宫颈妊娠的临床观察与护理

目的探讨宫颈妊娠的临床观察与护理.方法回顾性分析宫颈妊娠病例9例,行全子宫切除术3例占33.3%;保守治疗6例,其中行甲胺蝶呤(MTX)全身化疗3例,行5-Fu宫颈局部多点注射化疗1例,行选择性双侧子宫动脉灌注MTX+栓塞术2例,均1周后在B超监视下行钳刮术.结果 6例经保守治疗后血β-HCG明显下降,钳刮顺利,出血很少,效果满意.结论妊娠妇女体检时如出现宫颈增大、子宫正常体征,应考虑宫颈妊娠的可能,宫颈妊娠的保守治疗方法中,全身或局部化疗、子宫动脉栓塞术安全,疗效确切,既避免了手术损伤,也满足了患者的生育要求.采取相应的护理对策对宫颈妊娠安全有效,良好的护理可加速病人康复进程.     

宫颈妊娠16例临床分析

目的探讨宫颈妊娠的诊治方法及治疗效果。方法对2004年1月至2011年12月16例宫颈妊娠患者的临床资料进行回顾性分析,其中A组11例患者予甲氨蝶呤(MTX)联合米非司酮+钳刮术治疗,B组5例患者行介入治疗(子宫动脉化疗灌注加栓塞)+钳刮术。结果有1例患者发生无法控制的出血行子宫全切术,其余患者均保留子宫。结论超声检查对宫颈妊娠的早期诊断有重要价值,甲氨蝶呤联合米非司酮+钳刮术及介入治疗+钳刮术两种保守治疗疗效均可靠。     

子宫动脉栓塞术联合钳刮术治疗宫颈妊娠的效果

目的探讨子宫动脉栓塞术联合钳刮术治疗宫颈妊娠的效果。方法对36例宫颈妊娠病人,行子宫动脉栓塞术联合钳刮术,观察治疗后出血量、血β-人绒毛膜促性腺激素（β-hCG）水平变化及月经恢复时间。结果 36例病人双侧子宫动脉超选择性插管及栓塞成功率均为100%,钳刮术中仅有少量出血,血β-hCG水平术后8-15 d恢复正常,2月后恢复正常月经。结论子宫动脉栓塞术联合钳刮术治疗宫颈妊娠,操作简单,疗效明显。     

宫颈妊娠的诊治分析

阴道B超是宫颈妊娠诊断的首选方法。我院对4例宫颈妊娠患者采用了自凝刀消融诊刮、宫颈局部注射MTX、子宫动脉灌注MTX+子宫动脉栓塞等保守治疗均获得成功。     

宫颈妊娠及子宫瘢痕部位妊娠25例分析

目的探讨宫颈妊娠及子宫瘢痕部位妊娠的临床治疗措施。方法对直接吸刮术,甲氨蝶呤（MTX）化疗后再行吸刮术及血管介入治疗后吸刮术三种方法进行统计分析。结果 5例直接吸刮者有4例出现大出血,8例MTX化疗后吸刮者有2例出现大出血,12例血管介入治疗后吸刮者无1例大出血发生。结论 MTX治疗可有效减少吸刮术中术后出血,术前行双侧子宫动脉栓塞,即血管介入治疗,术后24 h再行B超下吸刮,则可基本杜绝术中术后大出血的可能,实为安全有效的治疗方法。     

超选择性子宫动脉栓塞术在产科治疗中的应用

目的评价超选择性子宫动脉栓塞术在产科治疗中的应用价值。方法对20例患者行超选择性子宫动脉栓塞术,包括产后出血15例、植入性胎盘3例、宫颈妊娠2例。栓塞物均为明胶海绵。结果栓塞治疗产后出血15例,13例即刻止血,2例2~7 d内止血;植入性胎盘3例,2例胎盘组织自动阴道排出,1例经宫腔镜下电切术钳刮干净;宫颈妊娠2例,1例自行阴道排出,1例宫腔镜下钳刮术后阴道流血完全停止。全部患者取得了良好的效果,未出现严重并发症。结论超选择性子宫动脉栓塞术治疗产后出血、植入性胎盘及宫颈妊娠是一种安全、迅速有效的措施。     

宫颈妊娠6例诊断与治疗

目的探讨宫颈妊娠的诊断及治疗的临床效果。方法回顾性分析2003年1月至2008年12月我科收治的6例宫颈妊娠患者的临床资料,采用甲氨蝶呤（MTX）肌肉注射、米非司酮口服、经子宫动脉MTX灌注及栓塞、手术切除子宫。结果 6例宫颈妊娠采用的治疗方法中1例因宫颈妊娠破裂大出血急诊行全子宫切除术,2例应用MTX肌肉注射＋米非司酮口服;1例应用MTX肌肉注射＋米非司酮＋中药;1例单纯经子宫动脉栓塞＋宫腔镜下清宫术;1例应用经子宫动脉MTX灌注及栓塞＋米非司酮;该5例患者经过不同保守治疗均成功。结论甲氨蝶呤杀胚治疗后可免于清宫或有效减少清宫术中出血量。采用甲氨蝶呤、介入及宫腔镜治疗安全有效,可极大限度地保留妇女的生育功能,但应个体化,需要根据血清β-人绒毛膜促性腺激素水平、孕周、是否存在胎心搏动、患者经济条件等具体情况来选择,必要时仍需行全子宫切除术。     

经子宫动脉灌注与栓塞联合宫颈搔刮治疗宫颈妊娠12例分析

目的：分析经子宫动脉化疗药物灌注、栓塞及刮宫术联合应用在宫颈妊娠治疗中的价值。方法：12例宫颈妊娠患者行选择性子宫动脉灌注甲氨蝶呤（MTX）、明胶海绵栓塞,1周内行刮宫术。术后监测-βHCG值的变化、月经恢复时间、并发症等。结果：12例患者均治疗成功,术后顺利行刮宫术,出血量少,术后-βHCG下降,无严重并发症。结论：子宫动脉药物灌注、栓塞术联合刮宫术可减少宫颈妊娠手术的出血,降低手术风险。     

双侧子宫动脉化疗栓塞术治疗宫颈妊娠的临床观察

目的 评估双侧子宫动脉化疗栓塞术（UACE）治疗宫颈妊娠的临床价值.方法 回顾性分析40 例宫颈妊娠患者双侧子宫动脉化疗栓塞前后的临床资料.结果 40 例患者中,8 例患者因宫颈妊娠行清宫术发生阴道大出血而采用急诊子宫动脉化疗栓塞介入治疗,32 例患者采用子宫动脉化疗栓塞序贯超声引导下清宫术治疗.所有存在阴道出血患者于介入术后均停止出血.UACE 术后行清宫术治疗过程中,所有患者均未出现大出血等严重并发症.1个月后复查,所有患者血茁-HCG 均完全降至正常水平.结论 UACE 术可用于宫颈妊娠患者清宫术中大出血的紧急止血治疗,而UACE 术序贯超声引导下清宫术治疗可以作为一种安全有效治疗宫颈妊娠的新策略.     

剖宫产瘢痕部位妊娠治疗方法探讨

目的研究剖宫产瘢痕部位妊娠（CSP）的临床表现及治疗方法,为临床医生提供一种安全有效的治疗方法。方法对23例患者的病史、临床表现,诊断方法及治疗方法进行回顾性分析。结果23例患者都经过彩色多普勒超声检查确诊,6例于外院直接行清宫术,术中大出血而转入我科,其中4例子宫动脉介入栓塞＋米非司酮＋MTX治疗成功,2例切除子宫;17例首诊于我科,1例行子宫全切除术;2例子宫前壁病灶清除术;14例保守治疗成功,其中11例行子宫动脉介入栓塞＋米非司酮＋MTX＋清宫术治疗。3例行米非司酮＋MTX＋清宫术。结论对于有剖宫产史的早孕妇女,宜常规行彩色多普勒超声检查明确诊断,子宫动脉介入栓塞＋米非司酮＋MTX＋清宫术可作为治疗剖宫产瘢痕部位妊娠的主要方法,可有效的避免术中大出血及子宫切除。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.