硫酸镁联合沙丁胺醇雾化吸入治疗慢性阻塞性肺疾病急性加重期临床观察

目的观察硫酸镁与沙丁胺醇联合雾化吸入治疗慢性阻塞性肺痰病（COPD）急性加重期的临床疗效。方法采用前瞻性随机对照研究方法，以116例Ⅱ级和Ⅲ级COPD急性加重期患者作为研究对象，随机分为4组：A组雾化吸入低剂量沙丁胺醇（2．5mg）0．5ml＋生理盐水3ml；B组雾化吸入等渗硫酸镁3lTll＋生理盐水0．5ml；C组雾化吸入沙丁胺醇（2．5mg）0．5ml＋等渗硫酸镁3ml；D组雾化吸入常规剂量沙丁胺醇（5mg）1ml＋生理盐水2．5ml。用药后30、60、90min进行肺功能、气急指数、呼吸频率、心率的检测并与治疗前进行比较。结果4组吸入治疗后90min一秒钟用力呼气量（FEV1）均明显增高（P〈0．01或P〈0．05），但4组间比较差异无显著性（P〉0．05）；最大吸气流量（PIF）及气急指数亦明显改善（P〈0．01或P〈0．05），但A、B组比较差异有显著性（P〈0．05），C、D组比较差异无显著性（P〉0．05）。治疗后4组血压、呼吸及心率变化不大，但D组部分患者发生心律失常。结论硫酸镁有支气管扩张作用，能减轻COPD患者气急症状，但单独应用疗效逊于沙丁胺醇（2．5mg）；等渗硫酸镁与沙丁胺醇合用有协同作用，可增加沙丁胺醇疗效，减少其副作用。PIF及气急指数可作为评价支气管扩张药用于COPD急性加重期的疗效指标。     

针药氧综合疗法改善脑卒中恢复期患者的神经功能

目的 观察在传统中药气雾吸入基础上，结合现代超声雾化吸入与氧疗技术综合形成针药氧综合疗法改善恢复期脑梗死患者神经功能的作用。方法 纳入河北省中医院2003-09／2005-09入院的动脉粥样硬化性血栓性脑梗死患者240例。采用随机数字表法分为治疗组和对照组各120例，治疗组采用针药氧综合疗法，将具有醒脑开窍、活血化瘀作用的中药脑康合剂（主要成分：川芎、薄荷、冰片、丹参、檀香各9g）提取其有效成分，制成药氧液，给予雾化吸入，同时施以针刺治疗，针刺选穴：肩隅、曲池、手三里、外关、合谷、环跳、风市、阳陵泉、足三里、昆仑，留针30rain，1次／d。对照组单纯采用氧针疗法。检测治疗前后血脂、血液流变学的变化，观察患者神经功能缺损评分以及临床疗效。结果 参与观察者对照组因资料不全脱落2例，最后进入结果分析238例。①治疗前后两组神经功能缺损评分比较：差异均有非常显著性意义（P〈0．01）；治疗后治疗组神经功能缺损评分低于对照组，差异有显著性意义（P〈0．05）。②总有效率：治疗组优于对照组（95％，88．1％，P〈0．01）。③治疗后三酰甘油、胆固醇水平：治疗组和对照组均较治疗前显著降低（P〈0．05或P〈0．01），且两组比较差异有显著性意义（P〈0．05）；治疗组低密度脂蛋白显著降低（P〈0．05），对照组高密度脂蛋白显著升高（P〈0．05）。④全血高切黏度、全血低切黏度、纤维蛋白原水平：两组较治疗前显著降低（P〈0．05或P〈0．01），治疗组血浆黏度、红细胞压积显著降低（P〈0．05或P〈0．01），治疗组全血高切黏度、全血低切黏度、红细胞压积与对照组比较差异有显著性意义（P〈0．05）。结论 脑康合剂胶囊通过调节血脂和改善血液流变学，从而改善了脑梗死恢复期患者的神经功能。     

超声、激光、肌电反馈治疗脑梗塞的临床研究

目的 研究超声、激光、肌电反馈治疗脑梗塞的经颅多普勒超声（TCD）和血液流变学变化。方法将72例脑梗塞患者分为声、光、电治疗组36例和单纯药物治疗36例，治疗前及治疗后检查TCD和血液流变学指标，研究声、光、电组对脑梗塞患者TCD和血液流变学的影响。结果 ①2组治疗后病损评分及Barther指数（BI）均有改善，与药物组相比，声、光、电组下肢功能恢复更显著（P〈0．05）；②声、光、电组治疗后TCD改善显著（P〈0．05）；③治疗后声、光、电组全血黏度低切、高切和红细胞电泳下降明显（P〈0．05），血浆黏度和红细胞压积下降较少（P〉0．05）。结论超声、激光、肌电反馈治疗脑梗塞可以促进偏瘫肢体康复，改善大脑血液循环和血液流变学。     

不同雾化吸入方法对慢性阻塞性肺疾病病人影响的研究

目的 观察3种雾化吸入方法对慢性阻塞性肺疾病（COPD）病人动脉血气分析及临床症状的影响。方法 将90例COPD病人分为3组，每组30例，用相同剂量的异丙托溴铵，分别采用空气压缩（A组）、高流量氧气（B组）及低流量氧气（C组）雾化吸入，雾化吸入前后分别采集动脉血气分析，同时观察病人临床症状的变化。结果 3组雾化吸入前后比较，pH及PaCO2无显著性差异（P〉0．05）。PaO2及SaO2A组显著降低（P〈0．01），而B、C组显著升高（P〈0．01）。临床症状加重的病人数A组多于B组（P〈0．05），A组显著多于C组（P〈0．01）。结论 氧气雾化优于空气压缩雾化，而低流量氧气雾化优于高流量氧气雾化，是COPD病人安全的雾化吸入方法。     

银杏达莫与低分子肝素钙联合治疗不稳定性心绞痛临床观察

目的观察银杏达莫注射液与低分子肝素钙联合治疗不稳定性心绞痛的临床疗效及对血液流变学的影响。方法将所观察的60例患者随机分为治疗组30例，采用银杏达莫注射液＋低分子肝素钙治疗；对照组30例，采用低分子肝素钙治疗。分别治疗7d后观察临床疗效，14d后观察血液流变学的变化。结果治疗组总有效率及治疗后心绞痛发作次数、心绞痛持续时间、发作间隔时间、Holter24h缺血总时间等改善方面均优于对照组（P〈0．05）。两组治疗后全血黏度（高切、低切）、血浆黏度均较治疗前明显下降（P〈0．05，P〈0．01），其中全血高切比黏度降低治疗组优于对照组（P〈0．05），而且治疗组能明显降低患者的纤维蛋白原（P〈0．01）。结论银杏达莫注射液与低分子肝素钙联合治疗不稳定性心绞痛疗效显著，且能降低血黏度及纤维蛋白原而无出血现象发生，值得临床推广应用。     

小青龙汤配合基础治疗对慢性阻塞性肺疾病患者血氧饱和度的影响

目的探讨小青龙汤结合基础治疗对慢性阻塞性肺疾病（COPD）患者血氧饱和度的影响。方法选择COPD急性期患者90例，按照随机数字表法随机分为治疗组和对照组各45例，治疗组患者在抗感染、雾化吸入等基础治疗的同时，每日用小青龙汤1剂水煎服；而对照组仅采用抗感染、雾化吸入等基础治疗。连续治疗2周，以用药前后血气分析的动脉氧分压（PaO2）、动脉二氧化碳分压（PaCO2）评定疗效。结果治疗前两组PaO2、PaCO2无明显差异（P〉0．05）；治疗2周后，两组PaO2明显升高、PaCO2明显降低（P〈0．01）；而治疗组与对照组比较，PaO2升高和PaCO2降低比对照组更明显（P〈0．01）。结论小青龙汤结合基础治疗可达到提高COPD患者血氧饱和度，改善患者缺氧状态的作用。     

缺氧缺血性脑病患儿血液流变学改变

目的观察缺氧、缺血性脑病患儿血液流变学指标的改变，并探讨其临床意义。方法选择了30例轻、中、重度缺氧、缺血性脑病惠儿和30例同日龄新生儿做对照。在出生24h内采静脉血做血液流变指标的检测，4h内检测完毕。结果发现缺氧、缺血性脑病患儿血液流变学指标（全血高切黏度、全血低切黏度、血浆黏度、血浆纤维蛋白原、血细胞比客及红细胞沉降率）与正常新生儿比较均有显著性差异（即P〈0．05和P〈0．01），且结果异常与疾病严重程度有关（重度组〉中毒组〉轻度组）。疾病组之间比较，差异也存在显著性（P〈0．05和P〈0．01）。结论缺氧、缺血性脑病惠儿血液流变性的改变，可能参与并加重缺氧、缺血的脑组织损伤。     

儿童肾脏疾病血液流变学检测结果分析

目的了解儿童各种常见类型肾脏疾病与血液流变学改变的关系。方法使用专用真空抗凝管空腹抽取静脉全血5mL，采用北京宏润达公司生产的YDA-Ⅳ血液黏度计测定全血黏度、血浆黏度，用库尔特血细胞计数仪测定红细胞压积。血样全部来自儿科病房及门诊。结果原发性肾病综合征组全血低切黏度、血浆黏度和IgA肾病组的血液流变学各项检测指标与健康对照组比较，差异有统计学意义（P〈0．01）；急性肾小球肾炎组全血低切黏度、血浆黏度与健康对照组比较明显增高（P〈0．05），其余指标差异无统计学意义；紫癜性肾炎组除红细胞压积外，其他各项指标均高于健康对照组（P〈0．05）。结论儿童肾脏疾病与血液流变学指标的改变密切相关，改善血液黏度对治疗儿童肾脏疾病有特殊的临床意义。     

杏丁注射液对急性心肌梗死患者血管内皮功能及血液流变学的影响

目的探讨杏丁注射液对急性心肌梗死（AMI）患者血管内皮功能及血液流变学的影响。方法将40例AMI患者随机分为2组。对照组（n=20）给予常规治疗（包括硝酸酯类、阿斯匹林、ACEI／ARB、β-受体阻滞剂、辛伐他汀等）共2周,杏丁组（n=20）则在常规治疗的基础上给予杏丁注射液25mL加入250mL生理盐水,静脉滴注,2次／d,共2周。另选取同期20例正常人作为正常对照组。观察治疗前后血浆ET-1、NO浓度、血液流变学（纤维蛋白原、血小板聚集率、血浆黏度、全血高切、低切黏度）变化。结果AMI患者与正常对照组比较其血浆ET-1升高、NO降低,纤维蛋白原浓度、血浆黏度、全血低切、高切黏度、血小板聚集率均升高,差异有极显著性（P〈0．01）。杏丁组治疗后患者与对照组比较其血浆ET-1明显下降、NO明显升高,纤维蛋白原浓度、全血低切黏度、高切黏度、血浆黏度及血小板聚集率均明显降低,差异均有显著性（P均〈0．05）;与治疗前比较差异有极显著性（P〈0．01）。结论AMI患者的发病与血管内皮功能和血液流变学异常有关,杏丁能改善血管内皮功能及冠心病患者血液流变学。     

黄芪注射液和丹参冻干粉针剂联用对早期糖尿病肾病血液流变学和肾功能的影响

目的探讨黄芪注射液和丹参冻干粉针剂联用对早期糖尿病肾病血液流变学和肾功能的影响。方法将2002-03-2005-03本院内科160例EDN患者随机分为治疗组和对照组各80例。两组均采用饮食控制和糖尿病常规治疗。治疗组加用黄芪注射液和丹参冻干粉针剂治疗，疗程4周。结果治疗组血液流变学各项指标较治疗前显著下降（P〈0．05或P〈0．01）；尿蛋白排泄率（UAER）、血肌酐（SCR）、尿素氮（BUN）和血脂明显下降（P〈0．05或P〈0．01），且明显优于对照组（P〈0．01或P〈0．05）。结论黄芪注射液和丹参冻干粉针剂联用能改善EDN患者的血液流变学、血脂和微循环，减少尿白蛋白的排出，减轻肾损害，改善肾功能。     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.