奥曲肽治疗肝硬化合并上消化道大出血疗效观察

目的探讨奥曲肽治疗肝硬化合并上消化道大出血的临床疗效。方法将52例肝硬化合并食管胃底静脉曲张破裂大出血的住院患者随机分为奥曲肽治疗组26例和垂体后叶素对照组26例,观察两组显效时间、平均止血时间、24 h止血率、再出血率等。结果治疗组的平均显效时间及平均止血时间、再出血率均低于对照组,24 h止血率高于对照组,两组比较差异均有统计学意义（P〈0.05）。结论奥曲肽治疗肝硬化合并食管胃底静脉曲张破裂大出血的止血效果明显优于垂体后叶素对照组,加之配合合理、及时有效的抢救措施,明显提高了临床疗效,改善了患者的生活质量。     

三腔两囊管联合奥曲肽治疗肝硬化食管胃底静脉出血效果观察

目的观察三腔两囊管联合奥曲肽与奥美拉唑治疗肝硬化并发食管胃底静脉曲张破裂出血的效果。方法将我院收治的72例肝硬化并发食管胃底静脉曲张破裂出血随机分为治疗组和对照组各36例,治疗组采用三腔两囊管联合奥曲肽与奥美拉唑治疗,对照组采用三腔两囊管联合垂体后叶素与奥美拉唑治疗,观察两组治疗24 h的效果及不良反应发生情况。结果治疗组总有效率91.67%,对照组总有效率72.22%,两组比较差异有统计学意义(P0.05)。治疗组不良反应发生率5.56%,对照组不良反应发生率19.44%,两组比较差异无统计学意义(P0.05)。结论三腔两囊管联合奥曲肽与奥美拉唑治疗肝硬化并发食管胃底静脉曲张破裂出血效果优于三腔两囊管联合垂体后叶素与奥美拉唑治疗。     

奥曲肽辅助治疗肝硬化食管胃底静脉曲张破裂出血疗效分析

目的:观察奥曲肽辅助治疗肝硬化食管胃底静脉曲张破裂出血的临床疗效.方法:64例肝硬化食管胃底静脉曲张破裂出血患者,随机分为治疗组(36例)和对照组(28例),在常规禁食、抗感染、抗休克、保肝、纠正电解质紊乱、输血止血等综合治疗基础上,前者应用奥曲肤治疗,后者应用垂体后叶素及硝酸甘油治疗.结果:治疗组显效率80.6%,总有效率为97.2%;对照组显效率53.6%,总有效率为82.2%,2组相比差异有统计学意义(P相似文献   

奥曲肽治疗肝硬化食管胃底静脉曲张出血疗效观察

目的 探讨奥曲肽治疗肝硬化食管胃底静脉曲张出血的疗效及安全性.方法 回顾性分析三门峡市第三人民医院56例肝硬化食管胃底静脉曲张出血病例资料,将所有病例随机分成两组,治疗组和对照组各28例.在常规治疗(禁食、输液、输血、对症处理)的基础上,治疗组给予奥曲肽注射液以50 μg/h的速度连续滴注48～72 h,对照组给予垂体后叶素以0.9 U/min静脉滴注,直至止血后16 h.治疗期间严密观察两组患者生命体征变化及不良反应.结果 治疗组与对照组相比,总有效率比较差异有统计学意义(P<0.05);再出血率明显降低(P<0.05);不良反应发生率治疗组明显优于对照组(P<0.05).结论 奥曲肽治疗肝硬化食管胃底静脉曲张出血效果良好,不良反应发生率低,安全可靠,值得临床推广使用.     

奥曲肽治疗肝硬化门静脉高压合并食管下段胃底静脉曲张首次破裂出血近期疗效观察

目的观察奥曲肽治疗肝硬化门静脉高压合并食管下段胃底静脉曲张首次破裂出血近期疗效及其不良反应。方法将50例肝硬化门静脉高压合并食管下段胃底静脉曲张首次破裂出血病人随机分为两组,对照组30例,奥曲肽治疗组20例,对照组在基础治疗(制酸、护肝、降低门静脉压、补液等)上加垂体后叶素治疗;治疗组在基础治疗上加奥曲肽治疗。同时观察两组止血情况及不良反应。结果治疗组有效率82.4%,对照组有效率61.2%,两组比较有差异统计学意义(P<0.05),且奥曲肽组不良反应少,患者耐受性好。结论奥曲肽治疗肝硬化门静脉高压合并食管下段胃底静脉曲张首次破裂出血近期疗效好,不良反应少,值得临床推广使用。     

醋酸奥曲肽与三腔二囊管联合垂体后叶素治疗食管胃底静脉曲张破裂出血的对比观察

目的：比较醋酸奥曲肽（奥宁）和三腔二囊管联合垂体后叶素治疗肝硬化并食管胃底静脉曲张破裂出血的疗效及不良反应。方法：74例肝硬化并食管胃底静脉曲张破裂出血的患者随机分为两组。治疗组（n=34）采用醋酸奥曲肽治疗,对照组（n=40）采用三腔二囊管联合垂体后叶素治疗,观察两组的止血效果和不良反应。结果：治疗组有效率79.4%（27/34）,对照组有效率82.5%（33/40）,差异无显著性（P〉0.05）;不良反应发生率治疗组5.9%（2/34）,对照组72.5%（29/40）,差异有显著性（P〈0.01）。结论：醋酸奥曲肽（奥宁）与三腔二囊管联合垂体后叶素治疗肝硬化并食管胃底静脉曲张破裂出血止血效果无明显差异,且不良反应小,安全性高。     

奥曲肽治疗肝硬化食管胃底静脉曲张破裂出血疗效观察

目的 观察奥曲肽治疗肝硬化食管胃底静脉曲张破裂出血的疗效.方法 86例肝硬化食管胃底静脉曲张破裂出血患者,随机分为三组,分别应用奥曲肽(1组,30例)、垂体后叶素(2组,28例)、奥曲肽+垂体后叶素(3组,28例)进行治疗.结果 1组治疗显效率73.3%,总有效率93.3%;2组治疗显效率39.3%,总有效率67.9%;3组治疗显效率75.0%,总有效率92.9%;其中1组、3组明显高于2组(P＜0.05),但1组与3组比较无差别.结论 奥曲肽治疗肝硬化食管胃底静脉曲张破裂出血安全有效,联合应用垂体后叶素并不能提高疗效.     

国产奥曲肽治疗食管胃底静脉曲张破裂出血24例

目的：观察国产奥曲肽针对食管胃底静脉曲张破裂出血的止血作用及不良反应。方法：48例食管胃底静脉曲张破裂出血患者,随机分成治疗组24例,奥曲肽25-50μg/h,持续静脉滴注;对照组24例,0.2-0.4 u/min持续静脉滴注。比较两组止血效果。结果：止血成功率治疗组87.5%,对照组54.2%,两组比较差异有统计学意义（P〈0.01）。治疗组平均止血时间12 h,平均输血量600 mL;对照组平均止血时间24 h,平均输血量1400 mL;两组比较差异有统计学意义（P〈0.05）。结论：国产奥曲肽止血效果优于垂体后叶素。     

奥曲肽联合三腔气囊管抢救食管-胃底静脉曲张破裂大出血的临床观察

食管-胃底静脉曲张破裂出血是肝硬化门脉高压的严重并发症,以往保守治疗多以脑垂体后叶素辅以常规止血措施,包括三腔气囊管应用。近年来,奥曲肽用于控制食管-胃底静脉曲张破裂出血,取得较好效果,但在抢救大出血时能否取代三腔气囊管尚少见报道。我们采用奥曲肽联合三腔气囊管与单纯使用奥曲肽进行治疗,并比较其疗效及预后。1　临床资料1.1　对象及分组　组:奥曲肽联合三腔气囊管压迫止血22例,组:单纯使用奥曲肽20例,组:既往住院患者20例,垂体后叶素联合三腔气囊管压迫止血。所有病例均经实验室检查,B超,CT或胃镜证实有肝炎肝硬化食管-胃底…     

奥曲肽注射液在辅助治疗食管胃底静脉曲张破裂出血中的应用研究

目的 研究奥曲肽注射液辅助治疗食管胃底静脉曲张破裂出血的临床疗效.方法 将50例食管胃底静脉曲张破裂出血患者随机分为两组,一组为实验组,一组为对照组,每组25例.其中实验组患者注射奥曲肽,对照组采取垂体后叶素治疗.观察实验组和对照组的止血率和不良反应.结果实验组的止血率达88.0 %,对照组的止血率为64.0 %;实验组的不良反应发生率为4.0 %,对照组的不良反应发生率为40.0 %;实验组止血率高于对照组,不良反应率低于对照组,差异均有统计学意义（P＜0.01）.结论 奥曲肽注射液在辅助治疗食管癌胃底静脉曲张破裂出血中的临床应用效果显著,值得深入研究和推广应用.     

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.