复方丙酸氯倍他索软膏联合UVB治疗寻常型银屑病的临床疗效及护理

目的 探讨用复方丙酸氯倍他索软膏联合UVB照射,并配合护理措施治疗寻常型银屑病的临床疗效.方法 治疗组于患处外涂复方丙酸氯倍他索软膏,每天2次,行UVB全身照射,1周2～3次,并配合适当的护理措施.对照组于患处外涂复方丙酸氯倍他索软膏,每天2次.根据PASI评分标准评价疗效.结果 治疗组有效率88.46%,对照组有效率65.38%,经统计学处理,x2=7.8000,P＜0.01;治疗组复发率19.05%,对照组复发率53.85%,经统计学处理,x2=4.4472,P＜0.05.结论 复方丙酸氯倍他索软膏联合UVB照射并配合适当的护理措施是治疗寻常型银屑病的有效方法.     

复方环磷腺苷乳膏治疗寻常型银屑病56例疗效观察及护理

目的：探讨复方环磷腺苷乳膏治疗寻常型银屑病的临床疗效及护理方法。方法：将112例寻常型银屑病患者按就诊顺序采用单双号抽签的方法分为治疗组和对照组各56例，治疗组于患处外涂复方环磷腺苷乳膏，2次／d，并配合适当的护理措施；对照组于患处外涂丙酸氯倍他索乳膏，2次／d。疗程均为12周，采用统一的评定标准进行疗效和安全性评价。结果：治疗组有效率94．64％，复发率20．00％；对照组有效率82．14％，复发率47．62％，两组比较均有显著性差异（P〈0．05）。结论：复方环磷腺苷乳膏配合适当护理措施是治疗寻常型银屑病的有效方法。     

复方环磷腺苷乳膏治疗寻常性银屑病的疗效与护理

目的探讨复方环磷腺苷乳膏治疗寻常性银屑病的临床疗效和护理方法。方法治疗组于患处外涂复方环磷腺苷乳膏,2次／d,并配合适当的护理措施;对照组于患处外涂维A酸乳膏,2次／d,疗程均为3月,根据PASI评分标准评价疗效。结果治疗1月、2月、3月后,治疗组积分下降明显优于对照组。两组比较差异有统计学意义（P〈0．05,P〈0．01）;治疗组有效率94．12％,对照组有效率61．78％．两组比较差异有统计学意义（P〈0．01）,治疗组复发率16．67％,对照组复发率45．45％,两组比较差异有统计学意义（P〈0．05）。结论复方环磷腺苷乳膏外用配合适当的护理措施是治疗寻常性银屑病的有效方法。     

复方环磷腺苷乳膏治疗寻常型银屑病56例疗效观察及护理

目的:探讨复方环磷腺苷乳膏治疗寻常型银屑病的临床疗效及护理方法.方法:将112例寻常型银屑病患者按就诊顺序采用单双号抽签的方法分为治疗组和对照组各56例,治疗组于患处外涂复方环磷腺苷乳膏,2;k/d,并配合适当的护理措施;对照组于患处外涂丙酸氯倍他索乳膏,2次/d.疗程均为12周,采用统一的评定标准进行疗效和安全性评价.结果:治疗组有效率94.64%,复发率20.00%;对照组有效率82.14%,复发率47.62%,两组比较均有显著性差异(P＜0.05).结论:复方环磷腺苷乳膏配合适当护理措施是治疗寻常型银屑病的有效方法.     

多种方法联合治疗寻常型银屑病疗效观察

目的探讨寻常型银屑病有效的治疗手段。方法103例寻常型银屑病患者随机分为治疗组和对照组,治疗组给予复方甘草酸苷、香丹注射液静脉滴注、阿维A胶囊口服,窄谱中波紫外线照射、卡泊三醇软膏外涂皮损;对照组给予阿维A胶囊口服、窄谱中波紫外线照射。两组疗程均为4周,观察皮损消退情况及不良反应。结果观察组和对照组有效率分别为94．34％、84％,两组比较差异有统计学意义（x2=4．806,P〈0．05）。结论香丹、复方甘草酸苷联合阿维A胶囊、卡泊三醇软膏、窄谱中波紫外线照射治疗寻常型银屑病疗效较好,无明显不良反应。     

阿维A胶囊治疗寻常性银屑病疗效观察

目的观察阿维A胶囊治疗中、重度寻常性银屑病的疗效。方法将75例中、重度寻常性银屑病患者随机分为治疗组和对照组,治疗组外搽丙酸氯倍他索软膏,口服阿维A胶囊;对照组外搽丙酸氯倍他索软膏,口服郁金银屑片。结果71例患者完成试验。治疗组36例患者,治愈16例（44．44％）,显效10例（27．78％）,有效6例（16．67％）,无效4例（11．11％）,总有效率72．22％;复发3例,复发率18．75％。对照组35例患者,治愈5例（14．29％）,显效8例（22．86％）,有效6例（17．14％）,无效16例（45．71％）,总有效率37．15％;复发5例,复发率100％。2组治愈率、总有效率及复发率比较差异均有显著性（均P〈0．01）。结论阿维A胶囊治疗中、重度寻常性银屑病疗效满意、复发率低。     

氧疗和湿润烧伤膏配合神灯治疗重度红臀的效果观察

[目的]观察局部氧疗和湿润烧伤膏外涂配合神灯照射治疗重度红臀的效果。[方法]将60例重度红臀的婴幼儿随机分为观察组和对照组各30例。经常规处理后,观察组采用患处局部氧疗和湿润烧伤膏外涂配合神灯治疗仪照射治疗,每天2次。对照组患处采用传统的鞣酸软膏外涂的方法治疗,每天3次或4次。两组治疗均为3d1个疗程。[结果]观察组、对照组治愈率分别为100.0%,63.3%,经比较差异有统计学意义(P<0.01)。[结论]氧疗和湿润烧伤膏外涂配合神灯治疗仪照射治疗重度红臀能加快红肿消退、收敛创口、促进表皮生长,从而提高治愈率。     

窄谱中波紫外线联合丙酸氟替卡松治疗寻常型银屑病疗效观察

目的观察窄谱中波紫外线联合丙酸氟替卡松治疗寻常型银屑病的临床疗效。方法 160例寻常型银屑病患者随机分对照组和观察组两组,每组各80例。对照组组使用窄谱中波紫外线治疗仪照射全身,初始剂量0.3 J/cm2,以后每次照增加15%照射剂量,隔日照射1次;观察组在对照组实施相同治疗基础上,联合丙酸氟替卡松软膏外涂患处2次/d。总疗程1个月。结果观察组总有效率为91.25%;对照组总有效率为67.50%;观察组总有效率高于对照组(P<0.05);观察组不良反应发生率17.50%与对照组的18.75%比较差异无统计学意义(P>0.05)。结论窄谱中波紫外线照射联合丙酸氟替卡松治疗寻常型银屑病患者,具有协同作用,能提高疗效,不良反应轻微,值得临床应用。     

新氢松与丹皮酚软膏序贯使用联合荆肤止痒颗粒治疗婴儿湿疹61例疗效观察

目的观察新氢松与丹皮酚软膏序贯使用联合荆肤止瘁颗粒治疗婴儿湿疹的疗效及安全性。方法治疗组61例全程口服荆肤止痒颗粒1．5g，2次／d。第1周每天早、晚外涂新氢松软膏，中午外涂丹皮酚软膏；第2周早、晚外涂丹皮酚软膏，中午外涂新氢松软膏；第3周，早、晚外涂丹皮酚软膏。对照组59例连续外用新氢松软膏，前两周2次／d，第3周改为1次／d。两组均治疗3周判定疗效，治疗过程中观察不良反应。随访4周。结果治疗组痊愈率72．1％，对照组痊愈率54.2％（χ^2=4．14，P〈0.05）。治疗组复发率45．5％，对照组复发率71.9％（χ^2=5.26，P〈0．01）。两组均未见明显不良反应。结论新氢松与丹皮酚软膏序贯使用联合荆肤止痒颗粒治疗婴儿湿疹近、远期疗效均优于单用新氢松软膏，且安全可靠。     

氦氖激光照射联合高锰酸钾液外用治疗成人水痘的疗效

【目的】探讨氦氖激光照射联合高浓度高锰酸钾液外用治疗成人水痘的临床疗效。【方法】选择成人水痘患者52例,根据患者意愿分为试验组和对照组,试验组27例,采用高浓度高锰酸钾液外涂患处皮损,再用XH—HN型多功能氦氖激光治疗机照射治疗患处皮损,每处10min,每日1次,共7d;对照组25例,用阿昔洛韦软膏外涂患处。【结果】试验组在止痒、退热、疱疹结痂时间上,疗效显著优于对照组（P〈0．05）,且病程明显缩短（P〈O．05）。【结论】氦氖激光照射联合高浓度高锰酸钾液外用治疗成人水痘能明显提高疗效,值得临床推广应用。     

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.     

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.