埃索美拉唑、克拉霉素与甲硝唑联合治疗消化性溃疡65例

目的研究埃索美拉唑、克拉霉素、甲硝唑三联治疗消化性渍疡的疗效。方法将126例经内镜诊断并检测证实幽门螺杆菌（Hp）阳性的消化性溃疡患者随机分为两组。治疗组65例，给予埃索美拉唑20mg＋克拉霉素500mg＋甲硝唑400mg，每日2次，共7d；对照组61倒，给予奥美拉唑20mg＋克拉霉素500mg＋甲硝唑400mg，每日2次，共7d。疗程结束4周后复查胃镜并检测Hp，观察腹痛缓解率、溃疡愈合率，Hp根除率及用药后的不良反应等。结果治疗组组第1d和第2d腹痛缓解率分别为33．8％和53．8％，高于对照组的16．4％和39．3％，有显著性差异（P〈0．05）。治疗组和对照组溃疡治愈率分别为90．8％和86．9％，治疗组和对照组Hp根除率分别为90．8％和86．9％，差异无显著性（P〉0．05）。两组用药后不良反应少，有较好的安全性。结论埃索美拉唑、克拉霉素、甲硝唑三联疗法治疗Hp阳性的消化性溃疡安全有效，腹痛缓解速度优于奥美拉唑三联疗法。     

含呋喃唑酮的序贯疗法与铋剂四联疗法根除幽门螺杆菌复发的比较

目的观察含呋喃唑酮的改良序贯疗法根除幽门螺杆菌(Hp)复发的效果。方法选取Hp阳性的十二指肠球部溃疡患者240例,按随机数字表法将其分为3组,每组80例。序贯疗法组(A组):先予雷贝拉唑10mg+阿莫西林1000mg,Bid,5d;再予雷贝拉唑10mg+克拉霉素500mg+呋喃唑酮100mg,Bid,5d。铋剂四联7d组(B组):雷贝拉唑10mg+枸椽酸铋钾220mg+阿莫西林1000mg+克拉霉素500mg,Bid,7d。铋剂四联10d组(C组):方案同B组,疗程10d。治疗结束停药至少4周后空腹行14C-尿素呼气试验,Hp根除者12个月后复查14C-尿素呼气试验。结果 229例患者完成治疗,A、B、C组Hp根除率分别为92.2%、78.9%、89.5%,A组较B组差异有统计学意义(P<0.05);根除者12个月后A、B、C组复发率分别为4.5%、15.8%、6.3%,A组较B组差异有统计学意义(P<0.05)。结论含呋喃唑酮的改良序贯疗法对Hp根除率较高,复发率较低,是一种可供选择的一线治疗方案。 更多还原     

雷贝拉唑三联疗法根除幽门螺杆菌疗效观察

目的观察雷贝拉唑与克拉霉素及阿莫西林联合应用根除幽门螺杆菌(Hp)的疗效。方法选择符合条件的76例十二指肠溃疡患者,口服雷贝拉唑10mg、克拉霉素500mg与阿莫西林1g,每天2次,连续5d;第6天开始单独服用雷贝拉唑10mg,每天1次,共9d。治疗4周后,复查胃镜及Hp检查。结果76例中Hp转阴72例,Hp根除率为94.7%,愈合74例,愈合率97.4%。未发生严重副作用。结论雷贝拉唑三联短程疗法能有效根除Hp,治疗十二指肠溃疡疗效佳。     

奥美拉唑三联疗法根除幽门螺杆菌疗效观察

目的探讨奥美拉唑＋克拉霉素＋阿莫西林三联疗法根除幽门螺杆菌（Hp）感染的疗效。方法选择86例Hp阳性消化性溃疡患者，将其分为治疗组和对照组，均给予奥美拉唑加两种抗生素1周三联治疗。治疗组：口服奥关拉唑（20mg／次）＋克拉霉素（500mg／次）＋阿莫西林1000mg／次）；对照组：口服奥美拉唑（20mg／次）＋甲硝唑片（400mg／次）＋阿莫西林（1000mg／次），均为2次／d，疗程为1周，一月后进行Hp检测。结果治疗组Hp根除率90．7％，对照组Hp根除率86．0％，两组根除率无统计学差异（P〉0．05）；治疗组不良反应发生率为14．0％，对照组为16．3％，两组比较无显著性差异（P〉0．05）。结论两组方案均能有效缓解消化性溃疡症状和根除Hp，但奥美拉唑＋克拉霉素＋阿莫西林三联疗法对Hp根除率相对较高，且不良反应相对较轻，值得临床推广应用。     

含雷贝拉唑的三联方案短程疗法根除幽门螺杆菌的疗效观察

【目的】观察含雷贝拉唑的三联方案4日疗法根除幽门螺杆菌(HP)的疗效。【方法】81例HP阳性患者,随机分为治疗组和对照组,治疗组口服雷贝拉唑10mg,阿莫西林1.0g,克拉霉素0.5g,均每日2次,共4d。对照组口服奥美拉唑20mg,阿莫西林1.0g,克拉霉素0.5g,均每日2次,共7天。5~6周后,复查14C-尿素呼气试验,记录副作用,计算用药成本及费用—效果比(C/E)。【结果】治疗组、对照组按治疗意向(ITT)分析的根除率为78.05%、72.50%,按完成随访病例(PP)分析的根除率为88.89%、85.29%(P>0.05),副作用发生率为9.76%、17.50%,C/E为3.46、5.12。【结论】含雷贝拉唑的三联方案4日疗法是一种短程、安全、高效、更为经济的根除HP方案。     

雷贝拉唑新三联疗法治疗HP阳性十二指肠溃疡疗效观察

目的观察雷贝拉唑新三联疗法治疗幽门螺杆菌（Helicobacter pylori,简称Hp）十二指肠溃疡（Du-odenal Ulcer,简称DU）的疗效及安全性。方法按随机化原则分为A组（n=46,雷贝拉唑20 mg＋阿莫西林1.0＋左氧氟沙星0.2,2次/d,口服）和B组（n=46,奥美拉唑20 mg＋阿莫西林1.0＋克拉霉素0.5,2次/d,口服）,疗程1周。疗程结束4周后复查胃镜并检测Hp。结果两组Hp根除率为93.48%~73.91%,溃疡愈合率为95.7%~91.3%。结论雷贝拉唑新三联疗法治疗HP阳性DU,疗效高,安全可靠。     

雷贝拉唑治疗幽门螺杆菌阳性十二指肠溃疡的近期疗效观察——附31例报告

目的:研究雷贝拉唑治疗幽门螺杆菌(Hp)阳性十二指肠溃疡的疗效及安全性。方法:将60例经内镜证实的十二指肠溃疡Hp阳性患者随机分成雷贝拉唑组31例和奥美拉唑组29例,雷贝拉唑组第一周予雷贝拉唑10mg加阿莫西林1g加呋喃唑酮100mg,口服,每日2次;以后每日顿服雷贝拉唑10mg。奥美拉唑组第一周以奥美拉唑20mg加阿莫西林1g加呋喃唑酮100mg,口服,每日2次;以后每日顿服奥美拉唑20mg。两组疗程均为4周。停药后复查内镜观察溃疡愈合情况,记录症状改善情况及不良反应。结果:治疗后,雷贝拉唑组疼痛消失时间与奥美拉唑组比较有统计学差异(P<0.05);治疗后2周末与4周末两组的症状消失率、溃疡愈合率、总有效率比较均无统计学差异(P>0.05);雷贝拉唑组的Hp根除率稍高于奥美拉唑组,但无统计学差异(P>0.05)。雷贝拉唑组的不良反应发生率为3%,奥美拉唑组为7%。结论:雷贝拉唑对Hp阳性十二指肠溃疡有较高的治愈率和症状改善率,疗效与奥美拉唑相当,用药后患者疼痛消失时间短于奥美拉唑,雷贝拉唑抗Hp活性与奥美拉唑相似,不良反应发生率较奥美拉唑少,患者耐受性好。     

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。     

三联疗法治疗幽门螺杆菌感染的疗效观察

目的探讨奥美拉唑、克拉霉素、阿莫西林三联疗法治疗儿童幽门螺杆菌现症感染的疗效。方法经13C尿素呼气试验(13C-UBT)及血清Hp-IgG测定2项阳性的反复腹痛患儿109例随机分组,A组治疗方案为阿莫西林50mg/(kg.d)、枸橼酸铋7～8mg/(kg.d)、甲硝唑15～20mg/(kg.d)疗程4周;B组为克拉霉素15mg/(kg.d)、洛赛克0.8mg/(kg.d)、阿莫西林50mg/(kg.d)疗程2周;停药后4周复查13C-UBT。结果A组Hp根除率74.1%;B组Hp根除率92.7%;两组比较差异有统计学意义(P<0.01)。结论以奥美拉唑、克拉霉素、阿莫西林三联治疗儿童Hp感染,具有疗程短、疗效高、耐药少、依从性好等优点。     

以雷贝拉唑与加替沙星为基础的三联疗法根除幽门螺杆菌的效果观察

目的比较两种三联疗法根治幽门螺杆菌（Hp）的疗效及安全性。方法选择快速尿素酶及14C-尿素呼气试验确诊的80例Hp感染患者,随机分为两组,每组40例。其中雷贝拉唑组采用雷贝拉唑、克拉霉素、加替沙星三联方案;枸橼酸铋钾（CBS）组用枸橼酸铋钾（CBS）、克拉霉素、加替沙星三联方案。疗程结束4周后复查快速尿素酶及14C-尿素呼气试验。结果奥美拉唑组与枸橼酸铋钾组Hp根除率分别为93.33%（40/56）和75.00%（40/45）,两种根除Hp的治疗方案比较差异有统计学意义（χ2=7.5664,P〈0.05）;两组不良反应发生率比较差异无统计学意义（P〉0.05）。结论雷贝拉唑、克拉霉素、加替沙星三联疗法在两种方案中Hp根治率高,值得临床推广。     

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.     

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.