糖尿病肾病不同时期血浆肝细胞生长因子及转化生长因子β1水平

目的观察糖尿病肾病不同时期患者血浆肝细胞生长因子(HGF)及转化生长因子β1(TGFβ-1)水平。方法分别检测单纯2型糖尿病患者30例(A组),糖尿病肾病肾功能正常患者25例(B组)和糖尿病肾病终末期肾功能衰竭患者25例(C组)的外周血HGF及TGF-β1水平,并对相关数据进行统计学分析。结果A组外周血HGF及TGFβ-1分别为(285.33±80.27)ng/L,(94.25±27.45)μg/L;B组为(2 000.23±835.65)ng/L,(138.96±26.75)μg/L;C组为(985.44±92.23)ng/L,(183.78±45.68)μg/L,各组间比较差别有统计学意义(P<0.05或P<0.01)。结论糖尿病患者随着肾损害的出现,其HGF及TGFβ-1水平亦逐渐增高,但进入终末期肾功能衰竭后HGF水平明显降低,而TGF-β1水平仍持续高水平存在。     

慢性肾功能衰竭患者颈部血管彩超的应用及临床价值

目的:探讨慢性肾功能衰竭患者颈部血管彩超的应用价值.方法:以2020年6—9月扬州市中医院门诊收治的93例慢性肾功能衰竭患者为研究对象,其原发病分别为高血压肾损害(n=33)、糖尿病肾病(n=30)及慢性肾小球肾炎(n=30),将其分别纳入高血压肾损害组、糖尿病肾病组及慢性肾小球肾炎组中,所有患者均接受颈部血管彩超检查...     

血清胱抑素C与尿微量清蛋白在2型糖尿病肾损害早期的变化及意义

目的探讨尿微量清蛋白(mAlb)、血清胱抑素C(CysC)在糖尿病肾病早期的变化及意义。方法应用免疫比浊法对糖尿病无肾病组46例、早期糖尿病肾病组42例、糖尿病明显肾病组27例患者进行血清CysC、尿mAlb/肌酐含量检测,并与30例健康对照组进行比较。结果早期糖尿病肾病组mAlb/肌酐、血清CysC含量分别为(148.25±35.42)mg/g、(2.87±0.98)mg/L,糖尿病明显肾病组分别为(396.56±62.80)mg/g、(5.26±1.74)mg/L,明显高于健康对照组的(16.95±6.53)mg/g、(1.03±0.48)mg/L及糖尿病无肾病组的(18.90±8.30)mg/g、(1.14±0.78)mg/L,差异有统计学意义(P<0.01)。结论尿中mAlb、血清CysC含量在糖尿病肾功能早期损伤中变化较明显。     

肾病综合征患儿血清IGF-1、ALB、hs-CRP水平及临床意义

目的观察肾病综合征患儿血清胰岛素样生长因子(IGF)-1、清蛋白(ALB)、超敏C反应蛋白(hsCRP)水平,并分析其临床意义。方法选取2016—2018年在该院接受治疗的100例肾病综合征患儿(肾病综合征组)为研究对象,并选取同期在该院接受体检的100例健康儿童作为对照组。观察两组研究对象IGF-1、ALB、hs-CRP、炎症因子[白细胞介素(IL)-6、肿瘤坏死因子(TNF)-α]、肾功能指标[尿素氮(BUN)、肌酐(Scr)、预估肾小球滤过率(eGFR)]的差异,分析肾病综合征患儿IGF-1、ALB、hs-CRP水平与炎症因子、肾功能指标的相关性。结果肾病综合征组患儿的血清IGF-1、hs-CRP水平分别为(284.1±8.6)ng/mL、(13.5±1.7)mg/L,高于对照组(P0.05),ALB水平为(30.2±6.3)g/L,低于对照组(P0.05)。肾病综合征组患儿的血清IL-6、TNF-α水平分别为(34.2±3.7)mg/L、(38.1±3.5)ng/L,均高于对照组(P0.05)。肾病综合征组患儿的BUN、SCr水平分别为(15.2±2.0)mmol/L、(104.3±9.6)μmol/L,均高于对照组(P0.05),eGFR水平为(56.5±3.7)mL/(min·1.73 m2),低于对照组(P0.05)。肾病综合征患儿的IGF-1、hs-CRP水平与IL-6、TNF-α、BUN、SCr呈正相关,与eGFR呈负相关,ALB水平与IL-6、TNF-α、BUN、SCr呈负相关,与eGFR呈正相关。结论肾病综合征患儿的血清IGF-1、hs-CRP、ALB水平与肾功能等指标密切相关,可作为病情判断的指标。     

血清结合珠蛋白对2型糖尿病患者肾功能预测价值分析

目的探讨血清结合珠蛋白水平对2型糖尿病患者早期肾功能下降的预测作用。方法选取2013年6月至2014年6月该院收治的2型糖尿病患者98例,按尿清蛋白排泄率(UAER)分为A组(UAER:30mg/24h,n=36)、B组(UAER:≥30~≤300mg/24h,n=32)和C组(UAER:300mg/24h,n=30),另选取30例同期健康体检者作为对照组。统计分析4组血清结合珠蛋白、尿微量清蛋白和尿β2-微球蛋白、血清肌酐、血清尿素氮和血清胱抑素C(Cys C)水平,并分析血清结合珠蛋白水平与各肾功能指标的关系。结果对照组血清结合珠蛋白水平(70.48±14.87)mg/L,低于A组、B组和C组的(124.48±24.15)、(153.41±26.74)、(206.54±30.55)mg/L,对照组尿微量清蛋白水平、尿β2-微球蛋白、血清肌酐、血清尿素氮和血清Cys C水平亦低于A组、B组和C组;A组血清结合珠蛋白水平、肾小球功能指标和肾功能指标低于B组和C组,且B组血清结合珠蛋白水平、肾小球功能指标和肾功能指标亦低于C组,差异有统计学意义(P0.05)。Pearson相关性分析结果显示,2型糖尿病患者血清结合珠蛋白水平与其尿微量清蛋白、尿β2-微球蛋白、血清肌酐、血清尿素氮和血清Cys C水平均呈正相关(r=0.718、0.724、0.762、0.748、0.783,P0.05)。结论2型糖尿病患者可出现血清结合珠蛋白水平的升高且随着患者UAER等肾功能指标的升高其血清结合珠蛋白水平升高,其血清结合珠蛋白水平可用于患者肾功能下降的预测。     

血清Apelin和补体C1q肿瘤坏死因子相关蛋白9与糖尿病肾病慢性肾脏病Ⅴ期患者血管钙化的关系

目的探讨糖尿病肾病慢性肾脏病Ⅴ期(chronic kidney disease-Ⅴ, CKD-Ⅴ)患者血清Apelin、补体C1q肿瘤坏死因子相关蛋白9(complement C1q tumor necrosis factor related protein 9, CTRP9)水平与血管钙化的关系。方法糖尿病肾病CKD-Ⅴ期患者139例,根据腹主动脉钙化评分分为钙化组67例和非钙化组72例。比较2组一般资料,血清Apelin、CTRP9、白蛋白、肌酐、胆固醇、三酰甘油、25-羟维生素D_3、甲状旁腺激素、血钙、血磷、血红蛋白水平以及预估肾小球滤过率、尿蛋白肌酐比值;多因素logistic回归分析糖尿病肾病CKD-Ⅴ期患者血管钙化的影响因素;绘制ROC曲线评价血清Apelin和CTRP9诊断糖尿病肾病CKD-Ⅴ期患者血管钙化的价值。结果钙化组血清Apelin[(57.62±4.91)μg/L]、CTRP9[(7.81±0.90)μg/L]水平低于非钙化组[(91.32±7.11)、(10.62±1.81)μg/L],年龄[(68.40±8.90)岁]、血磷[(2.31±1.20)mmol/L]、25-羟维生素D_3[(24.88±6.21)μg/L]和甲状旁腺激素[(469.13±98.31)ng/L]水平高于非钙化组[(62.10±6.20)岁、(1.91±0.90)mmol/L、(21.72±4.51)μg/L、(412.62±67.22) ng/L](P0.05);2组性别比例、血压、体质量指数和白蛋白、肌酐、胆固醇、三酰甘油、血钙、血红蛋白水平以及估算肾小球滤过率、尿蛋白肌酐比值比较差异均无统计学意义(P0.05)。多因素logistic回归分析结果显示,年龄≥65岁(OR=1.864,95%CI:1.079～3.220,P=0.025)、甲状旁腺激素水平≥440 ng/L(OR=2.289,95%CI:1.484～3.532,P0.001)是糖尿病肾病CKD-Ⅴ期患者发生血管钙化的独立危险因素,血清Apelin≥75μg/L (OR=0.817,95%CI:0.705～0.947,P=0.007)、CTRP9≥9μg/L(OR=0.901,95%CI:0.831～0.976,P=0.011)是其保护因素。血清Apelin、CTRP9分别以60μg/L、8μg/L为最佳截断值,诊断糖尿病肾病CKD-Ⅴ期患者血管钙化的AUC分别为0.816(95%CI0.751～0.874,P0.001)、0.824(95%CI:0.762～0.893,P0.001),灵敏度分别为76.7%、82.1%,特异度分别为81.2%、77.5%。结论糖尿病肾病CKD-Ⅴ期血管钙化患者血清Apelin、CTRP9水平降低,是糖尿病肾病CKD-Ⅴ期患者发生血管钙化的危险因素。     

2型糖尿病并急性脑梗死患者血清胰岛素样生长因子-1水平与神经功能缺损及临床预后相关性

目的探讨2型糖尿病并急性脑梗死患者血清胰岛素样生长因子-1(insulin-like growth factor-1,IGF-1)水平与神经功能缺损及临床预后的相关性。方法 2型糖尿病并急性脑梗死患者32例(脑梗死+糖尿病组)、急性脑梗死非糖尿病患者33例(脑梗死组)、单纯2型糖尿病患者33例(糖尿病组)和体检健康者30例(对照组),脑梗死+糖尿病组和脑梗死组分别于起病后3、14d检测血清IGF-1水平,采用美国国立卫生院卒中量表(the National Institutes of Health Stroke Scale,NHSS)评分评估神经功能缺损程度,90d行改良Rankin量表(modified Rankin scale,MRS)评分判断预后情况;糖尿病组和对照组分别于入院后3、14d检测血清IGF-1水平,并与脑梗死+糖尿病组、脑梗死组进行比较。结果脑梗死+糖尿病组3、14d时血清IGF-1水平[(88.08±24.22)、(114.43±24.54)μg/L]低于脑梗死组[(99.73±20.25)、(125.89±20.35)μg/L]、糖尿病组[(106.45±19.29)、(127.14±19.11)μg/L]和对照组[(152.50±28.56)、(152.56±26.40)μg/L](P0.01),脑梗死组与糖尿病组IGF-1水平低于对照组(P0.05),脑梗死组与糖尿病组比较差异无统计学意义(P0.05);脑梗死+糖尿病组3、14d时NIHSS评分(7.44±2.34、4.34±1.86)及90d时MRS评分(2.22±1.21)均高于脑梗死组(5.48±1.87、2.61±1.87,1.64±0.99)(P0.05);3、14d时NIHSS评分与3、14d时脑梗死+糖尿病组(r=-0.934,P=0.004;r=-0.821,P=0.000)和脑梗死组(r=-0.807,P=0.008;r=-0.653,P=0.005)IGF-1水平呈明显负相关,90d时MRS评分与3、14d时脑梗死+糖尿病组(r=-0.309,P=0.031;r=-0.306;P=0.029)和脑梗死组(r=-0.308,P=0.045;r=-0.369,P=0.037)IGF-1水平呈明显负相关。结论 2型糖尿病并急性脑梗死患者血清IGF-1水平可用于判断病情轻重及临床预后。     

血清C反应蛋白、白介素6和肿瘤坏死因子α与2型糖尿病肾病的关系

目的研究血清炎症因子C反应蛋白(CRP)、肿瘤坏死因子(TNF)-α、白介素-6(IL-6)、白细胞计数(WBC)在2型糖尿病肾病中的变化.方法 2型糖尿病100例,其中糖尿病肾病60例,分为早期肾病(DN1)组33例,临床肾病(DN2)组27例,2型糖尿病无白蛋白尿组(DM)40例,健康对照组30例;分别测定血清超敏CRP、IL-6、TNF-α、WBC.结果 DM组血清CRP(5.80±3.20) mg/L、IL-6(10.0±4.5) ng/L、TNF-α(16.2±8.5) ng/L较正常对照组升高[分别为(2.90±1.80) mg/L、(7.3±2.0) ng/L、(13.0±4.1) ng/L(P<0.05)];DN1、DN2两组的血清CRP、IL-6、TNF-α及WBC均较DM组、正常对照组升高(P<0.05或P<0.01);DN2组(12.50±8.60) mg/L又较DN1组(7.20±5.00) mg/L,CRP升高(P<0.05).相关分析发现,血清CRP与TC呈正相关(r=0.510,P<0.01);血清IL-6与总胆固醇(r=0.271,P<0.01)及糖化血红蛋白(r=0.351,P<0.01)呈正相关.血清TNF-α、WBC计数与体质量指数(r=0.236,P<0.01;r=0.254,P<0.01) 呈正相关.结论糖尿病肾病患者血清炎症因子水平升高,与尿蛋白排泄率呈正相关.血清超敏CRP、IL-6、TNF-α、WBC的测定可作为判断2型糖尿病肾损害程度及预后的指标.     

血清心肌肌钙蛋白对糖尿病患者心血管影响的研究

目的探索血清心肌肌钙蛋白水平对糖尿病患者心血管的临床影响。方法选取2014年12月至2016年12月于该院接受治疗的214例糖尿病患者为研究对象,按照患者血清心肌肌钙蛋白水平分为阳性组(n=46)和阴性组(n=168)。对比两组患者随机血糖、糖化血红蛋白、果糖胺、血红蛋白、C反应蛋白等指标水平差异。采用复诊的形式对两组患者心血管事件发生率进行统计。结果阳性组果糖胺(283.17±66.35)μmol/L,血红蛋白(93.24±21.03)g/L,明显低于阴性组的果糖胺[(334.84±82.04)μmol/L]、血红蛋白[(128.35±24.56)g/L]水平;阳性组C反应蛋白为(36.03±10.24)mg/L,明显高于阴性组的C反应蛋白水平[(7.23±1.79)mg/L,P0.05]。随访1年期间阳性组心血管事件总发生率为8.70%,显著高于阴性组(4.76%),差异有统计学意义(P0.05)。结论心肌肌钙蛋白水平较高的糖尿病患者C反应蛋白较高,同时血清果糖胺和血红蛋白水平较低,临床上应该对糖尿病患者血清肌钙蛋白进行密切关注,对患者发生的心血管疾病进行及时治疗。     

IGF-1在2型糖尿病肾病中的表达及作用

目的探讨胰岛素样生长因子-1(IGF-1)与2型糖尿病(DM)肾脏病变程度的关系及其临床诊断价值,为研究糖尿病肾病(DN)的发病机制提供参考依据。方法选择2017年1月10日—2018年1月10日在成都中医药大学附属医院确诊的90例2型DN患者作为研究对象,根据临床分期标准分为正常白蛋白尿期组[Ⅰ期,尿微量白蛋白/尿肌酐(mALB/UCr)3.41 mg/mmol]、微量白蛋白尿期组(Ⅱ期,mALB/UCr为3.41～34.09 mg/mmol)和大量白蛋白尿期组(Ⅲ期,mALB/UCr≥34.09 mg/mmol),每组各30例;根据肾功能受损程度分为肾功能正常组[30例,肾小球滤过率(eGFR)≥90 mL·min~(-1)·1.73 m~(-2)]、肾功能轻度受损组(43例,eGFR为60～90 mL·min~(-1)·1.73 m~(-2))和慢性肾功能不全组(17例,eGFR60 mL·min~(-1)·1.73 m~(-2))。另选择20例健康体检者作为健康对照组。采用酶联免疫吸附试验(ELISA)测定所有研究对象的血浆IGF-1水平,绘制受试者工作特征曲线(ROC),采用ROC曲线下面积(AUC)评估mALB、胱抑素C(Cys C)、IGF-1对肾功能受损情况的诊断价值。结果 2型DN组患者的IGF-1水平均明显高于健康对照组(μg/L:55.77±7.23),其中2型DN患者Ⅰ～Ⅲ期各组的IGF-1水平依次为DNⅢ期组DNⅡ期组DNⅠ期组(μg/L:178.79±10.03118.62±8.9477.06±7.54),组间两两比较差异均有统计学意义(均P0.05);随肾脏损伤程度增加,IGF-1水平逐渐升高,慢性肾功能不全组肾功能轻度受损组肾功能正常组(μg/L:178.48±9.61131.52±39.4992.36±8.24),组间两两比较差异均有统计学意义(均P0.05)。ROC曲线分析显示,IGF-1、mALB/UCr、Cys C诊断2型DN患者肾功能受损的AUC分别为0.81、0.93、0.69,当83.56μg/L作为IGF-1诊断肾功能受损的临界值时,敏感度(81.50%)和特异度(83.00%)均达到最佳。结论 IGF-1在2型DN肾功能受损评价方面具有一定价值,并在疾病不同临床阶段有不同程度的升高,故在2型DN早期诊断、疾病评估方面具有较好的临床应用前景。     

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.