催产素静滴同乳房按摩引产方法比较

催产素引产同乳房按摩引产的对比研究各60列,两组宫颈评分≤6分和≥7分总成功率无差别,P>0.9,P>0.75;但当宫颈评分≤6分时,两组成功率20.8％,当宫颈评分≥7分时,两组成功率87.7％,则有显著差别.P<0.05。结果提示:当宫颈评分≤6分时,可先采用乳房按摩引产;当宫颈评分≥7分时,采用催产素引产较好。     

宫颈扩张球囊加催产素引产和单纯催产素引产的临床疗效对比观察

目的:观察宫颈扩张球囊加催产素引产和单纯催产素引产的临床疗效。方法:将引产的孕妇共60例作为研究对象,根据随机分组的原则,分为对照组和观察组各30例。两组孕妇Bishop评分均≤6分,其中宫颈管消退评分≤1分。对照组孕妇进行单纯催产素引产,观察组孕妇进行宫颈扩张球囊加催产素引产。比对两组产妇的并发症发生情况;比对两组孕妇分娩时间、总产程时间等相关指标。结果:观察组孕妇并发症发生情况显著低于对照组,差异具有统计学意义(P<0.05)。观察组孕妇分娩时间、总产程时间等相关指标显著低于对照组,差异具有统计学意义(P<0.05)。结论:对孕周≥41周或因其他因素需终止妊娠的足月孕妇,宫颈条件不成熟进行宫颈扩张球囊加催产素引产可有效降低孕妇并发症发生情况,临床效果良好,具有一定价值。     

宫颈分泌物胎儿纤连蛋白检测与宫颈Bishop评分在延期妊娠引产预测中的应用

目的探讨宫颈分泌物胎儿纤连蛋白（fetal fibronectin,FFN）检测与宫颈Bishop评分在延期妊娠引产预测中的应用价值。方法对48例孕41-41＋6周孕妇引产前进行宫颈分泌物FFN检测及宫颈Bishop评分,按催产素引产常规引产,并记录取样至分娩时间。结果宫颈分泌物FFN阳性组、宫颈Bishop评分≥7分组3 d内引产分娩率均明显高于宫颈分泌物FFN阴性组、宫颈Bishop评分≤6分组（91.9%、81.3%vs 27.3%、25.0%,P均〈0.01）。宫颈Bishop评分≥7分的宫颈分泌物FFN阳性组〈24、〉72、24-72 h引产成功率均明显高于宫颈Bishop评分≤6分的宫颈分泌物FFN阳性组（60.0%、6.7%、33.3%vs 0、42.9%、57.1%,P均〈0.01,P〈0.05）。结论宫颈分泌物FFN检测联合宫颈Bishop评分进行引产预测,可提高引产成功率。     

COOK双球囊联合催产素用于羊水偏少足月妊娠引产疗效研究

选取2013年10月~2014年10月期间笔者收治的84例羊水偏少且具引产指征的足月妊娠产妇,随机分为观察组及对照组两组,各42例,对照组予以催产素进行引产,观察组给予COOK双球囊联合催产素进行引产,比较两组促宫颈成熟效果、分娩情况及引产成功率。两组治疗后宫颈成熟效果Bishop评分较治疗前均有所提高,且治疗后观察组评分7.98±2.01分,显著优于对照组6.15±1.16分,差异有统计学意义(P<0.05);观察组自然分娩31例(73.81%)显著高于对照组12例(28.57%),观察组产后出血量平均为133.5±52.2ml低于对照组161.2±50.5ml,差异有统计学意义(P<0.05);两组新生儿窒息及胎儿窘迫发生率差异无统计学意义(P>0.05)。COOK双球囊联合催产素用于羊水偏少足月妊娠引产其促宫颈成熟效果及引产成功率明显优于单独应用催产素,方法安全、有效。     

米非司酮用于晚期妊娠引产的临床疗效观察

选取2012年1月~2014年8月我院收治的100例晚期妊娠难以常规引产的孕妇,随机将其分为观察组和对照组各50例。对照组予以普拉睾酮静脉注射加催产素静滴,观察组采用米非司酮口服加催产素静滴。观察并比较两组的催产素用量、引产成功率及Bishop评分。结果两组比较,观察组Bishop评分增加3.5±2.3分,对照组增加2.1±1.3分,观察组评分明显比对照组高;观察组引产成功率100.0%,对照组引产成功率100.0%,观察组引产成功率与对照组相同,差异无统计学意义(P<0.05);但观察组使用的催产素用量比对照组少。米非司酮用于晚期妊娠引产效果显著,具有引产时间短、促进宫颈成熟、安全可靠等优点,值得在临床治疗中推广。     

宫颈分泌物胎儿纤维连接蛋白与宫颈Bishop评分预测延期妊娠引产效果观察

选取我院2013年12月~2015年12年收治的100例延期妊娠患者,均采用缩宫素进行引产,引产前行宫颈分泌物胎儿纤维连接蛋白检测及宫颈Bishop评分,记录引产开始至临产时间。f FN检测阳性组3d内引产分娩成功率为85.71%,显著高于f FN检测阴性组的22.73%(P0.05);Bishop评分≥6分组引产分娩成功率71.16%,显著高于Bishop评分6分组的43.75(P0.05);两者联合可将分娩成功率提升至93.10%,明显高于单独采用f FN检测阳性或宫颈Bishop评分≥6分者(P0.05)。f FN检测较之Bishop评分法预测延期妊娠引产分娩成功率较高,且f FN检测阳性与宫颈Bishop评分≥6分联合应用,可显著提高延期妊娠催产素引产分娩成功与否的预测价值,显著提高其预测引产分娩的成功率,降低无效引产率。     

欣普贝生用于足月胎膜早破引产的临床观察

目的:探讨欣普贝生用于足月胎膜早破引产的临床效果及安全性.方法:将90例足月胎膜早破6～12 h、宫颈Bishop评分3～6分、无阴道分娩禁忌证的单胎头位初产妇随机分为两组:45例欣普贝生组:阴道后穹窿放置欣普贝生引产,45例催产素组常规静滴催产素引产.比较两组产妇的宫颈Bishop评分和分娩情况、剖宫产率、新生儿窒息率和羊水污染发生率.结果:欣普贝生组促宫颈成熟有效率及引产成功率显著高于催产素组(P<0.05);欣普贝生组的剖宫产率(13.3%)低于催产素组(46.7%)(P<0.05);两组新生儿窒息率和羊水污染发生率差异无显著性.结论:欣普贝生用于足月胎膜早破促宫颈成熟和引产方便、安全、有效,能有效降低剖宫产率.     

经会阴B 超宫颈评分指标应用价值的探讨

目的 探讨经会阴Ｂ超宫颈成熟度评分指标的临床应用价值。方法 通过经会阴Ｂ超观测宫颈长度、内口扩张度、羊膜嵌入颈管内影像（ＨＭ）对１２５例孕妇宫颈成熟度进行评分,并与其临产时间、分娩方式相比较。结果 宫颈评分≥６分者２４小时内临产,第１组０～３分（３４例）,第２组４～６分（３４例）,第３组≥７分（３４例）的手术产率分别为７０．５９％,１４．７１％及８．８２％,０～３分组剖宫产率（５２．９４％）为≥７     

米索前列醇口服用于足月妊娠引产70例临床分析

目的 探讨小剂量口服米索前列醇用于足月妊娠引产的有效性和安全性。方法 A组70例，根据宫颈Bishop评分首次口服米索25pg～50pg，观察宫缩情况，若无规律宫缩则每3小时服药一次25μg，直至出现规律宫缩。总量不超过200μg；B组70例，静滴催产素引产作为对照组。结果两组引产成功率分别为88．57％和82．86％（P〉0．05）。A组从开始用药至临产时间较B组明显缩短（P〈0．05）。初产妇宫颈评分〈5分者，A组引产成功者高于B组（P〈0．05），两组剖宫产率，产时出血量及新生儿窒息的发生率均无显著性。结论小剂量米索口服用于足月妊娠引产，是一种安全、有效的方法。     

米索前列醇与催产素用于足月妊娠促宫颈成熟与引产的效果对比观察

目的对比米索前列醇与催产素在足月妊娠促宫颈成熟与引产中的效果。方法选取深圳市妇幼保健院足月妊娠、待引产的110例产妇,观察组以米索前列醇促宫颈成熟与引产,对照组静脉内滴注催产素。比较两组促宫颈成熟总有效率、引产成功率、分娩方式、用药前后宫颈Bishop评分及新生儿出生体质量、Apgar评分。结果用药前后两组宫颈Bishop评分均明显提高(P0.01),但观察组提高程度明显优于对照组(P0.01)。观察组促宫颈成熟总有效率、引产成功率及阴道分娩率均明显高于对照组(P0.05)。两组新生儿出生体质量和Apgar评分比较差异未见统计学意义(P0.05)。结论米索前列醇用于足月妊娠促宫颈成熟方便、有效,引产成功率高,产妇剖宫产率低,安全性较高,值得推广;使用时务必严格把握适应证,严密监测母儿情况,确保安全。     

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.