经颅多普勒对兔颈外动脉逆行穿刺后应用山莨菪碱的脑血流速度监护

目的 :探索山莨菪碱新的给药途经 ,更安全而有效地改善脑血流循环。方法 :解剖、显露兔颈外动脉 ,穿刺、插管逆行至颈总动脉内 ,结扎颈外动脉 ,以 1μg/ kg/ min缓慢推注山莨菪碱稀释液。用 4MHz脉冲 TCD探头动态监护脑血流速度 ,以大脑中动脉收缩期和舒张期血流速度 (Vs,Vd)为观察指标。结果 :正常值 Vs=(35 .7±6 .8) cm/ s,Vd=(2 3.5± 3.6 ) cm/ s。注射山莨菪碱后 5 min,Vs=(46 .9± 6 .6 ) cm/ s,Vd=(2 9.7± 3.9) cm/ s,升高有意义 (P<0 .0 5 )。 1 5～ 2 0 min达高峰。 Vs=(49.3± 7.1 ) cm/ s,Vd=(31 .8± 4.5 ) cm / s,具有统计学意义(P<0 .0 5 )。 30～ 45 min后开始下降 ,5 0 min后恢复至正常范围。结论 :经颈外动脉穿刺颈总动脉内注射微量山莨菪碱可明显提高兔脑血流速度     

彩色多普勒超声诊断子宫内膜癌的探讨

目的　探讨彩色多普勒超声对子宫内膜癌的诊断价值。方法　总结 5 4例经病理证实的子宫内膜癌彩色普勒超声所测得的子宫动脉和病灶血流的平均速度、博动指数 (PI)、阻力指数 (RI)及子宫内膜癌在各不同临床分期中的声像图特征。结果　本组病例子宫动脉血流平均速度为 16.4± 9.5cm/s ,PI为 1.3± 0 .6,RI为 0 .67± 0 .2。癌灶内显示的条状、点状血流平均速度为 8.2± 6.2cm/s ,PI为 0 .9± 0 .5 ,RI为 0 .4± 0 .2。在临床分期中 ,Ⅰ期为 61.9% ( 34 /5 4) ,Ⅱ期为 18.5 % ( 10 /5 4) ,Ⅲ期为 11.1% ( 6/5 4) ,Ⅳ期为 18.5 % ( 4/5 4)。结论　彩超对子宫内膜癌的诊断及临床分期可提供有价值的参考资料。     

妊高征患者分娩前后肾动脉血流参数变化的多普勒超声研究

目的　利用超声多普勒技术评价妊高征 (PIH)患者分娩前后肾动脉血流动力学变化。方法　重度妊高征患者 2 5例 ,正常妊娠 2 4例 ,彩色多普勒超声引导下利用脉冲多普勒超声检测肾动脉收缩期最大、最小、平均血流速度 (Vs,Vd ,Vm)及阻力指数 (RI)、搏动指数 (PI)等。产后复查。结果　妊高征患者肾动脉血流速度与正常妊娠组(Vs:6 5 33± 18 0 7cm/svs 6 5 0 6± 19 98cm/s;Vd :2 4 90± 7 81cm/svs 2 5 94± 8 6 8cm/s;Vm :44 2 1± 13 91cm/svs 42 18± 10 0 9cm/s)无显著差别 (P >0 0 5 ) ;RI、PI两组间亦无显著差别 (P >0 0 5 ) ;妊高征组及正常妊娠组分娩后上述指标均有不同程度增高 ,但相差不显著 (P >0 0 5 )。结论　妊高征患者肾动脉血流速度及RI与正常妊娠组无显著差别 ,正常妊娠及妊高征患者分娩前后肾动脉血流动力学未发生显著变化。     

血管内多普勒超声对Budd-Chiari综合征血流动力学障碍的研究

目的　研究Budd Chiari综合征 (BCS)患者血流动力学 (压力、血流速度及血流量 )障碍及其与正常对照的差异。方法　使用血管内多普勒导丝对 2 7例BCS患者下腔静脉 (IVC)和 (或 )肝右静脉 (RHV )介入治疗(PTA)前后血流速度及血流量的变化进行检测 ,并以 10例正常人的相应数据作为对照。结果　PTA前 ,BCS患者RHV和IVC的平均峰值流速 (APV)明显低于正常组 [RHV :( 5 .0 5± 3.6 9)cm/svs ( 14 .73± 4.5 2 )cm/s ,P <0 .0 0 1;IVC :( 3.0 2± 6 .87)cm /svs ( 2 3.6 7± 5 .38)cm /s ,P <0 .0 0 1]。PTA后 ,BCS患者APV显著增加至正常 ,但与对照组比较差异无显著性意义 [IVC :( 2 4.83± 11.34)cm /svs ( 2 3.6 7± 5 .38)cm/s ,P >0 .1;RHV :( 16 .13± 10 .5 6 )cm /svs ( 14 .73± 4.5 2 )cm/s ,P >0 .1) ] ;而血流量增加更明显 ,和对照组比较差异有显著性意义 [IVC :( 4 914 .79± 937.5 2 )ml/minvs ( 385 6 .96± 376 .92 )ml/min ,P <0 .0 1;RHV :( 90 2 .6 3± 5 12 .37)ml/minvs( 6 13.0 3± 2 0 8.5 6 )ml/min ,P <0 .0 1) ]。结论　BCS存在严重的血流动力学紊乱状态 ,PTA后IVC、RHV血流动力学指标大致恢复正常。     

经颅多普勒检测创伤后头痛患者脑血流速度变化及其机制探讨

目的研究创伤后头痛患者脑血流速度变化。方法对创伤后头痛患者30例行经颅多普勒(TCD)检测,观察其脑血流速度并与正常对照组对比分析。结果创伤后头痛患者大脑前动脉犤(95.7±10.3)cm/s犦、大脑中动脉犤(110.8±13.9)cm/s犦、大脑后动脉犤(93.3±9.5)cm/s犦和基底动脉犤(88.7±9.1)cm/s犦,平均血流速度均高于对照组犤(54.1±8.0),(53.7±7.9),(40.9±7.6),(35.2±6.0)cm/s犦(P<0.01)。结论创伤后头痛患者脑血流速度明显升高,出现不同程度的脑血管痉挛。     

正常成人颈内静脉多普勒血流频谱分析

目的　利用多普勒超声对正常成人不同年龄段颈内静脉血流动力学进行分析 ,探讨其血流频谱变化与呼吸、心动周期的关系。方法　对随机选取的 12 0名成年健康志愿者沿颈总动脉外侧探测颈内静脉 ,在二维切面的基础上获取其血流频谱 ,测定不同心动周期及呼吸周期中颈内静脉血流动力学指标。结果　在心动周期中 ,颈内静脉血流频谱呈现收缩期S波、舒张期D波和舒张期A波 ;在平静呼吸状态下 ,受检者吸气相和呼气相S波速率分别为 (2 7.17± 19.88)cm/s、(19.0 4± 14 .2 6)cm/s ,D波速率分别为(17.43± 12 .78)cm/s、(12 .70± 10 .57)cm /s ,吸气相速率较呼气相速率快 (均P <0 .0 0 1) ,呼吸周期中A波速率无明显变化 [(6.3 8± 6.3 2 )cm/s、(7.59± 7.42 )cm /s,P >0 .0 5] ;60岁以上组S和D波血流速率较 2 0～ 60岁组血流速度低 (P <0 .0 5)。结论　正常颈内静脉血流频谱由 3个波组成 ,频谱形态随心动周期、呼吸周期呈规律性变化 ;年龄因素影响颈内静脉多普勒血流速率 ;建立了正常成人颈内静脉多普勒血流速率参数的正常值     

经颅多普勒检测创伤后头痛患者脑血流速度变化及其机制探讨

目的 研究创伤后头痛患者脑血流速度变化。方法 对创伤后头痛患者30例行经颅多普勒(TCD)检测，观察其脑血流速度并与正常对照组对比分析。结果 创伤后头痛患者大脑前动脉[(95．7&;#177;10．3)cm／s]、大脑中动脉[(110．8&;#177;13．9)cm／s]、大脑后动脉[(93．3&;#177;9．5)cm／s]和基底动脉[(88．7&;#177;9．1)cm／s]，平均血流速度均高于对照组[(54．1&;#177;8．0)，(53．7&;#177;7．9)，(40．9&;#177;7．6)，(35．2&;#177;6．0)cm／s](P&;lt;0．01)。结论 创伤后头痛患者脑血流速度明显升高，出现不同程度的脑血管痉挛。     

肝移植患者重建肝动脉的彩色多普勒超声检查

目的　探讨肝移植患者不同肝动脉重建术后肝动脉频谱特征 ,比较端 -端吻合术及主动脉 -肝动脉旁路术后肝动脉的峰值血流速度 (PSV) ,舒张末期血流速度 (EDV)及阻力指数 (RI)。方法　回顾性分析了 48例肝移植术患者术后肝动脉的超声表现。其中 3 0例行端 -端吻合术 ,18例行旁路术。超声检查于术后 3～ 6个月进行 ,所有患者术后肝功能正常 ,无肝功能不全临床表现。结果　行端 -端吻合术者 ,肝动脉阻力指数较低 ,而行旁路术者肝动脉阻力指数较高。前者PSV平均为 ( 5 7± 16)cm s ,EDV平均为 ( 2 5± 14 )cm s ,RI 0 .3 3～ 0 .71,平均 0 .5 8± 0 .13 ;后者PSV平均为 ( 62± 16)cm s ,EDV平均为 ( 12± 4)cm s ,RI 0 .7～ 0 .78,平均 0 .77± 0 .0 6。结论　多普勒频谱形态及RI值与重建肝动脉的长度及管径有关 ,端 -端吻合者 ,重建的肝动脉路径短 ,管径细但均匀 ,故血流阻力低 ;而旁路术者 ,重建的肝动脉路径长 ,管径变化大 ,因此 ,血流阻力大。在肝移植术后的超声检查及并发症诊断中 ,检查者必须了解肝动脉的重建方式     

颈总动脉超声检测与冠心病患者心肌缺血程度的研究

目的 :了解不同程度心肌缺血冠心病患者颈总动脉超声测值之间的差异。方法 :5 2例有明确心绞痛症状但无心肌梗死病史患者 (一般 CHD组 )、 3 5例有心肌梗死病史患者 (MI组 )和 3 5例正常人。用 HP Sonos5 5 0 0彩超仪 +高频探头分别检测他们的颈总动脉内径、内中膜厚度 (IMT)、斑块发生率和部分血流动力学参数 ,结果进行统计学分析。结果 :1.　颈总动脉内径 :一般 CHD组 0 .69cm± 0 .0 7cm,MI组 0 .70 cm± 0 .0 8cm,两组间无显著差异 ,而正常组为 0 .62 cm± 0 .0 8cm,与前两组差异显著 ;2 .　 IMT:一般 CHD组 0 .87mm± 0 .2 3mm,MI组 0 .89mm± 0 .2 6mm,正常组 0 .66mm± 0 .15 mm,统计学处理结果与 1相同 ;3 .　收缩期最高血流速度 :一般 CHD组为 66.70 cm/ s± 18.0 1cm/ s,MI组为 5 8.79cm/ s± 15 .67cm/ s,正常组 75 .4 4 cm/ s± 15 .78cm/ s,三组间均有显著差异 ;4 .　血流阻力指数 :MI组 (0 .73± 0 .0 5 ) >一般 CHD组 (0 .71± 0 .0 7) >正常组>(0 .68± 0 .0 4 ) ;5 .　斑块探测率 :一般 CHD组为 5 3 .85 % (2 8/ 5 2 ) ,MI组为 62 .86% (2 2 / 3 5 ) ,正常组为 11.4 3 %(4/ 3 5 ) ;结论 :本研究表明颈总动脉的 IMT、斑块发生率与心肌缺血程度、病程长短以及左室收缩功能有关联。二维彩     

超声检查对乳腺实性肿块内血液动力学研究

目的　评价多普勒血流显像技术检测乳腺实性肿块内血流对乳腺实性肿块的定性诊断。方法　对乳腺实性肿块患者 97例进行超声检查及肿块内血流检测 ,并与术后组织病理学诊断对照。结果　 2 4例乳腺恶性肿块 2 2例测及动脉血流 ,收缩期最高峰速 (PSV)平均值 (30 .2 8± 2 0 .13) cm/s,阻力指数 (RI)平均值 0 .84 9±0 .0 98,73例乳腺良性肿块 4 4例测及动脉血流 ,收缩期最高峰速 (PSV)平均值 (2 0 .4 4± 11.4 3) cm/s,阻力指数 (RI)平均值 0 .6 12± 0 .0 98。当以 PSV=12 cm/s为乳腺良、恶性肿块的界限时 ,PSV诊断乳腺良、恶性肿块的敏感性率和特异性率分别为 87.5 %及 5 7.5 % ,当以 RI=0 .70为乳腺良、恶性肿块的界限时 ,RI诊断乳腺良、恶性肿块的敏感性率和特异性率分别为 87.5 %及 87.7%。二者敏感性率无显著差异 ,而 RI诊断乳腺恶性肿块的特异性率明显高与 PSV,差异具有显著性 (P<0 .0 1)。结论　用多普勒血流显像技术检测乳腺实性肿块的异常血流的 RI对乳腺实性肿块的性质预测具有一定的临床意义     

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.