肺炎支原体抗体、C-反应蛋白及血清降钙素原检测在儿童呼吸道感染诊断中的应用评价

目的研究肺炎支原体抗体(MP-Ig G、MP-Ig M)、C-反应蛋白(CPR)及血清降钙素原(PCT)检测在儿童呼吸道感染诊断中的价值。方法选择我院收治的呼吸道感染患儿52例,根据致病病原体分为细菌感染组21例、肺炎支原体感染组17例及病毒感染组14例。比较每组各项血清的阳性率与水平情况。结果肺炎支原体感染组MP-Ig G、MPIg M阳性率明显高于其他两组(P0.05)。细菌感染组WBC、CPR及PCT水平均高于其他两组(P0.05);肺炎支原体感染组CPR水平高于病毒感染组(P0.05)。结论 MP-Ig M、CPR与PCT能作为临床儿童呼吸道感染诊断标准,联合诊断意义较大,且对感染类型的判断准确率较高,值得临床推广。     

WBC、超敏CRP和PCT在儿童呼吸道感染中的诊断价值和应用

分析呼吸道感染疾病患儿白细胞计数(WBC)、超敏C反应蛋白(hs-CRP)及降钙素原(PCT)的变化及其临床意义。根据病原菌检测结果将接受治疗的128例呼吸道感染患儿划分为A组(细菌感染,41例)、B组(病毒感染,54例)及C组(支原体感染,33例),并选择46例同期健康体检儿童作为对照组,分别检测4组儿童的血WBC,hs-CRP和PCT水平,探究上述指标对呼吸道感染性疾病的诊断价值。A组WBC、hs-CRP及PCT水平均显著高于其他三组(P0.05),C组WBC、hs-CRP及PCT水平显著高于B组与对照组(P0.05),B组除hs-CRP水平显著高于对照组(P0.05)外,其他指标与对照组比较,无明显差异(P0.05);A组血WBC、hs-CRP、PCT单独及联合检测阳性率均显著高于B组与C组,C组WBC及联合检测阳性率显著高于B组,但B、C组hs-CRP、PCT单独检测阳性率比较无明显差异(P0.05)。血WBC、hs-CRP和PCT联合检测可提高儿童呼吸道感染的诊断阳性率,对于指导临床治疗及评估预后有显著作用,值得应用。     

血清降钙素原和超敏C-反应蛋白在小儿急性上呼吸道感染性疾病中的诊断价值

目的探讨降钙素原(PCT)和超敏C-反应蛋白(hs-CRP)检测在小儿急性呼吸道感染性疾病中的诊断价值,为急诊患儿早期治疗提供依据。方法选择2017年1月至2018年1月宝鸡市中心医院和宝鸡市中医医院儿科急性上呼吸道感染患儿522例,其中细菌感染患儿(细菌感染组)176例、病毒感染患儿(病毒感染组)268例、支原体感染患儿(支原体感染组)78例。同时,选择50例健康儿童作为对照组,分别检测PCT和hs-CRP的水平。对检测结果进行统计学分析。结果细菌感染组PCT和hs-CRP水平明显高于其他3组(P0.05),支原体感染组PCT和hs-CRP水平明显高于病毒感染组和对照组(P0.05),病毒感染组hs-CRP水平明显高于对照组(P0.05),但病毒感染组PCT水平与对照组比较差异无统计学意义(P0.05)。细菌感染组PCT和hs-CRP阳性率明显高于其他3组,差异有统计学意义(P0.05);支原体感染组PCT和hsCRP阳性率明显高于病毒感染组和对照组,差异有统计学意义(P0.05);病毒感染组PCT阳性率高于对照组,差异有统计学意义(P0.05),但hs-CRP阳性率差异无统计学意义(P0.05)。血清PCT、hs-CRP单独及联合检测对细菌性上呼吸道感染的ROC曲线下面积分别为0.850、0.797、0.913,灵敏度分别为76.8%、85.6%、92.3%,特异度分别为88.7%、72.3%、83.4%,PCT、hs-CRP单独诊断细菌性上呼吸道感染的截断值分别为0.62ng/mL、8.23mg/L。结论血清PCT和hs-CRP水平检测可用于小儿上呼吸道感染性疾病的诊断及鉴别诊断,可为早期合理用药提供依据。     

SAA、hs-CRP、IL-6联合检测在儿童感染性疾病中的诊断价值

目的探究血清淀粉样蛋白A(SAA)、超敏C反应蛋白(hs-CRP)及白细胞介素-6(IL-6)联合检测在儿童感染性疾病中的诊断价值。方法选择2018年1月至2019年6月于该院就诊的954例感染性疾病患儿分为细菌感染组426例、病毒感染组359例和肺炎支原体感染组169例,选择同期150例体检健康儿童纳入对照组。收集各组一般资料、诊疗信息,比较各组血清SAA、hs-CRP和IL-6的水平,绘制各项指标受试者工作特征(ROC)曲线,比较其诊断3种感染性疾病的特异度和灵敏度。结果与对照组比较,细菌感染组、病毒感染组、肺炎支原体感染组SAA水平均升高,且在病毒感染组、肺炎支原体感染组、细菌感染组中依次升高,两组间比较,差异均有统计学意义(P0.05)。与病毒感染组比较,hs-CRP和IL-6在细菌感染组和肺炎支原体感染组中表达水平升高,且细菌感染组明显高于肺炎支原体感染组,差异均有统计学意义(P0.05),但病毒感染组与对照组两项指标比较,差异无统计学意义(P0.05)。3项指标联合检测诊断细菌感染、病毒感染、肺炎支原体感染的ROC曲线下面积分别为0.944、0.934和0.940;灵敏度分别为92.2%、91.3%、89.2%,鉴别诊断性能优于单项检测。结论 SAA、hs-CRP及IL-6联合检测可提高对儿童感染性疾病的诊断性能。     

细胞免疫指标与血清hs-CRP、PCT早期鉴别诊断儿童肺炎的临床价值分析

目的探讨细胞免疫指标、超敏C反应蛋白(hs-CRP)、降钙素原(PCT)在不同病原体类型肺炎患儿中的水平变化及诊断价值分析。方法选取2015年1月至2016年12月在我院治疗的肺炎患儿90例,其中细菌性肺炎31例、病毒性肺炎30例,支原体肺炎29例,同时选取30例健康儿童作为对照组,检测各受试者细胞免疫指标、hs-CRP和PCT水平。结果细菌感染组、病毒感染组和支原体感染组CD3~+、CD4~+和CD4~+/CD8~+明显低于对照组(P0.05),而CD8~+明显高于对照组(P0.05);细菌感染组、病毒感染组和支原体感染组CD3~+、CD4~+、CD8~+和CD4~+/CD8~+比较差异无统计学意义(P0.05);细菌感染组hs-CRP和PCT分别为30.24±8.41mg/L和14.40±4.16μg/ml,明显高于病毒感染组和支原体感染组(P0.05);支原体感染组hs-CRP和PCT分别为21.17±9.04mg/L和10.14±3.44μg/ml,明显高于病毒感染组(P0.05);hs-CRP和PCT判断细菌性感染的ROC曲线下面积分别为0.864和0.913,P0.05;其中hs-CRP截断值为19.29mg/L,诊断灵敏度和特异度分别为90.30%和77.97%,PCT截断值为10.83μg/ml,诊断灵敏度和特异度分别为93.50%和80.25%。结论肺炎患儿体内有一定程度的细胞免疫抑制,hs-CRP和PCT明显升高,其中hs-CRP和PCT在鉴别病原类型方面有一定作用。     

儿童急性呼吸道感染中C反应蛋白、白细胞计数、降钙素原的应用价值

目的探讨白细胞计数(WBC)、C反应蛋白(CRP)及降钙素原(PCT)在儿童急性呼吸道感染中的应用价值。方法对410例检出病原体的急性呼吸道感染患儿进行回顾性分析,分为细菌感染组95例、病毒感染组94例、肺炎支原体(MP)感染组166例、混合感染组55例,并选择同期健康儿童20例作为健康对照组,比较各组血中WBC、CRP、PCT的检测结果。结果急性呼吸道感染患儿病原体检出比例从高到低分别为:MP感染组(40.5%)、细菌感染组(23.2%)、病毒感染组(22.9%)、混合感染组(13.4%),细菌感染组与混合感染组的WBC、CRP和PCT水平明显高于MP感染组、病毒感染组与健康对照组,差异有统计学意义(P0.05)。结论儿童发生急性呼吸道感染时,联合细菌培养、病原学检测和血WBC、CRP、PCT检测,综合考虑检测指标,以利于临床早期诊断与治疗。     

降钙素原与超敏C反应蛋白检测在肺部感染疾病诊断中的应用

目的探讨降钙素原(PCT)联合超敏C反应蛋白(hs-CRP)检测在肺部感染早期诊断和鉴别诊断中的临床应用。方法采用电化学发光法和免疫比浊法对120例肺部感染患者(包括细菌感染组62例,病毒感染组29例,支原体感染组25例,衣原体感染组4例)及60例健康体检者分别进行PCT和hs-CRP定量检测。结果细菌感染组PCT、hs-CRP水平较其他组明显升高,差异有统计学意义(P0.05);支原体感染组PCT、hs-CRP水平明显高于其他组,差异有统计学意义(P0.05);病毒感染组PCT与细菌感染组、支原体感染组比较,差异有统计学意义(P0.05),但与衣原体感染组、对照组比较,差异无统计学意义(P0.05),hs-CRP水平与其他组比较,差异均有统计学意义(P0.05);衣原体感染组PCT与细菌感染组、支原体感染组比较,差异有统计学意义(P0.05),hs-CRP水平与细菌感染组、病毒感染组、支原体感染组比较,差异有统计学意义(P0.05),而PCT、hs-CRP均与对照组比较,差异无统计学意义(P0.05)。结论 PCT与hs-CRP检测对肺部感染病原体诊断有一定的参考价值。     

感染性肺炎患儿FIB、PCT、hs-CRP水平的变化及意义

目的观察小儿感染性肺炎患者血浆纤维蛋白原(FIB)、血清降钙素原(PCT)、超敏C反应蛋白(hs-CRP)水平变化及意义。方法将细菌感染性肺炎(细菌组)104例、非细菌感染(非细菌组)109例和健康体检儿童110例(对照组)纳入本研究,观察各组FIB、PCT、hs-CRP水平变化。结果细菌组患者FIB、PCT、hs-CRP均高于非细菌组和对照组(P0.05)。病毒组、支原体组和衣原体组患儿FIB、PCT、hs-CRP水平比较,差异无统计学意义(P0.05)。非细菌组、细菌组联合检测阳性率明显高于单项指标检测阳性率(P0.05)。细菌组中患儿FIB水平与PCT、hs-CRP均呈正相关(r分别为0.445、0.396,P0.05)。PCT与hs-CRP呈正相关(r=0.487,P=0.021)。结论 FIB、PCT、hs-CRP联合检测能有效鉴别细菌感染和非细菌感染,对肺炎的病原体感染的诊断和疗效评价具有重要临床意义。     

NAP、hs-CRP及PCT在儿童呼吸道感染诊断中的应用研究

目的中性粒细胞碱性磷酸酶(NAP)、超敏C反应蛋白(hs-CRP)及降钙素原(PCT)在儿童呼吸道感染诊断中的应用研究。方法观察1 238例临床确诊儿童呼吸道感染患者,结合NAP、hs-CRP及PCT检测结果进行回顾性分析。结果细菌感染组NAP阳性积分、hs-CRP及PCT水平均明显高于健康对照组与病毒感染组;细菌感染组血清NAP阳性积分与PCT水平均高于支原体感染组;病毒感染组、支原体感染组的PCT及hs-CRP水平均高于健康对照组;支原体感染组的hs-CRP水平高于病毒感染组;上述比较,差异均有统计学意义(P0.05)。结论 NAP、hs-CRP及PCT能有效诊断、鉴别儿童呼吸道感染感染性疾病,值得在基层医院推广应用。     

血常规、T淋巴细胞亚群与hs-CRP水平检测对急性上呼吸道感染患儿的诊断价值

目的探究血常规、T淋巴细胞亚群与超敏C反应蛋白水平检测对急性上呼吸道感染患儿诊断效能的影响。方法选取我院2016年10月~2019年2月收治的176例急性上呼吸道感染患儿为观察组,并选取同期健康体检儿童89例为健康对照组,比较两组血常规、T淋巴细胞亚群及超敏C反应蛋白水平。结果观察组WBC、hs-CRP水平较对照组高,CD4^+/CD8^+水平较对照组低(P<0.05);细菌感染患儿WBC、hs-CRP水平较肺炎支原体感染患儿、病毒感染患儿高,CD4^+/CD8^+水平较肺炎支原体感染患儿、病毒感染患儿低(P<0.05);肺炎支原体感染患儿WBC水平较病毒感染患儿高,CD4^+/CD8^+水平较病毒感染患儿低(P<0.05)。结论血常规、T淋巴细胞亚群与hs-CRP水平与小儿急性上呼吸道感染发生存在一定联系,且三者水平检测能有效鉴别肺炎支原体感染、病毒感染与细菌感染,为临床鉴别感染病原体类型、选取针对性治疗方案提供循证数据指导。     

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.