大脑中动脉粥样硬化责任斑块与非责任斑块的高分辨磁共振对比研究

目的 探讨高分辨磁共振成像(HR-MRI)评估大脑中动脉(MCA)粥样硬化患者高危斑块的价值。方法 选取88例症状性MCA粥样硬化患者(症状组)和23例无症状狭窄者(无症状组),行头颅TOF磁共振血管成像(MRA)、覆盖MCA的M1段的轴位T1WI、T2WI和对比剂增强T1WI(CE-T1),以及脑DWI。定量分析狭窄率、最小管腔面积、斑块负荷以及各序列中斑块的信号强度指数。结果 症状组中,责任斑块88个,非责任斑块20个;无症状组非责任斑块23个。症状组责任病变的狭窄率和斑块负荷均明显高于无症状组非责任病变者(狭窄率:63.61%±24.13% vs 55.61%±24.83%,P=0.002;斑块负荷:86.24%±13.83% vs 75.40%±17.08%,P<0.0001);且责任病变的最小管腔面积明显低于非责任病变[(0.95±0.70)mm² vs (2.22±0.65)mm²,P<0.0001]。责任斑块与非责任斑块间斑块的T2WI和T1WI信号强度指数差异均无统计学意义(P均>0.05),但责任斑块呈混杂信号者所占比例明显高于非责任斑块(P均<0.05),症状组责任病变的CE-T1信号强度指数也明显高于无症状组非责任斑块(1.66±0.59 vs 1.37±0.62,P=0.0002)。结论 与单纯应用狭窄率对MCA动脉粥样硬化患者进行评价相比,HR-MRI的MCA管壁成像能够提供更多有价值的信息。评价MCA粥样硬化责任斑块时除了狭窄率,还应结合斑块负荷、斑块信号和强化等形态学指标进行综合考虑。     

基于分段读出平面回波序列的体素内不相干运动DWI在单纯性鼻炎和慢性肥厚性鼻炎中的应用

目的 研究基于分段读出平面回波序列（RS-EP）单指数模型DWI、双指数模型体素内不相关运动（IVIM）成像诊断单纯性鼻炎和慢性肥厚性鼻炎的价值。方法 收集鼻阻塞患者20例,按病理结果分为单纯性鼻炎组和慢性肥厚性鼻炎组。所有受试者均接受RS-EP序列的IVIM和单指数模型DWI检查,获得IVIM参数纯扩散系数（D）、假性灌注系数（D^*）、灌注分数（f）和ADC参数图。分别测量2组下鼻甲黏膜的前、中、后部3个区域的参数值。比较2组和3个区域间各扩散参数值的差异,采用ROC曲线分析其诊断效能。结果 慢性单纯性鼻炎组的ADC和D值分别为（1 938.84±170.46）×10^-6 mm²/s和（1 698.91±145.17）×10^-6 mm²/s,慢性肥厚性鼻炎组ADC值为（1 681.76±132.21）×10^-6 mm²/s,D值为（1 439.39±101.26）×10^-6 mm²/s,2组间差异有统计学意义（P均<0.05）。D^*和f值2组间差异无统计学意义（P均>0.05）。下鼻甲黏膜前、中、后部ADC值依次增高（P均<0.05）;下鼻甲前、中、后部D^*值差异无统计学意义（P>0.05）。ROC曲线分析表明,D值的曲线下面积高于ADC值（0.932±0.044 vs 0.896±0.058,P<0.05）,其敏感度、特异度、准确率、阳性预测值和阴性预测值分别为92.31%、93.75%、90.00%、93.75%、85.71%。结论 基于RS-EP序列的IVIM成像和单指数DWI成像在鉴别单纯性鼻炎和慢性肥厚性鼻炎中具有较大的应用价值,其中基于IVIM模型的D值较常规ADC值具有更高的诊断效能。     

MRI鉴别诊断表现为磨玻璃结节的早期浸润性肺腺癌

目的 探讨MRI鉴别诊断表现为磨玻璃结节的早期浸润性肺腺癌的价值。方法 回顾性分析34例表现为肺部磨玻璃结节的肺腺癌患者的MRI资料,根据病理结果将其分为非浸润性腺癌组（包括不典型腺瘤样增生、原位腺癌和微浸润性腺癌,n=15）和浸润性腺癌组（n=19）。测量并比较2组病变的最大径、T2WI信号强度和ADC值,绘制ROC曲线,评价其鉴别诊断浸润性腺癌的效能。结果 非浸润性腺癌组病变最大径小于浸润性腺癌组[（9.91±2.63）mm vs（13.12±2.71）mm,P<0.01]。非浸润性腺癌组病变T2WI信号强度低于浸润性腺癌组（92.97±8.33 vs 113.57±22.88,P<0.01）。非浸润性腺癌组病变ADC值低于浸润性腺癌组[（0.98±0.22）×10^-3 mm²/s vs（1.34±0.31）×10^-3 mm²/s,P=0.01]。ROC曲线分析结果显示,病变最大径诊断浸润性腺癌与非浸润性腺癌的AUC为0.791,临界值为11.52 mm,敏感度为73.72%,特异度为73.33%。结论 病变最大径、T2WI信号强度、ADC值对鉴别诊断表现为磨玻璃结节的浸润性与非浸润性肺腺癌具有一定价值。     

定量CT对比观察轻-中度慢性阻塞性肺疾病及哮喘

目的 观察稳定期轻-中度慢性阻塞性肺疾病（COPD）与哮喘患者近端气道结构及CT肺功能的差异。方法 对30例轻-中度COPD患者（mtmCOPD组）、30例轻-中度哮喘患者（mtmAs组）及30名健康对照者（健康对照组）行低剂量呼吸双相CT扫描及定量分析，比较其近端气道参数、肺气肿及空气潴留指数的差异。结果 mtmCOPD组与mtmAs组近端气道平均管腔面积（LA）/体表面积（BSA）分别为（10.93±2.58）mm²/m²和（10.81±3.20）mm²/m²，均小于健康对照组的（12.56±2.98）mm²/m²，mtmAs组与健康对照组差异有统计学意义（P=0.04）；mtmCOPD组和mtmAs组平均管壁面积百分比（WA%）分别为（63.02±2.34）%和（63.85±2.48）%，均大于健康对照组的（61.55±3.54）%，mtmAs组与健康对照组差异有统计学意义（P<0.01）。mtmCOPD组呼吸双相VI_-910（%）及VI_-950（%）均大于健康对照组（P均<0.01），呼气相平均肺密度（MLD）绝对值、呼气相VI_-856（%）及MLD E/I均大于健康对照组（P均<0.05）。mtmCOPD组与mtmAs组气道结构参数、肺气肿及空气潴留指数差异均无统计学意义（P均>0.05）。结论 轻-中度COPD及哮喘患者近端支气管管腔面积较健康对照者均有缩小，近端气道管壁面积百分比较健康对照者均有增大，且轻-中度哮喘患者更加明显。轻-中度COPD患者存在明显肺气肿及空气潴留。     

弥散张量成像诊断新生儿和婴儿胆道闭锁

目的 探讨弥散张量成像（DTI）对新生儿和婴儿胆道闭锁（BA）的诊断价值。方法 收集疑诊为BA或其他胆道疾病的患儿46例,以手术探查、腹腔镜探查、术中造影、病理检查或临床治疗结果作为金标准,将患儿分为BA组与非BA组（non-BA组）。对所有患儿应用1.5T MR扫描仪,采用单次激发自旋回波平面成像DTI序列（b值为1000 s/mm²）行肝脏扫描,经后处理获得平均扩散系数（AvgDC）图及FA图,测量AvgDC值及FA值。结果 46例中,BA组24例,non-BA组22例,BA组的AvgDC值显著低于non-BA组［（1.27±0.16）×10^-3 mm²/s vs （1.43±0.15）×10^-3 mm²/s,P=0.001)］。在BA组中,不同肝脏纤维化分级患儿间AvgDC值、FA值的差异均无统计学意义（P>0.05）;INF1~INF3级炎症分级患儿AvgDC值逐渐降低,但差异无统计学意义（F=2.15, P=0.14）,FA值差异有统计学意义（F=5.51, P=0.01）。应用AvgDC、FA值诊断BA的ROC曲线下的面积分别为0.80±0.07、0.60±0.09;AvgDC界限值为1.33×10^-3 mm²/s时,诊断敏感度为75.00%（18/24）,特异度为77.27%（17/22）。结论 DTI的AvgDC值可用于诊断新生儿和婴儿BA,但其诊断敏感度与特异度仍有待提高。     

IVIM-DWI鉴别诊断肝细胞癌和肝局灶性结节增生

目的 探讨体素内不相干运动扩散加权成像（IVIM-DWI）鉴别肝细胞癌（HCC）与肝局灶性结节增生（FNH）的价值。方法 对407例临床疑似HCC或FNH的患者行常规上腹部MR平扫、动态增强及IVIM-DWI扫描,60例患者（40例HCC,20例FNH）入组。IVIM采用单、双指数模型获得表观扩散系数（ADC）、慢速表观扩散系数（D）、快速表观扩散系数（D^*）及快速扩散成分所占比例（f）。结果 FNH组的ADC、D、D^*及f值分别为（1.60±0.25）×10^-3mm²/s、（1.12±0.17）×10^-3mm²/s、（44.89±18.23）×10^-3mm²/s和（34.80±9.68）%;HCC组分别为（1.32±0.21）×10^-3mm²/s、（0.82±0.21）×10^-3mm²/s、（49.82±20.11）×10^-3mm²/s和（28.72±13.84）%。2组间的ADC、D值差异有统计学意义（P均<0.001）,而D^*、f值差异无统计学意义（P>0.05）。D值相应ROC曲线下面积为0.90,以0.96×10^-3mm²/s为阈值诊断HCC的敏感度、特异度分别为84.44%、90.02%。结论 IVIM-DWI有助于鉴别诊断HCC和FNH,其中双指数模型计算的D值诊断效能更高。     

3.0T磁共振体素内不相干运动扩散加权成像鉴别诊断脊柱不典型血管瘤与溶骨性转移瘤

目的 探讨3.0T MR体素内不相干运动（IVIM）成像对脊柱不典型血管瘤与溶骨性转移瘤的鉴别诊断价值。方法 回顾性收集18例脊柱不典型血管瘤患者（19个病灶）和25例脊柱转移瘤患者（69个病灶）。对所有患者均行3.0T MR扫描,包括常规序列和IVIM DWI序列,采用单指数模型后处理软件获得ADC值,采用双指数模型后处理软件获得IVIM参数,包括慢速扩散系数（ADC_slow值）、快速扩散系数（ADC_fast值）及快速扩散分数（f值）。采用独立样本t检验或Mann-Whitney U检验比较各参数值的差异。结果 脊柱不典型血管瘤和转移瘤的ADC值分别为（1.16±0.30）×10^-3 s/mm²、（0.80±0.27）×10^-3 s/mm²,差异有统计学意义（t=5.00,P<0.001）;ADC_slow中位数分别为0.78×10^-3 s/mm²、0.55×10^-3 s/mm²,差异有统计学意义（P=0.02）;ADC_fast分别为（63.06±33.89）×10^-3 s/mm²、（70.78±39.62）×10^-3 s/mm²,差异无统计学意义（t=0.77,P=0.44）;f分别为（40.65±14.75）%、（32.49±11.50）%,差异有统计学意义（t=2.57,P=0.01）。结论 IVIM可定量评估脊柱不典型血管瘤和溶骨性转移瘤的水分子扩散及微血管灌注特性,ADC、ADC_slow值对脊柱不典型血管瘤和溶骨性转移瘤具有一定的鉴别诊断价值。     

高分辨率MR管壁成像评估缺血性脑卒中患者血管斑块稳定性

目的 分析高分辨率MR管壁成像（HR-VWI）评估不同亚型缺血性脑卒中患者血管斑块稳定性的价值。方法 回顾性分析43例临床诊断缺血性脑卒中患者的MR HR-VWI资料,包括15例载体动脉（斑块或血栓）阻塞穿支（PAOPA）（PAOPA组）,22例动脉到动脉栓塞（ATAE）（ATAE组）,3例低灌注/栓子清除下降（HP/IEC）及3例混合机制（MM）。比较PAOPA组与ATAE组责任斑块形态、分布、位置及管腔表现的差异。结果 PAOPA组与ATAE组间责任斑块分布差异无统计学意义（χ²=12.16,P>0.05）。ATAE组责任斑块表面不规则发生率（63.64%）及斑块负荷[（70.39±11.27）%]均高于PAOPA组[26.67%,（63.11±10.57）%,χ²=8.87,t=4.02,P=0.04、0.03]。ATAE组斑块2级强化发生率（81.82%）高于PAOPA组（26.67%,χ²=7.51,P=0.03）,斑块0级强化发生率（9.09%）低于PAOPA组（46.67%,χ²=8.02,P=0.03）;2组斑块偏心性分布发生率、斑块内T1高信号发生率、斑块厚度、责任斑块处管腔狭窄率及血管重构方式差异均无统计学意义（P均>0.05）。结论 HR-VWI对鉴别不同亚型缺血性脑卒中血管斑块的稳定性具有一定价值;相比PAOPA,ATAE斑块HR-VWI更多表现出不稳定特征。     

DWI及动态增强MRI鉴别诊断Ⅰa期子宫内膜癌与子宫内膜息肉

目的 探讨DWI及动态增强MRI（DCE-MRI）鉴别诊断Ⅰa期子宫内膜癌与子宫内膜息肉的价值。方法 回顾性分析经本院病理证实、并接受DWI及DCE-MRI检查的60例Ⅰa期子宫内膜癌和38例子宫内膜息肉患者资料。分析并比较病变的ADC、相对表观扩散系数（rADC）、达峰时间（TTP）、最大增强对比率（MCER）、90 s与60 s增强对比率差（ER_{90 s-60 s}）和时间-信号强度曲线（TIC）类型。评价DWI和DCE-MRI鉴别Ⅰa期子宫内膜癌与子宫内膜息肉的效能。结果 Ⅰa期子宫内膜癌与子宫内膜息肉的ADC[（0.76±0.17）×10^-3 mm²/s vs（1.33±0.20）×10^-3 mm²/s]、rADC（0.58±0.07 vs 1.02±0.13）、TTP[（76.47±13.37）s vs（101.86±14.62）s]、MCER[（119.48±42.51）% vs（178.32±88.24）%]、ER_{90 s-60 s}[（7.12±14.15）% vs（44.67±27.99）%]差异均有统计学意义（P均<0.05）。ROC曲线分析显示,鉴别Ⅰa期子宫内膜癌与子宫内膜息肉的ADC、rADC、TTP、MCER及ER_{90 s-60 s}阈值分别为0.904×10^-3 mm²/s、0.74、81.5 s、159.01%和19.25%,曲线下面积（AUC）分别为0.984、1.000、0.966、0.718和0.937。60例Ⅰa期子宫内膜癌中,Ⅰ型TIC 26例,Ⅱ型31例,Ⅲ型3例;38例子宫内膜息肉中,Ⅱ型TIC 9例,Ⅲ型29例,二者差异有统计学意义（χ²=57.167,P<0.001）。结论 DWI及DCE-MRI在Ⅰa期子宫内膜癌和子宫内膜息肉的鉴别诊断中具有重要价值,ADC、rADC、TTP、MCER、ER_{90 s-60 s}可作为有效的定量指标。     

颅内管腔非狭窄性脑卒中患者动脉粥样硬化斑块特点

目的 以高分辨率MRI（HRMRI）观察颅内管腔非狭窄性脑卒中患者动脉粥样硬化斑块的特点。方法 纳入41例MR血管造影（MRA）未见明显异常的动脉粥样硬化性缺血性脑卒中患者,根据HRMRI所见分析其颅内动脉粥样斑块,比较责任斑块与非责任斑块位置、强化、血管重构及斑块负荷的差异。结果 41例中,于33例（33/41,80.49%）中检出50个颅内斑块,平均负荷值（12.96±8.03）%;斑块所在血管正性重构率72.00%（36/50）。8例（8/41,19.51%）未见明确斑块。50个斑块中,17个为责任斑块,33个为非责任斑块,责任斑块位于前循环的比例明显高于非责任斑块（P<0.05）,其强化状态、负荷及血管重构差异均无明显统计学意义（P均>0.05）。结论 颅内管腔非狭窄性脑卒中患者斑块负荷较低,且斑块所在血管易发生正性重构,前循环斑块更多导致脑血管病事件。     

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.