临床用药对不稳定型心绞痛患者脂联素和相关指标的影响

目的探讨阿托伐他汀对不稳定型心绞痛（UAP）患者脂联素以及其他炎性指标的影响。方法48例UAP患者随机分成常规组和阿托伐他汀组,常规组使用常规药物治疗,阿托伐他汀组在常规治疗基础上加用阿托伐他汀20mg／d,均治疗2周,分别于治疗前和治疗后2周抽血测定脂联素及其他相关指标。同时设45例健康人群作为健康对照组。结果与健康对照组相比,UAP患者的血清脂联素显著降低,而炎性反应因子超敏C反应蛋白（hs-CRP）、肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）显著升高。治疗后阿托伐他汀组和常规组hs-CRP、TNF-α、IL-6均下降,但阿托伐他汀组治疗后较常规组明显下降（P〈0．05）。阿托伐他汀组治疗后血清脂联素明显升高。结论阿托伐他汀治疗能降低UAP患者hs-CRP、TNF-α、IL-6水平,有助于纠正UAP患者的炎性反应因子水平。     

不同剂量阿托伐他汀在青年急性脑梗死患者中的应用效果

目的评估不同剂量阿托伐他汀对青年急性脑梗死患者神经功能、血脂水平、炎性因子的影响及安全性。方法选择两家医院2018年4月～11月收治的82例青年急性脑梗死患者以治疗方案不同分为两组各41例,对照组患者予以小剂量(20mg/次,1次/d)阿托伐他汀治疗,观察组患者予以大剂量(40mg/次,1次/d)阿托伐他汀治疗。对比两组神经功能、血脂水平、炎性因子以及不良反应发生情况。结果治疗后,观察组NIHSS评分及TC、LDL-C、TG、IL-10、TNF-α、hs-CRP水平明显低于对照组,而HDL-C水平明显高于对照组(P<0.05);两组治疗前后AST、ALT、Cr组间组内比较均无显著性差异(P>0.05)。结论阿托伐他汀能够有效改善青年急性脑梗死患者神经功能,改善血脂指标,减轻炎性反应,且40mg/d剂量效果更佳,同时不会对患者肝肾功能产生影响,安全性良好。     

阿托伐他汀联合甲硝唑对慢性牙周炎合并动脉粥样硬化患者血脂及炎性因子水平的影响

目的探讨阿托伐他汀联合甲硝唑对慢性牙周炎(CP)合并动脉粥样硬化(AS)患者血脂及炎性因子水平的影响。方法选取2015年1月至2017年1月该院初诊的90例CP合并AS患者进行研究,按随机数字表法分为观察组和对照组,每组45例,对照组给予阿托伐他汀治疗,观察组在对照组的基础上联合甲硝唑治疗,检测两组血脂[总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白-胆固醇(LDL-C)、高密度脂蛋白-胆固醇(HDL-C)]和血清炎性因子[白细胞介素-6(IL-6)、C-反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、基质金属蛋白酶-2(MMP-2)]水平,对结果进行统计分析。结果两组治疗后TC、TG、LDL-C、HDL-C、IL-6、CRP、TNF-α、MMP-2水平优于治疗前,差异有统计学意义(P0.05);治疗后,观察组TC、LDL-C、IL-6、CRP、TNF-α水平优于对照组,差异有统计学意义(P0.05),而两组TG、HDL-C、MMP-2水平差异无统计学意义(P0.05)。结论阿托伐他汀联合甲硝唑治疗CP合并AS对改善患者血脂及炎性因子水平有明显作用。     

不同剂量瑞舒伐他汀治疗急性心肌梗死患者疗效及对血脂水平、炎症指标的影响

目的比较不同剂量瑞舒伐他汀治疗急性心肌梗死患者疗效及对血脂水平、炎症指标的影响。方法将2017年8月～2018年8月我院收治的90例急性心肌梗死患者随机分为观察组和对照组各45例。两组均予以常规药物治疗,对照组加用10mg/d瑞舒伐他汀治疗,观察组加用20mg/d瑞舒伐他汀治疗,比较两组治疗前后血脂及炎症指标水平差异。结果治疗后,两组血脂指标(TC、TG、HDL-C及LDL-C)水平显著改善,且相比于对照组治疗后,观察组治疗后TC、TG、LDL-C显著降低,HDL-C水平显著升高,差异均有统计学意义(P0.05);治疗后,两组炎症指标(TNF-a、hs-CRP、IL-6)水平显著改善,且观察组治疗后TNF-a、hs-CRP、IL-6显著低于对照组治疗后,差异均有统计学意义(P0.05)。结论20mg/d瑞舒伐他汀治疗急性心肌梗死有助调节血脂水平,降低炎症因子水平,疗效显著,值得在临床上推广应用。     

阿托伐他汀与瑞舒伐他汀治疗PCAD-AMI的临床效果对比

目的比较阿托伐他汀与瑞舒伐他汀治疗早发冠心病急性心肌梗死(PCAD-AMI)的临床效果。方法选取2019年1月～12月我院收治的PCAD-AMI患者96例,按随机编号法分为对照组和观察组各48例。常规治疗后,对照组加以阿托伐他汀治疗,观察组加以瑞舒伐他汀治疗。比较两组患者治疗前后血脂、心功能和炎性因子水平的变化,统计两组心血管不良事件发生率。结果治疗后,观察组的血脂和炎性因子各指标水平均优于对照组(P0.05),两组间心功能各指标水平及心血管不良事件发生率均比较,差异无统计学意义(P0.05)。结论阿托伐他汀与瑞舒伐他汀对PCAD-AMI患者的安全性和心功能的改善作用相当,但瑞舒伐他汀对血脂及炎性因子水平的改善作用更优。     

不同剂量阿托伐他汀对冠脉介入术后血脂、脂联素和炎性因子的影响研究

目的：研究不同剂量的阿托伐他汀对冠脉介入术（PCI）后患者血脂、脂联素和炎性因子的影响。方法选择行 PCI 治疗的急性冠脉综合征患者126例,随机平均分为三组：A 组患者（42例）给予阿托伐他汀20 mg 口服,B 组患者（42例）给予阿托伐他汀40 mg 口服,C 组患者（42例）给予阿托伐他汀80 mg 口服,1次/d。分别于用药前、用药后1周和4周测定患者血脂、脂联素、C 反应蛋白（CRP）、肿瘤坏死因子-α（TNF-α）及白细胞介素-6（IL-6）水平。结果三组患者用药后血脂水平均较用药前明显改善,但 C 组改善更明显（P ＜0．05）。三组患者用药后脂联素水平均较用药前明显升高,但 C 组升高更明显（P ＜0．05）。三组患者用药后 CRP、TNF-α及 IL-6水平均较用药前明显降低,但C 组降低更明显（P ＜0．05）。结论阿托伐他汀不仅能够调节血脂,而且还可以升高脂联素水平,减轻 PCI 术后炎性反应,并呈剂量依赖性。     

阿托伐他汀对急性心肌梗死患者冠脉介入治疗后的影响

目的:观察阿托伐他汀对急性心肌梗死患者冠状动脉介入治疗后炎症因子水平的影响。方法:选取2017年5月～2018年5月我院收治的60例AMI患者作为研究对象,随机分为对照组和实验组,每组30例。在进行PCI手术常规治疗的基础上,对照组给予辛伐他汀治疗,实验组给予阿托伐他汀治疗。治疗前后分别测定两组患者的血清TC、TG、LDL-c、hs-CRP和PCT水平,并记录两组PCI术后1个月内的心血管事件发生情况。结果:治疗前,两组TG、TC、LDL-c、hs-CRP和PCT水平相比较,差异均无统计学意义,P0.05;治疗后,两组TG、TC、LDL-c、hs-CRP和PCT水平均较同组治疗前显著降低,差异均有统计学意义,P0.05;且实验组的TG、TC、LDL-c、hs-CRP和PCT水平均明显低于对照组,差异均有统计学意义,P0.05;PCI术后1个月内,实验组的心血管事件发生率为6.67%,明显低于对照组的26.67%,差异有统计学意义,P0.05。结论:阿托伐他汀能显著降低急性心肌梗死冠脉介入治疗后患者的血脂、炎症因子水平,减少心血管事件发生率。     

不同剂量阿托伐他汀对脑梗死患者炎性因子及血脂的影响

目的研究不同剂量阿托伐他汀对脑梗死(CI)患者炎性因子及血脂的影响。方法选取沈阳市维康医院2014-02—2015-06收治的76例CI患者,抽签随机分为对照组和观察组各38例。在常规治疗基础上对照组给予小剂量阿托伐他汀治疗,观察组给予大剂量阿托伐他汀治疗,均持续治疗3个月,比较两组治疗对炎性因子超敏C反应蛋白(hs-CRP)和总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)和高密度脂蛋白胆固醇(HDL-C)等指标的影响。结果两组治疗后血清hs-CRP和血脂TC、TG、LDL-C较治疗前显著降低,差异有统计学意义(P0.05);观察组治疗后hs-CRP(3.51±0.54)mg/L、TC(3.67±0.42)mmol/L、TG(1.21±0.21)mmol/L、LDL-C(2.03±0.24)mmol/L,对照组hs-CRP(4.12±0.56)mg/L、TC(4.25±0.45)mmol/L、TG(1.33±0.23)mmol/L、LDL-C(2.49±0.28)mmol/L,观察组下降更明显,均差异有统计学意义(P0.05)。结论阿托伐他汀作为临床治疗脑梗死的有效药物,能充分调节血脂和抑制炎症反应,且服用大剂量阿托伐他汀抗炎调脂效果更佳。     

阿托伐他汀对急性心肌梗死冠脉介入治疗后炎性因子水平的影响

目的 评价阿托伐他汀对急性心肌梗死冠脉介入治疗(PCI)后炎症因子水平的影响 方法 将2017年5月至2018年5月在我院治疗的60例急性心肌梗死患者随机分为对照组和实验组,每组30例,在PCI手术常规治疗基础上,对照组给予辛伐他汀,实验组给予阿托伐他汀。分别于治疗前和治疗后测定总胆固醇、甘油三酯、低密度脂蛋白、hs-CRP和PCT水平,比较患者PCI术后一个月心血管事件发生情况。结果 治疗前两组甘油三酯( Triglyceride,TG)、血清总胆固醇(Total cholesterol,TC)和低密度脂蛋白(Low-density lipoprotein,LDL-c)水平相比无统计学差异(P＞0.05),治疗后两组TG、TC和LDL-c水平较治疗前均显著降低(P＜0.05);其中,实验组治疗后TG、TC和LDL-c水平均明显低于对照组(P＜0.05)。 两组治疗前后hs-CRP、PCT水平相比无统计学差异(P＞0.05),两组治疗后hs-CRP、PCT水平较治疗前显著降低(P＜0.05),实验组治疗后hs-CRP、PCT水平明显低于对照组(P＜0.05)。实验组患者心血管事件发生率明显低于对照组(6.67%和23.33%,P＜0.05)。结论 阿托伐他汀能显著降低急性心肌梗死冠脉介入治疗后患者的血脂、炎症因子水平,减少心血管事件发生率。     

瑞舒伐他汀治疗冠心病急性心肌梗死患者的临床疗效

目的观察瑞舒伐他汀治疗冠心病急性心肌梗死患者的临床疗效。方法选取冠心病急性心肌梗死患者72例,按随机数字表法分为阿托伐他汀治疗的对照组（36例）与瑞舒伐他汀治疗的观察组（36例）,观察2组患者血脂指标[血清总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）和高密度脂蛋白胆固醇（HDL-C）]、心功能指标[左室射血分数（LVEF）、左室收缩末期内径（LVESD）和左室舒张末期内径（LVEDD）]及不良反应（乏力、恶心和呕吐）发生率。结果治疗后,观察组血脂指标及心功能指标优于对照组（P<0.001或P<0.01）;2组不良反应发生率对比差异无统计学意义（P>0.05）。结论给予冠心病急性心肌梗死患者瑞舒伐他汀治疗,能促进血脂及心功能的改善,且不良反应少。     

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.