低剂量必可酮吸入治疗小儿咳嗽变异性哮喘32例分析

我院于１９９７年９月～２０００年６月应用低剂量必可酮(ＢＤＰ)吸入防治咳嗽变异性哮喘（ｃｏｕｇｈｖａｒｉａｎｔａｓｔｈｍａ，ＣＶＡ）３２例 ,近远期疗效满意 ,现报告如下。１临床资料１．１一般资料收集资料完整的５４例ＣＶＡ患儿 ,诊断符合１９９８年全国儿科哮喘防治协作组《儿童哮喘防治常规》标准 ［１］。患儿随机分为治疗组３２例 ,男２０例 ,女１２例。年龄２～１０岁 ,平均（５．５±２．０）岁。病程５～１６周 ,平均（９．１±３．６）周。对照组２２例 ,男１３例 ,女９例。年龄２．５～１２岁 ,平均（５．２±２．５）…     

普米克令舒联合氨茶碱雾化吸入治疗儿童支气管哮喘临床观察

目的：探讨雾化吸入普米克令舒、氨茶碱治疗儿童支气管哮喘急性发作临床疗效。方法：将120例儿童哮喘急性发作患儿随机分为对照组和观察组。对照组60例给予地塞米松、糜蛋白酶雾化吸入，治疗组60例雾化吸入普米克令舒、氨茶碱，观察比较两组的疗效。结果：治疗组在临床症状改善方面显效率90％，有效率98．3％，明显优于对照组（P〈0．01）。结论：普米克令舒联合氨茶碱雾化吸入治疗儿童支气管哮喘疗效显著。     

儿童咳嗽变异性哮喘22例治疗分析

分析确诊为咳嗽变异性哮喘（ＣＶＡ）且基本完成治疗患儿２２例，随机分成两组：对照组１０例，口服舒喘灵和酮替芬治疗；治疗组１２例，吸入舒喘灵和丙酸培氯松（必酮碟必可酮（ＢＤＰ）治疗，结果显示：两组患儿咳嗽均在治疗４周内消失，随访６月至３年，对照组１例咳嗽常复发，３例出现哮喘症状；治疗组仅１例出现哮喘。提示治疗组吸入法可降低ＣＶＡ咳嗽复发率及哮喘发生率     

高频喷射雾化吸入参附注射液治疗支气管哮喘

目的：观察高频喷射雾化吸入参附注射液治疗支气管哮喘的疗效。方法：６０例支气管哮喘患者随机分为２组。对照组２７例采用常规方法治疗；治疗组３３例除常规治疗外，加用高频喷射雾化吸入参附注射液治疗。结果：治疗后６小时，治疗组有效率达９０．９１％；经皮氧饱和度（ＳｐＯ２）升至０．９４±０．０４；１秒钟用力呼气量（ＦＥＶ１）占其预计值百分比（ＦＥＶ１％）增至６７．５１％±６．２２％。３项指标均显著高于对照组〔分别为６６．６７％、０．９１±０．０４和６２．７８％±６．６５％〕，Ｐ值分别为Ｐ＜０．０５、Ｐ＜０．０１和Ｐ＜０．０１。结论：支气管哮喘患者常规治疗加用高频喷射雾化吸入参附注射液，疗效优于单纯常规治疗。中西医结合治疗支气管哮喘，值得进一步探讨     

吸入丙酸培氯松和沙丁胺醇气雾剂治疗儿童哮喘130例疗效观察

目的；分析吸入丙酸培氯松和沙丁胺醇气雾剂治疗儿童哮喘的疗效。方法：治疗组130例哮喘患儿，以持续吸入丙酸培氯松和间断吸入沙丁胺醇，治疗前，治疗后3，6，12个月随访患儿最大呼气流量均值，对照组30例采用传统方法治疗。结果：治疗组临床控制47例，显效59例，无效18例，无效6例，总有效率95．4％，对照组临床控制1例，显效6例，好转10例，无效13例，总有效率为56．7％，两组比较有高度显著性差异（P＜0．01），治疗组患儿最大呼气流量均值治疗前后比较有高度显著性差异（P＜0．01），结论：持续吸入丙酸培氯松和间断吸入沙丁胺醇治疗儿童哮喘疗效好，副作用少。     

孟鲁司特治疗婴幼儿哮喘的疗效观察

【目的】观察孟鲁司特治疗5岁以下儿童哮喘的疗效。【方法】将128例非急性发作期的5岁以下（1～3岁）儿童哮喘患儿随机分为观察组和对照组，每组64例。观察组给予孟鲁司特每晚4mg口服，对照组常规吸入布地奈德混悬液1mL（0．5mg），疗程12周。遇哮喘急性发作时均予β2受体激动剂及必要时予抗感染、茶碱等强化治疗，观察比较两组患儿的疗效。【结果】治疗观察12周，观察组与对照组的多项哮喘控制参数均得到明显改善，两组间相比较差异无显著性（P〈0．01）。【结论】孟鲁司特治疗5岁以下儿童哮喘与糖皮质激素吸入同样有效，但患儿依从性较好，用药更为方便。     

术前访视在硬膜外麻醉患者中的应用

目的：探讨普米克令舒联合沙丁胺醇溶液雾化吸入治疗儿童哮喘急性发作的疗效及不良反应。方法：将90例哮喘急性发作患儿随机分为干预组和对照组各45例,对照组给予抗感染、对症、支持治疗;干预组在对照组常规治疗基础上,采用普米克令舒联合沙丁胺醇溶液通过高频超声雾化吸入。结果：干预组在PEF值升高及临床疗效方面明显好于对照组,两组比较有显著性差异（P〈0．05）。结论：普米克令舒联合沙丁胺醇溶液雾化吸入治疗儿童哮喘急性发作效果好,且安全经济,值得推广使用。     

利多卡因佐治中重度哮喘疗效观察

作者自１９９８年３月～２０００年１０月应用利多卡因雾化吸入佐治中、重度哮喘患者６０例 ,取得良好疗效 ,报告如下。１临床资料１．１一般资料６０例为本院住院的中、重度哮喘患儿 ,符合１９９３年儿童哮喘诊断标准［１］。男女各３０例。年龄３～１２岁 ,平均（７．２±２）岁。肺功能正常２例（３．３３ %） ,中度减退４８例（８０%） ,重度减退１０例（１６．６７%）。１．２方法随机均分两组 ,均予以β２受体激动剂、激素吸入及抗感染治疗。治疗组在此基础上加用２%利多卡因２ｍｇ／ｋｇ·次雾化吸入 ,３～４次／ｄ。评定方法 :测定…     

孟鲁司特联用布地奈德吸入防治儿童哮喘合并变应性鼻炎

目的：观察在吸入糖皮质激素（布地奈德）的基础上联合应用白三烯受体拮抗剂（孟鲁司特）对儿童哮喘伴变应性鼻炎的防治作用。方法：74例轻、中度支气管哮喘伴变应性鼻炎患儿随机分为治疗组和对照组各37例,进行3个月的治疗,观察组吸入布地奈德每天400μg,一个月后减至每天200μg,治疗组在此基础上加用孟鲁司特每天5mg。记录患儿的哮喘症状评分、变应性鼻炎症状评分、按需吸入β2受体激动剂的次数及测定气道反应性。结果：治疗后两组患儿的哮喘症状评分、变应性鼻炎症状评分及气道高反应性均明显改善。治疗组治疗后夜间哮喘症状评分及变应性鼻炎症状评分为0分及（0.30±0.36）分,对照组治疗后夜间哮喘症状评分及变应性鼻炎症状评分为（0.41±0.36）分及（1.29±0.54）分,两组比较差异有显著意义（P〈0.01）;按需吸入β2受体激动剂的次数治疗组为（1.84±0.04）喷,对照组为（2.97±0.03）喷,两组比较差异有显著性（P〈0.05）。结论：在吸入糖皮质激素的基础上联合应用白三烯受体拮抗剂可显著提高对儿童哮喘伴变应性鼻炎的疗效。     

静滴丙种球蛋白辅助治疗儿童哮喘的临床观察

目的：观察静滴丙种球蛋白辅助治疗儿童哮喘的疗效。方法：101例儿童哮喘患儿，观察组51例在抗感染、“三联”平喘治疗的基础上加用静滴丙种球蛋白辅助治疗，对照组50例常规抗感染“三联”平喘治疗，分别观察两组疗效。结果观察组治疗有效率高于对照组，两组疗效比较差异有统计学意义（P〈0.05），结论：静滴丙种球蛋白辅助治疗儿童哮喘可缩短哮喘缓解时间，效果较好。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.