3项指标在慢性阻塞性肺疾病检测中的临床意义

目的观察血浆D-二聚体(D-D)、纤维蛋白原(FIB)及纤维蛋白(原)降解产物(FDP)在慢性阻塞性肺疾病(COPD)检测中的临床意义。方法随机选择2015年1月至2016年12月在重庆市江津区第二人民医院进行治疗的COPD患者100例作为观察组,另选择同期100例健康体检者作为对照组,对两组研究对象均进行D-D、FIB、FDP水平检测,比较观察组与对照组上述指标水平,比较COPD急性发作期与稳定期患者D-D、FIB、FDP水平的差异。结果观察组患者D-D、FIB、FDP水平分别为(2.41±1.09)mg/L、(5.22±1.48)g/L、(7.04±3.22)mg/L,明显高于对照组的(0.33±0.22)mg/L、(3.19±0.73)g/L、(4.18±1.37)mg/L,差异均有统计学意义(P0.05);COPD急性发作期患者D-D、FIB、FDP水平分别为(3.27±1.66)mg/L、(6.16±2.03)g/L、(7.62±3.20)mg/L,明显高于COPD稳定期患者的(0.92±0.27)mg/L、(3.49±0.76)g/L、(4.53±1.08)mg/L,差异均有统计学意义(P0.05)。结论 D-D、FIB、FDP水平能够反映COPD患者病情的变化情况,可以作为COPD患者治疗方案的确定和疗效评估依据。     

维持性血液透析患者血浆 D-二聚体及纤溶系统变化研究

目的：观察维持性血液透析（M HD）患者血浆D-二聚体（D-D）水平及纤溶系统的变化,探讨血液透析对患者凝血及纤溶系统的影响。方法选择2012年5月至2013年5月江苏省连云港市东方医院血液透析中心治疗的尿毒症患者50例,分别测定透析前后D-D、纤维蛋白降解产物（FDP）、组织纤溶酶原激活物（t-PA ）及纤溶酶原激活物抑制物（PAI）水平,并与60例健康体检者（健康对照组）进行对照。结果透析前 M HD组患者血浆D-D、FDP水平及t-PA活性明显高于健康对照组,PAI明显低于健康对照组,差异有统计学意义（ P＜0．01）。透析后MHD患者血浆D-D、FDP水平及t-PA活性较透析前明显增高,PAI则明显降低,差异均有统计学意义（P＜0．05）。结论 M HD患者本身存在着纤溶系统的紊乱,而血液透析过程使得这种紊乱更加明显。     

急性白血病患儿血浆D-D、FDP及FIB水平变化和临床意义研究

目的探讨急性白血病(AL)患儿血浆D-二聚体(D-D)、纤维蛋白原降解产物(FDP)及纤维蛋白原(FIB)水平的变化,及其在其病情状态、疗效观察及预后判断中的临床意义。方法将65例AL患儿依据小儿AL的诊疗标准分为初诊组、化疗缓解组、复发组,并与健康对照组进行比较。采用胶体金方法测定其血浆D-D,酶联免疫吸附测定(ELISA)方法测定其FDP、FIB水平,观察各组血浆D-D、FDP及FIB水平的变化。结果与健康对照组比较,AL初诊组、复发组患儿血浆D-D、FDP及FIB水平均显著升高(P0.05),而化疗缓解组与健康对照组比较,差异无统计学意义(P0.05);与初诊组比较,化疗缓解组患儿血浆D-D、FDP及FIB水平均显著降低(P0.05),而复发组上述指标则显著升高(P0.05);与化疗缓解组比较,复发组上述指标显著增高,差异有统计学意义(P0.05)。结论 AL患儿在初诊、复发时D-D、FDP及FIB水平显著升高,化疗完全缓解时则降为正常,说明AL初诊、复发时存在不同程度的凝血与纤溶系统激活,有继发纤溶亢进;而随着化疗完全缓解后,继发纤溶亢进解除,提示小儿AL血浆D-D、FDP及FIB与病情状态密切相关,可作为其病情判断、化疗效果及预后评估的指标。     

浅析血浆FDP、FM、D-二聚体的含量在DIC诊断中的价值

目的通过检测血浆纤维蛋白原降解产物(FDP)、纤维蛋白单体(FM)和D-二聚体(D-D)的含量,分析与DIC诊断的相关性。方法检测我院2014年5月至2015年11月38例诊断为DIC患者和28例健康体检者的血浆FDP、FM和DD的含量。结果 DIC患者FDP、FM、D-D的含量分别为12.29±2.77mg/L、12.34±2.96ug/ml、7.11±1.23ug/ml明显高于正常对照组的4.65±1.16mg/L、4.65±1.3ug/ml、0.35±0.09ug/ml(P0.01),两者相比有统计学差异。结论检测FDP、FM、D-二聚体的含量有利于DIC的诊断并且了解患者凝血纤溶系统激活的状态。     

D-二聚体、纤维蛋白原检测在慢性阻塞性肺疾病合并2型糖尿病患者中的临床意义

目的观察慢性阻塞性肺疾病（COPD）合并2型糖尿病（T2DM）患者血浆D-二聚体（D-D）及纤维蛋白原（FIB）的含量,探讨COPD合并T2DM凝血与纤溶机能的变化。方法选择25例COPD合并T2DM患者、25例单纯COPD患者及25例正常对照组进行血浆D-D及FIB含量的检测。结果 COPD合并T2DM组血浆D-D及FIB含量分别与正常对照组比较,差异均有统计学意义,COPD合并T2DM组血浆D-D及FIB含量均高于单纯COPD组。结论 COPD合并T2DM患者体内可能存在凝血与纤溶平衡失调,通过对血浆D-D及FIB的检测,及时防治疾病的发生发展。     

慢性阻塞性肺疾病合并2型糖尿病患者凝血、纤溶功能的变化

目的通过对慢性阻塞性肺疾病（COPD）合并2型糖尿病（T2DM）患者血浆D-二聚体（D-D）、纤维蛋白（FIB）的检测,探讨COPD合并T2DM患者凝血、纤溶功能的变化。方法分组：单纯COPD组（30例）,有并发症组（30例）和无并发症组（30例）。分别检测各组血浆D-D、FIB的含量。采用SPSS17.0统计学软件,分别对各组的D-D、FIB进行比较。结果有并发症组的D-D、FIB均高于单纯COPD组及无并发症组,差异均有统计学意义（P〈0.01）,无并发症组的D-D、FIB与单纯COPD的比较差异无统计学意义（P〉0.05）。结论 CDPD合并T2DM患者伴有视网膜、肾和周围神经病变等微血管病变时,进一步加重患者的凝血、纤维功能紊乱。在诊治COPD合并T2DM并发症患者时,要充分考虑到患者存在的凝血纤溶功能异常,注意监测相关凝血纤溶指标,对防治COPD有重要意义。     

口腔颌面外科相关疾病血浆D-二聚休和FDP的联合检测及意义

目的 分析口腔颌面外科相关疾病与血浆D-二聚体（D D）和纤维蛋白（原）降解产物（FDP）的变化及临床意义.方法 采用免疫比浊法检测了口腔外科疾病患者444例,其中口腔外科间隙感染组（A组）30例、颌骨骨折组（B组）30例和颌面软组织损伤组（C组）31例、口腔良性肿瘤组（D组）113例、口腔恶性肿瘤组（E组）104例、恶性肿瘤术后组（F组）96例、恶性肿瘤术后转移组（G组）40例.50例健康体检者作为正常对照组.炎症外伤组为A组、B组和C组,肿瘤组为D组、E组、F组和G组.结果 血浆DD含量为：A组1.42±1.42 mg/L,B组2.30±2.83 mg/L,C组0.71±0.44 mg/L,D组0.56±0.67 mg/L,E组1.42±1.86 mg/L,F组0.72±0.67 mg/L,G组1.00±0.89 mg/L和正常对照组0.52±0.34mg/L.血浆FDP含量为：A组6.29±1.63 mg/L,B组7.16±3.41 mg/L,C组5.46±1.37 mg/L,D组5.34±1.47 mg/L,E组5.94±3.42 mg/L,F组5.18±1.36 mg/L,G组5.28±1.78 mg/L和正常对照组2.91±1.28 mg/L.A组、B组、C组、E组、F组和G组血浆DD水平与正常对照组比较差异有统计学意义（f=4.798～ 2.182,P均＜0.05）,D组血浆DD水平与正常对照组比较差异无统计学意义（P＞0.05）,A～G组血浆FDP水平与正常对照组比较差异均有统计学意义（f=10.272～ 6.053,P均＜0.05）.肿瘤各组血浆DD水平E组和G组高于D组（t=4.454, 2.894,P均＜0.05）,E组高于F组（t=3.621,P＜0.05）,G组高于F组（t=2.082,P＜0.05）;血浆FDP水平E组高于F组（t=2.095,P＜0.05）,肿瘤其他组两两比较差异均无统计学意义（P＞0.05）.炎症外伤组与正常对照组的组内方差分析结果比较差异有统计学意义（FDD=10.245和FFDP=34.204,P＜0.05）.肿瘤组和正常对照组的组内方差分析结果比较有统计学意义（FDD=10.568和FmP =17.487,P＜0.05）.结论 对口腔颌面间隙感染、颌骨骨折、颌面软组织损伤和口腔颌面肿瘤患者进行血浆DD和FDP的联合检测,可及时评估患者的凝血和纤溶的异常,同?     

急性脑梗死患者血浆ATⅢ、FDP、D-D水平检测的临床意义

目的探讨抗凝血酶Ⅲ（ATⅢ）、纤维蛋白／纤维蛋白原降解产物（FDP）、D-二聚体（D-D）在急性脑梗死诊疗中的临床意义。方法选择2013年8月至2013年12月神经内科收治的急性脑梗死患者80例为观察组,选择同期健康体检人员80例为对照组,分别检测两组人员的血浆ATⅢ、FDP、D-D。结果观察组ATⅢ活性（78．45±16．47）％低对照组（99．83±19．11）％,差异有统计学意义（P〈0．05）,而血浆D—D和FDP均明显高于对照组,差异均有统计学意义（P〈0．05）O结论急性脑梗患者存在血浆ATⅢ、D-D、FDP水平的异常,及早检测有助于早期诊断和病情判断,值得临床推广使用。     

肝硬化患者凝血抗凝及纤溶指标的变化及临床意义

目的探讨肝硬化患者凝血功能、抗凝及纤溶指标的改变及其对治疗和预后的指导作用。方法对正常人和肝硬化患者检测凝血酶原时间（PT）、活化部分凝血酶原时间（APTT）、纤维蛋白原（FIB）、凝血酶时间（TT）、抗凝血酶Ⅲ（ATⅢ）、蛋白C（PC）、纤溶酶原活性（PLG）、组织型纤溶酶原活化物（t—PA）、纤溶酶原激活物抑制剂（PAI）,用SPSS软件进行统计分析。结果肝硬化患者PT（P〈0．01）、APTT（P〈0．05）、TT（P〈0．01）、t-PA（P〈0．01）明显高于健康对照组,FIB（P〈0．05）、ATⅢ（P〈0．01）、PLG活性（P〈0．01）、PC（P〈0．01）、PAI（P〈0．01）明显低于健康对照组。结论肝硬化患者存在抗凝活性下降及易发纤溶,各指标可用于评价肝脏损伤程度,防止出血及判断预后。     

Ⅱ型糖尿病患者血浆纤维蛋白原及 D-二聚体检测的临床应用

目的观察2型糖尿病患者血浆纤维蛋白原（F IB ）和D-二聚体（D-D ）水平的变化,探讨两者与糖尿病血管病变的关系。方法测定72例2型糖尿病患者和71例健康对照者的血浆纤维蛋白原及D-D水平,并分析其与糖化血红蛋白（HbA1c）水平的相关性。结果2型糖尿病患者血浆 FIB、D-D水平明显高于健康对照组（ P＜0．05）。患者组FIB、D-D水平与HbA1c呈正相关。结论血浆FIB、D-D水平能反映2型糖尿病患者体内的高凝状态,监测微血栓形成以及血管病变的发生。     

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.