多索茶碱联合复方异丙托溴铵雾化吸入应用于慢性阻塞性肺疾病稳定期的效果

目的：观察多索茶碱联合复方异丙托溴铵雾化吸入治疗慢性阻塞性肺疾病稳定期患者的临床疗效。方法：采用随机数字表法将余干县人民医院2020年1月至2021年12月收治的68例慢性阻塞性肺疾病患者分为对照组与研究组,各34例,病情控制在稳定期后,对照组在常规治疗基础上给予多索茶碱治疗,研究组在对照组基础上联合复方异丙托溴铵气雾剂雾化吸入治疗。比较两组治疗效果、肺功能[1秒用力呼气容积(FEV₁)、FEV₁与用力肺活量比值(FEV₁/FVC)、最大呼气流量(PEF)]、炎症介质[白细胞介素-8(IL-8)、转化生长因子-β₁(TGF-β₁)、肿瘤坏死因子-α(TNF-α)]及不良反应。结果：研究组整体治疗效果优于对照组(P<0.05);治疗结束时,两组FEV₁、FEV₁/FVC、PEF均改善,且研究组FEV₁、FEV₁/FVC、PEF优于对照组(P<0.05);治疗结束时,两组IL-8、T...     

气球吹摆法联合膈肌电刺激训练在肺癌术后患者中的应用

目的：探讨气球吹摆法联合膈肌电刺激训练在肺癌术后患者中的应用效果。方法：将78例肺癌患者按随机数字表法分为对照组和实验组各39例，对照组采用常规护理干预，实验组在此基础上采用气球吹摆法联合膈肌电刺激训练。比较两组护理前、护理后2周肺功能康复情况[包括用力肺活量(FVC)、第一秒用力呼气容积(FEV₁)、最高呼气流量(PEF)、6分钟步行试验(6MWT)]及生活质量[采用中国癌症生活质量量表(QOL)]评分。结果：护理后2周，两组FVC、FEV₁、PEF及6MWT高于护理前(P<0.05),且实验组高于对照组(P<0.05);护理后2周，两组QOL各维度评分及总分均高于护理前(P<0.05),且实验组高于对照组(P<0.05)。结论：肺癌术后患者应用气球吹摆法联合膈肌电刺激训练，可改善呼吸功能，促进疾病快速康复，提高生活质量。     

体表膈神经电刺激对脑卒中恢复期呼吸功能的效果

目的探讨体表膈神经电刺激对恢复期脑卒中患者呼吸功能的影响。方法 2017年10月至2018年7月,恢复期脑卒中患者27例随机分为对照组(n=14)和观察组(n=13)。两组均予常规康复,观察组在此基础上增加体表膈神经电刺激。分别于治疗前和治疗4周后,对患者进行肺通气功能和呼吸肌肌力测定。结果治疗后,两组用力肺活量(FVC)、第1秒用力呼气容积(FEV1)、峰值呼气流速(PEF)、最大吸气压(MIP)、最大呼气压(MEP)均显著提高(t 5.075,Z=-3.366,P 0.001),观察组FVC、FEV1、PEF和MIP较对照组提高更多(t 0.921,Z=-2.746, P 0.05)。结论体表膈神经电刺激可改善恢复期脑卒中患者肺通气功能及吸气肌肌力。     

水中肺康复对慢性阻塞性肺疾病稳定期患者肺功能的效果

目的 观察水中肺康复在慢性阻塞性肺疾病(COPD)稳定期患者的疗效。方法 2020年2月至2021年2月,本院COPD稳定期患者50例根据训练方法分为对照组(n = 25)和试验组(n = 25),分别接受陆上和水中肺康复8周。治疗前后,采用肺功能仪测量患者第1秒用力呼气容积(FEV₁)、第1秒用力呼气容积占预计值的百分比(FEV_l%)、第1秒用力呼气容积占用力肺活量的百分比(FEV₁/FVC),采用表面肌电图测量膈肌和右腹横肌肌电均方根(RMS),采用改良版英国医学研究委员会呼吸困难量表(mMRC)、6分钟步行试验(6MWT)、成人COPD生活质量量表(COPD-QOL)进行评定。结果 治疗后,两组FEV₁、FEV_l%、FEV₁/FVC、膈肌和腹横肌RMS、6MWT距离和COPD-QOL评分均提高(t > 2.08, P < 0.05),试验组均较对照组提高更多(t > 2.27, P < 0.05);两组mMRC评分均减少(t > 2.09, P < 0.05),试验组较对照组减少(t = 2.13, P < 0.05)。结论 在水中进行肺康复训练,可显著改善COPD患者的肺功能,增强呼吸肌肌力,改善呼吸困难,提高运动耐量,改善生活质量。     

盐酸氨溴索联合头孢哌酮钠舒巴坦钠治疗老年肺癌患者化疗后肺部感染的疗效观察

目的探讨盐酸氨溴索联合头孢哌酮钠舒巴坦钠治疗老年肺癌患者化疗后肺部感染的临床疗效及对肺功能的影响。方法选取2018年6月至2019年6月该院收治的≥60岁的肺癌化疗后肺部感染患者90例作为研究对象,采用随机数字表法将其分为对照组与观察组,各45例。对照组给予头孢哌酮钠舒巴坦钠与盐酸溴己新片联合治疗,观察组给予盐酸氨溴索联合头孢哌酮钠舒巴坦钠治疗。比较两组临床疗效,治疗前后的肺功能指标[用力肺活量(FVC)、第一秒用力呼气容积(FEV₁)、峰值呼气流量(PEF)]、血气分析指标动脉血氧饱和度(SaO₂)、动脉血氧分压(PaO₂)、动脉血二氧化碳分压(PaCO₂)、氧合指数[PaO₂/吸入氧浓度(FiO₂)],以及临床症状、体征(发热、咳嗽咳痰、肺部湿啰音)的持续时间、住院时间。结果治疗后两组SaO₂、PaO₂、PaO₂/FiO₂、FVC、FEV₁、P...     

体外膈肌起搏对稳定期慢性阻塞性肺疾病病人肺康复影响的Meta分析

目的:系统评价体外膈肌起搏(EDP)对稳定期慢性阻塞性肺疾病病人肺康复的有效性。方法:系统检索维普数据库、中国知网、万方数据库、中国生物医学文献数据库、EMbase、PubMed、Web of Science、OVID、the Cochrane Library、医脉通、世界卫生组织(WHO)网站等获取文献,检索时限为建库至2022年3月,由2名评价员单独对纳入的文献进行数据提取,使用Cochrane风险偏倚评估工具进行质量评价,使用RevMan 5.4进行Meta分析。结果:共纳入9篇随机对照试验。Meta分析结果显示,试验组第一秒用力呼气容积占用力肺活量百分比(FEV₁/FVC)[MD=4.14,95%CI(2.54,5.74),P<0.000 01]、第1秒用力呼气量(FEV₁)[MD=0.34,95%CI(0.18,0.49),P<0.000 1]、第1秒用力呼气量占预计值百分比(FEV₁%)[MD=8.98,95%CI(8.75,9.21),P<0.000 01]、用力肺活量(FVC)[MD=0...     

超声电导仪药物透入对复治肺结核患者疗效及肺功能的影响

目的 探讨超声电导仪药物透入对复治肺结核患者疗效及肺功能的影响。方法 回顾性分析106例复治肺结核患者的临床资料,根据治疗方法不同分为2组,观察组53例进行超声电导仪药物透入治疗,对照组53例进行常规抗结核药物治疗。比较不同时点痰菌转阴率、空洞闭合率、呼吸功能、肺功能[峰值呼气流速(PEF)、第1秒用力呼气容积(FEV₁)、用力肺活量占预计值百分比(FVC%)、第1秒用力呼气容积与用力肺活量的比值(FEV₁/FVC)]以及并发症发生率。结果 观察组治疗后1、3、6个月的痰菌转阴率分别为67.92%、79.25%、92.45%,高于对照组的47.17%、58.49%、73.58%,差异有统计学意义(P<0.05)。观察组治疗后1、6个月的空洞总闭合率分别为67.92%、88.68%,高于对照组的47.17%、69.81%,差异有统计学意义(P<0.05)。治疗后1、6个月,PEF、FEV₁/FVC、FEV₁%、FVC%均较治疗前升高,差异有统计学意义(P<0.05);观察组治疗后1、...     

血清CXCL13、HSP90与支气管哮喘患儿气道高反应及机体变态反应的关系

目的 探究血清CXC趋化因子配体13(CXCL13)、热休克蛋白90(HSP90)与支气管哮喘患儿气道高反应及机体变态反应的关系。方法 选取2020年7月至2022年9月就诊于该院的70例支气管哮喘患儿作为观察组,选取同期51例体检健康儿童作为对照组,比较两组肺功能指标[最大呼气流量(PEF)、第1秒用力呼气容积(FEV₁)、用力肺活量(FVC)和FEV₁/FVC],呼吸道反应指标(呼吸阻力、支气管激发物反应阈值、呼吸阻力上升斜率)、CXCL13)、HSP90及机体变态反应指标[免疫球蛋白E(IgE)、嗜酸性粒细胞阳离子蛋白(ECP)、嗜酸性粒细胞计数(EOS)],分析CXCL13、HSP90水平与支气管哮喘患儿气道高反应和机体变态反应的相关性。结果 观察组FVC、PEF、FEV₁及FEV₁/FVC水平低于对照组(P<0.05),呼吸阻力和阻力上升斜率高于对照组(P<0.05),反应阈值低于对照组,CXCL13、HSP90、IgE、ECP以及EOS水平高于对照组(P<0.05)。P...     

全面协同护理对雾化吸入治疗肺炎患儿症状改善情况和治疗依从性的影响

目的：探讨全面协同护理对雾化吸入治疗肺炎患儿症状改善情况和治疗依从性的影响。方法：选取2018年1月1日～2021年12月31日收治的行雾化治疗的肺炎患儿160例为研究对象,随机分为对照组和观察组各80例,对照组采用常规护理,观察组采用全面协同护理干预;比较两组治疗后肺功能[包括第一秒用力呼气容量(FEV₁)、用力肺活量(FVC)、呼气峰流速(PEF)]、治疗依从性、症状改善情况。结果：观察组FEV₁、FVC、PEF优于对照组(P<0.01);观察组治疗依从性、总有效率均高于对照组(P<0.05)。结论：对雾化吸入治疗肺炎患儿采用全面协同护理,可改善患儿肺功能,缓解症状,提升治疗依从性。     

益气养阴清热汤辅助治疗对慢性支气管炎急性发作患者动脉血气及炎症因子表达的影响

目的 分析益气养阴清热汤辅助治疗对慢性支气管炎急性发作患者动脉血气及炎症因子表达的影响。方法 选取2018年1月至2022年12月南京市六合区中医院收治的80例慢性支气管炎急性发作患者,以随机数字表法分为参照组、研究组,各40例。参照组实施常规治疗,研究组在参照组基础上辅助应用益气养阴清热汤。比较两组患者治疗前后肺通气功能指标[最大呼气峰流速值(PEF)、第1秒最大呼气量(FEV₁)、FEV₁与用力肺活量比值(FEV₁/FVC)]、动脉血气指标[二氧化碳分压(PCO₂)、氧分压(PaO₂)、血氧饱和度(SaO₂)]、炎症因子[超敏-C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-4(IL-4)、白细胞介素-8(IL-8)]。结果 治疗后,两组患者PEF、FEV₁、FEV₁/FVC均升高,且研究组均高于参照组(均P <0.05)。治疗后,两组患者PCO₂均降低,P...     

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.