支气管动脉灌注化疗同步三维适形放疗治疗局部晚期非小细胞肺癌的临床研究

目的探讨支气管动脉灌注化疗同步三维适形放疗治疗局部晚期非小细胞肺癌的临床价值。方法 18例局部晚期非小细胞肺癌按随机数字表法分成研究组(8例)和对照组(10例)。研究组采用支气管动脉灌注化疗同步三维适形放疗方案,对照组采用静脉化疗同步三维适形放疗方案。观察2组治疗方案的有效率、生存期和不良反应。结果研究组和对照组的有效率分别为75%和70%,1年生存率分别为75%、70%,2年生存率分别为50%、40%。2组比较差异均无统计学意义(P均>0.05)。2组毒副反应比较差异无统计学意义(P>0.05)。结论支气管动脉灌注化疗同步三维适形放疗和全身静脉化疗同步三维适形放疗治疗不可手术的局部晚期非小细胞肺癌的疗效和毒副反应相似。     

全身化疗同期腔内放射治疗中晚期中央型肺癌的临床观察

目的 采用全身化疗同期支气管腔内近距离放射治疗中、晚期中央型肺癌,评价近期疗效和不良反应.方法 36例肺癌患者选用含铂类为主的方案全身化疗期间同时进行腔内局部放疗3～4次（1次/周,单次剂量6～7Gy）.结果 36例患者完全缓解24例,部分缓解9例,总有效率RR为91.7%.对不同病理类型肺癌疗效无显著性差异;症状改善好转率77.8%,稳定率22.2%.不良反应主要为骨髓抑制和放射性气管炎.结论 全身化疗同期支气管腔内放射治疗中、晚期中央型肺癌, 近期效果明显,临床症状迅速改善,病人生活质量明显提高,可安全应用于临床.     

支气管动脉灌注联合静脉及口服化疗治疗中晚期肺癌的疗效评价

目的:观察支气管动脉灌注化疗联合静脉化疗及口服VP-16治疗中晚期肺癌的近期疗效。方法:将经病理证实的中晚期肺癌110例随机分为单纯静脉化疗组、支气管动脉灌注化疗组(BAI)、BAI联合静脉化疗及口服VP-16组(观察组),WHO实体瘤疗效评定不同治疗方法对肺癌的近期疗效。结果:静脉化疗组40例,CR4例,PRl5例,总有效率47.5%;BAI组35例,CR2例,PRl6例,总有效率51.4%;观察组35例,CR6例,PR19例,总有效率71.4%:观察组分别与静脉化疗组和BAI组比较均有显著性差异(P<0.05),观察组的疗效优于静脉化疗组和BAl组的疗效。BAl组对局部疗效好,但对远处转移疗效差,而观察组对远处转移疗效较好。结论:支气管动脉灌注联合静脉化疗及口服VP-16治疗肺癌,其控制原发灶和转移灶的疗效优于单一的静脉化疗和BAI化疗的疗效,可作为中晚期肺癌较有效的治疗方法。     

经纤维支气管镜介导微波联合全身化疗治疗原发气管支气管肺癌23例疗效观察

目的 观察经纤维支气管镜微波治疗联合全身化疗治疗原发气管支气管肺癌的近期疗效.方法 23例经纤维支气管镜微波治疗,微波功率50 W,时间5 s,每次治疗总时间100～150 s,1周后重复治疗,共3～5次.非小细胞肺癌用NP方案：诺维本25 mg/m^2, 第1、8天静脉注射;顺铂40 mg,第1～3天,静脉注射;小细胞肺癌用CE方案：卡铂400或500 mg,第1天静脉注射;足叶乙甙100 mg,第1～5天静脉注射.28 d为1周期.结果 23例微波治疗联合全身化疗后,18例症状明显改善,纤维支气管镜下病灶好转率为78.26%,胸部CT及X线复查病灶吸收率达60.87%.结论 微波治疗联合全身化疗治疗腔内型肺癌疗效明显.     

腔内灌注化疗联合全身热疗治疗恶性胸腔积液的疗效

【目的】探讨腔内化疗联合全身热疗对恶性胸腔积液的疗效及毒副作用。【方法】84例胸腹水患者。分为两组,A组54例为肺癌组,行腔内中心静脉置管抽液后注入化疗药物联合全身热疗,B组30例为其他恶性肿瘤组,行腔内置管抽液化疗联合全身热疗。评价两组患者的近期疗效及毒副作用。【结果】A组治疗有效率为62.96%,B组为86.67%,两组间比较差异有显著性。两组消化道反应与血液学毒性发生率相比较均无明显差异。【结论】腔内灌注化疗联合全身热疗治疗恶性胸腔积液疗效高,且耐受性良好。     

西艾克、卡铂、丝裂霉素联合动脉灌注治疗晚期肺癌（附31例分析）

目的 探讨支气管动脉灌注（BAI）治疗晚期肺癌的联合化疗方案,了解不同病理类型的肺癌对西艾克、卡铂、丝裂霉素联合支气管动脉内灌注治疗有无差异,以及根据支气管动脉造影（BAG）分型了解富型和少血型肺癌与疗效的关系。方法 本组31例,经临床X线及病理证实后,先行BAG确定为肿瘤供血动脉后,再采用BAI灌入西艾克、卡铂及丝裂霉素。结果 本组共灌注85次,其中CR2例（6.45%）、PR18例（58.06%）、NC9例（29.03％）、PD2例（6.45％）,总缓解率64.52%,非小细胞肺癌（鳞癌＋腺癌）总缓解率为72.72%（16／22）。鳞癌、腺癌、小细胞未分化癌三组间疗效差异不显著（x^2检验P＞0.05）。富血型和少血型两组间疗效有非常显著差异（x^2检验P＜0.01）。结论 西艾克、卡铂以及丝裂霉素联合BAI治疗晚期肺癌疗效明显高于西艾克、卡铂、丝裂霉素联合静脉化疗,且具有疗程短、总用药量少、全身毒副反应小等优点。     

高频电刀联合化疗治疗晚期肺癌的观察与护理

目的:探讨纤维支气管镜高频电刀联合化疗治疗晚期气管、支气管肺癌的围手术期护理。方法:将51例晚期气管、支气管肺癌患者随机分为治疗组21例、对照组30例,治疗组给予纤维支气管镜高频电刀烧灼联合化疗,对照组给予单纯化疗。结果:治疗组有效率90.4%,对照组有效率23.3%,两组比较有统计学差异(P<0.01)。结论:纤维支气管镜高频电刀联合化疗治疗晚期肺癌疗效显著,患者痛苦小,值得临床推广应用。     

TC方案动静脉联合化疗治疗晚期非小细胞肺癌

目的 :评价泰素 (TAX )及卡铂 (CBP )支气管动脉灌注与全身静脉联合治疗晚期非小细胞肺癌(NSCLC)的近期疗效和毒性反应 ,并与单纯静脉化疗进行了比较。方法 :61例Ⅲ～Ⅳ期NSCLC患者 ,随机分为单纯静脉化疗 (A组 ) 2 8例 ,动静脉联合治疗 (B组 ) 3 3例 ,A组 :TAX 13 0～ 15 0mg/m2 、CBP 2 0 0～ 3 0 0mg/m2 静脉点滴 ,第 1天 ;B组 :TAX 13 0～ 15 0mg/m2 的 3 / 7药量、CBP 2 0 0～ 3 0 0mg/m2 行支气管动脉灌注 (BAI) ,TAX 13 0～ 15 0mg/m2 的 4/ 7药量经静脉点滴 ,第 1天。均 2 8～ 3 0d为一周期 ,连用两个周期以上评价疗效。结果 :全部患者无一例达到完全缓解 (CR) ;达到部分缓解 (PR)者分别为 :A组 8例 (2 8 6% ) ,B组 14例 (4 2 4% )。不良反应主要为血液学毒性 ,共有 3 9例 (63 9% )患者出现Ⅰ～Ⅲ度的外周血白细胞减少。结论 :动静脉联合治疗晚期非小细胞肺癌的近期疗效较单独静脉化疗为好 ,两种治疗方法可能具有一定的相互补充和协同作用 ,不良反应较轻 ,可以耐受 ,值得进一步研究和尝试     

肺癌支气管动脉灌注化疗合并放疗的疗效观察（与单纯放疗比较）

目的：探讨肺癌支气管动脉灌注化疗合并放疗与单纯放疗的效果比较。材料与方法；选取20例经活检病理证实的肺癌患者作支气管动脉藻注后，进行放疗，同时选取同样条件的病例行单纯放疗，以比较两者的近期疗效。结果：灌注合并放疗总有效率为95％，单纯放疗为70％，以统计学处理，两者有显著性差异。（x2＝5．5，p＜0．02）结论；肺癌支气管动脉灌注化疗合并放疗的效果较单纯放疗为优，并可减少肺损伤。     

动脉灌注丹参联合动脉化疗栓塞术治疗中心型肺癌的疗效分析

目的观察经动脉灌注丹参联合动脉化疗栓塞术治疗中心型肺癌的近期疗效.方法对13例中心型肺癌进行选择性支气管动脉、肋间动脉及胸廓内动脉造影,将3F同轴微导管置于肿瘤的供血动脉内,灌注复方丹参注射液16 ml,注入适当剂量的碘化油-顺铂乳剂.结果肿瘤供血动脉以支气管动脉为主者7例,以肋间动脉为主者4例,以胸廓内动脉为主者2例.治疗后临床症状改善率为100%,且无严重并发症发生,1年生存率为92.31%(12/13).结论动脉灌注丹参联合化疗栓塞术治疗中心型肺癌具有较好的临床疗效.     

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.