马齿苋外敷缓解诺维苯引起疼痛的临床观察

目的 探讨局部外敷中草药马齿苋缓解诺维苯所致疼痛的临床疗效.方法 将人选的接受诺维苯治疗的126例患者分为实验组70例和对照组56例.所有患者均采用诺维苯0.7 mg/kg静脉推注,实验组用药后第2天沿静脉走向将制作好的鲜马齿苋300～500 g均匀敷于整个穿刺侧肢体,外加软薄膜固定,持续30～60 min/次,连用4～6次,连用2 d;对照组常规用50%硫酸镁局部冷湿敷.比较2组患者的疼痛发生率.结果 实验组疼痛发生率为35.7%,对照组为94.6%,实验组疼痛发生率明显低于对照组(P＜0.01).结论 马齿苋外敷对缓解诺维苯所致的疼痛有显著疗效,可在临床推广使用.     

七叶皂苷钠预防诺维苯所致静脉炎的临床观察

目的探讨七叶皂苷钠预防诺维苯所致静脉炎的临床效果。方法选择我科2005年10月-2007年1月应用诺维苯的化疗患者25例，共化疗98例次，随机分为实验组和对照组，实验组13例，采用七叶皂苷钠治疗，对照组12例采用常规治疗，对诺维苯化疗后出现的静脉炎进行对照观察。结果实验组静脉炎发生率为4．0％，对照组静脉炎发生率为18．8％。结论七叶皂苷钠预防诺维苯所致静脉炎效果显著。     

止痛消炎软膏治疗静脉输液外渗的疗效观察

目的观察止痛消炎软膏外敷治疗静脉输液外渗疗效。方法将发生静脉输液外渗的109例患者，随机分为实验组和对照组，实验组54例，对照组55例。实验组采用止痛消炎软膏外敷；对照组采用50％硫酸镁热湿敷。比较2组患者疼痛和局部肿胀的情况。结果2组患者局部疼痛和肿胀情况比较，经统计学分析，均p〈0．05，差异有统计学意义。结论止痛消炎软膏治疗静脉输液外渗具有一定的疗效，可减轻患者局部疼痛和肿胀。     

诺维苯致皮肤反应的预防和护理

将使用诺维苯化疗的患者分 2组 ,实验组在使用诺维苯静滴前后静脉输入地塞米松 ,并于穿刺部位冷湿敷 5 0 %硫酸镁 ;对照组仅于使用诺维苯前静滴地塞米松。观察化疗后穿刺部位皮肤反应。结果示实验组皮肤反应发生率 2 5 % ;对照组皮肤反应发生率 2 0 83%。说明 5 0 %硫酸镁外敷 ,联用地塞米松可降低诺维苯致皮肤反应的发生率     

利多卡因混合液外敷缓解阿奇霉素引起疼痛的临床观察

[目的]探讨局部外敷75%乙醇、利多卡因混合液缓解阿奇霉素所致疼痛的临床疗效.[方法] 将入选的接受阿奇霉素治疗的126例病人分为实验组70例和对照组56例.所有病人均采用生理盐水250 mL加阿奇霉素0.5 g静脉输注,实验组静脉穿刺成功后用4层无菌纱布外敷于静脉穿刺点上方,滴上75%乙醇、利多卡因混合液,以不滴水为准,每隔10 min～20 min向纱布补充湿敷液,以保持湿度至输液完毕,连用3 d;对照组常规用50%硫酸镁局部冷湿敷,比较两组病人的疼痛发生率.[结果] 实验组疼痛发生率为35.7%,对照组为94.6%,经比较差异有统计学意义(P<0.01).[结论]利多卡因混合液外敷对阿奇霉素所致的疼痛有显著疗效.     

山茛菪碱预防阿奇霉素静脉滴注疼痛的疗效观察

目的 探讨山莨菪碱对静脉滴注阿奇霉素时引起穿刺局部疼痛的疗效。方法 对120例静脉滴注阿奇霉素患者按随机分组法分为实验组和对照组，实验组采用浸有2％山莨菪碱溶液的湿棉纱湿敷；对照组患者直接静脉滴注阿奇霉素。结果 对照组60例患者中有48例出现静脉穿刺局部疼痛，疼痛发生率达80％，而实验组60例患者中只有3例发生静脉局部疼痛，疼痛发生率为5％。结论 用浸有2％山莨菪碱溶液的棉纱湿敷，可减少静脉滴注阿奇霉素所致局部疼痛。     

山莨菪碱外涂减轻盖诺所致静脉炎的临床研究

目的探讨山莨菪碱局部外涂减轻盖诺所致静脉炎的效果。方法将我院肿瘤科住院病人中使用盖诺化疗的病人60例，随机分为两组，每组30例，共化疗167例次，平均使用盖诺2．7次，实验组在常规治疗的基础上用3％的山莨菪碱液在病人化疗前后局部外涂静脉及其周围皮肤以减轻静脉炎的发生，对照组行常规治疗，然后对盖诺化疗后出现的静脉炎进行对照观察。结果实验组静脉炎的发生率为7．3％；对照组52．94％，疼痛发生率实验组14．68％，对照组71．76％．结论使用3%山莨菪碱局部外涂可减轻盖诺所致的静脉炎，且静脉疼痛明显减轻。     

地卡因对前列腺素E1所致静脉炎的预防作用

目的寻求一种简便、安全、无创的预防前列腺素E1静脉输注所致静脉炎的有效方法。方法（1）选择需静脉输注前列腺素E1的患者185例，分别采取常规输注（空白组）、硫酸镁外敷输注（对照组A）、冰敷输注（对照组B）和1％地卡因外涂输注（实验组），输液过程中评估静脉炎分度及疼痛评分；（2）选择健康新西兰兔12只，左耳缘静脉用冰敷为动物对照组，右耳缘静脉用地卡因外涂为动物实验组，观察输液后局部组织的病理变化。结果实验组比对照组A、B及空白组的疼痛评分及静脉炎反应程度低（P〈0．01）；动物实验组的血管扩张和淤血、间质水肿、炎性细胞浸润等病理改变比对照组显著减轻（P〈0．01）。结论1％地卡因外涂可预防前列腺素E1静脉输注所致的疼痛，明显降低静脉炎的发生率。     

静脉输入硫酸镁预防诺维苯所致静脉炎的研究

目的 :探讨用 2 5 %硫酸镁预防诺维苯所致静脉炎的效果。方法 :将我院肿瘤科使用诺维苯化疗的病人分为 2组 ,每组 1 5例 ,平均使用诺维苯 4次。实验组实施护理干预 ,用 2 5 %硫酸镁静脉输入预防静脉炎 ;对照组行常规治疗。对诺维苯化疗后出现的静脉炎进行对照观察与研究。结果 :实验组静脉炎发生率为 8.3 % ;静脉炎发生时间 ,平均为诺维苯注射后的 31± 1 1 .35h ,疼痛程度评分为 4 .5± 2 .0 6 ,疼痛持续时间平均为 4 .1 2± 1 .9天 ;对照组静脉炎发生率为 2 8.3 % ,静脉炎发生时间 ,平均为诺维苯注射后的 1 7± 6 .32h ,疼痛程度评分为 6 .36± 1 .89,疼痛持续时间平均为 6 .63± 2 .34天。经 χ2 、t检验 ,两组在以上几个方面差异均有统计学意义。结论 :使用 2 5 %硫酸镁可使诺维苯引起的静脉炎发生率明显下降     

两种方法治疗两性霉素B所致静脉炎效果比较

目的 比较生土豆片外敷及硫酸镁湿敷治疗静脉输注两性霉素B所致静脉炎的临床效果.方法 将36例使用两性霉素B引起静脉炎的患者随机分为实验组20例和对照组16例.实验组使用生土豆片外敷,2次/d,20～30 min/次,疗程7 d.对照组用50%硫酸镁湿热敷静脉局部,2次/d,30 min/次,疗程7 d,比较两组疗效.结果 实验组疗效优于对照组(P=0.0337).结论 使用生土豆片外敷治疗两性霉素B所致静脉炎的效果优于50%硫酸镁湿热敷,患者生活质量得到提高,值得临床推广.     

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.