美托洛尔治疗充血性心力衰竭的临床观察

目的　观察美托洛尔治疗充血性心力衰竭患者的疗效。方法　选择 98例NYHA心功能Ⅱ～Ⅲ级患者分为治疗组 5 0例与对照组 4 8例。治疗组加服美托洛尔 ,首剂 6 2 5mg/d ,以后根据耐受情况逐渐加大用量 ,总量控制在 5 0mg/d。服药前后每 2个月进行一次胸片及超声心动图检查 ,每半月查一次心电图。观察两组患者心率、心律失常发生率、心胸比值及左室射血分数 (LVEF)。结果　治疗组在第 6个月后左室射血分数增加 ,心胸比值缩小 ,两者都高于对照组 (P <0 0 5 ) ,心率、心律失常发生率明显低于对照组 (P <0 0 1)。结论　美托洛尔治疗充血性心力衰竭患者能增加左室射血分数 ,改善心功能 ,同时也能降低心律失常发生率 ,是治疗充血性心力衰竭的理想药物     

螺内酯治疗充血性心力衰竭30例疗效观察

目的:观察螺内酯治疗充血性心力衰竭的疗效。方法:将55例充血性心力衰竭患者随机分为治疗组(n=30)和对照组(n=25),对照组采用基础治疗洋地黄 ACEI;治疗组在对照组基础上加用螺内酯20 mg,bid,用药时间12~18周。结果:对照组显效11例,好转4例,总有效率60%;治疗组显效19例,好转8例,总有效率90%。两组总有效率比较,差异有显著性(P<0.05)。结论:螺内酯对充血性心力衰竭患者安全有效,特别是与ACEI合用疗效更佳,其机理可能与其减轻心脏前负荷及抑制心室重构有关。     

国产米力农治疗充血性心力衰竭42例

目的：考察米力农注射液治疗充血性心力衰竭（ＣＨＦ）的疗效与不良反应。以氨力农作为对照组比较。方法：按ＮＹＨＡ心功能分级标准,心功能为Ⅲ或Ⅳ级的ＣＨＦ住院患者６３例,按２：１随机分层分为２组,米力农组４２例,氨力农组２１例,两组性别、年龄、心功能,病程、心室率均具有可比性。结果：米力农组显效率为７１．４３％,有效率为２１．４７％,无效率为７．１４％。治疗前后ＥＦ分别为０．３２±０．０４与０．４８±０     

国产氨力农治疗难治性心力衰竭的临床观察

国产氨力农治疗难治性心力衰竭的临床观察白求恩国际和平医院（０５００８２）朱旅云河北省人民医院黄希正，马淑平氨力农是非洋地黄、非儿茶酚胺类新型正性肌力药物，兼有扩血管作用［１］，对充血性心力衰竭（心衰）有良好的血流动力学影响，近称尚可改善心脏舒张功能［...     

美托洛尔治疗冠心病充血性心力衰竭的疗效评价

目的 :评价 β受体阻滞剂美托洛尔治疗冠心病充血性心力衰竭的疗效及安全性。方法 :90例冠心病充血性心力衰竭患者按就诊顺序随机分为两组 ,美托洛尔组 45例在常规抗心力衰竭治疗基础上加用美托洛尔12 5～ 2 5mg ,每天 2次。对照组 45例采用常规抗心力衰竭治疗 ,不用美托洛尔。坚持服药 ,定期来诊随访 ,观察临床表现 ,监测治疗前后心率、血压、心功能参数变化。结果 :美托洛尔组显效率 46 7% ,总有效率 86 7% ;对照组显效率 2 8 9% ,有效率 66 7% ,两者比较有显著性差异 (P <0 0 5 )。美托洛尔组患者心率减慢、血压降低较对照组明显 ,超声心动图复查显示治疗 6月后左室舒张末期内径缩小 ,左室射血分数增高较对照组显著。结论 :美托洛尔为冠心病充血性心力衰竭提供一种较为安全有效的药物治疗手段     

比索洛尔治疗老年充血性心力衰竭临床研究

目的 :观察比索洛尔对老年充血性心力衰竭患者心功能及心室重塑的影响。方法 :入选老年充血性心力衰竭患者 98例 ,左室射血分数 (EF)≤ 40 %,心功能 (NYHA)Ⅱ -Ⅳ级 ,在基础治疗上随机分为比索洛尔组和对照组。观察心功能及左室舒张末期内经 (LVEDD) ,左室收缩末期内经 (LVESD)、射血分数 (EF)、左室缩短分数 (FS)。结果 :观察治疗 1年。比索洛尔小剂量开始 ,平均用量 ( 4 11± 1 2 1)mg/l。比索洛尔组症状和心功能改善 ,与对照组比较 ,临床有效率明显上升 ( P <0 0 5 )。LVEDD、LVESD改善 ,EF、FS值上升 (P <0 0 1)。结论 :在基础治疗上加比索洛尔长期治疗可改善老年充血性心力衰竭患者的心功能 ,改善心室重塑 ,提高左室射血分数及左室缩短分数 ,且对老年人是安全的     

米力农治疗充血性心力衰竭的疗效观察

目的:观察米力农对充血性心力衰竭的疗效。方法:60例充血性心力衰竭心功能Ⅲ～Ⅳ级的住院患者.随机分成米力农治疗组30例,对照组30例。治疗组:米力农2.5mg,加注射用水20ml静注后,米力农12.5mg加注射用水250ml静滴,连续7d。对照组:除米力农外其他治疗相似。结果:治疗1周后,治疗组有效率93.3%,对照组有效率70%(P<0.01)。结论:米力农是治疗充血性心力衰竭的有效药物。     

培哚普利对充血性心力衰竭疗效的临床观察

目的 :观察培哚普利 (商品名 :雅施达 )对充血性心力衰竭的临床疗效。方法 :充血性心力衰竭 4 7例 ,随机分为A、B两组 ,两组均给予休息、限盐、吸氧、去除诱因、强心或 (和 )利尿或 (和 )扩血管治疗。A组 2 4例加用培哚普利 2～ 4mg ,1次 /d ;B组为对照组。疗程 2～ 4周 ,治疗期间记录心力衰竭的一般症状 ,治疗前后进行心功能分级(NYHA)。结果 :培哚普利可使充血性心力衰竭患者的心功能明显改善。结论 :充血性心力衰竭患者使用培哚普利可使心功能改善     

曲美他嗪治疗缺血性心肌病充血性心力衰竭临床观察

目的探讨曲美他嗪对缺血性心肌病充血性心力衰竭的疗效。方法选择缺血性心肌病充血性心力衰竭40例,随机分为治疗组和对照组。治疗组在常规治疗基础上加用曲美他嗪60mg/d口服,治疗6个月后采用6min步行试验及超声检查评估心功能。结果两组治疗后比较,治疗组LVEDV、LVEF、FS及6min步行试验均显著优于对照组(P<0.05)。结论曲美他嗪治疗缺血性心肌病充血性心力衰竭具有良好疗效,可显著改善心功能,提高运动耐量。     

左卡尼汀治疗慢性充血性心力衰竭疗效观察

目的:观察左卡尼汀治疗慢性充血性心力衰竭的疗效。方法:选择慢性充血性心力衰竭患者70例(治疗组和对照组各35例),两组均给予一致的心衰标准治疗,治疗组在此基础上加用左卡尼汀针,对照组加用复方丹参针,均治疗2周。结果:两组治疗后均有效,治疗组心功能改善总有效率明显优于对照组;心功能检查方面,治疗组治疗后较治疗前均有明显改善,与对照组相比有显著差异(P<0.05)。结论:左卡尼汀对慢性充血性心力衰竭患者具有显著改善心功能的作用。     

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.