血浆置换治疗重症肝炎18例临床分析

目的探讨血浆置换疗法治疗重症肝炎的临床疗效。方法利用血浆置换联合药物治疗对18名重症肝炎患者进行治疗,设对照组18例常规药物治疗,比较两组治疗效果。结果血浆置换联合药物治疗组,治疗后患者临床症状和实验室指标均有明显好转,缩短了治疗周期。结论重症肝炎患者采用血浆置换疗法,有效控制了患者的病情,改善了临床症状,实验室指标恢复较快,降低了重症肝炎的病死率。     

血浆置换治疗重症肝炎的护理

目的 探讨应用血浆置换治疗重症肝炎的临床效果及护理措施.方法 对19例重症肝炎病人实施血浆置换疗法,比较治疗前后的肝功能以及临床症状的改善情况.结果 治疗后患者肝功能及临床症状有显著改善(p＜0.05).结论 应用血浆置换治疗并加强术前、术中、术后护理能显著改善重型肝炎患者的病情,促进康复.     

血浆置换治疗重症肝炎的疗效分析

目的 探讨血浆置换法对重症肝炎的疗效。方法 应用国产伟力公司生产人工肝支持系统对60例重症肝炎进行血浆置换（PE）治疗，观察疗效及并发症。结果 血浆置换治疗中共发生并发症（13．3％），观察血清生化学指标明显好转（100％），凝血酶原时间缩短，症状好转（97％）。结论 血浆置换治疗重症肝炎，能够改善凝血机制、明显改善症状、降低异常生化学指标、减少死亡率，是一种行之有效、安全可靠的内科治疗手段。     

选择性血浆置换治疗重症肝炎的临床疗效及护理

选择性血浆置换治疗是一种治疗重症肝炎的有效方法，它可以有效地清除患者血液中的毒素，使肝细胞的再生加速。本院继开展单纯性血浆置换治疗重症肝炎后，2006年始又开展了选择性血浆置换治疗重症肝炎。本文对2007年2月本科选择性血浆置换治疗重症肝炎8例患者的临床资料及护理情况进行总结，报告如下。     

103例慢性乙型重型肝炎血浆置换治疗的疗效观察

目的观察血浆置换治疗慢性乙型重型肝炎的疗效。方法对103例慢性乙型重型肝炎患者进行血浆置换,观察血浆置换对慢性乙型重型肝炎患者有效率和病死率及生化指标的影响。结果血浆置换治疗慢性重型肝炎能明显降低病死率,显著改善肝功能等血清生化指标,提高抢救成功率。结论血浆置换治疗慢性乙型重型肝炎有肯定的治疗效果。     

103例慢性乙型重型肝炎血浆置换治疗的疗效观察

目的 观察血浆置换治疗慢性乙型重型肝炎的疗效.方法 对103例慢性乙型重型肝炎患者进行血浆置换,观察血浆置换对慢性乙型重型肝炎患者有效率和病死率及生化指标的影响.结果 血浆置换治疗慢性重型肝炎能明显降低病死率,显著改善肝功能等血清生化指标,提高抢救成功率.结论 血浆置换治疗慢性乙型重型肝炎有肯定的治疗效果.     

血浆置换在治疗重症肝炎中的应用36例分析

目的:评估人工肝支持系统中血浆置换的治疗作用。方法:对本院2005至今36例行血浆置换的患者,比较置换前后生化指标及病情变化。结果:血浆置换治疗重症肝炎总有效率为61%。结论:血浆置换治疗重症肝炎比较安全有效。     

血浆置换术治疗慢性重型肝炎116例的护理

目的探讨血浆置换术治疗慢性重症肝炎的护理方法。方法通过对收治116例慢性重症肝炎患者进行血浆置换术的护理措施及效果评价。结果在接受1~3次血浆置换治疗后临床症状和生化指标均有不同程度改善,精神好转,凝血酶原时间缩短,黄疸稳定下降,疗效显著。结论制定有效的护理措施,密切的病情观察以及治疗过程中的精心护理是血浆置换治疗顺利完成的必要保证。     

胆碱酯酶在重型肝炎患者血浆置换前后变化的临床意义

目的探讨血清胆碱酯酶(CHE)在血浆置换前后的变化及其临床意义。方法采用美国ASCA公司生产的全自动生化分析仪,对青岛市传染病医院血浆置换治疗的44例重型肝炎和20例重型肝炎倾向患者于治疗前后分别检测血清CHE、TBil、ALB和PTA等指标。结果CHE在两组中血浆置换治疗后均明显升高,且重型肝炎倾向组效果优于重型肝炎组(P<0.01),在重型肝炎组中存活组和死亡组比较差异有显著性(P<0.001),血清TBil、ALB和PTA等指标也在血浆置换治疗后显著好转,与CHE变化呈一致性。结论①人工肝血浆置换治疗重型肝炎和重型肝炎倾向患者有较好的疗效,且早期治疗效果更佳;②动态观察血清CHE水平变化可作为判断病情、预测转归的敏感、可靠的指标。     

舒适护理在人工肝支持系统治疗重症肝炎中的应用

目的:探讨人工肝血浆置换治疗重症肝炎的护理要点。方法:对88例重症患者行人工肝血浆置换治疗,比较治疗前后肝功能变化并进行护理总结。结果:人工肝血浆置换能明显改善重症肝炎患者的症状和体征,肝功能明显好转。结论:认真做好术前、术后临床监护及护理干预,严格无菌操作,防止并发症的发生,是保证人工肝血浆置换治疗成功的关键。     

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.