大剂量奥美拉唑防治应激消化道黏膜损伤的研究

目的 探讨持续静脉注射大剂量奥美拉唑防治重症患者并发应激性消化道黏膜损伤的疗效.方法 选取2006年8月至2008年10月山东大学附属省立医院的重症监护室的并发应激性消化道黏膜损伤的98例危重症患者,随机分为大剂量奥美拉唑组(A组)和对照组(B组).A组首剂5min内静脉推注80 mg奥美拉唑,后8.0 mg/h静脉泵入,72 h;B组40mg/h静脉滴注奥美拉唑,1次/8 h,1次/72 h.两组患者均定期用pH试纸枪测条监测胃液pH值,观察胃肠减压器中是否有咖啡色或红色引流物.全自动血细胞分析仪监测血红蛋白、全自动生化分析仪测定血尿素氮、动脉血气分析仪测定动脉血碱剩余.两组之间均数比较用t-test,发生率用χ2检验.结果 治疗4 h后,A组胃液pH值较B组升高[(6.63±0.62)vs.(3.14±0.26),P＜0.01],治疗8 h,16 h及24 h,胃液pH值也均高于B组(P＜0.05或P＜0.01).治疗后8 h,24 h,A组血红蛋白高于B组、血尿素氮低于B组、动脉血碱剩余负值低于B组(P＜0.05或P＜0.01).A组的胃肠道止血总有效率高于B组(95.35%vs.78.19%,P＜0.05).结论 重症患者并发应激性消化道黏膜损伤,大剂量奥美拉唑治疗效果优于常规给药.     

奥美拉唑与西咪替丁在急性胃黏膜病变治疗中的效果比较

选取100例接受治疗的急性胃黏膜病变患者,将其平均分为奥美拉唑组与西咪替丁组,对两组的治疗效果与止血效果进行观察与对比。经观察,西咪替丁组治疗总有效率为54.0%,奥美拉唑组为78.0%,差异明显,具有统计学意义(P<0.05);西咪替丁组平均止血时间为41.0±7.6h,奥美拉唑组为28.4±4.4h,差异性明显,具有统计学意义(P<0.05)。奥美拉唑能够有效治疗急性胃黏膜病变,值得临床应用与推广。     

应激性胃溃疡的治疗观察及分析

将我科2011年7月～2012年10月收治的86例诊断为应急性胃溃疡患者临床资料作为研究对象,并随机分为采用奥美拉唑治疗的研究组(46例)及采用西咪替丁进行治疗的对照组(40例),对两组的治疗效果进行统计学分析处理并进行对比。结果治疗后,研究组患者显效23例,有效19例,总治疗有效率为91.30%,且平均止血时间为26.1h;对照组显效17例,有效12例,总有效率为72.5%,平均止血时间为42.3h。两组间治疗有效率及平均止血时间均具有显著差异性(P<0.05)。相较于西咪替丁,H+-K+交换体抑制剂奥美拉唑对应激性胃溃疡有更好的治疗效果,值得临床实践中进一步推广使用。     

奥美拉唑联合生长抑素治疗急性上消化道出血效果评价

选取2014年1月~10月我院接受治疗的急性上消化道出血患者98例,随机分成两组各49例,单一组给予奥美拉唑治疗,联合组在单一组患者的基础上给予生长抑素治疗,比较两组患者的止血时间、不良反应发生情况及临床治疗效果。结果联合组患者的止血时间为(10.42±1.48)d,明显比单一组的止血时间(15.67±1.72)d短,差异存在统计学意义(即P0.05);单一组患者的临床总有效率为73.47%(36/49),明显低于联合组93.88%(46/49),差异存在统计学意义(即P0.05);两组患者的不良反应发生率无明显差异,不存在统计学意义(即P0.05)。采用奥美拉唑联合生长抑素对急性上消化道出血患者进行治疗,能有效缩短患者的止血时间,提高患者的临床总有效率,且安全性高,推荐临床应用。     

洛赛克治疗急性脑血管病并应激性溃疡出血的疗效观察

目的 :探讨洛赛克治疗急性脑血管病并发应激性溃疡出血的疗效。方法 :选择 5 2例患者 ,随机分为两组 ,分别静脉推注洛赛克 (A组 )、西咪替丁 (B组 ) ,连续用药 5d ,不加用其他止血药 ,同时治疗原发病。结果 :A、B组有效率分别为 95 .8%、46 .4% ,止血成功率A组明显高于B组 (P <0 .0 1) ;A组、B组平均止血时间分别为 (39.5± 1.7)h、(91.8± 4.2 )h ,止血速度A组较B组明显加快 (P <0 .0 1) ;B组未出现明显的毒副反应。结论 :洛赛克安全、起效快、合并症少 ,是治疗急性脑血管病并发应激性溃疡性出血的可靠药物     

奥美拉唑治疗51例小儿消化道出血的临床疗效观察

选择2010年1月~2013年1月我院收治的98例小儿消化道出血患儿,分为观察组51例和对照组47例。对照组采用常规治疗,观察组在对照组的基础加用奥美拉唑。观察组止血时间为29.53±6.65h,明显低于对照组,差异具有统计学意义(P0.05)。观察组总有效率为96.08%,明显高于对照组,差异具有统计学意义(P0.05)。奥美拉唑治疗小儿消化道出血疗效确切,止血迅速,值得临床推广应用。     

奥美拉唑联合奥曲肽治疗肝硬化出血疗效观察

目的 探讨奥美拉唑联合奥曲肽治疗肝硬化并发上消化道大出血的临床疗效.方法 收集肝硬化并发上消化道大出血患者102例,随机分为治疗组52例和对照组50例,治疗组采用奥美拉唑联合奥曲肽治疗,对照组单用奥曲肽,疗程为3d,观察临床疗效及止血时间.结果 治疗组显效率(78.85％0)与总有效率(94.2％)均显著高于对照组(54.0％和78.0％),平均止血时间(13.9±5.8)h显著小于对照组(19.8±5.0)h (P＜0.05).结论 奥美拉唑联合奥曲肽治疗肝硬化并发上消化道大出血,具有止血迅速、疗效显著、不良反应少等优点,有较高的临床应用价值.     

中西医结合治疗消化道出血疗效观察

目的:探讨中西医结合治疗消化道出血的临床效果。方法:选择在我院接受治疗的消化道出血患者92例作为观察对象,按随机原则分为对照组和观察组,每组46例。对照组单纯采用西药治疗,观察组则给予中西医结合治疗,观察并比较两组患者的疗效、止血时间、输血量等情况。结果:对照组总有效率为76.09%,止血时间为(38.34±9.61)h,输血量为(498.0±2.8)ml;观察组总有效率为97.83%,止血时间为(25.13±6.25)h,输血量为(260.0±1.6)ml:对照组的总有效率低于观察组,且治疗后止血时间较长,输血量较大,两组比较差异显著,P0.05,具有统计学意义。结论:采用中西医结合方法治疗消化道出血能缩短患者的止血时间,从而提高治疗效果。     

奥美拉唑治疗小儿上消化道出血的疗效和安全性观察

目的:观察国产奥美拉唑对小儿上消化道出血的疗效和安全性。方法:将78例经胃镜确诊的上消化道出血患儿随机分为治疗组40例,对照组38例,治疗组给予国产奥美拉唑0.9 mg.kg-1.次-1,静脉注射,1次/12 h;对照组给予法莫替丁0.9 mg.kg-1.次-1,静脉注射,1次/12 h。疗程均为5 d。每天观察呕血、黑便、血压、脉搏、肠鸣音等改变及有无不良反应。结果:治疗组显效率、总有效率、平均止血天数分别为57.5%、95.0%、(1.36±0.59)d;对照组分别为39.5%、76.3%、(2.98±0.54)d。治疗组显效率、总有效率均明显高于对照组(P0.05),止血时间明显短于对照组(P0.05)。治疗组无明显不良反应。结论:国产奥美拉唑是治疗小儿上消化道出血安全有效的药物。     

康复新液、凝血酶冻干粉与奥美拉唑联用方案治疗消化性溃疡出血的临床效果评价

目的分析消化性溃疡出血应用康复新液、凝血酶冻干粉与奥美拉唑联用方案的治疗效果,为临床医师选择合理用药方案提供参考。方法随机选择2015-12—2017-01来某院治疗消化性溃疡出血的患者100例作为研究对象,根据不同的治疗方法将其分为对照组(n=50)与实验组(n=50),对照组采用凝血酶冻干粉联合奥美拉唑治疗;实验组采用康复新液、凝血酶冻干粉与奥美拉唑联用方案治疗,分析对比两组患者的止血时间、住院时间、临床治疗有效率、止血率、复发率、血小板相关指标。结果实验组的止血时间(33.6±8.9)h、住院时间(7.2±1.5)d、复发率4%明显低于对照组的(64.7±7.8)h、(8.6±1.8)d、18%(P0.05);实验组的临床治疗有效率96%、止血率94%明显高于对照组的84%、80%(P0.05),血小板相关指数明显优于对照组(P0.05)。结论应用康复新液、凝血酶冻干粉与奥美拉唑联用方案治疗消化性溃疡出血,治疗效果显著,既可提高止血率、减少止血时间及住院时间,又可改善血小板相关指标,降低复发率。     

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.