米索前列醇预防产后出血的临床观察

目的 :探讨使用米索前列醇预防产后出血的临床意义。方法 :2 0 0 1年 10月～ 2 0 0 3年 4月有我院分娩 2 117例 ,其中剖宫产 1372例 ,选择对象为剖宫产可能发生产后出血的高危产妇 ,试验组剖宫产 187例 ,对照组剖宫产 81例 ,比较试验组 (催产素 +米索前列醇 )和对照组 (催产素组 ) ,用药后产后出血情况。试验组 :胎儿娩出后立即宫体肌注催产素 2 0U ,口服米索前列醇 6 0 0 μg。对照组 :胎儿娩出后宫体肌注催产素 2 0U ,静脉滴注催产素 30U。结果 :试验组剖宫产 187例 ,发生产后出血仅 3例 ,产后 2h出血量 (171+6 3)ml。对照组剖宫产 81例 ,发生产后出血 8例 ,产后 2h出血量 (2 79+78)ml。试验组和对照组比较 ,有显著差异 (P <0 .0 1)。结论 :米索前列醇对产后出血有很好的预防作用 ,且用药安全、方便。     

国产米索前列醇预防产后出血

目的 :观察国产米索前列醇 (米索 )预防产后出血的临床效果。方法 :选择 6 0 0例单胎、头位、无妊娠合并症、无前列腺素禁忌症、经阴道分娩的产妇 ,随机分为 2组 :米索组 30 0例 ,胎儿前肩娩出后口服国产米索前列醇 6 0 0μg ;催产素组 30 0例 ,胎儿娩出后静脉注射催产素 2 0IU。观察产后 2h出血量、产后出血发生率、第三产程时间及副反应。结果 :产后 2h出血量、出血发生率及第三产程时间分别为 :米索前列醇组 (181.85± 77.5 8)ml,2 .33% ,(6 .94± 3.6 6 )min和催产素组 (179.5 1± 96 .72 )ml,3% ,(6 .94± 3.6 3)min。两组间比较 ,其差异均无显著性 (P >0 .0 5 )。结论 :国产米索前列醇能有效预防产后出血 ,且用药方便、经济、安全。     

高危妊娠产妇产后出血的原因分析及预防对策

目的 探讨米索前列醇联合缩宫素对高危妊娠产妇产后出血的预防效果.方法 将112例各种原因的高危妊娠产妇随机分为试验组和对照组,所有孕妇均为剖宫产,试验组产妇于胎儿娩出后口服米索前列醇400μg加宫体注射缩宫素10 IU,对照组产妇于胎儿娩出后宫体注射缩宫素10 IU,并且静脉注射缩宫素20 IU,观察并记录两组第三产程时间、产后2h内出血情况以及记录用米索前列醇后的不良反应等.结果 试验组第三产程时间和产后2h内出血量明显小于对照组,产后出血的发生率比较差异有统计学意义(P＜0.05).结论 米索前列醇联合缩宫素可以有效地促进产后子宫收缩,降低第三产程时间和产后出血流量,对高危妊娠产妇产后出血具有较好的预防作用,且用药方便、不良反应少、安全.     

经直肠给予米索前列醇预防产后出血的临床观察

目的 :探讨经直肠给予米索前列醇预防产后出血的效果。方法 :足月妊娠阴道分娩产妇 2 0 0例 ,随机分成米索前列醇组(于胎儿娩出后立即直肠给予米索前列醇 4 0 0 μg)和催产素组 (于胎儿娩出后立即肌注催产素 2 0u) ,每组各 10 0例。观察两组第三产程时间 ,产后 2h、2 4h出血量 ,发生产后出血病例数及药物不良反应和血压变化情况。结果 :两组第三产程时间无显著性差异 (P >0 .0 5 ) ,产后 2h、2 4h出血量在米索前列醇组明显少于催产素组 ,有极显著差异 (P <0 .0 1) ,米索前列醇组未发生产后出血病例。两组用药后均无明显不良反应及血压改变。结论 :经直肠给予米索前列醇预防产后出血效果显著 ,方法简便、安全。     

米索前列醇用于减少产后出血的临床观察

目的：探讨预防和处理产后出血的有效方法。方法：选择160例有产后出血高危因素产妇，随机分为两组，试验组100例米索前列醇400μg直肠给药，对照组60例宫体注射催产素20U，用称重法统计产后2h出血量。结果：试验组产后2h出血量（230±65）ml，对照组出血量（340±68）ml，两组比较差异有极显著性（P〈0．01）。结论；催产素配伍米索前列醇促子宫收缩作用强于单用催产素，能较好的预防产后出血，用药方便、安全。另外，预防产后出血要识别出血高危因素早期预防，查找原因采取综合防治措施。     

米索前列醇预防产后出血的观察

目的观察米索前列醇用于产后出血效果.方法选择有产后出血高危因素的产妇124例,随机分成3组.米索前列醇组(I)40例、米索前列醇+催产素组(Ⅱ)41例、催产素组(Ⅲ)42例.I组于胎儿娩出后立即口服或肛塞米索前列醇600 ug.Ⅱ组米索前列醇用药方法同I组,于胎儿娩出后肌肉注射或静脉注射催产素20IU.Ⅲ组于胎儿娩出后肌肉注射或静脉注射催产素20IU.以上各组观察产后2小时出血量.结果产后2小时内平均出血量,I组为(170±50)ml;Ⅱ组为(165±53)ml;Ⅲ组为(285±76)ml.I组与Ⅲ组比较,差异有极显著性(P＜0.01).I组与Ⅱ比较,差异无显著性(P＜0.05).结论米索前列醇促进子宫收缩作用强于催产素.能较好地预防产后出血,且用药方便安全.     

舌下含服米索前列醇预防产后出血的临床观察

目的探讨舌下含服米索前列醇预防产后出血的效果。方法将可能发生产后出血的 384例高危产妇分为两组 :试验组 194例 ,第二产程末胎儿娩出后立即舌下含服米索前列醇 4 0 0 μg ;对照组 190例 ,第二产程末胎儿娩出后静脉注射缩宫素 2 0U。观察产后 2小时出血量。结果产后 2小时出血量 ,试验组及对照组分别为 (16 8.73± 89.78)ml、(2 6 2 .31± 10 1.4 6 )ml,有显著性差异 (P <0 .0 5 )。结论舌下含服米索前列醇 ,促进子宫收缩作用强于缩宫素 ,能减少产后出血量 ,并且用药简单方便 ,宜于推广。     

米索前列醇预防产后出血的观察

目的　观察米索前列醇用于产后出血效果。方法　选择有产后出血高危因素的产妇 12 4例 ,随机分成 3组。米索前列醇组 (Ⅰ ) 4 0例、米索前列醇 +催产素组 (Ⅱ ) 4 1例、催产素组 (Ⅲ ) 4 2例。Ⅰ组于胎儿娩出后立即口服或肛塞米索前列醇 6 0 0ug。Ⅱ组米索前列醇用药方法同Ⅰ组 ,于胎儿娩出后肌肉注射或静脉注射催产素 2 0IU。Ⅲ组于胎儿娩出后肌肉注射或静脉注射催产素 2 0IU。以上各组观察产后 2小时出血量。结果　产后 2小时内平均出血量 ,Ⅰ组为 (170± 5 0 )ml;Ⅱ组为 (16 5± 5 3)ml;Ⅲ组为 (2 85± 76 )ml。Ⅰ组与Ⅲ组比较 ,差异有极显著性 (P <0 .0 1)。Ⅰ组与Ⅱ比较 ,差异无显著性 (P <0 .0 5 )。结论　米索前列醇促进子宫收缩作用强于催产素。能较好地预防产后出血 ,且用药方便安全     

米索前列醇预防高危妊娠产后出血的效果观察

目的:观察米索前列醇预防高危妊娠产后出血的效果。方法:将102例有出血倾向的高危产妇随机分为两组:观察组52例和对照组50例。两组产妇均行剖宫产术。观察组暴露子宫下段,切开子宫前由助手经直肠给予米索前列醇400μg;对照组胎儿娩出后,立即宫体注射催产素20 U,并静脉点滴催产素30 U。结果:观察组产后2h平均出血量为(185.3±55.2)mL,对照组平均出血量为(300.5±66.6)mL,两组比较,差异有统计学意义(P<0.05)。结论:米索前列醇促进产后子宫收缩强于催产素,能较好地预防高危妊娠产后出血,且用药安全、方便。     

米索前列醇与催产素预防产后出血的临床对照观察

目的:观察米索前列醇预防产后出血的效果.方法:将正常足月妊娠阴道自然分娩者200例,随机分为米索前列醇组和催产素组各100例.米索前列醇组于胎儿娩出后立即肛门内置入米索前列醇200μg,催产素组胎儿娩出后立即宫壁注射催产素10IU.结果:米索前列醇组第三产程时间为(7.27±3.51)min,产后2h内出血量为(148.32±54.26)ml;催产素组第三产程时间为(11.42±3.56)min,产后2h内出血量为(238.64±58.74)ml.两组比较差异有显著性(P＜0.01).结论:米索前列醇促进子宫收缩作用强于催产素,能较好地预防产后出血,且用药方便安全.     

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.     

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.     

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.     

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.