经阴道彩色多普勒超声结合血β-HCG对先兆流产结局的评价

目的探讨先兆流产孕囊绒毛间隙血流动力学特点,并结合血β-HCG评估先兆流产妊娠的预后。方法经阴道彩色多普勒超声检测孕5~8周32例正常妊娠(A组)和62例先兆流产者,其中继续妊娠(B组)28例,必然流产(C组)34例,在不同孕周时观察其绒毛间隙血流频谱的变化,并测量血β-HCG,对其结果进行分析。结果C组在不同孕周血β-HCG的含量与A、B两组间比较差异有统计学意义(P<0.05),A、B两组随孕周的增加血β-HCG的含量升高,而C组的含量开始上升约在第7周下降。A、B两组分别与C组间比较在绒毛间隙血流的收缩期峰值流速(VPS)及收缩期上升支加速度时间(ACT)差异有统计学意义(P<0.05),阻力指数(RI)差异有统计学意义(P<0.01)。结论妊娠8周前随孕周增加血β-HCG减少、绒毛间隙血流RI增加、VPS减小、ACT增加的先兆流产患者无保胎价值,经阴道彩色多普勒超声结合血β-HCG对先兆流产妊娠预后具有较高的指导意义。     

血清瘦素、胱抑素C和人绒毛膜促性腺激素在妊娠高血压综合征检测中的意义

目的观察血清瘦素、胱抑素C(Cys C)和人绒毛膜促性腺激素(β-HCG)在妊娠高血压综合征检测中的意义。方法选取2011年1月至2014年6月收治的妊娠高血压患者150例为妊高症组;同期正常妊娠的患者60例为正常妊娠组;另选同期健康非妊娠妇女30例为健康对照组。观察健康对照组,正常妊娠组和妊高症组的瘦素、Cys C和β-HCG水平,与妊高症严重程度的关系,各指标之间的相互关系。结果正常妊娠组和妊高症组的瘦素、Cys C和β-HCG水平明显高于健康对照组(P0.01),而妊高症组明显高于正常妊娠组(P0.01)。随着妊高症病情严重程度的增加,瘦素,Cys C和β-HCG水平出现明显的增高(P0.01)。妊高症患者瘦素水平与Cys C(r=0.673,P0.01)和β-HCG(r=0.838,P0.01)水平呈正相关,Cys C与β-HCG(r=0.792,P0.01)水平呈正相关。结论检测瘦素、Cys C和β-HCG水平有助于对妊娠高血压患者的诊断和分级,其异常升高应引起临床的高度重视。     

阴道超声测量子宫内膜厚度、阻力指数结合β-HCG检测与异位妊娠患者临床症状的关系

目的分析阴道超声测量子宫内膜厚度（ET）、血流阻力指数（RI）与β-HCG检测与异位妊娠(EP)患者临床症状的关系及其在EP鉴别诊断中的应用价值。方法选择2017年1月~2019年3月间收治的60例符合EP患者作为EP组,50例人工中止妊娠及50例自然流产孕妇作为人工中止妊娠组及自然流产组;采用阴道超声测量ET、RI水平,并检测患者血中β-HCG水平;绘制ROC曲线分析ET、RI与β-HCG联合检测在鉴别诊断EP患者中的应用价值,采用logistics多元回归模型分析各指标与EP患者临床症状关系。结果EP组、自然流产组及人工中止妊娠组患者ET、RI及β-HCG水平差异有统计学意义（P < 0.05）,其中EP组患者ET及β-HCG水平最低,RI最高;ET、RI及β-HCG是影响EP患者临床症状的独立性影响因素（P < 0.05）;ET、RI、β-HCG联合应用鉴别诊断在EP中的敏感度、特异度及AUC均明显高于各指标单独应用（P < 0.05）。结论阴道超声测量ET、RI及血中β-HCG水平是影响EP患者临床症状的独立影响因素,且各指标联合应用可有效提高单独应用的临床应用价值。      

彩色多普勒超声评价血清氧化低密度脂蛋白/β2-糖蛋白Ⅰ水平对2型糖尿病肾病的影响

目的探讨应用彩色多普勒超声检查评价血清氧化低密度脂蛋白/β2-糖蛋白I(ox-LDL/β2-GPI)复合物水平对2型糖尿病肾病(DN)患者的影响。方法根据24h尿蛋白排泄率(UAER)将89例DN患者分成三组:A组(UAER<30mg/24h)、B组(UAER30～300mg/24h)和C组(UAER>300mg/24h),30例正常人作为D组对照。用酶联免疫吸附试验法测定其血清ox-LDL/β2-GPI复合物水平,并应用彩色多普勒超声仪检查四组受检者的肾脏血流灌注情况及肾脏各级动脉血流动力学参数。结果 B组、C组各级动脉的搏动指数(PI)、阻力指数(RI)均明显高于A、D组,差异均有统计学意义(t分别=1.96、2.02、2.14、2.58、2.07、2.22、2.51、2.76、2.18、2.32、2.66、2.84,P均<0.05),而收缩期最大血流速度(Vmax)、舒张期最低血流速度(Vmin)均明显低于A、D组,差异均有统计学意义(t分别=2.09、2.26、2.43、3.16、2.14、2.32、2.47、2.55、2.27、2.41、2.58、2.79,P均<0.05);C组各级动脉的Vmin均明显低于B组,而RI、PI则明显高于B组,差异均有统计学意义(t分别=1.73、1.99、1.81、2.07、1.95、2.13、1.76、2.32、2.09,P均<0.05);A、B、C三组血浆ox-LDL/β2-GPI水平均明显高于D组,差异均有统计学意义(t分别=2.81、3.35、3.97,P均<0.05),B、C两组血浆ox-LDL/β2-GPI水平均明显高于A组,C组血浆ox-LDL/β2-GPI水平明显高于B组,差异均有统计学意义(t分别=3.43、3.86、4.31,P均<0.05);ox-LDL/β2-GPI与B组及C组SRA的RI呈正相关(r=0.28、0.29,P均<0.05),且与B组及C组IRA的RI呈正相关(r=0.37、0.42,P均<0.05)。结论 ox-LDL/β2-GPI复合物水平与DN发病有关,应用彩色多普勒超声能够准确、快速检测DN患者的肾损伤。     

三组用药方案对异位妊娠的疗效对比

目的探讨甲氨蝶呤联合米非司酮不同用药方案治疗异位妊娠的治疗效果。方法选取2011年1月至2014年1月鄢陵县中心医院就诊的异位妊娠的患者159例,随机均分为A、B、C三组,A组患者采用阴道超声引导下穿刺杀胚术配合甲氨蝶呤(MTX)单次肌肉注射,B组患者给予MTX单次肌肉注射,C组患者给予小剂量MTX连续肌肉注射,三组均配伍米非司酮治疗。比较三组患者的有效率、不良反应发生率及治疗7、14d后的血人绒毛膜促性腺激素(β-HCG)下降率。结果A、B两组患者的有效率、血β-HCG下降率高于C组,不良反应发生率低于C组,差异有统计学意义(P0.05)。A组与B组患者的有效率、血β-HCG下降率和不良反应发生率的差异未见统计学意义(P0.05)。结论MTX单次肌肉注射联合米非司酮的临床疗效好,操作更加简单,风险较低,值得临床推广。     

双侧子宫动脉搏动指数差异诊断输卵管妊娠的临床研究

目的探讨双侧子宫动脉搏动差异在诊断输卵管妊娠(TP)中的临床应用价值,为临床诊断输卵管妊娠提供参考。方法选取2013年1月至2013年12月间入院诊治的70例输卵管妊娠的患者,作为实验组。根据TP包块与黄体位置、β-人绒毛膜促性腺激素(β-HCG)的水平分为A组(黄体与TP异侧)、B组(黄体与TP同侧,β-HCG≤800 m IU/ml)、C组(黄体与TP同侧,β-HCG800 m IU/ml)。选取同期入院检查的正常宫内早孕的70例孕妇作为对照组。观察并记录实验组与对照组双侧子宫动脉搏动指数(PI)的差异。结果实验组70例患者中A组7例(10.00%),B组26例(37.14%),C组37例(52.86%)。两组在平均值及S/D平均值方面比较差异无统计学意义(P0.05);实验组PI最小值0.99±0.37,明显低于对照组1.16±0.35,差异有统计学意义(P0.05)。对照组、A组、B组功能侧与非功能侧子宫动脉PI相比,差异无统计学意义(P0.05);C组功能侧子宫动脉PI为2.25±0.39,明显低于非功能侧的2.85±1.04,差异有统计学意义(P0.05)。两组间比较,功能侧C组明显低于对照组,A组明显高于C组,差异均有统计学意义(P0.05)。结论输卵管妊娠由于异位胚胎活力的影响,可造成功能侧与非功能侧子宫动脉搏动指数的差异,可为临床诊断输卵管妊娠提供一定的参考。     

血清β-HCG,CRP水平检测结合子宫动脉血流超声指标对胎儿宫内窘迫及宫内感染的诊断价值

目的探究血清β-人绒毛膜促性腺激素(β-HCG)、C反应蛋白(CRP)水平检测结合子宫动脉血流超声指标对胎儿宫内窘迫及宫内感染的诊断价值。方法采取回顾性分析的方式,选择2017年1月～2018年1月医院收治的妊娠期出现胎儿宫内窘迫或宫内感染的121例产妇为实验组,选择同时期医院收治的妊娠期正常的231例产妇为对照组。使用多普勒超声诊断仪检测两组产妇的子宫动脉血流搏动指数(PI)、阻力指数(RI)、收缩期血流速度与舒张期血流速度比值(S/D)。用化学发光法检测血清β-HCG水平,免疫比浊法检测血清CRP水平。采用统计学分析方法对比两组产妇子宫动脉PI,RI,S/D,血清β-HCG及CRP水平变化情况。分别以PI=0.96,RI=0.46,S/D=2.16,β-HCG=50μg/ml,CRP=20 mg/L为界值预测不良妊娠结局的敏感度、特异度和准确度。结果实验组产妇子宫动脉PI,RI及S/D值分别为1.21±0.34,0.69±0.21和2.69±0.68,均明显高于对照组(0.82±0.31,0.43±0.11和2.06±0.51),差异均具有统计学意义(t=10.840,12.735,8.957,均P0.001)。实验组产妇血清β-hCG,CRP水平分别为91.23±10.22μg/ml和34.65±6.55 mg/L,均明显高于对照组(36.56±6.53μg/ml和13.26±5.11 mg/L),差异具有统计学意义(t=53.408,31.280,均P0.001)。PI,RI,S/D,β-HCG和CRP联合检测预测不良妊娠结局的灵敏度、特异度和准确度分别为91.67%,90.98%和91.19%,均高于各单项检测,差异具有统计学意义(χ~2=48.531,25.210,76.043,均P0.05)。结论子宫动脉PI,RI,S/D及血清β-HCG,CRP水平检测在胎儿宫内窘迫及宫内感染的诊断中具有良好的应用价值,在一定程度上可以预测不良妊娠结局,具有较好的临床诊断价值。     

氨甲蝶呤联合手术治疗异位妊娠的疗效观察

目的分析腹腔镜手术联合氨甲蝶呤对异位妊娠患者血清β-人绒毛膜促性腺激素(β-HCG)、孕酮水平及生育结局的影响。方法分析湖北省恩施土家族苗族自治州建始县人民医院2013年8月至2015年8月收治的98例行腹腔镜手术治疗的异位妊娠患者的病历资料,将其中48例腹腔镜联合氨甲蝶呤治疗的患者作为A组,另外50例未采用氨甲蝶呤治疗的患者作为B组,比较两组术后恢复情况、治疗前后血清β-HCG及孕酮水平、输卵管通畅情况,术后随访2年了解两组再次妊娠情况。结果 A组积液吸收时间、月经恢复时间、术后住院时间、β-HCG恢复正常时间均短于B组(P0.05)。A组治疗第7天血清β-HCG、孕酮水平均低于B组(P0.05)。A组输卵管通畅率为91.66%,高于B组的76.00%(P0.05)。两组流产率比较,差异无统计学意义(P0.05);再次妊娠,A组宫内妊娠率为90.70%,高于B组的74.36%(P0.05);A组再次异位妊娠率为4.65%,低于B组的17.95%(P0.05)。结论腹腔镜手术联合氨甲蝶呤治疗异位妊娠临床疗效显著,可有效改善患者输卵管堵塞情况,提高术后妊娠率。     

射频超声技术评价冠心病患者颈动脉弹性的临床研究

目的 探讨射频超声血管测量技术在评价冠心病患者颈动脉弹性及其与冠状动脉病变关系中的应用价值.方法 选择临床疑似冠心病患者127例为研究对象,根据冠状动脉造影结果分为非冠心病组(A组:对照组)、冠状动脉粥样硬化病变组(B组)、单支病变组(C组)、多支病变组(D组).对以上4组患者行颈总动脉射频超声检查,记录颈动脉弹性参数,包括血管内中膜厚度(IMT)、脉搏波传导速度(PWV)、动脉管壁的扩张性系数(DC)和顺应性系数(CC)、硬度指数(α)、硬度指数(β),运用统计学方法比较4组间各参数的差异并对其进行相关性分析.结果 A、B、C及D组IMT分别为(586.250±124.12)、(586.567±128.21)、(626.432±124.51)、(691.033±132.01)μm,组间差异有统计学意义(F=3.923,P＜0.05),且A、B、C组分别与D组比较,差异有统计学意义(t=2.404、3.171、2.061,P均＜0.05);A、B、C及D组PWV分别为(7.561±1.411)、(7.742±1.715)、(9.014±2.339)、(9.420±2.624)m/s,组间差异有统计学意义(F=4.175,P＜0.01),且A、B组分别与C组比较,差异有统计学意义(t=1.996、2.343,P均<0.05),且A、B组分别与D组比较(t=2.471、2.917,P均<0.05);A、B、C及D组DC分别为(0.021±0.010)、(0.018±0.009)、(0.015±0.007)、(0.013±0.007)l/kPa,组间差异有统计学意义(F=3.740,P＜0.05),且A组与C组比较(t=3.089,P＜0.05),且A、B组分别与D组比较(t=2.761、2.416,P均＜0.05);A、B、C及D组CC分别为(1.141±0.620)、(0.997±0.522)、(0.749±0.353)、(0.706±0.360)mm2/kPa,组间差异有统计学意义(F=4.512,P＜0.01),且A、B组分别与C组比较,差异有统计学意义(t=2.685、2.284,P均＜0.05),且A、B组分别与D组比较(t=2.881、2.509,P均＜0.05);A、B、C及D组α 分别为(4.287±1.620)、(4.870±1.969)、(6.714±3.891)、(7.283±4.102),组间差异有统计学意义(F=4.103,P＜0.01),且A、B组分别与C组比较,差异有统计学意义(t=2.183、2.222,P均＜0.05),且A、B组分别与D组比较,差异有统计学意义(t=2.607、2.745,P均＜0.05);A、B、C及D组β分别为(8.662±3.259)、(9.927±3.969)、(13.599±7.781)、(14.777±8.235),组间差异有统计学意义(F=4.162,P＜0.01),且A、B组分别与C组比较,差异有统计学意义(t=2.215、2.206,P均＜0.05),且A、B组分别与D组比较,差异有统计学意义(t=2.656、2.753,P均＜0.05).结论 颈动脉弹性参数与冠状动脉病变程度呈一定相关性,射频超声血管测量技术评价颈动脉弹性有可能作为间接反映冠状动脉病变程度的超声无创诊断手段之一.     

联合检测CA125、β-HCG和孕酮在异位妊娠治疗中的临床意义

目的:探讨联合检测血清糖类抗原125(CA125)和血绒毛膜促性腺激素(β-HCG)、血清孕酮(P)水平在异位妊娠(EP)治疗中的临床意义。方法:用荧光免疫法对60例EP患者(分为药物保守组A组,手术治疗组B组)治疗前后的CA125、β-HCG、P水平进行联合检测。结果:异位妊娠(EP)患者治疗前A组的CA125、β-HCG、P均值低于B组,差异有显著性意义。A组治疗前后比较:β-HCG、P治疗后均下降,CA125治疗后升高,差异有显著性意义。B组治疗前后比较:β-HCG、P治疗后均明显下降,CA125治疗后明显升高,差异有显著性意义。结论:CA125、β-HCG、P联合监测指标在指导异位妊娠治疗方案方面具有重要意义。     

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.