孟鲁司特联合布地奈德治疗儿童支气管哮喘效果观察

目的:观察孟鲁司特联合布地奈德雾化吸入治疗儿童支气管哮喘的效果.方法:将60例支气管哮喘患儿随机分为治疗组和对照组,每组各30例.两组均予布地奈德200 μg加入0.9%氯化钠中雾化吸入,治疗组在此基础上每晚睡前口服孟鲁司特4 mg.两组疗程均为12周.结果:治疗组治疗总有效率为96.7%(29/30),对照组为86.7%(26/30),两组比较差异有统计学意义(P<0.01);疗程中哮喘平均发作次数、每次哮喘平均发作的天数,治疗组分别为(3.23±0.41)次、(3.07±0.23)天,对照组分别为(5.23±0.64)次、(4.90±0.12)天,两组比较差异有统计学意义(P<0.01);治疗后两组肺功能均明显改善,与治疗前比较差异有统计学意义(P<0.01),但组阃比较差异无统计学意义(P>0.05).结论:孟鲁司特口服联合布地奈德雾化吸入可明显提高儿童支气管哮喘临床治愈率,减少哮喘发作的时间和次数.并可改善惠儿肺功能,疗效优于单独应用布地奈德.     

变应性鼻炎儿童的行为调查与分析

目的探讨变应性鼻炎儿童与正常儿童在行为方面的差异。方法对6～12岁的60例变应性鼻炎和30例正常儿童(对照组)进行行为调查比较,行为调查内容包括睡眠、性格、记忆。结果变应性鼻炎儿童行为异常率为60%,明显高于对照组的20%,两者差异有高度显著性(P<0.05)。结论变应性鼻炎是一种慢性疾病的同时,经常还伴有行为方面的异常。     

支气管哮喘与变应性鼻炎和儿童行为异常关系的研究

目的:探究支气管哮喘与变应性鼻炎和儿童行为异常的关系。方法:收集2017年2月～2018年8月在儿科和耳鼻喉科门诊就诊的支气管哮喘患儿80例、变应性鼻炎80例及支气管哮喘合并变应性鼻炎80例,分别为A组、B组、C组三组,另选6～12岁健康儿童80例作为对照组(即D组)。对上述四组进行Achenbach、Conners问卷调查及行为调查进行比较。结果:与D组相比,A组、B组、C组Achenbach及Conners评分较高,差异具有统计学意义(P<0.05);干预后,A组、B组、C组Achenbach及Conners评分均教干预前显著降低,差异具有统计学意义(P<0.05)。与D组相比,A组、B组、C组睡眠影响率、性格影响率、记忆影响率以及总体影响率较高,差异具有统计学意义(P<0.05);与A组、B组相比,C组睡眠影响率、性格影响率、记忆影响率及总体影响率较高,差异具有统计学意义(P<0.05)。结论:支气管哮喘与变应性鼻炎疾病发生的同时还伴有儿童行为方面异常,其中支气管哮喘合并变应性鼻炎患儿的行为量表评分、多动指数明显高于正常儿童以及单纯患其中一种疾病者,积极干预以及规范化治疗能够有助于改善哮喘合并变应性鼻炎儿童的多动以及冲动等行为。     

支气管哮喘儿童心理行为调查

目的:探讨哮喘患儿与正常儿童在行为方面的差异。方法:对7～14岁的80例哮喘儿童和80例正常儿童用美国Achenbach儿童行为量表进行问卷调查。结果:哮喘儿童心理行为问题检出率明显高于对照组,差异有显著性(P<0.05),哮喘儿童往往存在焦虑、抑郁、自卑感、过分依赖等。结论:支气管哮喘儿童较普通儿童有更多心理行为问题,治疗支气管哮喘时应加强心理干预。     

痰液降钙素原在儿童支气管哮喘中的应用

目的探讨痰液降钙素原(PCT)与儿童支气管哮喘细菌感染的相关性研究,为临床抗生素的合理应用提供依据。方法将125例支气管哮喘患儿分为细菌感染组和非细菌感染组,分别测定患儿痰液PCT值、血清PCT及C反应蛋白(CRP)水平,并与50例对照组(支气管哮喘缓解期患儿)进行比较。结果细菌感染组患儿痰液PCT浓度为(3.41±1.45)μg/L,明显高于非细菌感染组[(0.81±0.36)μg/L]和对照组[(0.34±0.06)μg/L],差异有统计学意义(P<0.05)。痰液PCT阳性检出率为83%,均略高于血清PCT(74%)及CRP(72%),但差异均无统计学意义(P>0.05)。结论痰液PCT检测可作为儿童支气管哮喘急性发作时是否存在细菌感染的辅助诊断,检测快速、方便,对指导临床合理使用抗生素具有重要意义。     

移情法在儿童支气管哮喘学龄期治疗中的应用

目的 :观察移情法在儿童支气管哮喘治疗中的作用。方法 :68例支气管哮喘患儿随机分为观察组 3 6例和对照组 3 2例。观察组应用移情心理疗法并合用抗感染、消炎、平喘、对症等常规治疗 ;对照组除未用移情心理疗法外 ,其他治疗与观察组相同。结果 :观察组咳嗽、喘息、肺部哮鸣音消失时间均较对照组缩短 ,差异有显著性 (P<0 0 5 ) ;观察组与对照组临床治疗有效率分别为 83 3 %、5 6 2 % ,两者比较差异有显著性 (P <0 0 5 )。结论 :在儿童支气管哮喘治疗过程中 ,应用移情法可改善临床症状和体征 ,促进病情好转与恢复 ,可提高临床疗效     

哮喘儿童气质类型及行为问题的研究

目的研究3~7岁学龄前哮喘儿童的气质类型及行为问题,提供该类人群的基础数据,并且通过评估该年龄段哮喘儿童气质类型与行为问题之间的关系,从而更全面的了解哮喘儿童,为减轻儿童哮喘发作及减少行为问题发生提供干预和治疗的依据。方法选取2016年1月至2016年12月首都医科大学附属北京友谊医院儿科哮喘门诊就诊的哮喘儿童作为哮喘组(78例),同时按照随机数表法选取在北京市西城区某幼儿园就读的健康儿童作为对照组(75例)。同时根据儿童是否存在行为问题,哮喘组分为行为问题组(24例)和无行为问题组(54例);对照组分为行为问题组(12例)和无行为问题组(63例)。用“中国儿童气质量表”和“Conners儿童行为问卷父母用量表”分别对两组儿童进行问卷调查,评估出两组儿童气质分布以及出现行为问题的情况,并对两组儿童气质类型及行为问题进行相应比较分析。结果①哮喘组气质维度中活动水平、适应性、注意分散度得分高于对照组,差异具有显著性(P<0.05);哮喘组气质分布中平易型所占的比例低于对照组,麻烦型所占的比例高于对照组,差异有显著性(P<0.05);②哮喘组儿童行为问题的检出率高于对照组,差异具有显著性(P=0.031);哮喘组儿童品行问题、身心问题、多动指数方面的得分高于对照组,差异具有显著性(P<0.05);③哮喘组儿童中,行为问题组平易型所占的比例低于无行为问题组(P=0.028),而行为问题组中间偏烦型所占的比例高于无行为问题组(P=0.002)。结论哮喘儿童有其特定的气质及行为特征方面的表现,需要社会去了解并关注他们,并通过采取及时有效的心理、家庭、社会等方面的干预措施,协调儿童气质发展,减少行为问题的发生,从而全面提高哮喘儿童的健康水平。     

孟鲁司特及特布他林联用对支气管哮喘患儿的临床疗效分析

目的探究孟鲁司特联合特布他林治疗支气管哮喘患儿的临床疗效。方法选取2016年1月～2018年12月收治的支气管哮喘患儿82例,按随机数字表法将其分为观察组和对照组各41例。对照组行特布他林治疗,观察组在对照组的基础上行孟鲁司特治疗。观察两组患者的临床疗效、症状评分及其不良反应发生情况。结果观察组治疗总有效率为97.56%,显著高于对照组的82.93%,差异有统计学意义(P<0.05);干预后,观察组日间症状评分为1.28±0.31分、夜间症状评分为1.10±0.19分,均显著低于对照组的2.41±0.27分、1.27±0.44分,差异有统计学意义(P<0.05);观察组的不良反应率为7.32%,显著低于对照组的26.83%,差异有统计学意义(P<0.05)。结论孟鲁司特联合特布他林治疗儿童支气管哮喘可显著改善患儿的症状评分,具有较好的临床疗效,降低不良反应率。     

妥洛特罗贴剂治疗轻中度婴幼儿支气管哮喘临床观察

目的 观察妥洛特罗贴剂对轻中度婴幼儿支气管哮喘的治疗效果及其安全性.方法 将62例支气管哮喘患儿分为妥洛特罗贴剂组(32例)和对照组(30例),在丙酸氟替卡松气雾剂治疗基础上分别加用妥洛特罗贴刑和盐酸丙卡特罗片剂治疗2周.记录患儿的哮喘症状评分、喘鸣发作次数和短效β2受体激动剂的用量,并记录不良反应发生情况.结果 贴剂组治疗后哮喘日间症状评分[治疗1周后为(2.2±0.9)分/周、治疗2周后为(0.9 ±0.5)分/周]明显低于对照组[治疗1周后为(3.4 ±1.1)分/周、治疗2周后为(1.3±0.6)分/周],差异均有统计学意义(P均<0.05);贴剂组治疗1周后哮喘夜间症状评分[(1.8±0.7)分/周],明显低于对照组[(3.3 ±0.9)分/周],差异有统计学意义(P<0.05);贴荆组治疗期间喘鸣发作次数为(2.3±1.2)次,对照组为(3.6±1.3)次,2组比较差异有统计学意义(t=4.09,P<0.05);贴剂组的β2受体激动剂用量为(2.6 ±0.9)喷/周,对照组为(3.7 ±0.8)喷/周,差异有统计学意义(t=5.07,P<0.05);贴剂组不良反应发生率(3.12%)明显低于对照组(23.33%),2组比较差异有统计学意义(X2=3.89,P<0.05).结论 妥洛特罗贴剂是一种安全、有效的轻中度婴幼儿支气管哮喘治疗药物.     

无创正压通气治疗重症支气管哮喘的应用与有效性研究

探讨无创正压通气治疗重症支气管哮喘的应用效果及有效性。选择2014年10月~2016年8月期间本院收治的94例重症支气管哮喘患者作为研究对象,随机分为对照组和观察组,各47例。对照组患者常规氧疗、祛痰平喘、抗生素、纠正电解质紊乱等治疗,观察组在对照组基础上增加无创正压通气呼吸机治疗,比较两组治疗效果,并观察治疗后两组患者血气分析指标水平。观察组重症支气管哮喘治疗总有效率为93.62%,显著高于对照组(80.85%),组间差异P<0.05。观察组氧分压[(92.67±3.25)mm Hg]、血氧饱和度[(96.35±3.69)%]均显著高于对照组[(84.12±4.21)mm Hg、(86.26±5.24)%],观察组二氧化碳分压[(35.14±4.58)mm Hg]显著低于对照组[(62.43±8.14)mm Hg],差异均有统计学意义(P<0.05)。重症支气管哮喘临床治疗中应用无创正压通气治疗重临床疗效较好,值得推广借鉴。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.     

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.