血液流变检测质控物制备方法探讨

目的筛选简便易行的血液流变学检测质控物制备方法.方法静脉采血,与输血1号抗凝液8:1混合;分为2份,1份每100mL全血加入1640液25mL,混匀后无菌分装无添加物灭菌真空管(简称真空管)和枸橼酸钠缓冲液抗凝真空管(CTAD管),1份不加1640液分装上述管,2℃～4℃保存.每日测定上述4种质控液在150s-1、60s-1和10s-1切变率下的全血粘度,并测血浆粘度、红细胞压积(HCT)和红细胞沉降率(ESR),持续4周,统计变异系数(CV%)和第1周与最后1周数据t检验.每周测质控液的全血和血浆血红蛋白,计算溶血百分率.结果抗凝血加入1640液分装真空管连续4周的测定值CV%均＜4%,无显著差异(P＞0.05)),溶血率＜1%.未加1640液管组和分装CrAD管2组2周后开始溶血,3周后溶血率＞1%,CV%均＞6.4%.除血浆粘度和ESR外均有显著差异(P＜0.05).结论输血1号抗凝液抗凝全血加1640液分装真空管的质控物制备方法简便易行,保存时间长,质控结果良好,可进一步研究应用.     

患者数据移动均值法在血液流变学检测室内质控中的应用

血液流变学检测对预防和早期发现、早期治疗心脑血管疾病等方面具有十分重要的意义,其在临床上的应用已日益广泛.目前血液粘度测定的审内质控物为仪器生产厂家提供的专用质控油,仅能对全血粘度的高切粘度(200s-1)和低切粘度(1s-1)进行室内质控,而对全血中切粘度和血浆粘度测定的质控不能进行,从而难免会有测定结果 出现较大误差而不能及时发现的问题,影响临床诊疗.为解决这一问题,我室将移动均值法运用于血液流变仪的室内质控,对SA-6000血液流变分析仪的全血低切粘度(1s-1)、中切粘度(30s-1),高切粘度(200s-1),血浆粘度等4个项目建立了本室的质控参数,通过应用对血液流变学测定结果 的质量起到了可控的作用.     

应用浮动均值法作血液粘度测定室内质控

目前大多数实验室都缺少一种理想的血液粘度测定的室内质控物，使得血液粘度测定质控的开展较为困难，没有室内质控的保障，工作中难免遇到不能及时发现的误差。我室将浮动均值法运用于中勤世帝R80a30孔血液粘度仪的室内质控中，对低切(5S^-1)、中切(30S^-1)、高切(200S^-1)全血粘度、血浆粘度4个项目建立了我室的室内质控参数，报告如下：     

不全窒息对大鼠血液粘度的影响

目的观察不全窒息对大鼠全血粘度与血浆粘度的影响。方法Wistar1~32只,分为对照组（n。20）与不全窒息组（,l=12）,复制不全窒息模型,颈总动脉插管取动脉血,检测各切变率下的全血表观粘度、相对粘度及血浆粘度。结果不全窒息大鼠全血表观粘度（200s-1、100s-1、30s-1、10s-1、3s-1、1s-1）、相对粘度（100s-1）、血浆粘度（200s-1、100s-1）均显著高于对照组（P〈0．01）。结论不全窒息可导致大鼠高粘血症。     

2型糖尿病合并大血管病变患者血流变检测结果分析

目的 观察2型糖尿病及其合并大血管病变患者血流变学指标的变化。方法 应用YDA2Ⅳ血液粘度仪测定全血粘度及血浆粘度（mPa.s）,应用全自动血细胞分析仪测定红细胞压积（L/L）。结果 正常对照组全血粘度、血浆粘度及红细胞压积显著低于2型糖尿病无大血管病变组（P〈0.05）和2型糖尿病合并大血管病变组（P〈0.01）;2型糖尿病合并大血管病变组全血粘度、血浆粘度及红细胞压积显著高于2型糖尿病无大血管病变组（P〈0.05）。结论 长期、反复跟踪检测患者血流变学指标的变化,有助于提前预测2型糖尿病患者合并大血管病变的发生。     

血浆粘度和全血粘度测定的质控方法介绍

血浆和全血粘度的测定，目前国内从粘度计生产到测定方法都无统一规定（或要求），对所测结果亦无衡量标准和质控手段。我们自制一非牛顿流体对全血粘度测定进行质控，并采用血浆二次测定法对血浆粘度测定进行质控，实践证明此法可行．同时将全血比粘度等于全血与水流过同一毛细管的时间之比改为全血同非牛顿流体流过同一毛细管的时间之比，从而大大提高结果的准确性和重复性．     

ZL6000全自动血液流变仪室内质控的探讨

目的探讨非牛顿流体质控物在ZL6000型全自动血液流变仪全血黏度检测质量控制中的应用。方法使用nNF非牛顿流体质控物对血液流变学全血黏度检测的200s-1、50s-1、1s-1点进行了质量控制检测并分析结果。结果 2011年1至6月本室血液流变批内质控1s-1 x：22.04mPa.s,50s-1 x：3.72 mPa.s,200s-1 x：2.81 mPa.s;1s-1 s：1.26mPa.s,50s-1 s：0.07mPa.s,200s-1 s：0.06mPa.s;1s-1CV（%）：4.95,50s-1 CV（%）：1.7,200s-1CV（%）：1.5。1至6月质控检测数据稳定。结论使用该质控物对ZL6000型全自动血液流变仪进行检测,重复性好、精密度高、准确性强,但其不能用于血浆黏度、压积、血沉和纤维蛋白原的质量控制。     

血浆粘度测定质控液的研制与应用

羟乙基淀粉液（ＩＮＪＥＣＴＬＯ ＨＹＤＲＯＸＹＥＴＨＹＬＡＭＹＬＩ）作为血浆粘度测定的质控液，经临床实践证明，其粘度和正常血浆粘度较接近，批间误差较 小，且来源充足，价格低廉，使用方便。用该质控液进行室内与空间质控，取均得了 满意的效果。     

Westgard多规则控制方法结合Levey-Jennings质控图在TEG日常室内质控中的应用

目的通过应用Westgard多规则控制方法结合Levey-Jennings质控图对TEG分析仪进行日常室内质量控制与分析,持续改进检验质量,提高实验室TEG检测的精密度。方法应用Westgard多规则控制方法、Levey-Jennings质控图及同一批号质控品每日对TEG测定参数R值、K值、Angel值、MA值连续12个月进行室内质控监测分析,分别计算均值(■)、标准差(SD)和变异系数(CV%)来观察检验控制效果。结果应用此质量控制方法来及时纠正、分析和改善TEG室内质量控制中的系统错误,R值、K值、Angle值、MA值平均CV%值2019年1～6月为20.33%、13%、3.6%、9.65%;7～12月则分别减低为9%、3%、1.28%、5.35%。结论 Westgard多规则控制方法及Levey-Jennings质控图用于TEG室内质控检测结果可提升TEG临床检测结果的精密度。     

自配3M低泡多酶清洗液与原配清洗液在ZL9000PLUS全自动血液流变测试仪上的应用效果比较

[目的]探讨为节省血液流变学指标的检测成本,改原配清洗液为自配清洗液的应用效果.[方法]采用自配的3M低泡多酶清洗液和原配套清洗液,清洗旋转式血液粘度计切液锥和测试池.比较两种清洗液本底蒸馏水表观粘度值(D=120s-1,T=37℃)及临床标本使用两种清洗液在仪器设定的三种切变率(D=5s-1,30s-1,120s-1)下的全血粘度检测结果.[结果]原配组本底试验蒸馏水粘度值精确度(CV) 为2.16%;自配组CV为 2.07%.两组清洗液本底试验稳定,其差异无显著性(P>0.05);在全血标本测定后测定蒸馏水粘度值,原配清洗液组测试蒸馏水粘度值CV 2.73%;自配清洗液组测试蒸馏水粘度值CV2.37%,两样本均数的t检验无显著性差异(P>0.05);临床标本使用两种清洗液在仪器设定的三种切变率下的全血粘度检测结果差异均无显著性(P>0.01).[结论]自配3M多酶低泡清洗液,可以替代原装配套清洗液,并能保证ZL9000PLUS全自动血液流变测试仪的精度.     

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.