利多卡因静脉滴注治疗偏头痛的疗效观察及护理

目的观察利多卡因静脉滴注治疗偏头痛发作效果.方法采用2%利多卡因100 mg加入5%葡萄糖250 ml静脉滴注1次,比较用药前后头痛缓解情况及TCD(经颅多普勤超声)报告动态变化.结果治疗后,几乎所有患者临床症状缓解,TCD血流速度增快.结论利多卡因静脉滴注治疗偏头痛发作期有较好疗效,且药物价廉,有一定的临床应用价值.     

青年人椎动脉发育不良与眩晕的关系

目的:探讨青年人反复发作短暂性眩晕与椎动脉解剖变异之间的关系。方法:治疗组为反复发作眩晕两次以上的患者,对照组为健康体检者,分别进行磁共振血管造影(MRA)及经颅彩色多普勒(TCD)检查。结果:治疗组MRA异常率72.9%,TCD异常率77.1%;对照组MRA异常率11.5%,TCD异常率19.2%,两组相比差异有显著性。MRA检查与TCD检查相比差异无统计学意义。结论:青年人反复发作眩晕与先天性椎动脉发育不良有关,MRA与TCD检查均可作为诊断的客观依据之一。     

经颅彩色多普勒超声对儿童偏头痛血流动力学的研究

目的 采用经颅多普勒超声(TCD)探讨儿童偏头痛发作期及间歇期颅内动脉的功能状态.方法 对86例发作期偏头痛患者(观察组)和40例健康儿童(对照组)行TCD检查,并进行对照分析.结果 观察组脑动脉血流速度明显高于健康对照组.结论 颅内动脉管壁紧张度增高是偏头痛发作的原因之一.     

偏头痛186例经颅多普勒分析

目的探讨经颅多普勒（TCD）检查对偏头痛发作期和发作间期血流动力学改变的临床意义。方法对偏头痛患者发作期和发作间期经颅多普勒检查结果进行对照研究。结果偏头痛发作期和发作间期脑血流调节复杂,表现各不一致,发作期间多表现为血流速度增快,发作间期血流速度变化不大。结论偏头痛发作期或间歇期经颅多普勒（TCD）均可检测到脑血管的血流动力学特征及反应性同时可推测脑血管的功能状态。经颅多普勒（TCD）检测异常率达83.3%,对偏头痛的诊断及指导临床用药有较大帮助。     

偏头痛与癫痫关系的最新进展

偏头痛和癫痫是两种常见的神经系统发作性疾病,临床学家对二者之间关系的研究至今已有一个世纪了,它们的发作特点、发作时临床表现及其治疗有着诸多的相似之处,可以概括为:(1)都是具有多种发作表现形式的反复发作性疾病;(2)具有相似的发作危险因子,如女性生理周期变化、天气变化、情绪异常、吸烟、饮酒及睡眠障碍等危险因子;(3)都可经过一典型的过程,主要指前驱期、先兆期、发作期和发作后期;(4)均可有自限性,但癫痫持续时间短暂,多在数分钟,而偏头痛发作时间多较长,约数小时至数天;(5)癫痫发作后可以出现偏头痛样的头痛,偏头痛先兆期可出现癫痫样发作的抽搐,二者可以在同一     

偏头痛发作间期经颅多普勒超声观察及其意义

目的观察发作间期偏头痛颅内血流动力学及脑血管反应能力。方法对34例偏头痛发作间期患者进行常规经颅多普勒超声(TCD)检查和Muller呼吸抑制实验,以同期30例健康志愿者的检查结果作为对照。结果(1)患者组双侧大脑中动脉(MCA)平均血流速度呈轻度增高,血管阻力指数明显下降(P<0.05);(2)约1/3患者椎基底动脉(VA、BA)有类似改变;(3)患者组MCA呼吸抑制指数(BHI)明显增高(P<0.05)。结论偏头痛患者发作间期颅内血液动力学处于广泛、轻度的异常状态,脑血管的二氧化碳反应性存在缺陷,对其适当干预有可能预防偏头痛发作。     

欣百达防治伴有焦虑抑郁障碍的慢性偏头痛的疗效

目的:评价双通道再摄取抑制剂(欣百达)防治伴有焦虑抑郁障碍的慢性偏头痛的疗效.方法:采用焦虑自评量表(SAS)及抑郁自评量表(SDS)评价偏头痛患者的焦虑和抑郁程度;将同时伴有焦虑抑郁障碍的慢性偏头痛患者分为西比灵+乐松组(A组)、西比灵+乐松+欣百达组(B组),治疗后比较各组间的差异.结果:所观察偏头痛患者中有焦虑者占72.4%,抑郁者65.6%,焦虑抑郁共存者49.3%.治疗12周后,B组SDS和SAS评分明显降低(P<0.05),A组改善不明显(P>0.05).A组和B组治疗前后自身对照在头痛发作次数、持续时间及对生活的影响方面均有改善(P<0.05);治疗后B组症状改善程度较A组更明显(P<0.05).结论:双通道再摄取抑制剂(欣百达)对慢性偏头痛有明显防治效果,且改善慢性偏头痛伴随的情绪障碍.     

基底动脉型偏头痛26例分析

偏头痛是神经内科常见病 ,其发病率约为 14 .6 % ,基底动脉型偏头痛是偏头痛的一种特殊发作类型 ,严重影响人们的生活、学习和工作。作者自 1998～ 2 0 0 2年共收治 2 6例 ,现将其临床表现、发作诱因及颈颅超声多普勒 (TCD)检查结果分析如下。1　临床资料1.1　一般资料　本组男 9例 ,女 17例 ,年龄 15～ 4 1岁 ,病史 5个月～ 4 a,有家族史者 8例。发作时诱因为情绪紧张、心情不畅11例 ,劳累及睡眠不足 12例 ,发作与月经有关者 3例。前驱症状 :眩晕 18例 ,视觉障碍 12例 ,恶心、呕吐 5例 ,猝倒发作 3例 ,发作持续时间 0 .5～ 15 h,发作间歇…     

西比灵治疗儿童偏头痛频繁发作的脑血流状态研究

目的:探讨西比灵治疗儿童偏头痛频繁发作的脑血流状态变化及临床意义.方法:应用经颅多普勒超声技术(TCD)研究50例儿童偏头痛频繁发作患儿服药前及服药2周后脑血流改变及头痛发作变化情况.结果:(1)30例一侧偏头痛患儿服药前头痛侧与非头痛侧大脑中动脉(MCA)、大脑前动脉(ACA)的收缩期峰值流速(Vs)有显著性差异(P＜0.01),服药2周后双侧MCA、ACA的Vs无明显差异(P＞0.05),非头痛侧服药前与服药2周后Vs无显著性差异(P＞0.05);(2)20例双侧偏头痛患儿服药前与服药2周后的Vs有显著性差异(P＜0.01).结论:西比灵能明显改善偏头痛患儿的脑血流指标,可减少偏头痛的发作次数和头痛程度.     

颈部疼痛与偏头痛关系的观察性研究

目的:探讨颈部疼痛与偏头痛的关系。方法:连续选择因头痛首次就诊于龙岩市第一医院神经内科的病人,先进行颈部疼痛的问卷调查,而后由头痛专家进行诊断。结果:在310例头痛病人中,195例(63%)头痛同时有颈部疼痛发作,根据《国际头痛疾病分类第3版(试行版)》标准,其中诊断偏头痛的高达77%,大部分病人因颈部疼痛进行了不必要的检查和治疗,45%病人进行了颈部放射影像学检查。多元分析显示,低教育水平、无偏头痛先兆、头痛累及头后部是偏头痛合并颈部疼痛发作的独立预测因素。结论:大部分合并颈部疼痛发作的头痛病人为偏头痛病人,误诊将增加病人不必要的经济负担并降低病人的生活质量,在临床工作中应重视此类病人。     

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.