急性脑出血患者初次血糖、糖化血红蛋白A1c及血氨水平联合测定的临床分析

目的 通过对急性脑出血初次血糖（FBG）、糖化血红蛋白Alc（HbA1c）和血氨（AMM）联合测定，分析其结果与预后的关系，以便更好地指导治疗和判断预后，从而降低病死率。方法 168例脑出血患者进行欧洲脑卒中（ESS）评分，测定FBG，HbA1c，AMM，并按水平分组，比较各组间指标差异。结果 非糖尿病性高血糖组ESS评分低于正常血糖组（P〈0．01）和糖尿病性高血糖组（P〈0．05）。其AMM水平高于正常血糖组（P〈0．01）和糖尿病性高血糖组（P〈0．05），正常血糖组与糖尿病性高血糖组差异无显著性意义（P〉0．05）。结论 FBG增高伴HbA1c正常的急性脑出血患者的AMM水平高，病情重，预后差。急性脑出血患者血氨浓度增高出现较早，定期测试血氨浓度、有效地降低血氨浓度，对临床治疗有积极意义。     

血糖异常对急性脑出血预后的影响

目的探讨血糖异常对急性脑出血顸后的影响。方法对102例急性脑出血患者根据空腹血糖分为血糖升高组及血糖正常组,对预后进行对比分析。结果血糖正常组基本治愈比率明显高于血糠升高组,差异有统计学意义（P〈0．01）,血糖升高组的无效病例高于血糖正常组,差异有统计学意义（P〈0．05）;血糖升高组的死亡病例所占比率明显高于血糖正常组,差异有显著统计学意义（P〈0．01）。结论急性脑出血早期血糖升高的患者预后明显比血糖正常者差,积极处理脑出血合并高血糖,对于其病情转归及预后是非常重要的。     

急性脑血管病与早期白细胞、血糖水平及近期预后的关系

背景：白细胞和血糖升高是急性脑血管病发生时的一种应激性反应，常出现在急性脑血管病的早期临床阶段。 目的：观察急性脑血管病早期的白细胞、血糖水平，并探讨其与近期预后的相关性。 设计：以诊断为依据，以患者为观察对象的预后分析。 单位：青田县人民医院。对象：选择2000-05／2002-05青田县人民医院住院的急性脑血管患者235例。其中脑出血患者90例，男52例，女38例，年龄（63．13&;#177;9．55）岁；脑梗死145例，男73例，女72例，年龄（71．22&;#177;8．00）岁。病程≤1个月。按白细胞数分为正常白细胞组167例及白细胞增高组68例；根据血糖水平分为正常血糖组146例与高血糖组89例；神经功能缺损评分（轻型0～15分、中型16-30分、重型31～45分）。方法：所有患者入院后即刻行头颅CT检查，并于次日清晨空腹静脉采血，测定血白细胞和空腹血糖。采用X^2检验。主要观察指标：①急性脑血管病患者的病变类型与年龄的关系。②急性脑血管病病变类型、病情、预后与白细胞及血糖的关系。 结果：①年龄比较：脑梗死组明显高于脑出血组[（71．22&;#177;8．00，63．13&;#177;9．55）岁，t=6．90，P〈0．0011。②病变类型的百分率比较：白细胞增高组中，脑出血明显高于脑梗死（66％，34％，X^2=31.47，P〈0．005）；高血糖组中，脑出血高于脑梗死（51％，49％，X^2=9．12，P〈0．005）。③重型百分率比较：白细胞增高组明显高于正常白细胞组（26％，6％，X^2=21．12，P〈0．005）；高血糖组明显高于正常血糖组（27％，5％，X^2=21．70，P〈0．005）。④死亡百分率比较：白细胞增高组明显高于正常白细胞组（31％，6％，X^2=26．15，P〈0．005）；高血糖组明显高于正常血糖组（26％，5％．X^2=20．02，P〈0．005）。 结论：白细胞及血糖升高均损伤脑组织，可用其判断急性脑血管病患者的病情，估计预后并指导其治疗。     

高血压脑出血术后并存高血糖患者的预后分析及护理

目的探讨高血压脑出血（HICH）术后并存高血糖患者的预后及护理。方法对84例HICH患者依据是否并存糖代谢紊乱及紊乱类型分为3组，A组（HICH并存糖尿病）8例，B组（HICH并尿应激性高血糖）14例，C组（血糖正常）62例，对其进行预后比较。结果C组并发症发生率显著低于A、B组（P〈0．01，P〈0．05）。结论HICH并存高血糖的患者容易发生应激性上消化道出血，肺部感染等并发症，病死率高。严密监测血糖浓度，有效控制血糖水平，做好各项基础护理，可以减少和预防并发症的发生。     

自发性脑出血急性期血糖及其他危险因素与预后的关系

目的 探讨自发性脑出血患者急性期血糖及其他危险因素与预后的关系。方法 回顾性分析我院575例自发性脑出血急性期非糖尿病患者的临床资料,将病例分为血糖升高组和血糖正常组,两组的近期病死率,并采用Logistic回归分析血糖及其他因素对自发性脑出血近期预后的影响。结果 血糖升高组患者并发症发生率,肺部感染30．4％vs18．9％,消化道溃疡27．4%vs10．2％（均P〈0．01）,近期病死率均高于血糖正常组26．1vs9．6％（P〈0．01）,发病时意识障碍、高龄、血糖值和高血压影响疾病预后的因素。结论 自发性脑出血急性期患者出现高血糖是提示近期预后不良的危险因素,发病时意识水平、高龄、血糖和高血压也是近期预后不良的重要危险因素。     

应激性高血糖对急性脑出血预后的影响

[目的]探讨应激性高血糖对急性脑出血预后的影响。[方法]将无糖尿病史的120例急性脑出血病人按入院时血糖值分为应激性高血糖组和正常血糖组，比较两组病人并发症、病死率、住院时间及日常生活活动能力。[结果]应激性高血糖组肺部感染并发症发生率、病死率显著高于正常血糖组（P〈0.05），而且出院时日常生活活动能力差异有统计学意义（P〈0．05）。[结论]应激性高血糖明显影响急性脑出血病人的预后，积极控制血糖水平有助于提高病人的预后。     

急性脑卒中与早期血糖水平的关系探讨

目的：探讨脑卒中急性期血糖水平与病情程度及预后转归的关系。方法：120例急性脑卒中患者根据空腹血糖水平,分为正常血糖组及高血糖组,对比分析两组患者的欧洲脑卒中评分（European Stroke Scale,ESS）及转归情况。结果：高血糖组的ESS评分显著低于正常血糖组（P〈0.001）,而不良转归率高于正常血糖组（P〈0.01）。结论：急性脑卒中患者早期血糖水平与病情严重程度有密切关系,高血糖可增加患者的不良转归率,影响脑卒中的预后。     

急性颅脑危重症患者血糖升高与病情预后的分析及护理

目的探讨颅脑危重症患者血糖升高与病情预后关系。方法检测98例急性颅脑危重症患者血糖水平，对62例高血糖组患者和36例血糖正常组患者病情、预后进行分析。结果高血糖组重型患者及病死率明显高于正常血糖组（P〈0．01）。高血糖组患者血糖升高与病情呈正相关。结论高血糖可加重颅脑危重症患者脑组织损伤，加重病情。血糖变化对判断病情、预后及指导治疗有重要意义。     

非糖尿病性持续性高血糖与一过性高血糖对急性心肌梗死患者预后的影响

【目的】探讨非糖尿病性持续性高血糖对急性心肌梗死（AMI）患者预后影响。【方法】将2010年8月至2012年8月本院收治的125例A M I住院患者排除糖尿病后,根据住院期间患者随机血糖值分为：A组（入院24 h后空腹血糖＜6．1 mmol/L ）;B 组（入院24 h 后空腹血糖＜6．1 mmol/L 且随机血糖＜9．0 mmol/L ）;C组（入院24 h后空腹血糖≥6．1 mmol/L或随机血糖≥9．0 mmol/L ）。分析比较各组恶性心律失常、心力衰竭、死亡的发生率。【结果】C组恶性心律失常、心力衰竭、死亡发生率均高于A组、B组,且差异有显著性（P ＜0．05）。B组恶性心律失常及心力衰竭的发生率均高于A组,且差异有显著性（P ＜0．05）,A组与B组死亡的发生率相比较差异无显著性（ P＞0．05）。【结论】非糖尿病性持续性高血糖AMI患者的预后较一过性高血糖患者的预后差,检测其血糖水平对判断此类患者的预后具有一定的临床意义。     

脑卒中后应激性高血糖的临床意义

目的：探讨急性期脑卒中患者应激性高血糖与病情程度及预后的关系。方法：选择170例无糖尿病史的急性期脑卒中患者，进行空腹血糖测定、欧洲脑卒中（Ess）评分和不良转归率（恶化和死亡发生率）统计。按疾病类型（缺血性卒中及出血性卒中）和空腹血糖水平（正常血糖及高血糖）两种方法分组，比较各组间指标差异性。结果：出血性卒中组空腹血糖水平及不良转归率高于缺血性卒中组，Ess评分低于缺血性卒中组（P〈0．05）；应激性高血糖组Ess评分低于正常血糖组而不良转归率高于正常血糖组（P〈0．01）。结论：急性脑卒中后应激性血糖越高，病情越重，预后越差。其中以出血性卒中更显著。对急性期脑卒中患者应及时检测空腹血糖，以利于对病情及预后的判断。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.