超声斑点追踪成像技术对2型糖尿病患者左室收缩功能的研究

目的探讨超声二维斑点追踪成像技术对早期诊断2型糖尿病患者左室局部和整体收缩功能异常的临床价值。方法2型糖尿病患者63例,根据左室射血分数（LVEF）分为心功能正常组（A组,LVEF≥50%）45例,心功能衰竭组（B组,LVEF〈50%）18例;正常对照组30例。获取心尖位左室长轴观、二腔观和四腔观各节段收缩期纵向峰值应变,并计算左室基底段、中段、心尖段收缩期纵向平均应变值及左室整体应变值。结果两组糖尿病患者左室长轴室壁各节段收缩期纵向峰值应变均明显低于对照组（P〈0.001）,糖尿病B组除基底段前间隔、侧壁及后壁外,其他各节段峰值应变低于糖尿病A组（P〈0.05～0.001）;两组糖尿病患者基底段、中段、心尖段收缩期纵向平均应变值及左室整体应变值低于对照组（P〈0.001）,且两组糖尿病间比较差异有显著性意义（P〈0.001）。结论超声二维斑点追踪成像技术能够早期评价2型糖尿病患者左室局部和整体收缩功能异常。     

超声斑点追踪成像技术对糖尿病患者左心室收缩功能早期变化的研究

目的：应用超声斑点追踪成像技术评价2型糖尿病患者左心室短轴应变及左心室扭转运动的变化规律。方法：单纯糖尿病患者41例，糖尿病合并左心室肥厚患者25例，正常对照者37例。获取胸骨旁短轴二尖瓣水平、乳头肌水平、心尖水平二维图像，测量左心室径向和圆周收缩期局部及整体峰值应变、左心室扭转角度。结果：与对照组比较，两组糖尿病患者径向各应变参数值降低，但差异无统计学意义（P〉0．05）；两组糖尿病患者部分心肌节段、不同水平平均峰值应变及左心室整体圆周应变较对照组减低（P〈0．05），糖尿病合并左心室肥厚组低于单纯糖尿病组（P〈0．05）。两组糖尿病患者左心室扭转角度较对照组增大（P〈0．05），糖尿病合并左心室肥厚组高于单纯糖尿病组（P〈0．05）。结论：超声斑点追踪成像能够较早识别糖尿病患者左心室收缩功能异常。     

超声二维应变成像评价2型糖尿病患者左心室收缩功能

目的 探讨超声二维应变成像评价2型糖尿病患者左心室收缩功能的临床价值.方法 应用二维应变成像技术,测量无明显冠心病的37例单纯糖尿病患者、22例糖尿病合并左心室肥厚患者和30例正常对照者收缩期左心室长轴基底段、中段、心尖段纵向二维应变值,左心室短轴二尖瓣水平、乳头肌水平、心尖水平的径向二维应变值及二尖瓣水平、心尖水平心室的旋转角度.结果 两组糖尿病患者的左心室长轴基底段、中段、心尖段最大收缩期纵向平均应变值及左心室整体应变值明显低于对照组(P＜0.001),而糖尿病合并左心室肥厚组较单纯糖尿病组降低(P＜0.05或P＜0.001);二尖瓣水平、乳头肌水平、心尖水平各组间最大收缩期平均径向应变及左心室整体径向应变差异无统计学意义(P＞0.05);糖尿病患者左心室基底部、心尖部旋转角度及左心室扭转角度较对照组增大(P＜0.01或P＜0.001),糖尿病合并左心室肥厚组较单纯糖尿病组左心室心尖部旋转角度和左心室扭转角度增大(分别为P＜0.01,P＜0.05).结论 超声二维应变成像对早期诊断无明显冠心病的糖尿病患者左心室收缩功能受损有临床价值.     

超声斑点追踪成像技术评价2型糖尿病患者左心室收缩功能

目的探讨超声斑点追踪成像（STI）技术评价2型糖尿病（T2DM）患者左心室收缩功能的应用价值。方法选取T2DM患者38例,健康人29例,应用STI技术获取左心室长轴及短轴各切面的心内、外膜层心肌收缩期纵向、径向峰值应变及左心室心内、外膜层心肌的整体纵向和径向峰值应变值。结果T2DM患者左心室心内、外膜层心肌收缩期纵向峰值应变低于对照组（心内膜层：均P〈0．01;心外膜层：均P〈0．05）,径向峰值应变高于对照组（P〈0．05）。结论STI技术能够无创性评价T2DM患者早期左心室局部和整体收缩功能变化。     

斑点追踪技术评价糖尿病早期左室心内膜下心肌收缩功能

目的 应用斑点追踪成像技术评价糖尿病早期患者及糖尿病合并高血压患者左室心内膜下心肌的收缩功能.方法 应用斑点追踪成像技术测量无明显冠心病及左室心肌质量指数相近的30例单纯糖尿病患者、25例糖尿病合并高血压患者、30例正常人的超声心动图常规参数及左室心内膜下心肌长轴观基底段、中段、心尖段收缩期纵向二维应变值,比较三组间的差异.结果 除E/A的差异有统计学意义(P＜0.01)外,两糖尿病组较正常对照组之间各常规参数的差异无统计学意义.两糖尿病组整体心肌纵向收缩期峰值应变较对照组虽有所减低,但仅部分节段差异有统计学意义(P ＜0.01),而心内膜下心肌纵向收缩期峰值应变较对照组均减低,差异有统计学意义(P＜0.01～0.001).除少数心肌节段外,糖尿病合并高血压组心内膜下心肌纵向收缩期峰值应变均比单纯糖尿病组减低,差异有统计学意义(P＜0.01).结论 斑点追踪成像可用于早期诊断无明显冠心病的糖尿病患者左心室收缩功能受损情况.     

斑点追踪成像评价2型糖尿病患者左心室收缩功能的早期改变

目的：探讨斑点追踪成像（STI）技术评价2型糖尿病（T2DM）患者左心室收缩功能的早期改变。方法：选取77例LVEF正常的T2DM患者,依据有无合并高血压分为单纯糖尿病组（DM组）39例,糖尿病合并高血压组（DH组）38例,正常对照组（NC组）34例,应用STI技术测量左心室长轴切面的纵向收缩期峰值应变（SLs）、短轴切面的圆周（SCs）及径向收缩期峰值应变（SRs）。结果：左心室整体SLs在两病例组显著降低（P〈0．01）,其中DH组降低更加显著（P〈0．01）;左心室整体SCs及SRs仅在DH组显著降低（P〈0．01）。结论：无心力衰竭症状LVEF正常的他DM患者的左心室收缩功能已降低。     

二维斑点追踪成像技术评价糖尿病患者左心室功能早期改变

目的应用二维斑点追踪成像(STI)技术检测2型糖尿病患者左心室收缩功能的早期改变,并探讨其临床应用价值。方法 2型糖尿病患者(左心室射血分数≥50%)60例,分为单纯糖尿病组(A组)30例和糖尿病合并左心室壁肥厚组(B组)30例;正常对照组30例。分别测量左心室长轴及短轴各节段收缩期纵向、径向、圆周峰值应变,并计算其平均值。结果与对照组相比,糖尿病组收缩期纵向、圆周峰值应变及平均应变均明显减低(P<0.05),B组低于A组(P<0.05)。与对照组比较,糖尿病组径向峰值应变及平均应变亦减低,但差异无统计学意义(P>0.05)。结论 STI技术可早期检测糖尿病患者左心室心肌局部收缩功能异常。     

超声斑点追踪成像技术对2型糖尿病患者左心室扭转运动早期变化的初步研究

目的 探讨超声斑点追踪成像技术评价2型糖尿病患者左心室扭转运动早期变化的临床应用价值.方法 2型糖尿病患者66例,且左心室射血分数≥50%,其中单纯糖尿病41例,糖尿病并左心室肥厚25例,正常对照者37例.采集受检者胸骨旁短轴二尖瓣水平、心尖水平二维图像,测量各水平收缩期平均旋转角度峰值、各室壁节段旋转角度峰值,计算左心室整体扭转角度峰值.结果 与对照组比较,单纯糖尿病组各水平平均旋转角度峰值、心尖水平各室壁节段旋转角度峰值及左心室整体扭转角度峰值均较对照组增大（P＜0.05或P＜0.01）.糖尿病并左心室肥厚组二尖瓣水平部分室壁节段、心尖水平各室壁节段旋转角度峰值及各水平平均旋转角度峰值较对照组增大（P＜0.05或P＜0.01）,心尖水平部分室壁节段旋转角度峰值及平均旋转角度峰值较单纯糖尿病组增大（P＜0.05或P＜0.01）,左心室整体扭转角度峰值较正常对照组和单纯糖尿病组大（P＜0.01）.结论 在左心室收缩功能正常时,单纯糖尿病患者左心室扭转角度增大,合并左心室肥厚者更加明显,超声斑点追踪成像能够较早识别糖尿病患者左心室扭转角度改变.     

三维斑点追踪成像评价2型糖尿病患者左心室应变

目的 应用三维斑点追踪技术评价2型糖尿病(DM)患者左心室应变。方法 对30例2型DM患者(DM组)及30名健康志愿者(对照组)行三维斑点追踪成像,比较两组左心室整体及各节段应变。结果 DM组左心室收缩期整体应变(GS)、整体环向应变(GCS)、整体径向应变(GRS)及整体纵向应变(GLS)均低于对照组(t=2.18、3.27、2.05、3.76,P均<0.05)。DM组左心室前壁及侧壁环向收缩期峰值应变均低于对照组(P均<0.05);前壁基底段、中间段及侧壁径向收缩期峰值应变均低于对照组(P均<0.05);前间隔基底段、前壁基底段和中间段、侧壁中间段和心尖段、下壁心尖段纵向收缩期峰值应变均低于对照组(P均<0.05)。DM组基底段径向及纵向收缩期峰值应变均低于心尖段,中间段纵向收缩期峰值应变低于心尖段(P均<0.05)。对照组基底段环向、径向及纵向收缩期峰值应变均低于心尖段,中间段纵向收缩期峰值应变低于心尖段(P均<0.05)。结论 三维斑点追踪技术可用以评价2型DM左心室整体及节段收缩功能的早期改变。     

应变率显像技术评价风湿性二尖瓣狭窄患者左心室长轴收缩功能的变化

目的应用应变率显像（SRI）技术评价风湿性二尖瓣狭窄（MS）患者左心室长轴收缩功能的变化。方法选择MS患者50例为MS组和健康志愿者50例为对照组。在心尖四腔心、心尖两腔心和左心室心尖长轴切面,应用SRI技术测量左心室各壁基底段和中间段收缩期峰值应变（Ss）和收缩期峰值应变率（SRs）。结果MS组左心室壁各节段Ss和SRs均小于对照组相应节段（P〈0.05,0.01）。结论SRI技术能够准确评价风湿性MS患者左心室长轴收缩功能的变化。     

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.     

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.     

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.     

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.