静脉注射地尔硫（艹卓）和美托洛尔对快室率房颤治疗的疗效观察

目的：探讨静脉注射地尔硫（艹卓）和美托洛尔对快室率房颤治疗的有效性。方法：入选40例患者随机给予地尔硫（艹卓）或美托洛尔静脉注射,观察20 min。结果：20 min时地尔硫（艹卓）组和美托洛尔组总有效率分别为90%和80%,5 min后两组心室率均明显下降,20 min时平均心室率下降幅度分别为34.7%和28.6%;平均起效时间分别为（5.3±4.6）min和（9.4±6.4）min（P〈0.05）。无严重不良反应。结论：地尔硫（艹卓）和美托洛尔对快室率房颤治疗安全有效,地尔硫（艹卓）控制心室率下降幅度更大,起效更快。     

静脉注射胺碘酮与普罗帕酮治疗心房颤动的临床对比观察

目的　观察静脉应用胺碘酮与普罗帕酮对阵发性快速心房颤动 (房颤 )的疗效。方法　选择 4 9例患者按就诊顺序随机分为两组 ,胺碘酮组 (2 5例 ) :胺碘酮 15 0mg+生理盐水 10ml,静脉注射 ,10分钟注射完毕 ;普罗帕酮组 (2 4例 ) :普罗帕酮 70mg +生理盐水 10ml,静脉注射 ,5～ 10分钟注射完毕。观察 10～ 2 0分钟若未转复可重复应用 ,最大累积量胺碘酮为 4 5 0mg ,普罗帕酮为 2 10mg。 结果　转复率 :胺碘酮组 76 % (19/ 2 5 ) ,普罗帕酮组 75 % (18/2 4 ) ,两组转复率比较差异无统计学意义 (χ2 =0 .0 0 4 2 ,P >0 .0 5 )。转复时间 :胺碘酮组 (4 8.1± 15 .9)分钟 ,普罗帕酮组 (38.7± 14 .9)分钟 ,两组比较差异有统计学意义 (t=2 .13,P <0 .0 5 )。结论　胺碘酮和普罗帕酮对阵发性快速房颤均有较高的转复率 ,但转复时间普罗帕酮短于胺碘酮     

快速房颤急诊药物干预的疗效观察

[目的]比较急诊静脉注射地尔硫卓、胺碘酮及西地兰控制快速房颤心室率的疗效及安全性.[方法]将83例快速房颤的患者,按不同用药分为西地兰组(24例),以0.4 mg静脉注射,20 min后无效重复用药1次;地尔硫卓组(31例),以10 mg静脉注射,20 min后无效重复用药1次;胺碘酮组(28例),以150 mg静脉注入,20 min后无效重复用药1次.[结果]西地兰、地尔硫卓与胺碘酮控制房颤心室率的总有效率分别为75%、93.5%、92.8%,平均起效时间分剐为(40.1±10.3)min、(8.9±2.5)min、(14.1±8.7)min,心室率下降分别为(30.7±14.2)、(48.3±13.1)、(45.5±16.5)次/min.地尔硫卓、胺碘酮二组的总有效率、平均起效时间、心率下降均显著优于西地兰组(P<0.01).地尔硫卓组、胺碘酮组各出现无症状低血压2例.[结论]静脉注射地尔硫卓、胺碘酮较西地兰能更快速有效地控制快速房颤的心室率,地尔硫卓起效更快.     

左房内径大小及房颤发作时间对房颤转复影响的观察

目的：探讨左房内径大小及房颤发作时间对房颤转复影响。方法：选取阵发性房颤患者166例,根据左房内径大小分为A组（左房内径〈40mm）、B组（左房内径≥40mm）;A组中根据房颤发作时间分为A1组（房颤发作〈48h）、A2组（房颤发作时间≥48h）,B组中根据房颤发作时间分为B1组（房颤发作〈48h）、B2组（房颤发作时间≥48h）,均给予口服胺碘酮药物转复房颤,观察房颤转复成功率。结果：A组房颤转复成功率明显高于B组（P〈0．01）,有统计学差异。A1组较A2组、B1组较B2组房颤转复成功率明显增高（P〈0．05）。结论：左房内径大小及房颤发作时间对房颤转复有明显影响。     

静滴地尔硫、硝酸甘油治疗不稳定型心绞痛的对比研究

目的　评价地尔硫 艹卓 对不稳定型心绞痛的临床疗效。方法　 6 5例不稳定型心绞痛患者随机分为 2组。治疗组地尔硫艹卓5 0mg/d ;对照组硝酸甘油 10mg/d。 2组均加入 5 %葡萄糖溶液 2 5 0mL中静滴连用 7d。观察治疗前后痛疼缓解、HR、BP、心肌耗氧指数 (心率×收缩压 )、心电图 (ECG)的变化情况。结果　 1周内地尔硫 艹卓 组疼痛缓解率、发展为AMI的病例数较硝酸甘油组有显著差异 (P <0 .0 5 ) ;地尔硫艹卓 组治疗后心肌耗氧指数较治疗前显著下降 (P<0 .0 1)。 2组治疗后HR、BP均较治疗前有非常显著差异 (P <0 .0 1)。窦性心动过缓、房室传导阻滞为治疗的不良反应。结论　与硝酸甘油相比 ,静滴地尔硫艹卓 能更有效地控制不稳定型心绞痛 ,降低心肌耗氧指数 ,减少AMI的发生。     

静脉注射普罗帕酮与索他洛尔治疗阵发性非瓣膜病快速心房颤动的对比观察

目的:观察和比较静脉注射普罗帕酮、索他洛尔治疗阵发性非瓣膜病快速心房颤动的作用。方法:60例快速房颤发作在0.5-72h的患者,采用随机方式分为两组,分别静脉注射普罗帕酮70-210mg、索他洛尔1.5mg/kg,主要观察快速房颤转复情况及心室率的变化。结果:普罗帕酮、索他洛尔组转复快速房颤的有效率分别为78.1%、39.3%,未转复快速房颠的心室率平均下降幅度分别为5.2%与36%,平均起效时间分别为(46.5±38.2)min,(23.9±11.5)min。结论:在阵发性快速房颤转复过程中静脉注射普罗帕酮的有效率优于索他洛尔,而索他洛尔在减慢快速心室率方面优于普罗帕酮,且索他洛尔平均起效时间短于普罗幅酮。     

静脉应用胺碘酮和普罗帕酮转复阵发性房颤的临床观察

目的对比胺碘酮和普罗帕酮治疗阵发性心房颤动(房颤)的疗效及安全性。方法 40例阵发性房颤患者分别静脉用胺碘酮(胺碘酮组,20例),普罗帕酮(普罗帕酮组,20例),观察各组房颤的转复情况、复律时间及药物不良反应。其中对用普罗帕酮无效者再次予胺碘酮治疗,3例房颤转复,但未计入胺碘酮治疗有效组。结果胺碘酮组转复有效率优于普罗帕酮组(84.6%vs50.0%,P<0.05),普罗帕酮组转复时间短于胺碘酮组〔(103±67)vs(172±51)min,P<0.01〕。结论对于阵发性房颤,胺碘酮转复疗效优于普罗帕酮,安全性相似,但转复时间明显短于胺碘酮。     

门诊顿服不同剂量普罗帕酮转复房颤的疗效比较

目的对比研究顿服不同剂量普罗帕酮对转复急性房颤的疗效.方法房颤发作1～48 h的患者60例,临床排除心脏瓣膜病、心力衰竭(NYHA心功能≥Ⅱ级)、心肌梗死、可疑病窦、慢-快综合征者、Ⅱ度以上房室传导阻滞、甲状腺机能亢进、预激综合征、严重肝肾功能损害和严重低钾血症(血清钾＜3.0 mmol/L)者,初发房颤.分为二组一组予以普罗帕酮600 mg顿服;二组普罗帕酮450 mg顿服.监测血压、心电图,比较两组患者房颤转复时间及4 h转复率.结果顿服普罗帕酮600 mg转复时间为(96.67±46.90)min,顿服普罗帕酮450 mg组转复时间为(161.11±56.22)min,顿服普罗帕酮600mg组具有显著性(P＜0.05);4 h转复率差异无显著性.结论顿服普罗帕酮600 mg转复房颤,起效更快.     

静脉注射地尔硫和毛花甙C控制快速房颤心室率的疗效对比分析

我们自2002年始以随机方式对50例快速房颤患者静脉注射地尔硫艹卓和毛花甙C,疗效和安全性对比如下。1对象和方法1.1对象房颤患者50例,男28例,女22例,年龄(60±27)岁。冠心病10例,高心病18例,风心病12例,孤立性房颤6例,甲亢4例。房颤持续时间≥4 h,HR≥120次/m in,BP≥90/60mm Hg。心功能(按NYHA分级)1级18例,2级22例,3级10例。给药前未用或停用其他抗心律失常药物5个半衰期,并除外预激综合征、房室传导阻滞和病态窦房结综合征,随机分两组,每组25例。1.2方法地尔硫艹卓组:地尔硫艹卓注射剂(天津田边制药合贝爽注射剂)15 m g,用5%葡萄糖稀…     

静脉普罗帕酮和胺碘酮治疗新近发生房颤的疗效对比

目的研究静脉应用普罗帕酮和胺碘酮对新近发生房颤转复窦性心律的疗效。方法将79例心功能Ⅰ-Ⅱ级（NYHA分级）且持续时间〈24h的快速房颤患者,随机分组比较用药后窦性心律的转复情况及转复时间。结果转复率两组接近,差异无统计学意义（P〉0．05）;转复时间普罗帕酮组明显短于胺碘酮组,差异有统计学意义（P〈0．05）。结论普罗帕酮和胺碘酮转复新近发生快速房颤效果相似,均有较高转复率,普罗帕酮转复时间更短。     

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.