从微循环血液流变学变化探讨益母草对冠心病的疗效机理

本文观察益母草注射液治疗５２例冠心病的心电图疗效及血脂、血液流变学、微循环变化，结果心电图有效率明显优于低分子右旋糖歼对照组（Ｐ＜０．０１）．治疗前后比较血脂、血液流变学、微循环定量指标均有明显改善，经统计学处理有显著性差异（Ｐ＜０．０１或 Ｐ＜０．０５）。说明益母草注射液具有降低血粘度，降低红细胞聚集性，增加红细胞变形能力，降低血浆纤维蛋白原，降低血小板粘附性，降血脂及改善微循环作用，着重探讨益母草治疗冠心病疗效机理。     

从微循环和流变学变化探讨益母草对冠心病的疗效机理

本文观察益母草注射液治疗５２例冠心病的心电图疗效及血脂、血液流变学、微循环变化，结果心电图有效率明显优于低分子右旋糖酐对照组（Ｐ＜０．０１）。治疗前后比较血脂、血液流变学、微循环定量指标均有明显改善，经统计学处理有显著性差异（Ｐ＜０．０１或Ｐ＜０．０５）。说明益母草注射液具有降低血粘度，降低红细胞聚集性，增加红细胞变形能力，降低血浆纤维蛋白原，降低血小板粘附性，降血脂及改善微循环作用。着重探讨益母革治疗冠心病疗效机理。     

刺五加注射液治疗冠心病前后血液流变学临床观察

目的研究45例冠心病心绞痛患者经刺五加注射液治疗前后血脂、血液流变学变化。方法治疗组用药前后分别采取空腹静脉血做血脂和血液流变学检测。结果治疗组和对照组心电图疗效和心绞痛疗效差异不显著(P>0.05),但治疗前后血脂、血液流变学均有显著差异(P<0.01)。结论刺五加注射液治疗冠心病心绞痛疗效显著。     

金钠多治疗冠心病疗效观察

目的　观察金钠多注射液对冠心病(CHD)的疗效。方法　病人分为金钠多治疗组(44例)和复方丹参对照组(30例) ,治疗前后检测患者心电图、心功能、微循环、血液流变学等指标。结果　两组病人治疗后症状、体征及上述各项指标均有明显改善(P <0 .0 5～0 .0 1) ,但金钠多治疗组明显优于复方丹参对照组(P <0 .0 1)。结论　金钠多注射液对冠心病有明显疗效,比复方丹参疗效佳。     

灯盏细辛注射液治疗冠心病心绞痛60例

目的:观察灯盏细辛注射液治疗冠心病心绞痛的临床疗效与安全性。方法:60例患者随机双盲分为2组,治疗组30例予灯盏细辛注射液治疗2周,对照组30例予香丹注射液治疗2周。结果:治疗组治疗后全血黏度明显降低,与治疗前比较有显著性差异(P<0.01),对照组血液流变学也有明显改善(P<0.05),但治疗组改善更为明显(P<0.05或<0.01)。治疗组硝酸甘油消耗量明显下降(P<0.05),优于对照组(P<0.05)。结论:灯盏细辛注射液治疗冠心病心绞痛,在改善心绞痛症状、缺血心电图改变和血液流变学等方面有较好疗效,且较安全。     

阿魏酸钠和黄芪注射液联用对早期糖尿病肾病血液流变学和肾功能的影响

目的:观察阿魏酸钠和黄芪注射液联用对早期糖尿病肾病(EDN)血液流变学和肾功能的影响。方法:将140例EDN患者随机分为治疗组和对照组(各70例)。两组均采用饮食控制和糖尿病常规治疗,治疗组加用黄芪注射液和阿魏酸钠注射液治疗,疗程3周。结果:治疗组血液流变学各项指标较治疗前显著下降(P<0.05或P<0.01);尿白蛋白排泄率(UAER)、血肌酐(SC r)、尿素氮(BUN)和血脂均明显下降(P<0.05或P<0.01),且明显优于对照组(P<0.05或P<0.01)。结论:阿魏酸钠和黄芪注射液联用能改善EDN患者的血液流变性、血脂和微循环,减少尿白蛋白的排出,减轻肾损害,改善肾功能。     

丹红注射液治疗不稳定型心绞痛的临床疗效观察

目的 观察丹红注射液对不稳定型心绞痛（UA）患者在治疗上的有效性、安全性，并观察对UA患者微循环指标的影响。方法 将67例不稳定型心绞痛患者随机分为治疗组和对照组，对照组32例采用常规治疗方法（硝酸甘油5mg加入10％葡萄糖注射液或生理盐水250ml中3h内静脉滴注），治疗组35例在对照组基础上加用丹红注射液20ml加入10％葡萄糖注射液或生理盐水250ml中静脉滴注，检测两组在治疗前后心绞痛疗效、常规心电图ST改变、血脂、血液流变学等指标的变化，同时观察药物过敏及其他副作用。结果 治疗组与对照组相比较，能显著改善心绞痛患者的症状（P〈0．05），改善心绞痛患者的缺血心电图（P〈0．05），治疗组降低血脂、血液流变学指标下降均优于对照组（P〈0．05）。结论 丹红注射液治疗不稳定型心绞痛是安全和有效的，对不稳定型心绞痛患者微循环指标改善是安全肯定的。     

通心络胶囊对冠心病心绞痛甲襞微循环和血液流变学变化的影响

目的:探讨通心络胶囊治疗冠心病心绞痛的疗效机制。方法:选择符合WHO诊断标准的冠心病心绞痛患者112例,随机分为治疗组60例和对照组52例。两组均服用β受体阻滞剂、硝酸脂等西药常规治疗;治疗组在常规治疗基础上加用通心络胶囊,每次2粒,每日2次,连服2个月。观察两组患者治疗前后临床疗效、心电图疗效、甲襞微循环积分值和血液流变学变化。结果:治疗组用药后临床疗效总有效率达86.67%,心电图疗效总有效率达80.00%,与对照组(78.85%和69.23%)比较差异均有显著性(P均<0.01);治疗组甲襞微循环和血液流变学各项指标变化均优于对照组(P均<0.01)。结论:通心络胶囊治疗冠心病心绞痛疗效显著,可明显改善临床症状,逆转心电图缺血变化,显著改善甲襞微循环和血液流变学指标。     

磁脉冲治疗冠心病患者的疗效观察

目的 观察脉冲磁场治疗冠心病患者的疗效.方法 将56例冠心病患者分为治疗组及对照组,2组患者均给予常规药物干预,治疗组在此基础上辅以脉冲磁场治疗.于入选时及治疗30 d后对2组患者临床体征、血脂及血液流变学指标进行比较.结果经30 d治疗后,发现治疗组患者心绞痛、心电图、血脂和血液流变学指标均较入选时及对照组明显改善(均P<0.05).结论 冠心病患者在常规药物干预基础上辅以脉冲磁场治疗,能进一步缓解病情、改善机体血脂水平,有助于患者心脏供血功能恢复正常.     

马来酸桂哌齐特联合红花注射液治疗不稳定型心绞痛疗效观察

目的观察马来酸桂哌齐特联合红花注射液治疗不稳定型心绞痛临床疗效。方法将240例不稳定型心绞痛患者随机分为治疗组125例与对照组115例,对照组予钙离子拮抗剂、硝酸酯类药物、β受体阻滞剂等常规治疗。治疗组在常规治疗的基础上应用马来酸桂哌齐特注射液240 mg/d及联合红花注射液20 ml/d,14 d为一个疗程。监测治疗前后常规心电图、动态心电图、血液流变学、心肌酶、肌钙蛋白、肝肾功能、血糖、血脂等,记录心绞痛发作情况。结果治疗组及对照组临床总有效率分别为93.6%和67.8%,差异有统计学意义(P<0.01)。治疗组缺血心电图的疗效分析及血液流变学参数均明显优于对照组,差异有统计学意义(P<0.01)。且两组患者治疗相关不良反应均轻微。结论马来酸桂哌齐特联合红花注射液治疗不稳定型心绞痛疗效显著,且不良反应轻微,值得临床推广应用。     

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.     

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.