保鲜袋作为一次性血压计袖带套在血压监测中的应用

目的探讨采用保鲜袋作为血压计袖带套监测血压对血压测量值的影响。方法选取100例患者分别2d采用保鲜袋作为血压计袖带套测量血压并同时使用传统血压计袖带测量血压,采用自身对照法测量血压共400次,比较两种方法测得血压值结果。结果第1种方法先采用保鲜袋作为血压计袖带套测量100例患者血压收缩压、舒张压值分别为（120．92±19．35）,（72．12±15．10）mmHg与后使用传统血压计袖带测量血压收缩压、舒张压值（121．50±18．00）,（70．37±14．00）mmHg比较,差异均无统计学意义（t分别为0．73,0．32;P〉0．05）;第2种方法先用传统方法测量血压100例患者血压收缩压、舒张压值分别为（122．044-15．21）,（74．52±9．96）mmHg与后使用保鲜袋作为血压计袖带套垫测量血压收缩压、舒张压值（122．06±15．26）,（73．86±10．37）mmHg比较,差异均无统计学意义（t分别为0．03,0．06;P〉0．05）。结论采用保鲜袋作为一次性血压计袖带套监测血压,操作简便,符合感染管理要求,不影响血压数值的准确性。     

着衣测量血压对结果的影响

目的探讨血压计袖带缠绕上肢时隔一层衣物对血压测量结果的影响。方法用2种方法分别测量同一组研究对象的右上肢肱动脉血压，2种方法测得的血压值采用配对t检验的方法进行统计学分析。结果2种方法测得的收缩压和舒张压值在统计学上差异均有显著性，隔一层厚度〈0．5cm衣物测得的收缩压和舒张压值均显著高于标准方法测得的血压值（P〈0．01）。收缩压的平均差值为1．54mmHg，舒张压的平均差值为1．01mmHg。结论医护人员在为无血压异常病史的患者测量血压时，可以隔一层厚度〈0．5cm的衣袖缠绕袖带进行测量，这样对血压测量的结果不会有显著影响。对处于高血压或低血压临界值的患者，在测量血压时，一定要按标准方法操作。     

隔衣测量血压对测量值的影响研究

目的：探讨血压计袖带缠绕上肢时隔衣物测量血压对血压测量值的影响。方法：以裸臂法为对照组,隔薄衣法和隔厚衣法为试验组。分别测量同一组研究对象的同侧上肢肱动脉血压,3种方法测得的血压值采用方差分析的方法进行统计学分析。结果：对照组与试验组1（隔薄衣法）测得的收缩压和舒张压值无统计学意义（P〉0.05）。对照组与试验组2（隔厚衣法）测得的收缩压和舒张压值在统计学上差异均有显著性。试验组2测得的收缩压和舒张压值均高于对照组。收缩压的平均差值为4.440mmHg（1 mmHg=0.133 kPa）,差值的95%置信区间为1.408～7.472 mmHg。舒张压的平均差值为4.640 mmHg,差值的95%置信区间为1.365～7.915 mmHg。结论：医护人员在为无血压异常病史的患者测量血压时,可以隔一层厚度〈1 mm的衣袖缠绕袖带进行测量,该方法对血压测量的结果不会有影响。     

不同测量方法和判断标准对血压值的影响研究

[目的]探讨用汞柱式血压计进行不同的血压测量方法、判断标准时血压值的变化。[方法]选择内科病人126例,采用汞柱式血压计通过不同的血压测量和判断方法进行自身对照,比较左右上肢、听诊器胸件置于不同状态时,首次看到水银柱波动值与听到第一声搏动音、变音值与声音消失值血压变化。[结果]左上肢和右上肢的收缩压和舒张压差别有统计学意义;听诊器胸件置于不同状态的收缩压和舒张压也有差异;首次看到水银柱波动和听到第一声搏动音的读数也存在差异;舒张压以第1次变音和声音消失的判断结果也存在差异。[结论]血压测量部位一般选择右上肢,舒张压一般应以消失音(Korotkoff第5期)为准,袖带位置不准确使测得的血压偏低,水银波动值与主动脉压和收缩压的关系有待进一步研究。     

袖带内幅与臂围的比率引起血压值误差的研究

目的:研究袖带内幅与臂围的比率引起血压值误差的规律性。方法:应用不同内幅的袖带测定血压,以袖带内幅与臂围的比率为40％所测得的血压作为基准,与之相比较,求出臂围的20％～90％的袖带幅度所测得的血压误差的平均值,并找出其规律性。结果:臂围30％幅度的袖带测定的收缩压误差值为4.7 mmHg,舒张压误差值为3.5 mmHg;臂围50％幅度的袖带测定的收缩压误差值为-4.1 mmHg,舒张压误差值为-1.4 mmHg;臂围60％幅度的袖带测定的收缩压误差值为-8.9 mmHg,舒张压误差值为-4.9 mmHg。结论:袖带内幅与臂围的比率和血压误差值之间存在线性关系,回归方程:Y=28.32-0.69 x(收缩压),Y=19.12-0.48 x(舒张压)。     

听诊器胸件放于袖带内外对血压值影响的观察

目的探讨测量血压时,听诊器胸件分别置于袖带内和袖带外对血压值有无影响。方法将81例住院病人进行系统血压观察,对同一病人分别采用听诊器胸件放于袖带外和袖带内两种方法测量血压,对两种方法测得的收缩压值和舒张压值进行统计学分析。结果两种方法测量的收缩压、舒张压值比较,无显著性差异,P值均>0.05。结论测量血压时听诊器胸件置于袖带内和袖带外对血压值影响不大,两种方法临床均可采用。     

不同测量方法和判断标准对血压值的影响研究

[目的]探讨用汞柱式血压计进行不同的血压测量方法、判断标准时血压值的变化。[方法]选择内科病人126例，采用汞柱式血压计通过不同的血压测量和判断方法进行自身对照，比较左右上肢、听诊器胸件置于不同状态时，首次看到水银柱波动值与听到第一声搏动音、变音值与声音消失值血压变化。[结果]左上肢和右上肢的收缩压和舒张压差别有统计学意义；听诊器胸件置于不同状态的收缩压和舒张压也有差异；首次看到水银柱波动和听到第一声搏动音的读数也存在差异；舒张压以第1次变音和声音消失的判断结果也存在差异。[结论]血压测量部位一般选择右上肢，舒张压一般应以消失音（Korotkoff第5期）为准，袖带位置不准确使测得的血压偏低，水银波动值与主动脉压和收缩压的关系有待进一步研究。     

可携式血压监测仪

可携式血压监测仪(ABPM)是随身携带每天可随时多次测量血压的装置.这种自动测压仪有两个主要系统.1.听诊系统,是以Korotkoff 声学的拾音器探测法为基本原理。此法所得到的读数与使用听诊器和标准水银血压计测得的数据极相似,而拾音器的作用则相当于人耳。2.示波系统:血压可由袖带中压力下降所产生的颤动而测得,按波峰可准确测得动脉平均压,并依此推算出收缩压与舒张压.     

高血压危象病人无创血压与有创血压测量差别的对比研究

目的　探讨临床常用的汞柱式血压计测量高血压危象病人血压的误差及原因。方法　选取高血压危象病人2 8例 ,用汞柱式血压计测量肱动脉血压 ,用有创法测量同一上肢的桡动脉血压并记录桡动脉波形图。每例均用2种方法测不同时间点血压共 6次 ,获 168对血压值。结果　汞柱式血压计测量血压的结果与真实血压相比 ,在高血压危象病人中收缩压约低估 ( 18± 5 )mmHg(P <0 .0 1) ,血压越高差别越大 ;舒张压差别则无显著性 (P >0 .0 5 )。结论　用汞柱式血压计测量高血压危象病人的血压值与实际值有一定误差 ,对于收缩压误差较大 ,舒张压则较准确 ,对伴脑卒中的病人尤应注意这种差别 ,必要时应测有创血压     

袖带放置位置对肱动脉血压值的影响

目的探讨测量血压时,袖带放置位置对肱动脉血压值的影响。方法对207例住院患者进行血压观察,同一患者分别依次采用：袖带下缘距肘窝2～3cm（标准测量法）,下缘位于肘窝部（实验测量法1）,下缘位于肘窝下1cm（实验测量法2）,下缘位于肘窝下2cm（实验测量法3）4种方法测量血压,对标准测量法和另外3种测量方法所测得的收缩压和舒张压进行统计学处理并进行比较。结果实验测量法1所测得的血压值与标准测量法比较差异无统计学意义（P〉0．05）;实验测量法2和3两种方法所测得的血压值与标准测量法比较差异有统计学意义（P〈0．05）。结论袖带下缘位于肘窝部进行测量,所测得的血压值与标准测量方法比较影响不大,临床可采用,但袖带放置位置过低,测得的血压值将会下降。     

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.