血液透析患者的血压监测

目的　探讨血液透析患者血压监测的临床意义。方法　选择规律性血液透析患者 5 8例 ,根据患者临床表现分为病情稳定组(A组 )和低血压组 (B组 )。监测两组患者透析前、后血压、心率、体重及透析过程中的超滤量、血压、心率和临床表现。结果　A组41例 ,透析前平均血压为 ( 13 5 .0± 18.0 / 78.8± 10 .0 )mmHg ,心率 ( 79± 10 ) /min ,透析后平均血压为 ( 13 8.0± 2 0 .0 / 84.0± 9.3 5 )mmHg ,心率 ( 84± 14 )次 /min ,平均超滤量 ( 2 .42± 0 .71)kg。B组 17例 ,其中 14例在透析过程中收缩压下降≥ 3 0mmHg ,平均下降( 3 6.3 8± 7.5 0 )mmHg ;另 3例患者在透析过程中无低血压发生 ,但出现抽搐、出汗、心悸等症状 ,平均超滤量 ( 3 .47± 0 .67)kg。结论　根据患者临床表现结合血压监测 ,有助于确定合适的超滤量 ,调整干体重 ,防治透析过程中低血压的发生     

原发性高血压住院患者辨证分型与高血压分级、危险分层的关系

背景决定是否给予降压治疗时,不仅要根据其血压水平,还要根据其危险分层,目前国内已开展了对原发性高血压辨证分型与高血压分级、危险分层关系的探讨. 目的将传统中医辨证方法同现代医学进展相结合,探讨原发性高血压辨证分型与高血压分级、危险分层的关系. 设计叙述性观察. 单位上海市静安区中心医院中医科及上海大华医院. 对象上海市静安区中心医院中医科收治的不同性别、年龄的原发性高血压住院患者64例. 方法原发性高血压辨证分为风阳上扰、痰浊上蒙、气血亏虚、肝肾阴虚证4型.基于西医辨病与中医辨证相结合,探讨原发性高血压辨证分型与高血压分级、危险分层的关系. 主要观察指标原发性高血压辨证分型与患者年龄、病程、血压、血压分级、危险分层的关系. 结果64例患者均进入结果分析.①辨证分型与年龄、病程、血压高低的关系风阳上扰组患者年龄较痰浊上蒙及肝肾阴虚组轻[(59.0±10.9),(72.7±9.1),(71.6±10.1)年,P＜0.01];肝肾阴虚组患者病程较风阳上扰组及痰浊上蒙组长[(160.5±143.5),(64.8±70.8),(80.6±108.7)个月,P＜0.05];不同证型原发性高血压患者收缩压差异不显著,而舒张压风阳上扰组较其他3组高(99±8),(92±9),(89±11),(89±12)mmHg,P＜0.05].②辨证分型与血压分级、危险分层的关系不同证型患者血压分级差异不显著;风阳上扰组患者危险分层低于痰浊上蒙和肝肾阴虚组(极高危、高危、中危及低危分别有3,7,5,3;15,1,1,1;16,1,2,1例,P＜0.05). 结论中医证型的不同可能反映出高血压分级和分层的高低差异,可为确定治疗方针提供依据.     

伊贝沙坦治疗轻、中度原发性高血压的临床研究

目的观察伊贝沙坦对轻、中度原发性高血压患者的降压疗效。方法5 0例轻、中度高血压患者服用伊贝沙坦 ,每天 1次 ,每次 15 0mg ,连服 6周。采用偶测血压和 2 4h动态血压监测。结果临床总有效率为 84 % ,显效为 72 % ,有效为 16 % ,未达标者 8例 ,收缩压 (SBP)从治疗前的 (15 2 .4± 11.5 )mmHg降至治疗后 (130 .2± 8.2mm)Hg(P <0 .0 1) ,舒张压 (DBP)从治疗前 (96 .4± 4 .8)mmHg降至治疗后 (82 .1± 4 .6 )mmHg。动态血压监测SBP下降幅度为 (18.9± 0 .9)mmHg ,DBP下降幅度为(12 .8± 3.1)mmHg。降压谷 /峰比率 :SBP为 6 8% ,DBP为 6 3% ,血压负荷均有不同程度的降低。结论口服安博维对轻、中度原发性高血压降压疗效确切 ,不良反应少而轻。     

左旋氨氯地平治疗原发性轻中度高血压病的疗效及安全性评价

目的评价长效非二氢吡啶类钙拮抗剂左旋氨氯地平治疗原发性轻中度高血压的疗效与安全性。方法采用随机分组平行对照的方法 ,将 41例轻中度高血压患者分成左旋氨氯地平组 (2 4例 )口服 2 .5～ 5mg/d ,氯沙坦组 (1 7例 )口服 50～ 1 0 0mg/d ,观察 8周。结果用药 4周后治疗效果即已达到有效 ,至 8周末试验组偶测收缩压与舒张压分别降低(1 7.9± 7.3)mmHg、(1 6 .0± 3 .4)mmHg,动态血压显示试验组 2 4小时平均收缩压与舒张压分别降低 (2 4 .4± 40 .4)mmHg、(1 7.33± 2 7.7)mmHg。治疗前后比较 ,试验组收缩压与舒张压、血压负荷值均有非常显著性差异 (P <0 .0 1 )。试验组的显效率为 85 .8% ,总有效率为 1 0 0 %。试验过程中无明显不良反应发生 ,无明显实验室检查异常发现。结论左旋氨氯地平治疗原发性轻中度高血压不良反应少 ,与氯沙坦相似 ,但降压效果更确切     

氯沙坦复方制剂治疗轻中度原发性高血压疗效观察

目的　评价复方氯沙坦的降压疗效及安全性。方法　 30例轻中度原发性高血压患者 ,每天服复方氯沙坦 1～ 2片 ,观察降压疗效和对实验室检验结果的影响 ,在治疗 1、2、4、6、8周末记录血压、心率及不良反应情况。结果　服药 1周血压即下降 ,收缩压 /舒张压由治疗前的 (15 0 0± 16 8/10 3 2± 5 6 )mmHg降至 (138 6± 13 3/93 3± 6 9)mmHg ,8周后降至 (12 9 2± 12 6 /87 4± 7 8)mmHg ,心率无明显改变 ,不良反应少。结论　复方氯沙坦每天 1次口服 ,能有效控制血压 ,作用平稳 ,不良反应少 ,服药方便     

诊室偶测血压与自动电子血压计自测血压指导高血压治疗的对比研究

目的 :观察诊室偶测血压 (CBP)与自动电子血压计自测血压对高血压治疗的影响。方法 :45例治疗中的原发性高血压患者 ,用欧姆龙HEM 72 7型便携式电子血压计自测血压 ,每天 3次 ,分别于 7:3 0、11:3 0、16:0 0时 ,共 3 0d ,然后与CBP进行对比分析。结果 :CBP大于自测血压 ,两者差异有非常显著性 (P <0 0 1)。CBP以血压控制≤ 14 0 /90mmHg为满意 ,自测血压以血压控制≤ 13 5 /80mmHg为满意 ,CBP有 2 5例满意 ,自测血压有 3 5例满意 ,两者差异有显著性 (P <0 0 5 )。结论 :在指导高血压治疗中 ,自测血压较CBP更能反映患者的真实血压水平 ,前者是后者的重要补充 ,能更好地指导治疗 ,并提高患者对治疗的顺从性。建议高血压患者多使用高准确性的自动电子血压计自测血压     

不同时间服用依那普利对血压晨峰现象的影响

目的通过改变依那普利的服用时间来观察其对轻度高血压患者血压晨峰的影响。方法 42例轻度高血压患者给予依那普利10 mg上午(8～12点)服用,4周后监测24 h动态血压以观察白天、夜间和晨起血压情况;如果存在血压晨峰的患者则将依那普利改为晚上睡前服用,剂量不变,1周后再行24 h动态血压监测以观察白天、夜间和晨起血压情况。结果 4周后患者白天血压平均(129±10.5)/(80±6.7)mmHg,夜间血压平均(112±6.2)/(70±4.7)mmHg,晨起血压平均(142±9.5)/(89±5.5)mmHg,85.7%(36例)患者存在血压晨峰现象。改为睡前服用一周后白天血压平均(125±9.5)/(82±5.8)mmHg,与白天服用依那普利比较两者差异无统计学意义(P>0.05);夜间血压平均(110±7.3)/(68±6.6)mmHg,与白天服用依那普利比较两者差异无统计学意义(P>0.05);晨起血压平均(123±7.1)/(79±5.6)mmHg,与白天服用依那普利比较两者差异有统计学意义(P<0.05)。结论轻度高血压患者普遍存在血压晨峰现象,睡前服用依那普利能有效控制轻度高血压患者血压晨峰的发生。     

高血压脑出血术后颅内压监测及护理

目的探讨颅内压监测在高血压脑出血患者救治中的应用价值。方法将108例高血压脑出血手术后患者随机分为监测组和对照组。监测组:对59例高血压脑出血术后患者持续颅内压及血压监测,持续颅内压保持在6～20mmHg的情况下,控制血压;对照组:对49例高血压脑出血术后患者持续血压监测,并根据血压值调整引流量和脱水剂用量。比较2组患者治疗效果。结果监测组病死率明显低于对照组,有效率明显高于对照组,病死率和有效率2组比较均有显著性差异(p<0.05)。结论高血压脑出血术后患者行颅内压监测对于判断病情、指导治疗和预后估计有重要的临床意义。     

原发性高血压住院患者辨证分型与高血压分级、危险分层的关系

血压水平，还要根据其危险分层，目前国内已开展了对原发性高血压辨证分型与高血压分级、危险分层关系的探讨。目的：将传统中医辨证方法同现代医学进展相结合，探讨原发性高血压辨证分型与高血压分级、危险分层的关系。设计：叙述性观察。单位：上海市静安区中心医院中医科及上海大华医院。对象：上海市静安区中心医院中医科收治的不同性别、年龄的原发性高血压住院患者64例。方法：原发性高血压辨证分为风阳上扰、痰浊上蒙、气血亏虚、肝肾阴虚证4型。基于西医辨病与中医辨证相结合，探讨原发性高血压辨证分型与高血压分级、危险分层的关系。主要观察指标：原发性高血压辨证分型与患者年龄、病程、血压、血压分级、危险分层的关系。结果：64例患者均进入结果分析。①辨证分型与年龄，病程、血压高低的关系：风阳上扰组患者年龄较痰浊上蒙及肝肾阴虚组轻[（59．0&;#177;10．9），（72．7&;#177;9．1），（71．6&;#177;10．1）年，P〈0．01]；肝肾阴虚组患者病程较风阳上扰组及痰浊上蒙组长[（160．5&;#177;143．5），（64．8&;#177;70．8），（80．6&;#177;108．7）个月，P〈0.05]；不同证型原发性高血压患者收缩压差异不显著，而舒张压风阳上扰组较其他3组高[（99&;#177;8），（92&;#177;9），（89&;#177;11），（89&;#177;12）mmHg，P〈0．05]。②辨证分型与血压分级、危险分层的关系：不同证型患者血压分级差异不显著；风阳上扰组患者危险分层低于痰浊上蒙和肝肾阴虚组（极高危、高危、中危及低危分别有3，7，5，3；15，1，1，1；16，1，2，1例，P〈0．05）。结论：中医证型的不同可能反映出高血压分级和分层的高低差异，可为确定治疗方针提供依据。     

老年高血压患者血压昼夜节律及血压变异性的临床研究

本研究通过 2 4ｈ动态血压监测 ,观察 6 5例老年高血压病人和 5 0例健康老年人的血压昼夜节律及血压变异性 ,探讨老年高血压病人血压变异性的特点及血压昼夜节律的变化。1　资料与方法选择本院 1 999～ 2 0 0 0年门诊和住院老年高血压病人 6 5例 ,年龄 6 3 6 5± 1 0 6岁 ,男 40例 ,女 3 5例。其中高血压Ⅰ级 1 5例 ,Ⅱ级 3 0例 ,Ⅲ级 2 0例。上述病人均为初诊或停用降压药 2周以上的确诊高血压病人。对照组 :血压正常老年人 5 0例 ,年龄 6 0 6 8± 1 1 2 ,其中男 3 0例 ,女 2 0例。所有患者停药 2周后行动态血压监测。ＡＢＰＭ用德国Ｍ…     

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.     

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.