聚乳酸羟基乙酸/纳米羟基磷灰石-5-氟尿嘧啶复合微球的制备及体外释放

背景:由聚乳酸羟基乙酸/纳米羟基磷灰石复合材料制备的微球,在体外磷酸盐缓冲液中能够持续释放药物.目的:制备聚乳酸羟基乙酸/纳米羟基磷灰石-5-氟尿嘧啶复合微球,探讨纳米羟基磷灰石对复合微球的载药量、包封率和体外释放等性质的影响.设计、时间及地点:材料学体外观察,于2009-02/2009-07在华南理工大学材料学院实验室完成.材料:聚乳酸羟基乙酸为济南岱罡生物有限公司产品,纳米羟基磷灰石由华南理工大学特种功能材料教育部重点实验室自制,5-氟尿嘧啶为上海楷洋生物技术有限公司产品.方法:以水溶性抗癌药物5-氟尿嘧啶作为模型药物,先用纳米羟基磷灰石吸附药物,外包裹生物相容性好且可生物降解的聚乳酸羟基乙酸,采用单乳化溶剂挥发法(S/O/W)制备聚乳酸羟基乙酸,纳米羟基磷灰石-5-氟尿嘧啶复合微球.对载药前后的纳米羟基磷灰石进行透射电子显微镜、扫描电子显微镜观察和FTIR分析.采用扫描电镜、激光粒度仪和紫外分光光度计对微球的理化性质及体外释药性质进行分析.主要观察指标:纳米羟基磷灰石与5-氟尿嘧啶分子之间的相互作用,微球载药量和包封率,药物体外释放.结果:FTIR结果表明,纳米羟基磷灰石对5-氟尿嘧啶有较强的吸附作用.聚乳酸羟基乙酸/纳米羟基磷灰石-5-氟尿嘧啶复合微球的载药量和包封率分别为3.83%,86.78%,明显高于单纯的聚乳酸羟基乙酸-5-氟尿嘧啶微球.经过体外释放药物突释后,复合微球比单纯聚乳酸羟基乙酸微球的药物释放慢.在第27天,复合微球和单纯的聚乳酸羟基乙酸微球累积药物释率放分别为84.87%,99.87%.结论:与单纯的聚乳酸羟基乙酸-5-氟尿嘧啶微球相比,由于纳米羟基磷灰石对5-氟尿嘧啶存在较强的吸附作用,使聚乳酸羟基乙酸/纳米羟基磷灰石-5-氟尿嘧啶复合微球的载药量和包封率得到了较大提高,具有更好的药物缓释效果.     

利福平/聚乳酸-聚羟基乙酸缓释微球的制备及特性

背景:虽然国内外有很多制备利福平/聚乳酸-聚羟基乙酸共聚物(poly lactic acid-glycolic acid copolymer,PLGA)微球的报道,但这些微球粒径多在10 μm左右,不适合与磷酸钙骨水泥复合制备成具有良好降解性的抗结核修复材料.目的:制备大粒径利福平/PLGA缓释微球,观察其理化特性和体外缓释特性.方法:以PLGA为载体,将利福平分散于PLGA的有机溶剂中,采用复乳溶剂挥发法制备利福平/ PLGA缓释微球.光镜和扫描电镜下观察微球的形态特征,测定微球平均直径和跨距,高效液相色谱法测定载药量和包封率,以溶出法和高效液相色谱法观察其体外释药特性,并拟合药物体外释放曲线建立曲线方程.结果与结论:利福平/PLGA微球电镜观察呈圆球形,分散性好,粘连少,粒径分布集中,平均粒径(80.0±9.4) μm.载药量、包封率分别为(33.18±1.36)%,(54.79±1.13)%.体外缓释试验显示突释期内微球释放度为(14.66±0.18)%,前3 d累计释放度(18.09±0.45)%,到42 d体外累积释放度达到(92.17±1.23)%.提示利福平/PLGA微球具有良好的缓释效果,是一种较为理想的抗结核药物的载体材料和释放系统;PLGA是良好的药物缓释载体,可以用来制备载药缓释微球.     

聚乳酸-羟基乙酸共聚物吗啡微球的制备及其镇痛作用

背景:药物微球因其对特定器官和组织的靶向性及微粒中药物释放的缓释性而成为一种新的给药系统.国内外学者对局麻药缓释给药系统进行了一系列研究,但麻醉性镇痛药的微球制剂末见报道.目的:制各以聚乳酸-羟基乙酸共聚物为载体的吗啡生物可降解缓释微球制剂,并检测其镇痛作用.方法:采用溶剂挥发法制备吗啡聚乳酸-羟基乙酸共聚物微球,并计算其载药量及包封率.将雄性健康SD大鼠以数字表法随机分为3组:空白对照组(皮下注射生理盐水),阳性对照组(皮下注射盐酸吗啡注射剂)和吗啡微球组(皮下注射吗啡聚乳酸-羟基乙酸共聚物微球),利用CO2激光为热刺激进行痛阈测定.结果与结论:制成的吗啡聚乳酸-羟基乙酸共聚物微球为白色粉末,载药量为11.86%,药物包封产率为33%,微球可较明显延长吗啡作用时间至6 h以上.结果说明吗啡聚乳酸-羟基乙酸共聚物微球明显地延长了吗啡释放时间,缓释性好,但未达到预期的理想时间,仍然需要进行改进.     

5-氟尿嘧啶缓释剂制备及体外释药性能比较

背景：5-氟尿嘧啶-聚乳酸-乙醇酸共聚物缓释微球在青光眼滤过术后抑制滤过泡的瘢痕化具有潜在应用价值,但微球制备程序复杂,微球载药量一般较低,且药物突释现象明显。目的：比较乳化溶剂挥发法制备的5-氟尿嘧啶-聚乳酸-乙醇酸共聚物微球和喷雾成膜法制备的5-氟尿嘧啶-聚乳酸-乙醇酸共聚物缓释膜两种缓释剂的形态、载药量、体外释放规律,以探讨获得缓释效果较佳的5-氟尿嘧啶缓释剂制备方法。方法：以聚乳酸-乙醇酸共聚物为载体,采用乳化溶剂挥发法制备5-氟尿嘧啶-聚乳酸-乙醇酸共聚物微球;用喷雾成膜法制备5-氟尿嘧啶-聚乳酸-乙醇酸共聚物缓释膜。结果与结论：用乳化溶剂挥发法制备的微球外观圆整,粒径为（4447.4±359.8）nm,载药量（8.67±0.37）%,包封率为（86.68±1.92）%;用喷雾成膜法制备的缓释膜表面光滑平整,质量为（13.76±0.26）mg,直径为6mm,厚度为（0.24±0.005）mm,载药量（23.76±0.37）%,包封率为（95.04±1.36）%。缓释剂制备过程未影响5-氟尿嘧啶的药物性能。微球体外释放突释明显,缓释膜的体外释放平稳持久,释放曲线符合Higuchi方程。结果表明缓释膜制备方法更简单易行,且能明显提高缓释剂的载药量,降低突释现象,同时延长药物的缓释时间。     

乳酸-羟基乙酸共聚物缓控释微球的制备及突释成因与影响因素

背景:乳酸-羟基乙酸共聚物是一种生物可降解高分子材料,以乳酸-羟基乙酸共聚物为原料制备的载药微球和纳米粒既可提高药物的稳定性,又能实现缓释、控释和靶向释放.目的:分析乳酸-羟基乙酸共聚物缓控释微球的制备方法以及突释的成因、影响因素和改进方法.方法:应用计算机检索1990/2010中国期刊全文数据库和PubMed数据库与乳酸-羟基乙酸共聚物缓控释微球的制备及突释联系紧密的文章.结果与结论:目前乳酸-羟基乙酸共聚物缓释微球制备方法主要有单凝聚法、乳化-固化法、喷雾干燥法.造成其突释的原因首先是药物分子和聚合物分子之间的相互作用太弱,导致药物很容易从微球进入释放递质中,其次是在微球释放初期,药物从微球中的孔洞和缝隙中释放出来导致突释.影响突释程度的具体因素有乳酸-羟基乙酸共聚物的相对分子质量、浓度、微球载药量、主药理化性质、微球制备方法及制备参数等.虽然国内外对突释机制以及控制突释措施的研究都还处于初步阶段,通过对各影响因素加以适当优化与控制,可在一定程度上减少微球的突释率,突释问题应该能够得到解决和控制.     

乳酸-羟基乙酸共聚物缓控释微球的制备及突释成因与影响因素

背景：乳酸-羟基乙酸共聚物是一种生物可降解高分子材料,以乳酸-羟基乙酸共聚物为原料制备的载药微球和纳米粒既可提高药物的稳定性,又能实现缓释、控释和靶向释放。目的：分析乳酸-羟基乙酸共聚物缓控释微球的制备方法以及突释的成因、影响因素和改进方法。方法：应用计算机检索1990/2010中国期刊全文数据库和PubMed数据库与乳酸-羟基乙酸共聚物缓控释微球的制备及突释联系紧密的文章。结果与结论：目前乳酸-羟基乙酸共聚物缓释微球制备方法主要有单凝聚法、乳化-固化法、喷雾干燥法。造成其突释的原因首先是药物分子和聚合物分子之间的相互作用太弱,导致药物很容易从微球进入释放递质中,其次是在微球释放初期,药物从微球中的孔洞和缝隙中释放出来导致突释。影响突释程度的具体因素有乳酸-羟基乙酸共聚物的相对分子质量、浓度、微球载药量、主药理化性质、微球制备方法及制备参数等。虽然国内外对突释机制以及控制突释措施的研究都还处于初步阶段,通过对各影响因素加以适当优化与控制,可在一定程度上减少微球的突释率,突释问题应该能够得到解决和控制。     

聚乳酸-羟基乙酸共聚物作为曲安奈德控释载体的评价

目的:通过制备新型的曲安奈德缓释系统,对其形态、载药及体外释药性进行检测,评估应用生物可降解的聚乳酸-羟基乙酸共聚物作为曲安奈德控释载体的可行性。方法:实验于2005-08/2006-02在解放军第四军医大学化学教研室完成。①以包封率为指标,应用单因素试验粗选制备工艺条件,再应用正交设计实验,通过选择聚乳酸-羟基乙酸共聚物用量、曲安奈德用量、聚乙烯醇浓度等3个因素进行制备工艺优化。②以聚乙烯醇作为乳化剂,以乳化-溶剂挥发法制备具有控制释放功能的负载曲安奈德的聚乳酸-羟基乙酸共聚物微球。采用扫描电镜、激光粒度分析仪等对微球的理化特性及体外释药性质进行分析。结果:①曲安奈德微球及其冻干粉剂一般性质:微球表面光滑圆整,球体均匀度好,粒径分布范围较窄,平均粒径为(17.751±2.154)μm。冻干粉剂为白色疏松粉末,无塌陷或萎缩现象,加双蒸水后为白色乳状溶液,再分散性良好。②微球载药率与包封率测定情况:曲安奈德微球的载药率和包封率分别为(26.28±0.51)%和(66.73±1.24)%。③药物释放实验结果:微球体外释药规律符合Higuichi方程,28d内无突释现象,28d后其释放度达81.2%。结论:曲安奈德微球及其冻干粉剂制备工艺良好;微球中曲安奈德生物活性保存良好,体外具有明显缓释作用应用。这种新型药物控制释放系统在激素类药物给药途径中具有潜在价值。     

乳酸-羟基乙酸共聚物缓释微球的制备、性能及应用

用于制备乳酸-羟基乙酸共聚物缓释微球的方法很多,可根据聚合物和药物的性质进行选择,其中乳化-固化法是目前制备乳酸-羟基乙酸共聚物缓释微球中最常用的方法,适用于在连续相中不溶或难溶的药物,缺点在于使用有机溶剂,不利于保持药物的活性,复乳化时工艺也比较复杂,不适宜进行工业化生产;喷雾干燥技术是一种快速的一步微囊化过程,其条件温和,制得的微球具有粒度分布窄、包封率高等特点,其用于不稳定药物微囊化的大规模生产极具潜力.由于给药初期的突释有可能导致血药浓度接近或超过中毒水平,产生明显的毒副作用.乳酸-羟基乙酸共聚物的分子质量、乳酸-羟基乙酸共聚物的纯度、主药理化性质、微球制备方法及制备参数、微球载药量等均是影响突释程度的具体因素.目前防止突释或降低突释程度的方法主要有改变载体材料结构、适当的微球制备以及萃取、洗涤或加入附加剂等.乳酸-羟基乙酸共聚物微球控释系统具有延长药物释放时间、靶向释放、降低药物毒性和刺激性等特点,存在多种给药途径可肌肉注射、皮下注射、玻璃体内注射、关节腔内给药、植入给药、黏膜给药等.     

壳聚糖微球/纳米羟基磷灰石/聚乳酸-羟基乙酸复合支架制备及其蛋白缓释效果:与单纯纳米羟基磷灰石/聚乳酸-羟基乙酸支架、壳聚糖微球的比较

背景:骨组织工程骨构建中如何使生长因子持续高效发挥作用是影响成骨速度和质量的关键,现多以各种材料的微球或支架作为缓释载体,但缓释作用有待提高.目的:实验拟制备壳聚糖微球,然后复合到纳米羟基磷灰石/聚乳酸羟基乙酸支架上,形成双重缓释作用,并测量对牛血清白蛋白的释放效果.方法:以牛血清白蛋白为模型药物,采用乳化交联法制备壳聚糖微球.将微球与纳米羟基磷灰石、聚乳酸-羟基乙酸按一定比例混合,以冰粒子为致孔剂,采用冷冻干燥法制备壳聚糖微球,纳米羟基磷灰石,聚乳酸-羟基乙酸复合支架.利用扫描电镜、激光粒度分析仪、压泵仪和力学性能测试仪检测复合支架的形态性能,考察药物在缓释支架上的体外释放规律.结果与结论:所制备的壳聚糖微球形态良好,呈规则圆球形,粒径集中分布在20～40 μum,微球药物包封率为86.5%,载药量为0.8%,随牛血清白蛋白初始用量的增加,载药量可升高至2.6%,但包封率下降至74.1%.壳聚糖微球能均匀分布在聚乳酸-羟基乙酸支架上,形成壳聚糖微球,纳米羟基磷灰石/聚乳酸-羟基乙酸复合支架,孔径为1 00-400 μm,孔隙率>80%,压缩强度为1.1～2.3 MPa,10周降解率为26.5%.单纯纳米羟基磷灰石,聚乳酸-羟基乙酸支架其牛血清白蛋白在36 h累积释放量达85%以上,壳聚糖微球其牛血清白蛋白10 d累积释放量为33.6%,复合支架其牛血清白蛋白40 d累积释放量为81.5%.结果证实包埋壳聚糖微球的纳米羟基磷灰石,聚乳酸-羟基乙酸支架其压缩强度和降解速率合适,对蛋白类药物具有良好的缓释作用,有望作为组织工程的支架材料和生长因子的缓释载体.     

缓释双药物载体制备与性能

背景：骨结核患者常规用药,病灶处结核药物的有效浓度低,治疗效果差。目的：制备一种可直接植入骨结核病灶内的,且具有在骨结核周围组织能够长期保持一定的抗结核药物浓度,起到提高骨结核的治愈率有效治疗的新型生物材料。方法：采用乳剂-溶剂挥发法制备利福平-聚乳酸-羟基乙酸共聚物微球和异烟肼-聚乳酸-羟基乙酸共聚物微球,利用生物黏合剂α-氰基丙烯酸烷基酯将2种微球加工成长效缓释双组分药物载体,观察缓释双药物载体体外释药特性;然后将缓释双药物载体置入兔股骨转子间骨缺损部位,观察载药缓释载体植入后不同时间点药物释放浓度、组织相容性及骨缺损的愈合情况。结果与结论：利福平-聚乳酸-羟基乙酸微球平均粒径（240±13）μm,载药率为（26±1.5）%。异烟肼-聚乳酸-羟基乙酸微球平均粒径（250±10）μm,载药率为（28±1.8）%。利福平、异烟肼,90 d体外累积释放率可达到80%和90%。90 d体内释放利福平和异烟肼的浓度可达（0.5±0.4）和（0.6±0.3）μg/g。缓释双药物载体置入兔股骨转子间骨缺损部位可见筋膜、肌纤维之间出现少量中性粒细胞浸润,59 d 后肌肉组织中性粒细胞明显减少,X射线平片显示骨缺损明显缩小。提示该载体能够长时间保持骨结核周围组织中一定的药物浓度,弥补血中药物浓度不足,有望在骨结核手术治疗中提供一种新型的双药物缓释载体。     

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.