雷贝拉唑三联与四联疗法治疗消化性溃疡伴Hp感染的效果观察

目的 探讨雷贝拉唑三联与四联疗法治疗消化性溃疡伴Hp感染的临床效果。方法 选择我院收治68例消化性溃疡伴Hp感染患者纳入研究,随机为对照组和研究组各34例。两组分别给予雷贝拉唑三联与四联疗法治疗,比较两组患者溃疡愈合情况、临床症状积分与各血清学指标水平变化、Hp根除率及药物不良反应发生率;随访1年后,评价两组患者溃疡及Hp复发率。结果研究组患者溃疡愈合总有效率（94.12%）较对照组（76.47%）更高,两组之间相比（P<0.05）;研究组患者Hp根除率（97.06%）较对照组（79.14%）更高（P<0.05）;药物不良反应发生率方面两组比较无统计学差异（P>0.05）。结论 雷贝拉唑四联疗法更有利于溃疡愈合,缓解临床症状,清除Hp感染,疗效安全显著,复发率低,在消化性溃疡伴Hp感染患者治疗中较三联疗法更具优势。     

雷贝拉唑与奥美拉唑治疗幽门螺杆菌阳性消化性溃疡疗效及抑酸作用比较

目的 比较雷贝拉唑三联疗法与奥美拉唑三联疗法治疗幽门螺杆菌阳性消化性溃疡的疗效和抑酸作用.方法 幽门螺杆菌阳性的消化性溃疡患者56例随机分为雷贝拉唑组30例,奥美拉唑组28例.观察两组活动性溃疡愈合率、幽门螺杆菌根除率、不良反应以及胃内pH值.结果 两组溃疡愈合率及幽门螺杆菌根除率差异无显著性,用药后雷贝拉唑组及奥美拉唑组均出现不良反应1例,安全性相似.雷贝拉唑组胃内pH＞3起效时间较奥美拉唑组短,改善临床症状快,夜间pH＞4时闯较奥美拉唑组长,差异有显著性.结论 两组方案均能有效治疗消化性溃疡和缓解症状,并能有效根除幽门螺杆菌,但雷贝拉唑三联疗法在快速改善临床症状和促进溃疡愈合方面优于奥美拉唑三联疗法.     

三联疗法与红花逍遥胶囊治疗Hp阳性消化性溃疡疗效观察

目的:探讨幽门螺杆菌(Hp)阳性消化性溃疡采用三联疗法联合红花逍遥胶囊治疗的临床疗效。方法:选取我院2016年6月～2018年2月收治的120例Hp阳性消化性溃疡患者,随机分为对照1组、对照2组和观察组,各40例。对照1组采用四联疗法治疗,对照2组采用三联疗法治疗,观察组采用三联疗法联合红花逍遥胶囊治疗,对比三组疗效、症状积分、Hp根除率、复发率及不良反应发生情况。结果:观察组临床总有效率、Hp根除率显著高于对照2组(P0.05),与对照组1组比较无显著性差异(P0.05);治疗后,观察组复发率、症状积分低于对照2组(P0.05),与对照1组比较无显著性差异(P0.05);观察组不良反应发生率低于对照1组(P0.05),与对照2组比较无显著性差异(P0.05)。结论:Hp阳性消化性溃疡患者采用三联疗法联合红花逍遥胶囊治疗临床疗效优于采用三联疗法治疗。     

丽珠胃三联一周疗法幽门螺杆菌阳性消化性溃疡的临床观察

目的：评估以铋剂为基础的三联疗法根治Hp感染的疗效，方法：将67例Hp阳性的活动性胃，十二指肠溃疡患者随机分为治疗组和对照组，治疗组给予一周奥美拉唑及丽珠胃三联，对照组给予奥美拉唑，一周后检查溃疡愈合情况及一月后Hp根除率，结果：消化性溃疡患者治疗一周后复查胃镜，溃疡总愈合率：治疗组94．4％（34／36），对照组为87．1％（27／31），两组溃疡愈合率显显著性差异。停药一个月后Hp根除率：治疗组100％（36／36）,对照组12．9％（4／31），治疗组Hp根除率明显高于对照组，有显著性差异（P＜0．01），结论：丽珠胃三联疗法对消化性溃疡治疗中短期疗效显著，用法简便，不良反应少，安全，治疗效果优于其它标准方案。     

三联疗法治疗消化性溃疡疗效观察

目的：观察奥美拉唑、左氧氟沙星、阿莫西林三联疗法治疗消化性溃疡,根除幽门螺杆菌（Hp）的疗效。方法：选择90例Hp阳性消化性溃疡患者,随即分为观察组与对照组。观察组采用奥美拉唑、左氧氟沙星、阿莫西林三联疗法,治疗1周后继续服用奥美拉唑20mg3周。对照组采用奥美拉唑、甲硝唑、阿莫西林三联疗法,治疗1周后,继续服用奥美拉唑3周。治疗4周后比较两组溃疡愈合情况和Hp根除情况。结果：观察组和对照组溃疡愈合情况无统计学差异（P〉0．05）;Hp根除率,观察组和对照组分别是91．3％、54．5％,差异有统计学意义（P〈0．05）。结论：奥美拉唑、左氧氟沙星、阿莫西林三联疗法是根除幽门螺杆菌（Hp）,治疗消化性溃疡的理想方案。     

含雷贝拉唑与含兰索拉唑三联疗法治疗幽门螺杆菌阳性消化性溃疡的临床对照分析

目的比较含雷贝拉唑与含兰索拉唑三联疗法治疗幽门螺忏菌（Hp）阳性消化性溃疡的临床疗效。方法纳入本院门诊收治的Hp阳性消化性溃疡患行86倒,随机分为2组。治疗组44例,给予雷贝拉唑＋阿英西林＋克拉霉素,对照组42例,给予兰索拉唑＋阿英西林。克拉霉素。疗程结束停药4周后复查胃镜、快速尿素酶试验及14C呼气试验,观察溃疡愈合及Hp根除情况。结果治疗组溃疡愈合的治愈率、Hp根除半均高于对照组,而Hp感染复发率显著降低,且不良反应发生率低。结论雷贝拉唑、阿莫西林、克拉霉素的三联疗法治疗Hp阳性的消化性溃疡患者,可显菩提高溃疡愈合的治愈率、Hp根除率,降低Hp感染的复发牢,且安全性好,是较为理想的治疗方案,值得大力推广。     

溃疡汤联合三联疗法治疗幽门螺杆菌感染消化性溃疡的疗效

目的探讨溃疡汤联合三联疗法治疗幽门螺杆菌(Hp)感染消化性溃疡的临床疗效。方法将60例消化性溃疡患者按治疗方法的不同分为2组:观察组和对照组,每组30例。2组均适当休息,进清淡流质饮食或低脂、少渣半流质饮食或软食,忌烟、酒及辛辣食物,同时采用奥美拉唑、甲硝唑和克拉霉素治疗。2周后,改为奥美拉唑治疗。在此基础上,观察组采用溃疡汤治疗。观察2组的临床疗效及不良反应情况。结果观察组总有效率、Hp根除率均明显高于对照组(96.67%、96.67%比76.67%、80.00%,均P<0.05)。结论溃疡汤联合三联疗法治疗Hp感染消化性溃疡有利于提高临床疗效及Hp根除率,显著地改善患者的临床症状,促进溃疡愈合,且无明显的不良反应。     

奥美拉唑联合丽珠胃三联治疗消化性溃疡疗效观察

目的研究奥美拉唑联合丽珠胃三联治疗消化性溃疡的近期和远期疗效。方法将 191例消化性溃疡患者随机分为 3组 ,A组予奥美拉唑及丽珠胃三联治疗 ;B组予奥美拉唑、阿莫西林及甲硝唑治疗 ;C组予雷尼替丁、呋喃唑酮及甲硝唑治疗。疗程均为 2周 ,观察溃疡愈合及幽门螺杆菌根除情况。并于 6个月和 12个月后随访A、B两组患者 ,观察溃疡复发率。结果A、B两组的溃疡愈合率及Hp根除率均显著大于C组 (P <0 .0 1) ,但两组间无明显差异 (P >0 .0 5 )。A、B两组溃疡治愈后 6个月时的复发率无明显差异 (P >0 .0 5 ) ,但 12个月时的复发率A组低于B组 (P <0 .0 5 )。结论奥美拉唑联合丽珠胃三联治疗消化性溃疡的近期及远期疗效均比较满意 ,值得推广应用。     

雷贝拉唑治疗幽门螺杆菌阳性消化性溃疡的临床研究

选取我院2012年1月~2013年12月收治的Hp阳性消化性溃疡患者126例,随机分为观察组及对照组各63例。治疗组给予雷贝拉唑三联疗法,对照组给予奥美拉唑三联疗法。比较两组患者用药后临床症状改善情况、Hp是否根除及临床疗效。结果两组Hp根除率比较差异无统计学意义(P>0.05)。观察组溃疡愈合率明显高于对照组(P<0.05),两组总有效率比较差异无统计学意义(P>0.05)。雷贝拉唑与奥美拉唑均能有效治疗Hp阳性消化性溃疡。但雷贝拉唑起效更快,在促进溃疡愈合及快速改善临床症状方面优于奥美拉唑。     

铝碳酸镁、艾司奥美拉唑、幽门螺杆菌根治方案联合治疗对胃溃疡黏膜中VEGF、COX-2、EGF表达水平的影响

目的探讨铝碳酸镁、艾司奥美拉唑、幽门螺杆菌(Hp)根治方案联合治疗对胃溃疡黏膜中血管内皮生长因子(VEGF)、环氧合酶-2(COX-2)、表皮生长因子(EGF)表达水平的影响。方法选取我院2014年3月至2017年3月82例胃溃疡患者,按随机数表法分为观察组与对照组各41例。对照组予艾司奥美拉唑+Hp根治方案治疗,观察组在对照组基础上加用铝碳酸镁。比较溃疡愈合情况、Hp根除率、胃肠激素、炎症指标、胃酸分泌、黏膜细胞因子、不良反应以及胃溃疡复发率。结果观察组溃疡愈合总有效率、胃溃疡复发率与对照组比较差异有统计学意义(P0.05)。观察组治疗4周后胃内p H值、VEGF、COX-2、EGF水平显著高于对照组(P0.05)。结论铝碳酸镁+艾司奥美拉唑+Hp根治方案治疗胃溃疡,可以根除Hp,抑制胃酸分泌,增强VEGF、COX-2、EGF表达,加速溃疡黏膜愈合。     

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.