血清分离胶对生化指标测定的临床应用研究

目的 本文主要通过比较血清分离胶对12项生化指标测定结果的影响及其检测结果稳定性的动态分析，广泛提高血清分离胶在临床检验工作中的使用率。方法 采用血清分离胶真空采血管(检测组)与传统的普通玻璃采血管(对照组)进行随机采样，采集同一供血者血样标本，观察血清分离时间及其离心情况；并对12项生化指标测定结果分析比较；同时对检测结果的稳定性分析比较。结果血清分离胶真空采血管能明显缩短了血清析出时间，检测组与对照组血清生化指标测定结果经统计学处理比较均无显著性差异(t检验，P＞0．05)，表明分离胶的加入不影响血清各成份的含量；添加分离胶能有效的将血球与血清隔离，0小时测定结果与4℃放置24小时、48小时测定结果经统计学处理比较无显著性差异(t检验，P＞0．05)。结论 血清分离胶可用于对非抗凝血标本的血清分离，可以保持被分离血清各成份的性状，并且还可以保持血清各成份的稳定性，在临床检验中有很广泛的用途。     

血清分离胶在急诊生化检验中的临床应用观察

目的 探讨血清分离胶对24项常用急诊生化指标检测结果的影响以及保存标本2,4小时后检测结果的稳定性观察.方法 采用血清分离胶真空采血管与传统普通试管随机同时采集同一供血者的血液,观察其血液凝固时间和血清分离情况,并对两种方法分离的血清即时和室温24小时后使用VITROS 350干式生化分析仪分别检测24项常用急诊生化指标的结果进行比较和分析.结果 分离胶真空采血管能明显缩短血液凝固和血清析出时间,两种采血管分离的血清24项急诊生化指标20项检测结果有良好的相关性(P>0.05),有4项检测结果有统计学意叉(P<0.05);室温放置24小时后测定结果,分离胶真空采血管有11项指标无统计学意义(p>0.05),有13项指标有统计学意义(其中9项p<0.05,4项p<0.01),普通试管有11项指标无统计学意义(p>0.05),有13项指标有统计学意义(其中4项p<0.05,9项p<0.01).结论 血清分离胶可用于急诊生化检验,它能够加快血清分离的速度和保持血清各种成份的稳定性.     

分离胶制备的血清对常规生化指标测定结果的影响

目的：观察分离胶制备的血清对有关生化指标测定结果的影响。方法：在全自动生化分析仪上，对分离胶分离的血清各项生化指标进行测定，并对测得结果与常法分离的血清进行比较和评价。结果：分离胶血清与常法血清的绝大多数生化指标测定结果具有良好的可比性。结论：选择各种真空采血管必须进行各项生化指标比较，判断其是否适合临床检验工作质量要求，并使用新鲜的样本，这是检验结果的准确性和可靠性的保证。     

分离胶采血管与普通真空管对血液生化指标影响的差异性研究

目的观察分离胶采血管与普通真空管对血液生化指标影响及其差异。方法分别用分离胶采血管和普通真空采血管采集同一供者的血液,然后分离血清或直接冷藏保存,然后在不同时间点（1h内到7d）进行K、Na、C1、C02、Glu、Ca、Bun和Cre8项生化指标检测,对检测结果进行比较分析。结果1h内测定8项血清生化指标,经统计学分析,两种采血管无显著性差异;但随着时间的延长,K、Na、C1、CO2、Glu检测结果存在显著性差异,而Ca、Bun、Cre测定结果均无显著性差异。结论分离胶采血管和普通真空管在短时间对血液的生化检测影响无大的差别,但分离胶采血管在长时间保持血液中某些生化成分的稳定性方面更好。     

血清分离胶真空采血管与普通促凝干燥管使用结果比较

目的观察两种采血管分离血清进行临床生化检验项目检测的结果是否存在差异。方法采用血清分离胶真空采血管（检测组）与普通促凝干燥管（对照组）进行随机采样,采集同一供血者的血样标本,一针两管,分离血清,即时进行临床生化指标的测定,并对测定结果进行分析比较。结果检测组与对照组分离血清在临床生化检验分析中差异无统计学意义。结论用血清分离胶试管与普通促凝干燥管分离的血清在临床生化检验指标上有较好的符合性,血清分离胶试管可为检验科提供最佳品质的检测标本,使检验报告更精确。     

氟化钠抗凝管与分离胶真空采血管在血糖中的应用评价

目的 探讨氟化钠抗凝管与分离胶真空采血管对保存标本血糖检测的稳定性.方法 同一体检者分别抽取氟化钠抗凝管与分离胶真空采血管静脉血各1支,连续测定即时及24、48、72、96、120、144 h血糖浓度,观察两种采血管保存标本不同时间段血糖浓度的变化.结果 检测即时及24、48、72、96、120、144 h氟化钠抗凝管与分离胶真空采血管中血糖浓度,两种采血管之间结果差异无统计学意义(P>0.05);同时分别对两种采血管即时与144 h血糖浓度进行比较,结果显示两者差异无统计学意义(P>0.05).结论 以氟化钠抗凝管与分离胶真空采血管保存的血液标本血糖浓度具有较好的稳定性.     

不同方法制备的血清(浆)对常规生化检测的影响

目的 观察不同方法制备的血清(浆)对常规生化指标检测结果的影响.方法 在全自动生化分析仪上,对分离胶储血管分离的血清,肝素抗凝血浆的35项常规生化指标进行测定,并对检测结果与常规分离的血清进行比较和分析.结果 分离胶储血管制备的血清,肝素抗凝血浆与常法血清的绝大多数生化指标测定结果具有良好的可比性,肝素抗凝血浆不能用于AFU(α-L岩藻糖苷酶)的检测.结论 为了保证检验结果的准确性和可靠性,在用分离胶储血管制备的血清和肝素抗凝血浆进行各项生化指标的检测时,应对各项生化指标进行比较,才能判断其是否适合临床检验工作质量要求.     

血清分离胶技术在生化检验中的应用分析

血清分离胶是一种由数种化合物组成之半固体惰性胶 ,其比重约在 1.0 3,血细胞的比重在 1.0 4～ 1.0 5之间 ,三者离心后将分离成血细胞 (上层 )、分离胶 (中层 )及血细胞下层 )。分离胶能隔离血清与血细胞的接触 ,从而保证了血清的纯净度 ,并且血清分离胶又具有快速分离血清的优点 ,在生化检验中具有很好的应用前景。由于分离胶血清与普通血清在生化检验指标的差异性国内文献报道较少 ,所以我们做了实验对比分析 ,现报道如下。1　材料和方法1 1　血清标本的采集　用血清分离胶真空采血管 (奥地利产品 )和普通真空采血管 (江西益康产品 )一次…     

分离胶促凝管与普通干燥管在生化分析中的差异性研究

目的用分离胶促凝管分离的血清与普通干燥管分离的血清进行生化项目的检测,将得到的结果进行比对、分析。方法采用分离胶真空采血管（检测组）与普通干燥采血管（对照组）进行随机采样,采集同一供血者的血样标本,一针两管,分离血清,即时进行生化指标的检测,对测定的结果进行分析比较;检测组原管置4℃24h后再一次对其进行检测,并将检测结果与即时分离胶分离的血清检测结果进行分析比较。结果检测组血清与对照组血清生化指标差异无统计学意义,置4℃24h后分离胶血清和即时分离胶血清测定结果比较,绝大部分生化指标差异无统计学意义,有较好的符合性,仅有一小部分生化指标差异有统计学意义。结论用分离胶促凝管分离的血清与普通干燥管分离的血清在临床检验指标上有较好的符合性,血液分离胶促凝管可以帮助检验科提供最佳品质的检测标本,使检验报告更精确。     

3种真空采血管在临床生化检验中的应用和评价

目的观察3种真空采血管采集、保存样品对生化检验结果的影响,评价其在临床检验中的应用价值。方法(1)收集30例受检者的分离胶促凝真空管、无添加剂真空管以及不含分离胶的普通促凝真空管制备血清,采用东芝TBA-120FR全自动生化分析仪进行29项常规生化项目检测,分析结果差异有无统计学意义;(2)对2～8℃冰箱保存的分离胶促凝管原管血清30例,分别于第1、3、5、7、9、12、15天测定9项血清酶类和血糖,观察其活性和稳定性。结果(1)3种真空采血管在多数生化检验项目上的结果比较,差异无统计学意义(P0.05),但普通促凝真空管在血清钾、乳酸脱氢酶(LDH)、羟丁酸脱氢酶(HBDH)上与分离胶促凝真空管和无添加剂真空管组间比较差异有统计学意义(P0.05);(2)保存于分离胶促凝管的各种酶活性和血糖在15d内(LDH在9d内)比较差异无统计学意义(P0.05)。结论(1)临床实验室有必要对所采用的真空采血管进行某些指标的比对实验,判断其是否适合临床检验工作质量要求。(2)分离胶促凝管原管血清在2～8℃冰箱可以长期保存不影响酶类活性和可防止血液离体后的糖酵解。     

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.     

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.     

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.     

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.