宫颈电环形切除术后联合应用阿希米治疗宫颈炎疗效分析

目的探讨宫颈炎LEEP电环切除术后联合应用阿希米栓剂的临床效果。方法将120例宫颈炎患者中随机分为LEEP刀联合阿希米组(实验组),手术后即应用阿希米辅助治疗;单用LEEP刀组(对照组),每组60例。2组患者每例随访3个月,观察术后出血量、出血时间、阴道排液时间及宫颈创面愈合情况。结果实验组1次治愈率96.6%,对照组88.3%,有显著性差异(P<0.01)。实验组术后阴道出血量减少、出血时间缩短、阴道排液减少及宫颈创面愈合时间均比对照组缩短(P<0.01),实验组创面感染率少于对照组(P<0.01)。结论 LEEP联合应用阿希米栓剂治疗宫颈炎缩短了宫颈炎治愈的时间,减少了术后阴道排液量及出血量,缩短了术后阴道排液时间及出血时间,减少感染发生。     

LEEP刀联合臭氧治疗慢性宫颈炎的临床疗效观察

目的探讨LEEP刀联合臭氧治疗慢性宫颈炎的临床疗效。方法选取2016年4月～2018年3月我院收治的慢性宫颈炎患者126例,随机分为研究组和对照组各63例。对照组给予LEEP刀治疗,研究组在对照组的基础上加用臭氧治疗。比较2组患者的临床疗效及术中、术后情况。结果研究组总有效率明显高于对照组(P0.05),术中出血量、创口持续渗血时间、阴道流液时间、创口愈合时间均明显低于对照组(P0.05)。结论 LEEP刀、臭氧联合治疗慢性宫颈炎临床疗效显著,能有效促进术后创面的恢复,减少并发症的发生,值得临床推广应用。     

LEEP刀治疗慢性宫颈炎820例临床分析

目的评价超高频电波(LEEP)刀治疗慢性宫颈炎的临床疗效,总结治疗经验。方法整理2006～2009年采用LEEP刀治疗慢性宫颈炎的820例病例资料,对治疗、术后恢复及复发比率进行综合性分析。结果术后2个月治愈率为89.76%,术后6个月显效率为100%。结论 LEEP刀治疗慢性宫颈炎具有治疗彻底、复发率低的优势,还有利于病理检验的实施,对于预防宫颈癌变可起到积极作用。     

中医辨证治疗宫颈糜烂LEEP刀术后并发症临床观察

目的观察中医辨证论治宫颈糜烂LEEP刀治疗术后并发创面感染、阴道流液、全身乏力等症状的临床疗效。方法将134例宫颈糜烂患者随机分为两组。对照组67例采用单纯LEEP刀治疗方法,治疗组67例在对照组治疗基础上采用中医辨证论治。观察两组临床疗效及术后阴道流液、创面感染、全身乏力情况。结果治疗组总有效率100%,对照组总有效率97.01%,两组比较差异有显著性(P<0.05)。治疗组术后治疗后阴道流液、创面感染、全身乏力情况与对照组治疗后比较差异均有显著性(P<0.05)。结论中医辨证论治LEEP治疗宫颈糜烂术后并发症疗效满意。     

微波联合外用溃疡散治疗慢性宫颈炎的临床观察

目的探讨外用溃疡散辅助微波治疗宫颈炎的临床疗效。方法 110例慢性宫颈炎患者,随机分为两组。实验组55例于微波治疗后,加用外用溃疡散。对照组55例单用微波治疗。结果实验组术后阴道排液量、阴道出血时间少于对照组,两组比较差异具有统计学意义(P<0.05)。结论微波治疗宫颈炎术后加用中药外用溃疡散能促进创面愈合,减少排液量和出血时间。     

LEEP刀与微波疗法治疗慢性宫颈炎的临床对比观察

目的观察LEEP刀与微波疗法治疗慢性宫颈炎的临床疗效。方法选取2018年6月至2019年6月本院妇科门诊就诊的100例慢性宫颈炎患者为研究对象,根据治疗方法分为微波组及LEEP刀组,均50例。对比手术时间、手术出血量及宫颈创面愈合时间;术后3个月复查进行疗效判定,统计临床总有效率。结果两组术中出血量比较,无统计学差异(P>0.05);LEEP刀组手术时间、宫颈创面愈合时间明显短于微波组,差异有统计学意义(P<0.05);LEEP刀组临床总有效率96.00%高于微波组82.00%;两组临床总有效率比较,差异有统计学意义(P<0.05)。结论LEEP刀与微波疗法均可治疗慢性宫颈炎,但LEEP刀治疗可明显提高临床总有效率,缩短创面愈合时间。     

宫颈环形电切术与微波治疗中重度宫颈糜烂疗效比较

目的比较宫颈环形电切术(LEEP术)与微波治疗中重度宫颈糜烂的疗效和不良反应。方法将118例宫颈糜烂患者随机分为两组:治疗组60例采用LEEP术治疗,对照组58例采用微波治疗。术后两组均加用康复新液阴道给药,每周1次,连续放药4次。于术后6个月比较两组疗效和不良反应。结果治疗组治愈率及总有效率显著高于对照组(P0.01或P0.05);治疗组术后阴道出血量及排液量少于对照组(P0.01);阴道出血及排液时间短于对照组(P0.01或P0.05);治疗组复发率低于对照组(P0.05)。结论LEEP术治疗中重度宫颈糜烂疗效优于微波治疗,且阴道出血及排液量少,出血及排液时间短,恢复快,复发率低。     

LEEP刀手术治疗宫颈糜烂38例临床护理

目的:探讨利普刀(LEEP刀)手术治疗宫颈糜烂患者的临床护理方法。方法:将76例宫颈糜烂患者随机分为观察组和对照组各38例,对照组给予常规护理干预措施,观察组实施针对性护理干预措施。比较两组临床疗效及并发症发生情况。结果:观察组总有效率为89.47%,对照组总有效率为68.42%,两组比较差异有统计学意义(P0.05)。观察组患者术后阴道排液量月经量人数显著多于对照组(P0.05),术后排液时间7 d的人数显著多于对照组(P0.05);观察组术后阴道出血量月经量人数显著多于对照组(P0.05),术后阴道出血时间10 d的人数显著多于对照组(P0.05)。结论:对宫颈糜烂行LEEP刀手术治疗患者采用针对性临床护理,能够促进患者术后创面康复,提升手术治疗效果,值得临床推广应用。     

LEEP刀联合纳米银治疗40例慢性宫颈炎临床疗效观察

选取我院2013年5月~2014年5月收治的80例慢性宫颈炎患者。随机分为对照组和观察组各40例。对照组采用LEEP刀治疗,观察组采用LEEP刀联合纳米银治疗。比较两组治疗效果,术后愈合时间及并发症发生情况。结果观察组治疗治愈率、总有效率显著高于对照组,观察组术后初步愈合时间显著早于对照组,观察组术后4w完全愈合率显著高于对照组.LEEP刀联合纳米银治疗慢性宫颈炎疗效确切,安全性好,值得临床推广应用。     

保妇康凝胶联合干扰素对宫颈LEEP手术治疗后宫颈修复的疗效观察

目的:探讨保妇康凝胶联合重组人干扰素对宫颈LEEP刀手术治疗后宫颈修复的临床疗效。方法:采用前瞻性对照研究方法,将158例宫颈炎患者随机分为两组。实验组给予保妇康凝胶联合重组人干扰素α-2b栓治疗,对照组应用重组人干扰素α-2b栓,观察两组患者术后阴道流血时间、阴道排液时间、宫颈创面完全修复愈合所需时间以及术后出血、感染、颈管粘连等术后并发症情况。结果:两组并发症发生情况比较差异无统计学意义,实验组的阴道流血、排液及修复愈合时间均短于对照组(P<0.05)。结论:使用保妇康凝胶联合重组人干扰素α-2b栓可缩短宫颈病变手术后宫颈修复时间,无明显不良反应。     

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.