高频重复经颅磁刺激联合吸烟相关线索诱发对香烟成瘾的影响

目的:探讨作用于左侧背外侧前额叶皮质区(DLPFC)的高频重复经颅磁刺激(H-F rTMS)联合吸烟相关线索诱发对香烟成瘾患者香烟渴求度(VAS评分)、呼出气CO浓度(CO ppm)和睡眠质量(PSQI评分)的影响。 方法:60例香烟成瘾患者随机分为A组(相关线索诱发rTMS组)、B组(非相关线索...     

高频重复经颅磁刺激干预精神分裂症患者吸烟有效性研究

目的研究高频重复经颅磁刺激(rTMS)减少精神分裂症患者吸烟量及尼古丁渴求的有效性。方法本研究为随机双盲安慰剂对照试验,将60名符合入组条件的受试者随机分配至rTMS刺激组及rTMS伪刺激组各30例,研究组使用rTMS治疗(10Hz刺激左侧前额叶背外侧皮质、110%运动阈值、10s/串、间歇30s、20串/d),对照组使用伪rTMS设备干预,两组均每周治疗5次,为期3周,并随访至第6周。采用受试者自我报告的方式获悉每日吸烟数量、烟草依赖自评量表评估尼古丁渴求,使用阳性阴性症状量表(PANSS)、蒙哥马利抑郁量表(MADRS)和卡尔加里精神分裂症抑郁量表(CDSS)评定患者阴性抑郁症状。结果 (1)治疗3周末及随访期可观察到rTMS刺激组吸烟量及烟草依赖自评量表评分明显降低,与伪刺激组对比具有统计学差异(P0.01)。(2)阴性、抑郁症状变化和吸烟量改变之间未发现明显关联。结论刺激左侧前额叶背外侧皮质的高频rTMS可以减少精神分裂症患者的吸烟量及尼古丁渴求。     

重复经颅磁刺激技术对抑郁症患者吸烟依赖及睡眠的效果研究

目的 探讨重复经颅磁刺激(rTMS)技术在抑郁症患者治疗中的应用效果。方法 选取2020年7月-2022年7月我院诊治的72例抑郁症患者为研究对象,按随机数字表法分为对照组和观察组,各36例。对照组给予草酸艾司西酞普兰治疗,观察组在对照组的基础上加用rTMS治疗,连续治疗4周。比较两组心理状态、吸烟依赖、睡眠质量、生活质量、不良反应。结果 两组治疗前焦虑自评量表(SAS)、抑郁自评量表(SDS)、尼古丁依赖检验量表(FTND)、吸烟渴求量表(TCQ)、匹兹堡睡眠质量指数(PSQI)与生活质量综合评定问卷(GQOLI-74)评分比较,差异无统计学意义(P>0.05);观察组治疗后SAS、SDS、FTND、TCQ、PSQI评分低于对照组,GQOLI-74评分高于对照组(P<0.05);两组不良反应比较差异无统计学意义(P>0.05)。结论 rTMS技术治疗抑郁症效果显著,能够有效缓解焦虑、抑郁情绪,减轻吸烟依赖,改善睡眠质量及生活质量。     

重复经颅磁刺激对酒依赖者的影响

目的：研究重复经颅磁刺激（rTMS）对酒依赖者心理渴求、自我效能感（SE）及复饮的影响。方法：选择2021年4月～2022年6月于我院接受治疗的酒依赖患者86例,依据随机数字表法将86例酒依赖患者分为rTMS组（n=43）、对照组（n=43）。对照组行常规支持及替代治疗,rTMS组在对照组基础上行rTMS治疗。观察2组治疗前、治疗5周后及治疗后6个月酒精依赖、心理渴求、自我效能感及复饮情况;观察2组治疗后6个月,复饮以及再住院情况。结果：治疗完成后,2组酒精依赖戒断评估表（CIWA-Ar）、酒精依赖筛查量表（MAST）、心理渴求以匹兹堡睡眠质量指数量表（PSQI）、宾夕法尼亚酒精渴求量表（PACS）评分均较治疗前降低（P＜0.05）,且rTMS组CIWA-Ar、MAST、PSQI、PACS评分均低于对照组（P＜0.05）;治疗后6个月,rTMS组CIWA-Ar、MAST、PSQI、PACS评分均低于对照组（P＜0.05）,rTMS组CIWA-Ar、MAST、PSQI、PACS评分与治疗完成后差异无统计学意义,对照组CIWA-Ar、MAST、PSQI、PACS评分均高于治疗完成后（P＜0.05）。治疗完成后,2组一般自我效能感量表（GSES）评分均较治疗前升高,且rTMS组GSES评分均高于对照组（P＜0.05）;治疗后6个月,rTMS组GSES评分高于对照组（P＜0.05）,rTMS组GSES评分与治疗完成后差异无统计学意义,对照组GSES评分低于治疗完成后（P＜0.05）。治疗期间,2组均无显著副反应发生。治疗后6个月,rTMS组复饮以及再住院率均低于对照组（P＜0.05）。结论：rTMS治疗可有助于降低酒依赖患者酒精依赖程度及对酒精的心理渴求,缓解患者生理心理上的痛苦,增强其SE,降低复饮及再住院率。     

重复经颅磁刺激联合心理干预治疗帕金森病抑郁患者的疗效观察

目的探讨重复经颅磁刺激(rTMS)联合心理干预对帕金森病抑郁(dPD)患者抑郁症状、神经功能及生活质量的改善作用。方法采用随机数字表法将120例dPD患者分为心理组、rTMS组及观察组, 每组40例。所有患者均给予常规抗帕金森病及抗抑郁药物治疗, 在此基础上心理组、rTMS组患者分别给予心理干预或高频(10 Hz)rTMS治疗(刺激部位为左侧背外侧皮质区), 观察组患者则辅以心理干预及高频rTMS治疗, 3组患者均持续治疗8周。于治疗前、治疗8周后分别采用汉密尔顿抑郁量表(HAMD-24)、新版帕金森病综合评价量表(MDS-UPDRS)及生活质量评价量表(SF-36)对3组患者抑郁症状、神经功能受损程度和生活质量进行评估。结果治疗8周后3组患者HAMD评分、MDS-UPDRS评分及SF-36评分均较治疗前明显改善(P<0.05), 并且治疗后观察组HAMD评分[(13.98±2.46)分]、MDS-UPDRS评分、SF-36评分[(82.35±5.66)分]及临床缓解率(40.0%)、反应率(90.0%)等均显著优于心理组及rTMS组水平(P<0.05)。结论心理干预联合r...     

重复经颅磁刺激联合针刺治疗脊髓损伤后神经病理性疼痛的临床研究

目的：观察重复经颅磁刺激（rTMS）联合针刺治疗脊髓损伤（SCI）后神经病理性疼痛（NP）的临床疗效。方法：按随机数字表法将99例SCI后NP患者分成对照组、针刺组和联合组,各33例。对照组进行常规基础治疗,针刺组在对照组基础上进行针刺治疗,联合组在针刺组基础上进行rTMS治疗。分别于治疗前及治疗6周后对3组患者进行视觉模拟量表（VAS）、汉密顿抑郁量表（HAMD）、汉密顿焦虑量表(HAMA)及生活质量SF-36量表评估。结果：治疗6周后,3组患者VAS、HAMD和HAMA评分较治疗前均明显降低（P＜0.05）,SF-36量表各项评分较治疗前均明显升高（P＜0.05）;针刺组VAS、HAMD和HAMA评分较对照组均有降低（P＜0.05）,SF-36量表各项评分较对照组均有升高（P＜0.05）;联合组VAS、HAMD和HAMA评分较针刺组和对照组均有降低（P＜0.05）,SF-36量表各项评分较针刺组和对照组均有升高（P＜0.05）。结论：rTMS联合针刺治疗SCI后NP患者,有助于改善患者临床疼痛现象,且在改善患者情绪和生活质量方面疗效显著。     

高频重复经颅磁刺激联合认知训练治疗卒中后执行功能障碍的疗效

目的:探讨高频重复经颅磁刺激(rTMS)联合认知训练治疗卒中后执行功能障碍的疗效。方法:选取60例脑卒中后执行功能障碍患者，随机分成对照组和观察组各30例。对照组采用认知训练，同时给予假刺激治疗，观察组采用高频(10Hz)rTMS联合认知训练治疗，共治疗6周。2组患者于治疗前后采用额叶功能评定量表(FAB)、汉诺塔测试(TOH)、连线测验A(TMT-A)评定患者执行功能，同时评估事件相关电位P300潜伏期和波幅。结果:2组患者治疗前FAB评分、TOH评分、TMT-A评分、P300潜伏期及波幅的比较差异无统计学意义。治疗6周后，2组患者的FAB评分高于治疗前(P<0.05),TOH评分及TMT-A评分低于治疗前(P<0.05),P300潜伏期较治疗前缩短(P<0.05),波幅较治疗前增高(P<0.05);治疗后，观察组FAB评分较对照组升高(P<0.05),TOH及TMT-A评分较对照组降低(P<0.05),P300潜伏期较对照组缩短(P<0.05),P300波幅较对照组升高(P<0.05)。结论:高频rTMS联合认知训练可以有效改善脑卒中...     

高频重复经颅磁刺激在脑卒中后注意障碍患者中的临床研究

目的:探究高频重复经颅磁刺激(rTMS)对脑卒中后注意障碍患者的注意功能和事件相关电位的影响。方法:将60例卒中后注意障碍患者随机分为观察组和对照组各30例。2组患者均予以药物及常规康复治疗,在上述干预基础上观察组采用高频(10Hz)rTMS刺激,对照组予以rTMS假刺激。于治疗前及治疗4周后进行蒙特利尔认知评估量表(MoCA)、符号数字模式测试(SDMT)、数字广度测试(DST)、字母删除试验、事件相关电位P300的评定。结果:治疗后2组患者MoCA、SDMT、DST、正确删除数等评分均较治疗前提高(P<0.05),P300潜伏期缩短、波幅增高(P<0.05),观察组MoCA、SDMT、DST、字母正确删除数等评分较对照组提高更明显(P<0.05),P300潜伏期、波幅较对照组变化明显(P<0.05)。结论:高频rTMS可改善脑卒中后注意障碍患者的注意功能,P300可作为反映其注意功能受损的神经电生理指标。     

高频重复经颅磁刺激对大学生网络成瘾的干预效果

目的探讨高频重复经颅磁刺激(rTMS)对大学生网络成瘾程度及其相关症状的影响。方法选取不同程度的网络成瘾大学生受试者50例, 按随机数字表法分为治疗组和对照组, 每组受试者25例。2组均进行心理行为疗法治疗, 治疗组同时接受40 d、频率10 Hz的rTMS治疗, 刺激部位为左侧DLPFC区, 对照组则接受伪rTMS刺激治疗。于治疗前、治疗4周和治疗8周后采用中文版网络成瘾诊断量表(IAT)、Barratt冲动性量表中文修订版(BIS-11)和视觉模拟评分法(VAS)分别评估2组受试者的网络成瘾程度、冲动性和主观网络渴求程度, 并进行统计学分析。结果治疗4周后, 治疗组的BIS-11注意因子评分、BIS-11总分和VAS评分分别为(20.47±4.14)分、(68.05±6.10)分和(6.67±0.65)分, 与组内治疗前和对照组治疗4周后比较, 差异均有统计学意义(P<0.05);治疗8周后, 治疗组的IAT评分、BIS-11各项评分和VAS评分与组内治疗前、组内治疗4周后以及对照组治疗8周后比较, 差异均有统计学意义(P<0.05)。结论高频rTMS刺激网络成瘾大学生...     

高频重复经颅磁刺激结合平衡训练仪治疗对脑梗死患者平衡障碍的康复疗效

目的:研究高频重复经颅磁刺激(rTMS)结合平衡训练仪治疗对脑梗死患者平衡障碍的康复疗效。方法:选取2021年4月至2023年1月在潍坊市人民医院脑科分院康复科收治的急性脑梗死患者70例,随机分为高频rTMS组和对照组各35例。2组患者均行常规康复训练和平衡训练仪治疗,高频rTMS组给予高频rTMS刺激治疗,对照组则给予假高频rTMS刺激治疗,2组患者均治疗3周,共18次。分别于治疗前后对2组患者进行Fugl-Meyer平衡量表(FMB)评分、Berg平衡量表(BBS)评分、改良Barthel指数量表(MBI)评分,并以平衡训练仪测定患者运动时倾斜角度,行组内组间比较。结果:治疗3周后2组患者FMB评分、BBS评分、MBI评分、前后倾斜角度及左右倾斜角度均较治疗前有明显改善(均P<0.05),且高频rTMS组BBS评分、MBI评分、前后倾斜角度均明显高于对照组(均P<0.05)。结论:与单独使用平衡训练仪治疗比较,高频rTMS联合平衡训练仪治疗在改善脑梗死患者平衡障碍上效果显著,更有利于患者平衡功能恢复。     

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.     

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.     

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.     

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.