麝香保心丸治疗心绞痛的疗效分析

目的:观察麝香保心丸治疗冠心病心绞痛的疗效。方法:将冠心病心绞痛患者60例,随机分为麝香保心丸治疗组(30例)和消心痛对照组(30例),治疗组口服麝香保心丸,每日3次,每次2丸;对照组口服消心痛片,每日3次,每次10mg;2组疗程均为4个月,疗程结束后观察其对冠心病心绞痛的疗效。结果:治疗组对冠心病心绞痛的症状疗效、心电图疗效均优于对照组,即症状疗效分别为90%与60%(P<0.01),心电图疗效76.67%与46.67%(P<0.05)。结论:麝香保心丸治疗冠心病心绞痛具有较好疗效,而且安全可靠,是治疗冠心病心绞痛值得推广的纯中药制剂。     

葛根素注射液治疗心绞痛60例临床观察

目的 评价葛根素注射液治疗心绞痛的疗效及作用机制。方法 入选病例60例，其中对照组30例，治疗组30例，两组患者均给予消心痛5mg，tid，肠溶阿司匹林75mg，qd，无禁忌证的患者同时给予倍他乐克12．5mg，bid。治疗组同时给予葛根素注射液250ml，1次／d静点，12d为1个疗程。对照组不再给予其他药物。结果 两组间在性别、年龄、平均每周心绞痛发作次数、心绞痛发作时间及硝酸甘油用量等方面的差异无显著意义（P〉0．05），具有可比性。讨论 葛根素注射液在治疗心绞痛方面疗效确切，使用安全性好。     

万爽力治疗不稳定型心绞痛疗效评价

目的：探讨方爽力治疗不稳定型心绞痛疗效。方法：选择符合WHO诊断标准的不稳定型心绞痛54例，随机分为治疗组32例，对照组22例。治疗组万爽力20mg，Bid；对照组予丹参片3片，Tid；两组均给阿斯匹林、博苏、消心痛、非诺贝特，疗程4周。结果：治疗组有效率达96.8％，对照组82．7％。治疗组心绞痛缓解时间较对照组明显缩短，心绞痛发作次数明显减少。结论：长期口服万爽力有抗心绞痛作用，并能减少心绞痛发作次数。     

万爽力对慢性心力衰竭心功能影响的临床研究

92例慢性心力衰竭患者随机分为对照组和治疗组,对照组给予地高辛、利尿剂、ACEI或ARB及β-受体阻滞剂。治疗组在此基础上加用万爽力20mg,tid.连续用药6个月。观察两组治疗前后患者的心功能分级,6分钟步行距离（6MWT）,左室射血分数（LVEF）,左室舒张末期内径（LVDD）的变化。结果治疗组临床心功能分级明显改善,优于对照组（P〈0.05）,LVEF显著提高,LVDD显著减少,6MWT明显提高。万爽力能明显改善慢性心力衰竭患者的心功能,提高患者的生活质量。     

四逆汤治疗对冠心病心绞痛患者生活质量的影响

背景在心绞痛患者的干预效果评估中,症状和体征改善的同时,其生活质量提高与否也是一个非常重要的因素.目的探讨经典方四逆汤对冠心病心绞痛的干预效果,比较单纯中药、西药及中西医结合对患者生活质量的影响.设计以冠心病心绞痛患者为研究对象的前瞻性观察对比研究. 单位一所大学医院的中医科.对象病例为2003-02/2003-08在中山大学附属第一医院中医科门诊就诊的冠心病心绞痛患者,共88例.纳入标准符合“心血管系统药物临床研究指导原则”和“冠心病中医辨证标准”者.排除标准合并各种严重疾病者.所有患者随机分为四逆汤组、消心痛组和联合用药组,各组分别为29,30和29例.方法四逆汤组、消心痛组和联合用药组分别用四逆汤、消心痛和四逆汤联合消心痛治疗.在治疗开始前及结束,观察心绞痛发作次数、条件、程度、持续时间,记录心电图,分别在患者服药前及服药两周应用统一的调查表和检测工具进行生活质量评分.主要观察指标各组控制心绞痛发作的疗效、心电图表现及患者的生活质量评分的比较.结果消心痛和四逆汤均能明显缓解患者心绞痛,改善心电图表现,从躯体症状、健康愉快感和抑郁水平三方面提高生活质量评分(P＜0.01),四逆汤提高以上三方面生活质量评分的效果好于消心痛(P＜0.01),但四逆汤和消心痛联合应用时临床疗效和生活质量(健康愉快感、抑郁水平)改善最优(P＜0.01).结论四逆汤在改善冠心病心绞痛患者生活质量方面具有优势,临床干预用药时,应该取中西医之长.     

四逆汤治疗对冠心病心绞痛患者生活质量的影响

背景：在心绞痛患者的干预效果评估中，症状和体征改善的同时，其生活质量提高与否也是一个非常重要的因素。目的：探讨经典方四逆汤对冠心病心绞痛的干预效果，比较单纯中药、西药及中西医结合对患者生活质量的影响。设计：以冠心病心绞痛患者为研究对象的前瞻性观察对比研究。单位：一所大学医院的中医科。对象：病例为2003—02／2003—08在中山大学附属第一医院中医科门诊就诊的冠心病心绞痛患者，共88例。纳入标准：符合“心血管系统药物临床研究指导原则”和“冠心病中医辨证标准”者。排除标准：合并各种严重疾病者。所有患者随机分为四逆汤组、消心痛组和联合用药组，各组分别为29，30和29例。方法：四逆汤组、消心痛组和联合用药组分别用四逆汤、消心痛和四逆汤联合消心痛治疗。在治疗开始前及结束，观察心绞痛发作次数、条件、程度、持续时间，记录心电图，分别在患者服药前及服药两周应用统一的调查表和检测工具进行生活质量评分。主要观察指标：各组控制心绞痛发作的疗效、心电图表现及患者的生活质量评分的比较。结果：消心痛和四逆汤均能明显缓解患者心绞痛，改善心电图表现，从躯体症状、健康愉快感和抑郁水平三方面提高生活质量评分(P&;lt;0．01)，四逆汤提高以上三方面生活质量评分的效果好于消心痛(P&;lt;0．01)，但四逆汤和消心痛联合应用时临床疗效和生活质量(健康愉快感、抑郁水平)改善最优(P&;lt;0．01)。结论：四逆汤在改善冠心病心绞痛患者生活质量方面具有优势，临床干预用药时，应该取中西医之长。     

复方丹参滴丸治疗心绞痛68例临床观察

目的:评价复方丹参滴丸治疗心绞痛的临床疗效及安全性。方法:128例心绞痛患者随机分为治疗组(复方丹参滴丸组68例)与对照组(消心痛组60例)。治疗组口服复方丹参滴丸,每次10丸,每日3次;对照组口服消心痛片,每次10mg,每日3次,2组疗程均为4周。结果:用药后缓解症状有效率:治疗组94.1%,对照组90.0%,组间比较无显著性差异(P>0.05)。心电图有效率:治疗组47.1%,对照组46.7%,组间比较无显著性差异(P>0.05)。未发现毒副作用。结论:复方丹参滴丸是一种治疗心绞痛安全有效的药物。     

中医辨证施治对冠心病心绞痛患者生活质量的影响

目的:评价中医辨证施治对冠心病患者生活质量的影响,比较辨证与辨病治疗的差异。方法:全部病例来自2002-04/2003-03中山大学附属第一医院中医科住院部及门诊确诊的冠心病心绞痛患者,按中医辨证标准分为8组:痰浊组(n=13)、血瘀组(n=15)、气滞组(n=9)、寒凝组(n=15)、阴虚组(n=12)、气虚组(n=18)、阳虚组(n=15)及对照组(n=15)。各证型组口服四逆汤(熟附子10g,干姜6g,甘草4g,可根据个体的不同调整剂量,剂量比为5:3:2)为基本方的煎剂,200mL/剂,分两次口服,时间间隔为6～8h,1剂/d,疗程为2周;对照组口服消心痛10mg,3次/d,疗程为2周。于治疗前后采用简明健康调查表和西雅图心绞痛量表评估患者的生活质量。参与者均知情同意。结果:按实际处理分析,阴虚组12例中,有8例未能完成临床观察,故阴虚组未纳入结果;气虚组有2例,寒凝组和气滞组各有1例失访,未纳入统计分析。①简明健康调查表评分:四逆汤各证型组和对照组总分及生理功能、生理职能、躯体疼痛及一般健康等4个维度治疗后比治疗前明显改善,差异有显著性(t=2.16～4.08,P<0.05～0.01)。阳虚组和寒凝组治疗后在总分和4个维度改善比其他各组显著,精力和精神健康以阳虚组和寒凝组改善最为明显(t=2.39～3.56,P<0.05～0.01)。②西雅图心绞痛量表评分:四逆汤各证型组和对照组在躯体活动受限程度、心绞痛稳定状态、心绞痛发作频率及治疗满意程度等4个维度治疗后比治疗前明显改善,差异有显著性(t=2.75～4.71,P<0.05～0.01)。寒凝组和阳虚组治疗后在躯体活动受限程度、心绞痛稳定状态及心绞痛发作频率3个维度改善比其他组明显(t=2.27～3.85,P<0.05～0.01)。结论:以四逆汤为基础的辨证施治能够改善冠心病心绞痛患者的生活质量,辨证为寒凝和阳虚者效果更优。     

曲美他嗪治疗冠心病劳力型心绞痛43例疗效观察

目的 :评价曲美他嗪与传统药物相结合治疗劳力型心绞痛的效果。方法 :92例符合冠心病劳力型心绞痛患者 ,随机分成两组 :治疗组 43例 ,除用传统药物治疗心绞痛外加用曲美他嗪 (法国施维雅生产的万爽力 ) 2 0mg ,每天 3次口服 ;对照组共 49例接受传统药物治疗 ,不加曲美他嗪。观察两组患者心绞痛发作次数及心电图运动耐量试验的差异。结果 :治疗组接受治疗 1个月后心绞痛发作次数平均为 ( 2 6± 0 9)次 ,而对照组则为 ( 4 3±1 1)次 ,两组比较P <0 0 5 ;治疗组的运动耐量时间长于对照组 (P <0 0 5 ) ;治疗组有效率为 79% ,对照组则为6 7%。结论 :曲美他嗪能缓解和减少劳力型心绞痛的发作及改善劳力型心绞痛患者运动耐力     

螺内酯和卡托普利治疗慢性充血性心力衰竭的远期疗效及安全性

目的：探讨螺内酯和卡托普利联合抗醛固酮治疗对慢性充血性心力衰竭(CHF)的远期疗效和安全性。方法：连续入选慢性CHF患者67例，随机分为两组，A组34例为常规治疗组，B组33例在常规治疗的基础上加用螺内酯(20mg tid)和卡托普利(6．25mg-50mg tid)，分别于治疗后6、12、24个月进行心功能，死亡率、因心力衰竭再住院率的测定和生活质量评定。结果：B组心功能改善程度、生活质量较A组有不同程度的好转(P＜0．05—0．01)，E组因心力衰竭再住院率、远期死亡率较A组明显减少(P＜0．05)。结论：螺内酯和卡托普利联合治疗慢性CHF远期疗效好且安全可行。     

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.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

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.