小剂量尿激酶预防诺维苯所致血栓性静脉炎的效果观察

目的：观察小剂量尿激酶预防诺维苯导致的血栓性静脉炎的临床效果.方法：2005年3月～2007年2月,将我院肿瘤科使用诺维苯化疗的住院病人随机分为两组,实验组60例实施小剂量尿激酶缓慢静推预防血栓性静脉炎,对照组60例行常规治疗;对两组化疗后出现的静脉炎进行对照观察.结果：实验组和对照组静脉炎发生率分别为8.3%、28.3%（P ＜0.05）;实验组静脉炎发生时间平均为诺维苯注射后的（31.00±11.35）h,疼痛程度评分为（4.13±1.99）分,疼痛持续时间平均为（4.50±2.06）d ,对照组静脉炎发生时间平均为诺维苯注射后的（17.00±6.32）h,疼痛程度评分为（6.63±2.34）分,疼痛持续时间平均为 （6.36±1.89）d ,经t检验,两组在以上几个方面有显著性差异,具有统计学意义.结论：使用小剂量尿激酶缓慢静推能有效减少诺维苯引起的血栓性静脉炎发生,减轻静脉炎发生的程度.     

山莨菪碱预防异长春花碱所致静脉炎的研究

目的　探讨用山莨菪碱外敷预防异长春花碱所致静脉炎的效果。方法　将使用异长春花碱化疗的病人分为 3组 ,每组 15例 ,平均使用异长春花碱 4次。两组实施护理干预分别用 2 %山莨菪碱和 2 5 %的硫酸镁外敷。另外一组行常规化疗。对异长春花碱化疗后出现的静脉炎进行对照观察与研究。结果　实验组静脉炎发生率为 8.3% ;静脉炎发生时间平均为异长春花碱注射后的 (31± 11.35 )h ,疼痛程度评分为 (4 .5± 2 .0 6 ) ,疼痛持续时间平均为 (4 .12± 1.9)d ;经 χ2 ,t检验 ,实验组与另外两组以上几个方面差异均有统计学意义。结论　使用 2 %山莨菪碱可使异长春花碱引起的静脉炎发生率明显下降。     

山莨菪碱预防异长春花碱所致静脉炎的研究

目的探讨用山莨菪碱外敷预防异长春花碱所致静脉炎的效果.方法将使用异长春花碱化疗的病人分为3组,每组15例,平均使用异长春花碱4次.两组实施护理干预分别用2%山莨菪碱和25%的硫酸镁外敷.另外一组行常规化疗.对异长春花碱化疗后出现的静脉炎进行对照观察与研究.结果实验组静脉炎发生率为8.3%;静脉炎发生时间平均为异长春花碱注射后的(31士11.35)h,疼痛程度评分为(4.5±2.06),疼痛持续时间平均为(4.12±1.9)d;经x2,t检验,实验组与另外两组以上几个方面差异均有统计学意义.结论使用2%山莨菪碱可使异长春花碱引起的静脉炎发生率明显下降.     

地塞米松联合利多卡因预防诺维本所致静脉炎的观察及护理

目的观察地塞米松联合利多卡因预防诺维本化疗所致静脉炎的效果。方法将我院使用诺维本化疗的60例患者随机分为两组,每组各30例,实验组在使用诺维本药物前后给予静脉输入地塞米松联合利多卡因,对照组则在用药前后给予静脉输入地塞米松及生理盐水;观察两组化疗后发生静脉炎的情况。结果实验组与对照组静脉炎发生率分别为13.33%、36.67%,疼痛程度评分分别为3.71±0.49、6.68±0.76,平均疼痛持续时间分别为4.4±0.42d、6.68±0.76d,经字2或t检验,P<0.05或P<0.01,差异有统计学意义。结论地塞米松联合利多卡因可使诺维本化疗所致的静脉炎明显下降。     

诺维苯致皮肤反应的预防和护理

将使用诺维苯化疗的患者分 2组 ,实验组在使用诺维苯静滴前后静脉输入地塞米松 ,并于穿刺部位冷湿敷 5 0 %硫酸镁 ;对照组仅于使用诺维苯前静滴地塞米松。观察化疗后穿刺部位皮肤反应。结果示实验组皮肤反应发生率 2 5 % ;对照组皮肤反应发生率 2 0 83%。说明 5 0 %硫酸镁外敷 ,联用地塞米松可降低诺维苯致皮肤反应的发生率     

自制混合液外敷用于预防诺维苯所致静脉炎的观察

目的 探讨自制混合液预防诺维苯所致的静脉炎的疗效.方法 选择18例各行2个周期含诺维苯方案化疗的非小细胞肺癌患者,将其随机分为观察组和对照组.观察组采用50%葡萄糖20 ml、25%硫酸镁10 ml和维生素B12 500 ug配制成混合液外敷于输入诺维苯药物的皮肤上,对照组无特殊护理.结果 观察组的静脉炎发生率8.3%,显著低于对照组(61.1%),具有统计学意义.结论 自制的混合液能明显预防静脉炎的反应,疗效肯定.     

马齿苋外敷缓解诺维苯引起疼痛的临床观察

目的 探讨局部外敷中草药马齿苋缓解诺维苯所致疼痛的临床疗效.方法 将人选的接受诺维苯治疗的126例患者分为实验组70例和对照组56例.所有患者均采用诺维苯0.7 mg/kg静脉推注,实验组用药后第2天沿静脉走向将制作好的鲜马齿苋300～500 g均匀敷于整个穿刺侧肢体,外加软薄膜固定,持续30～60 min/次,连用4～6次,连用2 d;对照组常规用50%硫酸镁局部冷湿敷.比较2组患者的疼痛发生率.结果 实验组疼痛发生率为35.7%,对照组为94.6%,实验组疼痛发生率明显低于对照组(P＜0.01).结论 马齿苋外敷对缓解诺维苯所致的疼痛有显著疗效,可在临床推广使用.     

自制混合液外敷用于预防诺维苯所致静脉炎的观察

目的探讨自制混合液预防诺维苯所致的静脉炎的疗效。方法选择18例各行2个周期含诺维苯方案化疗的非小细胞肺癌患者,将其随机分为观察组和对照组。观察组采用50%葡萄糖20ml、25%硫酸镁10ml和维生素B12 500ug配制成混合液外敷于输入诺维苯药物的皮肤上,对照组无特殊护理。结果观察组的静脉炎发生率8.3%,显著低于对照组(61.1%),具有统计学意义。结论自制的混合液能明显预防静脉炎的反应,疗效肯定。     

七叶皂苷钠预防诺维苯所致静脉炎的临床观察

目的探讨七叶皂苷钠预防诺维苯所致静脉炎的临床效果。方法选择我科2005年10月-2007年1月应用诺维苯的化疗患者25例，共化疗98例次，随机分为实验组和对照组，实验组13例，采用七叶皂苷钠治疗，对照组12例采用常规治疗，对诺维苯化疗后出现的静脉炎进行对照观察。结果实验组静脉炎发生率为4．0％，对照组静脉炎发生率为18．8％。结论七叶皂苷钠预防诺维苯所致静脉炎效果显著。     

三种溶液混合湿敷预防静脉炎的临床研究

【】目的：研究在血液病化疗同步药物湿敷时,不同药物配比对预防静脉炎效果的影响。方法：随机选择成人患者90例分别平均分为三组,选择2%利多卡因5ml 25%硫酸镁15 ml 地塞米松2.5mg同步化疗前静脉湿敷为实验组1,2%利多卡因5ml 25%硫酸镁15 ml 地塞米松5mg同步化疗前静脉湿敷为实验组2,常规化疗不使用同步化疗前药物静脉湿敷为观察组。结果：实验组1和2均与观察组比较有显著差异(p＜0.01) 实验组1湿敷疗效高于实验组2,p＜0.05。结论：用2%利多卡因及25%硫酸镁联合地塞米松可以很好地预防静脉炎发生;2%利多卡因5ml 25%硫酸镁15 ml 地塞米松2.5mg比2%利多卡因5ml 25%硫酸镁15 ml 地塞米松5mg湿敷预防静脉炎效果更显著。     

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.