电针联合有氧运动对冠心病患者心率及运动能力的影响

目的:观察电针联合有氧运动对冠心病患者心率恢复及运动能力的影响,并通过对心率变异性和氧化应激的检测探讨其作用机制。方法:招募确诊的冠心病患者行心肺运动试验(CPET),将120例心率恢复异常(试验终止1min时的心率恢复值(HRR1)≤12次/分)的患者纳入研究,并随机分为有氧运动组(A组)、电针组(B组)、电针联合有氧运动组(C组)、对照组(D组)。有氧运动组以强度为60%—75%最大运动能力的有氧运动训练,每次30—60min;电针组选取内关、郄门穴进行电针针刺治疗,每次留针30min;C组运动治疗方案同A组,运动治疗结束后1h进行电针治疗,电针治疗方案同B组;D组照常生活,常规治疗。各组治疗均为每周5次,共12周。所有患者在12周治疗前后,进行CPET评估心率恢复及运动能力情况,心率变异性指标(低频指标LF、高频指标HF、低高频指标比值LF/HF、正常心搏间期标准差SDNN)评估自主神经功能,静脉血中超氧化物歧化酶SOD、一氧化氮NO、脂质过氧化物LOOH含量检测评估氧化应激水平。结果:治疗前,4组患者的HRR1、峰值功率(PP)、峰值摄氧量(VO2peak)、无氧阈(AT)、心率变异性指标(LF、HF、LF/HF、SDNN)、氧化应激水平(SOD、NO、LOOH含量)均无显著差异(P0.05)。12周治疗后,心率恢复情况,C组HRR1优于A组、B组、D组(P0.05),B组HRR1优于A组、D组(P0.05),A组的HRR1优于D组(P0.05)。运动能力方面,A组、C组的PP、VO2peak、AT均优于B组、D组(P0.05),且C组的PP、VO2peak、AT优于A组但无显著性意义(P0.05),B组PP、VO2peak、AT与D组比较无显著差异(P0.05)。C组的心率变异性指标改善优于A组、B组、D组。C组的氧化应激水平改善优于A组、B组、D组。结论:与单纯有氧运动治疗或单纯电针治疗相比,二者结合的联合治疗方法可以更显著地改善患者的心率恢复情况和运动能力,同时患者的自主神经功能和氧化应激水平也得到了明显改善。     

康复运动对冠心病患者心脏自主神经功能的影响

摘要 目的：探讨有氧运动对冠心病患者心脏自主神经功能的影响。 方法：18例女性冠心病患者（实验组）,14例女性非冠心病患者（对照组）为本研究的受试者,在康复程序前、后,对她们进行了运动前（安静时）和运动后的心率变异性（HRV）指标的测定,其中包括极低频功率（VLF）、低频功率（LF）、高频功率（HF）、总功率（TP）和低高频比值（LF/HF）。 结果：①与对照组相比,实验组康复程序前安静时VLF、LF、HF和TP均显著降低,而LF/HF显著增高（P＜0.01）,运动后也有相似的趋势。②与康复程序前相比,12周心脏康复程序后,实验组安静时VLF、LF、HF和TP均有显著增高,LF/HF有所降低（P＜0.01和P＜0.05）;运动后HF显著增高,LF/HF显著降低（P＜0.05）。③与安静时相比,康复程序前实验组递增负荷运动后心率变异性指标均无显著性改变;康复程序后实验组递增负荷运动后VLF、LF、TP和LF/HF均有显著降低（P＜0.01和P＜0.05）;对照组递增负荷运动后VLF、LF、HF和TP均有显著降低（P＜0.01和P＜0.05）,LF/HF有显著增高（P＜0.01）。 结论：12周运动心脏康复程序不仅可以提高冠心病患者安静时自主神经的调节功能,而且对改善一次急性运动后自主神经的均衡性也有积极作用。     

吸烟对老年男性冠心病患者自主神经功能康复的影响

目的:探索吸烟对老年冠心病患者自主神经功能康复的影响。方法:33例男性冠心病患者,根据吸烟情况分为吸烟组、不吸烟组,为了能针对吸烟对冠心病患者自主神经功能影响进行定量的分析,本研究又进一步根据吸烟的数量将吸烟组分为轻度亚组(≤20支/日)和重度亚组(20支/日)[1]。在心脏康复程序前后对他们进行了运动前(安静时)和递增负荷运动实验后(运动后)的心率变异性(HRV)指标以及辅助指标的测定,其中包括低频功率(LF)、高频功率(HF)、低高频功率比值(LF/HF)、总功率(TP)、心肌缺血(ST段)和心率收缩压双乘积(RPP)。结果:1康复程序前安静时两组患者间的LF、HF、LF/HF、TP、ST段、RPP未显示出显著性差异;2康复程序前运动后两组患者LF、LF/HF、RPP有升高的趋势,HF、TP、ST段有降低的趋势;3康复程序后安静时,与康复前相比两组患者HF和TP有显著性增高(P0.05,P0.01),但吸烟组HF、TP的改善程度小于不吸烟组,二者间有显著性差异(P0.05),吸烟组的重度亚组HF、TP的改善小于轻度亚组,亚组间有显著性差异(P0.05);4康复程序后运动后,与康复前相比两组患者HF有显著性增高(P0.05,P0.01),ST段降低显著减少(P0.05),LF/HF、RPP有显著性下降(P0.05,P0.01),吸烟组HF、RPP的改善程度小于不吸烟组,二者间有显著性差异(P0.05),吸烟组的亚组间HF有显著性差异(P0.05)。结论:12周运动心脏康复能提高冠心病患者自主神经的调节功能,但是吸烟将降低心脏自主神经功能的恢复效果。     

高血压患者腹腔镜手术CO2气腹过程中自主神经功能的变化

目的 探讨高血压患者在腹腔镜手术CO2气腹过程中自主神经功能的变化.方法 应用心率变异性(HRV)分析法对25例择期高血压患者腹腔镜手术(Ⅰ组)和25例无高血压腹腔镜手术患者(Ⅱ组)麻醉前、气管插管结束后15 min、腹腔内CO2充气完成后的心率变异性改变进行分析.结果 麻醉诱导及插管15min后Ⅰ组低频(LF)、高频(HF)、低频与高频的比值(LF/HF)及总功率(TP)显著降低(P＜0.05),Ⅱ组LF、LF/HF、11P亦显著降低(P＜0.05),而HF未见明显改变.腹腔CO2充气完成后两组HRV值均显著升高(P＜0.05).组间比较显示,插管15min后Ⅰ组HF和TP显著低于Ⅱ组,LF和LF/HF组间差异无统计学意义;气腹后Ⅰ组HF和TP亦显著低于Ⅱ组.而LF/HF显著高于Ⅱ组,LF组间差异仍无统计学意义.结论 高血压患者迷走神经活性厦总自主神经张力显著低于非高血压患者,迷走神经对心脏窦房结的调控作用严重受损.     

老年带状疱疹后神经痛患者的自主神经功能观察

目的:观察老年带状疱疹后神经痛患者的自主神经状态。方法:选取老年带状疱疹后神经痛患者33例为观察组(P组),正常老年人50例为对照组(C组)。采用HRV检测仪,观察两组的心率变异性情况。结果:P组心率变异性频谱分析低频正常化单位(LF%)、低高频功率比值(LF/HF)明显高于C组(P>0.05);高频功率(HF)、低频功率(LF)和高频正常化单位(HF%)与C组相比无统计学差异性(P>0.05)。结论:老年带状疱疹后神经痛患者自主神经功能紊乱,交感神经功能处于优势。     

康复运动对冠心病患者心脏自主神经功能的影响

目的探讨康复运动对冠心病患者心脏自主神经功能的影响。方法 30例冠心病患者作为实验组,30例健康人作为对照组。实验组患者采用个性化康复运动进行治疗,对照组不做处理。比较2组运动前后VLF、LF、HF、TP、LF/HF及心电运动指标。结果 2组治疗前后各频段功率比较,差异有统计学意义(P0.05)。与对照组相比,实验组患者治疗前后各频段功率均较低,而In LF/In HF仅在运动前较高,差异有统计学意义(P0.05)。与运动前相比,对照组In HF、In LF、In VLF均降低,差异有统计学意义(P0.05)。实验组治疗后的运动后各指标均有较大改善,与运动前比较差异有统计学意义(P0.05)。与治疗前比较,实验组患者治疗后运动前各频段指标差异均有统计学意义,运动后In HF增高,In LF/In HF降低,差异有统计学意义(P0.05)。治疗后实验组患者心率增值、最大收缩压、最大舒张压、心率-血压乘积、最大ST段压低和最大运动负荷均有较大程度的改善,与治疗前比较差异有统计学意义(P0.05)。结论康复运动对冠心病患者心脏自主神经功能有积极的调节作用。     

运动与吸烟对健康青壮年男性心率变异性的影响

目的:探讨每周训练时长与吸烟两个潜在的自主神经功能影响因子对健康青壮年男性心率变异性(HRV)的交互影响,为改善青壮年男性人群自主神经功能、降低心血管疾病发病率提供相应参考。方法:本研究共选取了149例受试者,依据受试者吸烟指数的大小分为不吸烟组(N组,n=66例)、吸烟多组(M组,n=45例)以及吸烟少组(F组,n=38例),其中,N组、M组和F组依据每周训练时间的长短又都分为运动多和运动少两个亚组,分别为:不吸烟运动少组(NF组,n=28例)、不吸烟运动多组(NM组,n=38例)、吸烟多运动多组(MM组,n=22例)、吸烟多运动少组(MF组,n=23例)、吸烟少运动多组(FM组,n=18例)和吸烟少运动少组(FF组,n=20例)。HRV测试包括时域指标有SDNN、RMSSD、SDSD以及PNN50等,频域指标有TP、HF、LF、HFnu、LFnu、LF/HF以及VLF等。结果:(1)不吸烟时,NM和NF组心率变异性的时域及频域各指标相差不大(P0.05);吸烟相对较少时,FM组的TP、HF和LF等指标的值均大于FF组对应指标的值(P0.05);吸烟相对较多时,MM组的LF/HF值大于MF组的LF/HF值(P0.05)。(2)运动相对较少时,NF组的LF值大于MF组的LF值(P0.05);运动相对较多时,NM组和FM组各时域及频域指标中除LF/HF和LFnu以外的其他各项指标的均值均大于MM组对应各指标的均值,其中,FM组的RMSSD和SDSD等的值与MM组对应两指标值的差异具有显著性意义(P0.05)。结论:(1)吸烟和缺乏规律性的健身活动(每周训练时间少于300min)都是影响心率变异性的风险因素。(2)吸烟指数少于200者,规律性的健身活动(每周总时长超过300min)对于心率变异性存在明显的改善作用。(3)吸烟指数大于200者,规律性的健身活动(每周总时长超过300min)未能干预吸烟对心率变异性形成的不良影响,必须戒烟。(4)运动强度作为影响心率变异性的一个重要因子,建议后续研究运动对于心率变异性影响时应作重点具体化考量。(5)吸烟引起心率变异性的变化是个急性效应,建议后续研究吸烟对于心率变异性的影响可以将每日吸烟支数作为影响因子。     

右美托咪定对支撑喉镜手术心率变异性的影响

目的研究右美托咪定对支撑喉镜手术心率变异性的影响。方法选择ASA分级Ⅰ~Ⅱ支撑喉镜手术患者60例,随机分成两组,D组在全麻诱导前15 min给予右美托咪定0.6μg/kg,C组以等容量的0.9%氯化钠溶液输注,两组采用相同的麻醉诱导维持用药、复苏方法。分别记录两组诱导前15 min(T0)、插管时(T1)、手术操作时(T2)、拔除气管导管时(T3)、拔除气管导管5 min后(T4)的心率变异性(HRV)频域分析指标低频功率(LF)和高频功率(HF),计算低频功率与高频功率的比值(LF/HF)。结果与T0比较,D组T2~T4时点HF值明显升高(P0.05),LF变化不明显,LF/HF明显降低(P0.05),与C组比较T2~T4时点HF值明显升高(P0.05),LF变化不明显,LF/HF明显降低(P0.05)。结论支撑喉镜手术中,单次应用右美托咪定能改变HRV,达到交感与迷走调节的均衡性,稳定心血管反应。     

有或无更年期症状妇女的短程心率变异性分析及临床应用

目的探讨有或无更年期症状妇女的短程心率变异性及其临床应用价值。方法收集2016年3至10月在山西医科大学第一附属医院妇科门诊诊断为更年期综合征的患者57例为更年期组(A组),将A组按Kupperman症状严重程度分为轻度组(A1)、中度组(A2)、重度组(A3),依据有无潮热将A组分为无潮热组(A4)与有潮热组(A5)。随机抽取体检中心健康妇女61例为对照组(B组),进一步分为围绝经期组(B1组)与绝经后组(B2组)。采用5 min自主神经功能检测仪监测记录每位受试者的高频功率(HF)、低频功率(LF)、低频正常化单位(LF%)、低高频功率比值(LF/HF)。结果与B组相较,A组HF明显升高(P<0.01),而LF/HF、LF%明显降低(P<0.01);B2组HF、LF低于B1组(P<0.05);各指标在A1、A2、A3组无统计学差异(P>0.05);各指标在A4、A5组亦无统计学差异(P>0.05)。结论有更年期症状的妇女存在自主神经紊乱,且副交感神经功能可能处于优势地位;心率变异性分析可以辅助诊断更年期综合征及评价其治疗效果。     

脑瘫患儿诱导气管插管过程中自主神经功能的变化

目的探讨脑瘫患儿腹部手术全麻诱导气管插管过程中自主神经系统功能的变化。方法应用心率变异性(HRV)分析法分析30例择期脑瘫患儿腹部手术(A组)和30非脑瘫患儿腹部手术(B组)麻醉前、麻醉诱导后、气管插管后的心率变异性。结果麻醉诱导后A组的低频(LF)、高频(HF)、LF/HF、总张力(TP)降低,B组的LF、LF/HF及TP亦降低,但HF末见明显改变;气管插管后两组的HRV值均升高;麻醉诱导后及气管插管后A组的HF和TP低于B组(P<0.05~0.01),而LF与B组间无显著性差异。结论麻醉诱导气管插管过程中脑瘫患儿神经活性及总自主神经张力低于非脑瘫患儿,脑瘫患儿迷走神经对心脏窦房结的调控作用受损。     

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.     

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.     

Molecular characterization of virulence and antimicrobial resistance profile of Shigella species isolated from children with moderate to severe diarrhea in northeastern Brazil

Molecular characterization of virulence and antimicrobial resistance profiles were determined for Shigella species isolated from children with diarrhea in Fortaleza, Brazil. Fecal specimens were collected along with socioeconomic and clinical data from children with moderate to severe diarrhea requiring emergency care. Shigella spp. were isolated by standard microbiological techniques, and we developed 4 multiplex polymerase chain reaction assays to detect 16 virulence-related genes (VRGs). Antimicrobial susceptibility tests were performed using disk diffusion assays. S. flexneri and S. sonnei were the predominant serogroups. S. flexneri was associated with low monthly incomes; more severe disease; higher number of VRGs; and presence of pic, set, and sepA genes. The SepA gene was associated with more intense abdominal pain. S. flexneri was correlated with resistance to ampicillin and chloramphenicol, whereas S. sonnei was associated with resistance to azithromycin. Strains harboring higher numbers of VRGs were associated with resistance to more antimicrobials. We highlight the correlation between presence of S. flexneri and sepA, and increased virulence and suggest a link to socioeconomic change in northeastern Brazil. Additionally, antimicrobial resistance was associated with serogroup specificity in Shigella spp. and increased bacterial VRGs.     

护理干预对面部中重度寻常型痤疮的临床疗效影响分析

目的研究护理干预对面部中重度寻常型痤疮的临床疗效影响。方法选取本院在2014年4月~2016年7月诊治的136例面部中重度寻常型痤疮患者,随机分为研究组与对照组,每组68例;所有患者均依据其情况给予对应的治疗,其中对照组在治疗期间给予常规护理,研究组在对照组的基础上再给予综合性护理干预,比较两组的治疗效果及护理满意度情况等。结果患者在接受治疗和护理后,研究组中度与重度患者的治疗效果较对照组均明显提高(P0.05),研究组护理满意度较对照组明显增高(P0.05)。结论对面部中重度寻常型痤疮患者在其治疗期间给予综合性护理干预,具有良好的效果。