插入式腹部按压心肺复苏术和标准心肺复苏术对心脏骤停病人脑复苏效果的对比研究

[目的]为明确院内心脏骤停病人在行标准心肺复苏术(CPR)的同时加插入式腹部按压(IAC)能否提高脑复苏成功率。[方法]将72例心脏骤停病人随机分为实验组和对照组。对照组按照ABC程序行标准心肺复苏术(S—CPR)；实验组在进行S—CPR的同时，在胸部按压放松时行一次腹部按压，按压力度为13．33kPa～26．67kPa，按压频率为100／min，压胸与压腹交替进行。监测两组心肺脑复苏效果。[结果]实验组在自主循环恢复率、自主呼吸恢复率、24h生存率、出院存活率及脑复苏结局评价方面均明显优于对照组，差异有统计学意义，并未发现明显并发症。[结论]IAC—CPR在显著提高心肺复苏成功率的同时提高了远期存活率和脑复苏效果，是一项有利于脑复苏的循环支持新技术。     

插入式腹部按压在心肺复苏中的应用

目的　明确院内心脏骤停的病人在行标准CPR的同时附加IAC能否提高复苏成功率并探讨IAC -CPR下冠脉灌注压的变化。方法　 10 2例ICU内发生的心脏骤停病人随机分为IAC -rockonCPR组 (即实验组n =5 0 )和标准CPR组 (即对照组n =5 2 )。对照组按照ABC程序紧急行标准心肺复苏术 (S -CPR) ;实验组在进行S -CPR的同时 ,在胸部按压放松时行一次腹部按压 ,按压力变为 15 0～ 2 0 0mmHg ,按压频率为 10 0～ 12 0次 /min ,压胸与压腹交替进行。两组均监测有创动脉压及右房压。结果　实验组自主循环恢复率为 80 .4 % ,对照组为 5 0 % ,P <0 .0 5 ;2 4h自主循环恢复率分别为 6 8%、2 8% ,P <0 .0 1;实验组冠脉最高灌注压为 (31.9± 12 .1)mmHg ,对照组为 (13.8± 7.1)mmHg ,P <0 .0 1。结论　IAC -CPR可明显地提高冠脉灌注压 ,增加自主循环恢复率和 2 4h自主循环恢复率 ,未发现明显并发症。     

持续心脏按压心肺复苏术在院内心脏骤停患者的应用研究

目的 探讨院内心脏骤停患者行连续胸外心脏按压心肺复苏能否提高复苏成功率.方法 67例院内发生心脏骤停的患者随机分为CCC-CPR组(即实验组n=35)和ICC-CPR组(即对照组n=32).两组均按照2005国际心肺复苏指南要求进行抢救,实验组采用人工呼吸时不停止胸外心脏按压,做连续胸外心脏按压;对照组按照2:30的比率进行人工呼吸和心脏按压,每次做人工呼吸时,胸外心脏按压必须暂停,做间歇胸外心脏按压心肺复苏(ICC-CPR).结果 实验组自主循环恢复率明显高于对照组(85.5% vs 61.4%,P<0.05);24 h生存率实验组明显高于对照组(28.6% vs 15.6%,P<0.01).结论 CCC-CPR可明显地提高院内心脏骤停患者自主循环恢复率和24 h生存率.     

急诊室病人心肺复苏术的护理配合

[目的]总结急诊室病人心肺复苏术的护理配合。[方法]对56例各种原因导致心脏骤停的病人及时进行正规的心肺复苏,同时给予病人全面、细致的观察和护理,预防复苏后的并发症。[结果]18例病人复苏成功。[结论]及时、正规、有效的心肺复苏及恰当的心肺复苏护理配合可提高心脏骤停病人的抢救成功率。     

吸气阻力阀联合心肺复苏术对心脏骤停患者疗效的Meta分析

目的系统评价应用吸气阻力阀（ITD）联合心肺复苏术（CPR）对心脏骤停患者的疗效。 方法计算机检索PubMed、ISI WOK平台数据库、Science Online、Nature、中文生物医学文献库（CMCC）、万方数据资源、CNKI中国知网、维普电子资源数据库中关于应用ITD和未使用ITD进行CPR的临床对照研究,检索时间为2000年至2015年6月。由2名研究者按照纳入及排除标准独立进行文献筛选、资料提取和质量评估后,采用Revman 5.3软件对数据进行Meta分析。 结果共纳入8项研究,共包括138 992例心脏骤停患者,其中应用ITD组（ITD组）患者7 056例,未应用ITD（对照组）患者6 936例。Meta分析结果显示,自主循环恢复率两组间比较差异无统计学意义[OR=1.03,95%CI（0.96,1.11）,Z=0.93,P=0.35],复苏后改良Rankin评分≤ 3的比例ITD组明显优于对照组[OR=1.74,95%CI（1.11,2.73）,Z=2.40,P=0.02],复苏后存活出院率ITD组优于对照组[OR=1.40,95%CI（1.04,1.91）,Z=2.18,P=0.03]。亚组分析结果显示,应用ITD联合主动胸外按压-减压心肺复苏术（ACD-CPR）（ITD + ACD-CPR）组的自主循环恢复率[OR=1.13,95%CI（1.01,1.26）,Z=2.11,P=0.03]、复苏后改良Rankin评分≤ 3的比例[OR=1.53,95%CI（1.22,1.93）,Z=3.67,P<0.001]及复苏后存活出院率[OR=1.25,95%CI（1.04,1.49）,Z=2.38,P=0.02]均明显优于对照组。 结论应用吸气阻力阀联合ACD-CPR可以提高心脏骤停患者心肺复苏成功率。     

心肺复苏技术的研究进展

心肺复苏(cardiopulmonary resuscitation,CPR)是抢救心脏骤停患者的有效方法之一,在过去10年围绕着这一技术进行了大量的研究,以改善脑及冠状动脉灌注,提高心肺复苏的成功率.心肺复苏中应充分监测的是冠状动脉灌注压,冠状动脉灌注压>15 mm Hg(1 mm Hg=0.133 kPa)预示可望心脏复苏成功及自主循环恢复,其可以影响神经系统的损害程度.心肺复苏术可供选择的技术若干,这些技术的临床效果也不断被评估,综述如下.     

心肺复苏技术的研究进展

心肺复苏(cardiopulmonary resuscitation,CPR)是抢救心脏骤停患者的有效方法之一,在过去10年围绕着这一技术进行了大量的研究,以改善脑及冠状动脉灌注,提高心肺复苏的成功率.心肺复苏中应充分监测的是冠状动脉灌注压,冠状动脉灌注压>15 mm Hg(1 mm Hg=0.133 kPa)预示可望心脏复苏成功及自主循环恢复,其可以影响神经系统的损害程度.心肺复苏术可供选择的技术若干,这些技术的临床效果也不断被评估,综述如下.     

心肺复苏技术的研究进展

心肺复苏(cardiopulmonary resuscitation,CPR)是抢救心脏骤停患者的有效方法之一,在过去10年围绕着这一技术进行了大量的研究,以改善脑及冠状动脉灌注,提高心肺复苏的成功率.心肺复苏中应充分监测的是冠状动脉灌注压,冠状动脉灌注压>15 mm Hg(1 mm Hg=0.133 kPa)预示可望心脏复苏成功及自主循环恢复,其可以影响神经系统的损害程度.心肺复苏术可供选择的技术若干,这些技术的临床效果也不断被评估,综述如下.     

心肺复苏技术的研究进展

心肺复苏(cardiopulmonary resuscitation,CPR)是抢救心脏骤停患者的有效方法之一,在过去10年围绕着这一技术进行了大量的研究,以改善脑及冠状动脉灌注,提高心肺复苏的成功率.心肺复苏中应充分监测的是冠状动脉灌注压,冠状动脉灌注压>15 mm Hg(1 mm Hg=0.133 kPa)预示可望心脏复苏成功及自主循环恢复,其可以影响神经系统的损害程度.心肺复苏术可供选择的技术若干,这些技术的临床效果也不断被评估,综述如下.     

心肺复苏技术的研究进展

心肺复苏(cardiopulmonary resuscitation,CPR)是抢救心脏骤停患者的有效方法之一,在过去10年围绕着这一技术进行了大量的研究,以改善脑及冠状动脉灌注,提高心肺复苏的成功率.心肺复苏中应充分监测的是冠状动脉灌注压,冠状动脉灌注压>15 mm Hg(1 mm Hg=0.133 kPa)预示可望心脏复苏成功及自主循环恢复,其可以影响神经系统的损害程度.心肺复苏术可供选择的技术若干,这些技术的临床效果也不断被评估,综述如下.     

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.     

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.     

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.     

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.