血浆置换术治疗华氏巨球蛋白血症的不良反应及对策

目的 分析血浆置换术(PE)在华氏巨球蛋白血症(WM)治疗中不良反应的发生率,探讨有效的预防、处理措施.方法 对12例WM患者进行的76例次PE治疗,观察所发生的不良反应,并对预防护理措施进行总结.结果 12例WM患者的76例次PE治疗中,有8例次发生不良反应,总发生率为10.4%,其中枸橼酸盐中毒3例次,过敏反应2例次,低血容量反应3例次.结论 PE在WM治疗中是比较安全的,其最常见的不良反应有枸橼酸盐中毒、低血容量反应及过敏反应,积极预防和处理可有效降低上述不良反应的发生.     

治疗性血浆置换术中不良反应分析

目的 观察治疗性血浆置换术中不良反应与临床处置。方法 应用血细胞分离机行44次血浆置换，观察血浆置换过程中出现的不良反应。结果44次血浆置换术中出现20次不同程度的枸橼酸盐中毒，占45．5％。血浆过敏反应5次，占11．4％。血容量失衡1次，占2．3％。结论 血浆置换术中出现的不良反应主要有枸橼酸盐中毒、过敏反应和血容量失衡等。置换过程中注意观察和及时对症处理，能有效减少不良反应，保证血浆置换的顺利进行。     

血浆置换术不良反应分析

目的：观察血浆置换（PE）治疗中的不良反应情况。方法：回顾性分析应用血细胞分离机对32例病人进行107次血浆置换治疗的不良反应情况。结果：血浆置换术中出现的不良反应主要有枸橼酸盐中毒、过敏反应、低血压及胃肠反应等。结论：治疗过程中应注意观察病情变化,及时处理并发症。     

血浆置换不良反应的护理

血浆置换术(PE)可治疗肾病、重症肌无力、红斑狼疮、急性多发性神经根炎、硬皮病、类风湿性关节炎、药物中毒、肝昏迷、高粘滞综合症、血友病、糖尿病、胰腺癌、结肠癌等200多种疾病,不良反应有过敏反应、低血压、低血症、心律失常、枸橼酸盐中毒等,发生率约在11～59％,严重不良反应约占4.5％。笔者亲历29例血浆置换治疗,4例发生不良反应,其中1例严重不良反应,经及时抢救成功,现总结报告如下。     

外周血干细胞／祖细胞采集及护理

本文总结了43例外周血干细胞／祖细胞的采集和护理的经验，指出了采集中出现的不良反应为血管的不良反应，枸橼酸盐中毒，血容量失衡，过敏反应，血管迷走神经反射引起的血液循环减少等，指出了处理这些不良反应的护理措施和保证出入血管通路和通畅是采集成功与否的关键。     

血浆置换不良反应发生情况及影响因素分析

目的 探讨血浆置换不良反应发生情况及影响因素.方法 收集2013年2月—2019年6月在本院血液中心进行血浆置换治疗的121例危重症患者的临床资料,观察血浆置换后患者不良反应发生的情况,将121例患者中发生血浆置换不良反应者纳为发生不良反应组(n=38),其他纳为未发生不良反应组(n=83);将可能的影响因素纳入,如性别、年龄、职业,抗凝剂、置换液、有效循环血容量、血浆置换次数及机器报警致暂停治疗时间等,经检验初次分析可能的影响因素,并将差异具有统计学意义的变量纳为自变量,经多因素Logistic回归分析血浆置换危重症患者不良反应的影响因素.结果 本组121例患者接受PE治疗,其中38例患者发生不良反应,发生率为31.40％;其中血浆过敏反应18例(14.88％),严重过敏反应3例(2.48％),低血压4例(3.31％),低血钙6例(4.96％),凝血5例(4.13％),其中严重凝血导致破膜1例(0.83％),以上不良反应均经有效处理后缓解;本研究单因素分析结果显示,两组患者的性别、年龄及职业比较,差异无统计学意义(P>0.05);发生不良反应组患者的抗凝剂、置换液、有效循环血容量及机器报警致暂停治疗时间与未发生不良反应组比较,差异均有统计学意义(P<0.05);经多因素Logistic回归分析结果显示,新鲜冰冻血浆、有效循环血容量下降、枸橼酸钠抗凝剂以及机器报警致暂停时间≥1 min是血浆置换发生不良反应的影响因素.结论 血浆置换常见不良反应包括血浆过敏、低血压、低血钙及凝血反应,其中新鲜冰冻血浆、有效循环血容量下降、枸橼酸钠抗凝剂以及机器报警致暂停时间≥1min是PE发生不良反应的独立危险因素.     

护理干预对治疗性血浆置换患者不良反应的影响

目的:探讨护理干预对治疗性血浆置换(PE)患者不良反应的影响.方法:对63例行PE患者实施有效的术前、术中、术后护理并观察临床效果.结果:63例患者行PE疗法117例次；发生不良反应6例,其中发生过敏反应4例、低钙血症1例、心力衰竭并终止治疗1例,经积极治疗后症状缓解.结论:积极有效的护理干预可减少PE患者不良反应的发生,从而提高临床效果.     

枸橼酸盐引起献血者、受血者低血钙不良反应的防范措施探讨

目的探讨枸橼酸盐引起献血者、受血者低血钙不良反应的防范措施。方法 997例单采血小板献血者分为对照组和预防性口服钙剂组,比较枸橼酸盐不良反应发生率,分析预防性口服钙剂组8例不良反应诱因;统计2597例受血者枸橼酸盐不良反应发生率,分析其中9例大量输血患者血钙和心电图变化。结果单采血小板献血者预防性口服钙剂组不良反应发生率1.25%(8/641),对照组4.78%(17/356),χ2=11.65,P0.01;预防性口服钙剂组发生的8例不良反应与抗凝剂比例、回输血液速度、个体差异有关;受血者枸橼酸盐不良反应发生率(0/2 597);9例大量输血患者血钙浓度均减低[(0.38±0.21)mmol/L],心电图未出现Q-T延长。结论单采血小板献血者在预防性口服钙剂同时,严格控制枸橼酸盐比例、回输血液速度,可进一步降低不良反应发生率;大量输血过程推荐血钙监测、心电监护、凝血功能"三联监控"措施,血钙监测为敏感指标,对控制低血钙不良反应和钙剂补充过量的高血钙不良反应具有重要意义。     

凯西莱治疗肝炎过程中不良反应的观察和处理

目的 观察凯西莱治疗肝炎过程中不良反应,研究其相应的处理措施。方法 随机选择100例慢性病毒性肝炎患者,凯西莱2片/次,3次/日,饭后口服,连服12周,观察整个疗程中全部患者的不良反应。结果 全部患者口服凯西莱后,发生胃肠道反应(恶心、呕吐、腹泻、食欲减退)14例,过敏反应(皮疹、皮肤瘙痒、面部发红)3例;经过相应的对症处理,发生的胃肠道反应和过敏反应,可以明显减轻、消失。结论 凯西莱治疗肝炎过程中会发生的胃肠道反应和过敏反应,恰当的对症处理,可减轻其不良反应。     

机采血小板献血者枸橼酸盐反应分析及处理

目的探讨机采血小板献血者发生枸橼酸盐反应的原因及处理措施。方法按照标准操作规程采集血小板。分析2009年4～10月血小板献血者枸橼酸盐反应。结果共采集373人次,男性献血者303人,献血反应4人,女性献血者70人,反应3人。女性献血者献血反应率高于男性,采集2个治疗量的反应率高于1个治疗量。结论在采集过程中应给予献血者,特别是女性献血者口服葡萄糖酸钙是预防枸橼酸盐反应的发生。     

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.