纳络酮联合氨茶碱在早产儿原发性呼吸暂停中的应用

目的观察纳络酮联合氨茶碱在早产儿原发性呼吸暂停中的应用疗效及其安全性。方法将56例生后发生原发性呼吸暂停的早产儿，随机分成对照组和治疗组各28例。治疗组在综合治疗的基础上给予纳络酮联合氨茶碱交替使用。对照组则在综合治疗的基础上给予氨茶碱常规应用。结果治疗组病例中显效22例，有效5例，总有效例数27例；对照组病例中显效12例，有效7例，总有效例数19例。两组病例治疗效果经卡方检验分析，差异具有显著性（P〈0．01）。结论纳络酮联合氨茶碱在早产儿原发性呼吸暂停中的应用疗效显著优于常规单独应用氨茶碱治疗。     

氨茶碱联合纳络酮治疗早产儿原发性呼吸暂停疗效观察

目的：观察纳络酮治疗早产儿原发性呼吸暂停疗效。方法：将83例原发性呼吸暂停早产儿随机分成治疗组（42例）和对照组（41例）,均予小剂量氨茶碱治疗,治疗组加用纳络酮,比较两组疗效。结果：治疗组显效率69.0%,总有效率92.9%;对照组显效率36.6%,总有效率68.3%,经统计学处理有统计学意义（P〈0.05）。结论：氨茶碱联合纳络酮治疗早产儿原发性呼吸暂停疗效显著。     

纳洛酮治疗早产儿原发性呼吸暂停30例分析

目的：观察使用纳洛酮治疗早产儿原发性呼吸暂停的疗效。方法：将所收治病人随机分为治疗组、对照组；对照组病人给与保暖、吸氧、使用氨茶碱、维持正常血糖、控制感染及其他综合治疗措施；治疗组则在对照组治疗基础上加用纳洛酮注射液，首次负荷量0．1mg／kg，静推，1小时后按0．01mg／（kg．h）的速度经输液泵持续静脉注射，每日总量不超过0．4mg／kg．结果：治疗组总有效率90．0%（27／30），对照组总有效率50％（15／30），经统计学处理：X^2=11．42．P〈O．001．有显著性差异．结论：治疗早产儿原发性呼吸暂停．在传统综合治疗基础上．加用纳络酮治疗．可取得显著疗效，其毒副作用轻微．使用安全。     

纳络酮联合氨茶碱治疗早产儿原发性呼吸暂停疗效观察

目的探索纳络酮治疗早产儿原发性呼吸暂停的临床资料。方法采用完全随机设计法,将58例出现原发性呼吸暂停的早产儿分为治疗组（纳络酮组30例）常规对照组（氨茶碱组）28例进行疗效对比分析。结果治疗组显效17例,有效10例,无效3例,总有效率90％;对照组显效10例,有效8例,总有效率64．3％．无效10例。两组疗效比较差异有统计学意义（x2=8．131,P=0．043〈0．05）。表明治疗组疗效高于对照组。结论纳络酮是治疗早产儿呼吸暂停安全有效药物。     

舒适护理干预对早产儿原发性呼吸暂停的影响

目的：探讨舒适护理干预对早产儿原发性呼吸暂停的影响。方法：将胎龄〈37周的早产儿125例随机分为观察组65例和对照组60例,观察组在常规治疗的基础上加用舒适护理（体位、喂养、声、光、热、冷、空气、疼痛）,对照组在出生后立即给予氨茶碱静滴及常规护理。结果：观察组早产儿心率、呼吸、速率增快,血氧饱和度及呼吸暂停时间明显优于对照组（P〈0.05）;观察组发生原发性呼吸暂停的次数较对照组减少3.68s,持续时间较对照组缩短3.9s,两组比较有极显著性差异（P〈0.01）。结论：舒适护理对早产儿原发性呼吸暂停的疗效显著,未见明显不良反应。     

纳洛酮联合氨茶碱治疗早产儿原发性呼吸暂停40例疗效

目的观察纳洛酮与氨茶碱联合治疗早产儿原发性呼吸暂停的临床疗效。方法将80例原发性呼吸暂停患儿按随机数字表法随机分为2组,治疗组（40例）与对照组（40例）。治疗组及对照组均应用氨茶碱治疗,首次剂量5 mg.kg^-1负荷量,继按2 mg.kg^-1,12 h 1次维持;治疗组加用纳洛酮,首次剂量0.1 mg.kg^-1负荷量,继之以0.1 mg.kg^-1,以0.03-0.05 mg.kg^-1.h^-1速度静脉泵泵入,连用3 d。比较2组原发性呼吸暂停的发生次数和时间、心率、血氧饱和度（SpO2）等的差异。结果 2组呼吸暂停次数治疗组均明显减少（P〈0.001）;呼吸暂停时间治疗组明显缩短;SpO2治疗组下降程度明显减轻（P〈0.005）。治疗组总有效率明显优于对照组（χ^2=6.56,P〈0.05）。结论纳洛酮联合氨茶碱治疗早产儿原发性呼吸暂停疗效显著。     

纳洛酮治疗早产儿原发性呼吸暂停疗效观察

目的评价纳洛酮治疗早产儿原发性呼吸暂停的临床疗效安全性。方法将96例呼吸暂停早产儿随机分为观察组50例，对照组46例。两组患儿在常规综合治疗的基础上，观察组应用纳洛酮10ug～20ug·kg·h^-1持续静脉点注，呼吸暂停控制后减量；对照组首次应用氨茶碱负荷量5mg·kg^-1，12h后予以维持剂量5mg·kg·d^-1，分2次静脉滴注，用药3d～5d。比较两组患儿原发性呼吸暂停的时间、发作的次数、心率、氧饱和度。结果观察组总有效率92．0％，对照组总有效率73．8％，观察组总有效率显著高于对照组（X^2=8．27，P〈0．05）。结论纳洛酮治疗早产儿原发性呼吸暂停疗效显著、起效快、安全性高。     

早产儿原发性呼吸暂停临床观察

目的：观察氨茶碱合用纳络酮治疗原发性呼吸暂停（AOP）早产儿临床疗效。方法：68例AOP早产儿随机分为观察组30例对照组38例,所有患儿予同样基础治疗,观察组同时加用纳洛酮。结果：观察组AOP时间明显缩短、SpO2及心率下降程度明显减轻,总有效率与对照组相比差异显著（χ2=4.58,P〈0.05）。结论：氨茶碱合用纳洛酮治疗早产儿AOP值得进一步研究和推广。     

改良鼻塞后持续气道正压通气治疗早产儿原发性呼吸暂停的效果

目的观察stephenCPAP呼吸机配合改良鼻塞治疗早产儿原发性呼吸暂停的临床效果。方法将68例原发性呼吸暂停早产儿按入院后诊断的先后顺序编号随机分为观察组与对照组，观察组36例采用stephenCPAP呼吸机配合改良鼻塞治疗，对照组32例采用stephenCPAP原配的鼻塞进行CPAP通气，记录各患儿的血气指标及通气情况的数据。结果观察组在鼻塞的滑脱次数、维持最佳通气时问及血气指标，均明显优于对照组（P〈0．01）。结论改良鼻塞配合cPAP呼吸机治疗早产儿原发性呼吸暂停优于原配鼻塞，同时有利于减轻护理人员的工作量。     

纳络酮治疗新生儿缺氧缺血性脑病临床疗效观察

目的探讨纳络酮治疗新生儿缺氧缺血性脑病（HIE）的效果。方法将73例HIE患儿随机分为治疗组和对照组，治疗组40例，在常规治疗基础上加用纳络酮治疗；对照组34例，采用常规治疗。观察2组患儿意识、肌张力及原始反射恢复情况及呼吸、循环功能改善情况。结果①2组显效率差异有显著性（χ^2=6．88，P〈0．05），总有效率差异有显著性（χ^2=3．837，P≤0．05）；②2组中、重度病例3d内中枢呼吸衰竭消失例数比较差异有显著性（χ^2=4．015，P〈0．05），3d内循环不良消失例数比较差异有显著性（χ^2=4．324，P〈0．05）。结论HIE患儿无论其病情程度如何均可加用纳络酮治疗。     

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.