人工关节置换术后下肢深静脉血栓形成的彩色多普勒超声诊断

目的探讨彩色多普勒超声在人工关节置换术后下肢深静脉血栓诊断中的价值。方法对人工关节置换术后65例下肢静脉同期行彩色多普勒超声检查和X线静脉造影,分析彩色多普勒超声诊断下肢深静脉血栓(DVT)的准确性。结果与X线静脉造影对比,彩色多普勒超声诊断人工关节置换术后深静脉血栓形成的灵敏度85%、特异度100%、准确度95.3%;在小腿肌间静脉血栓的诊断上优于静脉造影(P<0.05);伴有下肢深静脉瓣功能不全的静脉容易发生深静脉血栓(P<0.05)。结论彩色多普勒超声是诊断人工关节术后下肢深静脉血栓形成的可靠方法。     

彩色多普勒超声诊断下肢深静脉血栓的探讨

目的：探讨彩色多普勒超声对下肢深静脉血栓形成的诊断价值.方法：分析经超声检查和X线下肢静脉造影证实的下肢深静脉血栓62例69条病变血管的二维及彩色多普勒、脉冲多普勒特征,结合临床及有关文献深入探讨.结果：中央型（I型）6例6条（8.7%）病变血管,周围型（Ⅱ型）41例47条病变血管（68.1%）,混合型（Ⅲ型）15例16条病变血管（23.2%）.患者左侧多于右侧,左右侧之比为2.8∶1.急性血栓39条病变血管,亚急性血栓21条病变血管,慢性血栓9条病变血管.结论：二维超声结合彩色多普勒、脉冲多普勒对下肢深静脉血栓形成的诊断准确性高,与X线血管造影比较具有许多优点,但也有一些不足之处需要注意.     

彩色多普勒超声诊断下肢深静脉血栓的价值

目的探讨彩色多普勒超声检查对下肢深静脉血栓的诊断价值。方法回顾性分析35例下肢深静脉血栓患者的超声声像图特征。其中25例经静脉造影证实,其余10例经手术证实。结果本组35例下肢深静脉血栓患者中急性栓塞7例,亚急性栓塞21例,慢性栓塞7例。急性栓塞超声声像图均表现为管腔内见较均匀实性低回声或极低回声,栓塞部位静脉管腔内径增宽,探头加压管腔不能闭合。CDFI检查栓塞部位无血流信号或探及少量血流信号;亚急性栓塞超声声像图均表现为管腔内为实性中等回声,血栓收缩溶解变小,管腔随之变小,探头加压管腔不能被完全压瘪,CDFI检查管腔边缘处可见较细的条状血流信号;慢性栓塞超声声像图均表现为栓塞部位静脉管径正常或变小,管壁呈部分或弥漫性增厚,回声增强,静脉瓣增厚、僵硬,管腔内呈条索状实性回声,或附壁实性回声,CDFI管腔边缘处可见点线状、轨道状血流,部分可见远段静脉侧支循环开放。结论彩色多普勒超声检查对下肢静脉血栓形成部位及栓塞程度的判断有独特的优越性,具有无创、实时、准确及可重复性强等优点,是下肢深静脉血栓的首选检查方法,可早期发现、及时诊断急慢性下肢静脉血栓。     

彩色多普勒超声诊断下肢深静脉血栓的临床效果评价

目的评价彩色多普勒超声诊断下肢深静脉血栓的临床效果。方法回顾性分析我院2016年9月至2018年10月收治的76例可疑下肢深静脉血栓患者彩色多普勒超声及深静脉造影检查的相关资料,以深静脉造影检查结果为对照,计算彩色多普勒超声诊断下肢深静脉血栓的准确度及灵敏度,并比较彩色多普勒超声与深静脉造影对小腿深静脉及大腿深静脉的检查情况。结果彩色多普勒超声检查静脉数160条,深静脉造影检查静脉数245条;两种方法对小腿深静脉的检查差异有统计学意义(P 0.05),对大腿深静脉的检查差异无统计学意义(P0.05)。以深静脉造影结果为参照,彩色多普勒超声检查大腿深静脉的准确度及灵敏度较高,检查小腿深静脉的准确度及灵敏度较低。结论下肢深静脉血栓的诊断中,经彩色多普勒超声对大腿深静脉的检查与深静脉造影并无差异,而对于小腿深静脉的检查不如深静脉造影。     

彩色多普勒超声在急性下肢深静脉血栓诊断中的应用

目的探讨彩色多普勒超声在急性下肢深静脉血栓诊断中的应用价值。方法对60例急性下肢深静脉血栓患者进行彩色多普勒超声检查及下肢深静脉X线造影检查。结果本组病例中,单发于左下肢深静脉血栓有38例,单发于右下肢有14例,双下肢同时患病的有8例。结论彩色多普勒超声检查准确、敏感、无创,对下肢深静脉血栓的诊断具有重要价值。     

高频超声联合腹部彩色多普勒超声诊断下肢静脉血栓的临床效果评价

目的:研究分析高频超声联合腹部彩色多普勒超声诊断下肢静脉血栓临床效果。方法:选取本院2017年5月-2019年7月期间接诊疑似下肢深静脉血栓患者共71例设为研究对象开展回顾性研究分析,患者入院后先接受高频超声诊断,其后接受腹部彩色多普勒超声诊断。对比分析高频超声单一诊断、高频超声联合腹部彩色多普勒超声诊断结果差异性。结果:患者经X线静脉造影后,71例患者均确诊为深静脉血栓,其中左侧下肢深静脉血栓29例,右侧下肢深静脉血栓33例,双侧下肢深静脉血栓9例;经分析患者起病时间后可知急性血栓27例,亚急性血栓32例,慢性血栓12例。以静脉造影诊断结果为依据进行对比后发现,相较高频超声单一诊断,高频超声联合腹部彩色多普勒超声诊断确诊效果具有显著优势,P<0.05。结论:下肢深静脉血栓临床诊断中高频超声联合腹部彩色多普勒超声诊断的应用,可实现对患者病情的有效诊断,并可根据不同超声影像特点,对患者下肢深静脉血栓类型进行初步鉴别,临床应用效果显著。     

彩色多普勒超声诊断下肢深静脉血栓的临床价值分析

选取我院2011年10月~2014年12月收治的52例疑似下肢深静脉血栓患者,对52例疑似下肢深静脉血栓的患者均实施彩色多普勒超声诊断以及下肢深静脉造影检查,观察比较两种检查方式的结果。经下肢深静脉造影检查确诊为下肢深静脉血栓患者为40例。彩色多普勒超声诊断特异度为66.67%,敏感度为80.00%,误诊4例,误诊率为33.33%,漏诊8例,漏诊率为20.00%,诊断准确性为76.92%;有31例患者为左下肢静脉病变,有17例患者为右下肢静脉病变,有4例患者为双下肢静脉病变。彩色多普勒超声诊断下肢深静脉血栓对早期诊断、治疗具有重要的临床价值,值得推广。     

彩色多普勒血流显像诊断下肢深静脉血栓研究

以往认为 X线静脉造影是诊断下肢深静脉血栓 ( DVT)的金标准 ,但创伤大。彩色多普勒血流显像 ( CDFI)的出现 ,为诊断DVT提供了简单、快速和无创伤的检查方法 ,且准确率高。本文总结应用彩色多普勒血流显像诊断 34例下肢深静脉血栓。1　对象和方法1 997- 1 0～ 2 0 0 0 - 1 0我科用 CDFI检查下肢 DVT患者 34例 ,男 1 7例 ,女 1 7例 ,年龄 2 4～ 6 4岁 ,平均 45.8岁 ,病程 2 d～1 5a。其中 31例经 X线证实 ,3例经手术证实 ,急性血栓 5例 ,慢性血栓 2 9例。使用日本 Aloka SSD1 70 0型彩色超声诊断仪 ,线阵探头 ,频率 7.0 MHz。检查…     

彩色多普勒超声在诊断下肢深静脉血栓中的临床价值分析

目的分析彩色多普勒超声检查在诊断下肢深静脉血栓中的临床应用价值。方法选2017年3月至2018年5月在某院就诊的下肢深静脉血栓患者60例作为观察组,所有患者均经数字减影血管造影诊断确诊,并将数字减影血管造影诊断作为金标准。选同期健康体检人员60例作为对照组,两组均实施彩色多普勒超声检查,分析彩色多普勒超声诊断下肢深静脉血栓的价值。结果彩色多普勒超声诊断结果提示,正确诊断51例,正确诊断率为85.0%,错误诊断4例,无法诊断5例。特异度70.5%,敏感度81.6%,漏诊率9.8%,误诊率7.8%。观察组患者胫周围静脉近段、股总静脉、内侧腓肠静脉、骨浅静脉内径值较对照组高,组间比较,差异有统计意义(P0.05)。结论下肢深静脉血栓病症检查采用彩色多普勒超声检查诊断,能够有效提高临床应用价值,彩色多普勒超声检查对下肢深静脉血栓病症具备检查敏感度高、特异度高优势,且对患者没有创伤性,是下肢深静脉血栓检查有效方式。     

双功能彩色多普勒诊断下肢深静脉血栓形成

本文报告应用双功能彩色多普勒对３９５条肢体临床怀疑有下肢深静脉血栓形的患者进行检查，３８２例经此检测得出明确诊断，其中３６７例为下肢深静脉不完全栓塞，１５例完全栓塞，１３例正常。描述了正常下肢深静脉与血栓的声像图表现，对下肢ＤＶＴ形成的双功能彩色多普勒检查进行了详细讨论。认为多功能彩色多普勒血流检测以及有关的附加试验对确定血栓部位、静脉阻塞情况的判断有可靠的价值，可成为普查血管疾病的首选检查方法。     

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.