高脂血症性急性胰腺炎临床分析

目的：探讨高脂血症性急性胰腺炎（AHLP）临床特点、机制及治疗。方法：AHLP 16例,以非高脂血症性急性胰腺炎26例作为对照。观察各项化验指标、评分并比较。结果：AHLP血甘油三酯（TG）、淀粉酶、APACHE评分、Ranson评分与对照组比较差异有显著性,CTSI与对照组比较差异无显著性。结论：AHLP病情的轻重与血脂水平可能相关,治疗上控制血脂很重要。     

合并血脂增高酒精性胰腺炎患者临床观察

目的观察合并血脂增高酒精性胰腺炎患者病情及治疗后复发情况。方法选取自2010年1月至2011年4月在郯城县第一人民医院就诊的48例酒精性胰腺炎患者,根据血脂有无增高分为血脂增高组(Ⅰ组)和血脂正常组(Ⅱ组)。分别观察血清淀粉酶(AMY)、甘油三酯(TG)、总胆固醇(CHO)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、APACHEⅡ评分、CT严重指数、体质量指数,治疗后转归及复发情况。结果Ⅰ组与Ⅱ组比较,TG、CHO、ALT、AST、APACHEⅡ评分、CT严重指数、体质量指数显著增高,差异有统计学意义(P<0.05),AMY两组比较差异无统计学意义(P>0.05)。Ⅰ组与Ⅱ组比较,重症比例、6个月内复发率显著增高,差异有统计学意义(P<0.05)。结论合并高血脂酒精性胰腺炎患者病情较重,治疗后易复发。     

血清miR-216a水平与急性胰腺炎严重程度的相关性研究

目的探讨血清miR-216a水平与急性胰腺炎(AP)严重程度的相关性。方法选择广州医科大学附属乐从医院2015年6月至2016年6月收治的轻型急性胰腺炎(MAP组)17例,重型急性胰腺炎(SAP组)23例和经检查无异常的健康成人(对照组)30例,采集血液标本检测淀粉酶活性(AMYA)和血清miR-216a的表达水平,采用Ranson评分、急性生理学及慢性健康状况评分系统(APACHEⅡ)和改良的CT严重(MCTSI)指数来评价AP的严重程度,分析上述指标与血清miR-216a表达水平的相关性。结果急性期MAP组与SAP组患者血液淀粉酶活性均高于本组恢复期及对照组,差异有统计学意义(P0.05),且急性期SAP组高于MAP组,差异有统计学意义(P0.05);急性期MAP组和SAP组血清miR-216a均显著高于该组恢复期及对照组,差异有统计学意义(均P0.05),且SAP组高于MAP组,差异有统计学意义(P0.05);miRNA-216a表达水平与Ranson评分、APACHEⅡ评分和MCTSI指数呈正相关(r=0.667,P0.05;r=0.396,P0.05;r=0.648,P0.05)。结论急性胰腺炎患者血清miR-216a表达水平显著高于健康者,表达水平与急性胰腺炎的严重程度呈正相关,对于SAP的诊断具有重要意义。     

持续血液净化配合护理干预对重症急性胰腺炎患者的影响

目的:探讨持续血液净化配合护理干预对重症急性胰腺炎(SAP)患者的影响。方法:对40例SAP患者给予胰腺炎常规治疗配合血液净化治疗及护理干预,分别记录治疗前后患者的体温、血压、呼吸等生命体征,并进行APACHEⅡ评分,比较治疗前后患者血清淀粉酶、肝肾功能、动脉血气分析等指标;判断病情变化情况。结果:本组患者35例治愈出院,5例死亡,存活率为87.5%;持续血液净化治疗时间为(73.8±6.2)h;治疗后,所有治愈患者病情均得到缓解,各项生命体征及APACHEⅡ评分与治疗前比较差异具有统计学意义(P0.05),血清总胆红素、血清淀粉酶等指标与治疗前比较差异具有计学意义(P0.05)。结论:持续血液净化治疗对SAP患者效果明显,配合针对性护理干预临床效果满意,建议临床推广。     

血必净注射液联合杂合式血液净化序贯治疗对急性重症胰腺炎患者APACHE-Ⅱ评分及预后的影响

目的:研究血必净注射液联合杂合式血液净化序贯治疗对急性重症胰腺炎(SAP)患者慢性健康状况评分系统Ⅱ(APACHE-Ⅱ)评分及预后的影响。方法:选取我院治疗的SAP患者54例。随机抽签法分为两组,各27例。对照组予以常规集束化治疗;观察组在对照组基础予以血必净注射液+杂合式血液净化序贯治疗。统计对比两组治疗前后APACHEⅡ评分、腹痛消失时间、住ICU时间及临床治疗效果。结果:治疗后与对照组比较,观察组APACHEⅡ评分较低,腹痛消失时间及住ICU时间较短(P0.05);观察组临床治疗总有效率92.59%(25/27)较对照组66.67%(18/27)高,差异有统计学意义(P0.05)。结论:血必净注射液联合杂合式血液净化序贯治疗急性重症胰腺炎患者,可提高疗效,降低APACHE-Ⅱ评分,缩短腹痛消失时间及住ICU时间。     

脉冲式高容量血液滤过与连续性血液滤过治疗重症急性胰腺炎的疗效比较

目的:比较脉冲式高容量血液滤过(PHVHF)与连续性血液滤过(CVVH)治疗重症急性胰腺炎(SAP)的疗效。方法:38例SAP患者随机接受PHVHF或CVVH治疗,分别为18例及20例,血滤72h后观察两组治疗前后临床症状,急性生理学及慢性健康状况评价Ⅱ(APACHEⅡ)评分,生化指标的改变及病死率。结果:治疗后两组症状明显改善,APACHEⅡ评分、血清淀粉酶、肝功能、血肌酐、白细胞和CRP均有下降(P<0.05)。低氧血症,酸中毒纠正,PHVHF组优于CVVH组,在心率、呼吸、肝功能、APACHEⅡ评分方面差异显著(P<0.05)。PHVHF组病死率为11.1%,CVVH组为25%。结论:PHVHF治疗SAP效果显著,明显优于CVVH组,可以作为SAP的重要辅助治疗。     

重症急性胰腺炎患者CBP与CCPD治疗护理效果的比较

目的 观察重症急性胰腺炎(severe acute panreatitis,SAP)患者连续性血液净化治疗的护理效果.方法 选取2007年7月～2011年6月SAP患者63例,随机分为2组,一组接受连续性血液净化(continuity blood purification,CBP)疗法(A组),另一组接受持续循环腹膜透析(continuous cyclic peritoneal dialysis,CCPD)疗法(B组).观察2组患者的临床转归、生命体征、APACHEⅡ评分和临床症状的变化.结果 A组ICU存活率为93.8%,2例患者死于严重颅内感染;B组ICU存活率为80.6%,3例患者死于严重颅内感染,3例患者死于霉菌性败血症;A组患者存活率高于B组(P<0.05).A组和B组患者治疗24 h后,体温、平均动脉压稍有下降,心率、呼吸、APACHEⅡ评分下降明显(P<0.05);A组治疗后患者心率、呼吸、APACHEⅡ评分较B组治疗后患者下降更明显(P<0.05).A组和B组患者治疗24～72 h后,患者腹痛、腹胀、恶心、呕吐、腹膜炎等体征明显改善.结论 重症急性胰腺炎患者虽然病死率高,但采用连续性血液净化治疗后,患者有良好的临床转归,生命体征、APACHEⅡ评分和临床症状均得到明显缓解,临床上仔细观察、加强连续性血液净化治疗技术的护理对改善重症急性胰腺炎患者的预后起着重要作用.     

APACHEⅡ评分、Ranson评分及EPIC评分对急性胰腺炎预后评价的比较——附198例报告

目的：比较急性生理学及慢性健康状况Ⅱ（acute physiology and chronic health evaluation Ⅱ,APACHE Ⅱ）评分、Ranson评分及腹部CT胰腺外炎症（extrapancreatic inflammation on abdominal computed tomography,EPIC）评分预测急性胰腺炎（acute pancreatitis,AP）预后的价值。方法：临床资料完整的AP患者198例,其中确诊为重症急性胰腺炎（severe acute pancreatitis,SAP）60例,轻症急性胰腺炎（mild acute pancreatitis,MAP）138例,采用受试者工作特性曲线分析APACHE Ⅱ评分、Ranson评分、EPIC评分预测AP的病情严重程度、并发症的价值。结果：198例患者中,SAP和MAP患者APACHE Ⅱ评分、Ranson评分、EPIC评分分值比较差异有统计学意义（均为P〈0．01）。EPIC评分标准判断SAP的敏感度、特异度最高,曲线下面积最大,且其预测局部并发症的曲线下面积最大,而APACHE Ⅱ评分预测全身并发症的曲线下面积最大。结论：对入院24h内的AP患者,EPIC评分结合APACHE Ⅱ评分能有效预测其预后,而Ranson评分不具优势。     

降钙素原和C反应蛋白在急性胰腺炎病情及预后评估中的应用价值

【目的】探讨降钙素原（Procalcitonin ,PCT ）和C反应蛋白（C reactive protein ,CRP）在急性胰腺炎（acute pancreatitis ,AP）病情及预后评估中的价值。【方法】选取AP患者86例,根据患者的病情严重程度分为三组：轻度急性胰腺炎（MAP）27例（MAP组）,中度急性胰腺炎（MSAP）39例（MSAP组）,重度急性胰腺炎（SAP）20例（SAP组）。比较三组患者急性生理与慢性健康评分（APACHE Ⅱ）、血清淀粉酶、PCT和CRP水平。【结果】与治疗前相比,三组患者治疗后APACHE Ⅱ评分、淀粉酶、PCT和CRP水平随时间依次降低,差异具有统计学意义（ P ＜0．05）,且各组患者不同时段APACHE Ⅱ评分、淀粉酶、PCT 和CRP水平比较有统计学差异（ P＜0．05）;患者的疾病严重程度、APACHE Ⅱ评分、血清淀粉酶、PCT和CRP水平与患者预后具有明显的相关性（ P ＜0．05）。出院后随访6个月,MAP组无患者死亡,MSAP组死亡率2．56％（1／39）;SAP组死亡率35．00％（7／20）,三组死亡率比较差异有统计学意义（ P ＜0．05）。【结论】PCT和CRP水平可反映AP患者的病情严重程度,二者检测简单、方便,在AP患者预后评估中有重要的应用价值。     

连续性静脉-静脉血液滤过治疗重症急性胰腺炎疗效观察

目的:观察连续性静脉-静脉血液滤过(continuous venovenous hemofiltration,CVVH)治疗重症急性胰腺炎(severe acute pancreatitis,SAP)的疗效。方法:21例SAP患者在传统治疗方法的基础上加用CVVH治疗。观察治疗前、后临床症状改善情况、急性生理学及慢性健康状况评价Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分、生化指标、动脉血气分析等变化。结果:经过CVVH治疗后,患者临床症状改善明显,APACHEⅡ评分下降明显,血清总胆红素(TP)、丙氨酸氨基转移酶(ALT)、血淀粉酶(AMS)、血钾(K)、血尿素氮(BUN)、血清肌酐(Scr)亦明显下降(TB、AST、AMS、K:P<0.05;BUN、Scr:P<0.01),酸中毒及低氧血症得到纠正(HCO-3:P<0.05;PaO2:P<0.01)。21例患者中存活18例(存活率为85.7%),死亡3例(病死率为14.3%),疗效明显。结论:CVVH治疗SAP有明显的效果,能有效改善患者病情,降低病死率。     

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.     

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.