高血压脑出血并发上消化道出血的治疗观察(附68例报告)

目的探讨高血压脑出血并发上消化道出血的治疗方法。方法对 68例高血压脑出血并发上消化道出血患者不同治疗方案的临床效果进行分析。结果洛赛克静脉注射治疗高血压脑出血并发上消化道出血患者的止血率为 95 .1% ,止血效果明显优于经胃管注入冰盐水加去甲肾上腺素 (P <0 .0 1)。结论洛赛克是治疗高血压脑出血并发上消化道出血的一种有效药物。其止血效果好 ,作用迅速     

洛赛克在预防内镜下逆行胰胆管造影术后胰腺炎的作用

目的 :评价洛赛克对内镜下逆行胰胆管造影术 (ERCP)后高淀粉酶血症及急性胰腺炎的预防作用。方法 :将 2 4 1例患者随机分为洛赛克治疗组 (A组 )及使用安慰剂的对照组 (B组 ) ,A组 (132例 )分别于术前 1d ,当日及术后 1d给予洛赛克 (40mg/d ,静脉滴注 ) ,B组 (10 9例 )给予安慰剂。术前、术后 3h及 2 4h检测血清淀粉酶 (参考值 10～ 12 0U/L)。结果 :A组有 4例 (3.0 3% ) ,B组有 9例 (8.2 6 % )发生急性胰腺炎 (P <0 .0 5 ) ,A组有 33例 (2 5 .0 0 % ) ,B组有 5 8例 (5 3.2 1% )出现高淀粉酶血症 (P <0 .0 1)。结论 :洛赛克能预防ERCP术后高淀粉酶血症及急性胰腺炎的发生。     

洛赛克与雷尼替丁防治脑出血并发上消化道出血80例疗效对比观察

目的 :了解洛赛克与雷尼替丁对防治脑出血并发上消化道出血的疗效。方法 :在脑出血常规治疗的基础上分别加用洛赛克与雷尼替丁。结果 :使用洛赛克组发生上消化道出血明显少于雷尼替丁组 (P <0 .0 5 )。     

巴曲酶与奥美拉唑联合治疗急性脑血管病并上消化道出血的临床观察

目的：为进一步提高急性脑血管病并发上消化道出血的诊治水平，减少急性血管病的病死率，探讨联合使用巴曲酶(立止血)与奥美拉唑(洛赛克)治疗急性脑血管病并发上消化道出血有效性。方法：采用立止血lku iv bid与洛赛克40mg iv qd治疗急性脑血管病并发上消化道出血25例，与常规止血药治疗症状相似急性脑血管病并发上消化道出血25例比较。结果：观察组与对照组治疗急性脑血管病并发上消化道出血的显效率分别为76%与58％，总有效率分别是94％与83％。结论：巴曲酶与奥美拉唑联合使用是治疗急性脑血管病并发上消化道出血的最佳方法之一，具有有效性和安全性。     

洛赛克与雷尼替丁注射液治疗消化性溃疡合并出血疗效比较

目的观察洛赛克、雷尼替丁分别对消化性溃疡所致急性上消化道出血的止血作用。方法将100例确诊的消化性溃疡并发出血的病人随机分为两组,洛赛克组(洛组)5 0例、雷尼替丁(雷组)5 0例在常规治疗的基础上除加用止血敏、止血芳酸外,仅分别加用洛赛克、雷尼替丁,观察其止血情况。结果洛组有效率为98%,雷组有效率为84%,两组相比有显著性差异(P<0.01)。结论洛赛克治疗消化性溃疡合并出血与雷尼替丁相比有显著疗效,值得在临床上推广应用。     

巴曲酶与奥美拉唑联合治疗急性脑血管病并上消化道出血的临床观察

[目的]探讨联合使用巴曲酶（立止血）与奥美拉唑（洛赛克）治疗急性脑血管病并发上消化道出血的有效性.[方法]50例急性脑血管病并发上消化道出血病人,随机分为两组各25例.观察组采用立止血每次lku 静推,每天2次,与洛赛克每次40 mg静推,每天1次,连用3 d;对照组以常规止血药治疗,比较两组的疗效.[结果]观察组与对照组显效率分别为60%与40%,总有效率分别是84%与72%,观察组疗效明显优于对照组（P〈0.05）.[结论]巴曲酶与奥美拉唑联合使用是治疗急性脑血管病并发上消化道出血的最佳方法之一,具有有效性和安全性.     

善得定、凝血酶、洛赛克联合治疗肝炎后肝硬化并上消化道出血的疗效观察

目的:观察善得定、凝血酶、洛赛克联合治疗肝炎后肝硬化并上消化道出血的疗效。方法:84例肝炎后肝硬化并上消化道出血患者随机分为A,B,C三组。A组27例,在护肝、输血及一般止血药物治疗的基础上给予善得定0.1mg加入5%葡萄糖注射液20mL缓慢静脉注射,然后以25μg/h缓慢静脉滴注维持到止血为止;B组28例,在A组的基础上加用凝血酶2000u溶于20mL冰生理盐水口服;C组29例,在B组治疗的基础上给予洛赛克40mg加生理盐水100mL静脉滴注,三组疗程均为2～4d。结果:C组显效率(76.86%)较B组(50.00%)和A组(48.15%)均有明显升高,C组较A和B组的平均止血时间明显缩短(t=2.45,t=2.40,P<0.05),A与B组间的差异无统计学意义(t=0.25,P>0.05)。结论:善得定、凝血酶、洛赛克联合治疗肝炎后肝硬化并上消化道出血有良好的疗效。     

生长抑素十四肽联合奥美拉唑治疗肝硬化合并食管胃底静脉曲张破裂出血52例疗效观察

目的 观察生长抑素十四肽联合奥美拉唑治疗肝硬化合并食管胃底静脉曲张破裂出血的疗效,以期找到一种最有效的抢救措施.方法 回顾性分析2005-01-2008-02肝硬化合并食管胃底曲张静脉m血住院患者107例,分为A组(52例)和B组(55例).A组为生长抑素十四肽联合奥美拉唑治疗组,B组为垂体后叶素联合硝酸甘油治疗组,观察两组的止血效果.结果 A组24 h止血显效率为78.84%,明显高于B组(50.91%),差异有统计学意义(P<0.05);平均止血时间(20.45±8.52)h,短于B组(29.96±7.64)h;输血量为(1.73±0.57)单位,少于B组(2.61±0.65)单位;48 h再出血率为1.92%,低于B组(9.09%),差异有统计学意义(P均<0.05).结论 生长抑素十四肽联合奥美拉唑组治疗食管胃底曲张静脉破裂出血疗效明显优于垂体后叶素联合硝酸甘油组,具有止血速度快、输血量减少及早期冉出血发生率低的特点.     

大黄对有机磷农药中毒并发胃肠功能衰竭的治疗作用

目的 :观察大黄对有机磷农药中毒并发胃肠功能衰竭的疗效。方法 :将 10 7例急性有机磷农药中毒患者随机分为治疗组 ( 5 4例 )、对照组 ( 5 3例 ) ,观察大黄对胃粘膜出血的止血疗效和恢复肠蠕动的疗效。结果 :治疗组与对照组间止血和预防再出血有显著性差异 (P <0 .0 5 ) ,缓解腹胀 ,恢复肠蠕动有显著性差异 (P <0 .0 5 )。结论 :大黄能有效防治有机磷农药中毒并发胃肠功能衰竭 ,促进胃肠蠕动恢复 ,保护胃肠粘膜屏障。     

中西医结合治疗青春期功血止血效应的临床观察

目的:观察妇科养荣胶囊联合妈富隆治疗青春期功血的止血效果。方法:将54例青春期功血患者随机分为A、B、C三组各18例:A组口服妇科养荣胶囊;B组口服妈富隆;C组联合口服妇科养荣胶囊+妈富隆。分别观察三组24h、48h、72h出血控制率及完全止血率、完全止血时间、药物性不良反应。结果:24hA、B、C三组出血控制率分别为16.67%、44.44%、66.67%;48h出血控制率分别为44.44%、72.22%、94.44%;72h出血控制率分别为55.56%、100%、100%。完全止血率A、B、C三组分别为50.00%、88.89%、100%;完全止血时间为A组(88.52±12.71)h、B组(55.63±14.12)h、C组(45.27±12.62)h。以上指标经统计学处理(P<0.05),组间差异有显著性。A组9例(9/18)用药后有不规则出血表现,B组5例(5/18)用药后有突破性出血表现,C组无不规则及突破性出血表现;A、C两组无不良反应,B组有恶心反应者6例。结论:妇科养荣胶囊联合妈富隆治疗青春期功血的止血效果显著优于妇科养荣胶囊和妈富隆,且无药物性出血反应及其它不良反应。     

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.