急性出血坏死型胰腺炎的生长抑素治疗

目的：探讨急性出血坏死型胰腺炎生长抑素的治疗效果。方法：36例急性出血坏死型胰腺炎随机分为治疗组（n=15)与对照组(n=21)，对照组给予常规治疗，治疗组除常规治疗，给予生长抑素持续静脉滴注，6mg/d，连用5－7d，结果：治疗组痊愈率（73．33％）高于对照组（38．10％）（P＜0．05）；对照组局部并发症发生率（14．29％）高于治疗组（6．67％），但差异无显著性（P＞0．05）；对照组病死率（47．62％），高于治疗组20．00％），但差异无显著性（P＞0．05）。结论：生长抑不是治疗急性出血坏死型胰腺炎最有效的药物之一。     

急性重症胰腺炎患者生长抑素干预前后pHi监测及其临床意义

目的 :探讨胃黏膜 p H值 (p Hi)在急性重症胰腺炎患者生长抑素干预前后的变化及其临床意义。方法 :按有无生长抑素 (施他宁 )干预将 4 6例急性重症胰腺炎患者分为生长抑素治疗组 (2 0例 )和无生长抑素治疗组 (对照组 ,2 6例 ) ,2组基础治疗相同。在治疗前、治疗后第 3日和第 7日用胃张力计导管法测定 2组患者p Hi,同时每日评价 2组患者器官功能 ,在患者器官功能衰竭最严重时测定 p Hi,比较 p Hi与器官功能衰竭的相关性。结果 :1生长抑素干预组患者并发器官功能衰竭的发生率显著低于对照组 (45 %比 5 8% ,P<0 .0 5 ) ;2治疗后第 7日生长抑素治疗组 p Hi值较对照组显著增高 (7.392± 0 .0 5 8比 7.335± 0 .10 1,P=0 .0 0 7) ;3p Hi值与功能衰竭器官数目呈显著负相关 (r=0 .5 92 ,P<0 .0 0 1)。结论 :生长抑素可降低急性重症胰腺炎患者器官功能衰竭的发生率 ,其作用机制可能与提高 p Hi、改善患者组织供氧有关     

思他宁和加贝酯治疗急性胰腺炎疗效观察

目的：评价生长抑素（somatostatin,商品名Stilamin,思他宁）和甲磺酸加贝酯（gabexate mesilate,GM）治疗急性胰腺炎患者的疗效,及这两种药物对急性出血坏死型胰腺炎的临床疗效。方法：采用随机对照研究,按是否出血坏死型随机分为治疗组和对照组,在常规治疗的基础上,分别接受思他宁或甲磺酸加贝酯治疗,并观察疗效。结果：思他宁用于治疗急性水肿型胰腺炎,总有效率达100.0%,痊愈率达78.9%,略高于对照组加贝酯（63.6%）,但差异无显著性（P〉0.05）。腹痛、上腹胀等症状均能在3～5d内基本缓解或消失。思他宁用于治疗急性出血坏死型胰腺炎,总有效率90%,高于对照组加贝酯66.7%,差异有显著性（P〈0.05）。治疗过程中仅2例丙氨酸转氨酶轻度升高,未发现过敏、皮疹、白细胞明显下降等明显不良反应,肝、肾功能和电解质等生化指标和血常规监测显示其具有较好的安全性。结论：思他宁和加贝酯用于治疗急性水肿型胰腺炎和出血坏死型胰腺炎均有较好的疗效,不良反应较少。在急性水肿型胰腺炎治疗中,二者总有效率无显著性差异;在出血坏死型胰腺炎治疗中,思他宁总有效率高于加贝酯。     

生长抑素在治疗急性胰腺炎中的疗效及作用

目的 :观察生长抑素治疗急性胰腺炎的疗效。方法 :选择 1994年～ 2 0 0 1年 17例急性胰腺炎病例 (用禁食、胃肠减压、抗感染、维持水电解质及酸碱平衡、静脉营养支持、抑制胰腺分泌药物等方法治疗 )为对照组 ,而治疗组中的 17例为 2 0 0 1年至今均在上述治疗基础上加用生长抑素 (思他宁 2 5 0ug/h ,以静脉输注泵 2 4h维持 ,共 5～ 7d)治疗的急性胰腺炎患者。结果 :应用生长抑素组病人的血淀粉酶复常时间和总住院日均明显低于对照组 ( P <0 .0 5 )。结论 :生长抑素对急性胰腺炎有明显疗效     

生长抑素对大鼠急性胰腺炎免疫调节的作用

目的　观察生长抑素对急性胰腺炎时炎症性细胞因子和抗炎症细胞因子的调节作用 ,从免疫角度探讨生长抑素治疗急性胰腺炎的作用机制。方法　实验用雄性SD大鼠分 3组 :(1)正常对照组 (n=6 ) ;(2 )用开腹胰管注射 5 %牛黄胆酸钠 (1 0ml/kg)制备急性胰腺炎模型 (n =8) ;(3)胰腺炎诱导成功后皮下注射生长抑素 (3μg/kg) ,12h重复一次。手术后 2、 6、 2 4h处死动物 (每时段 n =7) ,分别抽血查TNF α、IL 1、IL 6 ,IL 10 ,TGF β及胰淀粉酶、胰腺湿重、血中白细胞计数。结果　在急性胰腺炎时血中的炎症性细胞因子和抗炎症细胞因子均显著升高 ,在使用生长抑素治疗后 ,上述因子均下降 ,TNF -α、IL 1、IL 6在 2、 6、 2 4h均明显下降 (P <0 0 5 ) ,IL 10和TGFβ在 2 4h时段下降最为明显(P <0 0 5 )。 1组、 2组和 3组动物 2 4h胰腺湿重分别为 (0 5 3± 0 0 9)g ,(1 5 3± 0 13)g ,(0 6 8± 0 15 )g。 3组动物 2 4h淀粉酶分别为 (374 2± 92 84 )U/L、 (1817 2 5± 4 5 9 35 )U/L、 (797 4± 2 2 5 9)U/L ,对比生长抑素治疗前后 ,可见反映胰腺炎病情严重性的胰腺湿重和淀粉酶两项指标均明显好转 (P <0 0 5 )。结论　生长抑素可以同时抑制急性胰腺炎时血中过高的炎症性细胞因子和抗炎症细胞因子 ,从而     

生长抑素+乌司他丁在急性重症胰腺炎治疗中的效果观察

目的:研究生长抑素+乌司他丁在急性重症胰腺炎治疗中的应用效果。方法:采用随机数字表法将2016年9月~2018年12月收治的重症胰腺炎患者90例分为观察组与对照组,各45例。所有患者均给予常规治疗,对照组加用生长抑素治疗,观察组加用生长抑素+乌司他丁治疗。均治疗2周,比较治疗前后血白细胞计数、白蛋白、血淀粉酶、白介素-6、白介素-8及肿瘤坏死因子-α水平,并评估两组治疗效果。结果:治疗前,两组血白细胞计数、白蛋白以及血淀粉酶、白介素-6、白介素-8及肿瘤坏死因子-α水平比较无显著性差异(P>0.05);治疗后,观察组白细胞计数、血淀粉酶、白介素-6、白介素-8及肿瘤坏死因子-α水平均明显低于对照组,白蛋白水平明显高于对照组(P<0.05);观察组治疗总有效率93.33%,显著高于对照组的77.78%(P<0.05)。结论:生长抑素联合乌司他丁治疗急性重症胰腺炎的效果优于单用生长抑素,可有效控制患者病情进一步发展,改善炎性反应。     

生长抑素辅助治疗重症急性胰腺炎患者的有效性及不良反应分析

目的探讨生长抑素辅助治疗重症急性胰腺炎患者的有效性及不良反应情况。方法选取我院2016年3月至2018年10月收治的81例重症急性胰腺炎患者作为研究对象,将其按照随机数字表法分为两组,对照组(n=40)采用泮托拉唑钠治疗,观察组(n=41)在此基础上给予生长抑素治疗,对比两组患者治疗效果差异。结果观察组总有效率为95.12%,明显高于对照组75.00%(P0.05);观察组各项症状体征缓解时间均明显短于对照组(P0.05);两组患者治疗前白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hs-CRP)差异无统计学意义(P0.05),治疗后两组炎性因子水平均明显改善,其中观察组改善程度更明显(P0.05);观察组不良反应发生率为4.88%,明显低于对照组(20.00%),P0.05。结论生长抑素辅助治疗重症急性胰腺炎患者的有效性高,不良反应少。     

低分子右旋糖酐对急性胰腺炎早期的保护作用

目的　通过建立大鼠急性胰腺炎模型 ,观察低分子右旋糖酐对发病早期胰腺局部微循环的保护作用。方法　建立大鼠急性胰腺炎模型 ,比较对照组 (生理盐水 )与实验组 (低分子右旋糖酐 )微循环变化及腹水内游离胰蛋白酶原活性肽和局部血管紧张素基因转录水平的改变。结果　对照组与实验组比较发现 ,胰腺重量增加 2 7% (P <0 0 0 5 )、胰腺血流量减少 5 7% (P <0 0 0 1)、胰腺灌流量减少 6 4 % (P <0 0 0 1)。比较腺泡坏死评分实验组腺泡坏死程度明显低于对照组 (P <0 0 1)。实验组腹水内游离胰蛋白酶原活性肽的量明显低于对照组 (P <0 0 0 1)。对照组胰腺局部血管紧张素基因转录水平明显增强。结论　急性胰腺炎早期应用低分子右旋糖酐 ,具有阻止或延缓由水肿型向出血坏死型发展的作用     

乌司他丁联合生长抑素治疗急性胰腺炎的疗效分析

目的 观察乌司他丁联合生长抑素治疗急性胰腺炎的疗效.方法 将62例急性胰腺炎患者按随机数字表法分为观察组(n=32)和对照组(n=30).对照组采用内科常规治疗,并给予生长抑素十四肽3 mg加入5%GS 50 mL中微量泵入,q 12 h;观察组在对照组治疗的基础上加用乌司他丁10万U加入5%GS 250 mL中静脉滴注,2次·d-1.对2组疗效进行比较.结果 观察组治愈率为93.8%,对照组治愈率为90.0%,2组比较差异无统计学意义(P＞0.05).观察组的临床症状缓解时间、血淀粉酶恢复正常时间、平均住院时间均低于对照组(均P＜0.05).结论 乌司他丁联合生长抑素治疗急性胰腺炎,可有效地缓解临床症状,缩短住院时间.     

生长抑素联合加贝酯对急性胰腺炎患者腹痛、白细胞及C反应蛋白的影响观察

目的 观察生长抑素及加贝酯联合治疗对急性胰腺炎患者腹痛、白细胞及C反应蛋白的影响。方法 随机将112例急性胰腺炎患者分为观察组及对照组各56例;观察组在常规治疗基础上给予生长抑素及加贝酯治疗;对照组在常规治疗基础上给予生长抑素治疗;对比观察治疗前及治疗第3、7d患者腹痛、白细胞及C反应蛋白变化情况。结果对照组在治疗第3、7d腹痛、白细胞及C反应蛋白改善好于对照组(P0.05)。结论 生长抑素联合加贝酯治疗急性胰腺炎通过降低白细胞及C反应蛋白水平,从而减轻或缓解腹痛,达到临床缓解。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.