急诊上消化道异物内镜治疗215例临床效果分析

目的：探讨急诊上消化道异物的临床特征及内镜治疗的效果。方法收集沈阳军区总医院内窥镜科2012年1月至2014年1月收治的通过内镜治疗的急诊上消化道异物215例。结果215例急诊上消化道异物内镜治疗的成功率99%。68例经X线透视证实,62例经CT确诊,85例经电子内镜下确诊。其中食管异物195例,胃内异物18例,十二指肠异物2例。结论急诊上消化道异物应尽早明确诊断,确定异物位置,尽快进行内镜治疗是成功取出异物的关键。     

胃镜治疗上消化道异物46例分析

目的探讨上消化道异物的发病因素与内镜下治疗方法的选择。方法对2002-08-2010-12收治的上消化道异物46例发病因素及内镜下治疗方法的分析。结果经胃镜取出上消化道异物44例,占95.65%,转外科手术2例,所有患者均未发生严重并发症。结论内镜下治疗上消化道异物必须了解异物的部位、种类,据此选择合适的治疗方法。     

内镜下小儿上消化道异物取出术26例的护理

目的总结26例内镜下小儿上消化道异物取出术的护理方法。方法对26例行内镜下上消化道异物取出术的患儿进行护理,术前掌握好适应证、做好术前准备,术中掌握配合技巧、与医生密切配合,术后严密观察患儿病情、重视饮食指导及健康教育。结果 26例上消化道异物患儿中有25例经内镜将异物成功取出,成功率为96%,另1例因贲门部金属丝嵌入肌层未取,转上级医院治疗。25例成功取出异物的患儿均在清醒状态下完成治疗,无1例发生并发症。结论内镜是治疗上消化道异物的首选处理方法,有效的护理是内镜下小儿上消化道异物取出术成功的必要条件,加强健康教育是预防小儿上消化道异物发生的重要措施。     

上消化道异物41例胃镜下治疗分析

目的总结上消化道异物的内镜治疗方法及效果。方法对该院2014年10月-2016年5月41例上消化道异物内镜下治疗病例临床资料进行分析。结果上消化道异物中老年患者多见,异物潴留部位多见于食管(53.6%),异物类型以枣核为主(56.1%),41例患者异物均成功取出,合并穿孔1例。结论内镜治疗上消化道异物是一种安全、有效的方法。     

内镜在儿童上消化道异物取出中的应用分析

目的：探讨内镜下儿童上消化道异物取出术的有效性及安全性。 方法：对47例儿童上消化道异物采用成人内镜行内镜下异物取出术。结果：47例患儿中有45例成功取出，患儿无严重并发症发生。 结论：儿童上消化道异物取出术是一种安全、创伤小的方法，值得推广。     

上消化道异物66例分析

目的：了解我院上消化道异物病因分布情况。方法：对我院1996～2005年上消化道异物66例病例进行统计分析。结果：66例上消化道中，食道异物16例。胃内异物45例。十二指肠异物5例。异物性质：胃石32例，金属丝2例。毛刷头2例。牙刷柄1例，金戒指2例。金属币4例，内镜成功取出63例。3例失败。成功率95．4％。结论：内镜下取上消化道异物方法简便易行。病人免遭外科手术。痛苦小，并发症少安全有效，成功效率高，是治疗上消化道异物较好的首选方法。     

内镜治疗上消化道异物36例分析

目的探讨内镜下直视治疗上消化道异物的疗效与可行性。方法对2008-01-2009-12成都医学院第一附属医院消化内科内镜室收治的36例上消化道异物患者进行回顾性分析,总结异物取出经验。结果该组36例经胃镜直视下取异物,35例获得成功,无大出血、穿孔等严重并发症,1例经外科手术取出。结论内镜直视下取异物简便、安全、有效,并发症可控,为上消化道取异物的首选方法 ,值得临床进一步推广应用。     

内镜治疗上消化道异物分析

目的探讨上消化道异物的内镜治疗方法。方法对78例上消化道异物患者的临床资料进行回顾性分析。结果 78例病例中,内镜下成功取出72例（92.3%）,其中39例食管异物成功取出34例（94.2%）,26例胃内异物成功取出25例（96.1%）,13例十二指肠异物全部取出（100%）。结论内镜下上消化道异物取出术是安全有效的。     

急诊取儿童上消化道异物回顾性分析

目的 探讨急诊内镜下取儿童上消化道异物的方法、经验及预防措施.方法 回顾性分析1997年～2009年上消化道异物行急诊内镜治疗资料,进行归纳分析.结果 共行儿童急诊上消化道异物取出术45例,金属异物最多,共31例,占73.81%,其中硬币28例,占急诊的66.67%.22例异物在食管上段,6例在胃内,3例急诊未发现异物,占儿童异物的6.67%.结论 急诊内镜治疗儿童上消化道异物安全、有效,避免儿童将玩具,尤其是硬币放入嘴里,会明显减少儿童上消化道异物的发生.     

特殊人群上消化道异物内镜下取出术的护理配合

目的探讨特殊人群上消化道异物内镜下取出术的护理配合要点。方法回顾性分析69例特殊人群上消化道异物急诊内镜下治疗的术前准备及术中配合要点。结果 69例患者中67例内镜下成功取出,未出现大出血、穿孔等严重并发症;另外1例改用十二指肠侧视镜顺利取出;2例均转外科手术治疗。结论充分的术前准备,熟练的手术护理配合是特殊人群上消化道异物成功取出顺利完成的保障。     

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.