脑源性神经营养因子基因修饰骨髓间充质干细胞治疗坐骨神经损伤

背景:对周围神经损伤的治疗,目前希望能提高损伤局部的脑源性神经营养因子浓度来促进神经的修复再生.目的:观察坐骨神经损伤大鼠体内植入脑源性神经营养因子基因修饰的骨髓间充质干细胞后神经纤维的再通及运动功能的恢复情况.设计、时间及地点:随机对照动物实验,于2007-05/2008-05在福建省神经病学研究所完成.材料:无菌条件下取2月龄F344雄性大鼠股骨、胫骨制备骨髓间充质干细胞.利用构建好的慢病毒载体PNL-BDNF-IRES2-EGFP制备脑源性神经营养因子基因修饰的骨髓间质干细胞.方法:将60只成年SD大鼠经钳夹制作成右坐骨神经损伤模型,随机分为磷酸盐缓冲液组,骨髓间质干细胞组,脑源性神经营养因子基因修饰骨髓间质干细胞组.在损伤处分别注射磷酸盐缓冲液2 μ L,骨髓间质干细胞混悬液2 μ L和脑源性神绛营养因子基因修饰骨髓间质干细胞混悬液2 μL.主要观察指标:在术后2,4周,通过辣根过氧化物酶示踪观察损伤侧L4,5脊髓前角存活的神经细胞数目,通过测量坐骨神经功能指数值观察大鼠损伤侧肢体运动功能恢复情况,同时应用荧光激发及免疫组化技术检测骨髓间质干细胞存活和脑源性神经营养因子表达情况.结果:脑源性神终营养因子基因修饰骨髓间质干细胞组损伤侧L4,5脊髓前角细胞的存活数目多于磷酸盐缓冲液组和骨髓间质干细胞组,并且神经功能恢复也比其他两组好.骨髓间质干细胞组和脑源性神经营养因子基因修饰骨髓间质干细胞组可观察到神经损伤处有较多的骨髓间质干细胞存活,并且脑源性神经营养因子基因修饰骨髓间质干细胞组脑源性神经营养因子表达明显比骨髓间质干细胞组多.结论:脑源性神经营养因子基因修饰骨髓间质干细胞对周围神经损伤后神经纤维的再通及功能恢复有促进作用.     

胶质细胞源性神经营养因子基因修饰骨髓基质干细胞移植脑出血大鼠神经营养因子的表达

背景:研究证实,细胞移植和神经营养因子相结合治疗脑损伤能促进大鼠神经功能的恢复。目的:观察移植胶质细胞源性神经营养因子基因修饰的骨髓基质干细胞对大鼠脑出血后神经营养因子表达的影响。方法:通过脑立体定位仪向SD大鼠脑尾壳核注射胶原酶和肝素建立脑出血动物模型,将48只模型鼠随机分为3组,骨髓基质干细胞组、胶质细胞源性神经营养因子/骨髓基质干细胞组和对照组于建模后第3天在脑出血部位分别移植骨髓基质干细胞、胶质细胞源性神经营养因子/骨髓基质干细胞以及生理盐水。结果与结论:与对照组和骨髓基质干细胞组相比,胶质细胞源性神经营养因子/骨髓基质干细胞组大鼠神经功能恢复更好;与对照组相比,移植后1,2周其他2组各神经营养因子表达均显著增加(P<0.05)。提示胶质细胞源性神经营养因子基因修饰的骨髓基质干细胞移植治疗脑出血大鼠比单纯骨髓基质干细胞有更好的神经保护作用。     

移植胶质细胞源性神经营养因子基因修饰骨髓基质干细胞对脑出血大鼠的神经保护作用

背景:研究显示,细胞移植对脑出血脑损伤有保护作用,有学者在脑梗死后移植骨髓基质于细胞能促进大鼠神经功能恢复.目的:观察移植胶质细胞源性神经营养因子基因修饰的骨锈基质干细胞是否比单纯骨髓基质干细胞移植对脑出血有更好的保护作用.方法:采用自体血制作大鼠脑出血模型,36只SD成年大鼠随机抽签法分为3组,每组按不同时间点分为2个亚组,每个时间点6只.胶质细胞源性神经营养因子/骨髓基质干细胞组、骨髓基质干细胞组分别在脑出血壳核注射胶质细胞源性神经营养因子基因修饰的骨髓基质干细胞、骨髓基质干细胞20μL/只:对照组注射生理盐水20μL.分别在1,2周处死大鼠,免疫组织化学染色观察突触素和神经生长相关蛋白在脑出血周边区的表达.结果与结论:各时间点胶质细胞源性神经营养因子/骨髓基质干细胞组的突触素和神经生长相关蛋白43免疫阳性产物比骨髓基质干细胞组和对照组显著增加(P＜0.05).提示胶质细胞源性神经营养因子基因修饰的骨髓基质干细胞比单一骨髓基质干细胞对大鼠脑出血有更好的保护作用.     

骨髓间质干细胞源性神经元样细胞与控释神经营养因子移植治疗猴脊髓损伤:电生理评价

背景:临床研究表明诱发电位监测能准确监测脊髓的损伤,因此通过对电生理的监测来评估干细胞移植治疗脊髓损伤的效果具有重要意义.目的:通过电牛理监测评估骨髓间质干细胞源件神经元样细胞与控释神经营养因子移植治疗猴脊髓损伤的疗效.设计、时间及地点:随机对照动物实验,于2004-06/2005-11在中山大学附属二院骨外科实验室完成.材料:健康雄性恒河猴8只,随机分为移植组、模型组,4只,组.方法:两组猴均建立急性脊髓损伤模型.造模后第10天,取体外分离培养的猴骨髓间质干细胞源性神经元样细胞3.0×106cells/kg,与含1 μg胶质细胞源性神经营养因子的控释生物材料用200 μL PBS制成悬液,分5点沣射到移植组脊髓损伤部位;模型组同法给予等量磷酸盐缓冲液.主要观察指标:皮质体感诱发电位检查结果,运动诱发电位检查结果,行为学Tarlov分级.结果:①造模前两组动物均检测到正常皮质体感诱发电位信号,造模后两组动物皮质体感诱发电位波幅消失.移植后四五个月,移植组3只恒河猴皮质体感诱发电位波幅有明显恢复,但波幅仍明显低于造模前(P＜0.01),且潜伏期也延迟(P＜0.01);模型组动物末见有皮质体感诱发电位波幅恢复.②造模后两组动物运动诱发电位缺失.移植后4～5个月,移植组运动诱发电位波型有轻微恢复,但潜时期平均延长3.1 ms,波幅下降超过50%;模型组运动诱发电位仍然缺失.③移植后四五个月,移植组行为学Tadov分级为1或2级,模型组为0级.结论:电牛理评估结果表明,骨髓间质干细胞源性神经元样细胞与胶质细胞源性神经营养因子控释材料联合移植可以促进损伤脊髓的一定程度恢复.     

骨髓间充质干细胞移植对永久性大脑中动脉阻塞大鼠生长相关蛋白43及脑梗死体积的影响

背景:大量实验表明骨髓间充质干细胞植入缺缸大鼠脑内能够通过血脑屏障在脑中成活并迁移,可部分转变为神经元,并能促进多种神经营养因子分泌,明显改善神经功能缺损,较神经保护剂具有更长的治疗时间窗.目的:观察骨髓间充质干细胞移植对大鼠永久性大脑中动脉阻塞后内源性轴突再生标志物生长相关蛋白43的表达及脑梗死体积的影响.方法:将成年SD大鼠按随机数字表法分为模犁对照组、假手术组、干细胞移植组.另取成年SD大鼠4只制备骨髓间充质干细胞,并以5-溴脱氧尿嘧啶核苷标记.假手术组分离结扎右侧颈总动脉:其余大鼠制备永久性右侧大脑中动脉缺血模型,造模后,干细胞移植组移植骨髓间充质干细胞,模型对照组推注等量磷酸盐缓冲液.于移植前、移植后7,14,21,28d进行神经功能缺损评分,应用免疫组织化学法检测脑梗死灶周边区生长相关蛋白43表达.结果与结论:干细胞移植组移植后7d在梗死灶能检测到5-溴脱氧尿嘧啶核苷标记的阳性细胞,移植后14 d增多达高峰,移植后28 d逐渐减少并消失;移植后7,14 d脑梗死灶周边区生长相关蛋白43免疫活性显著高于模型对照组(P<0.05).假手术组大鼠无神经损伤症状,神经功能评分均为0分;随时间推移,模犁对照组和干细胞移植组神经功能评分逐渐降低,从移植后14 d开始,干细胞移植组神经功能评分明显低于模型对照组(P<0.05).与模型对照组相比,干细胞移植组脑梗死体积均显著减小(P<0.05).结果显示,骨髓间充质干细胞移植能上调局灶性脑缺血大鼠脑梗死灶周边区生长相关蛋白43的表达,并显著减小脑梗死体积.     

经颈动脉移植骨髓间充质干细胞治疗局灶性大鼠脑缺血损伤

目的:经颈动脉移植骨髓间充质干细胞至大脑中动脉闭塞大鼠体内,观察移植后大鼠缺血性脑损伤神经功能的恢复作用。方法:实验于2006-04/11在天津医科大学环湖医院实验室进行。实验材料:健康成年SD大鼠,体质量250～300g,雄性,由中国军事医学科学院动物中心(北京)提供(SCXK-(军)2002-001)。实验方法:①骨髓间充质干细胞分离、原代培养及诱导:采用梯度密度离心法和贴壁法分离SD大鼠骨髓间充质干细胞,待细胞生长达80%～90%融合时开始进行诱导分化,诱导液为DMEM培养基 2%二甲基亚砜 200μmol/L3-叔丁基-4羟基茴香醚 5mmol/Lβ-巯基乙醇。倒置相差显微镜观察骨髓间充质干细胞形态学变化。②动物模型建立及颈动脉骨髓间充质干细胞移植:采用改良Longa's线栓法阻断SD大鼠左侧大脑中动脉,制成局灶性脑缺血模型。模型建立成功判定:大鼠清醒后,观察其体征,以右侧肢体瘫痪,前肢为重表明模型制作成功。模型建立成功后24h,骨髓间充质干细胞治疗组于同侧颈外动脉注射2×106个Brdu标记的、诱导过的骨髓间充质干细胞,磷酸盐缓冲液组接种同等体积磷酸盐缓冲液,对照组不接种,每组12只。③神经功能缺损评估:在模型制制作后,每3d采用Combs法进行神经功能评估,观察大鼠在行为学方面差异。④实验评估:制备大鼠脑组织石蜡切片,采用免疫组织化学方法检测骨髓间充质干细胞成活情况。结果:36只大鼠中每组各有2只于造模后48h内死亡,死因考虑为急性脑水肿和蛛网膜下腔出血,共30只大鼠进入结果分析。①各组大鼠神经功能缺损评分:骨髓间充质干细胞治疗组大鼠神经功能评分明显高于对照组和磷酸盐缓冲液组(3d:4.45±1.25,2.85±1.01,2.98±0.79;7d:6.67±2.12,4.47±1.08,4.56±1.27;14d:7.94±2.27,5.15±1.66,5.24±1.46,P<0.05)。②免疫组化染色检测骨髓间充质干细胞移植后成活情况:对照组和磷酸盐缓冲液组均未见到Brdu免疫组化阳性细胞着色,骨髓间充质干细胞治疗组各时间点均可见到Brdu阳性细胞,细胞呈圆形,较神经细胞小,阳性细胞主要见于缺血侧大脑皮质、皮质下和海马区。结论:①经颈动脉移植的骨髓间充质干细胞可在缺血性大脑损伤大鼠脑内存活、迁移。②经颈动脉移植骨髓间充质干细胞对缺血性脑损伤神经功能恢复有明显促进作用。     

骨髓间充质干细胞移植脊髓全横断模型大鼠运动和体感诱发电位的评价

背景：临床常用皮质运动诱发电位和皮质体感诱发电位来分别评价脊髓损伤后运动传导路和感觉传导路的损伤或修复情况。目的：以脊髓诱导电位监测骨髓间充质干细胞移植后急性脊髓完全性损伤大鼠下肢神经功能的变化。方法：选取健康Wistar大鼠50只,分成5组,即生理盐水组、骨髓间充质干细胞移植组、脑源性神经营养因子修饰组、神经营养素3＋骨髓间充质干细胞移植组和假手术组。除假手术组外,其余各组均制作Allen’s脊髓完全性损伤动物模型,造模后各组均行相应治疗。治疗后4,8和12周行大鼠后肢运动功能评分,并于造模后24h,3,7,14d行运动和体感诱发电位检测。结果与结论：运动诱发电位检测结果提示,各治疗组的运动功能均有不同程度的恢复,与生理盐水组间差异均有显著性意义（P〈0.05）,大鼠后肢BBB评分也证实了各治疗组后肢运动功能明显优于生理盐水组（P〈0.05）。提示经脑源性神经营养因子修饰的骨髓间充质干细胞可移植到脊髓损伤处,可改善大鼠的后肢运动,神经营养素3蛋白有可能提高骨髓间充质干细胞在体内的生存率,促进受损脊髓的轴突再生。     

骨髓间充质干细胞移植脊髓全横断模型大鼠运动和体感诱发电位的评价

背景:临床常用皮质运动诱发电位和皮质体感诱发电位来分别评价脊髓损伤后运动传导路和感觉传导路的损伤或修复情况。目的:以脊髓诱导电位监测骨髓间充质干细胞移植后急性脊髓完全性损伤大鼠下肢神经功能的变化。方法:选取健康Wistar大鼠50只,分成5组,即生理盐水组、骨髓间充质干细胞移植组、脑源性神经营养因子修饰组、神经营养素3+骨髓间充质干细胞移植组和假手术组。除假手术组外,其余各组均制作Allen’s脊髓完全性损伤动物模型,造模后各组均行相应治疗。治疗后4,8和12周行大鼠后肢运动功能评分,并于造模后24h,3,7,14d行运动和体感诱发电位检测。结果与结论:运动诱发电位检测结果提示,各治疗组的运动功能均有不同程度的恢复,与生理盐水组间差异均有显著性意义(P<0.05),大鼠后肢BBB评分也证实了各治疗组后肢运动功能明显优于生理盐水组(P<0.05)。提示经脑源性神经营养因子修饰的骨髓间充质干细胞可移植到脊髓损伤处,可改善大鼠的后肢运动,神经营养素3蛋白有可能提高骨髓间充质干细胞在体内的生存率,促进受损脊髓的轴突再生。     

骨髓基质细胞移植缺血性脑梗死大鼠后神经营养因子的表达

背景：骨髓基质细胞在适宜条件下可分化为神经元和星形胶质细胞,分泌可溶性分子促进神经元存活。目的：观察骨髓基质细胞移植后缺血性脑梗死大鼠脑组织神经营养因子表达情况及其对神经功能的影响。方法：改良的Longa栓线法制作大鼠大脑中动脉缺血模型,1h后再灌注,24h后治疗组尾静脉注射3×106骨髓基质细胞,盐水对照组尾静脉注射1mL生理盐水,空白对照组不进行注射。结果与结论：在梗死后第7,14天治疗组的神经损伤评分明显低于对照组（P〈0.05）;治疗组神经生长因子和脑源性神经营养因子表达在各时间点均高于对照组（P〈0.05）。结果显示静脉移植骨髓基质细胞可改善缺血性脑梗死大鼠神经功能,移植骨髓基质细胞后缺血脑组织中神经生长因子及脑源性神经营养因子表达促进了神经功能的恢复。     

骨髓基质细胞移植缺血性脑梗死大鼠后神经营养因子的表达

背景:骨髓基质细胞在适宜条件下可分化为神经元和星形胶质细胞,分泌可溶性分子促进神经元存活。目的:观察骨髓基质细胞移植后缺血性脑梗死大鼠脑组织神经营养因子表达情况及其对神经功能的影响。方法:改良的Longa栓线法制作大鼠大脑中动脉缺血模型,1h后再灌注,24h后治疗组尾静脉注射3×106骨髓基质细胞,盐水对照组尾静脉注射1mL生理盐水,空白对照组不进行注射。结果与结论:在梗死后第7,14天治疗组的神经损伤评分明显低于对照组(P<0.05);治疗组神经生长因子和脑源性神经营养因子表达在各时间点均高于对照组(P<0.05)。结果显示静脉移植骨髓基质细胞可改善缺血性脑梗死大鼠神经功能,移植骨髓基质细胞后缺血脑组织中神经生长因子及脑源性神经营养因子表达促进了神经功能的恢复。     

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.