肺心病血液高凝状态的诊断

检测１０３例慢性肺原性心脏病（肺心病）急性发作期患者的血小板活性和凝血、抗凝血、纤溶功能。结果表明肺心病急性发作期患者的血小板活性增强，βＴＧ与ＰＦ４均明显升高（Ｐ＜００５）。血小板粘附性增强，ｖＷＦ：Ａｇ显著升高（Ｐ＜００１），Ｆｎ升高但无显著差异（Ｐ＞００５）。凝血功能增强，ＦⅧ：Ｃ显著升高（Ｐ＜００１），Ｆｇ显著升高（Ｐ＜００１）。抗凝功能减弱，ＡＴⅢ下降（Ｐ＜００１），α１ＡＴ升高（Ｐ＜００５），α２ＭＧ无明显改变。纤溶功能减弱ｔＰＡ下降（Ｐ＜００１），ＤＤ显著升高（Ｐ＜００１），但α２ＰＩ下降（Ｐ＜００５），ＰＡＩ、ＰＬＧ无明显改变。提示肺心病患者血液呈高凝状态。但缺乏特异性诊断指标。     

鞘膜内注射及静注神经生长因子并中药“神脑康胶囊”与静滴神经生长因子对重型脑梗死患者神经功能和脂蛋白影响的比较

目的：观察鞘膜内注射神经生长因子（ＮＧＦ）联合中药“神脑康胶囊”治疗重型脑梗死的临床疗效,以及对患者神经功能和脂蛋白的影响。方法：１０６ 例重型脑梗死患者随机分为２ 组。治疗组（５６ 例）鞘膜内注射ＮＧＦ２ ０００ ＢＵ,每周１ 次,同时静注ＮＧＦ１ ０００ ＢＵ,每日１ 次,并口服中药“神脑康胶囊”,每次３ 粒,每日３ 次;对照组（５０ 例）静滴ＮＧＦ２ ０００ ＢＵ,每日１ 次;疗程均为４ 周。治疗前后观察高密度脂蛋白（ＨＤＬ）、低密度脂蛋白（ＬＤＬ）、甘油三酯（ＴＧ）、总胆固醇（ＴＣ）的变化,并对患者进行神经功能缺损评分的比较。结果：治疗组治疗后神经功能缺损评分〔（２１０±１６）分〕与对照组〔（３００±１２）分〕比较显著降低（Ｐ＜ ００１）;临床总有效率（８９３％ ）显著高于对照组（５８０％ ,χ２＝ １００９,Ｐ＜ ００１）;与对照组治疗后比较,治疗组治疗后ＨＤＬ升高显著（Ｐ＜ ００１）,ＬＤＬ、ＴＧ、ＴＣ下降显著（Ｐ＜ ００５ 或Ｐ＜ ００１）。结论：鞘膜内注射ＮＧＦ联合中药神脑康治疗重型脑梗死能明显改善神能功能缺损程度,提高临床疗效,并能使患者的脂代谢紊乱得到改善     

乌拉地尔对高血压患者血浆降钙素基因相关肽与内皮素含量的影响

目的探讨新型降压药乌拉地尔（ＵＲＡ）对高血压患者血浆降钙素基因相关肽（ＣＧＲＰ）和内皮素（ＥＴ）含量的影响。方法采用放射免疫方法测定１５例高血压患者ＵＲＡ治疗前后血浆ＣＧＲＰ和ＥＴ含量变化。结果高血压患者血浆ＣＧＲＰ明显低于正常对照组（Ｐ＜００１）。血浆ＥＴ及ＥＴ／ＣＧＲＰ明显高于正常对照组（Ｐ＜００１）。经静脉ＵＲＡ治疗后５ｍｉｎ,高血压患者血浆ＣＧＲＰ明显升高（Ｐ＜００１）,ＥＴ及ＥＴ／ＣＧＲＰ则明显降低（Ｐ＜００１）。结论ＣＧＲＰ与ＥＴ共同在高血压发病过程中起重要作用。ＵＲＡ可明显提高人体内ＣＧＲＰ水平,在降低血压的同时对ＥＴ有明显的拮抗效应。     

茶色素对冠状动脉粥样硬化性心脏病左室舒张功能不全的影响

目的：探讨茶色素对冠状动脉粥样硬化性心脏病（冠心病）左室舒张功能（ Ｌ Ｖ Ｄ Ｆ）不全的影响。方法：将２００ 例冠心病 Ｌ Ｖ Ｄ Ｆ不全患者随机分为２ 组,治疗组１００ 例口服茶色素１２５ ｍ ｇ,每日 ３ 次;对照组口服巯甲丙脯酸１２５ ｍ ｇ,每日３ 次。２ 组疗程均为３０ 日。结果：治疗组治疗后舒张早期血流峰值速度（ Ｐ Ｅ）、舒张早期血流速度时间积分（ Ｅ Ｓ）均明显增加（ Ｐ 均＜ ００１）,舒张晚期血流峰值速度（ Ｐ Ａ）、舒张晚期血流速度时间积分（ Ａ Ｓ）均明显下降（ Ｐ＜ ００５ 和 Ｐ＜ ００１）, Ｐ Ａ／ Ｐ Ｅ、 Ａ Ｓ／ Ｅ Ｓ均显著下降（ Ｐ 均＜ ００１）,舒张早期快速充盈减速度（ Ｄ Ｃ）明显增快（ Ｐ＜ ００５）;而对照组除 Ｐ Ｅ、 Ｅ Ｓ、 Ａ Ｓ变化较明显（ Ｐ 均＜ ００５）外,其余均无显著性差异（ Ｐ 均＞００５）。治疗组治疗后显著降低了血脂、血粘度,改善了微循环和心电图的疗效。结论：茶色素不但能明显降低冠心病患者血脂、血粘度,改善微循环,并有明显改善 Ｌ Ｖ Ｄ Ｆ的作用。     

血浆PAF、TXB_2和6-k-PGF_(1α)检测在老年脑梗塞、高血压患者中的临床意义

采用放射免疫、生物学方法测定２３例老年脑梗塞患者，２８例老年高血压患者及２０例正常对照组血浆血小板活化因子（ＰＡＦ）、血栓素Ｂ２（ＴＸＢ２）和６－酮－前列腺素Ｆ１α（６－ｋ－ＰＧＦ１α）水平。对９例老年脑梗塞患者和１４例老年高血压患者作应激状态下血浆ＰＡＦ、ＴＸＢ２和６－ｋ－ＰＧＦ１α测定。结果表明，老年脑梗塞患者血浆ＰＡＦ、ＴＸＢ２较健康对照组显著增高（Ｐ＜０．０１），老年高血压患者血浆ＴＸＢ２与健康对照组比较显著增高（Ｐ＜０．０１），但ＰＡＦ、６－ｋ－ＰＧＦ１α无显著差异（Ｐ＞０．０５）。老年脑梗塞患者应激后ＰＡＦ、ＴＸＢ２增加明显（Ｐ＜０．０１），且持续时间长。这些结果表明血浆ＰＡＦ、ＴＸＢ２和６－ｋ－ＰＧＦ１α检测对老年心脑血管疾病的诊断、治疗和预后有一定的临床价值。     

套扎与硬化治疗食管静脉曲张出血的临床对比研究

【目的】比较应用内镜治疗肝硬化食管静脉曲张出血不同方法的疗效。【方法】对８１例肝硬化食管静脉曲张出血的病人随机采用套扎治疗（ＥＶＬ）或硬化治疗（ＥＶＳ）,治疗后每３个月及再出血时接受内镜检查。【结果】ＥＶＳ组平均随访期（４１４±３８）ｄ,ＥＶＬ组（３９８±３５）ｄ。两组静脉曲张消除率相似（ＥＶＳ组９２５％,ＥＶＬ组９２７％,Ｐ＞０．０５）;ＥＶＬ组达到完全消除所需的平均治疗次数较少（２．７±０．３比３．６±０．１,Ｐ＜００５）,但所需时间较长（３８±２．５比２２±２．０,Ｐ＜０．０１）;ＥＶＳ组的并发症率明显高于ＥＶＬ组（２０．０％比０％,Ｐ＜００５）,但ＥＶＬ组静脉曲张复发率较高（３６６％比１２．５％,Ｐ＜０．０５）;两组的再出血率及死亡率比较差异无显著性（２０．０％比１７１％;２７．５％比２１．９％,均Ｐ＞０．０５）。【结论】两种方法疗效相似,ＥＶＬ在短期随访中优点突出,而随时间延长,静脉曲张复发率较高,所有患者第１年随访期均需接受频繁的内镜检查。     

茶色素（心脑健）治疗各种肾脏疾患临床疗效观察

观察了心脑健对２８例肾脏疾病患者的临床疗效。结果表明：（１）其降脂作用在ＣＲＦ组中以降胆固醇（ＣＨ）为主（Ｐ＜０．０５）；在ＮＳ及ＧＮ 组以降甘油三酯（ＴＧ）为主（Ｐ＜０．０５）；ＮＳ组有升高ＨＤＬ作用（Ｐ＜０．０１）；ＧＮ和ＣＲＦ组降ＬＤＬ效果明显（Ｐ＜０．０５）。（２）其血液流变学在ＮＳ、ＧＮ组Ｆｂｇ明显降低（Ｐ＜０．０１，Ｐ＜０．０５）；ＧＮ、ＣＲＦ组血小板聚焦率下降（Ｐ＜０．０５）；三组病     

危重病人血浆甲状腺激素含量变化及其临床意义

目的　探讨危重病人血浆甲状腺激素（ Ｔ Ｈ） 的变化及其临床意义。方法　应用放射免疫分析法测定７３ 例危重病人和６０ 例健康人（ 对照组） 的血浆 Ｔ Ｈ 含量。结果　危重病人血浆 Ｔ３／ Ｆ Ｔ３ 含量〔（１０５ ±０４６）ｎ ｍｏｌ／ Ｌ〕／〔（２８５ ±１４１）ｐｍｏｌ／ Ｌ〕明显低于对照组〔（１９８ ±０５１）ｎｍｏｌ／ Ｌ, Ｐ＜ ００１〕／〔（６３７ ±１３１）ｐｍｏｌ／ Ｌ, Ｐ＜０００１〕;死亡组 Ｔ３／ Ｆ Ｔ３ 水平与非死亡组 Ｔ３／ Ｆ Ｔ３ 水平相比较有显著差异（ Ｐ＜ ００５／ Ｐ＜ ００１） 。结论　 Ｔ Ｈ 参与了危重病人的病理生理过程,监测危重病人血浆 Ｔ Ｈ 水平可作为反映病情程度和评估预后的一项参考指标。     

充血性心衰患者血浆内皮素、肿瘤坏死因子含量变化

目的　探讨充血性心力衰竭（ＣＨＦ） 患者血浆ＥＴ 和ＴＮＦ 含量变化及其意义。方法　检测７０ 例充血性心力衰竭患者血浆ＥＴ 和ＴＮＦ 含量,选３０ 例健康体检者作为正常对照组。结果　ＣＨＦ 患者ＥＴ 和ＴＮＦ 水平明显高于正常对照组（ Ｐ＜ ０ ．０１） ,且心衰程度越重,血浆ＥＴ 和ＴＮＦ 水平越高,ＣＨＦ 患者血浆ＥＴ 与ＴＮＦ 含量呈正相关（ ｒ ＝ ０ ．７２４６ ,Ｐ＜ ０ ．００１） 。结论　血浆ＥＴ 和ＴＮＦ 的测定有助于诊断心力衰竭和判断心力衰竭的程度。     

复脉抗衰注射液对不稳定型心绞痛患者内皮细胞保护作用的观察

目的：观察复脉抗衰注射液对不稳定型心绞痛（ＵＡ）患者内皮细胞的保护作用。方法：将６０例ＵＡ患者随机分为常规组和治疗组,治疗组在常规组治疗基础上加用复脉抗衰注射液。观察治疗前后２组患者血中各指标的变化。结果：治疗后,２组患者血栓素Ｂ２（ＴＸＢ２）水平明显降低,６酮前列腺素Ｆ１α（６ｋｅｔｏＰＧＦ１α）水平明显增高（Ｐ均＜０．０１）,但治疗组变化程度大于常规组（Ｐ均＜０．０１）;治疗组脂质过氧化物（ＬＰＯ）、遗传性假血友病第Ⅷ因子（ｖＷＦ）和纤维结合蛋白（Ｆｎ）水平均降低,超氧化物歧化酶（ＳＯＤ）水平增高（Ｐ均＜０．０１）,常规组ＬＰＯ、ＳＯＤ、ｖＷＦ和Ｆｎ则无显著变化（Ｐ均＞０．０５）。治疗前ＵＡ患者ＬＰＯ与ｖＷＦ呈直线相关（ｒ＝０．５２,Ｐ＜０．０１）,治疗后ＬＰＯ与ｖＷＦ降低值呈直线相关（ｒ＝０．７１,Ｐ＜０．０１）。结论：复脉抗衰注射液具有抗脂质过氧化反应,调整血栓素Ａ２／前列环素（ＴＸＡ２／ＰＧＩ２）比例平衡,保护血管内皮细胞及促进损伤血管内皮细胞修复的作用。     

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.     

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.