关节通片联合玻璃酸钠治疗踝关节创伤性关节炎的临床观察

目的：观察关节通片联合玻璃酸钠治疗踝关节创伤性关节炎的临床疗效。方法：本研究收集病例80例,随机分为治疗组和对照组,每组40例。对照组给予玻璃酸钠关节腔注射治疗,治疗组给予玻璃酸钠关节腔注射＋口服关节通片治疗,5周为1个疗程。比较两组治疗前后的VAS、ROM和临床疗效。结果：两组治疗后的VAS、ROM均比治疗前明显改善（P＜0.05）,治疗5周后两组的VAS、ROM和总有效率比较无明显差异（P＞0.05）,治疗后6个月治疗组的VAS、ROM和总有效率优于对照组（P＜0.05）。结论：关节通片联合玻璃酸钠治疗踝关节创伤性关节炎的临床疗效明显、持久。     

关节腔内注射玻璃酸钠治疗踝关节创伤性关节炎的价值

目的研究关节腔内注射玻璃酸钠治疗踝关节创伤性关节炎的价值。方法将接受治疗踝关节创伤性关节炎患者100例作为研究对象,随机分为观察组与对照组各50例,对照组采用基础治疗,观察组在对照组基础上采用病变关节腔内注射玻璃酸钠治疗,对比两组治疗前后疼痛程度及治疗效果。结果观察组治疗后疼痛程度比对照组明显减轻,病情得到有效控制,临床疗效明显,差异有统计学意义(P0.05)。结论在关节腔内注射玻璃酸钠治疗踝关节创伤性关节炎有较高的临床价值,可以有效减轻患者疼痛及肿胀情况,值得临床推广应用。     

腓骨沉降术配合玻璃酸钠关节腔注射治疗膝关节内侧间室骨性关节炎的临床研究

目的:研究腓骨沉降术配合玻璃酸钠关节腔注射治疗膝关节内侧间室骨性关节炎的临床疗效。方法:将40例膝关节内侧间室骨性关节炎的患者随机分为两组:实验组(腓骨沉降术配合玻璃酸钠关节腔注射组)20例和对照组(玻璃酸钠关节腔注射组)20例,比较两组在治疗1周、2周、3周后的视觉模拟疼痛评分变化(VAS)、膝关节活动度(ROM)。结果:实验组在治疗1周、2周、3周后的VAS评分和ROM与对照组比较,差异均具有统计学意义,P0.05。结论:腓骨沉降术配合玻璃酸钠关节腔注射治疗膝关节内侧间室骨性关节炎的临床疗效优于玻璃酸钠关节腔注射,值得临床推广应用。     

臭氧联合玻璃酸钠关节腔内注射在骨性膝关节炎患者治疗中的应用

目的:探讨臭氧联合玻璃酸钠关节腔内注射治疗骨性膝关节炎的疗效及护理方法。方法:将128例骨性膝关节炎患者随机分为观察组和对照组各64例,对照组采用综合理疗治疗,观察组采用臭氧联合玻璃酸钠关节腔内注射治疗,均给予精心护理。痛觉评估采用视觉模糊评分(VAS),比较两组治疗效果。结果:两组VAS比较差异有统计学意义(P<0.05)。结论:臭氧联合玻璃酸钠关节腔内注射治疗骨性膝关节炎临床疗效确切,精心护理是患者康复的保障。     

玻璃酸钠关节腔填充踝关节骨折后创伤性关节炎的6个月随访

背景：玻璃酸钠主要用于骨性关节炎的治疗,踝关节骨折术后创伤性关节炎主要也是关节软骨的退变。目的：观察玻璃酸钠踝关节腔内注射治疗踝关节骨折后创伤性关节炎的疗效。方法：选取2009-07/2011-06就诊于承德医学院附属医院康复医学科的踝关节骨折修复后创伤性关节炎患者60例行关节腔内玻璃酸钠注射,分别于治疗后、治疗后1,6个月后对比治疗前后踝关节疼痛、关节活动范围及无痛行走距离等方面改善的差异。结果与结论：60例患者踝关节疼痛目测类比量表评分较治疗前明显降低（P〈0.01）;关节活动范围与治疗前比较其度数明显增加（背伸、跖屈、内收、外展、内翻与治疗前比较P〈0.01,外翻与治疗前比较P〈0.05;无痛行走距离比治疗前增加（P〈0.01）。结果证实,玻璃酸钠关节腔内注射可以明显改善踝关节创伤性关节炎的临床症状与踝关节功能。     

腓骨沉降术配合玻璃酸钠关节腔注射对膝关节内侧间室骨性关节炎的临床研究

【】 目的：研究腓骨沉降术配合玻璃酸钠关节腔注射对膝关节内侧间室骨性关节炎的临床疗效。方法：将40例膝关节内侧间室骨性关节炎的患者随机分为两组,实验组(腓骨沉降术配合玻璃酸钠关节腔注射组)20例,对照组(玻璃酸钠关节腔注射组)20例,比较实验组和对照组在治疗后1周、2周、3周的视觉模拟疼痛评分变化(visual analog scale,VAS)、膝关节活动度(range of motion ,ROM)。结果：实验组患者在治疗后1周、2周、3周的VAS评分和对照组比较差异具有统计学意义(P ＜ 0．05);实验组患者在治疗后1周、2周、3周的ROM与对照组比较差异有统计学意义(P ＜ 0．05)。结论：腓骨沉降术配合玻璃酸钠关节腔注射对膝关节内侧间室骨性关节炎的临床疗效优于玻璃酸钠关节腔注射。     

中药塌渍联合玻璃酸钠关节腔注射治疗膝骨性关节炎研究

目的:观察中药塌渍联合玻璃酸钠关节腔注射治疗膝骨性关节炎的临床疗效。方法:将符合标准的63例患者随机分为2组,治疗组31例采用中药塌渍联合玻璃酸钠膝关节腔内注射治疗;对照组32例单纯应用玻璃酸钠膝关节腔内注射治疗。并于治疗前及治疗4周后对患膝进行相关评分、统计学分析。结果:对照组和治疗组在治疗后,患肢症状均有明显缓解。治疗组在总有效率、VAS评分及Lequesne指数方面均优于对照组(P0.05)。结论:中药塌渍联合玻璃酸钠关节腔注射治疗膝骨性关节炎临床疗效明显,可减轻患肢疼痛,对缓解肿胀、晨僵等方面疗效明显,并且具有价格低廉、不良反应少等优点,可在临床推广。     

温和灸联合关节腔内注射玻璃酸钠治疗膝骨性关节炎60例临床观察

目的:观察温和灸联合关节腔内注射玻璃酸钠治疗膝骨性关节炎(KOA)的临床疗效。方法:将120例膝骨性关节炎(KOA)患者随机分为治疗组、对照组,治疗组用温和灸联合关节腔内注射玻璃酸钠治疗,对照组给予关节腔内注射玻璃酸钠治疗及口服氨基葡萄糖胶囊治疗,以7天为1个疗程,4个疗程观察疗效。结果:治疗组有效率为90%,对照组为71.7%,治疗组高于对照组,差异具有统计学意义(P0.05)。结论:温和灸联合关节腔内注射玻璃酸钠治疗膝骨性关节炎操作简便,患者依从性好,临床疗效肯定,值得临床推广运用。     

玻璃酸钠关节腔内注射联合物理因子治疗踝关节创伤性关节炎的疗效观察

目的观察玻璃酸钠关节腔内注射联合物理因子治疗踝关节创伤性关节炎的疗效。 方法选取我院康复医学科收治的踝关节创伤性关节炎患者80例,均给予关节腔内玻璃酸钠注射及物理因子（包括蜡疗及红外激光治疗）治疗。玻璃酸钠注射每周治疗1次,治疗5周为1个疗程;蜡疗及红外激光照射每周治疗5d,治疗10次为1个疗程。分别于治疗前、治疗2周、治疗1个月及治疗结束后6个月时对入选患者踝关节疼痛、关节活动范围及无痛行走距离等指标进行评定。 结果入选患者在治疗2周、治疗1个月及治疗结束后6个月时,其踝关节疼痛评分［分别为(1.98±1.42)分、（2.04±1.44）分和（2.06±1.36）分］、关节活动范围及无痛行走距离均较治疗前明显改善（P<0.05）,表明其近期及远期疗效理想。 结论玻璃酸钠关节腔内注射联合物理因子治疗对踝关节创伤性关节炎具有良好疗效,能明显缓解患者疼痛,提高关节活动范围及运动功能,且治疗过程中无明显不良反应发生,值得临床推广、应用。     

新型联合药物治疗膝骨性关节炎的临床疗效

目的:探讨新型联合药物治疗膝骨性关节炎的临床疗效。方法:将120例膝骨性关节炎患者分为3组。第一治疗组采用玻璃酸钠和得宝松、盐酸利多卡因联合并行新式关节腔内注射治疗;第二治疗组在第一治疗组方法基础上加内服祖师麻片治疗;对照组采用单纯关节内注射玻璃酸钠治疗。分别观察比较两组起效时间、疼痛缓解程度、5周及3个月后关节功能改善情况,记录并发疼痛情况。结果:各组缓解总有效率分别为95.8%、97.9%、89.4%。两治疗组在缓解疼痛和改善关节功能等方面均优于对照组(P<0.01),无明显疼痛并发症。第二治疗组略优于第一治疗组(P<0.05)。结论:新型联合药物治疗(联合注射玻璃酸钠和得宝松、盐酸利多卡因加内服祖师麻片)具有更好的临床疗效,新式关节腔内注射引起的疼痛并发症减少。     

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.