劳拉西泮与丁螺环酮治疗焦虑症临床观察

目的观察劳拉西泮与丁螺环酮治疗焦虑症的临床疗效及安全性。方法将32例广泛性焦虑症患者随机分为劳拉西泮组和丁螺环酮组各16例,治疗6w。于治疗前及治疗第1w、2w、4w、6w末采用汉密顿焦虑量表和副反应量表评定疗效和不良反应。结果两组总有效率均为81．25％,两组不良反应比较差异无显著性,程度均较轻,且随着治疗时间的延长及调整药物剂量后而减轻或逐渐消失。结论劳拉西泮与丁螺环酮治疗焦虑症疗效相当。     

万拉法新与多虑平治疗焦虑症对照研究

目的　比较万拉法新与多虑平治疗焦虑症的疗效与副反应。方法　将 6 8例符合CCMD - 3诊断标准的焦虑症患者 ,随机分为万拉法新治疗 (A)组 34例 ,多虑平治疗 (B)组 34例 ,共治疗 6w。于治疗前及治疗第 2、4、6w末 ,采用HAMA、SAS和TESS评价临床疗效与副反应。结果　万拉法新组治疗 1w后HAMA、SAS评分与治疗前比较有非常显著性差异 (P <0 .0 1;多虑平组治疗 2w后HAMA、SAS评分与治疗前比较有非常显著性差异 (P <0 .0 1;两组间比较除第 1w末有显著性差异 (P <0 .0 5外 ,2、4、6w末差异无显著性 (P >0 .0 5 ) ;万拉法新组副反应明显少于多虑平组 ,两组比较差异有显著性 (P <0 .0 1)。结论　万拉法新治疗焦虑症安全、有效     

丁螺环酮和阿普唑仑治疗老年性焦虑症的对比分析

目的：评价丁螺环酮治疗老年性焦虑症的临床疗效和不良反应。方法：对60例焦虑症患者,分别应用丁螺环酮和阿普唑仑进行对照治疗,疗程4周采用Hamihon焦虑量表（HAMA）和副反应量表（TESS）评定疗效和不良反应。结果：丁螺环酮与阿普唑仑对焦虑症的疗效差异无统计学意义。但丁螺环酮不良反应少。结论：丁螺环酮治疗焦虑症有效,不良反应轻。     

丁螺环酮和阿普唑仑治疗焦虑症的对照研究

目的：评价丁螺环酮治疗焦虑症的临床疗效和不良反应。方法：对60例焦虑症患者，分别应用丁螺环酮和阿普唑仑进行对照治疗，疗程4周采用Hamihon焦虑量表（HAMA）和副反应量表（TESS）评定疗效和不良反应。结果：丁螺环酮与阿普唑仑对焦虑症的疗效差异无显著性。两药不良反应相仿。结论：丁螺环酮治疗焦虑症有效，不良反应轻。     

丁螺环酮与阿普唑仑治疗广泛性焦虑症临床观察

丁螺环酮是20世纪80年代研制的一种非苯二氮落类抗焦虑剂，通过其与5-HT1A受体的选择性结合，降低焦虑症过高的5-HT活性，达到抗焦虑效果。它摒弃了传统苯二氮苓类抗焦虑剂的副作用，因而受到临床的广泛应用。本研究是用丁螺环酮治疗广泛性焦虑症，并选择阿普唑仑作对照研究，以观察丁螺环酮抗焦虑的疗效和安全性。     

盐酸帕罗西汀与阿普唑仑治疗广泛性焦虑症的对照研究

目的比较盐酸帕罗西汀与阿普唑仑治疗广泛性焦虑症的疗效及不良反应。方法将61例广泛性焦虑症随机分为两组，分别服用盐酸帕罗西汀与阿普唑仑，疗程6周。于治疗前及治疗后第2、4、6周末进行汉密尔顿焦虑量表(HAMA)及副反应量表(TESS)评定疗效和不良反应。结果盐酸帕罗西汀与阿普唑仑疗效相当，且帕罗西汀不良反应少而轻，疗效更持久，无药物依赖性。结论盐酸帕罗西汀是治疗广泛性焦虑症的安全、有效药物，患者服药依从性好。     

西肽普兰治疗广泛性焦虑症临床观察

目的观察西肽普兰治疗广泛性焦虑症的临床疗效及安全性。方法将67例广泛性焦虑患者随机分为西肽普兰组35例和丁螺环酮组32例。于治疗前及治疗1w、2w、4w、6w末采用汉密顿焦虑量表评定疗效、副反应量表评定不良反应。结果治疗6w末,西肽普兰组显效率68.6%,总有效率82.7%;丁螺环酮组分别为62.5%,85.5%(χ2=0.27,0.28,P>0.05);汉密顿焦虑量表评分西肽普兰组治疗1w末起较治疗前有极显著性下降(P<0.01),丁螺环酮组治疗2w末起较治疗前有极显著性下降(P<0.01),同期评分西肽普兰组治疗1w末较丁螺环酮组下降显著(P<0.05),两组不良反应均轻微。结论西肽普兰治疗广泛性焦虑症疗效显著,与丁螺环酮相当,但起效更快,安全性高,依从性好。     

丁螺环酮与阿普唑仑治疗儿童广泛性焦虑症对照研究

目的　比较丁螺环酮与阿普唑仑治疗儿童广泛性焦虑症的临床疗效与不良反应。方法　将76例儿童广泛性焦虑症 患者随机分为丁螺环酮治疗组(研究组)与阿普唑仑治疗组(对照组),每组各38例,疗程8w;于治疗前及治疗第8w末采用汉 密尔顿焦虑量表、临床疗效总评量表评定临床疗效,第4、8周末采用副反应量表评定不良反应。疗效判定标准:汉密尔顿焦虑 量表减分率≥75%为痊愈,60～74%为显著进步,30～59%为进步,<30%为无效。结果　研究组有效率92.1%,对照组有效 率89.5%;治疗前后两组汉密尔顿焦虑量表总分、精神焦虑、躯体焦虑、临床疗效总评量表 GI、 SI评定均有极显著性差异(P <0.01);治疗后两组间精神焦虑因子有显著性差异(P<0.05),临床疗效总评量表 SI、临床疗效总评量表 GI比较均有极显 著性差异(P<0.01)。结论　丁螺环酮是治疗儿童广泛性焦虑症安全有效的药物。     

阿普唑仑与丁螺环酮治疗焦虑症合并睡眠障碍的效果研究

目的：分析阿普唑仑与丁螺环酮治疗焦虑症合并睡眠障碍的效果。方法：选取2022年1月至2023年1月平度市人民医院收治的焦虑症合并睡眠障碍患者68例作为研究对象,按照入院的奇偶数顺序分为对照组和观察组,每组34例。对照组口服阿普唑仑,观察组口服丁螺环酮,比较患者症状恢复情况。结果：对照组患者症状改善率是88.24%,观察组患者症状改善率是94.12%,2组患者疗效比较,差异无统计学意义(P>0.05)。用药后对照组、观察组患者的PSQI评分、SAS及SDS均有所下降,组间分数比较,差异均有统计学意义(均P<0.05)。对照组中患者出现不良反应8例,观察组中患者发生不良反应2例,对照组的不良反应发生率更高,差异有统计学意义(P<0.05)。对照组患者的身体状况、心理状态、环境领域及认知能力测评得分均相对较低,与观察组分数比较,差异均有统计学意义(均P<0.05)。结论：阿普唑仑与丁螺环酮均为治疗焦虑症合并睡眠障碍的有效药物,其中丁螺环酮应用后患者的不良反应较少,安全性更高。     

万拉法新与帕罗西汀治疗抑郁症效果对照观察

目的 比较万拉法新与帕罗西汀的抗抑郁效果及不良反应。方法 随机将60例符合CCMD-3情感性精神障碍(抑郁发作)诊断标准的患者分为万拉法新组(30例)和帕罗西汀组(30例)。疗程6周，在0，1，2，4，6周评定汉密尔顿抑郁量表(HAMD，17项)，并评定疗效、记录出现的不良反应。结果 万拉法新从疗后第1周HAMD评分开始显著下降，而帕罗西汀从疗后第2周HAMD评分才显著下降；但治疗6周后，万拉法新组的有效率显著高于帕罗西汀组。两组患者的不良反应相似，差异无显著性(P&;gt;0．05)。结论万拉法新的起效快，疗效好，不良反应少。     

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.