溶血磷脂酸及CA125在卵巢癌诊断中的价值对比分析

目的 对比CA 125与溶血磷脂酸(LPA)在卵巢癌诊断中的作用.方法 对2006-2008年入院的450例卵巢肿瘤患者进行手术前测定CA 125和LPA,其中良性卵巢肿瘤408例,恶性卵巢肿瘤42例.恶性肿瘤患者于术后4周复测CA125和LPA以进行对比研究.结果 卵巢恶性肿瘤组血浆LPA(5.25±1.57)和CA125(159.6±58.7)U/L均高于卵巢良性肿瘤组[分别为(1.74±0.71)μmol/L],(11.10±6.89)U/L,恶性肿瘤患者二者均有明显的升高,差异有统计学意义(t值分别为12.032、8.205,P均＜0.05).LPA诊断准确率高于CA125(82.4%与36.0%,x2=3.96,P＜0.05).恶性肿瘤外周后复查CA125和LPA阳性率分别为74%与100%(x2=2.76,P＞0.05).结论 与CA125相比LPA在卵巢癌的诊断和随访中具有重要的价值.     

溶血磷脂酸及CA125在卵巢癌诊断中的价值对比分析

目的 对比CA 125与溶血磷脂酸(LPA)在卵巢癌诊断中的作用.方法 对2006-2008年入院的450例卵巢肿瘤患者进行手术前测定CA 125和LPA,其中良性卵巢肿瘤408例,恶性卵巢肿瘤42例.恶性肿瘤患者于术后4周复测CA125和LPA以进行对比研究.结果 卵巢恶性肿瘤组血浆LPA(5.25±1.57)和CA125(159.6±58.7)U/L均高于卵巢良性肿瘤组[分别为(1.74±0.71)μmol/L],(11.10±6.89)U/L,恶性肿瘤患者二者均有明显的升高,差异有统计学意义(t值分别为12.032、8.205,P均＜0.05).LPA诊断准确率高于CA125(82.4%与36.0%,x2=3.96,P＜0.05).恶性肿瘤外周后复查CA125和LPA阳性率分别为74%与100%(x2=2.76,P＞0.05).结论 与CA125相比LPA在卵巢癌的诊断和随访中具有重要的价值.     

血清乳酸脱氢酶及其同工酶检测在卵巢癌诊治中的初步应用

目的:探讨血清乳酸脱氢酶(LDH)及其同工酶检测在卵巢癌诊治中的意义。方法:检测72例卵巢癌、22例子宫恶性肿瘤、33例卵巢良性肿瘤患者术前和30名健康成年女性(对照组)血清LDH及其同工酶水平,治疗后测定卵巢癌患者血清LDH的变化。结果:卵巢癌患者术前血清LDH含量为(405.9±331.5)u/L,明显高于子宫恶性肿瘤(198.2±60.1)U/L、卵巢良性肿瘤(205.0±70.5)U/L和对照组(168.6±69.3)U/L(P<0.001),晚期患者高于早期患者(P<0.05),各病理类型之间无明显差异。卵巢癌治疗有效患者血清LDH下降明显,与治疗无效或稳定患者相比差异亦有显著性(P<0.01)。血清LDH同工酶检测显示卵巢癌患者LDH1、LDH2明显低于对照组(P<0.05),LDH5水平高于对照组(P<0.001)。结论:测定卵巢癌患者血清LDH及其同工酶水平对卵巢癌的诊断、鉴别诊断以及随访具有一定的临床意义。     

卵巢肿瘤患者血浆溶血磷脂酸水平及其受体Edg-2/Edg-7的表达

目的:探讨卵巢肿瘤患者血浆溶血磷脂酸(lysophosphatidic acid,LPA)水平及其受体Edg-2/Edg-7在卵巢肿瘤组织中的表达情况.方法:测定57例卵巢恶性肿瘤患者、66例卵巢良性肿瘤患者及37例健康对照者血浆LPA水平,并用RT-PCR方法检测其中16例正常卵巢组织、24例卵巢恶性肿瘤组织及32例卵巢良性肿瘤组织Edg-2/Edg-7 mRNA的表达情况.结果:卵巢恶性肿瘤患者、卵巢良性肿瘤患者及健康对照者血浆LPA水平分别为(5.63±2.35)、(2.80±1.13)、(2.51±1.08) μmol/L,前者血浆LPA水平与后两者相比,差异有显著性(P＜0.01),后两者之间血浆LPA水平差异无显著性(P＞0.05).Edg-7在卵巢恶性肿瘤组织的表达水平高于卵巢良性肿瘤组织及正常卵巢组织(P＜0.01),Edg-2在卵巢良性肿瘤组织及正常卵巢组织的表达水平高于卵巢恶性肿瘤组织(P＜0.01),Edg-2/Edg-7在卵巢肿瘤组织中的表达呈相反趋势.结论:卵巢恶性肿瘤患者血浆LPA水平明显高于卵巢良性肿瘤患者和健康对照者;卵巢恶性肿瘤组织多表达Edg-7受体,大多数正常卵巢组织和卵巢良性肿瘤组织表达Edg-2受体,血浆LPA及其受体Edg-2/Edg-7可能成为治疗卵巢恶性肿瘤的新靶点.     

P185、LPA和CA125在卵巢癌诊断中的价值

目的探讨可溶性P185蛋白对卵巢癌诊断和预后观测的价值。方法采用酶联免疫吸附法和比色法分别对初发或复发卵巢癌患者、卵巢良性肿瘤患者和正常对照组各60例进行血清中P185、Ca125和LPA检测,以评价三项指标对卵巢癌检测中的敏感性和特异性。结果初发或复发卵巢癌组与卵巢良性肿瘤组相比,血清P185和LPA的水平有显著性差异(P<0.01)。复发转移组与正常对照组相比,血清CA125水平差异有统计学意义(P<0.01)。结论联合检测血清CA125、P185和LPA可对提高卵巢癌诊断的准确度、特异性及监测疗效和预后有重要的价值。     

CA125监测进展期卵巢癌疗效和复发的意义

目的　评估CA12 5监测进展期卵巢癌疗效及复发的应用价值。方法　采用ES3 0 0全自动酶免疫分析系统检测 5 4例Ⅲ、Ⅳ期原发卵巢癌患者、42例综合治疗后随访卵巢癌患者、2 4例治疗后复发或远处转移患者、15例卵巢良性肿瘤和65例健康女性血清CA12 5水平。结果　 ( 1) 5 4例进展期原发卵巢癌患者血清CA12 5水平显著高于正常人和卵巢良性肿瘤患者。以 3 5U/ml为限定值 ,卵巢上皮癌 10 0 %阳性 ,非上皮癌中 2例内胚窦瘤为阴性 ,其余均阳性。良性肿瘤 13 .3 %假阳性。Ⅲ、Ⅳ期间无显著差异。 ( 2 )原发卵巢癌患者经综合治疗后 ,CA12 5明显下降 ,病情转归与CA12 5下降的幅度相关 ,但与治疗前水平无关。 ( 3 ) 42例随访未出现复发者 ,10 2次检测CA12 5平均值为 2 7.85± 12 .66U /ml ,连续 2次CA12 5升高者 2例 ,治疗后复发或远处转移者 2 4例 ,CA12 5平均值为 3 3 9.5 5± 2 46.6U/ml,其中 95 .8% ( 2 3 /2 4)高于限定值。CA12 5判断复发的准确率为 95 .4% ( 63 /66)。结论　CA12 5的连续监测可作为进展期卵巢癌疗效评价、复发转移及预后的一个有用指标。     

ROMA模型联合HE4与CA125检测在卵巢癌诊断中的作用

目的探讨卵巢恶性肿瘤风险计算法(ROMA)联合血清人附睾蛋白4(HE4)与糖类抗原125(CAl25)检测在预测卵巢癌诊断中的价值。方法采用通过化学发光方法检测100例卵巢癌患者(卵巢癌组)、100例卵巢良性肿瘤患者(良性组)及100例女性健康对照者(健康对照组)的血清HE4与糖类抗原CAl25浓度,采用ROMA方法计算卵巢癌预测概率(PP),评价PP值的诊断效果。结果 (1)卵巢癌组血清HE4和CAl25水平分别为320.2±210.6pmo L/L和350.6±162.8k U/L,卵巢良性肿瘤组血清HE4和CAl25水平分别为52.8±12.6pmo L/L和32.6±10.5k U/L,健康对照组血清HE4和CAl25水平分别为36.4±12.8pmo L/L和21.4±8.2k U/L,卵巢癌组血清HE4和CAl25水平分别与卵巢良性肿瘤组和健康对照组比较,差异均有统计学意义(P0.01)。(2)未绝经和绝经女性PP值的临界值分别为11.4%和29.9%,诊断未绝经患者的灵敏度和特异性分别为87.0%和83.8%,阳性预测值和阴性预测值分别为71.1%和93.4%;诊断绝经患者的灵敏度和特异度分别为88.4%和81.3%,阳性预测值和阴性预测值分别为91.0%和76.5%。结论 ROMA联合血清HE4与CAl25判定有助于提高患者卵巢癌诊断的准确度。     

溶血磷脂酸与CA125在复发性卵巢癌中的价值分析

目的 分析血浆溶血磷脂酸（lysophosphatidic acid,LPA）及CA125在卵巢癌复发患者中的表达情况和监测价值.方法 选择2013年1月-12月广州市第一人民医院收治的32例上皮性卵巢癌复发患者,测定血浆LPA和CA125表达情况,检测同期28例上皮性卵巢癌治疗后完全缓解患者、30例初诊上皮性卵巢癌患者及30例正常女性的血浆LPA和CA125作为对照,分析LPA和CA125在卵巢癌复发患者中的敏感度和特异度.结果 上皮性卵巢癌复发组血浆LPA（9.52±4.64 mol/L）明显高于完全缓解患者组（2.02±1.94 mol/L）（t=7.96,P＜0.05）及正常人群组（1.91±2.21 mol/L）（t=8.15,P＜0.05）,与初诊患者组（9.19±2.47 mol/L）差异无统计学意义（t=0.35,P＞0.05）,上皮性卵巢癌复发组血浆CA125（75.42±10.66 U/ml）明显高于完全缓解患者组（11.42±9.67 U/ml） （t=28.830,P＜0.05）及正常人群组（10.45±6.42 U/ml）（t=24.220,P＜0.05）,与初诊患者组（63.29±132.32 U/ml）差异无统计学意义（69.29±7.32 U/ml）（t=2.622,P＞0.05）.采用LPA和CA125诊断上皮性卵巢癌复发的诊断价值有差异（χ^2=37.834,P=0.022）,其中LPA敏感度（93.8％）高于CA125（65.6％）,特异度无明显差异（χ^2=24.501,P=0.99）.结论 LPA水平对判断上皮性卵巢癌的复发有重要价值,可能成为监测上皮性卵巢癌复发的新方法.     

麻黄对去卵巢肥胖大鼠体质量、血脂、血糖及激素水平的影响

背景近年来,中药麻黄用于肥胖症的治疗并有一定的效果,但麻黄对围绝经期妇女的肥胖是否有效有待研究.目的观察口服麻黄水煎剂对去卵巢肥胖大鼠体质量、血脂、血糖及激素水平的影响.设计完全随机分组设计,对照实验.单位兰州大学基础医学院生理学和心理学研究所.材料实验于2006-02/06在甘肃省新药临床前研究重点实验室和兰州大学基础医学院生理学和心理学研究所实验室完成.选用健康雌性SD大鼠44只,随机分为4组,每组11只,分别为假手术组,去卵巢组,雌激素替代治疗组和麻黄组.方法①大鼠用氯胺酮(110 mg/kg)麻醉,除假手术组外全部行双侧去卵巢术.假手术组进行同样的手术过程,但不切除卵巢.②假手术组和去卵巢组大鼠术后每天皮下注射芝麻油(0.2 mL/只),持续到实验结束.③雌激素替代治疗组大鼠术后每天皮下注射雌激素(1 mg/kg),持续到实验结束.④麻黄组大鼠术后自然口服1%浓度的麻黄水煎剂,到第6天浓度逐渐增至8%,持续到实验结束.⑤每天测定大鼠的摄食量,每隔10天测定大鼠的体质量.⑥实验结束时,所有实验动物禁食12 h后,颈动脉取血测定血清指标.同时测定体质量和体长计算李氏指数[(g)×103/体长(cm)].主要观察指标①不同时间点各组大鼠体质量及李氏指数.②不同时间点各组大鼠摄食量结果.③大鼠血脂和血糖水平.④不同组别大鼠血清雌激素、孕激素和胰岛素水平. 结果大鼠44只全部进入结果分析.①不同时间点各组大鼠体质量及李氏指数结果去卵巢组大鼠实验开始第20,30,40,50天体质量分别为(256.4±14.3),(271.3±16.1),(276.4±12.7),(285.7±24.2)g,均大于假手术组大鼠相应时间点[(226.5±11.5),(241.8±12.6),(243.1±13.5),(251.1±22.4)g,P＜0.05～0.01],李氏指数大于假手术组(317.2±13.5,280.4±11.2,P＜0.01).雌激素替代治疗组实验开始第40,50天体质量分别为(243.7±14.8),(246.2±11.9)g,低于去卵巢组相应时间点(P＜0.05～0.01),李氏指数为289.9±13.5,小于去卵巢组(P＜0.01).麻黄组大鼠实验开始第40,50天体质量分别为(245.4±14.1),(252.4±14.9)g,李氏指数为294.4±11.0,小于去卵巢组(P＜0.05).②不同时间点各组大鼠摄食量结果麻黄组大鼠实验开始第30,40,50天摄食量分别为(17.8±2.4),(22.3±3.9),(26.1±3.5)g/d,与去卵巢组比减少[(25.9±4.7),(28.5±5.3),(32.8±5.5)g/d,P＜0.05].③大鼠血脂和血糖水平去卵巢组大鼠血清三酰甘油、胆固醇、低密度脂蛋白胆固醇含量分别为(1.73±0.32),(1.45±0.50),(0.78±0.19)mmol/L,高于假手术组[(0.94±0.29),(1.05±0.30),(0.08±0.11)mmol/L,P＜0.01].雌激素替代治疗后三酰甘油、胆固醇、低密度脂蛋白胆固醇含量及血糖浓度分别为(1.10±0.34),(1.14±0.30),(0.17±0.05),(5.88±1.21)mmol/L,低于去卵巢组(P＜0.05～0.01),高密度脂蛋白胆固醇含量高于去卵巢组[(1.11±0.31),(0.88±0.21)mmol/L,P＜0.05].麻黄组三酰甘油、胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇含量分别为(0.97±0.16),(1.11±0.20),(0.59±0.07),(0.45±0.061)mmol/L,低与去卵巢组(P＜0.05～0.01).④不同组别大鼠血清雌激素、孕激素和胰岛素水平去卵巢组大鼠雌激素、孕激素水平分别为(17.09±9.00)ng/L,(28.51±7.99)μg/L,低于假手术组[(58.69±12.11)ng/L,(62.73±10.93)μg/L,P＜0.01],胰岛素含量高于假手术组[(31.74±6.69),(23.75±6.66)mU/L,P＜0.01].雌激素替代治疗组及和麻黄组雌激素水平为(36.03±8.83),(30.18±8.61)ng/L,高于去卵巢组(P＜0.05～0.01),胰岛素水平分别为(21.34±4.57),(24.86±6.20)mU/L,低于去卵巢组(P＜0.05～0.01),麻黄组孕激素水平为(17.68±6.19)μg/L,低于去卵巢组(P＜0.01).结论麻黄能明显降低去卵巢肥胖大鼠的体质量,降低血脂和胰岛素水平,增加血中雌激素水平.     

卵巢癌的生物学标志物的分析与探讨

目的 探讨肿瘤标志物联合检测与卵巢恶性肿瘤诊断的关系,提高卵巢恶性肿瘤的诊断率.方法 采用电化学发光法检测血清CYFRA21-l和CA125水平,化学比色法测定血浆LPA水平.将卵巢恶性肿瘤组的测定结果与正常女性对照组及卵巢良性肿瘤组进行比较,了解卵巢癌发生情况,分析比较血清CYFRA21-1、CA125,血浆LPA水平预测患者发生卵巢癌的价值.结果 卵巢恶性肿瘤患者血清CYFRA21-1、CA125和血浆LPA水平及阳性率均明显高于正常女性对照组及卵巢良性肿瘤对照组(P<0.05或P＜0.01).三项标志物组合检测的敏感性和诊断准确性均比单项检测高.结论 联合检测血清中的CYFRA21-1、CA125和血浆LPA水平,可显著提高卵巢恶性肿瘤的诊断率.     

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.