海洛因依赖者复吸因素分析

收集自１９９８年７月～２００１年２月首次自愿住院脱毒治疗，符合ＤＳＭ－Ⅲ－Ｒ海洛因依赖和滥用诊断标准者４６２例进行分析如下。１ 对象１．１ 社会人口学特征（１）性别：男性３７５例（８１．１７％）；女性８７例（１８．８３％）。（２）首吸年龄：２０岁以下１０２例（２２．０８％），２１～２５岁１８３例（３９．６１％），２６～３１岁１２０例（２５．９７％），３１～３５岁５０例（１０．８２％），３６岁以上７例（１．５１％）。（３）文化程度：文盲２０例（４．３３％）；小学８６例（１８．６１％），初中２６０例（…     

缺血性脑梗死患者血浆D-二聚体测定的意义

目的　为了解缺血性脑梗死病人在不同阶段血浆 Ｄ－ 二聚体测定的意义。方法　随机选择８４ 例到本院急诊科就诊的缺血性脑梗死患者（ 年龄５１ ～９０ 岁，男性４２ 例，女性４２ 例） ，分别于急性期（ ＜ ６ 天，ｎ ＝ ５３ ，年龄５１ ～８７ 岁，平均７０ 岁） 和亚急性期（６ ～２０ 天，ｎ ＝ ３１ ，年龄５３ ～９０ 岁，平均７２ 岁） 行血浆 Ｄ－ 二聚体测定。全部患者均经头颅 Ｃ Ｔ 或 Ｍ Ｒ Ｉ证实为缺血性脑梗死。同时选择年龄相匹配的２０ 例其他非凝血及血栓性疾病患者（ 年龄６０ ～９５ 岁，平均７２ 岁） 作为对照组。结果　缺血性脑梗死患者的血浆 Ｄ－ 二聚体水平在急性期未见升高（ ＜ ０３ｍｇ／ Ｌ） ，而在亚急性期显著升高（ ≥０３ ｍｇ／ Ｌ，０３ ～２ ｍｇ／ Ｌ） ，亚急性期与对照组（ ＜ ０３ ｍｇ／ Ｌ） 比较有显著差异（ Ｐ＜ ００００１） ，与急性期比较也有显著差异（ Ｐ＜ ００００１）（ 正常值为＜ ０３ ｍｇ／ Ｌ） 。结论　缺血性脑梗死患者的纤溶系统显著激活并非在急性期，而是在亚急性期。这也为急性期进行溶栓治疗提供了依据。     

急性脑血管病患者血清一氧化氮水平测定及临床相关因素分析

本文探讨了血清ＮＯ水平和脑血管病的发生发展的关系及临床意义。１材料与方法对照组:体检正常人５０例,男性３０例,女性２０例,年龄３０～６５岁,平均５３．２岁。观察组:临床诊断患有脑血管病患者７７例,男性４９例,女性２８例,年龄２１～７５岁,平均５５．８岁,病程为１～７ｄ（急性期）。脑出血３２例,脑梗塞３８例,蛛网膜下腔出血７例。检测方法:采用电子捕获检测器的气相色谱法测定血清ＮＯ含量,水平比较用ｔ检验。２结果观察组急性期平均血清ＮＯ浓度为（１６９．７１±７３．１０）μｍｏｌ／Ｌ与对照组（１１０．５５±３８．７９…     

掌腕部离断再植及康复治疗46例

掌腕部断肢再植。要获得良好的功能恢复并非易事。本院自１９８７～１９９８年共行掌、腕部离断再植术４６例（４７只手）,成活率达到９１．５%,经１～１０年随访,普遍获得较好的功能,报告如下。１材料与方法１．１临床资料４６例中有１例为双手掌离断,共计４７只手。男性３８例（３９只手）,女性８例。年龄最小７岁,最大５７岁,平均２５．７岁。完全离断３２例（３３只手）,不全离断１４例。致伤原因:切割伤２９例,电锯伤１４例,挤压伤３例。肢体缺血时间６～３１ｈ,平均１５．２ｈ,其中１２ｈ以内１６例,１２～２４ｈ２５例,２４ｈ以上５…     

静脉滴注酚妥拉明治疗慢性肺心病难治性心力衰竭22例

静脉滴注酚妥拉明治疗慢性肺心病难治性心力衰竭２２例解放军第１００医院内科（苏州市２１５００７）耿岘萍应用静脉滴注酚妥拉明治疗慢性肺心病难治性心衰２２例。报告如下。１．临床资料１．１一般情况：男性１８例，女性４例，年龄５３～７３岁。慢性咳喘病史１０～２...     

刺五加注射液治疗急性脑梗死的临床疗效观察

刺五加提取液用于治疗急性缺血性脑血管病近来倍受关注。我科自１９９６年至今共收治急性脑梗死１５０例 ,其中采用刺五加注射液治疗８１例 ,获得一定疗效。报告如下。１资料和方法１．１一般资料１５０例均符合１９９５年第四次全国脑血管病学术会议的诊断标准［１］,并经头颅ＣＴ证实。其中男性８６例 ,女性６４例 ,年龄５０～７８岁 ,平均６３．１岁。分为治疗组（Ａ组）８１例 ,对照组（Ｂ组）６９例。Ａ组合并高血压５４例 ,合并糖尿病２０例 ;Ｂ组合并高血压３３例 ,合并糖尿病２２例。两组年龄、性别、病程及合并症 ,无显著性差异（…     

肝癌及肝硬化患者血清中p185蛋白检测

癌基因Ｃ－ｅｒｂＢ－２的扩增及其产物ｐｌ８５蛋白的过度表达与人类多种恶性肿瘤（乳癌、卵巢癌、胃、肝、肺癌等）的发生发展密切相关［１～３］。我们对本市及周边地区经临床确诊为肝癌和肝硬化患者血清中ｐｌ８５水平进行了检测，结果如下。１材料和方法１．１疾病组肝癌及肝硬化患者各２４例，选自１９９７年ｌ～９月自贡市第一、第三医院及内江市第一医院临床确诊病人。肝癌组中男性２２例、女性２例，平均年龄５７．２５岁（３０～７８岁）。大于４５岁者２１例（８７．５０％）。肝硬化组中男性１９例女性５例，平均年龄４７．５岁…     

儿童精神发育迟滞康复治疗的探讨

为了探讨儿童轻度精神发育迟滞以及边缘智力康复治疗的效果，本文选择１９９５年１月～１９９９年１２月５１例门诊患儿进行对照研究。１资料与方法１．１资料本组共５１例，男２９例，女２２例，男女之比为１．３２：１。首次门诊年龄分布，５～６岁７例（１３．７３％），７～１０岁２５例（４９．０２％），１１～１４岁１９例（３７．２５％）。采用ＣＣＭＤ—２—Ｒ诊断标准诊断边缘智力２５例，轻度精神发育迟滞２６例。首次门诊均作韦氏幼儿或儿童智力测验，经过１—３年的康复训练，再作智力测验，并进行比较研究。康复治疗组３１例…     

肾癌的CT分期（附51例CT－病理对照分析）

肾癌的ＣＴ分期（附５１例ＣＴ－病理对照分析）王东，徐家兴本文对５１例肾细胞癌进行ＣＴ－病理对照分析，旨在进一步探讨ＣＴ对肾癌术前分期的价值。１材料与方法本文男４０例，女１１例，年龄２８～７３岁，平均５３岁，全部病例部经手术病理证实。ＣＴ扫描使用Ｐｉｃ...     

急性脑血管疾病患者血浆神经肽及降钙素基因相关肽浓度监测临床对照研究

通过对脑血管和脑梗死患者血浆中神经肽（ＮＰＹ）及降钙素基因相关肽（ＣＧＲＰ）的浓度变化的总结分析,对加深神经肽对心脑血管生理、病理调节机制的认识,进一步探索神经肽在脑血管疾病中的作用,为寻找影响其合成、释放、代谢药物,为脑血管疾病防治具有重大理论与实际意义。１　材料与方法１－１　临床资料　脑出血组３９例,男２６例,女１３例,３５～８２岁,平均年龄６３－３３岁。脑梗死组３８例,男２５例,女１３例,年龄４２～８４岁,平均年龄６２－０３岁。正常对照组６０例,男３８例,女２２例,年龄４０～７４岁,平均年…     

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.