中西医结合治疗老年人下呼吸道感染疗效观察

目的　观察清热化痰汤结合头孢哌酮 舒巴坦抗感染治疗老年人下呼吸道感染的临床疗效。方法　所选病例随机分为两组 ,治疗组 35例 ,年龄 71～ 90岁 ,平均年龄 (81 3± 6 2 )岁。对照组 32例 ,年龄 70～ 92岁 ,平均年龄 (81 6± 8 0 )岁。治疗组与对照组均用头孢哌酮 舒巴坦 2 0 g ,每天 2次静脉滴注。治疗组另加中药汤剂清热化痰汤。疗程均为 7～ 14d。结果　治疗组和对照组有效率分别为 94 3%和 71 9% ,两组疗效比较差异有显著意义 (P <0 0 5 )。细菌清除率分别为 89 2 %和 70 0 % (P <0 0 5 )。结论　中西医结合治疗老年人下呼吸道感染可提高临床疗效及细菌清除率。     

阿莫西林/舒巴坦钠治疗急性细菌性感染的随机对照多中心临床研究

目的评价阿莫西林/舒巴坦钠治疗急性细菌性感染的有效性和安全性.方法以氨苄西林/舒巴坦钠为对照,采用多中心随机对照临床试验治疗急性细菌性感染113例,其中试验组58例、对照组55例.阿莫西林/舒巴坦钠每日4.5-6.0g、氨苄西林/舒巴坦钠每日4.5-12.0g,两药均分次静脉滴注,疗程7-14日.结果试验组与对照组的痊愈率和有效率分别为75.86%与80.0%(P＞0.05)和94.83%与98.18%(P＞0.05).两组细菌产酶率分别为67.35%与69.57%(P＞0.05).细菌清除率分别为93.88%与95.65%.两组均未见严重不良反应.结论阿莫西林/舒巴坦钠治疗急性细菌性感染临床疗效确切,使用安全.     

头孢哌酮／舒巴坦治疗急性细菌性感染的疗效与安全性评价

目的：评价头孢哌酮／舒巴坦治疗急性细菌性感染的临床疗效与安全性。方法：123例明确诊断的急性细菌性感染的病例随机分为头孢哌酮／舒巴坦治疗组和头孢哌酮对照组，通过观察两组患者的临床疗效、药物敏感性和不良反应，评价头孢哌酮／舒巴坦治疗急性细菌性感染的临床疗效与安全性。结果：头孢哌酮／舒巴坦组和头孢哌酮组的有效率分别为91．9％和67．2毙；不良反应发生率分别为6．45％和4．92％；未发现严重不良反应。纸片药敏试验结果表明，对头孢哌酮／舒巴坦和头孢哌酮的细菌敏感率分别为95．4％和70．9茗。结论：头孢哌酮／舒巴坦治疗急性细菌性感染临床疗效好，比较安全。     

头孢哌酮／舒巴坦治疗下呼吸道感染

目的 评价头孢哌酮/舒巴坦治疗下呼吸道感染的临床疗效及安全性.方法 采用回顾性研究分析方法,分析2004年6月至2006年12月我院内科50例下呼吸道感染患者使用头孢哌酮/舒巴坦治疗的资料.结果 头孢哌酮/舒巴坦治疗有效率为82.0%,细菌清除率为94.1%,对细菌的敏感率为82.4%,不良反应发生率2.0%.结论 头孢哌酮/舒巴坦治疗下呼吸道感染安全、有效、不良反应低.     

哌拉西林钠-舒巴坦钠治疗细菌性感染临床分析

目的 分析哌拉西林钠-舒巴坦钠治疗细菌性感染的临床效果和安全性,并探讨其经济学效果.方法 将外科细菌性感染的141例随机分为哌拉西林钠-舒巴坦钠组(观察组)(n =70)和哌拉西林钠-他唑巴坦钠组(对照组)(n=71),观察组与对照组分别静脉滴注上述药物3.0 g,每日2次,疗程5～14d.比较两组的临床效果,并运用成本-效果分析法分析其经济学效果.结果 观察组与对照组痊愈率分别为65.71%和64.79%,总有效率分别为91.43%和90.14%,不良反应发生率为2.86%和4.23%,两组比较差异均无统计学意义(P>0.05),而观察组的成本较低.结论 普外科细菌性感染应用哌拉西林钠-舒巴坦钠治疗安全、有效、经济.     

头孢菌素类抗生素的临床应用观察

目的观察头孢菌素类抗生素的临床应用效果。方法选择2008年2月~2011年3月在我院接受治疗的下呼吸道感染患者100例,随机分成观察组和对照组各50例,观察组患者采用头孢哌酮舒巴坦钠治疗,对照组患者采用头孢曲松钠治疗,观察比较两组的临床治疗效果。结果观察组的总有效率为92%,明显高于对照组的84%,差异具有统计学意义(P<0.05)。观察组发现1例患者用药后2d出现恶心、皮肤瘙痒,1例出现腹泻,均处理后转好;对照组2例出现恶心、皮肤瘙痒,1例用药后出现转氨酶升高,治疗后转好。结论对于下呼吸道感染患者,利用头孢哌酮舒巴坦钠抗菌治疗,效果理想,无严重的不良反应,值得进一步推广使用。     

美罗培南与亚胺培南/西司他汀治疗重度呼吸道感染的效果比较

目的比较美罗培南与亚胺培南/西司他汀治疗重度呼吸道感染的效果。方法选取重度呼吸道感染患者120例,随机分为观察组与对照组各60例。2组均给予内科对症支持治疗,观察组给予美罗培南治疗,对照组给予亚胺培南/西司他汀治疗。比较2组患者的疗效、菌株清除率及不良反应发生情况。结果观察组总有效率93. 3%,细菌清除率87. 8%,不良反应发生率6. 7%;对照组总有效率90. 0%,细菌清除率84. 6%,不良反应发生率8. 3%。2组患者上述指标比较,差异均无统计学意义(P 0. 05)。结论美罗培南与亚胺培南/西司他汀治疗重度呼吸道感染疗效相近,安全性高。     

头孢哌酮/舒巴坦与亚胺培南/西司他丁治疗慢性阻塞性肺疾病继发严重下呼吸道感染比较

目的比较头孢哌酮 /舒巴坦 (海舒必 )与亚胺培南 /西司他丁 (泰能 )对COPD继发严重下呼吸道感染的疗效。方法回顾性分析 88例COPD继发严重下呼吸道感染患者 ,随机分为 2组 ,4 5例用头孢哌酮 /舒巴坦 2 .0 g加 5 %葡萄糖10 0ml静滴 ,每 12小时 1次 ;4 3例用亚胺培南 /西司他丁 0 .5 g加 5 %葡萄糖 10 0ml静滴 ,每 8小时 1次 ;均 7～ 10天为一疗程。结果头孢哌酮 /舒巴坦组临床有效率 91.1% ,痊愈率 71.1% ;亚胺培南 /西司他丁组临床有效率 93.0 % ,痊愈率 74 .4 % ,两组比较无统计学意义 (P >0 .0 5 )。结果头孢哌酮 /舒巴坦与亚胺培南 /西司他丁治疗COPD继发严重下呼吸道感染疗效相同。     

注射用阿莫西林-舒巴坦治疗下呼吸道细菌感染的临床随机对照试验

目的 :评价注射用阿莫西林 舒巴坦治疗常见致病菌引起的中、重度急性下呼吸道细菌感染性疾病的临床疗效和安全性。方法 :通过以氨苄西林 舒巴坦为对照药 ,采用双盲随机对照平行试验设计 ,入选病例 4 4例 ,剔除 3例 ,中辍 1例 ,共完成4 0例。其中急性支气管炎 2 2例 ,肺炎 1 8例。试验组 (1 9例 )应用注射用阿莫西林 舒巴坦 ,2 .2 5 g/次 ,2 /d静脉滴注 ,对照组(2 1例 )应用氨苄西林 舒巴坦 ,2 .2 5g/次 ,2 /d静脉滴注 ,疗程均为 7～ 1 4d。结果 :试验组与对照组入选病例基本情况、病情程度差异无统计学意义。阿莫西林 舒巴坦治疗组的痊愈率和有效率分别为 6 8.4 %、89.5 % ,与氨苄西林 舒巴坦对照组差异无统计学意义 (痊愈率和有效率分别为 4 2 .9%、95 .2 % ,P >0 .0 5 )。阿莫西林 舒巴坦对分离细菌的清除率为 87.5 % ,氨苄西林 舒巴坦组为 90 .0 % ,两组细菌清除率的差异无显著性。应用注射用阿莫西林 舒巴坦未见严重不良反应 ,仅发生皮疹 3例、恶心 1例 ,发生率为 1 9.1 % (4 /2 1 ) ,对照组皮疹 1例、恶心 1例 ,8.7% (2 /2 3) ,其差异无显著性 (P >0 .0 5 )。结论 :阿莫西林 舒巴坦对临床常见致病菌引起的中、重度下呼吸道感染 ,尤其是产酶菌引起的严重感染 ,临床疗效较好 ,使用安全 ,有较高     

头孢哌酮-三唑巴坦与头孢哌酮-舒巴坦治疗急性细菌性感染随机对照研究

目的：评价国产头孢哌酮-三唑巴坦治疗急性细菌性呼吸道感染、泌尿道感染以及其他系统感染的有效性与安全性。方法：采用区组随机、平行对照、开放研究设计，头孢哌酮-三唑巴坦和头孢哌酮一舒巴坦均为每次给药2．0g，静脉滴注30～60min，每日2次或3次，疗程7～14d。结果：本试验共入选病例57例，因各种原因淘汰4例，进入疗效分析的病例数为53例，其中头孢哌酮-三唑巴坦组27例，头孢哌酮-舒巴坦组26例，治疗结束头孢哌酮-三唑巴坦与头孢哌酮-舒巴坦临床有效率分别为96．3％与92．3％，各种致病菌清除率分别为95．8％与90．9％，两组不良反应发生率分别为7．1％与7．4％，上述结果经统计学处理，差异均无显著性。结论：头孢哌酮-三唑巴坦与头孢哌酮-舒巴坦在治疗临床常见的敏感细菌引起的细菌性感染均有效、安全。     

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.