聚乙二醇电解质散联合莫沙必利在结肠镜检查前肠道准备中的应用

目的 探讨聚乙二醇电解质散联合莫沙必利口服在结肠镜检查前清洁肠道的临床效果。方法将440例行结肠镜检查前肠道准备的患者随机分为四组：A组（120例）于首次口服聚乙二醇电解质散前半小时口服莫沙必利10mg。B组（122例）于首次口服聚乙二醇电解质散同时口服莫沙必利10mg,C组（90例）于首次口服聚乙二醇电解质散后1h口服莫沙必利10mg,D组（108例）仅口服聚乙二醇电解质散。比较四组肠道清洁效果和不良反应情况。结果A组、B组和C组、D组比较,服药至首次排便时间和大便清澈时间较短、总排便次数增加和Boston肠道准备量表（BBPS）评分较高,有显著性差异（P＜0．05）;A组和B组不良反应评分明显少于D组,有显著性差异（P〈0．05）。结论聚乙二醇电解质散剂较早联合莫沙必利口服,可以缩短患者首次排便时间及大便清澈时间,增加排便次数,并能提高患者肠道准备效果,减少不良反应。     

电子结肠镜检查不同肠道准备方法的效果观察

[目的]观察电子肠镜检查不同肠道准备方法的效果.[方法] 306例行电子肠镜检查病人随机分为3组,A组100例采用传统灌肠进行肠道准备,B组102例口服电解质进行肠道准备,C组104例采用聚乙二醇电解质溶液进行肠道准备.观察并比较3组病人肠道清洁程度、肠道准备过程中的依从性和服药后不良反应发生情况.[结果]C组肠道清洁程度、肠道准备过程中的依从性均优于A组和B组;C组服药后不良反应发生率低于A组和B组.[结论]口服聚乙二醇电解质溶液进行电子结肠镜检查肠道准备效果明显.     

聚乙二醇电解质溶液分次与单次口服肠道准备方案的清洁效果和耐受性比较

目的 比较结肠镜检查患者分次与单次口服聚乙二醇电解质溶液进行肠道准备的清洁效果和耐受性。 方法 将进行结肠镜检查的120例患者采用随机法分为A组（单次口服）和B组（分次口服）。A组于检查前5 h单次口服3 L聚乙二醇电解质溶液;B组于检查前夜和检查前4 h分次口服1.5 L聚乙二醇电解质溶液。结肠镜检查时分别对结肠的3个解剖分段处（左半结肠、横结肠、右半结肠）进行Boston肠道准备量表评分,并在检查结束后记录120例患者服药期间的耐受性、依从性、不良反应发生率进行比较分析。 结果 两组患肠道准备方案均达到结肠镜检查要求,Boston肠道准备量表评分相似（P>0.05）,但B组Boston肠道准备量表评分较A组有明显差异（P<0.01）。两组患者耐受性及不良反应发生率的结果显示B组优于A组（P<0.05）。 结论 分次口服聚乙二醇电解质溶液的肠道清洁准备方案在取得满意的清洁效果同时患者耐受性更好,不良反应发生率更低,值得临床推广应用。       

不同口服肠道准备法对老年便秘患者结肠镜检查的效果

目的探讨用于老年慢性便秘患者安全及有效的肠道准备方法,以提高结肠镜检查的成功率。方法选择2009年7月—2010年7月在上海交通大学附属第六人民医院拟行电子结肠镜检查的老年慢性便秘患者150例,随机分为A组、B组和C组各50例;肠道准备:A组采用复方聚乙二醇电解质散,B组采用番泻叶、甘露醇和口服补液盐,C组采用番泻叶和复方聚乙二醇电解质散。观察并详细记录肠道准备效果,肠镜检查中肠道清洁程度,患者的依从性和不良反应发生情况。结果①C组的肠道清洁度有效率为94.0%,高于A组的66.0%和B组的74.0%;②3组均无严重不良反应发生,C组的不良反应发生率为10.0%,低于A组的26.0%和B组的30.0%。A组与B组在清洁效果与不良反应发生率方面差异均无统计学意义(P>0.05),C组与A组和B组比较,差异有统计学意义(P<0.05)。结论采用口服番泻叶和复方聚乙二醇电解质散应用于老年慢性便秘者的肠道准备效果满意,不良反应小,可提高患者结肠镜检查的成功率,使患者得到及时的诊疗。     

牙哈凝析气田产层段内高渗透条带储层分布特征及对开发的影响

目的 观察复方聚乙二醇电解质散溶液不同口服速度对肠道清洁的效果.方法 将180例行结肠镜检查的患者按随机数字表分成A、B、C组,每组60例.服药方法：将2包复方聚乙二醇电解质散用2 000 ml温开水冲调后,A组在1 h内服完,B组在2 h内服完,C组在3 h内服完.观察患者服药后不良反应发生情况,在肠镜检查时进行肠道清洁质量总体评分.结果 A组肠道清洁质量总体评分优于B组、C组,P＜0.01;肠道准备质量：右侧结肠清洁度A组与B、C组比较有统计学意义（P＜0.01）,中间结肠清洁度3组组间比较无统计学意义,左侧结肠清洁度A组与B、C组比较有统计学意义（P＜0.05）.A组5例出现腹胀、呕吐;B组3例患者出现腹胀,没有呕吐;C组无明显不良反应发生.结论 1 h内服完复方聚乙二醇电解质散药液,肠道清洁效果最好.     

老年慢性便秘患者结肠镜检查不同肠道准备方法的比较

【】目的 探讨用于老年慢性便秘患者安全及有效的肠道准备方法,以增加肠镜检查的成功率及患者的依从性,并减少肠镜检查的不良反应及并发症。方法 将150例在我院行电子结肠镜检查的老年慢性便秘患者采用方便取样的方法分为A组、B组和C组。分别采用复方聚乙二醇电解质散(A组),番泻叶、甘露醇和口服补液盐(B组),番泻叶和复方聚乙二醇电解质散(C组)作为肠道准备药物。在肠道准备过程中观察并详细记录肠道准备效果,肠镜中肠道准备清洁程度(Ⅰ—Ⅳ级),病人的依从性和不良反应发生率。结果 ①C组的肠道清洁度满意率为92.0%高于A组的66.0%和B组的74.0%;②3组均无严重不良反应发生,C组的不良反应发生率为10%低于A组的26%和B组的30%.A组与B组在清洁效果与不良反应发生率方面均无统计学意义(P＞0.05),C组与A组和B组比较,差异有统计学意义(P＜0.05)。结论 口服番泻叶和复方聚乙二醇电解质散组应用于老年慢性便秘者肠道准备效果满意,不良反应小,可提高患者结肠镜检查的成功率,使老年慢性便秘者得到最佳的诊疗,值得临床广泛应用,尽可能避免医疗资源的浪费。     

不同时间口服复方聚乙二醇电解质散进行肠道准备的效果观察

[目的]观察不同时间口服复方聚乙二醇电解质散进行肠道准备的效果。[方法]将180例结肠镜检查病人随机分为A组、B组、C组,每组60例,A组检查前1d20:00服用2盒复方聚乙二醇电解质散进行肠道准备,B组检查当天06:00服用2盒复方聚乙二醇电解质散进行肠道准备,C组检查前1d20:00及检查当天06:00各服用1盒复方聚乙二醇电解质散进行肠道准备。比较3组病人肠道清洁度和主观耐受度。[结果]3组病人肠道准备均符合要求,3组病人肠道清洁程度比较,差异无统计学意义(P>0.05);3组病人主观耐受度比较,差异有统计学意义(P<0.05),C组优良率高于A组、B组(P<0.05)。[结论]检查前1d20:00及检查当天06:00各服用1盒复方聚乙二醇电解质散进行肠道准备的效果满意,不良反应小、病人易于接受,是比较理想的结肠镜前肠道准备方法。     

慢性便秘患者结肠镜检查前肠道准备效果研究

目的对慢性便秘患者行电子结肠镜检查前肠道准备效果进行分析,寻找一种更安全、有效的清洁肠道的方法。方法将276例慢性便秘行结肠镜检查患者随机分为甘露醇组(A组),复方聚乙二醇电解质散组(B组)和一清胶囊加复方聚乙二醇电解质散组(C组),各92例,进行肠道准备。比较三组肠道清洁有效率、清洁范围和不良反应的发生率。结果 C组肠道清洁有效率、清洁范围显著高于A组和B组。C组不良反应发生率显著低于A组。结论一清胶囊加复方聚乙二醇电解质散组对慢性便秘患者行电子结肠镜检查肠道准备效果最佳。     

不同剂量的聚乙二醇电解质溶液在全结肠镜检查肠道准备中的效果

目的 探究不同剂量的聚乙二醇电解质溶液在全结肠镜检查肠道准备中的效果。方法 选取2016年1月-2017年1月消化内科收治的进行结肠镜检查的患者共9 000例,随机分为A组、B组和C组各3 000例。A组患者服用2L聚乙二醇电解质溶液,B组服用3L聚乙二醇电解质溶液,C组服用4L聚乙二醇电解质溶液,比较3组患者肠道清洁质量、全结肠镜检查时间、息肉检出率、不良反应的发生率以及患者的耐受性和依从性。结果 3组患者肠道清洁质量评分及息肉检出率比较,差异均无统计学意义,A组患者不良反应的发生率低于B组和C组;A组患者的依从性和耐受性高于B组和C组。结论 低剂量聚乙二醇电解质溶液不良反应的发生率较低,患者的依从性和耐受性好。     

不同肠道准备方法在结肠镜检查中的应用及护理

目的：探讨不同肠道准备方法在结肠镜检查中的应用及护理体会。方法：将2004年6月～2008年1月518例接受结肠镜检查的病人随机分为A组、B组和C组，A组应用20％甘露醇口服，B组蓖麻油联合番泻叶口服，C组蓖麻油联合复方聚乙二醇电解质散口服。观察服药过程中肠腔清洁效果和副反应发生情况。结果：C组肠道清洁显效率（1级）68．68％，有效率（1级和2级）92．86％，且不良反应发生率低，与A组及B组相比有显著性差异。结论：复方聚乙二醇电解质散联合蓖麻油进行肠道准备的方法效果佳，耐受性好。     

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.     

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.     

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.     

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.