血管回声跟踪技术评价冠心病患者颈动脉弹性与肱动脉内皮功能的相关性

目的探讨颈动脉弹性参数与肱动脉内皮功能的相关性。方法冠心病组、冠状动脉粥样硬化组、健康对照组各30例,回声跟踪技术检测颈动脉弹性参数：压力应变弹性系数（Ep）、硬化参数（β）、顺应性（AC）、脉搏波传导速度（PWVβ）和增大指数（AI）;肱动脉袖带加压检测血流介导的内皮依赖性血管舒张功能（FMD）。结果冠心病、冠状动脉粥样硬化患者Ep、β、PWVβ均较对照组增高,AC、FMD减低（P〈0．01）;所有受试者、冠心病组、冠状动脉粥样硬化组、对照组的FMD分别与Ep、β、PWVβ呈负相关,与AC呈正相关,与AI无相关性。结论颈动脉弹性各参数与肱动脉内皮功能呈高度相关,提示回声跟踪技术能早期、定量反映冠心病患者血管的改变,是评价血管内皮功能简便实用的方法。     

血管回声跟踪技术评价严格血糖控制对2型糖尿病患者颈动脉弹性的影响

目的采用血管回声跟踪（ET）技术评价严格血糖控制对2型糖尿病（T2DM）患者颈动脉弹性的影响。方法选择病程2～5年的T2DM患者68例和正常对照组54例,采用ET技术测定颈动脉弹性参数,即硬化值（β）、弹性系数（Ep）、增大指数（AI）、顺应性（AC）和单点脉搏波传导速度（PWVβ）。结果①与正常对照组比较,T2DM组β、Ep、AI和PWVβ值明显增高,而AC值降低（P〈0．05）;②T2DM组糖化血红蛋白（HbAlc）与13、Ep、AI和PWVβ呈显著正相关,与Ac呈显著负相关;③严格血糖控制的T2DM1组β、Ep、AI和PWVβ值较血糖控制不佳的T2DM2组明显降低,而AC值升高。结论严格血糖控制可明显增加T2DM患者颈动脉弹性,改善血管内皮功能。     

血管回声跟踪技术评价颈动脉弹性与冠心病的相关性

目的探讨应用血管回声跟踪技术（E—Tracking）评价颈动脉弹性与冠心病的相关性：方法对103例疑似冠心病患者同时行冠状动脉造影检查（CAG）和E-Trackingk检查,根据造影结果分为非冠心病组（A组：对照组）和冠心病组,冠心病组又根据冠状动脉病变的范围和血管阻塞程度由轻至重依次分为B、C、D、E四组。分析比较各组间应用E—Tracking检查获得的颈动脉弹性参数（包括压力应变弹性系数Ep、硬化参数β、动脉顺应性AC、单点脉搏波速度PWVβ、增大指数AI）。结果冠心病组的参数Ep、β和PWVβ较对照组明显增高,差异有统计学意义（p〈0．05）,且随着各组间冠状动脉病变程度的不断加重,参数Ep、β和PWVβ逐渐增高,差异有统计学意义（p〈0．05）,两者之间存在相关性。参数AC和AI在各组间无明显差异（p〉0．05）。结论应用血管回声跟踪技术测量的颈动脉弹性参数大小与冠状动脉的病变程度有相关性.     

血管回声跟踪技术评价2型糖尿病患者股动脉弹性的临床研究

目的应用血管回声跟踪技术（ET）对2型糖尿病患者的股总动脉弹性进行评价,初步确定2型糖尿病患者股动脉硬化的诊断指标。方法应用肼技术检测60例2型糖尿病患者双侧股总动脉弹性参数,并与60健康正常人的各弹性参数进行统计学分析,初步确定股动脉硬化田参数的诊断截断值。结果2型糖尿病组股总动脉硬度指数（β）、压力应变弹性系数（Ep）、脉搏波传导速度（PWVp）均较正常对照组升高（P〈0．01）,顺应性（AC）较对照组降低（P〈0．01）,膨大系数（AI）差异不明显（P〉0．05）;受试者工作特征曲线（ROC）分析β、Ep、PWVβ、AC、AI的曲线下面积分别为0．84、0．85、0．84、0．75、0．61。结论糖尿病患者动脉弹性下降发生在内中膜（IMT）增厚之前,其中以β、Ep、PWVβ作为2型糖尿病患者股总动脉硬化评价参数的准确性较高,AC可作为辅助参考指标,AI暂不推荐。本研究者认为,β11．25、Ep130．5kPa、PWVβ7．05m／s、AC0．74mm^2／kPa可作为诊断2型糖尿病患者股总动脉硬化的截断值。     

应用新版eTRACKING技术对高血压患者颈动脉斑块的研究

目的应用新版血管回声跟踪eTRACKING技术对高血压患者颈动脉无斑块组与斑块组的特征进行研究。方法高血压颈动脉无斑块组43例,高血压颈动脉软斑组56例,高血压颈动脉硬斑组24例,正常对照组39例。应用新版血管回声跟踪技术评估颈动脉硬化参数,包括压力应变弹性系数(Ep)、硬化参数(β)、顺应性(AC)、脉搏波传导速度(PWVβ)和增大指数(AI),并对高血压组上述参数进行相关分析。结果高血压颈动脉无斑块组与斑块组Ep、β、PWVβ、AI较正常对照组明显增高,AC明显减小(P<0.01);高血压颈动脉硬斑组Ep、β、PWVβ较软斑组明显增高(P<0.01);高血压组的PWVβ与Ep、β呈正相关,与AC呈负相关;高血压组的AI与Ep、β、AC无相关性。结论新版血管回声跟踪技术对高血压颈动脉无斑块组与斑块形成组均有评估价值。     

血管回声跟踪技术定量评价缺血性脑血管病患者颈动脉弹性

目的应用血管回声跟踪技术（ET）评价缺血性脑血管病患者颈动脉弹性的变化,从而全面分析病因、评估预后。方法随机选择住院的短暂性脑缺血（TIA）患者30例、脑梗塞患者30例,正常对照组30例,应用ET术评估颈动脉硬化参数：血管压力应变弹性系数（Ep）、僵硬度（β）、顺应性（AC）、脉搏波传导速度（PWVβ）、增大指数（AI）、收缩期最大血管内径（Ds）及舒张期最小血管内径（Dd）。结果①脑梗塞患者β、Ep、AI及PWVβ较正常组升高,AC较正常组降低,且差异有统计学意义。TIA患者β、Ep、AI及PWVβ较正常组升高,AC较正常组降低,但差异无统计学意义。②脑梗塞组年龄〈60岁者的Ds和Dd与≥60岁者无明显差异;正常组、TIA组年龄≥60岁者较〈60岁者的Ds和Dd增大（P〈0．05）。结论ET技术能有效评价缺血性脑血管病患者颈动脉的弹性改变,为临床提供较丰富的信息。     

子痫前期孕妇颈动脉僵硬度血管回声跟踪技术检测及其与围产儿结局的相关性

目的：应用血管回声跟踪技术评估和分析子痫前期（PE）孕妇的颈动脉僵硬度是否与正常妊娠孕妇存在差异，并分析病例组孕妇颈动脉僵硬度与PE严重程度和围产儿结局的相关性。方法：对30例PE孕妇及30例正常妊娠孕妇进行病例-对照研究。应用血管回声跟踪技术方法检测两组孕妇颈动脉僵硬度，得到以下检测指标：弹性压力（Ep）、硬化参数（β）、顺应性（AC）、单点脉搏波传导速度（PWVβ）和反射波增强指数（AI）。结果：PE组母体颈动脉Ep、β、PWVβ、AI明显高于对照组，AC明显低于对照组。PE组Ep、β、PWVβ和AI均与收缩压、舒张压和平均动脉压呈正相关。PE组孕妇颈动脉AI与新生儿体质量呈负相关，与1 min Apgar评分呈负相关。结论：PE孕妇颈动脉僵硬度较正常孕妇增加。PE孕妇颈动脉僵硬程度与血压呈正相关。PE孕妇颈动脉僵硬程度增高提示未来发生围产儿预后不良的可能性增大。     

2型糖尿病患者颈动脉血管回声跟踪技术与内中膜厚度相关性研究

目的探讨2型糖尿病患者颈动脉血管回声跟踪技术（ET）的各弹性参数变化规律,及其与颈动脉内中膜厚度（IMT）的相关性。方法对60例2型糖尿病患者及50例正常对照者行双侧颈总动脉ET检测及IMT测量,分析两者之间的相关性。结果 2型糖尿病组的弹性系数（Ep）、僵硬度（β）、单点脉搏波传导速度（PWVβ）高于对照组（P〈0.01）,顺应性（AC）则低于对照组（P〈0.01）,增大指数（AI）与对照组差异无统计学意义（P〉0.05）。Ep、β、PWVβ与颈动脉IMT呈正相关（r分别为0.514、0.523、0.421,均P〈0.001）,AC与颈动脉IMT呈负相关（r=-0.462,P〈0.001）。结论 ET技术有助于评估2型糖尿病患者颈动脉弹性的功能改变,并能在颈动脉IMT增厚之前对2型糖尿病患者颈动脉硬化做出预测。     

高血压病患者左心室舒张功能与颈总动脉弹性关系的超声研究

目的探讨高血压病患者左心室舒张功能与颈总动脉弹性间的关系。方法对临床确诊的高血压病患者41例和正常对照组31例，采用频谱多普勒和组织多普勒检测心脏舒张功能，即左心房收缩末期最大径（LA）、二尖瓣前叶射血分数斜率（EFS）、二尖瓣口舒张早期充盈速度（Ve）、舒张晚期充盈速度（Va）、Ve／Va、二尖瓣环舒张早期最大运动速度（Em）、二尖瓣环舒张晚期最大运动速度（Am）和Em／Am。采用血管回声跟踪技术（ET）测量颈总动脉弹性指标，主要有血管僵硬系数（B）、压力应变弹性系数（Ep）、动脉顺应性（AC）、增大指数（AI）和脉搏波传播速度（PWVβ）。结果（1）高血压病组LA、EFS和Ve与对照组相比差异无统计学意义（P〉0.05），高血压病组Va和Am高于对照组（P〈0．05，P〈0．01），而Em、Ve／Va和Em／Am低于对照组（P〈0．05）；（2）高血压病组双侧颈总动脉内膜．中层厚度（IMT）均高于对照组（P〈0．05，P〈0．01）；（3）高血压病组颈总动脉Ep、PWVβ高于对照组（P〈0．05，P〈0．01）；（4）Va与Ep和PWVβ、Ve／Va与AC、Am与Ep和PWVβ呈显著正相关，Ve／Va与PWVβ、Era／Am与岱和PWVβ呈显著负相关，Em与各弹性指标均无相关性。结论高血压病患者左心室舒张功能及血管弹性较正常对照组降低，大动脉弹性降低与左心室舒张功能降低呈正相关。     

血管回声跟踪技术定量评价脑梗塞患者颈动脉弹性相关性研究

目的 探讨高分辨力超声结合血管回声跟踪技术定量评价脑梗塞患者颈总动脉弹性参数的临床价值.方法 选用脑梗塞患者160例和正常对照组40例,应用高频线阵探头采用血管回声跟踪技术测量颈总动脉,获取颈总动脉的弹性系数(Ep)、僵硬度(β)、顺应性(AC)、脉搏波放大指数(AI)、单点脉搏波传导速度(PWVβ)、收缩期血管内径(Ds)及舒张期血管内径(Dd)等指标,分析这些指标与性别、年龄及心率的关系.结果 脑梗塞患者与正常人颈动脉弹性相比较,压力-应变弹性系数(Ep)、硬度指数(β)、AI及PWVβ较正常对照组明显升高(P<0.05);AC较正常对照组明显减低.性别差异对脑梗塞患者颈动脉弹性参数无影响.脑梗塞患者的β、Ep、AC、AI、PWVβ、Ds、Dd与年龄呈正相关;脑梗塞患者心率与AC、AI、Ds、Dd呈正相关;心率与β、Ep、PWVβ呈负相关.结论 应用血管回声跟踪技术能够准确定量评价脑梗塞患者颈总动脉弹性.     

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.     

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.     

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.     

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.