果:两组治疗后骨痛"闪烁"现象发生率、骨痛缓解率比较差异有统计学意义(P<0.01,P<0.05).结论:云克联合153Sm-EDTMP治疗多发性骨转移癌骨痛的疗效明显优于单纯使用153Sm-EDTMP,可降低骨痛"闪烁"现象发生率,提高骨痛缓解率.     

^153Sm—EDTMP治疗骨转移癌163例焦虑、抑郁调查及心理干预

目的：探讨^153Sm—EDTMP治疗骨转移癌患者焦虑、抑郁状况及心理干预效果。方法：对接受^153Sm—EDTMP治疗的163例骨转移癌患者进行问卷调查,根据存在的心理问题给予系统的心理干预,比较干预前、后SDS、SAS评分。结果：心理干预前SDS、SAS评分分别为（49．68&#177;10．21）分、（48．15&#177;10．33）分心理干预后SDS、SAS评分分别为（40．13&#177;8．72）分、（40．26&#177;8．42）分,心理干预前、后SDS、SAS评分比较有极显著性差异（P〈0．01）。结论：心理干预能明显改善^153Sm—EDTMP治疗骨转移癌患者抑郁、焦虑状态,提高患者生活质量,增强治疗信心。     

钐—乙二胺四亚甲基磷酸治疗骨转移癌的临床观察

目的 观察^153钐－乙二胺四亚甲基磷酸（^153Sm-EDTMP）治疗骨转移癌的疗效。方法 对23例骨转移癌患者给予剂量范围为18.5-55.5MBq/kg的^153Sm-EDTMP治疗。结果 患才疼痛总缓解率为87.0％，部分患者骨转移灶缩小、消失。结论 ^153Sm-DETMP对骨转移癌骨痛疗效显著，使用安全，有临床推广价值。     

~(153)SM-EDTMP治疗骨转移癌的临床研究

多种癌症可能转移到骨，而乳腺癌可高达50％，前列腺癌甚至高达80％，骨转移癌可为孤立一处，亦可呈多发性骨转移，我院用153SMEDTMP静脉注射治疗34例48人次骨转移癌，取得了较好疗效，现报告如下。1材料与方法153SM－EDTMP系四川都中国核动力研究设计院第一研究所提供。患者34     

骨水泥成形辅以放射治疗应用于恶性肿瘤骨转移癌:可为临床首选方案?

背景:骨水泥成形具有即刻止痛和稳定骨折的作用,可明显提高肿瘤患者的生活质量,但其用于临床时间尚短,许多学者认为这种技术缺乏远期随访资料和更多病例验证,对复杂部位转移灶的治疗仍值得深入分析.目的:回顾性分析单纯放射治疗及骨水泥成形辅以放射治疗恶性肿瘤骨转移癌患者的效果.方法:2006-09/2009-02上海市第六人民医院收治的60例恶性肿瘤骨转移癌患者,随机分成2组,单纯放射治疗组30例,采用6 MV X射线,照射剂量2 Gy/次,5次/周,照射4周,总照射剂量40 Gy;联合组30例,采用骨水泥成形治疗,并辅以放射治疗.采用VRS法疼痛程度分级和目测类比评分法相结合的方式进行骨痛评分,测定起效时间.结果与结论:治疗前两组患者骨痛评分基本相似(P>0.05);治疗后与单纯放射治疗组比较,联合组痛程度显著缓解,骨痛评分明显降低(P<0.05).单纯放射治疗组共13例患者治疗无效,联合组共8例患者治疗无效,单纯放射治疗组患者的起效时间迟于联合组.在10个月的随访期内,单纯放射治疗组共有25例患者死亡,联合组共有21例患者死亡,不同随访时间段内联合组生存患者多于单纯放射治疗组.全部死亡病例中均未发现与骨水泥有关的证据,提示应用骨水泥成形辅以放射治疗骨转移瘤比单纯行放射疗法对疼痛的缓解更为有效,可作为骨转移癌首选的治疗方式.     

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.