中西医结合治疗小儿病毒性腹泻60例临床疗效观察

目的:观察中西医结合治疗小儿病毒性腹泻的临床疗效。方法:选取本院儿科收治的病毒性腹泻患儿120例为研究对象,按随机数字表法分为对照组和观察组各60例,对照组给予西医治疗,观察组在对照组基础上加用中药治疗,比较两组治疗后疗效。结果:两组患儿治疗后,总有效率分别为73.33%和95.00%,观察组疗效优于对照组,差异有统计学意义(P0.05);观察组退热时间、止泻时间、腹胀消失时间、呕吐消失时间及住院时间短于对照组,差异均有统计学意义(P0.05);两组不良反应发生率比较差异无统计学意义(P0.05)。结论:中西医结合治疗小儿病毒性腹泻可有效改善临床症状,缩短治疗时间,且不良反应少,值得临床推广。     

甲氰咪胍联合思密达治疗小儿病毒性腹泻

目的 观察甲氰咪胍联合思密迭治疗小儿病毒性腹泻的有效性与安全性.方法 58例小儿病毒性腹泻被随机分成两组,治疗组30例应用甲氰咪胍联合思密达治疗,对照组28例应用病毒唑治疗.结果 治疗组总有效率93.3%,对照组总有效率71.4%,两组差异有统计学意义(P＜0.05),在止泻时间和总疗程治疗组短于对照组,两者差异有统计学意义(P＜0.05).治疗组未见明显不良反应.结论 甲氰咪胍联合思密达治疗小儿病毒性腹泻临床疗效确切,无明显不良反应,方法简便,价廉易得,易于接受,适于推广.     

小儿支气管肺炎患儿应用沐舒坦加酚妥拉明注射液治疗的疗效分析

目的观察小儿支气管肺炎患儿治疗中应用沐舒坦加酚妥拉明注射液治疗的疗效。方法选取2016年10月～2017年3月我院儿科接诊的80例小儿支气管肺炎的患儿,随机分为观察组和对照组各40例。两组行常规治疗,对照组在此基础上给予沐舒坦治疗,观察组在此基础上辅以沐舒坦加酚妥拉明注射液治疗。比较两组患儿临床症状的消失时间、疗效、住院天数以及不良反应发生情况。结果观察组患儿临床症状消失时间及住院时间明显短于对照组,差异有统计学意义(P0.05);观察组疗效明显好于对照组,差异有统计学意义(P0.05);两组不良反应发生情况比较,差异无统计学意义(P0.05)。结论小儿支气管肺炎患儿应用沐舒坦加酚妥拉明注射液治疗的疗效显著,可在临床上推广使用。     

丙种球蛋白联合磷酸果糖治疗小儿病毒性心肌炎的疗效分析

将我院小儿病毒性心肌炎患儿60例随机分为观察组和对照组,对照组给予常规治疗,观察组给予丙种球蛋白联合磷酸果糖治疗,评估两组临床治疗效果及安全性。观察组患儿总有效率明显高于对照组,两组比较差异具有统计学意义(P<0.05)。观察组患儿症状消失时间、心电图恢复时间及心肌酶恢复时间明显短于对照组,两组比较差异具有统计学意义(P<0.05)。丙种球蛋白联合磷酸果糖治疗小儿病毒性心肌炎的疗效明确,值得应用。     

法莫替丁和干扰素联合补锌治疗小儿轮状病毒感染性腹泻的临床研究

研究分析法莫替丁与干扰素联合补锌治疗小儿轮状病毒感染性腹泻的临床效果。选取小儿轮状病毒感染性腹泻患儿98例,分为观察组与对照组各49例。对照组采用法莫替丁和干扰素进行治疗,观察组在对照组基础上联合葡萄糖酸锌口服液治疗,观察对比两组患儿的治疗效果。观察组患儿治疗的总有效率明显高于对照组,差异有统计学意义(P0.05);观察组患儿的大便复常时间、体温复常时间与纠正脱水时间明显低于对照组,差异有统计学意义(P0.05);比较两组患儿的不良反应发生率,差异无统计学意义(P0.05)。法莫替丁与干扰素联合补锌治疗小儿轮状病毒感染性腹泻的临床效果更加明显,能够更好的帮助患儿身体恢复,值得广泛推广。     

喜炎平注射液联合双歧杆菌对病毒性腹泻患儿康复进程的影响

目的研究喜炎平注射液联合双歧杆菌对病毒性腹泻患儿康复进程的影响。方法选取我院2016年3月~2017年3月收治的86例病毒性腹泻患儿,按入院顺序分为对照组和观察组各43例。对照组给予双歧杆菌治疗,观察组采用喜炎平注射液+双歧杆菌治疗,观察比较两组临床疗效、康复进程(住院时间、退热时间及止泻时间)及不良反应(头晕、呕吐、恶心)发生率。结果观察组总有效率为97.67%,显著高于对照组76.74%,观察组退热时间、住院时间及止泻时间均短于对照组,差异具有统计学意义(P0.05);两组不良反应发生率比较差异无统计学意义(P0.05)。结论喜炎平注射液联合双歧杆菌治疗病毒性腹泻患儿,可提高治疗效果,加快患儿康复进程。     

小儿肺咳颗粒联合阿莫西林克拉维酸钾治疗小儿急性支气管炎的疗效观察

目的探讨小儿急性支气管炎采用小儿肺咳颗粒联合阿莫西林克拉维酸钾治疗效果。方法选取我院2017年5月～2018年4月收治的急性支气管炎患儿102例,根据治疗方案不同可分为观察组和对照组各51例。对照组采用阿莫西林克拉维酸钾治疗,观察组于对照组治疗基础上联合小儿肺咳颗粒治疗,比较两组临床疗效、治疗前后症状评分、临床症状消失时间及不良反应发生情况。结果观察组总有效率98.04%较对照组82.35%高,差异有统计学意义(P0.05);治疗后,两组临床症状评分均较治疗前降低,且观察组较对照组低,差异有统计学意义(P0.05);观察组肺部啰音消失、体温恢复正常及咳嗽消失时间短于对照组,差异有统计学意义(P0.05);观察组不良反应发生率1.96%与对照组1.96%相比,无显著性差异(P0.05)。结论小儿急性支气管炎采用小儿肺咳颗粒联合阿莫西林克拉维酸钾治疗的疗效确切,可有效减轻患儿症状,加速症状消失时间,安全性高。     

消旋卡多曲联合双歧杆菌四联活菌及蒙脱石散治疗小儿急性腹泻的效果分析

目的分析消旋卡多曲联合双歧杆菌四联活菌及蒙脱石散治疗小儿急性腹泻的效果。方法选取2014年11月至2017年2月于某院接受治疗的小儿急性腹泻患儿88例,采用随机数表法将其分为对照组与观察组,每组44例。对照组接受双歧杆菌四联活菌及蒙脱石散治疗,观察组则在对照组治疗基础上接受消旋卡多曲治疗。对比两组疗效、症状改善情况、不良反应及再次腹泻发生情况。结果观察组治疗总有效率为95.45%,高于对照组的79.55%,大便性状及次数恢复正常时间、呕吐及腹胀腹痛停止时间、退热时间均较对照组短,差异具有统计学意义(P0.05);两组不良反应发生率比较,差异无统计学意义(P0.05);观察组再次腹泻发生率较对照组低,差异具有统计学意义(P0.05)。结论消旋卡多曲联合双歧杆菌四联活菌及蒙脱石散治疗小儿急性腹泻安全有效,在提升患儿治疗效果的同时还可较快促进患儿症状消失,降低腹泻复发率。     

红霉素联合阿奇霉素序贯疗法治疗小儿支原体肺炎临床研究

目的探讨红霉素联合阿奇霉素序贯疗法治疗小儿支原体肺炎的效果。方法选取支原体肺炎患儿70例,将其随机分为两组,每组35例。对照组给予单一的阿奇霉素序贯疗法治疗,观察组给予红霉素联合阿奇霉素序贯疗法治疗,对比分析两组临床症状消失时间、临床疗效及不良反应。结果对照组治疗总有效率为77.1%,明显低于观察组的94.3%,差异有统计学意义(P0.05);对照组咳嗽消失时间、胸片阴影消失时间、退热时间、肺部湿啰音消失时间均明显长于观察组,差异有统计学意义(P0.05);对照组不良反应发生率为31.4%,明显高于观察组的11.4%,差异有统计学意义(P0.05)。结论红霉素联合阿奇霉素序贯疗法治疗小儿支原体肺炎效果显著,可明显改善患儿的症状,促进康复,且不良反应少。     

小儿咳喘灵联合氨溴特罗治疗小儿病毒性肺炎的效果评价

目的:探讨小儿咳喘灵口服液与氨溴特罗口服液联合治疗小儿病毒性肺炎的临床效果。方法:选取2017年1月～2019年5月收治的90例小儿病毒性肺炎患儿为研究对象,按照随机数字表法分为对照组和观察组,每组45例。对照组给予氨溴特罗口服液治疗,观察组在对照组基础上给予小儿咳喘灵口服液治疗。比较两组临床疗效、临床症状消失时间、炎症因子、免疫球蛋白以及不良反应发生情况。结果:观察组治疗总有效率明显高于对照组(P0.05);观察组退热时间、咳嗽消失时间、肺啰音消失时间均短于对照组(P0.05);治疗后,观察组C反应蛋白、白介素-6、降钙素原水平均低于对照组,免疫球蛋白G、免疫球蛋白A、免疫球蛋白M水平均高于对照组(P0.05);两组不良反应发生率比较,差异无统计学意义(P0.05)。结论:小儿咳喘灵口服液与氨溴特罗口服液联合治疗小儿病毒性肺炎的效果较单纯氨溴特罗口服液治疗更加显著,能够有效缓解患儿临床症状,减轻肺部炎症反应,改善免疫功能,且不良反应少,安全性良好。     

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.