恶性肿瘤患者血液流变指标观察

检测各种恶性肿瘤患者２６１例的血流变水平，与健康人比较，结果表 明，恶性肿瘤患者的全血低切粘度、血浆粘度及血沉均有明显升高（ｐ〈０．０５和０． 01）；而红细胞压积大都低于健康人（ｐ＜０．０１）。纤维蛋白原水平除恶性淋巴瘤及肠 癌外均有明显增高（Ｐ＜０．０５和０．０１）。肿瘤复发转移患者仅血浆粘度高于无复发 转移者（ｐ＜０．０１）。同时在原发性肿癌和肝硬化、胃癌和慢性胃炎等病人，发现某些 血流变指标有明显差异，以血浆粘度变化尤为明显。认为对良、恶性的肝、胃疾患可 能有一定的鉴别诊断意义。     

NIDDM合并视网膜病变患者红细胞聚集性变化及其影响因素

本文测定了 ＮＩＤＤＭ合并视网膜病变患者２１例、无视网胰病变患 者１９例及正常对照２０例的红细胞聚集性有关参数。的果显示，ＮＩＤＤＭ视网膜病 变组的低切全血粘度、红细胞聚集指数均显著高于无视网膜病变组及对照组（Ｐ＜ ０．０１）。ＮＩＤＤＭ组和合并视网膜病变组的血沉及血沉方程Ｋ值均显著高于对照组 （Ｐ＜０．０１）。ＮＩＤＤＭ视网膜病变组的血浆纤维蛋白原水平及糖化血清蛋白指数 均显著高于无视网膜病变组和对照组（Ｐ＜０．０５，Ｐ＜０．０１）。ＮＩＤＤＭ视网膜病变 组血清白蛋白及超氧化物歧化酶（ＳＯＤ）均显著低于无视网膜病变组和对照组（Ｐ ＜０．０５，Ｐ＜０．０１）．ＮＩＤＤＭ视网膜病变组红细胞聚集指数与血浆纤维蛋白原、 糖化血清蛋白指数呈显著正相关（ｒ值 ０．４５２、０．４４６，Ｐ＜０．０５）．与血清ＳＯＤ、白蛋 白呈显著负相关（ｒ－０．４６２、－０．４３９，Ｐ＜０．０５）．结果提示，ＮＩＤＤＭ合并视网膜 病变患者上细胞聚集性增高，这种增高与血中纤维蛋白原水平增高，蛋白质非酶糖 基化增加、ＳＯＤ及白蛋白水平降低有关．     

脉络宁和量子血疗对静脉血栓患者血液流变性的影响

将４８例静脉血栓患者随机分为两对．治疗组（２８例）采用脉络宁和量子血疗治疗．与脉络宁对照组（２０例）比较治疗后的血液流变学指标变化．治疗前后自身比较结果．治疗组血流变 ４项指标均显著降低（Ｐ＜０．０１）．对照组全血比粘度、纤维蛋白原明显下降（Ｐ＜０．０５～０．０１），血浆比粘度、红细胞压积治疗前后比较结果无显著差异（Ｐ＞０．０５）．治疗后组间对照ｔ检验，纤维蛋白原指标不存在显著差异（Ｐ＞０．０５），全血比粘度显示显著差异（Ｐ＜０．０５），其余两项指标具有极显著差异（Ｐ＜０．０１）．表明治疗组的疗效明显优于对照组．     

过敏性紫癜血液流变性研究

测定了２６例过敏性紫癜患者血液流变学参数。结果表明患者全血粘度、血浆粘度、纤维蛋白原，红细胞电泳时间均有显著性改变（Ｐ＜０．０５或Ｐ＜０．０１）。提示过敏性紫癜患者存在血液流变学性异常。本文就其改变机制及意义进行探讨。     

银屑病血液流变学观察与探讨

本文对４０例银屑病患者和４０例健康人血液流变学八项指标进行了检测对照。患者全血比粘度、全血还原粘度、血浆比粘度、纤维蛋白原增高，血沉加快，血沉方程Ｋ值增大，均有显著性改变（Ｐ＜０．０５ 或＜０．００１）。而红细胞压积和红细胞电泳时间无显著性差异。尚对５０例银屑病治疗前后血液流变学指标进行配对比较，发现病情缓解后，红细胞压积、全血还原比粘度、纤维蛋白原改变有显著性差异（Ｐ＜０．０５）。     

慢性支气管炎和慢性支气管炎急性发作期的血液流变性观测

对 ５２例慢性支气管炎（慢支）、３８例慢性支气管炎急性发作（慢支急发组）和５７例正常人进行血液流变学指标的检测，结果发现：慢支的高低切全血粘度和全血还原粘度与对照组比较有显著改变（Ｐ＜０．０１）。而慢支急发组和对照组及慢支组之间的高低切全血粘度、血浆粘度、全血还原粘度和纤维蛋白原之间存在显著差异（Ｐ＜０．０１、Ｐ＜０．０５）。说明慢支患者在疾病发展过程中，具有不同的血液流变性特点。     

85例新生儿临床与血液流变学观察

本文报道７５例新生儿窒息、硬肿症、败血症及１０例正常新生儿血液流变学结果，新生儿窒息组全血粘度、红细胞压积及纤维蛋白原定量增高、血沉减慢，硬肿症组全血粘度增高，与正常对照组比较差异非常显著（Ｐ＜０．０５～０．０１），败血症组血沉呈增快趋势，但与正常组比较无明显差异（Ｐ＞０．０５）。认为红细胞压积和聚集性增加是引起新生儿窒息的重要原因。     

镇心痛口服液对缺血性心脏病患者心功能及血液流变学的影响

目的：探讨镇心痛口服液对缺血性心脏病患者心功能及血液流变学的影响。方法：６４例缺血性心脏病患者口服镇心痛口服液治疗３０天。用电脑超声仪观察治疗前后患者心功能：射血分数（ＥＦ）、心输出量（ＣＯ）、心脏指数（ＣＩ）、左室舒张末期容积（ＬＶＥＤＶ）和左室收缩末期容积（ＬＶＥＳＶ）；血液流变学观察全血高、低切比粘度、血浆比粘度、红细胞压积及纤维蛋白原的变化。结果：ＥＦ治疗后较治疗前显著升高（Ｐ＜０．０１），ＣＯ、ＣＩ升高（Ｐ均＜０．０５），ＬＶＥＳＶ、ＬＶＥＤＶ降低（Ｐ均＜０．０５）；全血高切比粘度、血浆比粘度、纤维蛋白原均非常显著下降（Ｐ均＜０．０１），全血低切比粘度、红细胞压积均明显下降（Ｐ均＜０．０５）。结论：镇心痛口服液对缺血性心脏病患者的心功能及血液流变学具有明显改善作用。     

茶色素对糖尿病,心,肺,脑血管病患者的血液流变性影响

选择糖尿病、心、肺、脑血管病患者３９４例，口服茶色素胶囊，采用自 身对照观察临床疗效作血液流变学１７项指标检测。结果显示：服茶色素 ３０天后， （ｌ）ＴＣ、ＴＧ明显降低（Ｐ＜０．０１及Ｐ＜０．００１）；（２）全血粘度（高、中、低切及还原粘 度），血浆粘度均显著降低（Ｐ＜０．０５）；（３）纤维蛋白原、血小板粘附率、体外血栓长 度明显下降（Ｐ＜０．０５及Ｐ＜０．０１）；（４）红细胞压积，红细胞电泳及红细胞刚性指 数下降（Ｐ＜０．０５及Ｐ＜０．０１）；（５）血沉及血沉方程Ｋ值亦有较大下降（Ｐ＜０．０１ 及Ｐ＜０．０５）；（６）电脑综合分析结果五大血症变化率为５３．７８％，综合疗效佳；（７） 头昏、胸闷、失眠、阳萎等２０余项临床症状的明显改善说明茶色素有多方面的治疗 作用和双项调节作用，对中老年人心脑血管病、糖尿病有防病治病的双重作用。     

血液流变指标在脑中风诊断中的应用

本文对８０例脑中风病人，其中６０例缺血性中风，２０例出血性中风， 并与２０例正常对照进行比较，发现缺血性中风的全血粘度、血浆粘度、纤维蛋白原 和正常对照相比差异显著（Ｐ＜０．０１），红细胞压积、血沉和正常对照相比无明显差 异（Ｐ＞０．０５）。而出血性中风的红细胞压积、血沉与正常对照相比差异显著（Ｐ＜０． ０１），全血粘度、血浆粘度、纤维蛋白原与正常对照相比无明显差异（Ｐ＞０．０５）。认 为这些指标的差异，可作为两类不同性质脑中风鉴别诊断参考。     

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.