脓毒症及脓毒性休克患者诊断中血浆肝素结合蛋白联合降钙素原+C-反应蛋白的作用

目的 探究血浆肝素+蛋白（heparin binding pprotein,HBP）联合降钙素原（procalcitonin,PCT）+C-反应蛋白（c-reactive protein,CRP）在脓毒症及脓毒性休克患者诊断中的作用。方法 选取2020年1—12月张家港市第一人民医院重症医学科收治的脓毒症及脓毒性休克患者156例,按脓毒症指南标准,分为轻度组56例、严重组62例和休克组38例。按临床预后,可分为存活组117例、死亡组39例。另选同期健康体检者59名为健康组。检查HBP、PCT、CRP等临床指标。结果 脓毒症组HBP(83.45±5.29)μg/L、PCT(8.19±1.25)μg/L、CRP(87.94±5.37)mg/L水平高于健康组的（4.82±0.58）μg/L、（0.24±0.02）μg/L、（1.34±0.21）mg/L,差异有统计学意义（P<0.05）。休克组HBP、PCT、CRP水平比严重组、轻度组高,且严重组HBP、PCT、CRP水平比轻度组高,差异有统计学意义（P<0.05）。生存组HBP、PCT、CRP水平低于死亡组,差异有统计学意义（P...     

脓毒症患者白细胞计数、血清C反应蛋白、肝素结合蛋白、降钙素原表达及与病情进展及预后关系

目的 探讨白细胞计数(WBC)、血清C反应蛋白(CRP)、肝素结合蛋白(HBP)和降钙素原在脓毒症患者病情进展和预后评估中的应用价值。方法 将2018年4月至2023年3月内江市第一人民医院收治的205例脓毒症患者纳入本次回顾性研究,根据病情严重程度分为脓毒症组(n=129)和脓毒性休克组(n=76),并根据患者预后情况分成存活组(n=154)和死亡组(n=51)。检测脓毒症组与脓毒性休克组、存活组与死亡组患者的WBC、血清CRP、HBP、降钙素原水平,收集患者的急性生理与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分和序贯器官衰竭评估(SOFA)评分,分析WBC、血清CRP、HBP、降钙素原与APACHEⅡ、SOFA评分的相关性;采用受试者工作特征(ROC)曲线分析上述4个指标单独及联合检测评估脓毒症患者预后。结果 脓毒性休克组的WBC、血清CRP、HBP、降钙素原分别为(19.83±3.09)×10⁹/L、(114.10±35.17) mg/L、(78.92±13.14)μg/L和(11.13±0.91)μg/L,均显著高于脓毒症组[(9.55±2.87)×10...     

肝素结合蛋白浓度检测在脓毒症诊断中的应用价值

目的探讨肝素结合蛋白(HBP)浓度检测在脓毒症诊断中的应用价值。方法选取2018年1月—12月成都市郫都区中医医院收治的52例脓毒症患者作为研究对象,根据疾病严重程度的不同分为脓毒症组(26例)和脓毒性休克组(26例);另选35例健康体检者作为健康对照组。采用酶联免疫吸附试验(ELISA法)检测所有受检者的HBP,采用酶联免疫荧光法检测降钙素原(PCT),采用免疫层析法检测超敏C-反应蛋白(hs-CRP),采用全自动血液分析仪检测白细胞计数(WBC),观察各组的HBP、PCT、hs-CRP和WBC检测结果进行比较,并绘制受试者工作特征曲线(ROC),评估HBP对脓毒症的诊断价值。结果健康对照组、脓毒症组、脓毒性休克组的HBP、PCT、hs-CRP和WBC均呈逐步上升趋势〔HBP(μg/L):2.85±0.76、8.55±1.27、96.72±21.35,PCT(μg/L):0.25±0.09、0.38±0.34、1.86±0.67,hs-CRP(g/L):2.63±1.33、3.17±1.53、10.91±6.21,WBC(×10~9/L):7.29±0.80、9.26±0.87、12.49±1.56〕,各组之间两两比较差异均有统计学意义(均P0.05),其中脓毒性休克组的HBP升高最为明显(P0.01)。HBP诊断脓毒症和脓毒性休克的敏感度和特异度均明显优于PCT、hs-CRP、WBC(均P0.05)。ROC曲线分析结果显示,HBP预测脓毒症的ROC曲线下面积(AUC)为0.882〔95%可信区间(95%CI)=0.745～1.000,P=0.002〕,最佳临界值为7.295μg/L时,敏感度为0.625、特异度为1.000。结论在脓毒症诊断中,应用HBP浓度检测能够有效鉴别脓毒症的感染程度,使患者得到及时的治疗,提高预后疗效。     

血清microRNA-25对脓毒症患者病情严重程度及预后的评估价值

目的:探究血清microRNA-25对评估脓毒症患者病情严重程度及预后的价值,分析影响脓毒症患者预后的危险因素。方法:选取82例脓毒症患者作为研究对象,根据患者病情严重程度分为脓毒症组及脓毒性休克组,30例健康体检者作为对照组。采用实时荧光定量检测方法(RT-PCR)检测血清microRNA-25表达量。记录入组患者的一般资料(性别、年龄、感染部位)和相关指标(WBC、CRP、PCT、D-D、Lac、Cys-C、SOFA评分、APACHEⅡ评分)。根据28 d预后情况分为存活组和死亡组。筛选影响脓毒症患者预后的独立危险因素,评估死亡独立危险因素对脓毒症患者死亡的预测效果。结果:①脓毒症组和脓毒性休克组间、存活组和死亡组间的性别、年龄、感染部位等差异均无统计学意义(P0.05)。②与脓毒症组相比,脓毒性休克组患者的PCT、D-D、Lac、Cys-C、SOFA评分及APACHEⅡ评分均升高(P0.05);③脓毒性休克组患者血清microRNA-25表达量低于脓毒症组(P0.05);④与存活组相比,死亡组患者的PCT、D-D、Lac、Cys-C、SOFA评分及APACHEⅡ评分显著升高(P0.05);死亡组患者microRNA-25明显低于存活组,差异有统计学意义(P0.05)。⑤PCT、D-D、Lac、Cys-C、microRNA-25、SOFA评分、APACHEⅡ评分是脓毒症患者28 d死亡危险因素,且Lac、Cys-C、microRNA-25、SOFA评分是脓毒症患者28 d死亡的独立危险因素。结论:血清microRNA-25可作为评估脓毒症患者病情严重程度及判断预后的生物标志物;Lac、Cys-C、microRNA-25、SOFA评分是脓毒症患者28 d死亡的独立危险因素。     

降钙素原及N末端钠尿肽前体在老年脓毒性休克病情评估的临床应用研究

目的 降钙素原（PCT）及N末端钠尿肽前体（NT-ProBNP）对老年脓毒性休克病情评估的临床应用价值.方法 比较严重脓毒症（80例）及脓毒性休克（67例）PCT、NT-ProBNP差异,比较不同临床结局脓毒性休克PCT、NT-ProBNP差异,研究PCT、NT-ProBNP与急性生理与慢性健康评分（APACHEⅡ评分）相关性.结果 脓毒性休克组PCT、NT-ProBNP及APACHEⅡ评分均高于严重脓毒症组,差异均有统计学意义（P＜0.05）;复苏成功组、复苏无效组、死亡组三组随病情的恶化程度加深,PCT、NNT-ProBNP及APACHEⅡ评分均出现不同程度的升高,组间差异有统计学意义（P＜0.05）;APACHEⅡ评分与PCT呈正相关（r=0.668,P＜0.05）,与NT-ProBNP也呈正相关（r=0.738,P＜0.05）,相关系数以NT-ProBNP较高.结论 对脓毒症、脓毒性休克监测降钙素原、N末端钠尿肽前体有重要的临床应用价值.     

降钙素原对脓毒症患者病情及预后的临床价值

目的：探讨降钙素原（procalcitonin,PCT）对脓毒症患者病情及预后的临床价值,及其与急性生理学与慢性健康状况Ⅱ评分（APACHEⅡ评分）的相关性。方法回顾性分析2013年1月1日至2014年12月31日收住本院急诊科（包括普通病房及急诊重症监护室 EICU）、感染科的109例脓毒症患者的临床资料（包括入院24 h 内 PCT 值、白细胞计数 WBC 及中性粒细胞百分比Neut％、APACHEⅡ评分等）。据患者病情严重程度（脓毒血症组、严重脓毒症组和脓毒性休克组）、临床结局（存活组和死亡组）及多器官功能障碍综合征 MODS （MODS 组和非 MODS 组）不同进行分组,比较各组中各指标差异,分析 PCT 与 APACHEⅡ评分两者之间的相关性,评价 PCT、APACHEⅡ评分和 APACHEⅡ评分＋PCT 在评估患者预后及多器官功能障碍综合征中的价值,及分析 PCT 对脓毒症患者预后的独立效应及脓毒症患者预后的影响因素。结果脓毒血症组中 PCT 值、APACHEⅡ评分均低于严重脓毒症组和脓毒性休克组,严重脓毒症组均低于脓毒性休克组,三组之间差异均有统计学意义（P ＜0.05）。脓毒血症组中 WBC 明显低于脓毒性休克组（P ＜0.05）。死亡组较存活组中的 APACHEⅡ评分显著升高,差异有统计学意义（P ＜0.01）,而 PCT 值、WBC、Neut％在两组间则差异无统计学意义。非 MODS 组中 APACHEⅡ评分、WBC、Neut％、PCT 值均显著低于 MODS 组（均 P ＜0.05）。PCT 与 APACHEⅡ评分之间呈显著正相关关系（rs ＝0.403,P ＜0.01）。通过绘制 PCT、APACHEⅡ评分、APACHEⅡ评分＋PCT 三者的受试者工作曲线（ROC）来评估脓毒症患者预后情况,得出三者的 ROC 曲线下面积（AUC）分别为0.617、0.899、0.917,而APACHEⅡ评分、APACHE Ⅱ评分＋PCT 的预后评估价值均较 PCT 高（均 P ＜0.01）,且 PCT、APACHEⅡ评分的截断值（cut-off）、灵敏度、特异度分别为（3.40 ng／mL、88.24％、38.04％）和（20分、94.12％、81.52％）。同样 PCT、APACHEⅡ评分、APACHEⅡ评分＋PCT 三者评估脓毒症患者多器官功能障碍综合征的 AUC 分别为0.824、0.796、0.871,PCT 分别与 APACHEⅡ评分、APACHEⅡ评分＋PCT 间差异无统计学意义,且 PCT、APACHEⅡ评分的截断值、灵敏度、特异度分别为（7.26 ng／mL、88.24％、63.79％）和（17分、64.71％、87.93％）。PCT 对脓毒症患者预后的 COR、AOR 分别为1.008、1.014,性别与 APACHEⅡ评分是影响脓毒症患者预后的独立危险因素。结论 PCT 值、APACHEⅡ评分能评估脓毒症患者病情,三者间均呈正相关关系。APACHEⅡ评分、APACHEⅡ评分＋PCT 较 PCT 能更好评估患者预后,且 PCT 不能作为预后评估的独立指标;而 PCT、APACHEⅡ评分、APACHEⅡ评分＋PCT 对脓毒症患者多器官功能障碍综合征的评估效能均较好。PCT 研究需考虑混杂因素,性别与 APACHEⅡ评分是脓毒症患者预后的两个独立危险因素。     

肺炎继发脓毒症患者血清降钙素原和C反应蛋白变化及预后因素分析

目的探讨肺炎继发脓毒症患者血清降钙素原(procalcitonin,PCT)、C反应蛋白(C-reactive protein,CRP)的变化及预后危险因素。方法 122例肺炎患者,其中单纯肺炎52例为肺炎组,肺炎继发脓毒症57例为继发脓毒症组,肺炎继发脓毒性休克13例为脓毒性休克组;比较3组PCT、CRP、急性生理与慢性健康状况(Acute Physiology and Chronic Health EvaluationⅡ,APACHEⅡ)评分、序贯器官衰竭估计(Sequential Organ Failure Assessment,SOFA)评分;绘制ROC曲线,分析PCT、CRP、APACHEⅡ评分对肺炎继发脓毒症和脓毒性休克的诊断价值;继发脓毒症患者70例根据预后分为存活组32例和死亡组38例,比较2组临床资料及PCT、CRP、APACHEⅡ评分和SOFA评分,采用多因素logistic回归分析肺炎继发脓毒症死亡的危险因素。结果肺炎组白细胞计数、PCT、CRP、APACHEⅡ评分[7.59(5.44,10.28)×10~9/L、0.12(0.05,0.33)μg/L、26.85(7.95,74.40)mg/L、2.0(1.0,4.0)分]低于继发脓毒症组[12.20(7.25,17.55)×10~9/L、0.80(0.21,1.96)μg/L、97.80(55.95,127.40)mg/L、11.0(7.5,17.0)分]、脓毒性休克组[15.90(7.00,22.34)×10~9/L、3.49(0.29,50.00)μg/L、122.90(48.90,200.00)mg/L、21.0(15.5,26.0)分](P0.05),继发脓毒症组PCT、APACHEⅡ评分及SOFA评分[5.0(3.0,7.0)分]低于脓毒性休克组[9.0(7.5,11.5)分](P0.05),白细胞计数、CRP水平与脓毒性休克组比较差异无统计学意义(P0.05);PCT、CRP、APACHEⅡ评分及三者联合检测诊断肺炎继发脓毒症的AUC分别为0.791、0.770、0.924、0.943,诊断脓毒性休克AUC分别为0.736、0.718、0.898、0.899;肺炎继发脓毒症死亡组年龄[(69.9±15.2)岁]、SOFA评分[(7.7±3.5)分]、氧合指数SOFA评分[3.0(2.0,4.0)分]、意识障碍发生率(71.1%)、APACHEⅡ评分[(16.7±7.1)分]高于生存组[(58.6±21.3)岁、(4.7±1.9)分、3.0(2.0,3.0)分、37.5%、(9.6±5.0)分](P0.05);氧合指数SOFA评分增高及APACHEⅡ评分增高是肺炎继发脓毒症死亡的独立危险因素(OR=2.979,95%CI:1.307~6.791,P=0.009;OR=1.179,95%CI:0.997~1.394,P=0.050)。结论 PCT、CRP及APACHEⅡ评分对肺炎继发脓毒症诊断有一定价值,APACHEⅡ评分对肺炎继发脓毒症及脓毒性休克的诊断准确性高于PCT、CRP,且三者联合可提高肺炎继发脓毒症的诊断效能;氧合指数SOFA评分和APACHEⅡ评分升高是肺炎继发脓毒症患者死亡的危险因素。     

MR-proADM、HBP及PCT在脓毒症患者血清中的表达及意义

目的研究肾上腺髓质前体中段肽(MR-proADM)、肝素结合蛋白(HBP)和降钙素原(PCT)联合检测在脓毒症早期诊断中的临床价值。方法选取2015年9月至2017年6月该院重症监护室收治的脓毒症患者54例,根据疾病严重程度分为脓毒症组(25例)、严重脓毒症组(17例)和脓毒性休克组(12例),选取同期有局部感染的非脓毒症患者30例作为对照组。检测各组患者血清MR-proADM、HBP及PCT表达水平,运用受试者工作特征曲线分析各指标联合检测诊断脓毒症的效能并探讨各指标的相关性。结果 4组研究对象血清MR-proADM、HBP和PCT表达水平比较,差异均有统计学意义(P0.05),且表达水平由高至低依次为脓毒性休克组、严重脓毒症组、脓毒症组、对照组。MR-proADM、HBP和PCT联合检测诊断脓毒症的效能高于单独检测MR-proADM、HBP和PCT。MR-proADM与HBP、MR-proADM与PCT、HBP与PCT均呈正相关(r=0.306、0.676、0.443,P=0.000)。结论血清MR-proADM、HBP和PCT表达水平与脓毒症严重程度相关,三者联合检测可有助于脓毒症的早期诊断。     

降钙素原联合血小板检测对脓毒症诊断及判断预后的临床意义

目的探讨降钙素原(PCT)联合血小板(PLT)对脓毒症的诊断及判断预后的意义。方法收集160例ICU危重全身炎症反应综合征(SIRS)患者,按脓毒症诊断标准分为脓毒症组与对照组,按是否发生脓毒性休克,将脓毒症组分为非脓毒性休克组与脓毒性休克组。所有患者急性生理学及慢性健康状况评分系统(APACHEⅡ)评分大于10分。收集入院24hAPACHEⅡ评分、序贯器官衰竭估计(SOFA)评分、白细胞(WBC)、C反应蛋白(CRP)、降钙素原(PCT)、血小板计数(PLT)情况。采用SPSS21.0统计软件进行统计分析,比较非脓毒性休克组、脓毒性休克组和对照组间的PLT、CRP、PCT差异,脓毒症组PCT、PLT与SOFA、APACHEⅡ评分的相关性采用Pearson相关分析,绘制受试者工作特征(ROC)曲线确定PCT、PLT的诊断价值。结果脓毒症组PLT明显低于对照组,脓毒性休克组PLT明显低于非脓毒性休克组,脓毒症组CRP、PCT明显高于对照组,脓毒性休克组CRP、PCT明显高于非脓毒性休克组,差异均有统计学意义(P0.05)。Pearson相关分析显示,脓毒症组PCT与SOFA、APACHEⅡ评分呈显著正相关,PLT与二者呈显著负相关。ROC曲线确定PLT≤100×10~9/L,PCT≥2.0μg/L为最佳截点值,ROC曲线下面积(AUC)分别为0.839、0.857,灵敏度分别为89.4%、87.4%,特异度分别为74.2%、69.8%。结论 PCT联合PLT对脓毒症诊断具有较高的临床意义。     

血清和肽素对脓毒症早期诊断及预后评估的临床意义

目的 探讨血清和肽素对脓毒症早期诊断和预后评估的价值.方法 感染患者149例,其中普通感染患者(普通感染组)50例,脓毒症患者(脓毒症组)49例,严重脓毒症及脓毒性休克患者(严重脓毒症及脓毒性休克组)50例,另取同期健康体检者65例为正常对照组,测定各组血清和肽素浓度,并与降钙素原(PCT)、APACHEⅡ评分相互比较,观察其与脓毒症诊断及预后的关系.结果 严重脓毒症及脓毒性休克组、脓毒症组、普通感染组血清和肽素、PCT浓度较对照组明显升高(均P<0.05),脓毒症组与普通感染组比较差异有统计学意义(P<0.05).脓毒症组与严重脓毒症及脓毒性休克组血清和肽素、PCT浓度比较差异有统计学意义(P<0.05),随病情加重有不断升高趋势.脓毒症生存组血清和肽素、PCT浓度明显低于死亡组(P＜0.05).血清和肽素浓度及PCT浓度与APACHEⅡ评分呈正相关.结论 和肽素有助于脓毒症的早期诊断,和肽素、PCT和APACHEⅡ评分的联合应用有助于评估脓毒症患者的病情严重程度和预后.     

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.