剪切波弹性成像在慢性肾脏疾病诊断中的初步研究

目的探讨剪切波弹性成像技术在慢性肾脏疾病早期诊断中的应用价值。方法应用剪切波弹性成像技术测量并比较30例经左肾穿刺活检确诊为慢性肾脏疾病患者(病例组)和30例正常健康成人(正常对照组)的左肾皮质部、髓质部及肾窦部杨氏模量最大值(Emax)和平均值(Emean)。绘制受试者工作特征(ROC)曲线并计算曲线下面积以评价各部位杨氏模量值诊断慢性肾脏疾病的效能。结果正常对照组左肾皮质部Emax和Emean分别为(3.47±0.54)k Pa、(1.87±0.68)k Pa,髓质部Emax和Emean分别(2.45±1.09)k Pa、(1.08±0.68)k Pa,肾窦部Emax和Emean分别(9.01±3.74)k Pa、(7.49±2.77)k Pa,3个部位Emax和Emean值比较差异均有统计学意义(均P0.01)。病例组左肾皮质部Emax和Emean分别为(4.12±1.71)k Pa、(2.76±1.06)k Pa,髓质部Emax和Emean分别为(2.57±1.07)k Pa、(1.27±0.68)k Pa,肾窦部Emax和Emean分别为(8.76±2.45)k Pa、(6.78±2.57)k Pa,3个部位Emax、Emean比较差异均有统计学意义(均P0.05)。两组肾皮质部Emax、Emean比较差异均有统计学意义(均P0.05)。皮质部杨氏模量值诊断慢性肾脏疾病的ROC曲线下面积为0.758,当截断值为3.15 k Pa时,其诊断准确率和特异性分别为56.7%、63.3%。结论慢性肾脏疾病肾脏皮质部硬度变化与病变部位及程度密切相关,剪切波弹性成像可定量评价肾脏不同部位的杨氏模量值,为临床肾脏疾病诊断提供更丰富诊断信息。     

剪切波定量超声弹性成像技术在肾脏中应用的初步研究

目的探讨肾脏皮质部与髓质部的弹性是否存在差异。方法运用Supersonic Imagine公司AixPlore型全数字化彩色多普勒超声诊断仪的剪切波弹性成像技术分别测量137例男性体检者的左肾下段的皮质部与髓质部杨氏模量值,比较左肾下段皮质部与髓质部弹性是否存在差异。结果左肾下段的皮质部杨氏模量值为(4.440±2.445)kPa,髓质部杨氏模量值为(3.971±2.659)kPa,两者比较差异具有统计学意义(P=0.021)。结论剪切波超声弹性成像可以定量评价肾脏杨氏模量值,肾脏下段皮质部杨氏模量值大于髓质部杨氏模量值;剪切波超声弹性成像可能为肾脏疾病提供常规超声之外的诊断信息。     

剪切波弹性成像技术诊断肾脏弥漫性病变的价值

目的探讨剪切波弹性成像技术在肾脏弥漫性病变诊断中的价值。方法肾脏弥漫性病变患者80例(观察组),同期健康体检者20例(对照组),检测2组血清尿素氮、血浆胱抑素C、血清肌酐、24h尿蛋白定量、尿微量白蛋白水平;采用二维超声检测2组肾脏大小、肾皮质厚度、肾动脉阻力指数;采用声触诊组织定量技术检测2组肾皮质、髓质、肾窦部剪切波速度;绘制ROC曲线分析肾皮质、髓质、肾窦部剪切波速度诊断肾脏弥漫性病变的效能。结果观察组24h尿蛋白定量[(2 474.89±1 362.99)mg]、血浆胱抑素C[1.00(0.86,1.27)mg/L]、尿微量白蛋白[2 025.32(986.52,3 352.35)mg/L]水平高于对照组[(1 046.77±493.95)mg、0.83(0.82,0.96)mg/L、797.22(482.83,1 135.34)mg/L](P0.05),2组血清肌酐、尿素氮水平比较差异无统计学意义(P0.05);2组左、右侧肾脏长、宽、厚、实质厚度比较差异均无统计学意义(P0.05);观察组左、右侧肾皮质剪切波速度[(3.18±0.33)、(3.17±0.44)m/s]、肾髓质剪切波速度[(2.22±0.32)、(2.26±0.38)m/s]、肾窦部剪切波速度[(1.45±0.28)、(1.36±0.32)m/s]均较对照组快[肾皮质:(2.81±0.33)、(2.72±0.37)m/s;肾髓质:(1.79±0.38)、(1.77±0.38)m/s;肾窦部:(1.14±0.23)、(0.93±0.26)m/s](P0.05);观察组左侧肾动脉阻力指数(0.63±0.05)高于对照组(0.57±0.03)(P0.05),右侧肾动脉阻力指数与对照组比较差异无统计学意义(P0.05);ROC曲线分析结果显示,肾皮质剪切波速度以3.025m/s为最佳截断值,诊断肾脏弥漫性病变的AUC为0.845(95%CI:0.759~0.931,P0.001),灵敏度为75.25%,特异度为85.00%;肾髓质剪切波速度以为1.830m/s为最佳截断值,诊断肾脏弥漫性病变的AUC为0.892(95%CI:0.817~0.967,P0.001),灵敏度为97.50%,特异度为65.00%;肾窦部剪切波速度以1.260 m/s为最佳截断值,诊断肾脏弥漫性病变的AUC为0.888(95%CI:0.819~0.958,P0.001),灵敏度为78.80%,特异度为95.00%。结论剪切波弹性成像技术对肾脏慢性弥漫性病变的诊断具有一定价值。     

剪切波弹性成像在前列腺癌诊断中的临床价值

评价新型剪切波弹性成像技术对前列腺癌的诊断价值。方法 回顾性分析49例前列腺癌患者（前列腺癌组）和15例前列腺良性病变患者（良性病变组）的剪切波弹性成像资料,测量并比较其杨氏模量值;绘制平均杨氏模量值诊断前列腺癌的受试者工作特征曲线,确定其诊断界值并计算其敏感性、特异性、阳性预测值、阴性预测值、诊断准确率及曲线下面积;分析可疑病灶区与邻近周缘带内正常组织的平均杨氏模量值之比（Eration）与前列腺Gleason评分之间的相关性。结果 前列腺癌组杨氏模量值为（Emin44.3±11.2、Emax73.2±15.9Kpa、Emean57.6±11.7Kpa、Eration5.8±2.9 ）,良性病变组杨氏模量值为（Emin24.3±10.5Kpa、Emax42.2±9.7Kpa、Emean、30.3±10.4Kpa、Eration2.8±1.3）,两组比较,（差异有统计学意义,p值分别为0.020、0.018、0.013、0.010）。平均杨氏模量值诊断前列腺癌的ROC曲线：当Emean截断点选为41KPa时,诊断效率较高。（敏感度91%,特异度78%,阳性预测值64.6%,阴性预测值为95.3%,曲线下面积是0.934） Gleason评分为8分、9分的前列腺癌组织的Eration要明显高于Gleason评分为6、7分的组织,二者之间p值＜0.001。结论 经直肠剪切波弹性对于前列腺癌的诊断价值较好,具有较高的诊断准确率。     

声辐射力脉冲成像技术在移植肾中的应用

目的探讨声辐射力脉冲成像(ARFI)技术检测移植肾弹性及评估移植肾功能的方法和临床价值.方法2009年12月至2010年12月在北京武警总医院接受肾移植手术及术后复查患者98例.采用ARFI技术测量98例移植肾受者移植肾皮质、肾髓质和肾窦部剪切波速度.采用独立样本t检验比较移植肾功能异常患者与移植肾功能正常患者、动脉阻力指数(RI)增高患者与移植肾功能正常患者、移植肾功能异常患者与动脉RI增高患者移植肾皮质、肾髓质和肾窦部剪切波速度差异.结果74例移植肾功能正常患者移植肾皮质、肾髓质、肾窦部剪切波速度分别为(3.39±0.54)、(2.52±0.61)、(1.12±0.41)cm/s.24例移植肾功能异常患者移植肾皮质、肾髓质、肾窦部剪切波速度分别为(3.07±0.67)、(2.31±0.42)、(1.51±0.81)cm/s,9例动脉RI增高患者移植肾皮质、肾髓质、肾窦部剪切波速度分别为(2.47±0.46)、(2.48±0.52)、(1.93±0.93)cm/s.移植肾功能异常患者、动脉RI增高患者移植肾皮质剪切波速度较移植肾功能正常患者降低,而肾窦部剪切波速度较移植肾功能正常患者升高,且差异均有统计学意义(肾皮质:t=2.308、P=0.035,t=3.229、P=0.0019;肾窦部:t=-3.026、P=0.003,t=-3.827、P=0.0003).动脉RI增高患者移植肾皮质剪切波速度较移植肾功能异常患者降低,且差异有统计学意义(t=2.256,P=0.0323).结论 ARFI是一种用于评价移植肾弹性及初步判断移植肾功能的新技术,值得进一步研究.     

剪切波弹性成像技术评估子痫前期胎盘弹性的临床价值

目的评价剪切波弹性成像技术对子痫前期的诊断价值。 方法前瞻性纳入2019年10月至2020年12月在常州第二人民医院超声科检查的晚孕期孕妇177名。根据临床诊断将孕妇分为健康组152名和子痫前期组25例。采用单因素分析比较2组间一般临床资料、二维超声、彩色多普勒超声参数及胎盘（母体面和胎儿面）杨氏模量值（Emean、Emax、Emin）间的差异。采用Spearman相关分析胎盘杨氏模量值与胎儿脐血流参数间的相关性,并建立受试者工作特征曲线,评价胎盘杨氏模量值诊断子痫前期的诊断效能。 结果健康组与子痫前期组孕妇的羊水指数、胎盘厚度以及脐动脉血流收缩/舒张期速度比（S/D）、阻力指数（RI）、搏动指数（PI）比较,差异均无统计学意义（P均＞0.05）。除胎盘母体面Emin以外,子痫前期组孕妇胎盘母体面Emean、Emax及胎儿面Emean、Emax、Emin均高于健康组［（5.87±0.41）kPa vs（5.30±0.53）kPa;8.67（8.30,9.66）kPa vs 8.01（7.56,8.50）kPa;（5.15±0.34）kPa vs（4.65±0.52）kPa;（8.07±0.70）kPa vs（7.11±0.85）kPa;（3.28±0.44）kPa vs（3.01±0.54）kPa］,差异具有统计学意义（t=-6.215、Z=-4.566、t=-6.298、t=-5.376、t=-2.430,P＜0.001、＜0.001、＜0.001、＜0.001、=0.016）。健康组和子痫前期组孕妇胎盘自身的母体面Emean、Emax、Emin均高于胎儿面,差异具有统计学意义（t=11.319、Z=-8.461、t=12.118、t=6.266、Z=-3.807、t=5.416,P均＜0.001）。相关性分析显示2组中各杨氏模量值与脐动脉血流的S/D、RI、PI值均无显著相关性（P均＞0.05）。当截断值为5.85 kPa时,胎盘母体面的Emean值诊断子痫前期的效能最佳,其敏感度、特异度、准确性分别为68.0%、85.5%、83.1%。 结论子痫前期孕妇胎盘的杨氏模量值高于健康孕妇。剪切波弹性成像技术可通过评价胎盘硬度辅助子痫前期的诊断。     

经直肠超声剪切波弹性成像在鉴别前列腺外周带良恶性病变中的应用

目的研究经直肠超声剪切波弹性成像定量参数在前列腺外周带良恶性病变鉴别诊断中的应用价值。方法回顾性分析确诊的前列腺病变患者,根据穿刺组织条病理结果分为癌症及增生两组,比较两组间经直肠剪切波弹性成像的最小弹性模量值(Emin)、最大弹性模量值(Emax)及平均弹性模量值(Emean)差异,并使用受试者操作特征(ROC)曲线分析其诊断前列腺癌的价值。结果前列腺癌组的Emean、Emax均高于前列腺增生组(P0.05),Emean对前列腺外周带良恶性病变诊断的准确性最高,Emean及Emax鉴别外周带前列腺病变良恶性的最佳阈值为38.9 kPa及53.8 kPa,对应的曲线下面积分别为0.887、0.790。结论应用剪切波弹性成像可对前列腺外周带良恶性病变进行鉴别诊断,Emean及Emax在前列腺癌的诊断效能较高。     

经直肠超声剪切波弹性成像诊断外周带前列腺癌及与Gleason评分间关系

目的探讨经直肠超声剪切波弹性成像在外周带前列腺癌诊断中的应用及与Gleason评分间的关系。方法选取拟行前列腺活检的患者123例,按活检部位分别记录外周带相应各区域弹性最大值(Emax)、平均值(Emean)、绘制ROC曲线。分析弹性值与Gleason评分间的关系。结果共774针弹性图像,前列腺癌Emax (74.99±46.70)kPa,Emean (62.81±38.12)kPa,前列腺良性病灶Emax(33.39±12.23)kPa,Emean (27.07±10.83)kPa。前列腺癌的Emax和Emean均高于前列腺良性病灶。Emax、Emean的ROC曲线下面积分别为0.829,0.833。Emax诊断前列腺癌的阈值为48.75kPa (灵敏度60.6%、特异度91.7%、阳性预测值74.77%、阴性预测值85.12%)。Emean诊断前列腺癌的阈值为39.85kPa (灵敏度62.8%、特异度89.9%、阳性预测值71.66%、阴性预测值85.87%)。前列腺良性病灶与Gleason 6分间弹性值无差异,低未分化(8、9、10分)的弹性值要高于中分化(6、7分)。结论经直肠超声剪切波弹性成像可以提高前列腺癌的诊断率,具有较高的特异度,对预测癌灶的病理分化程度有较大作用。     

Logistic回归模型评价剪切波弹性成像技术鉴别乳腺病灶良恶性的价值

目的应用Logistic回归模型评价剪切波弹性成像技术在乳腺病灶良恶性鉴别诊断中的应用价值。方法对2012年3-12月浙江省宁波市镇海龙赛医院经手术病理证实的91例患者共91个乳腺病灶进行剪切波弹性成像检查,并测量其杨氏模量值（最大值Emax及平均值Emean）。以手术病理诊断结果作为金标准,绘制操作者工作特性（ROC）曲线,得出乳腺良、恶性病灶Emax、Emean的诊断临界值;并结合二维灰阶超声检查,建立Logistic回归模型评价Emax、Emean、边缘、内部回声、形态及内部钙化等6个因素对乳腺病灶良恶性的预测效果。结果91个病灶中,良性病灶73个,恶性病灶18个。乳腺良性病灶的Emax、Emean分别为（23.46±11.44）、（38.59±14.28） kPa,乳腺恶性病灶的Emax、Emean分别为（61.45±24.88）、（99.73±41.15）kPa;乳腺恶性病灶的Emax及Emean均大于乳腺良性病灶,且差异均有统计学意义（t值分别为-15.05、-14.12,P均为0.00）。Emax的曲线下面积为0.932,大于Emean的曲线下面积0.915,分别以63.70、44.22 kPa作为乳腺良恶性病灶Emax、Emean的诊断临界值,敏感度和特异度分别为83.3%和94.5%、77.8%和97.3%。Logistic回归分析结果显示,Emax对乳腺病灶良恶性的预测效果最优,其次是病灶边缘,再次是Emean。结论二分类Logistic回归模型筛选出对乳腺病灶良恶性鉴别诊断有意义的特征变量。剪切波弹性成像技术较其他弹性成像技术更有助于鉴别乳腺病灶良恶性,为鉴别乳腺病灶良恶性提供了一种新的方法。     

实时剪切波弹性成像定量评价健康儿童腮腺组织弹性

目的采用实时剪切波弹性成像(SWE)初步建立健康儿童腮腺弹性模量最大值(Emax)及平均值(Emean)参考范围。方法选取246例健康儿童行SWE检查并记录相关Emax、Emean进行定量分析;同时分析健康儿童性别、年龄、腺体层厚度与腮腺Emax、Emean的相关性。结果 246例健康儿童腮腺Emax为(10.14±2.84)kPa,Emean为(8.86±2.75)kPa,男童及与女童、左右侧腮腺Emax、Emean差异无统计学意义(P0.05);年龄、腺体层厚与Emax、Emean存在一定相关性。结论 SWE可替代临床医师对腮腺的触诊较为准确的评估腮腺硬度,并依据所收集的数据计算健康儿童腮腺组织Emax、Emean参考范围,为超声医师早期、准确发现腮腺硬度改变提供参考。     

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.