频谱多普勒超声诊断椎基底动脉供血不足的价值

目的 探讨椎基底动脉系统脑血流量和椎基底动脉收缩期峰值流速在频谱多普勒超声诊断椎基底动脉供血不足(VBI)中的价值.方法 将107例临床怀疑椎基底动脉供血不足患者分为三组:重度VBI组、轻一中度VBI组和非VBI组.分别检测椎动脉和基底动脉二维图像和血流频谱,比较椎动脉、基底动脉收缩期峰值流速和椎基底动脉系统脑血流量在诊断椎基底动脉供血不足中的差异.结果 椎动脉和基底动脉收缩期峰值流速在重度VBI组患者中明显低于轻-中度VBI组,差异有统计学意义(P＜0.05);在轻-中度VBI组患者中低于非VBI组,但差异无统计学意义(P＞0.05).结论 脑血流量在判定患者是否为椎基底动脉供血不足及程度上有诊断价值,可以作为超声诊断VBI的有效指标.     

椎-基底动脉供血不足性眩晕经颅多普勒超声分型与中医证型在治疗中的价值

目的探讨椎-基底动脉供血不足性眩晕经颅多普勒超声(TCD)分型与中医证型在治疗中的价值。方法将150例处于发作期的椎-基底动脉供血不足性眩晕患者根据TCD检查的血流速度分为流速缓慢组、流速增快组、流速正常组,同时行中医证型分类,并且分为常规治疗组、结合TCD治疗组、结合TCD和中医证型治疗组。结果 150例患者中,肝阳上亢证30例,气血亏虚证73例,肾精不足证16例,痰湿中阻证14例,瘀血阻窍证17例。椎-基底动脉供血不足性眩晕以肝阳上亢证和气血亏虚证为主。中医证型在流速缓慢组、流速增快组、流速正常组中分布有显著差异(P 0. 001)。常规治疗组、结合TCD治疗组、结合TCD和中医证型治疗组的疗效有显著差异(P=0. 001)。结论结合TCD分型与中医证型对椎-基底动脉供血不足性眩晕进行治疗能提高疗效。     

血栓通注射液对椎基底动脉供血不足性眩晕患者血流速度的影响

目的：应用经颅多普勒脑血流测定仪对38例椎基底动脉供血不足性眩晕患者血栓通注射液治疗前后，椎基底动血流速度等进行对比观察。方法：所有病例均用血栓通注射液10ml加5％葡萄糖注射液或生理盐水250ml静脉滴注，每日1次，连用2周。治疗前后用经颅多普勒血流分析仪，检测左、右椎动脉、基底动脉，记录峰值血流速度、舒张末期血流速度、平均血流及搏动指数。结果：治疗后椎基底动脉供血不足性眩晕患者椎动脉及基底动脉峰值血流速度、舒张末期血流速度、平均血流速度均明显增加(P＜0.05)，搏动指数降低(P＜0.05)。结论：血栓通注射液增加椎基底动脉供血疗效确切。     

青少年颈椎曲度异常致颈源性头痛患者脑血管功能状态分析

目的:观察青少年颈椎曲度异常性颈源性头痛患者的脑血管功能障碍的状况和发生频率,并与正常人进行比较。方法:选择1999-06/2004-06解放军空军总医院收治的青少年颈椎曲度异常性颈源性头痛患者120例熏年龄小于35岁。用经颅多普勒超声对其9条颅内血管(双侧大脑前、中、后动脉、椎动脉及基底动脉)进行检测,检测内容包括平均血流速度、收缩期峰值流速、舒张期末流速、搏动指数、阻力指数和非对称指数。并以同年龄健康人40例为对照组。结果:160例受试者全部进入结果分析。①颈曲异常组受检1062条颅内血管中的平均血流速度异常128条,异常率12.1%,收缩峰值流速和舒张期末流速异常的血管数分别为142条穴13.4%雪和155条穴14.5%雪,与对照组比较差异显著穴2.2%,4.55%,2.3%,P均<0.01雪。②颈曲异常组大脑前、中动脉、椎动脉和基底动脉的平均血流速度、收缩期峰值流速和舒张期末流速均显著高于对照组(P<0.05或0.01)。③颈曲异常组左椎动脉的阻力指数显著高于对照组(0.531±0.065,0.506±0.051,t=2.514,P=0.014)。④颈曲异常组的左右成对动脉的平均血流速度差异增大,其代表值-非对称指数的异常率以及均值显著高于对照组(P<0.01)。结论:青少年颈椎曲度异常致颈源性头痛患者脑血管功能紊乱的发生率显著高于正常对照组,经颅多普勒超声异常改变有颅内动脉流速增高、降低和不对称。     

针刺前后椎-基底动脉供血不足患者脑血管功能相关指标的变化

目的:观察针刺对椎-基底动脉供血不足患者脑血管功能的影响,分析其可能的作用机制。方法:选择2002-08/2004-05在广西中医学院附属瑞康医院针灸推拿科就诊的60例椎-基底动脉供血不足患者。穴取风池(双)、肩中俞(双),采用缓慢捻转进针法对患者治疗,留针20～30min,每隔5min行针1次,1次/d,6次为1疗程,每疗程后休息1d。所有患者在治疗前、治疗5个疗程后采用经颅多普勒检测椎-基底动脉供血不足患者左椎动脉、右椎动脉及基底动脉治疗前后收缩期峰流速、舒张期末峰流速、平均峰流速、脉动指数以及血管弹性指标,观察其指数的改变情况。结果:纳入患者60例全部进入结果分析。①治疗效果评价:总有效率86.7%。②平均峰流速治疗前后的变化情况:动脉血流速度变慢患者治疗后左、右椎动脉和基底动脉平均峰流速为(27.57±4.69),(26.37±5.85),(33.54±4.23)cm/s,明显高于治疗前[(23.65±4.31),(23.27±4.17),(29.67±4.55)cm/s,P<0.05～0.01]。动脉血流速度增快患者治疗后左、右椎动脉及基底动脉平均峰流速为(42.27±3.26),(43.35±5.72),(50.49±4.37)cm/s,明显低于治疗前[(48.27±3.47),(46.03±4.03),(55.94±3.40)cm/s,P<0.05～0.01]。③脉动指数变化情况:患者左右椎动脉、基底动脉的脉动指数治疗后分别为0.92±0.26,0.88±0.33,1.19±0.33,均低于治疗前(1.27±0.15,1.18±0.14,1.38±0.17),差异有统计学意义(P<0.05～0.01)。④血管弹性指数的变化情况:椎-基底动脉供血不足综合征患者左、右椎动脉及基底动脉其血管弹性指数治疗后分别为0.51±0.27,0.52±0.26,0.54±0.21,均低于治疗前(0.89±0.17,0.76±0.16,0.80±0.23),差异有统计学意义(P<0.05～0.01)。结论:针刺疗法可改善椎-基底动脉供血不足综合征患者脑动脉血流速度,可降低其血管弹性指数及脉动指数。     

应用经颅多普勒超声测量估计脑血流量

应用经颅多普勒超声(TCD)测量了60名正常人的估计脑血流量(ECBF),大脑中动脉(MCA)的ECBF平均为264.7±29.4ml/min,椎动脉(VA)的ECBF平均为181.6±29.3ml/min;基底动脉(BA)的ECBF平均为345.8±39.4ml/min;与60名椎—基底动脉供血不足患者ECBF比较,两者之间呈现极为显著的差异性(P<0.001)。     

椎动脉彩色多普勒对椎-基底动脉供血不足的诊断价值

目的　探讨椎动脉彩色多普勒对椎 基底动脉供血不足的诊断价值。方法　对 2 99例临床诊断为椎 基底动脉供血不足患者进行椎动脉彩色多普勒检查 ,观察多项血流参数。结果　椎动脉彩色多普勒超声诊断椎 基底动脉供血不足的阳性率为 5 6% (168/2 99)。阳性患者椎动脉内径狭窄 (P <0 .0 5 ) ;收缩期最大流速 (Vs) ,平均流速 (Vm )及舒张末期流速(Vd)较阴性患者明显减低 ,阻力指数 (RI)和搏动指数 (PI)增高 ,有显著性差异 (P <0 .0 1)。结论　结果表明椎动脉彩色多普勒及频谱多普勒超声对诊断椎 基底动脉供血不足确有实用价值     

尼莫地平联合参芪四虫汤治疗椎基底动脉供血不足性眩晕

目的:探究尼莫地平联合参芪四虫汤治疗椎基底动脉供血不足性眩晕的疗效及对患者血流动力学的影响。方法:选取2017年1月~2018年12月收治的椎基底动脉供血不足性眩晕患者80例,按随机数字表法分为对照组和实验组,各40例。对照组采用尼莫地平治疗,实验组采用尼莫地平联合参芪四虫汤治疗。比较两组临床疗效,治疗前后椎动脉与基底动脉收缩期峰流速、舒张期末流速、平均流速。结果:实验组治疗总有效率95.00%高于对照组的80.00%,差异有统计学意义(P<0.05)。治疗前,两组椎动脉、基底动脉收缩期峰流速、舒张期末流速、平均流速比较,差异无统计学意义(P>0.05);治疗后,两组椎动脉和基底动脉收缩期峰流速、舒张期末流速、平均流速均较治疗前上升,且实验组高于对照组,差异有统计学意义(P<0.05)。结论:采用尼莫地平联合参芪四虫汤治疗椎基底动脉供血不足性眩晕患者可有效缓解患者的临床症状,促进患者血流动力学改善,疗效确切。     

腹型紫癜患儿病程中肠系膜上动脉彩色多普勒血流参数变化

目的观察腹型紫癜患儿病程中肠系膜上动脉彩色多普勒血流参数变化有无规律.方法 测量10例腹型紫癜患儿急性期、恢复期肠系膜上动脉彩色多普勒血流参数,包括收缩期峰值流速、舒张末期流速、阻力指数,并与17名体检健康儿童比较.结果 腹型紫癜组患儿急性期肠系膜上动脉收缩期峰值流速为(41.57±8.02)cm/s,恢复期为(33.38±7.44)cm/s,健康对照组儿童为(35.34±9.73)cm/s,三者之间的差异无统计学意义(F=2.471,P=0.10);腹型紫癜组患儿急性期肠系膜上动脉舒张末期流速为(7.63±4.28)cm/s,高于恢复期的肠系膜上动脉舒张末期流速(4.23±2.57)cm/s和健康对照组儿童的肠系膜上动脉舒张末期流速(3.77±0.87)cm/s,且差异均有统计学意义(t=0.066,P=0.025;t=0.059,P=0.003);腹型紫癜组的患儿急性期肠系膜上动脉阻力指数为(0.85±0.17),低于恢复期的肠系膜上动脉阻力指数(1.00±0.15)和健康对照组儿童的肠系膜上动脉阻力指数(1.04±0.13),差异也均有统计学意义(t=1.391,P=0.020;t=1.239,P=0.026).结论在腹型紫癜患儿病程中,肠系膜上动脉彩色多普勒血流参数变化有规律,可用于评估腹型紫癜病情变化.     

病毒性前庭神经炎31例误诊分析

目的探讨病毒性前庭神经炎眩晕与椎-基底动脉供血不足眩晕二者临床不同特点。方法对125例眩晕患者的病历资料进行回顾性分析,从其中筛选出31例有明确病毒感染者作为A组,同期94例无病毒感染的椎-基底动脉供血不足/TIA作为B组,两组对比。结果 31例病毒感染患者前庭周围性眩晕发生率低于前庭中枢性眩晕;椎-基底动脉供血不足/TIA表现周围性眩晕亦极少。A组经颅多普勒(TCD)异常率低(22.6%),B组异常率高(77.7%)。结论病毒感染后前庭中枢性眩晕容易与椎-基底动脉供血不足/TIA眩晕相混淆。TCD对于二者有较好的鉴别意义,应是首选检查手段。     

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.