不同透析方法对维持性血透患者微炎症状态的影响

目的 分析不同的透析方法对维持性血透患者微炎症状态的影响.方法 通过对江苏省如皋市人民医院血透42例维持性血透患者的微炎症状态,使用常规血液透析(HD)、高通量透析(HFHD)、血液灌流(HD+HP)三种不同的净化方法,观察并分析不同透析方法的影响.结果 HFHD及HD+HP组与HD组比较,CRP、HB、Alb、TNF-α、TC、TG均有显著变化(P＜0.05);CRP、TNF-α、TC、TG有不同程度的降低,HB、Alb上升;HFHD组与HD+HP组比较CRP、TND-α、TC、TG差异有统计学意义(P＜0.05).结论 HD+ HP组和HFHD组能有效的清除大中分子炎症因子,改善维持性血透患者微炎症状态且HD+ HP优于HFHD.     

维持性血液透析对血清胆红素与血脂水平的影响

目的 探讨维持性血液透析(MHD)对慢性肾功能衰竭(CRF)尿毒症期患者血清胆红素与血脂水平的影响及临床意义.方法 42例CRF尿毒症期患者分别于血液透析前及持续血液透析半年后测定血清总胆红素(TB),直接胆红素(DB)、间接胆红素(IB)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白A1(apoA1)、载脂蛋白B(apoB)及血红蛋白(Hb)浓度、红细胞(RBC)计数,并与健康对照组进行比较.结果 尿毒症组血液透析前TB、DB、IB、Hb、RBC等指标均低于健康对照组(P＜0.01或P＜0.05),血清TG、LDL-C和apoB明显高于对照组(P＜0.01或P＜0.05),HDL-C明显低于对照组(P＜0.01),TC和apoA1虽略高于对照组,但差异无统计学意义(P＞0.05);而透析后TB、DB、IB较透析前下降(P＜0.01或P＜0.05),TC、TG、HDL-C,LDL-C、apoA1、apoB、Hb与RBC无明显变化(P＞0.05).结论 血液透析患者血清胆红素水平的下降、血脂代谢的紊乱是心脑血管并发症的主要危险因素.     

尿毒症血液透析患者血脂变化及临床意义

目的通过对40例尿毒症患者进行肾透析,评价肾透析后患者发生冠心病危险性有效的血液生化指标。方法采用费森尤斯4008S型血液透析机,费森尤斯F14透析器,并用碳酸氢盐透析液透析,反渗水处理,患者每周透析2～3次,每次3～4h,以肝素抗凝,首剂量2 000U,以1 200U/h维持至透析前30min。结果尿毒症患者首次透析前血脂水平与正常组比较:三酰甘油(TG)水平升高(P<0.01),极低密度脂蛋白胆固醇(VLDL-C)、低密度脂蛋白胆固醇(LDL-C)水平升高(P<0.05),高密度脂蛋白胆固醇(HDL-C)降低。尿毒症患者透析前后血脂比较TG高于透析前,差异有统计学意义(P<0.01),LDL-C、VLDL-C高于透析前,差异有统计学意义(P<0.05),HDL-C则低于透析前,差异有统计学意义(P<0.01)。结论透析前患者具有IV型高脂血症特点,TG、TC(总胆固醇)、VLDL-C、LDL-C升高,HDL-C降低,其中高TG血症,高VLDL-C血症最为突出。透析后血脂异常加重,TG、VLDL-C、LDL-C进一步升高,HDL-C降低。     

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。     

血脂水平与乳腺癌发生、发展的关系研究

目的探讨血脂水平与乳腺癌发生、发展的关系。方法选取该院2014年1月至2017年12月收治的乳腺癌患者102例为病例组,选取同期非乳腺癌女性100例为对照组,检测两组总胆固醇(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)水平;同时比较两组绝经与未绝经状态下的TC、TG、LDL-C、HDL-C的水平;比较淋巴结转移与无淋巴结转移患者的血脂水平。结果病例组TG、LDL-C水平均高于对照组,HDL-C水平低于对照组,差异有统计学意义(P0.05);病例组已绝经患者TG、LDL-C水平高于对照组已绝经研究对象,HDL-C水平低于对照组,差异有统计学意义(P0.05);病例组未绝经患者TG、LDL-C水平高于对照组未绝经研究对象,HDL-C水平低于对照组,差异有统计学意义(P0.05)。淋巴结转移组TG水平高于无淋巴结转移组,差异有统计学意义(P0.05),而TC、LDL-C、HDL-C水平差异无统计学意义(P0.05)。结论血脂水平与乳腺癌的发生有一定相关性,具体表现为TG、LDL-C升高,HDL-C降低,而与TC无关。     

尿毒症腹膜透析患者血脂变化的临床观察

【目的】观察腹膜透析对尿毒症患者血脂的影响。【方法】尿毒症患者42例，对照组40例，分别在腹膜透析前、透析后检测血脂水平。【结果】尿毒症患者血清胆固醇（TC）、甘油三脂（TG）、低密度脂蛋白胆固醇（LDL-C）、载脂蛋白A（ApoA）较健康人的血脂水平明显升高（P〈0．05）；透析后患者血清TG、LDL-C、Apo A较透析前明显升高（P〈0．05）。【结论】尿毒症患者透析前存在血脂异常，腹膜透析可能会加重患者的高脂血症。     

维持性血透患者营养不良、炎症与脂质代谢紊乱的相关性分析

目的:探讨尿毒症维持性血透(MHD)患者营养不良、炎症与脂质代谢紊乱三者间的相关关系,以及对心血管并发症的预测。方法:测51例尿毒症维持性血透患者血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、载脂蛋白(Apo)A1、ApoB、脂蛋白(a)LP(a)、白蛋白(ALB)、C反应蛋白(CRP)、血清铁蛋白(SF),与30例正常人进行对照研究。结果:MHD患者TG、LDL、ApoB、LP(a)、CRP、SF显著增高,HDL、ApoA1、ALB显著降低(P<0.05);随着透析时间的延长,各项检测指标变化进一步加重;且心血管事件发生者血清CRP和LP(a)明显增高,ALB明显降低,血脂紊乱更显著。相关性分析:ALB与HDL、ApoA1正相关,与CRP、LP(a)、TC、TG、ApoB负相关;CRP与LP(a)、TC、TG、ApoB、LDL、SF正相关,与HDL、ApoA1负相关,P均<0.05。结论:MHD患者存在明显的脂质代谢紊乱、炎症和营养不良,三者的相互促进和影响可能是心血管事件发生的危险因素。     

血脂异常与维持性血液透析患者脑卒中的相关性研究

目的:探讨血脂异常与维持性血液透析患者脑卒中的相关性。方法:选取2012年6月~2015年6月我院收治的75例维持性血液透析患者为观察组,并选同期40例健康体检者作为对照组。比较两组血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)等水平及TC/HDL-C比值。结果:观察组较对照组TG、LDL-C、TC/HDL-C均明显升高,HDL-C明显降低(P0.05);脑卒中组较非脑卒中组HDL-C水平明显降低,TC/HDL-C比值明显增大(P0.05);脑卒中组血透后较血透前HDL-C水平明显降低,TC/HDL-C比值明显增大(P0.05);Logistic回归分析,TC/HDL-C值为维持性血液透析患者脑卒中发生的独立预测因子。结论:维持性血液透析患者并发脑卒中与血脂代谢异常密切相关,HDL-C水平降低、TC/HDL-C比值增大为脑卒中发生的重要影响因素,且TC/HDL-C是脑卒中发生的独立预测因子。     

氟伐他汀对老年冠心病病人调脂作用的观察

目的观察氟伐他汀对老年冠心病病人血脂的调节作用。方法将100例冠心病合并高脂血症患者随机分为观察组和对照组,各50例。观察组使用氟伐他汀,对照组不使用氟伐他汀,只用低脂饮食等综合治疗,观察治疗前后两组病人血脂变化情况。结果治疗组治疗后总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)有明显降低,差异有统计学意义(P<0.05),对照组虽TC、TG、LDL-C有所降低,但差异无统计学意义(P>0.05);治疗组与对照组相比,在降低TC、TG、LDL-C方面作用显著,差异有统计学意义(P<0.05)。结论对于老年冠心病病人,氟伐他汀的调脂作用效果较好。     

STEMI患者血脂指标与Gensini评分的相关性分析

【目的】探讨急性ST段抬高型心肌梗死(STEMI)患者血脂指标与Gensini评分的相关性。【方法】选择2020年1月至2022年1月本院收治的131例因胸痛行冠状动脉造影的患者,其中冠状动脉造影正常者52例(对照组),STEMI患者79例(观察组)。比较两组总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、极低密度脂蛋白胆固醇(VLDL-C)及TC/TG、TG/HDL-C、TG/LDL-C、LDL-C/HDL-C,采用Pearson相关法分析及多重线性回归分析STEMI患者血脂指标与Gensini评分的相关性。【结果】观察组TC、LDL-C明显高于对照组(P<0.05);两组TG、HDL-C、VLDL-C比较,差异无统计学意义(P>0.05)。观察组TC/TG、LDL-C/HDL-C明显高于对照组,TG/LDL-C明显低于对照组,差异有统计学意义(P<0.05);两组TG/HDL-C比较,差异无统计学意义(P>0.05)。观察组Gensini评分为(25.30±7.32)分。Pearson相关性分析结果显示,STEMI患者TC、LDL-C、TC/TG、LDL-C/HDL-C与Gensini评分呈正相关(P<0.05),TG/LDL-C与Gensini评分呈负相关(P<0.05),TG、HDL-C、VLDL-C、TG/HDL-C与Gensini评分无明显相关性(P>0.05)。多重线性回归显示,STEMI患者LDL-C/HDL-C与Gensini评分仍呈正相关(P<0.05)。【结论】STEMI患者TC、LDL-C、TC/TG、TG/LDL-C、LDL-C/HDL-C与Gensini评分有明显相关性,其中LDL-C/HDL-C是评价STEMI患者冠状动脉病变严重程度的可靠指标。     

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.     

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.