离子型和非离子型造影剂用于子宫输卵管造影的效果观察及护理

目的：探讨离子型造影剂复方泛影葡胺与非离子型造影剂碘比醇用于子宫输卵管造影中的效果及护理方法。方法：将100例不孕症患者随机分A、B两组各50例，A组采用复方泛影葡胺造影，B组采用碘比醇造影剂，比较两组子宫输卵管造影的效果及不良反应。结果：A、B两组均能显示子宫输卵管的通畅情况，但B组不良反应及并发症少于A组，两组比较有显著性差异（P〈0．05）。结论：非离子型造影剂可作为子宫输卵管造影的首选造影剂。     

欧乃派克和复方泛影葡胺在CT增强扫描中副反应的对比研究

目的对比观察非离子型造影剂欧乃派克和离子型造影剂复方泛影葡胺在CT增强扫描中的副反应，讨论其机理及临床应用价值。材料与方法：观察受检病人1178例，欧乃派克组262例，60％复方泛影葡胺组916例，造影剂量60～100ml。结果：欧乃派克发生副反应2例（0．76％）；复方泛影葡胺发生到反应52例（5．68％）（P＜0．001）。结论：非离子型造影剂由于其良好的理化特性，副反应明显低于离子型造影剂，因此在CT扫描中，特别是高危人群应尽量使用非离子型造影剂。     

对子宫输卵管造影检查中两种常用造影剂的评价

目的：对子宫输卵管造影检查中应用40％碘化油和欧乃派克的比较。方法：选取400名不孕症妇女，随机分为碘油组和欧乃派克组，对影像质量、术后腹痛、造影结果和方便程度及价格作出对比。结果：在影像质量和造影结果方面二者无显著性差异，术后腹痛和方便程度欧乃派克组优于碘油组。结论：欧乃派克副作用小，患者所受痛苦小，有推广价值。     

碘化油和复方泛影葡胺在诊断不孕症输卵管造影的应用价值

目的探讨碘化油和复方泛影葡胺在诊断因输卵管阻塞所致的不孕症，进行子宫输卵管造影后的随访影像表现，追踪输卵管通畅情况。进一步砚确这两种造影剂的应用价值。方法回顾不孕症患者79例，碘化油38例，复方泛影葡胺41例，将跟踪随访后的影像及受孕情况进行分析。结果碘化油组较前次造影黏阻加重的23根，改善39根，通畅9根，受孕1例；复方泛影葡胺组黏阻加重3根，改善47根，畅通16根，受孕6例。结论不孕症的子宫输卵管造影，首先应为复方泛影葡胺，它具有快捷、无粘连和不影响着床等优点，且受孕率较高。碘化油黏稠度大，造影后加重了粘连，有不易排空、残留的倾向，造成慢性炎症反应后影响受孕和着床。因此，在不孕症的子宫输卵管造影中应尽量少用，甚至不用。     

欧乃派克与泛影葡胺皮试情况观察

欧乃派克与泛影葡胺均为含碘造影剂,我院主要用于子宫、输卵管造影检查。但在实际应用中发现两种造影剂在进行皮试时皮丘颜色、大小、硬度、阳性率、局部疼痛等有明显不同。为了明确原因,对此进行了观察。现将观察结果报告如下。1　资料与方法1.1　一般资料　选取2 0 0 3年1月—2 0 0 3年11月因继发不孕行子宫、输卵管造影检查病人3 0 0例,将其随机分成欧乃派克组与泛影葡胺组,每组15 0例。3 0 0例病人中年龄最大3 5岁,最小2 4岁,平均年龄2 9.3岁。1.2　皮试方法　按要求欧乃派克以原液作为试敏液,泛影葡胺采用上海淮海制药厂直接配备的3 0 …     

76%复方泛影葡胺在子宫输卵管造影中的应用

泛影葡胺是一种经肾脏排泄的造影剂，即3，5二乙酰胺基2，4，6三碘苯甲酸葡胺盐。由于在体内代谢过程中，其毒性小，副反应较轻，临床应用较安全，因此目前应用较广泛。子宫输卵管造影为不孕症患者X线检查中最常见的方法。以前通常使用40％碘化油作为造影剂进行子宫输卵管造影。但因碘化油目前较缺以及造影副反应多等原因，我院于1989年以来应用76％的复方泛影葡胺做子宫输卵管造影收到极满意的效果。现介绍如F。1资料和方法1．且一般资料199年1月至Ic月就诊我科的不孕症患者80例，其中25例采用76％复方泛影葡胺子宫输卵管造影术。年龄27…     

200例子宫输卵管造影影像分析

子宫输卵管造影是妇科病患者最常用的方法之一。近年来,我们又对带避孕环者的子宫形态与环的关系进行了研究。兹总结如下: 资料和方法1986年7月至1989年3月间,行子宫输卵管造影检查资料完整者200例进行分析。采用西种造影剂即碘化油及泛影葡胺。为便于总结,将200例患者分为西组:第一组不孕症患者120例,采用碘化油造影50例,76%泛影葡胺70例,第二组80例,均用20～30%泛影葡胺。患者年龄在22～37岁,其中24～31岁者占80%。     

欧乃派克与泛影葡胺皮试情况观察

欧乃派克与泛影葡胺均为含碘造影剂，我院主要用于子宫、输卵管造影检查。但在实际应川中发现两种造影剂在进行皮试时皮丘颜色、大小、硬度、阳性率、局部疼痛等有明显不同。为了明确原因，对此进行了观察：现将观察结果报告如下。     

子宫输卵管造影对不孕症诊断价值分析

目的了解子宫输卵管造影准确性及不同造影剂的影响。方法对116例因输卵管异常行输卵管成形术患者的术前子宫输卵管造影结果进行了回顾性分析,以了解其诊断的可靠性及影响因素。结果116例中以40%碘化油造影70例,76%泛影葡胺造影46例。总的诊断符合率对输卵管积水,间质部、峡部阻塞,输卵管狭窄,分别为86%,53%及47%。以40%碘化油进行子宫输卵管造影,其诊断符合率较泛影葡胺造影显著增高,尤其对输卵管间质部、峡部阻塞,及输卵管积水的诊断(P<0·01,P<0·05)。结论子宫输卵管造影是输卵管成形术前可靠的诊断方法,尤其以40%碘化油作造影剂,具有较高的诊断准确性。     

子宫输卵管40％碘化油造影与76％复方泛影葡胺造影对照分析（附100例报告）

子宫输卵管造影术，是一种诊断不孕症及其子宫输卵管疾病的最常用的方法．过去我们习惯用40％碘化油做造影．行人工对比。从98年以来．我院采用76％复方泛影葡胺做子宫输卵管造影，在不孕症患者中，我们随机抽样各50例对照分析，结果76％复方泛影葡胺显影效果满意，简化了造影，缩短造影时间。副作用小，并发症少，诊断准确，值得推广。     

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.     

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.