肝动脉化疗栓塞后患者血常规和肝功能指标的变化分析与护理

目的观察分析TACE术后患者血常规和肝功能化验指标的变化情况。方法采用自身对照法,对66例住院行TACE治疗患者治疗前、后的血红蛋白、白细胞、血小板和丙氨酸氨基转移酶、天冬氨酸氨基转移酶、总胆红素、直接胆红素、血清白蛋白和总蛋白的化验指标分析,比较其变化情况。结果TACE术后患者的血红蛋白和血小板计数均低于术前,白细胞计数较术前增高,丙氨酸氨基转移酶、天冬氨酸氨基转移酶、总胆红素和直接胆红素均增高,血清白蛋白和总蛋白均降低,差异有显著性意义（P〈0.01或P〈0.05）。术后血红蛋白的变化与血清白蛋白和丙氨酸氨基转移酶的变化有关,血小板的变化与总蛋白、直接胆红素和丙氨酸氨基转移酶的变化有关。结论TACE术后患者血常规及肝功能较术前存在明显变化。     

肝动脉化疗栓塞后患者血常规和肝功能指标的变化分析与护理

目的观察分析TACE术后患者血常规和肝功能化验指标的变化情况。方法采用自身对照法,对66例住院行TACE治疗患者治疗前、后的血红蛋白、白细胞、血小板和丙氨酸氨基转移酶、天冬氨酸氨基转移酶、总胆红素、直接胆红素、血清白蛋白和总蛋白的化验指标分析,比较其变化情况。结果TACE术后患者的血红蛋白和血小板计数均低于术前,白细胞计数较术前增高,丙氨酸氨基转移酶、天冬氨酸氨基转移酶、总胆红素和直接胆红素均增高,血清白蛋白和总蛋白均降低,差异有显著性意义（P〈0.01或P〈0.05）。术后血红蛋白的变化与血清白蛋白和丙氨酸氨基转移酶的变化有关,血小板的变化与总蛋白、直接胆红素和丙氨酸氨基转移酶的变化有关。结论TACE术后患者血常规及肝功能较术前存在明显变化。     

肝癌患者经肝动脉化疗栓塞前后血常规及肝功能变化

目的 观察肝癌患者肝动脉化疗栓塞前后血常规、肝功能的变化,了解此治疗方法对血常规、肝功能的影响。方法 肝癌患者术前和术后1、2、3周血常规、肝功能各项指标检验,以观察治疗前后血常规、肝功能的变化。结果 肝癌患者经肝动脉化疗栓塞后虽有丙氨酸氨基转移酶升高,白细胞、血小板降低,但2周后全部恢复正常。结论 肝动脉化疗栓塞虽出现骨髓抑制、肝功能损害现象,但很轻微并且两周全部恢复正常。     

聚乙烯醇颗粒在原发性肝癌经导管肝动脉化疗栓塞术中的应用

目的 探讨聚乙烯醇颗粒(PVA)在原发性肝癌经导管肝动脉化疗栓塞术(TACE)中的应用价值.方法 对20例肝癌患者行TACE术,术中先使用碘化油化疗药物混合乳剂栓塞肿瘤血管,再用PVA颗粒超选择性插管栓塞肿瘤供血动脉.观察患者术后1个月、3个月、6个月、1年时肿瘤缩小程度、治疗有效率及甲胎蛋白(AFP)水平变化;术后1周及1个月时血清天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)及总胆红素(TBILI)水平,记录疾病进展时间及生存期.结果 术后1个月、3个月、6个月、1年肿瘤直径均较术前明显缩小(P＜0.05),其治疗有效率(完全缓解+部分缓解)分别为80.00%、90.00%、95.00%、95.00%,AFP水平较术前明显下降(P＜0.05).术后1周AST、ALT、TBILI均较术前明显升高(P＜0.05),但1个月时AST、ALT、TBILI均恢复为术前水平.随访时间12～32(19.8±7.0)个月,疾病进展时间为(17.0±6.8)个月,总生存时间为(19.3±7.0)个月.结论 PVA颗粒作为永久性栓塞材料,在肝癌TACE中栓塞效果明显,但术中需超选择性插管到肿瘤供血动脉内进行栓塞治疗.     

超声引导下腹腔镜射频消融术治疗肝血管瘤的临床观察

目的:探讨超声引导下腹腔镜射频消融术治疗肝血管瘤的临床效果。方法:回顾性分析2018年1月～2019年7月收治的70例肝血管瘤患者临床资料,按治疗方式不同分为对照组34例和观察组36例。对照组行肝血管瘤介入栓塞术治疗,观察组行超声引导下腹腔镜射频消融术治疗。比较两组患者围术期指标与术前、术后7 d肝功能指标。结果:与对照组相比,观察组手术用时较短,手术总出血量较少,差异有统计学意义(P<0.05);两组住院时间比较,差异无统计学意义(P>0.05)。术后7 d,两组血清总胆红素、丙氨酸氨基转移酶及天门冬氨酸氨基转移酶指标均上升,但观察组血清总胆红素较对照组低,丙氨酸氨基转移酶及天门冬氨酸氨基转移酶较对照组高,差异有统计学意义(P<0.05)。结论:采用超声引导下腹腔镜射频消融术治疗肝血管瘤患者效果优于肝血管瘤介入栓塞术,可有效缩短手术用时,减少手术总出血量,改善肝功能指标,利于患者预后。     

慢性胰腺炎合并幽门螺杆菌感染患者的临床特征分析

[目的]探讨幽门螺杆菌感染对慢性胰腺炎的影响,为临床防治提供一定的理论基础.[方法]回顾性分析本院2005年1月至2007年7月间收治的慢性胰腺炎患者入院时血淀粉酶、血钙、血糖、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、血清白蛋白、血肌酐、尿素氮等因素和幽门螺杆茵感染的相关性.[结果]与时照组(无幽门螺杆菌感染)相比,观察组(幽门螺杆茵感染)血肌酐和尿素氮水平明显升高(P＜0.01),血清白蛋白水平明显降低(P＜0.01),血淀粉酶恢复时间(P＜0.05)、腹痛时间(P＜0.01)及住院天数(P＜0.01)均明显延长,1年复发率(P＜0.05)显著升高.[结论]幽门螺杆菌感染能加重慢性胰腺炎患者的病情,并影响其治疗疗效,其作用机制可能与幽门螺杆菌感染能加重慢性胰腺炎患者肾功能损害、降低患者血清白蛋白水平有关.     

温阳消饮汤在脾肾阳虚证肝硬化患者临床辅助治疗中的应用

目的：探讨温阳消饮汤在脾肾阳虚证肝硬化患者临床辅助治疗中的应用。方法：选取2018年12月~2020年1月收治的131例肝硬化患者,根据随机数字表法分为对照组65例与观察组66例。对照组接受常规西医治疗,观察组在此基础上加用温阳消饮汤治疗。对比两组临床疗效、肝功能（门冬氨酸氨基转移酶、丙氨酸氨基转移酶、总胆红素、白蛋白）水平及治疗期间不良反应。结果：观察组总有效率为90.91%,较对照组的75.38%高,差异有统计学意义（P＜0.05）。治疗后,两组门冬氨酸氨基转移酶、丙氨酸氨基转移酶、总胆红素均降低,白蛋白均升高,但观察组门冬氨酸氨基转移酶、丙氨酸氨基转移酶、总胆红素低于对照组,白蛋白高于对照组,差异有统计学意义（P＜0.05）。两组不良反应对比,差异无统计学意义（P＞0.05）。结论：温阳消饮汤用于脾肾阳虚证肝硬化患者中,能够有效改善肝功能,提升治疗疗效。     

神经肌肉放松训练对慢性乙型肝炎病人肝功能的影响

[目的]探讨神经肌肉放松训练对慢性乙型肝炎病人肝功能的影响。[方法]治疗组50例,在药物治疗基础上进行神经肌肉放松训练干预,对照组40例进行常规药物治疗,在干预前分别检查肝功能指标,以观察干预前后的效果。[结果]干预后病人肝功能改善,丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、白蛋白(ALB),总胆红素(TBiL),结合胆红素(DBiL)较干预前均有改善。[结论]在常规治疗基础上配合神经肌肉放松训练,可以有效改善慢性乙型肝炎病人肝功能。     

血清总胆汁酸和前白蛋白联合检测在肺结核病中的临床意义

目的探讨血清总胆汁酸(TBA)和前白蛋白(PA)联合检测在肺结核病中的临床应用价值.方法采用循环酶法和免疫透射比浊法分别检测406例肺结核病人治疗前后血清TBA和PA,同时检测丙氨酸氨基转移酶(ALT)及天门冬氨酸氨基转移酶(AST)作为对比.结果在肺结核病人治疗1个月后血清TBA和PA检测结果较治疗前结果差异有显著性意义(P＜0.01),ALT和AST均较治疗前升高(P＜0.05);随着疗程的延长,血清PA显著降低(P＜0.01),而TBA显著升高(P＜0.01);治疗后1个月血清PA和TBA的异常率分别为89.9%和56%,与ALT和AST的异常率相比较有显著性差异(P＜0.01),治疗3个月后,血清ALT和AST的异常率(98%、99%)和TBA的异常率(83%)的差异有显著性意义(P＜0.05).结论联合检测血清TBA和PA对判断抗结核治疗后早期肝功能损伤有重要临床意义,可作为抗结核治疗后检测肝功能的常规指标.     

超声引导下微波消融术联合TACE术治疗原发性肝癌的临床效果

目的 探讨超声引导下微波消融术联合肝动脉化疗栓塞术（TACE）治疗原发性肝癌的临床效果。方法选取2016年1月至2019年3月兰考县中心医院收治的原发性肝癌患者156例,按随机数字表法分为2组：对照组78例采用TACE术治疗,研究组78例采用超声引导下微波消融术+TACE术治疗。比较2组疾病控制率、治疗前后肝功能指标[血清丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）]、血清肿瘤标志物[甲胎蛋白（AFP）、糖蛋白抗原724（CA724）]水平、并发症发生率及术后1年生存率。结果 与对照组比较,研究组疾病控制率显著升高（P<0.05）;与治疗前比较,2组治疗后血清ALT、AST、AFP及CA724水平均显著降低,且研究组治疗后上述指标水平降低更为明显（均P<0.05）;2组术后并发症发生率比较,差异无统计学意义（χ2=0.880,P=0.348）;与对照组比较,研究组术后1年生存率显著升高（χ2=7.590,P=0.006）。结论 超声引导下微波消融术、TACE术联合治疗可有效控制原发性肝癌,对患者肝功能、肿瘤标志物表达改善均有积极作用,可显著提高患者生存率,且不增加治疗风险。     

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.     

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.