低分子肝素治疗新生儿脓毒症DIC的疗效观察

选取我院收治的96例脓毒症DIC的新生儿患者,均为足月新生儿。随机分为观察组和对照组各48例。均采用抗感染等对症治疗,对照组予普通肝素治疗,观察组予低分子肝素治疗。观察比较两组患者的临床疗效和治疗前后DIC指标变化情况。结果观察组的肝素使用时间、出血停止时间、DIC指标恢复时间均明显短于对照组,且差异具有统计学意义(P<0.05);观察组的出血加重病例数也明显少于对照组,差异具有统计学意义(P<0.05);两组治疗后DIC指标均较治疗前明显改善,且观察组改善程度明显优于对照组(P<0.05),提示观察组对改善DIC指标有显著的效果。低分子肝素在治疗新生儿脓毒症合并DIC病理过程和恢复正常凝血功能中起着至关重要的作用,值得临床推广。     

低分子肝素治疗新生儿脓毒症并DIC的疗效观察

选取2013年3月~2014年2月在我院进行治疗的新生儿脓毒症合并DIC患儿64例,随机分为研究组和对照组各32例。其中给予对照组患儿普通肝素进行治疗,研究组患儿使用低分子肝素进行治疗。治疗结束后,比较两组患儿的治疗效果、不良反应发生情况及两组患儿治疗情况。结果经过治疗后,研究组患儿的治疗总有效率为93.75%,对照组患儿的治疗总有效率为75.00%。其中研究组患儿治疗时的各项指标改善显著,与对照组相比差异具有统计学意义(P<0.05),两组患儿均未发现有严重的不良反应。给予新生儿脓毒症并DIC患儿低分子肝素进行治疗可以有效提高患儿的治疗有效率,减轻体内的炎症,有利于患儿各项指标的恢复,值得在临床进行推广。     

低分子肝素抗凝治疗脓毒症合并弥散性血管内凝血或凝血病的疗效分析

目的研究低分子肝素治疗脓毒症合并弥散性血管内凝血(disseminated intravascular coagulation,DIC)或脓毒症诱发凝血病(sepsis-induced coagulopathy,SIC)的疗效。方法回顾分析中国医学科学院肿瘤医院重症加强治疗科2017年11月至2019年10月收治的脓毒症患者,应用低分子肝素进行抗凝治疗,将应用低分子肝素≥3d为抗凝组(140例),应用低分子肝素≤2d为对照组(138例)。两组再根据患者凝血障碍情况分为DIC合并SIC组,单纯DIC组和单纯SIC组。结果①抗凝组年龄大于对照组,差异有显著性(P=0.001),两组性别、合并症、急性生理与慢性健康评分、简化急性生理评分、序贯器官衰竭评分、脓毒症休克、转入方式、感染部位比较,差异无显著性(P>0.05)。②两组ICU病死率和住院死亡率比较,差异无显著性(P>0.05),抗凝组机械通气时间、住ICU时间和住院时间较对照组显著延长,差异有显著性(P<0.05)。③低分子肝素不能改善抗凝组和对照组中DIC合并SIC组,单纯DIC组,单纯SIC组的住院死亡率。④Kaplan-Meier曲线分析发现:抗凝组和对照组1年预后比较,差异无显著性(P=0.271);抗凝组和对照组中DIC合并SIC组,单纯DIC组,单纯SIC组1年生存率比较,差异无显著性(P均>0.05)。结论脓毒症患者无论是否合并DIC或SIC,低分子肝素不能改善住院死亡率和1年生存率。     

小剂量肝素钠与低分子肝素钙对脓毒症治疗作用的对比研究

目的观察小剂量肝素钠与低分子肝素钙对脓毒症的治疗效果差异。方法将90例脓毒症患者随机分为A、B、C三组,A组给予常规治疗包括早期广谱抗生素,液体复苏等,B组常规治疗基础上持续给予小剂量肝素5~10U/(kg·h)静脉泵入,C组在常规治疗基础上加低分子肝素钙0.6 ml皮下注射。对比三组患者治疗前及治疗后第1、3、5、7 d急性生理学慢性健康状况Ⅱ(APACHEⅡ)评分,治疗前和治疗后的凝血指标、炎症因子指标、播散性血管内凝血(DIC)发生率、28 d病死率和不良反应发生率。结果 B、C两组患者治疗后各时点APACHEⅡ显著低于A组(P0.05),C组患者治疗5 d后APACHEⅡ分值显著低于B组(P0.05)。B、C两组患者治疗后血小板(PLT)、纤维蛋白原(Fib)、凝血活酶时间(APTT),凝血酶原时间(PT)水平显著优于A组(P0.01),C组患者各指标显著优于B组(P0.05)。B、C两组患者治疗后血清肿瘤坏死因子(TNF-α)、白细胞介素-6(IL-6)、C反应蛋白(CRP)水平显著低于A组(P0.05),C组患者TNF-α水平显著低于B组(P0.05)。B、C两组患者DIC发生率、28 d病死率显著低于A组(P0.01,P0.05),C组患者DIC发生率显著低于B组(P0.05)。结论低分子肝素钙对脓毒症的治疗更为有效,可以有效改善患者的凝血功能及炎症水平,具有临床应用价值。     

小剂量低分子肝素治疗儿童急性早幼粒细胞白血病DIC的临床观察

目的:探讨小剂量低分子肝素治疗急性早幼粒细胞白血病弥漫性血管内凝血(DIC)的疗效及其安全性。方法:初次接受治疗的40例急性早幼粒细胞白血病(APL)患儿随机分成两组,小剂量低分子肝素治疗组(A组)20例,常规治疗组20例,比较两组的DIC发生率和完全缓解率。结果:低分子肝素治疗组DIC的发生率较常规治疗组低(P<0.05),而完全缓解率差异无统计学意义(P>0.05)。结论:小剂量低分子肝素可以有效减少急性早幼粒细胞白血病患儿DIC的发生,具有良好的安全性。     

低分子肝素治疗产科弥漫性血管内凝血的临床分析

目的 观察低分子肝素治疗产科弥散性血管内凝血(DIC)的疗效.方法 将62例产科DIC患者随机分为治疗组和对照组,分别给予低分子肝素和普通肝素静脉滴注治疗,动态观察血浆凝血酶原时间(PT)、凝血酶原时间(APTT)、纤维蛋白原(FIB)、血小板(PLT)、D-二聚体(DD)等变化.结果 治疗组的总有效率、住院时间、各项观察指标均优于对照组,差异有统计学意义(P<0.05与＜0.01).结论 低分子肝素治疗产科DIC疗效较好,值得临床进一步推广应用.     

不同剂量低分子肝素联合瑞舒伐他汀治疗肾病综合征的临床疗效分析

目的研究分析不同剂量低分子肝素联合瑞舒伐他汀治疗肾病综合征的临床疗效。方法选取2015年1月至2016年1月收治的60例肾病综合征患者,治疗医师根据所用药物的应用量不同将所有患者分为A组和B组,所有患者均给予低盐低脂饮食,同时行降低血压促进排尿和相关激素治疗。A组在行瑞舒伐他汀钙片治疗基础上行大剂量的低分子肝素治疗,B组在行瑞舒伐他汀钙片治疗基础上行小剂量的低分子肝素治疗。观察两组患者治疗前后的24h尿蛋白定量检查指标及血浆清蛋白等检查指标,然后对所有患者治疗后进行临床疗效评估。结果 A组治疗后的24h尿蛋白定量值和血肌酐水平明显低于B组,血浆清蛋白水平明显高于B组(P0.05),A组治疗后的三酰甘油、总胆固醇水平明显低于B组(P0.05);A组治疗后临床疗效缓解率明显高于B组,差异有统计学意义(P0.05)。结论任何剂量的低分子肝素联合瑞舒伐他汀钙片治疗复发性肾病综合征均能取得较好的临床疗效,均可改善患者高凝状态,特别是大剂量地应用低分子肝素治疗,除了上述优点外,还具有更好的临床疗效缓解率。     

前列地尔联合瑞替普酶和低分子肝素对急性肺栓塞合并肺动脉高压患者的临床疗效

目的:探讨前列地尔联合瑞替普酶和低分子肝素对急性肺栓塞合并肺动脉高压患者的临床疗效。方法:将2011-03-2013-03我院收治的93例急性肺栓塞合并肺动脉高压的患者分为A组、B组和C组。A组给予前列地尔联合瑞替普酶和低分子肝素,B组给予瑞替普酶和低分子肝素,C组给予前列地尔和低分子肝素。评价患者的治疗效果、肺功能(FEV1及FEV1/FVC)、溶栓后血管再通率、肺动脉平均压,检测患者治疗前后血浆中的D-二聚体(D-D)、蛋白S(PS)、蛋白C(PC)、凝血调节蛋白(TM)、抗凝血酶Ⅲ(AT-Ⅲ)、纤溶酶原激活物抑制物-1(PAI-1)、组织型纤溶酶原激活物(t-PA)。结果:B组和C组的总有效率和和肺功能改善情况显著低于A组(P0.05);治疗后B组和C组的动脉收缩压值和动脉氧分压值显著低于A组(P0.05);治疗后B组和C组的肺动脉压力显著高于A组(P0.05);治疗后B组和C组的PS、PC、D-D、PAT-1和TM含量显著高于A组(P0.05)。结论:前列地尔联合瑞替普酶和低分子肝素的治疗方案治疗急性肺动脉栓塞合并肺动脉高压具有更加显著的治疗效果。     

茵栀黄联合布拉氏酵母菌散治疗新生儿黄疸效果分析

目的分析茵栀黄颗粒联合布拉氏酵母菌散治疗新生儿黄疸的临床疗效和安全性。方法选择新生儿黄疸患儿105例,采用随机数表法分为对照组、治疗A组和治疗B组。对照组采用单纯蓝光照射治疗;在对照组的基础上,治疗A组和B组分别给予布拉氏酵母菌散和布拉氏酵母菌散联合茵栀黄颗粒,比较三组患儿治疗前后血清胆红素水平、黄疸消失时间和光照治疗时间、临床疗效以及治疗相关不良反应。结果治疗后,三组患儿的血清胆红素水平均低于治疗前(P0.05);其中治疗组低于对照组(P0.05),治疗B组低于治疗A组(P0.05)。治疗A组和治疗B组患儿的黄疸消失时间和光照治疗时间均短于对照组(P0.05),且治疗B组短于治疗A组(P0.05)。对照组、治疗A组和治疗B组的总有效率分别为54.29%、77.17%和94.29%,治疗B组高于对照组和治疗A组(P0.05)。对照组、治疗A组和治疗B组患儿的不良反应发生率(20.00%、11.43%、14.29%)比较,差异未见统计学意义(P0.05)。结论茵栀黄颗粒联合布拉氏酵母菌散治疗能有效降低黄疸患儿胆红素水平,缩短黄疸消失时间和光照治疗时间,且安全性较高。     

丹参酮ⅡA磺酸钠联合低分子肝素钙对不稳定型心绞痛的疗效观察

目的:观察丹参酮ⅡA磺酸钠注射液联合低分子肝素钙注射液对不稳定型心绞痛的临床疗效。方法:对80例不稳定心绞痛患者随机分为对照组和治疗组各40例,对照组予丹参粉干针和常规治疗,治疗组采用丹参酮ⅡA磺酸钠注射液联合低分子肝素钙治疗加常规治疗,观察两组临床疗效、心电图及凝血、生化指标。结果:治疗组缓解心绞痛症状和心电图缺血性ST-T改善的有效率均明显高于对照组,P<0.05,而两组凝血、生化指标无显著差异,P>0.05。结论:低分子肝素钙联合丹参酮ⅡA磺酸钠注射液对不稳定心绞痛有较好的疗效,值得推广应用。     

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.