正常中晚孕期胎儿肺静脉血流频谱分析

目的 探讨正常中晚孕期单胎胎儿肺静脉血流频谱特点,建立肺静脉血流参数正常参考值范围.方法 应用彩色多普勒超声检测340例19～40孕周正常单胎胎儿肺静脉血流参数:心室收缩期峰值速度(S)、心室舒张期峰值速度(D)、心房收缩期血流速度(A)、速度时间积分(velocity time integral,VTI)、静脉峰值速度指数(peak velocity index,PVI)、静脉搏动指数(pulsatility index,PI)、心室收缩期峰值速度与心室舒张期峰值速度比值(S/D).结果 肺静脉血流参数S、D、A、VTI随孕龄增大逐渐增高,PVI、PI随孕龄增大逐渐降低,各参数拟合的回归方程均有统计学意义;S/D与孕龄无线性关系.所有病例心房收缩期均无反向血流出现.结论 正常胎儿肺静脉血流频谱形态与成人不同.相关参数正常参考值范围曲线可为评价病理情况下胎儿肺静脉血流变化及心功能改变提供依据.     

正常胎儿静脉血流频谱分析及其临床意义

目的对正常胎儿不同孕周肺静脉、下腔静脉、静脉导管血流频谱进行分析,探讨正常胎儿静脉循环血流动力学变化。方法采用高分辨率血流显像(HDF)技术显示200例20～40周正常胎儿肺静脉、静脉导管及下腔静脉,测量其血流参数:心室收缩期峰值速度(S),心室舒张期峰值速度(D),心房收缩期速度(A)。结果正常胎儿肺静脉、下腔静脉及静脉导管均呈三相波:心室收缩期波峰,心室舒张期波峰及心房收缩期波谷,其中肺静脉及静脉导管频谱前向血流持续整个心动周期,下腔静脉心房收缩期波谷与心室收缩期波峰及心室舒张期波峰呈反向;肺静脉S、D及A随着孕龄的增大而增加(P<0.05);下腔静脉S、D及A在妊娠中早期流速较低,在28周之后流速明显增高(P<0.05);静脉导管S、D及A在孕32+1～36周流速最高(P<0.05);36周后与32+1～36周比较无统计学差异。结论胎儿肺静脉、下腔静脉及静脉导管的流速随着孕周的增加有不同的变化。     

肺静脉血流检测对妊娠高血压疾病胎儿左心舒张功能的评价

目的通过胎儿肺静脉血流参数评价妊娠高血压疾病对胎儿左心舒张功能的影响。方法应用彩色多普勒检测90例妊娠高血压孕妇,及其孕龄匹配的正常孕妇60例胎儿肺静脉频谱,测量肺静脉血流参数:心室收缩期峰值流速S、心室舒张期峰值流速D、心房收缩期峰值速度A、搏动指数(PI)及静脉峰值速度指数(PVIV)。结果重度子痫前期组血流参数A较健康对照组减低,PI、S/A及PVIV增高(P0.01);重度子痫前期组血流参数A较轻度子痫前期组及妊娠高血压组减低,PI、S/A及PVI增高(P0.05);轻度子痫前期组血流参数A较正常组减低,PI、S/A及PVI增高(P0.05)。结论通过对胎儿肺静脉检测能够定性及定量判断胎儿左心舒张功能改变。     

肺静脉血流频谱改变对胎儿心脏异常的诊断价值

目的 探讨肺静脉血流频谱改变对胎儿心脏异常的诊断价值.方法 对206例胎龄为22～38周的胎儿行心脏超声检查,根据胎儿心脏是否正常分为正常组146例和异常组60例,异常组中包括心律失常8例和心脏结构异常52例.检测两组肺静脉血流相关参数:S波(收缩期峰值速度)、D波(舒张期峰值速度)、A波(心房收缩期峰值速度),计算S/D、S/A、(S-A) /D(静脉峰值速度指数),比较两组间上述参数,以上参数与胎龄行线性相关性分析.结果 52例心脏结构异常胎儿中,5例肺静脉频谱A波缺失,9例A波反向;8例房性早搏肺静脉频谱中A波提前出现,打乱正常的A-A间期,A波之后可见一高大的S波.正常组与心脏结构异常组中A波正向病例比较:(S-A) /D差异有统计学意义(P＜0.05),其余参数差异无统计学意义(P＞0.05).(S-A) /D与孕周相关系数为-0.156,P-0.061.结论 肺静脉血流参数可作为评价胎儿心脏异常的一项指标.     

探讨胎儿呼吸样运动对肺静脉血流频谱的影响及临床意义

目的:研究正常胎儿呼吸样运动对肺静脉血流频谱的影响及临床意义。方法:应用彩色多普勒超声诊断系统检测43例27~36周正常胎儿肺静脉血流,测量它们在呼吸样运动中及无呼吸样运动时的血流频谱参数:心室收缩期峰值速度(S),心室舒张期峰值速度(D),心房收缩期峰值速度(A),静脉搏动指数(PIV),静脉峰值速度指数(PVIV)。结果:呼吸样运动时,PIV、PVIV降低,A升高。结论:胎儿呼吸样运动时,胎儿左房压减小,胎儿左室顺应性增加。     

彩超观察胎儿肺静脉在产前二级筛查中的应用

目的探讨彩超观察胎儿肺静脉在产前二级筛查中的应用价值。方法对113例妊娠20～34周孕妇进行常规胎儿产前彩超筛查,重点观测胎儿肺静脉及其血流参数:S波(心室收缩期峰值流速)、D波(心室舒张期峰值流度)、A波(心房收缩期流速),计算S/D值和PVI值〔峰值血流指数,PVI=(S-A)/D〕。将其中100例正常胎儿列入对照组(A组),对比分析其4条肺静脉血流参数;将13例产前彩超筛查有先天性心脏病(CHD)的胎儿列入实验组(B组),比较两组的右下肺静脉血流参数。结果 A组4条肺静脉的S波、D波、S/D及PVI差异均有统计学意义(P<0.05),多数A波表现为正向波,但差异无统计学意义(P>0.05)。B组与A组S波、D波及S/D无显著差异(P>0.05),B组A波均值反转,与A组比较差异显著(P<0.05),PVI明显高于A组(P<0.05)。结论观测肺静脉A波、PVI可作为CHD产前筛查的一项指标。在测量肺静脉血流参数时应选取某一条固定的肺静脉进行测量。     

Tei指数联合肺静脉及静脉导管血流参数评估妊娠期高血压患者胎儿心功能

目的应用组织多普勒成像Tei指数及肺静脉、静脉导管血流参数综合评估妊娠期高血压患者胎儿心功能,为产前评估胎儿心功能提供有价值的信息。方法选取孕周28~41+6周的孕妇193例,妊娠期高血压孕妇69例为疾病组,与其孕龄匹配且血压正常的孕妇124例为对照组。测量胎儿的各项参数:(1)Tei指数。(2)肺静脉及静脉导管:心室收缩期峰值流速S、心室舒张期峰值流速D、心房收缩期峰值流速A,并计算S/A、静脉搏动指数PI、静脉峰值流速指数PVIV。随访所有新生儿生后1min Apgar评分。结果疾病组胎儿左、右心室Tei指数均较对照组增高(P0.05);疾病组胎儿肺静脉及静脉导管血流参数S、D、A均较对照组减低(P0.05);疾病组胎儿肺静脉及静脉导管指数S/A、PI、PVIV均较对照组增高(P0.05);疾病组胎儿出生后窒息率均较对照组增高(P0.05)。结论通过对妊娠期高血压患者胎儿左、右心室Tei指数及肺静脉、静脉导管血流参数的研究,可对胎儿心功能变化进行监测。     

胎儿肺静脉血流频谱在心肺功能评价中的应用

目的 探讨正常妊娠中晚期胎儿肺静脉多普勒血流频谱特征及其在心脏功能评价中的应用价值.方法 86例正常孕23～41周胎儿,应用彩色多普勒超声心动图检测胎儿肺静脉,测量指标包括:右上肺静脉舒张期峰值速度(D)、D波减速时间、D波减速度(Ddec),右上肺静脉收缩期峰值速度(S)、S波加速时间、S波加速度(Sacc),计算Sacc/Ddec值.计算左室Tei指数.结果 D波峰值速度、减速时间及Ddec与孕周呈正相关(P ＜0.05);S波峰值速度、S波加速时间及Sacc与孕周无明显相关性.以孕28周分组,孕龄小于28周Sacc/Ddec比值多小于1,大于28周多大于1,组间差异有统计学意义(P＜0.05),一致性检验系数为0.88.Tei指数与孕周呈正相关(P＜0.05).结论 右上肺静脉D波血流速度,D波减速时间及Ddec与心脏整体功能指标有良好的相关性.Sacc/Ddec可以作为反映心脏整体功能与肺组织发育程度的新指标.     

超声心动图对糖尿病孕妇胎儿肺静脉血流频谱的动态研究

目的对糖尿病孕妇胎儿肺静脉血流频谱进行动态观察,并与正常胎儿比较,为糖尿病孕妇胎儿左心室舒张功能评价提供客观依据。方法分别在妊娠20～28周、32～38周,应用胎儿超声心动图观察34例糖尿病孕妇和54例正常孕妇的胎儿心脏结构。探测胎儿肺静脉、二尖瓣血流,测量肺静脉S波(收缩期峰值速度)、D波(舒张期峰值速度)、A谷(心房收缩波速度),二尖瓣E峰速度、A峰速度,并计算肺静脉S/D值及二尖瓣E/A值。结果无论在中孕期或晚孕期,研究组肺静脉血流频谱S/D值、A谷速度与正常对照组比较差异有显著性意义(P<0.05),而常规采用的二尖瓣血流E/A值两组间差别无显著性意义(P>0.05)。结论糖尿病孕妇胎儿左室舒张功能在中孕期及晚孕期均已发生改变;胎儿肺静脉血流频谱S/D值、A谷速度较二尖瓣血流E/A值能更敏感地反映胎儿左室舒张功能的变化。     

妊娠高血压疾病胎儿肺静脉血流参数在左心舒张功能评估中的临床价值

目的 探讨妊娠期高血压疾病(HDCP)胎儿肺静脉(PV)血流参数在左心舒张功能评估中的价值。方法 选择我院产科2017年7月至2018年11月收治的HDCP患者137例(疾病组),其中妊娠高血压49例(A组),轻度子痫前期46例(B组),重度子痫前期42例(C组),选择同期于我院产检的健康孕妇40例(对照组)。对各组胎儿进行心脏超声检查,比较各组胎儿PV血流参数,包括心房收缩期峰值流速(A)、心室收缩期峰值流速(S)、心室舒张期峰值流速(D),肺静脉搏动指数(PI)、肺静脉峰值流速指数(PVIV),分析疾病组各血流参数的相关性。并比较疾病组是否发生新生儿窒息胎儿的PV血流参数。结果 疾病组A峰流速低于对照组,PI、PVIV值高于对照组,差异均有统计学意义(P＜0.05);     

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.     

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.     

Molecular characterization of virulence and antimicrobial resistance profile of Shigella species isolated from children with moderate to severe diarrhea in northeastern Brazil

Molecular characterization of virulence and antimicrobial resistance profiles were determined for Shigella species isolated from children with diarrhea in Fortaleza, Brazil. Fecal specimens were collected along with socioeconomic and clinical data from children with moderate to severe diarrhea requiring emergency care. Shigella spp. were isolated by standard microbiological techniques, and we developed 4 multiplex polymerase chain reaction assays to detect 16 virulence-related genes (VRGs). Antimicrobial susceptibility tests were performed using disk diffusion assays. S. flexneri and S. sonnei were the predominant serogroups. S. flexneri was associated with low monthly incomes; more severe disease; higher number of VRGs; and presence of pic, set, and sepA genes. The SepA gene was associated with more intense abdominal pain. S. flexneri was correlated with resistance to ampicillin and chloramphenicol, whereas S. sonnei was associated with resistance to azithromycin. Strains harboring higher numbers of VRGs were associated with resistance to more antimicrobials. We highlight the correlation between presence of S. flexneri and sepA, and increased virulence and suggest a link to socioeconomic change in northeastern Brazil. Additionally, antimicrobial resistance was associated with serogroup specificity in Shigella spp. and increased bacterial VRGs.     

护理干预对面部中重度寻常型痤疮的临床疗效影响分析

目的研究护理干预对面部中重度寻常型痤疮的临床疗效影响。方法选取本院在2014年4月~2016年7月诊治的136例面部中重度寻常型痤疮患者,随机分为研究组与对照组,每组68例;所有患者均依据其情况给予对应的治疗,其中对照组在治疗期间给予常规护理,研究组在对照组的基础上再给予综合性护理干预,比较两组的治疗效果及护理满意度情况等。结果患者在接受治疗和护理后,研究组中度与重度患者的治疗效果较对照组均明显提高(P0.05),研究组护理满意度较对照组明显增高(P0.05)。结论对面部中重度寻常型痤疮患者在其治疗期间给予综合性护理干预,具有良好的效果。