心脏型脂肪酸结合蛋白定性检测对急性心肌梗死早期诊断的价值

目的:探讨心脏型脂肪酸结合蛋白(H-FABP)在急性心肌梗死(AMI)早期诊断中的价值。方法:运用胶体金免疫层析技术定性检测104例发病3h内胸痛患者的血H-FABP,比较其与心肌肌钙蛋白(cTnI)、肌酸激酶同功酶MB(CK-MB)、肌红蛋白(MYO)诊断早期AMI的敏感度、特异度。结果:入选患者中最终确诊为AMI患者50例,非AMI54例。H-FABP、cTnI、CK-MB和MYO检出AMI的敏感度分别为88.00%、68.00%、64.00%和84.00%,H-FABP显著高于cTnI和CK-MB(均P<0.05),与MYO比较无显著差异(P>0.05);检测特异度分别为90.74%、87.04%、85.19%和70.37%,H-FABP显著高于MYO(P<0.05),分别与cTnI和CK-MB比较均无显著差异(均P>0.05)。在四种心肌损伤标志物中,H-FABP的准确诊断指数最高。结论:H-FABP用于AMI早期诊断具有快速、简便,灵敏度和特异度高的特点,值得临床推广应用。     

H-FABP与多项心肌标志物在急性心肌梗死早期检测中的比较

目的 比较血清心肌型脂肪酸结合蛋白(H-FABP)检测与常规的检测项目肌酸激酶同工酶(CK-MB)、肌钙蛋白I(cTnI)对于急性心肌梗死(AMI)的诊断效果,探究H-FABP的临床应用价值,以便为AMI的早期诊断提供更好的检测指标.方法 本院38例AMI确诊患者作为观察组,43例冠心病患者作为对照组,对所有患者进行全血cTnI、CK-MB质量的测定.对血清中的H-FABP进行定性分析,并进行数据的统计学处理与分析.结果 患者入院后的24 h内,H-FABP、CK-MB和cTnI对AMI的敏感度分别为:84.21%、79.07%、76.32%,特异度分别为:100%、76.74%、76.74%;AMI患者胸痛发作6 h内H-FABP的诊断敏感度最高,达到78.26%,其次是CK-MB(73.91%)和cTnI(69.57%).结论 在AMI的早期诊断中,H-FABP检测比CK-MB、cTnI检测具有更好的诊断价值,有望成为临床上AMI早期诊断中有效的检测指标.     

心肌肌钙蛋白Ⅰ和肌红蛋白定量检测对急性心肌梗死的诊断价值

目的探讨心肌肌钙蛋白Ⅰ(cTnI)和肌红蛋白(MB)对急性心肌梗死(AMI)的诊断价值。方法对192例AMI患者、50例健康对照者和100例非AMI胸痛患者进行血清cTnI和MB检测,并对结果进行统计学分析。结果 AMI患者cTnI和MB较其他两组对照均显著升高(P<0.01),健康对照组和非AMI胸痛组之间差异无统计学意义(P>0.05)。cTnI在AMI胸痛发作12~24 h达到高峰,峰值为(9.68±2.64)μg/L;MB在AMI胸痛发作4~8 h达到高峰,峰值为(378.6±198.6)μg/L。cTnI和MB对AMI诊断灵敏度在AMI发作0~4 h和3~7 d均有显著性差异,4 h~2 d诊断灵敏度无显著性差异,在健康对照组中cTnI和MB对AMI诊断特异度分别为98.0%和84.0%,非AMI胸痛组cTnI和MB对AMI诊断特异度分别为97.0%和74.0%。结论 cTnI诊断AMI具有很高的特异性和较宽的诊断时间,MB对于AMI的早期诊断具有很高的敏感性,两者结合可提高AMI的诊断率,为梗死时间提供必要的信息。     

心肌损伤标志物联合检测在急性心肌梗死早期诊断中的应用价值

目的探讨心肌损伤标志物心肌钙蛋白-I(cTnI)、肌红蛋白(MYO)、肌酸激酶同工酶MB(CK-MB)、脑钠肽前体(proBNP)和心脏型脂肪酸结合蛋白(H-FABP)联合检测对心肌梗死(AMI)的早期诊断意义。方法选择2015年7月至2016年6月,因急性胸痛发作6h内入院的患者186例,其中AMI确诊患者100例(AMI组),非AMI患者86例(非AMI组)。同期体检健康者60例纳入对照组。比较各组患者各指标单独及联合检测的阳性率,以及各指标对AMI的诊断灵敏度及特异度。结果与对照组相比,AMI组与非AMI组proBNP、H-FABP、cTnI、MYO、CK-MB水平均明显升高(P0.05)。AMI组各指标在单独检测阳性率高于非AMI组和对照组,且5项指标联合检测的阳性率高于单项指标检测(P0.05)。5项指标中,H-FABP诊断AMI的灵敏度最高,cTnI特异度最高;5项指标联合检测的诊断灵敏度和特异度均高于各指标单项检测(P0.05)。结论 proBNP、H-FABP、cTnI、MYO、CK-MB联合检测对AMI的早期诊断灵敏度和特异度较高,但各指标各有优势,应根据实际情况选择合适的指标进行联合检测。     

血清骨膜蛋白对急性心肌梗死的诊断价值研究

目的探讨血清骨膜蛋白对急性心肌梗死(AMI)的诊断价值。方法采用酶联免疫吸附试验(ELISA)测定76例AMI患者和93例非AMI患者入院时血清骨膜蛋白水平,采用电化学发光法检测血清心肌肌钙蛋白I(cTnI)和肌酸激酶同工酶MB(CK-MB)水平,并进行比较分析、诊断效能分析和相关性分析。结果 AMI组血清骨膜蛋白、cTnI和CK-MB水平均高于对照组(P0.05)。血清骨膜蛋白诊断AMI的最佳临界值为22.9ng/L,受试者工作特征曲线(ROC曲线)下面积(AUC)为0.86,灵敏度、特异度分别为84.2%、87.8%。血清骨膜蛋白水平与cTnI和CK-MB的相关系数分别为0.261、0.228(P0.05)。结论骨膜蛋白检测有助于辅助诊断AMI,血清骨膜蛋白水平与cTnI和CK-MB显著相关,骨膜蛋白可能是AMI的危险因子。     

cTnI、CK-MB和MB定量检测在急性心肌梗死诊断中的价值

目的探讨心肌肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)和肌红蛋白(MB)定量分析对急性心肌梗死诊断的临床价值。方法对96例急性心肌梗死(AMI)患者胸痛发作后24h内定量检测血清cTnI、CK-MB、MB浓度,比较它们对AMI诊断的敏感性和特异性。结果急性AMI患者的cTnI、CK-MB、MB的检测结果分别为(7.17±6.32)μg/L、(93±45)IU/L和(593±218)μg/L,较正常对照组均有显著性升高(P0.05)。cTnI、CK-MB、MB对AMI的敏感性分别为97.9%、78.1%和100%,特异性分别为97.5%、95.8%和87.5%。结论急性AMI患者的cTnI、CK-MB、MB值均明显升高。CK-MB、MB在AMI诊断中具有较高的灵敏度和特异性,cTnI具有很高的灵敏度和特异性。cTnI是诊断AMI最好指标,为梗死诊断提供必要的信息。     

心型脂肪酸结合蛋白在急性心肌梗死早期诊断中的价值

目的探讨血清心型脂肪酸结合蛋白(H-FABP)在急性心肌梗死(AMI)早期诊断中的临床应用价值。方法随机选择110例临床疑似AMI胸痛患者,采用时间分辨免疫荧光测定法(TRIFA)检测患者入院即刻血清中H-FABP含量,并与心肌肌钙蛋白I(cTnI)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、超敏C反应蛋白(hsCRP)和肌红蛋白(MYO)进行比较;对11例患者入院即刻和入院6 h后进行动态分析;以60例体检健康者作对照,绘制各心肌损伤标志物受试者工作特征(ROC)曲线并进行曲线下面积(AUC)比较,分析6种心肌损伤标志物诊断早期AMI的敏感度和特异度。结果 AMI患者入院即刻各心肌损伤标志物的AUC由大到小依次为H-FABP、hsCRP、cTnI、CK-MB、CK和MYO,最佳临界值诊断灵敏度分别为85.0%、78.7%、81.3%、73.8%、72.5%和61.3%,特异度分别为93.3%、95.0%、93.3%、100.0%、100.0%、98.3%。H-FABP的AUC与hsCRP、cTnI比较差异无统计学意义(P>0.05),与CK-MB、CK、MYO比较差异有统计学意义(P<0.05)。H-FABP诊断早期AMI的阳性率达85.0%。结论 H-FABP对于AMI早期诊断具有相对较早的检测窗口期和相对较好的特异度,在时效性、灵敏度和特异度等方面具有综合优势,可作为AMI早期诊断或排除诊断的血清标志物。多项心肌损伤指标联合检测可提高AMI实验室诊断的灵敏度、特异度及准确性。     

疑似心肌梗死患者cTnI、Mb、CK-MB联合测定临床分析

目的探讨肌钙蛋白(cTnI)、肌红蛋白(Mb)、肌酸激酶同工酶(CK-MB)联合检测在急性心肌梗死(AMI)早期诊断中的临床价值。方法在电化学发光仪上同时定量检测108例凝似AMI患者的cTnI、Mb、CK-MB。结果 cTnI、Mb和CK-MB单项检测对AMI的敏感度分别为92.7%、94.2%、88.4%,特异度分别为97.4%、46.1%、56.4%;3项指标联合检测对AMI的敏感度达88.4%,特异度达100.0%。结论 cTnI、Mb、CK-MB联合定量检测,快速而准确,对AMI的早期诊断具有较好的临床价值。     

血清miR-1对急性心肌梗死的诊断价值研究

目的探讨血清miR-1对急性心肌梗死的诊断价值。方法选取2013年2月至2016年12月该院急诊就诊的胸痛患者148例,根据急性心肌梗死诊断标准将其分为心梗组(82例)和非心梗组(66例),并选取同期健康体检者74例作为健康对照组,检测3组血清miR-1、心肌肌钙蛋白I(cTnI)、肌酸激酶同工酶(CKMB)水平,分析心梗组中miR-1水平与cTnI、CK-MB水平的相关性,以及miR-1、cTnI、CK-MB诊断急性心肌梗死的灵敏度和特异度。结果心梗组血清miR-1、cTnI、CK-MB水平明显高于非心梗组和健康对照组,而非心梗组血清miR-1、cTnI、CK-MB水平高于健康对照组,差异均有统计学意义(P0.05);心梗组中,miR-1水平与cTnI、CK-MB水平呈正相关(r值分别为0.733、0.779,P0.05);受试者工作特征曲线分析显示,miR-1早期诊断急性心肌梗死的灵敏度和特异度分别为90.57%和97.53%。结论 miR-1可以作为早期诊断急性心肌梗死和评估其严重程度的新指标,且灵敏度较cTnI和CK-MB高。     

临床诊断急性心肌梗死3个常用“金指标”的价值对比分析

目的探讨肌红蛋白(Mb)、肌钙蛋白I(cTnI)及肌酸激酶同工酶(CK-MB)在急性心肌梗死(AMI)早期临床诊断应用价值对比分析。方法采用雅培化学发光免疫分析系统对25例AMI患者、16例不稳定性心绞痛(UA)患者及23例其他疾病患者的血清Mb、cTnI进行检测,用日立7180生化仪检测CK-MB,分别进行组间分析,比较其敏感性高低以及敏感性与患病时间的差异。结果Mb、cTnI诊断AMI灵敏度一致,差异无统计学意义(P0.05),阳性率分别为84.0%、96.0%,明显高于CK-MB的64.0%;UA组中Mb、cTnII阳性率分别为25.0%、43.75%,明显低于AMI组,差异有统计学意义(P0.01)。AMI患病的前16h内Mb、cTnI阳性诊断率均高于82.0%,而CK-MB则为32.4%。结论cTnI和Mb在AMI的早期诊断中具有较高灵敏度,用于AMI与UA的早期诊断与鉴别时要优于CK-MB。     

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.