定量组织速度成像测定二尖瓣环运动速度对尿毒症患者左心舒张功能的评价

目的应用定量组织速度成像(QTVI)测定二尖瓣环运动速度评价尿毒症病患者左室舒张功能。方法应用定量组织速度成像测定30例正常人和32例尿毒症患者的二尖瓣环舒张早期峰值速度(Ve)、左房收缩期峰值速度(Va),计算Ve/Va比值;并用脉冲多普勒测定二尖瓣口舒张早期峰值血流速度E峰、舒张晚期峰值血流速度A峰,计算E/A值。结果正常组舒张早期峰值速度(E)>左房收缩期峰值速度(A),E/A>1;二尖瓣环舒张早期峰值速度(Ve)>左房收缩期峰值速度(Va),Ve/Va>1,正常组与尿毒症患者组二尖瓣口血流频谱及二尖瓣环运动组织速度成像测值有显著性差异,尿毒症患者组中二尖瓣环运动速度Ve/Va与二尖瓣血流频谱V/A无显著性差异。但在检出病例数中QTVI阳性例数明显高于血流频谱。结论应用定量组织速度成像测定二尖瓣口运动速度能较准确估计尿毒症患者左室舒张功能。     

组织多普勒超声心动图对扩张型心肌病患者急性左心功能衰竭的研究

目的 应用组织多普勒超声心动图定量分析心肌运动状态与扩张型心肌病患者急性左心功能衰竭的关系.方法 25例扩张型心肌病患者分为急性左心功能衰竭组(Ⅰ a组)与慢性左心功能不全组(Ⅰ b组),正常对照组20例.频谱多普勒超声心动图测量二尖瓣舒张早期血流速度(E峰)与舒张晚期血流速度(A峰)及E峰减速时间、E/A比值.组织频谱多普勒超声心动图测量二尖瓣环收缩期心肌运动速度(s峰)、舒张早期心肌运动速度(e峰)及舒张晚期心肌运动速度(a峰)与s/e比值.结果 在正常对照组中,Ve大于Vs;在伴有急性左心衰竭扩心病患者中,Vs减低不明显,而Ve、Va则明显减低,Vs/Ve比值增高.且随着临床症状改善,Ve值明显增高.在慢性左心功能衰竭扩心病患者组中,Ve、Va明显高于Vs,Vs/Ve比值小于1.结论 在扩张型心肌病患者中,导致急性左心功能衰竭的原因是由于心肌舒张功能损害,而不是心肌收缩功能减低.     

多普勒组织成像评价高血压病患者左室舒张功能

目的　探讨应用多普勒组织成像 (DTI)技术检测二尖瓣环运动速度评估原发性高血压病左室舒张功能的应用价值。方法　应用DTI技术 ,对 5 6例原发性高血压病患者和 5 0例正常对照者二尖瓣环运动速度进行测定 ,并与常规多普勒超声心动图检查结果对照分析。结果　与正常组相比 ,高血压病患者收缩期DTI速度峰值 (S)差异无显著性意义 ,舒张早期DTI速度峰值 (Ve)显著减低 (P <0 .0 5 ) ,舒张晚期DTI速度峰值 (Va)无显著变化 ,舒张早期与舒张晚期DTI速度峰值的比值 (Ve Va)显著减低 (P <0 .0 5 )。Ve Va值与二尖瓣血流频谱E A值之间存在高度相关性。结论　DTI技术检测二尖瓣环舒张期运动速度参数可用于无创评价原发性高血压病左室舒张功能。     

定量组织速度成像评价二尖瓣置换术后左、右心室长轴方向运动特点

目的 通过定量组织速度成像评价二尖瓣置换术后左、右心室长轴方向运动特点.方法 二尖瓣置换术的患者60例分为A、B两组,A组患者35例于二尖瓣置换术同期行三尖瓣人工瓣环成形术,B组患者25例为二尖瓣置换术同期未行三尖瓣手术,另选取健康对照组20例.分别于术前、术后2周通过超声心动图测量左室射血分数(LVEF)和右室射血分数(RVEF),定量组织速度成像测量二、三尖瓣环收缩期峰值速度(Vs).舒张早期峰值速度(Ve),舒张晚期峰值速度(Va)和收缩期位移(Ds).结果 A组与B组术前二尖瓣环Vs、Va、Ds及LVEF与对照组相比均显著减低,术后Vs、Ve、Va及LVEF均较术前减低(P＜0.05);A组术前三尖瓣环Vs、Va、Ds及RVEF与对照组相比均显著减低,术后A组与B组三尖瓣环Vs、Ve、Va、Ds均较术前减低(P＜0.05),而RVEF虽有所减低,但差异无统计学意义(P＞0.05);A组术前二、三尖瓣环Ve/Va＞1,术后Ve/Va＜1;B组术前Ve/Va＜1,术后Ve/Va＞1.结论 二失瓣置换术的患者术后左、右室长轴方向收缩运动均减低,术后LVEF减低,而RVEF无显著减低;二尖瓣置换术患者术后左、右心室舒张功能发生改变.     

定量组织速度成像对糖尿病下肢动脉病变患者左室收缩及舒张功能的评价

目的 应用定量组织速度成像(QTVI)评价糖尿病下肢动脉病变患者左心室收缩及舒张功能.方法 选取糖尿病下肢动脉病变患者50例及正常对照组50例,应用QTVI技术测量二尖瓣环左心室侧壁、前间隔、前壁、下壁、后间隔、后壁二尖瓣水平的收缩期(Vs)、舒张早期(Ve)、舒张晚期(Va)室壁峰值运动速度,比较糖尿病组及正常组的差异,并进行统计学分析.结果 糖尿病下肢动脉病变组Ve低于正常组,二者有统计学意义(P＜0.05),Vs低于对照组,Va高于对照组,但无显著性差异(P＞0.05).Ve/Va明显低于正常组,二者有统计学意义(P＜0.001).结论 QTVI为定量评价糖尿病下肢动脉病变患者左室收缩及舒张功能提供了一种准确实用的新方法.     

定量组织多普勒技术在评价早期2型糖尿病左心室舒缩功能中的临床应用

目的探讨组织多普勒成像(TDI)技术在评价早期2型糖尿病患者(T2DM)左室功能方面的临床应用价值。方法对早期T2DM患者(T2DM组)及正常组(NC组)各45例,应用TDI技术检测二尖瓣环左室壁侧运动频谱,测量收缩期、舒张早期、舒张晚期运动峰值(分别为Vs、Ve、Va),并计算Ve/Va;应用脉冲多普勒(PDE)检测二尖瓣口血流频谱,测量二尖瓣口舒张早期、舒张晚期血流速度(分别为E、A),并计算E/A;常规超声心动图用Simpson′s法测量左室射血分数(LVEF)。结果收缩功能指标:T2DM组与NC组的LVEF均在正常范围,差异无统计学意义(P>0.05),而T2DM组二尖瓣环室壁侧Vs低于NC组(P<0.05)。舒张功能指标:T2DM组Ve、Ve/Va、E/A均低于NC组(P均<0.05);T2DM组Va、A均高于NC组(P均<0.05);T2DM组舒张功能异常检出率TDI法为51.1%,高于PDE法的26.7%(P<0.01)。结论 T2DM患者早期即存在舒张、收缩功能异常,TDI技术测量二尖瓣环运动速度可为评价左心室功能提供新的、更为敏感的定量指标。     

定量组织速度成像测量二尖瓣环运动速度

目的　应用定量组织速度成像测量二尖瓣环运动速度评价扩张型心肌病患者左室舒张功能。方法　定量组织速度成像测量 14例正常人和 14例扩张型心肌病患者二尖瓣环 6个节段 (后间隔和侧壁、前间隔和后壁、前壁和下壁 )舒张早期峰值速度Ve、左房收缩期峰值速度Va ,计算Ve Va ;多普勒超声心动图测量二尖瓣口血流快速充盈速度E峰、左房收缩充盈速度A峰 ,计算E A值。结果　正常人和扩张型心肌病患者两组间E A无显著统计学差异 ,而扩张型心肌病组二尖瓣环平均Ve Va、平均Ve较正常组显著减低 (Ve Va :0 .89± 0 .11vs 1.76± 0 .76,P =0 .0 0 1;Ve :-4 .79± 2 .2 2vs -8.42± 2 .2 7,P<0 .0 0 0 1) ;正常组中二尖瓣环平均Ve Va与E A显著相关 (r =0 .63 ,P =0 .0 0 8) ,而扩张型心肌病组二尖瓣环平均Ve Va与E A无显著相关。结论　扩张型心肌病患者二尖瓣口血流频谱表现为假性正常化 ,定量组织速度成像测量二尖瓣环运动速度可准确评价其左室舒张功能。     

定量组织速度成像对扩张型心肌病患者左心室舒缩功能的研究

目的探讨定量组织速度成像评价扩张型心肌病患者左心室局部舒缩功能的价值。方法采集30例正常人和30例扩张型心肌病患者的动态组织多普勒图像后，分别测量其不同心肌节段在收缩期、舒张早期和舒张晚期的峰值速度；用二维超声心动图方法测量左室射血分数（LVEF）。结果扩张型心肌病组收缩期峰值速度（Vs）、舒张早期峰值速度（Ve）、舒张晚期峰值速度（Va）及舒张早期与舒张晚期峰值速度之比（Ve／Va）明显低于正常组；二尖瓣环水平的平均Vs与LVEF显著相关（r=0．571，P=0．009）。结论定量组织速度成像可快速、直观、无创性定量评价扩张型心肌病患者左心室舒缩功能。     

定量组织速度成像评价急性心肌梗死后不同时段左心室功能

目的:应用定量组织速度成像技术对急性心肌梗死后不同时段的二尖瓣环运动进行检测,探讨定量组织速度成像评价再灌注治疗急性心肌梗死疗效的临床应用价值。方法:对60例初次急性前壁心肌梗死患者(心梗后再灌注治疗28例,未再灌注治疗32例)和年龄匹配的健康人25例应用定量组织速度成像技术分别测量、计算二尖瓣环的收缩期、舒张早期和舒张中晚期平均峰值运动速度(Vs,Ve,Va)。测量左室射血分数(LVEF)、左室短轴缩短率(FS)和二尖瓣血流速度(E,A),LVEF采用Simpson's原理。急性心肌梗死患者分别于发病后第2周、4周、12周进行上述测量。比较分析再灌注治疗对急性心肌梗死患者左室功能的短期影响。结果:再灌注组12周死亡率为0,未再通组12周死亡率为15.6%。Vs与LVEF呈显著正相关(r=0.76,P<0.01);Ve/Va与二尖瓣口血流速度E/A显著正相关(r=0.68,P<0.01)。急性心肌梗死患者发病后第2,4,12周Vs,Ve,Va,LVEF,FS,Ve/Va,E/A均低于对照组(P<0.05～0.01);再灌注组2,4,12周Vs,Ve,LVEF,FS,Ve/Va均显著优于未再灌注组(P<0.05～0.01);再灌注组4,12周Vs,Ve,LVEF,FS,Ve/Va与2周时比较有显著改善(P<0.05～0.01);未再灌注组12周Vs,Ve,LVEF,FS与2周时比较有显著改善(P均<0.05),而4周与2周时比较无显著差异(P>0.05)。结论:QTVI测量二尖     

脉冲组织多普勒显像评价原发性高血压病患者右室舒张功能

目的：应用脉冲组织多普勒显像技术检．禳3三尖瓣环舒张期运动速度，结合三尖瓣血流频谱，评价高血压痛患者右室舒张功能。方法：应用脉冲血流多普勒测量50例原发性高血压患者（高血压组）和50例健康人（对照组）舒张早期三尖瓣血流峰值速度（e），舒张晚期峰值速度（a），并计算e／a。应用脉冲组织多普勒测量三尖瓣瓣环舒张早期峰值速度（Ve）、舒张晚期峰值速度（Va），并计算Ve／va。结果：高血压组e、e／a、Ve和Ve／Va均较对照组显著减低（均P〈005）；高血压组的a及Va均高于对照组（均P〈0．05）。结论：高血压可引起右室舒张功能减低，组织多普勒显像能够评价高血压病患者右室舒张功能。     

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.