经电子支气管镜电刀切除主气道肿瘤34例分析

目的：观察电子支气管镜介导下高频电刀治疗良性气道肿瘤的临床疗效及其安全性,为临床治疗此类患者提供可靠的理论证据。方法：对34例支气管恶性肿瘤所致的气道阻塞患者,进行支气管镜下高频电刀烧灼切割术,对治疗结果进行统计,观察气道打通程度、肺通气功能、气促指数及并发症的发生率。结果：34例恶性肿瘤,其中16例鳞状细胞癌,8例小细胞癌,6例腺细胞癌,4例大细胞癌。电灼后完全打通气道,彻底治愈。电灼过程中均未出现大出血、呼吸道穿孔、纵隔气肿等严重并发症。结论：支气管镜下高频电刀治疗恶性肿瘤引起的气道阻塞疗效显著,避免了开胸手术。     

经纤维支气管镜高频电刀治疗大气道狭窄的临床研究

各种原因引起的大气道狭窄是临床常见急症,也是长期困扰呼吸科及胸外科医生的一大临床难题.患者表现为明显的呼吸困难、咳嗽、咳痰不畅,严重时可窒息死亡,因此需要临床医生采取及时有效的措施解除气道狭窄,改善患者的临床症状,提高生活质量.近年来,随着介入肺脏病学的迅速发展,经支气管镜气道内支架、激光、微波、冷冻、高频电刀等介入技术先后应用于临床[1-3].本院于2001年10月～2009年11月期间对43例大气道狭窄患者开展经电子支气管镜高频电刀治疗,取得了满意疗效,现报道如下.     

高频电刀联合化疗治疗晚期肺癌的观察与护理

目的:探讨纤维支气管镜高频电刀联合化疗治疗晚期气管、支气管肺癌的围手术期护理。方法:将51例晚期气管、支气管肺癌患者随机分为治疗组21例、对照组30例,治疗组给予纤维支气管镜高频电刀烧灼联合化疗,对照组给予单纯化疗。结果:治疗组有效率90.4%,对照组有效率23.3%,两组比较有统计学差异(P<0.01)。结论:纤维支气管镜高频电刀联合化疗治疗晚期肺癌疗效显著,患者痛苦小,值得临床推广应用。     

经电子支气管镜介导高频电治疗主气道肿瘤

目的 探讨经支气管镜介导高频电切除主气道肿瘤的治疗方法.方法 对12例主气道内肿瘤阻塞患者行支气管镜介导高频电切除,并分析疗效.结果 12例患者共治疗19次,6例患者治疗1次;5例治疗2次,1例治疗3次.治疗后患者症状明显减轻.有效率91.7%.结论 支气管镜介导高频电治疗主气道肿瘤能迅速缓解气道阻塞,操作方便,并发症少.     

电子支气管镜介导下高频电刀治疗良性气道肿瘤

目的 观察电子支气管镜介导下高频电刀治疗良性气道肿瘤的临床疗效及其安全性,为临床治疗此类患者提供可靠的理论证据.方法 对8例支气管良性肿瘤所致的气道阻塞患者,进行支气管镜下高频电刀烧灼切割术.对治疗结果进行统计,观察气道打通程度、肺通气功能、气促指数及并发症的发生率.结果 8例良性肿瘤,其中2例气管软骨瘤,2例结核肉芽肿,4例炎性肉芽肿,电灼后完全打通气道,彻底治愈.8例患者16次电灼过程中均未出现大出血、呼吸道穿孔、纵隔气肿等严重并发症.结论 支气管镜下高频电刀治疗良性肿瘤引起的气道阻塞疗效显著,避免了开胸手术,可达到临床根治.     

高频电切电凝联合放化疗在治疗气道恶性肿瘤中的临床应用

目的 观察经电子支气管镜下高频电切电凝术联合放化疗在治疗气管及主支气管恶性肿瘤中的临床作用.方法 对37例气管及主支气管恶性肿瘤引起呼吸困难、咳嗽等症状的患者,经电子支气管镜下行高频电切割及电凝治疗联合放化疗.结果 治疗组37例气管及支气管肿瘤患者临床症状均立即明显改善.气促分级改善1～2级.阿氏评分平均上升10～30分.无明显副反应.结论 经电子支气管镜介导下高频电切割及电凝技术联合放化疗既可以将患者气道内肿瘤尽可能清除干净,可迅速改善患者的症状,改善生活质量,又尽可能延长患者生命,为晚期患者的治疗提供新的思路.     

经支气管镜高频电圈套治疗气管良恶性肿瘤的临床应用

目的观察经支气管镜高频电圈套治疗气管良恶性肿瘤的临床疗效及其安全性。方法对14例良恶性气管肿瘤所致的气管阻塞患者,通过支气管镜进行高频电圈套切除气管肿瘤,观察患者的症状缓解情况及并发症。结果通过支气管镜行高频电圈套治疗气管肿瘤14例,术后症状全部缓解,其中鳞癌8例,腺癌3例,平滑肌肉瘤1例,纤维脂肪瘤l例,结核性肉芽肿1例。结论经支气管镜高频电圈套治疗气管良恶性肿瘤疗效良好,安全性好。     

支气管镜下高频电刀治疗气道平滑肌瘤的临床应用

目的观察电子支气管镜下高频电刀在治疗气道平滑肌瘤的可行性及其安全性,观察临床疗效。方法对6例确诊为支气管良性肿瘤所致的气道阻塞患者,在支气管镜下进行高频电刀电凝及电切术,观察气道打通程度、临床症状改善情况及并发症的发生率,并对治疗结果进行统计。结果 6例平滑肌瘤共行10次高频电刀电凝及电切术治疗后均完全打通气道,临床症状完全缓解,彻底治愈。电烧灼切割治疗过程中均未出现纵隔气肿、呼吸道穿孔及大出血等严重并发症。结论经支气管镜下高频电刀电凝及电切术在治疗气道平滑肌瘤引起的气道阻塞疗效显著,可达到临床根治,又避免了开胸手术及减轻医疗费用,可在临床推广。     

经支气管镜支架置入治疗恶性气管狭窄及气管食管瘘16例临床分析

气管狭窄是胸部恶性肿瘤的常见急症之一,多数患者已失去手术机会,近3年来,我们在支气管镜直视下于气管或主支气管内置入镍钛记忆合金支架,治疗恶性肿瘤所致气管狭窄及气管食管瘘患者共16例,其中4例严重气管狭窄患者于支气管镜下高频电刀烧灼切割术后放置支架治疗,取得较满意的效果,现报告如下.     

经纤维支气管镜置入支架治疗气道狭窄26例临床分析

目的 对气道狭窄患者纤维支气管镜引导下行气道内支架成形术的临床应用进行评估.方法 纤维支气管镜引导下予26例气道狭窄合并严重气促患者行气道内支架成形术.结果 26例均获成功,支架留置后患者气促立即改善.结论 纤维支气管镜引导下内支架成形术能显著提高气道狭窄患者的生活质量.气管支架置入术是治疗重症气道狭窄的有效方法.     

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.