小青龙汤联合穴位敷贴治疗寒饮型哮喘的100例临床疗效观察

目的：观察小青龙汤联合穴位敷贴治疗寒饮型哮喘的临床疗效。方法：将100例患者随机分成观察组和对照组,各50例,对照组给予西医常规治疗,治疗组在西医常规治疗的基础上,予小青龙汤配合中药穴位敷贴治疗,治疗4周后分析临床疗效情况。结果：治疗组总有效率94%,对照组总有效率74%,两组比较差异有统计学意义(P<0.05);FEV₁、FVC、FEV₁%、SpO₂指标明显升高,治疗组治疗后与治疗前比较,差异具有统计学意义(P<0.05),治疗组治疗后与对照组治疗后比较,差异具有统计学意义(P<0.05)。结论：小青龙汤联合穴位敷贴治疗后,临床疗效显著,能显著改善肺功能相关指标,比西医常规治疗疗效好,在临床上值得推广。     

中药复方联合穴位敷贴治疗顽固性失眠合并高血压45例临床疗效观察

目的:探讨中药复方联合穴位敷贴治疗顽固性失眠合并高血压的临床疗效。方法:将90例患者随机分成观察组和对照组各45例,两组患者均给予硝苯地平缓释片口服。在此基础上,对照组给予舒乐安定口服治疗,观察组予中药复方配合中药穴位敷贴治疗,1个疗程后分析临床疗效。结果:观察组总有效率93.3%,对照组总有效率71.1%,两组比较差异有统计学意义(P0.05);与本组治疗前比较,两组血压均有不同程度下降,差异具有统计学意义(P0.05);观察组治疗后匹兹堡睡眠质量量表(PSQI)积分明显降低,与对照组治疗后比较,差异具有统计学意义(P0.05)。结论 :中药复方联合穴位敷贴治疗顽固性失眠合并高血压得到改善,临床疗效显著,比西医常规治疗疗效好,临床上值得推广。     

射干麻黄汤联合穴位敷贴治疗慢性喘息性支气管炎急性发作疗效观察

目的:观察射干麻黄汤联合穴位敷贴治疗慢性喘息性支气管炎急性发作的疗效,以供临床参考。方法:选取我院2010年4月²013年3月收治的慢性喘息性支气管炎急性发作患者90例,根据就诊顺序奇偶数法分组,奇数者归为对照组,偶数者归为实验组。对照组接受西医常规治疗,实验组接受射干麻黄汤联合穴位敷贴治疗。对比两组在治疗效果和不良反应方面的差异性。结果:两组总有效率比较差异无统计学意义(P>0.05);实验组不良反应发生率明显低于对照组,差异具有统计学意义(P<0.05)。结论:采用射干麻黄汤联合穴位敷贴治疗慢性喘息性支气管炎急性发作效果显著,不良反应轻微,值得临床推广应用。     

加味小青龙汤联合六味地黄丸对支气管哮喘患儿肺功能及生活质量的影响

目的:探讨加味小青龙汤联合六味地黄丸对支气管哮喘患儿肺功能及生活质量的影响。方法:选取符合标准的113例支气管哮喘患儿,按照随机数表法分为观察组57例与对照组56例。对照组在常规治疗基础上给予布地奈德气雾剂,观察组在对照组基础上联合加味小青龙汤与六味地黄丸治疗,2组均治疗1个月。对比2组临床疗效、治疗前后肺功能[最大呼气峰流速值(PEF)、1秒率(FEV1/FVC)、1秒用力呼气容积与预计值百分比(FEV1%)]及生活质量评分。结果:与对照组比较,观察组临床疗效更为显著,总有效率[94.74%(54/57)比80.36%(45/56)]较对照组高(P0.05);2组治疗前PEF、FEV1%及FEV1/FVC比较无显著差异(P0.05),治疗后2组PEF、FEV1%及FEV1/FVC比较,观察组均高于对照组(P0.05);2组治疗前生活质量评分比较无显著差异(P0.05),治疗后2组生活质量评分比较,观察组高于对照组(P0.05)。结论:常规西药治疗基础上给予BA患儿加味小青龙汤联合六味地黄丸治疗,可取得显著疗效,有利于改善患儿肺功能及生活质量。     

小青龙汤加减治疗支气管哮喘外寒内饮证疗效分析

目的:通过西药和西药联合小青龙汤治疗支气管哮喘的疗效对比,评价小青龙汤对支气管哮喘的治疗作用。方法:将60名患者随机分为对照组和治疗组,对照组给予西药常规治疗(抗炎、抗过敏、平喘、必要时吸氧等),治疗组在西医治疗基础上辨证给予小青龙汤加减,疗程均为10d,并进行为期3个月的长期随访。在治疗前后进行外周血嗜酸性粒细胞计数(EO)、免疫球蛋白E(Ig E)检测,结合肺功能(PEF、FEV1)等评价其疗效,并采用哮喘控制问卷(ACQ)评价远期疗效。结果:治疗组各项疗效指标均优于对照组,差异具有统计学意义(P0.05)。结论:西药联合小青龙汤能显著改善支气管哮喘的临床症状及实验室检测指标,其疗效优于单纯西药组。     

阳和平喘颗粒对支气管哮喘慢性持续期寒哮证气道炎症的影响

目的:观察阳和平喘颗粒治疗支气管哮喘慢性持续期寒哮证的临床疗效及对气道炎症的影响.方法:60例患者随机分为2组各30例.对照组采用西医常规治疗,治疗组在西医常规治疗的基础上加用阳和平喘颗粒,2组疗程均为4周.结果:2组有效率、治疗后肺功能(FEV1.0%、PEF)及血清INF-γ,血清IL-4水平,与对照组比较,均有统计学差异(P＜0.05).结论:阳和平喘颗粒配合西医常规治疗可有效减轻支气管哮喘慢性持续期寒哮证患者临床症状,改善肺功能,减轻气道炎症.     

苏子降气汤辅助治疗支气管哮喘急性发作的可行性分析

目的:分析苏子降气汤联合西药治疗支气管哮喘急性发作的效果及其对肺功能的影响。方法:选取2014年6月~2016年11月我院收治的支气管哮喘急性发作患者116例,按照随机数字表法分为对照组和试验组,每组58例。对照组采用常规西药治疗,试验组在对照组的治疗基础上加用苏子降气汤治疗,比较两组的治疗效果和肺功能改善情况。结果:试验组的治疗总有效率明显高于对照组,差异有统计学意义,P0.05;治疗前,两组的FEV1/FVC、FEV1和FVC相比较,差异无统计学意义,P0.05;治疗后,试验组的FEV1/FVC、FEV1和FVC均明显优于对照组,差异有统计学意义,P0.05。结论:支气管哮喘急性发作在常规西医治疗的基础上加用苏子降气汤的治疗效果确切,可显著改善肺功能。     

穴位贴敷联合督灸治疗慢性阻塞性肺疾病临床分析

目的:探讨穴位敷贴联合督灸治疗慢性阻塞性肺疾病的临床效果。方法:选取2016年5月~2017年5月我院收治的慢性阻塞性肺疾病患者98例,随机分为对照组和研究组各49例。对照组采用常规西医治疗,研究组在对照组治疗基础上予以穴位敷贴联合督灸治疗,观察两组治疗效果。结果:研究组治疗总有效率显著高于对照组(P0.05);治疗后,研究组症状积分低于对照组,FEV1%及FEV1/FVC%高于对照组(P0.05)。结论:慢性阻塞性肺疾病患者在西医常规治疗基础上辅以中医穴位敷贴联合督灸治疗的效果更为理想,有助于改善患者临床症状及肺功能,临床应用价值较高。     

糖皮质激素空气压缩雾化及干粉吸入用于老年长期干预不佳哮喘患者的临床疗效观察

目的探讨糖皮质激素空气压缩雾化及干粉吸入用于老年长期干预不佳哮喘患者的临床疗效。方法选取我院94例老年哮喘长期干预不佳患者,抽签分为观察组与对照组各47例,对照组给予干粉吸入剂治疗,观察组使用空气压缩雾化器雾化吸入糖皮质激素治疗,均持续治疗2月,比较两组用药期间哮喘急性发作次数及每日缓解药物平均使用次数,两组最大呼气流量(PEF)变异率、一秒用力呼气容积(FEV1)及哮喘控制测试(ACT)评分差异,以及两组用药期间不良反应发生率。结果两组急性发作次数比较差异无统计学意义(P0.05)。两组每日缓解药物使用次数比较差异无统计学意义(P0.05);治疗后观察组PEF变异率低于对照组,FEV1、ACT高于对照组(P0.05);两组均未出现全身性不良反应,口咽部局部不良反应比较差异无统计学意义(P0.05)。结论糖皮质激素经空气压缩雾化给药较常规干粉吸入治疗长期激素规律性干预疗效不佳者更为有效,可降低PEF变异率,提高FEV1及ACT评分,且未见激素性不良反应明显增加,临床应用可行。     

冬病夏治穴位贴敷治疗咳嗽变异性哮喘患儿的临床效果分析

目的探讨冬病夏治穴位贴敷治疗小儿咳嗽变异性哮喘的临床疗效。方法选取我院儿科2017年12月～2018年9月收治的咳嗽变异性哮喘(CVA)患儿62例,随机分为对照组30例和观察组32例;对照组予以常规西药治疗,观察组在对照组基础上予以冬病夏治穴位贴敷治疗。观察两组患者临床疗效,患儿血清免疫球蛋白水平、ACT评分、肺功能变化。结果治疗后,观察组临床疗效明显高于对照组,差异有统计学意义(P0.05);观察组血清免疫球蛋白LgA、LgM、LgG水平明显高于对照组,Lg E明显低于对照组,差异有统计学意义(P0.05);观察组ACT评分、第一秒用力呼气量(FEV1)、峰值呼气流速(PEF)、第一秒用力呼气量/最大肺活量(FEV1/FVC)明显高于对照组,差异有统计学意义(P0.05)。结论冬病夏治穴位贴治疗儿童咳嗽变异性哮喘能明显改善患儿呼吸功能,增强机体免疫功能,临床效果好。     

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.