中医定向透药法联合针灸治疗肺结核盗汗的疗效观察

目的观察中医定向透药法联合针灸治疗肺结核盗汗的临床疗效。方法将128例肺结核盗汗患者按随机数字表分为观察组和对照组各64例。对照组采用穴位针灸治疗,观察组在对照组治疗基础上联合中医定向透药法治疗。结果治疗2周后观察组治疗有效率98.44%,对照组治疗有效率57.81%,观察组出汗程度视觉模拟评分、盗汗及其他伴随症状评分优于对照组,比较差异均有统计学意义。结论中医定向透药联合针灸治疗肺结核盗汗疗效较好。     

针刺结合棍棒操治疗肩周炎疗效观察

目的：观察棍棒操疗法对改善肩周炎肩关节功能障碍的疗效。方法：肩周炎患者28例,分为观察组16例和对照组12例,2组均采用针灸治疗。观察组同时加用棍棒操疗法。结果：治疗1个月后,2组肩关节功能恢复疗效评分均较治疗前明显提高（P〈0.01）,观察组明显高于对照组（P〈0.05）。结论：在采用针灸治疗基础上加用棍棒操能进一步缓解肩痛及增加肩关节活动范围,恢复肩关节功能,提高肩周炎的治疗效果。     

肩关节镜联合中医针灸推拿治疗老年肩袖损伤的疗效研究

目的：探究肩关节镜联合中医针灸推拿治疗老年肩袖损伤的临床疗效。方法：采用随机数字表法，将医院2020年8月至2022年8月收治的80例老年肩袖损伤患者分为两组，每组40例。对照组采用保守治疗，观察组采用肩关节镜手术联合中医针灸推拿康复治疗，两组均治疗3个疗程。比较两组临床疗效、治疗前后疼痛评分（NRS）、肩关节功能评分及并发症发生率。结果：观察组治疗总有效率高于对照组（P＜0.05）。观察组治疗后的NRS评分低于对照组，日常生活活动能力、力量测试、疼痛、肩关节活动范围、总评分均高于对照组（P＜0.05）。两组并发症发生率比较，差异无统计学意义（P＞0.05）。结论：肩关节镜联合中医针灸推拿在老年肩袖损伤治疗中可获得较好的临床效果，患者肩关节功能可得到有效改善，肩部疼痛感明显减轻，且无明显并发症，安全性高。     

针灸联合中医定向透药疗法治疗脑卒中偏瘫后肩手综合征

目的探究针灸联合中医定向透药疗法在脑卒中偏瘫后肩手综合征患者中的临床应用价值。方法选取脑卒中偏瘫后肩手综合征患者120例,按摸球法分为3组,每组40例。对照组患者实施原发病对症治疗、常规康复训练,试验A组在对照组基础上联合针灸治疗,试验B组在试验A组基础上联合中医定向透药治疗,对比3组疗效、治疗前后上肢疼痛程度[采用视觉模拟评分量表(VAS)测评]、上肢运动功能[经Fugl-Meyer评定量表(FMA)评定]和日常生活能力[经日常生活活动能力量表(ADL)测评]。结果3组治疗前FMA、ADL和VAS评分比较差异均无统计学意义(P>0.05)。治疗后,试验B组总有效率、FMA和ADL评分高于对照组及试验A组,VAS评分低于对照组及试验A组(均P<0.05)。结论脑卒中偏瘫后肩手综合征患者实施针灸联合中医定向透药治疗可缓解患者上肢疼痛及水肿,提升患者日常生活能力。     

温针灸联合中医定向透药治疗寒湿证腰椎间盘突出症的效果观察及对炎症因子的影响

目的:探讨温针灸联合中医定向透药对寒湿证腰椎间盘突出症患者血清炎症因子的影响,以观察其临床应用价值。方法:将我院中医5科2017年4月至2019年3月收治的100例寒湿证LDH患者随机分为对照组和观察组,每组50例。对照组采用温针灸,研究组采用温针灸联合中医定向透药疗法,6d视为一疗程,共治疗4个疗程。观察两组治疗前后的血清炎症因子水平和腰椎功能恢复情况,比较2组临床疗效。结果:经过4个疗程的治疗后,观察组血清IL-6、TNF-α水平明显低于对照组(P0.05),观察组临床体征、主观症状和日常活动受限度评分明显高于对照组(P0.05),观察组总有效率96.00%,高于对照组的总有效率80.00%(P0.05)。结论:温针灸联合中医定向透药疗法通治疗寒湿证LDH患者疗效确切,能够减轻炎性反应,缓解腰部疼痛,促进腰椎功能恢复。     

半导体激光联合肩三针温针灸对肩周炎疼痛程度及肩关节功能的影响

目的探讨半导体激光联合肩三针温针灸对肩周炎疼痛程度及肩关节功能的影响。方法选取收治的肩周炎患者87例,按随机数字表法分成对照组(44例)和观察组(43例)。对照组给予半导体激光治疗,观察组接受半导体激光联合肩三针温针灸治疗,比较两组疼痛程度、肩关节功能。结果观察组治疗后疼痛分级指数(PRI)、视觉模拟疼痛评分(VAS)、现在疼痛状况(PPI)评分较对照组低,差异具有统计学意义(P0.05);观察组治疗后日常生活活动、肌力、疼痛、关节活动度评分高于对照组,差异具有统计学意义(P0.05)。结论半导体激光结合肩三针温针灸治疗,可有效改善肩周炎疼痛程度,提升肩关节功能,可行性高。     

肩三针温针灸治疗肩周炎对患者肩关节活动及功能的影响

目的:探讨肩三针温针灸治疗肩周炎对患者肩关节活动及相关功能的影响。方法:选取2018年9月~2019年9月收治的82例肩周炎患者,以抽签法分为对照组与观察组,各41例。对照组以肩三针治疗,观察组在对照组基础上增加温针灸治疗,比较两组患者的治疗疗效、肩关节功能及疼痛评分。结果:观察组治疗总有效率高于对照组,差异有统计学意义(P<0.05)。治疗前两组肩关节功能评分对比,差异无统计学意义(P>0.05);治疗后两组肩关节功能评分中功能、活动度及疼痛评分对比,差异有统计学意义(P<0.05),且观察组高于对照组(P<0.05)。治疗前两组肩部疼痛评分对比,差异无统计学意义(P>0.05);治疗后两组肩部疼痛评分对比,差异有统计学意义(P<0.05),且观察组各项评分优于对照组(P<0.05)。结论:肩三针联合温针灸在治疗肩周炎中治疗效果较高,能有效改善患者肩关节功能及疼痛状况。     

牛膝醇提液联合中医定向透药治疗膝骨性关节炎的效果及对膝关节功能的影响

目的探讨牛膝醇提液联合中医定向透药治疗膝骨性关节炎的效果及对膝关节功能的影响。方法选取2016年12月至2019年3月在我院就诊的膝骨性关节炎患者60例,随机将其等分为观察组与对照组,对照组给予常规护理,观察组采用牛膝醇提液联合中医定向透药治疗,比较两组治疗前和治疗5 d后的膝关节功能评分(Lysholm)、西安大略和麦克马斯特大学骨关节炎(WOMAC)评分。结果治疗5 d后,观察组患者的Lysholm评分高于对照组(P<0.05),WOMAC评分低于对照组(P<0.05)。结论牛膝醇提液联合中医定向透药治疗可很好的改善膝骨性关节炎患者的治疗效果,提高膝关节功能。     

子午流注中医定向透药配合电针治疗缺血性脑卒中偏瘫肢体康复护理观察

目的:观察探讨子午流注中医定向透药配合电针治疗缺血性脑卒中偏瘫肢体的临床应用效果。方法:选取本院康复科缺血性脑卒中(中医证型为风痰阻络型)患者80例,随机分为对照组和观察组,每组40例。对照组给予化痰通络配合针灸康复治疗、功能训练和护理指导;观察组在常规训练基础上实施子午流注中医定向透药配合电针治疗干预措施。对比两组患者治疗前和出院前的偏瘫肢体运动功能评估(FMA)、日常生活活动能力(ADL)改良Barthel指数评估结果。结果:治疗前,两组患者运动功能、日常生活活动能力评估指标比较无明显差异(P>0.05);出院前,两组患者运动功能、日常生活活动能力评估指标均明显优于治疗前,但观察组各项指标又明显优于对照组,差异有统计学意义(P<0.05)。结论:子午流注中医定向透药配合电针治疗能有效促进脑卒中肢体偏瘫患者肢体运动功能和肌张力的恢复,有助于提高日常生活活动能力,提高总体生活质量。     

针灸、推拿配合中药汤剂治疗肩周炎的临床疗效观察

目的 探析针灸+推拿+中药汤剂治疗肩周炎的临床疗效。方法 选取本院2021年1月至2022年12月收治的60例肩周炎患者，随机分为对照组和观察组各30例。对照组给予针灸+推拿治疗，观察组给予针灸+推拿+中药汤剂治疗，对比分析两组临床疗效。结果 治疗后，两组患者中医证候积分均显著低于治疗前，且观察组更低，差异有统计学意义（P<0.05）。治疗后，观察组肩关节Neer评分显著高于对照组，差异有统计学意义（P<0.05）。观察组治疗总有效率为93.33%，高于对照组的73.33%，差异有统计学意义（P<0.05）。结论 行针灸+推拿+中药汤剂治疗肩周炎，临床疗效显著，可改善患者肩关节功能。     

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.