静脉注射胺碘酮或普罗帕酮治疗阵发性室上性心动过速的对比研究

目的:观察静脉注射胺碘酮或普罗帕酮治疗阵发性室上性心动过速(PSVT)的疗效及副作用。方法:静脉注射胺碘酮治疗44例PSVT,并与普罗帕酮静脉注射治疗46例PSVT对比观察。结果:胺碘酮组和普罗帕酮组总终止率分别为82%和85%,无显著差异(P>0.05);复律时间:胺碘酮组的20±5min明显慢于普罗帕酮组的8.5±2.5min(P<0.05);副作用发生率二者无显著差异性,但普罗帕酮组的副作用较重。结论:胺碘酮治疗PSVT疗效确切、安全,可作为治疗PSVT的一线药物之一。     

普罗帕酮与维拉帕米治疗阵发性室上性心动过速的疗效对比

目的对比分析普罗帕酮与维拉帕米治疗阵发性室上性心动过速(PSVT)的疗效及不良反应。方法选择2008年1月至2010年10月在我科收治的88例PSVT患者,随机分为2组:普罗帕酮组(45例)给予普罗帕酮70mg加入生理盐水20ml中缓慢静脉推注;维拉帕米组(43例)给予维拉帕米5～10mg加入20ml生理盐水缓慢静脉推注。观察、比较2组患者治疗效果及不良反应。结果普罗帕酮组与维拉帕米组转复率分别为84.4%和95.3,2组比较差异无统计学意义(P>0.05);普罗帕酮组平均转复时间明显长于维拉帕米组(P<0.05);2组不良反应发生率比较差异无统计学意义(P>0.05)。结论维拉帕米与普罗帕酮均可有效终止PSVT,维拉帕米治疗效果更佳,但应注意其并发症的发生。     

静脉注射胺碘酮与普罗帕酮治疗心房颤动的临床对比观察

目的　观察静脉应用胺碘酮与普罗帕酮对阵发性快速心房颤动 (房颤 )的疗效。方法　选择 4 9例患者按就诊顺序随机分为两组 ,胺碘酮组 (2 5例 ) :胺碘酮 15 0mg+生理盐水 10ml,静脉注射 ,10分钟注射完毕 ;普罗帕酮组 (2 4例 ) :普罗帕酮 70mg +生理盐水 10ml,静脉注射 ,5～ 10分钟注射完毕。观察 10～ 2 0分钟若未转复可重复应用 ,最大累积量胺碘酮为 4 5 0mg ,普罗帕酮为 2 10mg。 结果　转复率 :胺碘酮组 76 % (19/ 2 5 ) ,普罗帕酮组 75 % (18/2 4 ) ,两组转复率比较差异无统计学意义 (χ2 =0 .0 0 4 2 ,P >0 .0 5 )。转复时间 :胺碘酮组 (4 8.1± 15 .9)分钟 ,普罗帕酮组 (38.7± 14 .9)分钟 ,两组比较差异有统计学意义 (t=2 .13,P <0 .0 5 )。结论　胺碘酮和普罗帕酮对阵发性快速房颤均有较高的转复率 ,但转复时间普罗帕酮短于胺碘酮     

胺碘酮和普罗帕酮急诊转复阵发性室上性心动过速60例疗效分析

探讨胺碘酮和普罗帕酮急诊转复阵发性室上性心动过速(PSVT)的疗效及安全性;选取急诊收治的阵发性室上性心动过速患者120例,随机分为观察组和对照组各60例,观察组给予胺碘酮治疗,对照组给予普罗帕酮治疗,观察记录两组即时复律时间、24h复律情况、72h室上性心动过速复发率及不良反应等情况。胺碘酮转复PSVT总有效率为93.33%,普罗帕酮为95.00%,两组差异无统计学意义(P>0.05),胺碘酮与普罗帕酮转复PSVT起效时间比较差异无统计学意义(P>0.05),观察组72h PSVT复发率及药物不良反应发生率显著低于对照组,差异具有统计学意义(P<0.05)。胺碘酮可作为急诊转复PSVT的首选药物。     

普罗帕酮、维拉帕米与毛花甙丙治疗阵发性室上性心动过速的临床对比观察

目的：观察普罗帕酮、维拉帕米与毛花甙丙治疗阵发性室上性心动过速（PSVT）的疗效。方法：对196例PSVT分别用普罗帕酮、维拉帕米与毛花甙丙3种药治疗,观察PSVT终止时间和有效率。结果：维拉帕米组首次静推有效率、总有效率及复律时间最快,优于普罗帕酮组和毛花甙丙组,普罗帕酮组次之,毛花甙丙组最慢。结论：治疗PSVT应首选维拉帕米,特殊情况下选普罗帕酮或毛花甙丙。     

胺碘酮与心律平治疗阵发性室上速的疗效观察

目的：比较胺碘酮与心律平静脉注射治疗阵发性室上性心动过速（PSVT）的临床疗效。方法：使用胺碘酮150mg、心律平70mg静注治疗PSVT各25例。首剂治疗无效者隔15-20分钟重复1次。结果：胺碘酮组23例PSVT发作终止，心律平组22例PSVT发作终止，都恢复窦性心律。两组复律成功率分别为92％和88％（P〉0．05）。结论：静注胺碘酮与心律平治疗PSVT疗效满意，可作为抢救PSVT患者的首选药物之一。     

静脉注射普罗帕酮与索他洛尔治疗阵发性非瓣膜病快速心房颤动的对比观察

目的:观察和比较静脉注射普罗帕酮、索他洛尔治疗阵发性非瓣膜病快速心房颤动的作用。方法:60例快速房颤发作在0.5-72h的患者,采用随机方式分为两组,分别静脉注射普罗帕酮70-210mg、索他洛尔1.5mg/kg,主要观察快速房颤转复情况及心室率的变化。结果:普罗帕酮、索他洛尔组转复快速房颤的有效率分别为78.1%、39.3%,未转复快速房颠的心室率平均下降幅度分别为5.2%与36%,平均起效时间分别为(46.5±38.2)min,(23.9±11.5)min。结论:在阵发性快速房颤转复过程中静脉注射普罗帕酮的有效率优于索他洛尔,而索他洛尔在减慢快速心室率方面优于普罗帕酮,且索他洛尔平均起效时间短于普罗幅酮。     

宽QRS波群心动过速应用胺碘酮静脉注射治疗的即时疗效和安全性研究

目的:观察和比较静脉注射胺碘酮、普罗帕酮治疗宽QRS波群心动过速的即时疗效和安全性。方法:40例宽QRS波群心动过速患者随机分为治疗组和对照组各20例,治疗组和对照组分别用胺碘酮150mg(3～5mg/kg)稀释于20mL生理盐水中和普罗帕酮70mg加入10%葡萄糖20mL中5～10min内静脉注射完毕,其后以1mg/min静滴,观察15min,若无效,则分别再予75mg和35mg静注。结果:治疗组和对照组治疗宽QRS波群心动过速的总有效率分别为90%和60%,平均起效时间分别为(12.6±5.8)min和(8.3±4.2)min。两组均未见有心衰加重和促心律失常作用表现。结论:静脉注射胺碘酮能迅速、安全、有效地治疗宽QRS波群心动过速。     

胺碘酮治疗室性心律失常的疗效与QT间期的关系——附100例报告

目的:探讨胺碘酮治疗室性心律失常时QT间期与疗效的相关性.方法:100例室性心律失常患者予胺碘酮(负荷量600 mg/d治疗7日,再给予400 mg/d治疗7日,其后用200 mg/d治疗2周,继以100～200 mg/d治疗4个月)治疗,观察患者治疗后QT间期延长与抗心律失常有效率的关系及其不良反应.结果:胺碘酮治疗室性心律失常有效率高达95%,其维持量小(100～200 mg/d),且无明显不良反应.治疗后QT间期延长者较QT间期不延长者效果好.对负荷期末QT间期不延长者,延长其用药负荷期后部分患者可取得满意疗效.结论:胺碘酮用于治疗室性心律失常时,QT间期延长者较不延长者疗效好.     

静脉用胺碘酮治疗血液透析并发严重快速性心律失常的临床疗效分析

目的观察静脉使用胺碘酮对血液透析并发快速性心律失常的疗效. 方法 15例急、慢性肾衰竭重症患者,男性6例,女性9例,年龄(55.0±21.5)岁,于透析中共出现快速性心律失常22例次,给予胺碘酮50～100mg缓慢静脉注射,然后100～150mg持续静脉滴注(8～24ug/kg/min),必要时重复;观察症状、心率、心律、QT间期变化,并与15例非透析对照患者比较疗效.结果 13例次(59.1%)15分钟内复律及心室率降到100次/分以下;6例次(27.3%)15～30分钟复律或心室律降到100次/分以下;3例次(13.6%)30分钟后心室率未转为窦性或心室率未降至100次/分以下,但心室率亦明显下降至120～130次/分,于补钾后以西地兰0.2mg静脉滴注复律.治疗后症状明显改善,QT间期无显著性差异(P>0.05).1例出现窦性心动过缓,停用胺碘酮后恢复正常.疗效与对照组比较无显著性差异(P>0.05).结论静脉注射胺碘酮对重症尿毒症患者透析中出现的快速性心律失常疗效显著、安全.     

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.