剪切波弹性成像对急性缺血性脑卒中患者颈动脉僵硬度评价的可行性分析

目的：分析剪切波弹性成像技术评价急性缺血性脑卒中患者颈动脉硬度的可行性。方法：以153例首发急性缺血性脑卒中患者为观察组,同期150例健康自愿者对照组。收集所有受试者的一般资料;应用超声测量双侧颈动脉脉搏波传导速度(PWV);应用实时剪切波弹性成像(SWE)技术测量双侧颈动脉的纵向平均弹性模量的平均值(MEmean)、最大弹性模量的平均值(MEmax)以及最小弹性模量的平均值(MEmin)。分析两组受试者的相关指标,对受试者的PWV值和MEmean值进行相关性分析,绘制ROC曲线评估PWV和MEmean在预测急性缺血性脑卒中方面的价值。结果：与对照组比,观察组的体重指数(BMI)、收缩压、舒张压、甘油三脂(TG)、低密度脂蛋白(LDL-C)、空腹血糖、颈动脉内-中膜厚度(CIMT)、血管弹性系数(EP)、PWV、 MEmean 、MEmax值及高血压、糖尿病患者的例数均明显升高,而观察组的高密度脂蛋白(HDL-C)、血管顺应性(AC)值降低,差异均有统计学意义(P<0.05)。PWV值和MEmean值呈正相关(r=0.651,p=0.000)。PWV、MEmean预测急性缺血性脑卒中的ROC曲线下面积及P值分别为：AUC=0.846,P=0.000;AUC=0.805,P=0.000。结论：SWE能有效的评估急性缺血性脑卒中患者颈动脉的僵硬度,且对急性缺血性脑卒中有一定的预测价值。     

血管内径追踪和矢量应变技术评价糖尿病患者颈总动脉弹性的价值

目的 探讨血管内径追踪和矢量应变技术在评价颈总动脉血管弹性中的价值.方法 病例组选择单纯糖尿病患者38例,与病例组年龄、性别匹配的健康志愿者37例作为对照组.应用血管内径追踪和矢量应变技术测量颈总动脉弹性指标:脉搏波传导速度(PWV)、顺应性系数(CC)、僵硬指数(β),内膜环向应变、应变率、应变时间,外膜环向应变、应变率、应变时间,径向应变、应变率、应变时间.分析两组间参数的显著性差异及相关性.结果 糖尿病组颈总动脉PWV、β较对照组显著增高(P＜0.05),CC较对照组明显减低(P＜0.05);内外膜环向应变、应变率和径向应变、应变率指标较对照组显著减低(P＜0.05),相对应的应变时间较对照组延长(P＜0.05);两组间纵向应变指标差异无统计学意义.糖尿病组CC与PWV呈显著负相关(r=-0.872,P＜0.001),年龄、收缩压、β与PWV正相关(分别r=0.322,P=0.005;r=0.384,P=0.001; r =0.927,P＜0.001).结论 血管内径追踪技术所测量的硬度及顺应性指标和矢量应变技术所获得的环向及径向应变指标能够直观地反映糖尿病患者血管弹性的变化.     

血管回声跟踪技术对2型糖尿病患者颈动脉弹性功能的定量检测

目的探讨血管回声跟踪（ET）技术对2型糖尿病患者颈动脉弹性功能定量检测的价值。方法应用ET技术检测30例2型糖尿病患者及30例正常人的颈动脉弹性指标：血管收缩期内径、舒张期内径、压力应变弹性系数、硬度指数、顺应性和脉搏波传导速度。糖尿病患者根据颈动脉内-中膜厚度分为A组IMT≤1．0mm,B组IMT〉1．0mm,正常对照组30例。结果A、B组压力应变弹性系数、硬度指数、脉搏波传导速度均高于对照组（P〈0．01）;A组和B组动脉顺应性低于对照组（P〈0．05）,血管收缩期内径、舒张期内径各组比较均无统计学差异（P〉0．05）;A组与B组比较各项指标无统计学意义（P〉0．05）。结论ET技术能早期反映2型糖尿病患者血管内皮功能受损,是评价糖尿患者血管并发症的简便、实用而客观的方法。     

血管内-中膜自动跟踪及血管回声跟踪技术评价青年吸烟者颈动脉血管弹性

目的 探讨血管内-中膜(IMT)自动跟踪技术(IMT技术)和血管回声跟踪技术(ET技术)评价青年吸烟者颈动脉IMT应变和血管弹性功能的应用价值,并分析两者的相关性。方法 对30名主动吸烟者(吸烟组,年龄19~27岁)及27名非吸烟者(对照组,年龄21~24岁)应用ET技术检测两侧颈总动脉,测量血管收缩期最大内径(Ds)、舒张期最小内径(Dd)、僵硬度(β)、弹性系数(Eρ)、顺应性(AC)、膨大指数(AI)以及脉搏波传导速度(PWVβ)等指标。同时用IMT自动跟踪技术观察两组双侧颈总动脉收缩期及舒张期IMT,得出收缩期内-中膜厚度(IMT_收)、舒张期内-中膜厚度(IMT_舒),一个心动周期时间(t),并计算IMT应变率、时间应变、脉压差应变。结果 与对照组比较,吸烟组Dd－Ds、β、Eρ、AC、AI、PWVβ均无显著差异(P＞0.05);吸烟组IMT时间应变、脉压差应变低于对照组(P＜0.05),IMT应变率组间比较无统计学意义(P＞0.05);吸烟组IMT应变率、脉压差应变与AC成正相关。结论 采用IMT应变分析技术,通过观察时间应变、脉压差应变,能早期发现血管弹性功能改变。     

剪切波弹性成像评价急性缺血性脑梗死患者颈动脉僵硬度的可行性分析

目的探讨剪切波弹性成像(SWE)技术评价急性缺血性脑梗死患者颈动脉硬度的可行性。方法选取我院首发急性缺血性脑梗死患者153例(观察组)和同期150例健康志愿者(对照组)。应用超声测量双侧颈动脉的血管僵硬度(β)、颈动脉内-中膜厚度(CIMT)、血管弹性系数(Eρ)、顺应性(AC)及脉搏波传导速度(PWV);SWE技术测量双侧颈动脉的纵向平均弹性模量的平均值(MEmean)、最大弹性模量的平均值(MEmax)及最小弹性模量的平均值(MEmin)。比较两组上述各指标,并对β及PWV与MEmean的相关性进行分析;受试者工作特征曲线分析PWV和MEmean在预测急性缺血性脑梗死方面的价值。结果观察组CIMT、Eρ、β、PWV、MEmean及MEmax均明显升高,AC明显降低,与对照组比较差异均有统计学意义(均P0.05)。β及PWV与MEmean值均呈正相关(r=0.651、0.723,均P0.05)。PWV、MEmean预测急性缺血性脑梗死的曲线下面积分别为0.846、0.805。结论 SWE能在一定程度上评估急性缺血性脑梗死患者颈动脉的僵硬度,且对急性缺血性脑梗死有一定的预测价值。     

血管回声跟踪技术定量评价脑梗塞患者颈动脉弹性相关性研究

目的 探讨高分辨力超声结合血管回声跟踪技术定量评价脑梗塞患者颈总动脉弹性参数的临床价值.方法 选用脑梗塞患者160例和正常对照组40例,应用高频线阵探头采用血管回声跟踪技术测量颈总动脉,获取颈总动脉的弹性系数(Ep)、僵硬度(β)、顺应性(AC)、脉搏波放大指数(AI)、单点脉搏波传导速度(PWVβ)、收缩期血管内径(Ds)及舒张期血管内径(Dd)等指标,分析这些指标与性别、年龄及心率的关系.结果 脑梗塞患者与正常人颈动脉弹性相比较,压力-应变弹性系数(Ep)、硬度指数(β)、AI及PWVβ较正常对照组明显升高(P<0.05);AC较正常对照组明显减低.性别差异对脑梗塞患者颈动脉弹性参数无影响.脑梗塞患者的β、Ep、AC、AI、PWVβ、Ds、Dd与年龄呈正相关;脑梗塞患者心率与AC、AI、Ds、Dd呈正相关;心率与β、Ep、PWVβ呈负相关.结论 应用血管回声跟踪技术能够准确定量评价脑梗塞患者颈总动脉弹性.     

射频数据处理技术对单纯收缩期高血压患者颈总动脉结构和功能的评估

目的 探讨高频超声射频数据处理技术(RF-data)评价单纯收缩期高血压(ISH)患者颈总动脉内-中膜厚度(IMT)和血管弹性改变及脉压(PP)与血管弹性的关系.方法 比较39例ISH患者与41例正常人颈总动脉舒张期内径(Dd)、收缩期内径(Ds)、PP、IMT、颈总动脉扩张性(CD)、单点脉搏波传播速度(PWVβ)、僵硬度(β)的改变,并分析PP与CD、PWVβ、β之间的关系.结果 ISH组SBP、PP均显著高于对照组.ISH组颈总动脉Ds、Dd 、IMT、PWVβ、β显著高于正常对照组;而CD显著低于对照组( P<0.001) .ISH组PP与PWVβ呈显著正相关(r=0.298,P<0.05),PP与β呈显著正相关(r=0.291,P<0.05),而PP与CD相关性不显著.结论 RF-data技术能够自动、实时、准确检测ISH患者颈总动脉IMT和血管弹性的变化.ISH患者颈总动脉IMT和血管僵硬度明显高于健康者.随着脉压的增大,PWVβ增快,血管僵硬度增高.     

血管回声跟踪技术定量评价早期高血压患者颈动脉与肱动脉扩张性

目的应用回声跟踪技术(e-tracking)定量分析早期高血压患者颈动脉及肱动脉的扩张性.方法研究对象为早期高血压组19例(平均年龄57.05±7.73岁),正常对照组22例(平均年龄54.29±9.67岁),采用高频线阵探头测量双侧颈总动脉及右侧肱动脉收缩期内径(Ds)、舒张期内径(Dd)、内中膜厚度(IMT)、内中膜厚度/收缩期内径比值(IMT/Ds)、阻力指数(RI),应用回声跟踪技术获取血管内径随心动周期的变化曲线,测量出弹性系数(Eρ)、僵硬度(β)及顺应性(AC),分析这些指标在早期高血压组及正常对照组中的差异性.结果两组间血管Ds、Dd、IMT、IMT/Ds、RI统计学无差异性.高血压组Eρ及β增高,AC减小,三支血管均有显著性差异.结论早期高血压患者动脉扩张性减低,应用回声跟踪技术能够准确获取颈总动脉及肱动脉性能参数,是一种有效的无创性评价动脉血管扩张性的新方法.     

血管回声跟踪技术评价冠心病患者颈动脉弹性与肱动脉内皮功能的相关性

目的探讨颈动脉弹性参数与肱动脉内皮功能的相关性。方法冠心病组、冠状动脉粥样硬化组、健康对照组各30例,回声跟踪技术检测颈动脉弹性参数：压力应变弹性系数（Ep）、硬化参数（β）、顺应性（AC）、脉搏波传导速度（PWVβ）和增大指数（AI）;肱动脉袖带加压检测血流介导的内皮依赖性血管舒张功能（FMD）。结果冠心病、冠状动脉粥样硬化患者Ep、β、PWVβ均较对照组增高,AC、FMD减低（P〈0．01）;所有受试者、冠心病组、冠状动脉粥样硬化组、对照组的FMD分别与Ep、β、PWVβ呈负相关,与AC呈正相关,与AI无相关性。结论颈动脉弹性各参数与肱动脉内皮功能呈高度相关,提示回声跟踪技术能早期、定量反映冠心病患者血管的改变,是评价血管内皮功能简便实用的方法。     

利用血管跟踪技术对脂肪肝患者动脉弹性功能的临床研究

目的:通过血管回声跟踪(ET)技术对脂肪肝患者的颈动脉弹性进行检测,为超声早期诊断血管弹性功能异常提供必要的参考依据。方法:利用ET技术获取各组脂肪肝患者双侧颈总动脉的僵硬度(β)、弹性模量(Ep)、顺应性(AC)值及脉搏波传导速度(PWVβ)等生理参数,并进行数据处理,观察各组脂肪肝患者的动脉弹性变化程度。结果:轻、中、重度脂肪肝组分别与正常对照组比较,其颈动脉弹性参数β、Ep、PWVβ值增高,AC值降低,差异有统计学意义(P<0.05)。分别与轻度脂肪肝组和中度脂肪肝组比较,重度脂肪肝组颈动脉弹性参数β、Ep、PWVβ值增高,而AC值降低,差异有统计学意义(P<0.05)。轻度脂肪肝组与中度脂肪肝组之间各项参数比较差异无显著性。结论:ET技术可以定量检测脂肪肝患者颈动脉弹性功能,有助于在形态学改变之前早期发现血管弹性功能异常,及时防止心脑血管事件的发生。     

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.