米索前列醇配伍缩宫素预防产后出血的临床观察

目的探讨米索前列醇配伍缩宫素预防产后出血的临床效果。方法选用有产后出血高危因素阴道分娩的产妇32 0例 ,随机分为米索前列醇加缩宫素组 (观察组 ) 1 2 0例、米索前列醇组 1 1 0例及缩宫素组 90例。米索前列醇组于第 2产程末 ,胎头着冠时 ,给予米索前列醇 40 0 μg口服 ,缩宫素组在胎儿娩出时 ,立即静脉注射缩宫素 2 0U ;观察组用药分别同以上两组。结果第 3产程时间及产后 2小时总出血量 ,米索前列醇组与观察组比较 ,无显著性差异 (P >0 .0 5 ) ,缩宫素组与观察组比较 ,有显著性差异 (P <0 .0 5 )。结论米索前列醇配伍缩宫素预防产后出血疗效显著     

米索前列醇防治轻度妊高征产后出血疗效观察

目的 比较米索前列醇防治妊高征产后出血的效果.方法 将40例妊高征患者随机分为2组:米索前列醇组、催产素组,各20例.胎儿娩出后米索前列醇组立即口服米索前列醇400μg,催产素组立即臀部肌肉注射催产素20IU,观察各组的产后出血、第3产程、用药前后平均动脉压、血红蛋白变化以及副作用情况.结果 米索前列醇组较催产素组出血量少,第3产程缩短,具有统计学差异(P＜0.05).两组用药前后MAP和Hb均无明显变化(P＞0.05).结论 米索前列醇用于防治妊高征产后出血疗效优于催产素,无明显循环改变和副作用.     

米索前列醇预防产后出血的效果观察

目的观察米索前列醇用于预防产后出血的效果。方法选择 30 0例阴道分娩者 ,随机分为米索前列醇组和缩宫素组。米索前列醇组 1 52例 ,在胎儿娩出后一次性口服米索前列醇 60 0 μg ;缩宫素组 1 4 8例 ,胎儿娩出后经臀部肌内注射缩宫素 2 0U。观察产后出血量。结果米索前列醇组第三产程平均时间为 8.78分钟 ,缩宫素组 8.0 8分钟 ,两组无显著性差异 (P >0 .0 5)。产后 2小时内出血量 :米索前列醇组为 (387.51± 62 .34)ml,缩宫素组为 (30 9.1 3± 57.2 0 )ml;产后 2 4小时内平均出血量 :米索前列醇组为 (443 .72± 64 .33)ml,缩宫素组为 (365 .87± 60 .2 5)ml,两组比较有显著性差异 (P <0 .0 5)。结论米索前列醇预防产后出血的作用较缩宫素弱。     

米索前列醇预防妊高征剖宫产术后出血的临床观察

目的 观察米索前列醇用于预防妊娠高血压综合征(下称妊高征)剖宫产术后出血的效果.方法 选择96例妊高征剖宫产者,随机分为研究组及对照组.研究组41例,术中打开腹膜时口服米索前列醇600 μg;对照组45例,胎儿娩出后,宫体肌内注射缩宫素20 U,再静脉滴注缩宫素20 U.观察两组术中及术后2 h内出血量.结果 术中及术后2 h平均出血量,研究组为242.6±86.2 ml,对照组为344.3±181.2 ml,差异有统计学意义(P＜0.001).结论 米索前列醇促进子宫收缩的作用较强,能较好地预防妊高征剖宫产术后出血.     

米索前列醇配合缩宫素预防产后出血316例临床观察

目的:观察米索前列醇配合缩宫素预防产后出血的效果.方法:选取我院足月妊娠且无妊娠并发症,近期内未使用前列腺制剂的自然分娩者626例,随机分为观察组(316例)、对照组(310例).对照组予胎儿前肩娩出后即注射缩宫素20 U;观察组注射缩宫素10 U,在胎儿娩出后1小时口服米索前列醇400 μg.观察两组第3产程时间、产后2小时出血量、产后出血率、血压的变化.结果:第3产程时间、产后 2小时出血量、产后出血发生率观察组分别为(8.2±3.5)分钟、(151.9±46.8)mL、0.6%,对照组分别为(12.9±3.9)分钟、(248.3±69.3)mL、4.0%,两组比较差异有统计学意义(P＜0.01).两组产后血压比较差异无统计学意义(P＞0.05).结论:米索前列醇配合缩宫素预防产后出血优于单用缩宫素,值得临床推广.     

米索前列醇联合缩宫素预防产后出血疗效观察

目的观察米索前列醇联合缩宫素预防产后出血的疗效。方法将120例产后出血患者随机分为治疗组和对照组,治疗组在胎儿娩出后予米索前列醇直肠给药,并肌肉注射缩宫素;对照组仅肌肉注射缩宫素。观察并对比两组产后2h出血量和第三产程时间等变化。结果治疗组产后2h出血量和第三产程时间较对照组显著减少（P〈0．01或P〈0．05）。结论米索前列醇联合缩宫素能够有效加强宫缩,预防产后出血。     

米索前列醇配伍缩宫素预防高危妊娠产后出血的临床观察

目的探讨米索前列醇配伍缩宫素预防高危妊娠产后出血的临床效果。方法选用高危分娩因素以及有产后出血高危因素阴道分娩的产妇280例。随机分为米索前列醇加缩宫素组（观察组）100例，米索前列醇组90例，缩宫素组90例。米索前列醇组于胎儿娩出后给予米索前列醇600μg口服，缩宫素组在胎儿娩出时，立即静脉注射缩宫素20U；观察组用药分别同以上两组。结果第3产程时间，产后2小时出血量及产后24小时总出血量，米索前列醇组与观察组比较，无显著差异（P〉0．05），缩宫素组与观察组比较，有显著性差异（P〈0．05）。结论米索前列醇配伍缩宫素预防高危妊娠产后出血疗效显著。     

舌下含服米索前列醇预防产后出血的临床观察

目的探讨舌下含服米索前列醇预防产后出血的效果。方法将可能发生产后出血的 384例高危产妇分为两组 :试验组 194例 ,第二产程末胎儿娩出后立即舌下含服米索前列醇 4 0 0 μg ;对照组 190例 ,第二产程末胎儿娩出后静脉注射缩宫素 2 0U。观察产后 2小时出血量。结果产后 2小时出血量 ,试验组及对照组分别为 (16 8.73± 89.78)ml、(2 6 2 .31± 10 1.4 6 )ml,有显著性差异 (P <0 .0 5 )。结论舌下含服米索前列醇 ,促进子宫收缩作用强于缩宫素 ,能减少产后出血量 ,并且用药简单方便 ,宜于推广。     

米索前列醇治疗妊高征产后出血30例分析

目的观察米索前列醇对妊振高血压综合征(妊高征)患者产后出血的疗效。方法60例妊振高血压综合征患者在分娩中随机分成两组:试验组和对照组各30例。试验组,胎儿娩出后立即给予米索前列醇400μg口服,对照组在胎儿娩出后立即臀部肌肉注射缩宫素20 IU。观察两组患者的第三产程时间、产后出血量、产后出血发生率以及使用米索前列醇组药物前后的血压变化。结果①试验组:第三产程时间7.28±3.33 min,产后出血量173.5±93.5ml,产后出血发生率6.7%;对照组:第三产程时间9.62±3.55 min,产后出血量280.5±120.8 ml,产后出血发生率26.7%。两组相比试验组第三产程时间、产后出血量及产后出血发生率皆明显低于对照素组(P<0.01)。②30例服用米索前列醇的患者服药前收缩压21.2±3.1 kPa,舒张压13.1±2.06 kPa;服药后收缩压19.6±2.01 kPa,舒张压13.1±1.64 kPa.服药后收缩压和舒张压皆有所下降,但差异无显著性(P>0.05)。③试验组出现2例恶心及呕吐,5例寒颤,皆为一过性,无需特殊处理。结论妊高征患者胎儿娩出后口服米索前列醇400μg能产生强有力的子宫收缩,缩短第三产程,减少产后出血,是一种简单、安全、高效的预防妊高征患者产后出血的方法。     

垂体后叶素、米索前列醇联合缩宫素治疗产后出血的临床分析

目的研究垂体后叶素、米索前列醇联合缩宫素治疗产后出血的临床治疗效果。方法选取100例产后出血的孕产妇,将其分为对照组与观察组,对照组应用缩宫素单一治疗,观察组应用垂体后叶素、米索前列醇联合缩宫素治疗。对比产后出血量及治疗效果并进行临床治疗分析。结果垂体后叶素、米索前列醇联合缩宫素治疗方法的出血量明显少于单一治疗法,治疗效果明显优于单一治疗法,这是一种有效的治疗孕产妇产后出血症状的方法。结论垂体后叶素、米索前列醇联合缩宫素治疗法不能作用于心脏器官出现问题及妊高征、脑部血管受损、癫痫病的患者等,该治疗方法有人群限制,然而总体来说,这种治疗方法花费的成本少、操作简便,是一种非常值得推广的产后出血治疗方案。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.