阿托伐他汀对2型糖尿病血管内皮功能的影响

目的研究阿托伐他汀对2型糖尿病血管内皮功能及血脂的影响。方法分别检测180例2型糖尿病（rr2DM）患者的血糖、血压、血脂、一氧化氮（NO）、血管内皮素（ET）、6-酮-前列腺素（PGF1a）。同时采用高分辨超声检测内皮细胞依赖性舒张功能（FMD％）、内皮细胞非依赖性舒张功能（GTN％）。结果阿托伐他汀治疗后NO、PGF1a明显增加（P〈0．05）,ET明显降低（P〈0．05）;FMD％明显改善（P〈0．05）,GTN％无明显变化（P〉0．05）。结论阿托伐他汀通过降低低密度脂蛋白、提高高密度脂蛋白、升高NO、PGF1a,降低ET水平等途径实现对T2DM患者内皮功能保护作用,减少内皮功能紊乱（ECD）相关性疾病的发生发展。     

他汀改善实验性糖尿病内皮细胞功能的研究

目的研究阿托伐他汀对链脲佐菌素（STZ）诱导的Ⅰ型糖尿病大鼠血管内皮功能不良的影响。方法8周龄SD雄性大鼠两次腹腔注射STZ诱发实验性Ⅰ型糖尿病,以不足产生降血脂作用小剂量阿托伐他汀对糖尿病大鼠进行干预,应用在体后肢自动灌注模式（autoperfused hindlimb model）测定大鼠体内血管内皮依赖性舒张功能,并观察主动脉壁组织中内皮一氧化氮合成酶（eNoS）耐州A的表达。结果与大鼠正常对照组相比,糖尿病组大鼠内皮依赖性血管舒张功能显著下降（P〈0．05）,血清NO含量明显降低（P〈0．05）,主动脉壁组织中eNOS mRNA表达下调（P〈0．05）。与糖尿病对照组相比,阿托伐他汀干预组大鼠内皮依赖性血管舒张显著增加（P〈0．05）,血清NO含量显著升高（P〈0．05）,主动脉壁组织中一氧化氮合成酶（eNOS）mRNA的表达显著上调（P〈0．05）。结论低剂量阿托伐他汀能显著改善链脲佐菌素诱导的Ⅰ型糖尿病大鼠血管内皮依赖性舒张功能,其机制与阿托伐他汀降血脂作用无关。     

阿托伐他汀对长期吸烟者内皮功能的改善作用

目的 探讨阿托伐他汀对长期吸烟者血管内皮功能改善及炎症因子的影响.方法 长期吸烟者264例,随机分为两组;治疗组接受12周阿托伐他汀(20mg/d),对照组服用安慰剂,应用高分辨超声测定肱动脉血管内皮依赖性舒张功能及非内皮依赖性血管舒张功能,以及检测受试者外周血清中一氧化氮( nitric oxide,NO)、内皮素1(endothelin,ET)、C反应蛋白(C reactive protein,CRP)水平,观察受试者内皮功能改善情况.结果 治疗组服用12周阿托伐他汀治疗后血管内皮依赖性舒张功能及非内皮依赖性血管舒张功能均有明显改善,与治疗前比较,NO水平明显升高,(78.7±14.32)μmol/L vs (67.2±13.02) μmol/L; ET、CRP水平明显下降,ET (44.6±8.54) ng/L vs(86.1±6.81) ng/L、CRP(2.84±3.12)mg/L vs (5.80±5.29) mg/L,差异有统计学意义(P＜0.05).治疗组血流介导的血管舒张反应(FMD) (11.48±5.35)％ vs (7.76±3.87)％及硝酸甘油介导的血管舒张反应(NMD) (10.80±3.12)％ vs (7.80±2.29)％较治疗前有明显改善.结论 阿托伐他汀通过抗氧化应激对长期吸烟者血管内皮功能有明显的改善作用,从而保护其血管内皮功能.     

阿托伐他汀对老年高脂血症者内皮功能和hsCRP的影响

[目的]探讨老年高脂血症者应用阿托伐他汀治疗后对血管内皮舒张功能和高敏C-反应蛋白（hs-CRP）的影响.[方法]128 例老年低密度脂蛋白胆固醇（LDL-C） ≥ 3.37 mmol/L或总胆固醇（TC）≥ 5.18 mmol/L者随机分成阿托伐他汀治疗组65 例及对照组（不接受任何药物治疗）63 例,比较治疗3个月后血脂、血管内皮舒张功能及hs-CRP的变化.[结果]治疗组治疗3个月后与治疗前比较,血脂、hs-CRP 水平和血管内皮依赖性舒张功能有显著改善（ P 〈0.01或 P 〈0.05）;与对照组比较,血脂、血管内皮舒张功能及hs-CRP 水平有明显改善（ P 〈0.01或 P 〈0.05）.[结论]老年高脂血症者应用阿托伐他汀治疗后除改善血脂情况外,可进一步改善内皮依赖性血管舒张功能及减轻炎症反应.     

不同剂量阿托伐他汀对高龄急性脑梗死患者血管内皮功能的影响

目的观察不同剂量阿托伐他汀对高龄急性脑梗死患者血管内皮功能的影响。方法根据随机数字表法将100例高龄急性脑梗死患者分为A组和B组,每组50例。A组给予20 mg/d阿托伐他汀,B组给予60 mg/d阿托伐他汀。比较2组血管内皮功能、血脂指标、斑块厚度、神经功能缺损程度及用药安全性。结果治疗后,2组血管舒张反应(FMD)、一氧化氮(NO)高于治疗前,内皮素(ET)低于治疗前,且B组FMD、NO高于A组,ET低于A组,差异有统计学意义(P0.05); 2组甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)低于治疗前,高密度脂蛋白胆固醇(HDL-C)高于治疗前,且B组TG、TC、LDL-C低于A组,HDL-C高于A组,差异有统计学意义(P0.05); 2组颈动脉内膜中层厚度(IMT)、神经功能缺损评分(NIHSS)均低于治疗前,且B组低于A组,差异有统计学意义(P0.05)。2组患者治疗期间无严重不良反应发生。结论与低剂量相比,高剂量阿托伐他汀改善高龄急性脑梗死患者血脂、血管内皮功能效果更优,可减轻神经缺损程度,且具有一定安全性。     

阿托伐他汀对脑梗死患者血管内皮舒张功能的影响

目的评价阿托伐他汀对脑梗死患者血管内皮舒张功能的影响。方法将84例病程3个月以上的动脉粥样硬化性脑梗死患者随机分为阿托伐他汀治疗的研究组（44例）和对照组（40例）,观察治疗12周前后应用高频超声检测肱动脉血流介导的舒张功能及血中一氧化氮浓度变化。结果研究组治疗后血管内皮依赖性舒张功能明显改善（P〈0．01）,一氧化氮浓度显著增加（P〈0．01）,而对照组治疗前后比较差异无显著性（P〉0．05）。结论脑梗死患者应用阿托伐他汀降脂治疗同时可改善血管内皮舒张功能。     

不同剂量阿托伐他汀和停服后对肥胖高胆固醇血症患者血管内皮功能和炎症因子的影响

目的:研究在肥胖高胆固醇血症患者中应用不同剂量阿托伐他汀及停服后对血管内皮功能和炎症因子的影响,探讨其可能的机制。方法:观察入选的55名肥胖高胆固醇血症患者和58名健康者肱动脉内皮依赖性舒张功能,并检测血清中NO,可溶性E-选择素(SE)及高敏C反应蛋白(hs-CRP)含量的变化。将55名肥胖高胆固醇血症患者随机双盲分成两组:A组27例,在常规饮食控制基础上予阿托伐他汀10 mg/d;B组28例,在常规饮食控制基础上予阿托伐他汀20 mg/d。8周1疗程,观察两组治疗前、治疗后及停药1周后上述指标及血脂的变化。结果:阿托伐他汀治疗8周后可明显降低肥胖高胆固醇血症患者总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、SE和hs-CRP水平(均P0.01),明显提高NO水平(P0.01),改善肱动脉内皮依赖性舒张功能(P0.05或P0.01);其中B组较A组上述改变更显著(P0.05)。停药1周后两组TC和LDL-C水平均较治疗8周时明显升高(P0.05),但仍低于治疗前水平(P0.05或P0.01);两组NO和肱动脉内皮依赖性舒张功能均明显下降,恢复至治疗前水平(P0.05),两组SE和hs-CRP均明显升高,也恢复至治疗前水平(P0.05)。结论:对肥胖高胆固醇血症患者应用阿托伐他汀20 mg/d较10 mg/d更能有效控制血脂水平,改善内皮功能和抑制炎症反应。而突然终止阿托伐他汀治疗可在1周内完全逆转该药对血管内皮功能的改善作用和炎症反应的抑制作用,停药对血管内皮功能和炎症因子的影响是非胆固醇依赖性作用。     

阿托伐他汀联合硝苯地平控释片治疗老年高血压的疗效观察

目的观察硝苯地平控释片联合阿托伐他汀治疗老年高血压患者的疗效。方法选取老年高血压病患者156例,随机分为降压治疗组及联合治疗组,降压治疗组给予硝苯地平控释30mg治疗,联合治疗组在降压治疗组的基础上给予20mg阿托伐他汀治疗,治疗12周。治疗前后检测患者血压、血脂,并用高分辨率超声测定患者反应性充血和含服硝酸甘油后肱动脉内径变化。结果与治疗前比较,两组的血压均显著下降（P〈0．05）,但组间比较无统计学意义（P〉0．05）。血清总胆固醇及低密度脂蛋白治疗后联合治疗组明显降低,而降压治疗组不明显血管内皮依赖性舒张功能指标（FMD）两组用药前后比较均有统计学意义,组间比较联合治疗组FMD改善程度显著优于降压治疗组,两组非依赖性血管内皮舒张功能用药前后比较均无显著统计学差异。结论硝苯地平控释片可以显著的降低老年高血压患者血压,联合阿托伐他汀治疗后,可以进一步的降低血脂,改善内皮细胞功能,降低老年高血压患者的危险因素,减少冠心病、脑卒中等心脑血管并发症的发生。     

终止他汀治疗对心脏术后患者肱动脉内皮功能的影响

目的观察终止阿托伐他汀治疗对冠状动脉旁路手术患者术后血脂水平以及肱动脉内皮功能的影响。方法2i例冠心病患者术前服用阿托伐他汀钙片（20mg／d）,于术后短期停药,分别检测术前及术后不同时间点肱动脉直径、反应性充血血流量并测定血清一氧化氮（N0）、血浆内皮素以及血脂的变化。结果术后停药与停药前比较,肱动脉血流介导的血管舒张反应（FMD）明显减小（6．3±0．2）％VS（11．2±0．5）％,肱动脉反应性充血血流量减低（4i2．6±50．4）％VS（568．7±47．6）％（均P〈0．05）;血清NO减少,内皮素增加（P〈0．05）。结论冠状动脉旁路手术患者术后停用他汀治疗可损伤内皮依赖性舒张功能,建议术后早期恢复他汀治疗。     

前列地尔对血管内皮保护作用的实验研究

目的：观察前列地尔（PGE1）短期干预对高脂饮食兔动脉粥样硬化（AS）及血管内皮功能的影响.方法：日本大耳白兔24只随机分为空白对照组、高脂对照组、氟伐他汀组、前列地尔组.于实验第8、12周测定一氧化氮（NO）与内皮素（ET）,并对主动脉进行组织形态学观察.结果：氟伐他汀及前列地尔干预4周后,与高脂对照组比较,NO明显升高（P〈0.01）,ET明显下降（P〈0.01）,而两组之间无明显差异（P〉0.05）.结论：前列地尔通过升高血清NO、降低ET抑制AS斑块形成.     

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.