哮喘病人支气管舒张反应曲线的研究

目的探讨哮喘病人支气管舒张反应曲线的特点。方法应用福莫特罗进行支气管舒张试验，多时间点观测34例哮喘病人和14例健康人肺通气功能随时问的变化。结果哮喘病人。各项指标在15min、30min、60min、120min、240min的测量值较基础值增高，差异均有统计学意义（P〈0．05），在相同时间点哮喘患者各项肺通气功能指标的测量值较正常对照下降，差异有统计学意义（P〈0．05）。哮喘患者支气管舒张反应曲线有逐渐上升的变化趋势，正常对照支气管舒张反应曲线成波浪型变化。哮喘病人各项肺通气功能指标中，FEV1、FEV1／FVC、PEF、FEF25、FEF25/75，随时间点变化的拟合二次曲线模型方程有统计学意义（P〈0．05）；正常对照组的拟合二次曲线模型方程，无统计学意义（P〉0．05）。结论哮喘病人支气管舒张反应曲线有一定的特点，并且气道扩张存在一定的规律。     

小气道功能异常对急性支气管炎患者的临床意义

目的探讨小气道功能测定异常对急性气道炎症的临床意义。方法使用Vmax8500肺功能仪测定102例急性支气管炎患者的肺活量（VC）、用力肺活最（FVC）、第一秒用力呼气容积（FEV1）、一秒率（FEV1／FVC）、最大通气量（MVV）、峰值呼气流速（PEF）、用力呼气25％～75％肺活量时的平均流速（FEF25%～75%）、用力呼气50％肺活量的瞬间流速（FEF50%）等。分为小气道功能正常组（52例）与小气道功能异常组（50例）,判定标准：FEV1／FVC≥70％的肺通气功能正常者,FEF25％-75%和FEF50％均小于正常预计值的80％为小气道功能异常。结果2组VC、FVC、FEV-、FEV1／FVC、MVV、PEF等常规肺功能指标均正常（P〉0．05）。但反映小气道功能的FEF25%-75%和FEF50%小气道功能异常组均降低,与正常组差异均有统计学意义（P〈0．05）。结论急性气道炎症患者存在小气道功能异常,小气道功能检测可为诊治提供循证。     

咳嗽变异性哮喘支气管舒张试验的肺功能变化特征及临床意义

目的:探讨咳嗽变异性哮喘(CVA)肺功能指标FEV1、FEF25、FEF50、FEF75在舒张试验中的特点、参数变化的临床意义及对临床诊断的价值。 方法:56位CVA患者及57位正常人群作对为研究对象。受试者进行资料采集，肺通气功能检查、支气管舒张试验检查，分别记录基线数据和舒张试验前后FEV1、FEF25、FEF50、FEF75的数值及改善率。 结果: 本次研究中的CVA患者肺功能检查出现阻塞性通气功能障碍的比例为19.64%，出现小气道功能障碍为39.29%，小气道功能正常为41.07%，支气管舒张试验阳性的占8.9%。与对照组对比， 2.CVA患者FEV1/preFEV1、FEV1/ FVC(%)、FEF25%pred、FEF50%pred、FEF75%pred差异具与对照组对比有明显统计学差异（，P值分别为：P=0.005、P=0.003、P=0.000、P=0.000、P=0.004）。 3.CVA肺功能出现阻塞性通气功能障碍的CVA患者行支气管舒张试验后，FEV1、 FEF25、 FEF50、FEF75改善率与对照组对比有明显统计学差异，（P值分别为：P=0.000、P=0.001、P=0.001、P=0.014）。 4.在CVA中仅出现小气道功能障碍的患者行支气管舒张试验后， FEV1改善率与对照组相比无明显统计学差异（P=0.682）；FEF25、FEF50、FEF75改善率与对照组对比有统计学差异（，P值分别为：P=0.049、P=0.041、P=0.005），而FEV1改善率与对照组相比无明显统计学差异（P=0.682）；。 5.CVA大、小气道功能均为正常的患者行支气管舒张试验后，FEV1、 FEF25、 FEF50、 FEF75改善率与对照组对比无明显统计学差异（，P值分别为：P=0.842、P=0.452、P=0.161、P=0.107）。结论: CVA患者大小气道功能均可异常，亦可正常；MEFV曲线参数中能更好反映其小气道功能特点的是FEF50、FEF75；出现阻塞性通气功能障碍患者肺功能明显低于对照组，行支气管舒张试验后FEV1改善率较对照组高，气道可逆性强，提示支气管舒张试验FEV1改善率对该组可能有预测价值。仅出现小气道功能障碍的CVA患者行舒张试验后FEV1改善率与对照组无明显变化，FEF25、FEF50、FEF75改善率与对照组相比有明显增加。大小气道功能均正常的CVA患者行支气管舒张试验后FEV1、FEF25、FEF50、FEF75改善率与对照组对比无明显变化，提示该组患者单用支气管扩张药物治疗可能效果差。     

戒烟对慢性阻塞性肺疾病患者肺功能的影响

目的研究烟龄（年）、烟量（年支）、戒烟时间（年）与慢性阻塞性肺疾病（COPD）患者肺通气功能指标『FEV1％、FEV1／FVC（％）、PEF％、FEF25％、FEF50％、MMEF％]的关系。方法测定156例稳定期COPD患者的肺功能[FEV1％、FEV1／FVC（％）、PEF％、FEF25％、FEF50％、MMEF％]，根据气道阻塞程度分为ⅡA、ⅡB、Ⅲ级COPD。结果各组间的PEF％、FEF；％、FEF。％、MMEF％等肺通气功能指标的比较差异均有统计学意义（P〈0．05）。FEV1％、FEV1／FVC（％）、FEF25％、FEF50％、MMEF％等肺通气功能指标与烟量及烟龄存在负相关，与戒烟时间存在正相关；在控制年龄、烟量等因素后，FEV1％、FEV1／FVC（％）、FEF25％、FEF50％、MMEF％等肺通气功能的指标与戒烟时间存在正相关，而与烟龄存在负相关。结论戒烟可减缓COPD患者肺功能的恶化。     

咳嗽变异型哮喘患者T细胞亚群水平变化与小气道功能的关系

目的：探讨咳嗽变异型哮喘（CVA）患者外周血T细胞亚群数量与小气道功能变化的相关性及其临床意义。方法：用流式细胞仪测定分析32例CVA患者（CVA组）及24例健康人（正常组）外周血T细胞亚群（CD2^＋T、CD4^＋T、CD4^＋T、CD4／CD8的比值）水平的变化。并测定反映大气道和小气道（FVC、FEV1和FEF25％-75％、FEF75％-85％）功能的指标。结果：①CVA组患者外周血CD4^＋T及CD4／CD8比值显著高于正常组（P〈0．05，P〈0．01）；CD8^＋T显著性低于正常组（P〈0．01）；CD3^＋T与正常组差异无显著性意义。②CVA组FEF25％-75％及FEF75%-85％值明显低于正常组（P〈0．05）。③FEF25%-75%、FEF75%-85％与CD^4＋T水平皆呈负相关（前者r=-0．462，P=0．021；后者r=-0．461，P=0．019），与CD4／CD8比值也呈负相关（前者r=-0，529，P=0．009，后者r=-0．501，P=0．013）；FVC、FEV1与外周血CD3^＋T、CD4^＋T、CD8^＋T及CD4／CD8比值无相关性。结论：FEF25％-75%、FEF75％-85%对CVA患者的早期诊断有重要意义；CVA患者FEF25%-75%、FEF75％-85％与CD4^＋T、CD4／CD8的比值有负相关性，说明患者体内细胞免疫功能异常，在哮喘变应性气道炎症中起重要作用。可能是导致CVA患者小气道功能进一步减退的原因。早期诊断、治疗CVA，可防止典型哮喘发作，降低入院率及死亡率。     

支气管舒张试验在婴幼儿哮喘诊治中的应用探讨

目的通过潮气呼吸肺功能测定探讨支气管舒张试验在婴幼儿哮喘诊治中的价值。方法选择婴幼儿哮喘患儿35例，在沙丁胺醇溶液雾化前后进行潮气呼吸肺功能测定。结果经沙丁胺醇雾化后呼吸频率（RR）较雾化前减慢（P〈0．05）；吸气时间（TI）较雾化前延长（P〈0．01）；达峰时间（TPEF）、达峰时间比（TPEF／TE）、达峰容积（VPEF）、达峰容积比（VPEF／VE）较雾化前均明显增高（均P〈0．01）；潮气呼吸呼气流速（PTEF）较雾化前减慢（P〈0．01）。大部分哮喘婴幼儿流速容积环变窄，呼气相升支陡峭，高峰提前，降支倾斜，甚至凹向容量轴，即流速容积环呈现特征性阻塞图形；雾化后呼气降支的斜率有所减小。结论利用潮气呼吸肺功能检测技术进行婴幼儿支气管舒张试验，达峰时间比（TPEF／TE）改善率或达峰容积比（VPEF／VE）改善率≥15％，可以作为小年龄儿童支气管舒张试验的评定标准，作为婴幼儿哮喘患儿的诊治的重要依据。     

筒式吸舒器在支气管哮喘急性发作吸入治疗中的效果观察

目的探讨筒式吸舒器在支气管哮喘急性发作患者吸入治疗中的疗效观察。方法将93例哮喘急性发作患者随机分为观察组（n=44）和对照组（n=49），对照组直接应用沙丁胺醇定量气雾剂，观察组在此基础上运用沙丁胺醇定量气雾剂联合筒式吸舒器。结果治疗后观察组肺功能指标FVC、FEV1、PEF明显优于对照组（P〈0．01）；观察组总有效率88．63％，对照组总有效率55．1％，差异有统计学意义（P〈0．01）。结论筒式吸舒器联合应用在哮喘吸入治疗中总体优于沙丁胺醇定量气雾剂。     

新生大鼠支气管上皮衍生舒张因子信号传导

目的研究支气管上皮衍生舒张因子（BrEpDRF）是否经一氧化氮（NO）-3＇，5＇-鸟嘌呤核苷环一磷酸（cGMP）及磷脂酰三肌醇（PI3）／蛋白激酶B（Akt）通路传导。方法支气管结合的肺动脉经血栓烷A2（TXA2）类似物U46619预刺激肺动脉收缩，在PI-3激酶／Akt抑制剂LY294002和NO-GMP抑制剂ODQ存在／不存在下，测定乙酰甲胆碱（Mch）引起的血管舒张比率。结果结合支气管的肺动脉在经U46619预刺激后，Mch引起血管舒张率为39．37％；Mch中加入PI-3激酶／Akt抑制剂引起的血管舒张率为11．72％，两者比较差异有显著性，（P〈0．01）。Mch中加入NO-GMP抑制剂引起的血管舒张率为2．15％，与单一Mch比较统计学上有差异，（P〈0．01）。结论新生大鼠在生理条件下BrEpDRF经NO-cGMP及PI3／Akt通路传导。     

钦州市2250例新生儿梅毒筛查与分析

[目的]了解新生儿梅毒的感染及流行特点，为梅毒的监测和预防控制工作提供科学依据。[方法]采集并分离新生儿静脉血待用。实验采用甲苯胺红不加热血清试验（TRUST）筛查，阳性者采用梅毒螺旋体抗体凝集试验（TPPA）确诊。[结果]2250例新生儿中梅毒阳性28例，感染阳性率1．24％（28／2250）。男性新生儿感染阳性率1．22％（13／1064），女性新生儿感染阳性率1．26％（15／1186），两者差异无统计学意义（P〉0．05）；城市新生儿感染阳性率0．66％（9／1365），乡村新生儿感染阳性率2．15％（19／885），两者差异有统计学意义（P〈0．01）；汉、壮族新生儿感染阳性率0．79％（12／1511），京、苗等少数民族新生儿感染阳性率2．17％（16／739），两者差异有统计学意义（P〈0．01）。[结论]应加强健康教育，杜绝梅毒对新生儿的危害。     

普米克令舒联合博利康尼雾化吸入治疗小儿支气管哮喘的疗效

目的探讨普米克令舒联合博利康尼雾化吸入对轻中度小儿支气管哮喘的治疗效果。方法将230例支气管哮喘患儿按随机数字表法分为对照组和治疗组,每组115。2组均予吸氧、抗感染、静脉氨茶碱及对症等治疗。对照组给予博利康尼混悬液1mL雾化吸入,10～15min.次-1,2次.d-1,连用3d;治疗组在对照组治疗的基础上加普米克令舒混悬液2mL雾化吸入,10～15min.次-1,2次.d-1,连用3d。对2组治疗前、治疗后7d肺功能[FEV1,PEF,FEF 50%]及动脉血气水平进行比较。结果治疗组的总有效率为96.5%,对照组的总有效率为77.4%,2组比较差异有统计学意义（P〈0.05）。2组治疗后7dFEV1、PEF、FEF50%和PO2较治疗前明显提高,且治疗组提高较对照组更为明显（P〈0.01或P〈0.05）。结论普米克令舒联合博利康尼雾化吸入治疗小儿支气管哮喘疗效显著,不良反应较小,并有协同作用。     

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.