探讨肺心病急性加重期与慢性重度心力衰竭脑钠素的水平及意义

目的探讨慢性肺源性心脏病患者急性加重期与慢性重度心力衰竭患者血浆脑钠素(BNP)水平及临床意义。方法用免疫荧光法定量测定血浆BNP,慢性重度心力衰竭患者(心衰组)41例,慢性阻塞性肺病(COPD)合并肺心病急性加重期患者(肺心病组)31例,健康对照者(对照组)31例。并在肺心病组监测血气分析。结果心衰组血浆BNP(889.41±606.38)ng/L,肺心病组(374.00±377.95)ng/L,分别与对照组(12.08±9.24)ng/L比较差异有显著性(P<0.05),心衰组与肺心病组比较差异亦有显著性(P<0.05);肺心病组血浆BNP与PO2、PH、PCO2之间均无相关性(P>0.05)。结论血浆BNP升高参与肺心病的病理生理过程,并可用于鉴别心源性和肺源性呼吸困难。     

老年高血压及高血压心脏病血浆神经肽Y和神经降压素的变化

目的 :探讨老年高血压及高血压心脏损害血浆神经肽Y(neuropeptideY ,NPY)和神经降压素 (neurotensin ,NT)的变化及其临床意义。方法 :采用同位素放射免疫分析法 ,对 5 0例老年高血压患者和 30例正常健康老年人进行血浆NPY和NT含量的检测。结果 :老年高血压患者血浆NPY含量 [( 1 5 0 .7± 1 5 .5 )ng/L]明显高于正常对照组 [( 1 0 1 .9±37.9)ng/L],血浆NT含量 [( 4 8.5± 1 9.1 )ng/L]则明显低于对照组 [( 88.4± 2 7.8)ng/L];高血压心脏病患者血浆NPY含量 [( 1 6 5 .7± 2 0 .1 )ng/L]明显高于无心脏损害患者 [( 1 2 0 .7± 2 3.4)ng/L],而NT含量 [( 4 0 .5± 1 6 .4)ng/L]则明显低于无心脏损害患者 [( 5 9.4± 1 7.3)ng/L]。 结论 :老年高血压及心脏损害患者存在血浆NPY水平异常增加和NT含量的降低 ,二者可能协同促进了老年高血压及高血压心脏病的形成。检测血浆NPY和NT的水平在一定程度上可作为评估老年高血压及其靶器官心脏损害受损程度的指标。     

肺心病患者血浆内源性一氧化碳水平及其临床意义

目的　探讨慢性肺源性心脏病患者血浆内源性一氧化碳 (CO)的水平及其临床意义。方法　肺心病组 30例 ,正常对照组 30例。血浆CO测定采用分光光度法 ,同时测定血浆内皮素 1(ET 1)水平、动脉血氧分压 (PaO2 )及反映肺动脉压的超声指标—右室射血前期时间 (RVPEP)与肺动脉血流加速时间 (AT)的比值。结果　肺心病组急性加重期血浆CO水平 (1.78± 0 .79)ng/L和缓解期血浆CO水平 (1.2 1± 0 .38)ng/L ,均高于正常对照组 (0 .87± 0 .2 3)ng/L(均P <0 .0 0 1) ,且血浆CO水平与ET I、RVPEP/AT呈正相关 ,与PaO2 呈负相关。结论　内源性CO参与了肺心病的病理生理过程 ,肺心病患者血浆CO水平升高对于延缓肺动脉高压的发展具有一定的保护意义     

丹参粉对肺心病患者血浆神经肽Y和神经降压素的影响

目的:观察丹参粉对肺心病急性加重期患者血浆神经肽Y、神经降压肽(neurotensin,NT)的影响,为临床肺心病急性加重期的治疗及实施康复干预提供理论依据。方法:选择住院的肺心病急性加重期患者60例,分为2组。丹参粉组30例、常规治疗组30例、对照组(健康体检正常者30例)。将应用丹参粉前、后患者分别与常规治疗前、后患者血浆血浆神经肽Y,NT含量与对照组作比较。结果:治疗前常规组及丹参粉组血浆神经肽Y都明显高于对照组〖分别为(233±24),(224±31),(146±33)ng/L,t=10.33,9.43,P<0.01〗,NT含量稍低于对照组,但差异无显著性意义(P>0.05)。治疗后常规组和丹参粉组血浆神经肽Y含量都未恢复正常犤(190±16),(171±18),(146±33)ng/L,t=6.56,3.64,P<0.01〗,丹参粉组NT含量显著高于常规组犤(98±31),(82±27)ng/L,t=2.13,P<0.05〗。结论:丹参粉有助于肺心病急性加重期血浆血浆神经肽Y下降,促进NT产生,减轻肺动脉高压。     

急性冠状动脉综合征患者血浆神经肽Y的变化及意义

目的 :研究急性冠状动脉综合征发病时神经肽 Y( NPY)的作用及临床意义。方法 :用放射免疫分析法测定冠心病患者胸痛发作时及治疗缓解 3天后血浆中 NPY浓度。结果 :稳定性心绞痛组胸痛发作期及治疗缓解 3天后血浆NPY浓度与正常对照组无显著差异。不稳定性心绞痛组和急性心肌梗死组入院胸痛发作时血浆 NPY浓度明显高于对照组 [( 2 69.5± 10 0 .7) ng/ L ,( 2 70 .8± 99.7) ng/ L对 ( 15 5 .6± 3 7.8) ng/ L ,P<0 .0 1) ],经治疗缓解后均下降到与对照组相比无差异 [( 172 .4± 10 0 .9) ng/ L,( 176.8± 60 .5 ) ng/ L 对 ( 15 5 .6± 3 7.8) ng/ L,P>0 .0 5 ) ]。急性心梗组入院时泵功能 ～ 级者 ( n=5 )血浆 NPY浓度明显高于 ～ 级者 ( n=5 ) [( 3 3 3 .7± 79.4 ng/ L 对 ( 167.9± 3 6.9) ng/ L,P<0 .0 5 ) ]。结论 :急性冠状动脉综合征患者发病时 NPY增高可能是由于严重心肌缺血、剧烈胸痛引起交感神经过度兴奋及血小板释放 NPY增多所致 ,而 NPY增加进一步引起冠脉痉挛 ,加重心肌缺血     

慢性肺原性心脏病患者血浆心钠素、C型利尿利钠因子的测定及临床意义

目的观察慢性肺原性心脏病患者血浆心钠素 (ANP)和 C型利尿利钠因子 (CNP)的变化及与 Pa O2 的关系。方法采用放射免疫分析法 ,检测 30例肺心病急性发作期及缓解期患者血浆 ANP和 CNP的水平 ,同时行动脉血气分析 ,并和 2 0例健康体检者对照。结果肺心病患者急性加重期和缓解期血浆 ANP水平 (6 0 9.2 1± 16 6 .6 5 )ng/L,(2 87.0 6± 10 9.0 6 ) ng/L、CNP水平 (73.38± 33.2 9) ng/L,(4 3.18± 9.6 8) ng/L 明显高于对照组 (5 0 .77±2 6 .89) ng/L,(16 .89± 9.16 ) ng/L(P值均 <0 .0 0 1) ;急性加重期血浆 ANP、CNP水平显著高于缓解期 (P值均 <0 .0 0 1) ;肺心病组动脉血氧分压 (Pa O2 )急性加重期 (5 0 .82± 15 .2 3) m m Hg明显低于缓解期 (77.5 7± 10 .0 8) m m Hg(P<0 .0 0 1) ;肺心病组急性加重期和缓解期血浆 ANP、CNP水平与 Pa O2 均呈显著负相关 (r=- 0 .6 0 ,P<0 .0 0 1;r=- 0 .5 7,P<0 .0 1;r=- 0 .48,P<0 .0 1,r=- 0 .79,P<0 .0 0 1) ;肺心病组急性加重期和缓解期血浆 ANP与 CNP水平均呈显著正相关 (r=0 .5 7,P<0 .0 1;r=0 .49,P<0 .0 1)。结论 ANP和 CNP间彼此相互作用 ,在肺心病发生和发展中起重要的作用。     

丹参粉对肺心病患者血浆神经肽Y和神经降压素的影响

目的：观察丹参粉对肺心病急性加重期患者血浆神经肽Y、神经降压肽(neurotensin，NT)的影响，为临床肺心病急性加重期的治疗及实施康复干预提供理论依据。方法：选择住院的肺心病急性加重期患者60例，分为2组。丹参粉组30例、常规治疗组30例、对照组(健康体检正常者30例)。将应用丹参粉前、后患者分别与常规治疗前、后患者血浆血浆神经肽Y，NT含量与对照组作比较。结果：治疗前常规组及丹参粉组血浆神经肽Y都明显高于对照组[分别为(233&;#177;24)，(224&;#177;31)，(146&;#177;33)ng／L，t=10．33，9．43，P&;lt;0．01]，NT含量稍低于对照组，但差异无显著性意义(P&;gt;0．05)。治疗后常规组和丹参粉组血浆神经肽Y含量都未恢复正常[(190&;#177;16)，(171&;#177;18)，(146&;#177;33)ng／L，t=6．56，3．64，P&;lt;0.01]，丹参粉组NT含量显著高于常规组[(98&;#177;31)，(82&;#177;27)ng／L，t=2．13，P&;lt;0．05]。结论：丹参粉有助于肺心病急性加重期血浆血浆神经肽Y下降，促进NT产生，减轻肺动脉高压。     

乌拉地尔对围术期高血压患者血浆心血管活性肽的影响

目的:探讨高血压患者血浆神经肽Y（NPY）,内皮素（ET）,神经降压素（NT）,降钙素基因相关肽（CGRP）与平均动脉压（MAP）的关系;观察乌拉地尔（URA）对诸指标的影响;探讨心血管活性肽变化在URA降压机制中的作用。方法:麻醉前高血压患者40例。用放射免疫分析方法测定血浆NPY,ET,NT,CGRP水平并与40例健康者作对照;采用自身对照方法观察高血压患者URA（0.4～0.6mg·kg-1）静脉注射后4种心血管活性肽水平及血压变化;应用SAS软件行统计学分析。结果:高血压患者NPY（228.73±87.27ng/L）,ET（60.81±14.47ng/L）显著高于正常对照组（分别是91.33±41.74ng/L和36.99±12.52mg/L,均P<0.001）;NT（42.18±14.27ng/L）显著低于正常对照组（85.97±42.97ng/L,P<0.001）。多元逐步回归分析发现NPY对高血压患者MAP作用最为显著（Y=15.549+0.0099X3）。URA治疗后高血压患者血浆NPY（104.07±67.79ng/L）,ET（47.33±16.48ng/L）水平显著下降（均P<0.001）;血浆NT（74.51±29.45ng/L）,CGRP（3.15±10.21ng/L,水平显著升高（均P<0.001）。结论:NPY可能在高血压发生、发展中起重要作用。URA的降压机制中可能与血浆NPY、ET水平下降,CGRP、NT水平升高有关。     

急重期慢性肺心病患者血浆肾上腺髓质素浓度测定及基础研究

目的探讨慢性肺源性心脏病(chronicpulmonaryheartdisease,CPHD)患者血浆肾上腺髓质素(adrenomedullin,AM)浓度的变化及机制.方法用放免法测定了28例急性加重期的CPHD患者血浆AM浓度及大鼠主动脉和肺动脉在不同条件下孵育液和孵育组织中AM含量.结果CPHD患者血浆AM浓度(30.4±6.8ng/L)显著高于正常对照组(10.4±2.4ng/L,P＜0.01),并且AM浓度同PaO2(r=-0.65,P＜0.01)和pH值(r=-0.39,P＜0.05)呈显著相关关系.在脂多糖、缺氧和酸中毒条件下主动脉和肺动脉孵育液中AM含量也几乎均显著高于对照组.结论细菌感染、缺氧和酸中毒可能参与了CPHD急性加重期血浆AM的升高机制.     

肺心病患者血浆脑钠素的水平及意义

目的　探讨慢性肺源性心脏病患者血浆脑钠素 (BNP)的水平及其临床意义。方法　肺心病组 30例 ,分为急性加重期和缓解期 ;正常对照组 30例。血浆BNP测定采用放射免疫分析法 ,同时测定血浆内皮素 1(ET 1)水平、动脉血氧分压 (PaO2 )及反映肺动脉压的超声指标—右室射血前期时间 (RVPEP)与肺动脉血流加速时间 (AT)的比值。结果　肺心病组急性加重期血浆BNP和缓解期血浆BNP水平均高于正常对照组 (均P <0 .0 0 1) ;且血浆BNP水平与ET I、RVPEP/AT呈正相关 ;与PaO2 呈负相关。结论　血浆BNP参与了肺心病的病理生理过程 ,肺心病患者血浆BNP水平升高可能对肺心病的发生发展具有一定的保护作用     

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.     

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.