心康口服液对大鼠异丙肾上腺素性心肌损伤的保护作用

目的:探讨心康口服液对缺血心肌损伤的保护作用.方法:皮下注射异丙肾上腺素85mg/kg,造成大鼠缺血心肌损伤模型,并检测各组大鼠血中内皮素(ET)、超氧化物歧化酶(SOD)、丙二醛(MDA),肌酸激酶(CK)、乳酸脱氢酶(LDH)的含量.结果:心康组大鼠血中ET、MDA、CK、LDH含量明显低于模型组(P＜0.01或0.05),SOD含量明显高于模型组(P＜0.01);CK含量明显低于舒心组(P＜0.01),SOD含量明显高于舒心组(P＜0.01).结论:心康口服液能很好地预防缺血性心肌损伤.     

B型钠尿肽和窦性心律震荡现象与慢性心力衰竭患者预后的相关性研究

目的:探讨血浆B型钠尿肽(B-type natriuretic peptide,BNP)水平、窦性心律震荡现象在判断慢性心力衰竭(chronic heart failure,CHF)患者预后中的价值.方法:选择112例慢性心力衰竭和120例健康人,分别测定血浆BNP、室性期前收缩后的震荡初始(turbulence onset,TO)和震荡斜率(turbulence slope,TS)值、左室射血分数(left ventricular ejection fraction,LVEF),随访观察患者出院后30 d和3个月严重不良心脏事件发生情况,并分析BNP、TO、TS与LVEF的相关性.结果:CHF组BNP、TO明显高于对照组(P<0.05),TS明显低于对照组(P<0.05).心源性猝死组、非猝死组TO明显高于存活组(P<0.05),TS明显低于存活组(P<0.05),均有显著性差异,LVEF与BNP、TO、TS明显相关.结论:CHF患者血浆BNP值明显升高、HRT现象明显减弱,两者对CHF患者的心源性猝死及预后有一定的预测价值.     

缬沙坦治疗急性心肌梗死合并心房颤动

目的 观察缬沙坦治疗急性心肌梗死合并阵发性心房颤动的疗效.方法 选择急性心肌梗死合并阵发性心房颤动患者,随机分为治疗组,对照组.治疗组根据血压水平给予缬沙坦口服(40～160 mg,每日1次),长期用药.对照组未服.患者门诊随访12个月,定期以心电图、动态心电图检查.结果 阵发性房颤再发率:治疗组4例(12.5%),明显低于对照组7例(25%),经统计学比较(P＜0.05).转为持续性或永久性房颤的发生率:治疗组2例(4.5%),明显低于对照组4例(13%)经统计学比较P＜0.05.缺血事件的发生率:治疗组7例(21%),明显低于对照组12例(42%),经统计学比较P＜0.05.结论 缬沙坦治疗急性心肌梗塞合并房颤的患者,不但能使心衰及冠心病恶化等缺血事件明显减少,而且能够降低阵发性房颤的复发率,减少持续性及永久性房颤的发生率.     

妇炎康复片治疗慢性盆腔炎230例

目的:观察妇炎康复片治疗慢性盆腔炎的疗效.方法:采用妇炎康复片治疗230例(试验组),并与静脉滴注青霉素、灭滴灵220例(对照组)作对比,疗效均为2周.结果:2组间治愈率、显效率、有效率比较,均有显著差异(P值均＜0.01),试验组明显优于对照组.结论:妇炎康复片有活血化瘀、改善血液循环、促进炎症吸收的作用,治疗慢性盆腔炎疗效明显.     

补脾益肾升血方治疗肾性贫血的临床研究.

目的:探讨补脾益肾升血方治疗慢性肾衰竭(CRF)肾性贫血的疗效.方法:将74例肾性贫血患者随机分为2组,治疗组38例应用补脾益肾升血方联合促红细胞生成素(EPO),对照组36例应用EPO.观察2组治疗前后血红蛋白(Hb)、红细胞压积(HCT)、尿素氮(BUN)、血清肌酐(Scr)和内生肌酐清除率(Cer)变化,以及对中医症状积分的影响.结果:治疗后2组Hb、HCT均有明显的提高(P<0.01),症状体征改善也比较明显(P<0.05,P<0.01),且治疗组较对照组比较有显著性差异(P<0.05,P<0.01);治疗组的BUN、Scr、Ccr有明显改善(P<0.01,P<0.05),较对照组有显著性差异(P<0.01).结论:补脾益肾升血方可明显改善肾性贫血、保护残肾功能、改善中医症状,并能较快达到治疗目标.相应减少EPO用量.     

中药和认知行为干预对亚健康失眠转归的影响

目的:观察中药和认知行为干预(CBT)对亚健康失眠的短期疗效及中长期转归的影响.方法:亚健康失眠者62例,知情同意后分为中药组、CBT组和对照组(不予干预),干预时间4周.疗效观察:主要指标为匹兹堡睡眠质量指数(PSQI);次要指标为宗氏焦虑自评量表(SAS)、宗氏抑郁自评量表(SDS).观察时点为基线期、干预结束时、干预后3个月、干预后5个月.结果:短期疗效:干预结束时,中药组及CBT组PSQI均明显下降(P<0.05).中长期转归:随访期3组PSQI均明显下降,组间无明显差异(P>0.05).随访期3组焦虑均改善(P<0.05),组间无明显差异(P>0.05);中药组和CBT组抑郁均改善(P<0.05),对照组抑郁无明显改善(P>0.05).结论:中药和CBT短期干预亚健康失眠均有效,对其中长期转归无明显优势,亚健康预后较好,多数可以改善.     

护理干预对老年胸外科患者围术期心理状况的影响

目的:探讨护理干预对老年胸外科患者围术期心理状况的影响.方法:将120例胸外科手术患者随机分为实验组65例和对照组55例,实验组给予围术期护理干预,对照组给予常规护理.比较两组患者手术前后HAMA、HAMD评分.结果:实验组HAMA、HAMD评分明显低于对照组(P＜0.05),患者发生心理问题程度明显轻于对照组(P＜0.05),患者满意度明显高于对照组(P＜0.05).结论:实施护理干预可有效降低老年胸外科患者围术期心理问题,提高患者预后及满意度.     

颈、股动脉内-中膜厚度及血管内皮舒张功能与冠心病的相关性

目的:探讨颈动脉、股动脉内-中膜厚度(IMT)及肱动脉流量介导的舒张功能(FMD)与冠心病的相关性.方法:经冠状动脉造影正常者29例(正常组),冠状动脉有病变者76例(冠心病组),利用高频超声检测颈动脉、股动脉IMT及肱动脉FMD.结果:单支病变组、多支病变组颈动脉、股动脉IMT明显高于正常组,肱动脉FMD则明显低于正常组(均P<0.01),单支病变组与多支病变组之间差异亦有统计学意义(P<0.01);冠状动脉病变积分(修正Gensini积分)与颈动脉、股动脉IMT呈明显正相关,与肱动脉FMD呈明显负相关(均P<0.000 1).结论:颈动脉、股动脉IMT及肱动脉FMD与冠心痛存在相关性,超声检测颈动脉、股动脉IMT及肱动脉FMD可为早期发现、治疗和预防冠心病提供依据.     

尿毒清颗粒联合羟苯磺酸钙胶囊治疗早期糖尿病肾病的临床研究

目的:探讨尿毒清颗粒联合羟苯磺酸钙胶囊治疗早期糖尿病肾病(DN)的临床疗效.方法:将80例早期DN患者随机分为羟苯磺酸钙组(对照组)和尿毒清颗粒联合羟苯磺酸钙组(治疗组),每组40例,疗程均为3个月.观察两组治疗效果,检测空腹血糖(FBG)、血清总胆固醇(TC)、甘油三酯(TG)、血肌酐(SCr)、尿素氮(BUN)、尿微量白蛋白排泄率(UAER)等变化情况.结果:两组FBG均较治疗前下降(P<0.05);与治疗前比较,治疗组TC、TG明显下降(P<0.01),对照组上述指标变化不明显(P>0.05);治疗组治疗后SCr明显下降(P<0.05),而对照组变化不明显(P>0.05).两组均能显著改善早期DN患者UAER(P<0.05或P<0.01),而治疗组较对照组疗效显著(P<0.05).两组治疗后BUN均无明显变化(P>0.05).结论:尿毒清颗粒联合羟苯磺酸钙胶囊治疗早期DN疗效确切.     

依达拉奉对急性颅脑外伤手术患者的脑保护作用

目的:研究依达拉奉对急性颅脑外伤手术患者的超氧化物歧化酶(SOD)活性、丙二醛(MDA)、一氧化氮合酶(NOS)活性的影响,探讨依达拉奉早期脑保护作用.方法:30例急性开颅血肿清除术患者分为两组,每组各15例,A组为对照组,B组为依达拉奉组.B组使用与A组同样药物异丙酚维持静脉麻醉,在手术切皮时开始静脉滴注依达拉奉30 mg,30 min内输注完毕.在麻醉诱导前(T1),麻醉后(T2),手术切皮时(T3),手术开始后1 h(T4),2 h(T5),手术结束后24 h(T6)各时间点抽取静脉血测定SOD、MDA、NOS.结果:SOD活性测定两组在T4、T5、T6相比,B组高于A组(P ＜ 0.05),与T1相比,A组在T3、T5、T6增加明显(P ＜ 0.05),B组在T3、T4、T5、T6增加明显(P ＜ 0.05).MDA含量测定B组在T6明显低于A组(P ＜ 0.05),两组在T4、T5、T6比T1下降明显(P ＜ 0.05).NOS活力测定两组比较无明显差异,与T1相比在T4、T5、T6降低明显(P ＜ 0.05).结论:在急性颅脑开颅血肿清除术中,依达拉奉作为氧自由基清除剂使用安全有效,对早期脑保护有积极意义.     

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.