生血宁联合促红细胞生成素治疗慢性肾衰肾性贫血临床观察

目的:观察生血宁联合促红细胞生成素治疗慢性肾衰肾性贫血疗效。方法:选取慢性肾衰患者36例随机分成治疗组和对照组,对照组常规给予促红细胞生成素,每次3000U,每周皮下注射2~3次,治疗组在此基础上加用生血宁2片,每日3次口服,疗程2个月。疗程结束后检测各组Hb、HCT。结果:治疗组血红蛋白和红细胞压积水平显著高于对照组(P<0.05)。结论:生血宁联合促红细胞生成素治疗能明显改善慢性肾衰患者肾性贫血,并能延长红细胞寿命,改善慢性肾衰患者生活质量。     

生血宁片联合rhEPO对老年肾性贫血患者微炎症状态的影响

目的:探讨对老年肾性贫血患者给予生血宁片联合重组人促红细胞生成素治疗的效果及对微炎症状态的影响。方法:选取2018年3月～2019年1月收治的79例老年肾性贫血患者为研究对象,以随机数字表法分为对照组39例和观察组40例。对照组实施基础支持治疗+重组人促红细胞生成素治疗方案,观察组实施基础支持治疗+重组人促红细胞生成素+生血宁片治疗方案。比较两组治疗效果及治疗前后微炎症状态指标,并统计两组不良反应发生情况。结果:观察组治疗总有效率明显高于对照组,差异有统计学意义(P0.05);观察组治疗后血清C反应蛋白、肿瘤坏死因子α、白介素-6均低于对照组,差异有统计学意义(P0.05);两组不良反应发生率比较,差异无统计学意义(P0.05)。结论:对老年肾性贫血患者给予生血宁片联合重组人促红细胞生成素治疗的效果理想,还可显著减轻微炎症反应,安全可靠。     

补肾生血汤治疗肾性贫血的临床观察

目的：探讨补肾生血汤治疗肾性贫血的临床效果。方法：收集我院2011年2月-2015年9月收治的82例肾性贫血患者资料,其中实施促红细胞生成素等西医治疗的42例患者为对照组,另40例采用中药加促红细胞生成素治疗者为观察组,比较两组临床症状,并对血红蛋白浓度(Hb)、红细胞压积(Hct)疗效进行对比。结果：临床疗效上,观察组97.50%,显著高于对照组的78.57%(P＜0.05)；Hb、Hct两组于治疗前无显著差异(P＞0.05),经2月不同治疗后,观察组2指标显著高于治疗前与对照组(P均＜0.05)。结论：中西医结合治疗肾性贫血,可有效纠正贫血状态,改善肾功能,值得推广。     

补肾生血汤治疗肾性贫血的临床观察

目的:探讨补肾生血汤治疗肾性贫血的临床效果。方法:收集我院2011年2月~2015年9月收治的82例肾性贫血患者资料,其中实施促红细胞生成素等西医治疗的42例患者为对照组,另40例采用中药加促红细胞生成素治疗者为观察组,比较两组临床症状,并对血红蛋白浓度(Hb)、红细胞压积(Hct)及疗效进行对比。结果:观察组总有效率为97.50%,显著高于对照组的78.57%(P0.05)。两组治疗前Hct、Hb比较无显著差异(P0.05)。治疗2个月后,两组Hct、Hb与治疗前比较均显著提高(P0.05)。结论:中西医结合治疗肾性贫血,可有效纠正贫血状态,改善肾功能,值得推广。     

左卡尼汀联合促红细胞生成素治疗肾性贫血的疗效观察

目的观察左卡尼汀对重组人红细胞生成素（r-HuEPO）治疗肾性贫血疗效的影响。方法将36例维持性血液透析患者随机分为治疗组和对照组,每组18例,2组同时于血透后予以r-HuEPO 100～150U／（kg·周）皮下注射,待血红蛋白Hb≥110g／L,红细胞压积（Hct）≥30％后减量,维持Hct在30％～35％;治疗组另于每次血透后静脉注射左卡尼汀1．0g,共12周。结果2组患者的血红蛋白,红细胞压积较治疗前明显升高,治疗组优于对照组（P〈0．05）;治疗组红细胞生成素的每周平均用量较对照组少,2组对比差异有显著性（P〈0．05）。结论左卡尼汀能显著提高促红细胞生成素治疗肾性贫血的疗效,减少促红细胞生成素的用量。     

左卡尼汀与促红细胞生成素联用治疗维持性血液透析肾性贫血临床分析

目的分析左卡尼汀与促红细胞生成素联用治疗维持性血液透析肾性贫血的临床效果。方法选取2011年4月至2013年3月收治的维持性血液透析肾性贫血患者60例，随机分为两组，对照组30例，给予皮下注射促红细胞生成素；观察组30例在对照组的基础上加用左卡尼汀静脉滴注，对两组患者进行临床分析。结果观察组症状改善情况明显优于对照组，观察组不良反应发生率明显低于对照组，观察组血细胞比容及血红蛋白改善情况明显优于对照组，两组比较差异有统计学意义（P〈0．05）。结论对血液透析肾性贫血患者采用左卡尼汀与促红细胞生成素联用治疗的方法能有效改善临床症状，与常规治疗相比，联用治疗可减少不良反应发生率。     

左旋卡尼丁联合促红细胞生成素治疗肾性贫血的疗效

目地观察左旋卡尼丁联合促红细胞生成素治疗肾性贫血的临床疗效。方法将36例肾性贫血患者随机分为观察组与对照组,每组18例。2组均给予促红细胞生成素（重组人促红素）10 000U皮下注射,每周1次,观察组在上述基础上加用左旋卡尼丁2.0g静脉注射,每周2次,疗程12周。2组患者均常规补充铁剂、叶酸、维生素B12等造血原料。结果治疗后2组的血红蛋白（Hb）、红细胞压积（Hct）水平较治疗前均明显升高（P〈0.05）;观察组较对照组升高更为明显（P〈0.05）。观察组不良反应发生率显著低于对照组（22.2%vs 50.0%,P〈0.05）。结论联合应用左旋卡尼丁及促红细胞生成素治疗肾性贫血非血液透析患者具有较好的疗效。     

促红细胞生成素联合琥珀酸亚铁片对血液透析肾性贫血患者贫血相关指标的影响

目的:探讨促红细胞生成素联合琥珀酸亚铁片对血液透析肾性贫血患者贫血相关指标的影响。方法:选取2016年8月～2019年4月收治的血液透析肾性贫血患者109例,按随机数字表法分观察组55例和对照组54例。对照组予以促红细胞生成素治疗,观察组予以促红细胞生成素联合琥珀酸亚铁片治疗。比较两组不良反应、贫血相关指标水平、红细胞携氧能力。结果:治疗后两组贫血相关指标水平均明显升高,且观察组高于对照组(P0.05);治疗后两组红细胞携氧能力均明显升高,且观察组高于对照组(P0.05);观察组不良反应发生率为3.64%(2/55)与对照组的1.85%(1/54)比较无显著性差异(P0.05)。结论:促红细胞生成素联合琥珀酸亚铁片治疗血液透析肾性贫血能有效提升红细胞携氧能力,纠正贫血症状,且不增加不良反应发生风险。     

补脾益肾升血方治疗肾性贫血的临床研究.

目的:探讨补脾益肾升血方治疗慢性肾衰竭(CRF)肾性贫血的疗效.方法:将74例肾性贫血患者随机分为2组,治疗组38例应用补脾益肾升血方联合促红细胞生成素(EPO),对照组36例应用EPO.观察2组治疗前后血红蛋白(Hb)、红细胞压积(HCT)、尿素氮(BUN)、血清肌酐(Scr)和内生肌酐清除率(Cer)变化,以及对中医症状积分的影响.结果:治疗后2组Hb、HCT均有明显的提高(P<0.01),症状体征改善也比较明显(P<0.05,P<0.01),且治疗组较对照组比较有显著性差异(P<0.05,P<0.01);治疗组的BUN、Scr、Ccr有明显改善(P<0.01,P<0.05),较对照组有显著性差异(P<0.01).结论:补脾益肾升血方可明显改善肾性贫血、保护残肾功能、改善中医症状,并能较快达到治疗目标.相应减少EPO用量.     

左卡尼汀+促红细胞生成素对肾性贫血的治疗效果及相关指标分析

目的探究分析左卡尼汀结合促红细胞生成素方案用于治疗肾性贫血的临床疗效及对患者相关指标的影响。方法在2017年5月至2020年5月本院收治的肾性贫血患者中抽取64例作为观察对象,根据患者入院顺序的不同将所有患者对半分为对照组和观察组,每组患者分别为32例,对照组患者给予常规促红细胞生成素进行治疗,观察组患者在此基础上结合左卡尼汀治疗,对比两组患者的整体贫血治疗有效率、治疗前后的血象指标、患者及其家属的满意度、不良反应情况。结果观察组肾性贫血患者接受了左卡尼汀结合促红细胞生成素方案治疗后,和对照组贫血患者相比较,血红蛋白(Hb)及红细胞(RBC)的血象结果得到了明显改善,整体贫血治疗有效率更高,患者及其家属的满意度更高,差异对比显著(P<0.05)。两组患者在治疗期间并未发生严重的不良反应。结论肾性贫血的临床治疗周期长,利用左卡尼汀结合促红细胞生成素方案进行治疗能够显著改善患者的相关症状,提升贫血指标,且安全性较为突出,值得基层医院进一步推广适用。     

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.     

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.     

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.     

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.