弥可保联合葛根素治疗糖尿病周围神经病变36例疗效观察

目的:探讨糖尿病周围神经病变(DPN)的治疗方法,评价弥可保联合葛根素治疗糖尿病周围神经病变的临床疗效。方法:选择36例糖尿病周围神经病变患者,采用弥可保联合葛根素治疗,口服弥可保糖衣片0.5mg,每日3次,葛根素注射液500mg,加入生理盐水250mL中静脉点滴,每日1次,观察治疗前后的神经传导速度和临床症状的变化。结果:治疗后患者临床症状(疼痛、麻木、感觉障碍等)明显减轻,神经传导速度改善显著。结论:弥可保联合葛根素治疗糖尿病周围神经病变有确切疗效。     

联用灯盏细辛与弥可保治疗糖尿病周围神经病的疗效

目的：探讨灯盏细辛与弥可保联合应用对糖尿病周围神经病变（DPN）的疗效。方法：106例DPN患者随机分为2组各53例，在常规口服降糖药或胰岛素治疗基础上，2组均采用弥可保注射液500μg静脉推注，每日1次。观察组同时加用灯盏细辛注射液30ml于生理盐水250ml中静脉滴注。结果：与治疗前比较，2组患者治疗4周后血糖均明显下降（P〈0．05），血脂、尿微量白蛋白排泄率、纤维蛋白原观察组明显改善，对照组无显著变化；神经传导速度在治疗4及6周时2组均缓慢上升，观察组上升速度明显快于对照组。临床疗效比较，观察组总有效率明显高于对照组（83．0％与52．8％，P〈0．01）。结论：灯盏细辛与弥可保联合应用治疗DPN可显著改善患者临床症状，提高疗效。     

弥可保治疗糖尿病周围神经病变的临床观察

目的：观察弥可保治疗糖尿病周围神经病变的临床疗效。方法：50例糖尿病合并周围神经病变患者随机分为治疗组和对照组，对照组采用DPN常规治疗，治疗组在常规治疗基础上加用弥可保肌注治疗12周。结果：与对照组比较．治疗组神经症状和体征明显改善，神经传导速度显著增加，两者比较差异有显著性（P〈0．05）。结论：弥可保不但能改善糖尿病周围神经病变患者的临床症状．还能提高其神经传导速度。是一种比较理想的治疗糖尿病周围神经病变的常用药物。     

斯美欣与弥可保联合治疗糖尿病周围神经病变的观察

目的：观察斯美欣联合弥可保对糖尿病周围神经病变的疗效。方法：将72例糖尿病周围神经病变患者随机分为对照组36例，单用弥可保肌肉注射，500mg／d，连续4周；治疗组36例，给予斯美欣（盐酸丁略地尔）200mg溶于250ml生理盐水中，静脉滴注，1次／d，同时弥可保肌肉注射，每日500mg／d，共4周。结果：两组患者治疗后临床症状及神经传导速度均有改善，治疗组改善明显优于对照组。结论：斯关欣与弥可保联合应用可明显提高对糖尿病周围神经病变的疗效。     

丹参与弥可保联合治疗糖尿病周围神经病变的观察

目的：评价丹参与弥可保联合应用对糖尿病周围神经病变的疗效。方法：50例糖尿病周围神经病变患随机分为两组,治疗组30例,每日给 丹参注射液16ml加入生理盐水500ml静脉滴注,弥可保500ug肌注,均为1次／d,共4周,对照组20例常规糖尿病治疗。结果：治疗组显效率和总有效率分别达56．67％和90％,明显高于对照组的18．18％（P＜0．05）和45．45％（P＜0．01）。结论：丹参与弥可保联合应用对糖尿病周围神经病变有较好的疗效。     

银杏达莫与甲钴胺联合治疗糖尿病周围神经病变的临床观察

目的观察银杏达莫注射液与甲钴胺注射液联合治疗糖尿病周围神经病变（DPN）的疗效。方法将46例DPN患者随机分成两组，对照组给予甲钴胺片500μg口服，每日3次；治疗组给予甲钴胺注射液500μg肌注，银杏达莫注射液20ml＋0．9％NS250ml静脉滴注，每日1次，连用15天。结果治疗组总有效率达88．5％，明显高于对照组的55％（P〈0．01），治疗后腓总神经传导速度有一定程度的改善，与对照组比较具有统计学意义（P〈0．01）。结论银杏达莫与甲钴胺联合治疗糖尿病周围神经病变安全有效。     

高压氧、弥可保联合治疗糖尿病并发下肢周围神经病变的观察与护理

目的：观察高压氧、弥可保联合治疗糖尿病并发下肢周围神经病变的疗效和护理工作在治疗中的作用。方法：随机将糖尿病并发下肢周围神经病变70例分为A、B两组。A组40例肌注弥可保500μg，每日1次，共4周；B组30例高压氧、弥可保联合治疗4周，治疗后测量下肢神经传导速度（NVC），观察下肢症状改善情况。结果：B组神经传导速度较A组快（P＜0．05），症状改善，显效率也明显高于A组（P＜0．05）。结论：高压氧与弥可保联合应用治疗糖尿病并发下肢周围神经病变有较好疗效，配合有效护理，对巩固疗效和促进患康复至关重要。     

弥可保与盐酸丁咯地尔联合治疗糖尿病周围神经病变

目的　评价弥可保与盐酸丁咯地尔联合治疗糖尿病周围神经病变的效果。方法　将糖尿病周围神经病变患者随机分为 2组。治疗组 :2 2例 ,盐酸丁咯地尔 30mg溶于生理盐水 2 5 0ml静脉滴注 ,1次 /d ,同时每日肌注弥可保 5 0 0 μg ,共 6周 ;对照组 :2 0例 ,单用弥可保肌注 ,每日 5 0 0 μg ,共 6周。结果　治疗组有效率明显高于对照组 (6 8%与 4 5 % ,P <0 .0 5 ) ,神经传导功能有明显提高 (P <0 .0 5 )。结论　弥可保与盐酸丁咯地尔联合应用可明显提高糖尿病周围神经病变的治疗效果。     

红花注射液与甲钴胺联合治疗糖尿病周围神经病变的临床观察

目的评价红花注射液与甲钴胺联合治疗糖尿病周围神经病变的疗效。方法将88例糖尿病周围神经病变患者随机分为红花注射液联合甲钴胺治疗组和甲钴胺对照组；观察患者血脂、血流动力学、神经传导速度及血糖的变化。结果治疗组总有效率为88．6％，对照组为56．8％，治疗组在神经传导速度、血流动力学等方面优于对照组。结论红花注射液联合甲钴胺可明显改善糖尿病周围神经病变。     

中药联合前列腺素E1改善老年2型糖尿病周围神经症状的疗效观察

目的 观察前列腺素El(PGE1)与丹参联合应用对老年2型糖尿病周围神经病变的疗效。方法 160例老年2型糖尿病周围神经病变患者随机分为2组，观察组80例，每日给予丹参注射液20mL加生理盐水250mL静脉点滴，前列腺素El20μg加人生理盐水250mL静脉滴注。对照组80例，丹参注射液20mL加生理盐水250mL静脉点滴，两组均为1次／d，共4周。在治疗前和治疗4周后，观察感觉神经症状(肢体疼痛和麻木)，采用丹麦DISA2500C型肌电图仪，对两组患者进行右腓总神经的运动神经传导速度(MNCV),感觉神经传导速度(SNCV)测定。结果 治疗组总有效率达90％(72／80)，明显高于对照组的56．2％(X^2=l948，P&;lt;0．005)。治疗组的神经传导速度在治疗后与对照组比较均有明显的改善(t=2．4l，2.57，P&;lt;0.05)；治疗组治疗前后比较也有明显改善(t=2．32，2．35,P&;lt;0．05)。结论 PGE1与丹参联合应用对对老年2型糖尿病周围神经病变有较好的疗效。     

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.