中西医结合治疗排卵障碍性不孕症43例

目的 观察补肾调经汤配合克罗米芬治疗排卵障碍性不孕症的临床疗效.方法 选择符合排卵障碍性不孕症患者86例,随机分成治疗组和对照组各43例,治疗组以补肾调经汤为基本方,随证加减,配合克罗米芬治疗;对照组给予克罗米芬治疗.结果 治疗组受孕率69.76%,总有效率86.05%;对照组受孕率34.90%,总有效率81.40%,两组疗效相比差异有统计学意义(P<0.01).结论 补肾调经汤配合克罗米芬治疗排卵障碍性不孕症疗效较好.     

补肾活血汤治疗排卵障碍性不孕

目的:探讨补肾活血汤治疗肾虚血瘀型排卵障碍性不孕症临床疗效。方法:将62例肾虚血瘀型排卵障碍性不孕症患者随机分为两组,治疗组32例运用补肾活血法,内服补肾活血汤治疗,对照组30例服用西药克罗米芬治疗,治疗1个月经周期为1个疗程,3个疗程后综合判定疗效。结果:治疗组32例中,排卵21例,排卵率为65.6%;对照组30例中,排卵23例,排卵率为76.7%:两组排卵率比较无明显差异(P>0.05)。治疗组妊娠率为40.6%;对照组妊娠率为23.3%:两组比较有显著差异(P<0.05)。结论:补肾活血汤促排卵疗效肯定,补肾活血法通过改善卵巢功能及子宫内膜发育,提高患者妊娠率,是治疗肾虚血瘀型排卵障碍性不孕较理想的方法之一。     

疏肝补肾汤联合来曲唑治疗多囊卵巢综合征不孕不育症的临床观察

目的观察疏肝补肾汤联合来曲唑治疗多囊卵巢综合征不孕不育症的临床疗效。方法将60例排卵功能障碍不孕症患者随机分为治疗组30例和对照组30例,治疗组30例用疏肝补肾汤配合来曲唑促排卵治疗,对照组30例用来曲唑促排卯治疗。并对照观察两组治疗前后主要临床症状、排卵率、妊娠率及子宫内膜厚度等的改善情况。结果经1～2个疗程治疗后,治疗组在排卵率、妊娠率、自然流产率方面均优于对照组。结论疏肝补肾汤结合西药来曲唑能有效提高多囊卵巢综合征不孕症患者的排卵率,并减轻来曲唑的副反应,改善机体内环境,明显提高受孕率,中西结合治疗优势突出。     

补肾活血法改善排卵障碍32例：B超评估

目的：观察补肾活血法提高排卵障碍疾病的疗效，及对未破裂卵泡黄素化和黄体功能不全发生的影响。方法：于2002-10／2006-02选择安徽中医学院第一附属医院门诊和住院的排卵障碍患者52例。随机抽签法分为2组，中药治疗组（n=32）：阳对照组（n=20）。治疗组在B超监测下根据中医肾-天癸-冲任-胞宫生殖轴的的理论，按月经后（卵泡期）-氤氲时（排卵期）-月经前（黄体期）的不同阶段，给予补肾养血（促卵泡，服用补肾八珍汤7d）-补肾活血化瘀（促排卵，服促排卵方5d）-温肾养血（促黄体，服用补肾八珍汤加枸杞10g、巴戟天10g，7d）的周期治疗，并配合克罗米酚促排卵（周期第5天配合克罗米酚50-100mg／a，5d，3个周期后停用）建立一个有排卵的正常月经周期。西药对照组在月经或黄体酮撤药第5天给予克罗米酚50-100mg／d，5d。两组连续治疗3-6个周期。疗效标准：治愈，治疗3-6个月经周期，月经周期正常，基础体温高温相≥12d，B超监测发生排卵或已受孕；有效，月经周期基本正常，B超监测发生排卵。但黄体功能欠佳，基础体温高温相〈12d，未受孕；无效，月经周期不规则，基础体温单相，B超监测无排卵。结果：两组患者均完成治疗，全部进入结果分析。①中药治疗组32例患者治疗156个周期中，有排卵133个周期，排卵率明显高于西药对照组（85．3％，58．7％，X^2=3．96，P〈0．05）。②两组在促排卵周期治疗中，中药治疗组未破裂卵泡黄素化发生率明显低于西药对照组（7．1％，20．2％，X^2=7．653，P〈0．01）；中药治疗组黄体功能不全发生率明显低于对照组（17.3％，39．4％，X^2=9．002,P〈0．01）。⑧所选择不孕症的促排卵治疗中，中药治疗组的受孕率显著高于西药对照组（77％，39％，X^2=6．49，P〈0．05）；④中药治疗组在给予中药补肾活血法促排卵治疗后治愈率明显高于西药对照组（78％，45％，P〈0．05）；经Ridit分析，西药对照组95％置信区间为（0．536，0．794）。结论：应用补肾活血法能提高排卵率，降低单用克罗米酚而引起的未破裂卵泡黄素化和黄体功能不全的发生率，提高治疗崩漏、闭经和不孕的疗效。     

超声检查监测卵泡发育的临床探讨

目的探讨超声检查卵泡发育／排卵在治疗排卵障碍性不孕症中的价值。方法超声检查对105例100个为自然周期和50个为促排卵周期的卵泡发育情况进行观察。结果自然周期排卵前卵泡直径平均为22．5mm，每天平均增长1．6mm；促排卵泡周期排卵前卵泡直径平均为24．0mm，每天平均增长2．0mm。促排卵有效率为70％，妊娠率为55．2％。结论在治疗排卵障碍性不孕症中，B超检查可监测了解卵泡发育过程，指导药物使用，准确预测排卵日期，指导性生活时间，从而提高不孕者的受孕率。     

中西医结合治疗不孕症43例

目的:观察中西医结合治疗排卵障碍性不孕症的临床疗效。方法:将73例患者随机分成治疗组43例和对照组30例,治疗组予补肾促孕汤辨证加西药克罗米芬治疗,对照组予单纯克罗米芬促排卵治疗。结果:治疗组治愈率(妊娠率)46.5%,明显高于对照组的妊娠率23.3%,差异有显著性意义(P<0.05)。结论:中西医结合治疗排卵障碍性不孕症的效果优于单纯克罗米芬。     

经阴道超声监测药物诱导排卵的临床应用

排卵障碍是导致不孕的重要原因之一,通过药物诱导排卵是治疗卵巢功能紊乱引起的不孕症最有效的方法,而超声检查逐渐成为促排卵治疗中的重要监测手段。我们应用阴道超声对30例不孕症妇女的51个治疗周期进行了排卵监测并指导用药,从而提高了受孕率,现报告如下。1 资料与方法1.1 研究对象1999年6月～2000年4月我院妇产科诊治的不孕症妇女30例,年龄24～33岁,不孕年限2～8年,月经周期规律或稀发,用药前均经过不孕症的筛查诊断为排卵障碍性不孕。其中原发性不孕11例,继发性不孕19例。1.2 治疗方法每个病例于月经周期第5天开始口服克罗米…     

补肾促孕汤联合来曲唑对肾虚型排卵障碍性不孕症患者妊娠的影响

目的：探讨补肾促孕汤联合来曲唑对肾虚型排卵障碍性不孕症患者妊娠的影响。方法：选取2019年1月~2020年6月收治的92例排卵障碍性不孕症患者,根据随机数字表法分为对照组和观察组,各46例。对照组采用来曲唑治疗,观察组采用来曲唑+补肾促孕汤治疗。对比两组血清激素水平、子宫内膜厚度、中医证候积分、排卵情况及妊娠情况。结果：治疗后,两组促黄体生成素、雌二醇及促卵泡生成素水平均升高,且观察组较对照组高,差异有统计学意义（P＜0.05）;治疗后,两组子宫内膜厚度及中医证候积分均改善,且观察组子宫内膜厚度水平较对照组高,中医证候积分较对照组低,差异有统计学意义（P＜0.05）;观察组排卵率、妊娠率较对照组高,差异有统计学意义（P＜0.05）。结论：补肾促孕汤联合来曲唑治疗肾虚型排卵障碍性不孕症,可有效调节患者血清激素水平,增加子宫内膜厚度,改善临床症状,提升排卵率及妊娠率。     

补肾调经法对调经健内膜的疗效分析

目的:观察补肾调经法对不孕症患者调经健内膜的疗效。方法:60例患者随机分为2组,各30例。治疗组根据女性正常月经周期的生理变化,分阶段以补肾调经法治疗。对照组采用激素疗法。观察2组疗效。结果:治疗组在调经效果、子宫内膜厚径、妊娠率等方面明显优于对照组。在周期性卵泡发育及排卵方面,2组间无显著性差异。结论:补肾调经法具有较好的整体调节作用,并产生双相调节效果。     

中药补肾调周法联合西药治疗肾阳虚型多囊卵巢综合征临床研究

目的:观察石英毓麟汤补肾调经,中药人工周期序贯治疗,联合西药雌-孕激素调周期,氯菧酚胺、尿促性素、绒促性素促排卵治疗肾阳虚型多囊卵巢综合征的疗效。方法:将60例肾阳虚型多囊卵巢综合征按患者意愿分2组,中西医组合组30例,西医组30例,2组均采用雌-孕激素调周期后,氯米芬、尿促性素、绒促性素促排卵,累计3个周期未妊娠者停用,通过β-HCG、孕酮测定、B超了解胎心博动和胚芽确定妊娠。结果:中西医结合组妊娠率73.3%,明显高于西医组妊娠率40%(P0.01)。结论:石英毓麟汤补肾调经,中药人工周期序贯治疗,联合西药调周期促排卵,较单纯的西药治疗受孕率高。     

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.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

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.