奥沙利铂联合亚叶酸钙/5-氟脲嘧啶持续泵入治疗晚期胃肠癌的临床观察

目的观察奥沙利铂(L-OHP)联合亚叶酸钙(CF)、5-氟脲嘧啶(5-FU)方案对晚期胃肠癌病人的近期疗效。方法26例晚期胃肠癌患者化疗前经锁骨下静脉留置管内给药。L-OHP150mg/m2,静滴3h,第1天;CF100mg/d,静滴2h,第1～5天;5-FU1000mg/m2,微量泵持续泵入,第1～2天,每14d为1个周期。结果全组26例骨髓抑制发生率为57.7%,Ⅲ/Ⅳ度者仅1例。胃肠道反应主要为口腔粘膜炎与腹泻,发生率为53.8%,无Ⅲ/Ⅳ度胃肠道反应。结论L-OHP联合CF/5-FU持续泵入治疗晚期胃肠癌的近期疗效较好,药物不良反应低,病人耐受性好,值得推广。     

奥沙利铂联合化疗治疗晚期大肠癌的观察与护理

目的：观察奥沙利铂联合氟尿嘧啶（5-FU）和亚叶酸钙（CF）治疗晚期大肠癌的疗效和毒性反应，探讨奥沙利铂联合化疗的护理措施。方法：将晚期大肠癌患者83例分为两组：治疗组，奥沙利铂130mg／m^2静滴3小时。第1天给药；CF100mg／m^2静滴2小时，第1～5天给药；5-FU 425mg／m^2静滴，第1～5天给药。每三周晕复，每例患者至少完成两个同期对照组，CF100mg／m^2静滴2小时，第1～5天给药；5-FU425mg／m^2静滴，第1-5天给药，每三周重复，每例患者至少完成两个周期。结果：治疗组有效率为46．5％，对照组有效率为17．5％；两组毒副反应的发生率，除神经毒性发生率的差别有统计学意义外，其它毒性发生率的差别无统计学意义。护理的重点是奥沙利铂的神经性护理、奥沙利铂的正确使用及外渗的处理。     

中晚期胃癌100例联合化疗分析

目的：观察LFP方案和FOLFOX4方案治疗中晚期胃癌的疗效和毒副反应。方法：100例中晚期胃癌,使用LFP方案和FOLFOX4方案治疗,即亚叶酸钙0.1 g/m2静脉输注第1~5天,5-氟尿嘧啶500 mg/m2静脉输注第1~5天,顺铂20 mg静脉滴注第1~5天。奥沙利铂（L-OHP）85 mg/m2加入5%葡萄糖溶液中静滴2 h,第1天;亚叶酸钙（CF）200mg/m2加入5%葡萄糖溶液中静滴2 h,第1~2天;5-氟尿嘧啶（5-Fu）400 mg/m2静脉推注,然后600 mg/m2加入5%葡萄糖溶液中持续静脉泵入22 h,第1~2天。每2周重复1次。至少使用4个周期评价疗效。结果：以上化疗方案疗效取得较满意效果,毒副反应主要为恶心、呕吐和骨髓抑制,多为~度,一过性的外周感觉神经异常。结论：LFP方案和FOL-FOX4方案治疗中晚期胃癌,近期有效率较高,毒副反应低,值得临床进一步推广使用。     

奥沙利铂联合亚叶酸钙和氟尿嘧啶治疗晚期大肠癌32例分析

目的：奥沙利铂（L-OHP）联合亚叶酸钙（CF）和氟尿嘧啶（5-FU）治疗晚期大肠癌疗效及不良反应。方法：32例晚期大肠癌患者给予：L-OHP 130mg／m^2静滴4h，第1天；CF 200mg／m^2静滴2h，第1～5天；继以5-Fu500 mg／m^2静滴5h，第1～5天；每3周为一周期，行3周期后评价疗效。结果：观察32例，其中CR1例，PR13例，SD10例，PD8例，总有效率43．7％。主要不良反应为骨髓抑制消化道反应、口腔炎，外周神经毒性可以耐受且可逆。结论：L—OHP联合CF和5-FU是一种安全有效的治疗晚期大肠癌的药物。     

中医施治联合奥沙利铂、5-FU、CF治疗晚期结肠癌18例

目的:观察中医施治联合奥沙利铂、5-FU、CF治疗晚期结肠癌客观疗效。方法:奥沙利铂(Oxaliplatin)135mg/㎡+5%葡萄糖500ml静滴3h,第1天在CF给药前执行,CF:200mg+5%葡萄糖500ml静滴,维持2小时,5-FU:500mg/㎡+5%葡萄糖100ml,于CF静滴一半时快速滴入。化疗期间采用健脾理气法,化疗后采用扶正、祛邪、散结、健脾法。结果:18例患者中,部分缓解9例,稳定8例,进展1例。结论:中医施治联合治疗晚期结肠癌具有疗效高、价廉、使用方便、痛苦少等特点,适合晚期结肠癌治疗。     

FOLFOX4方案治疗晚期大肠癌28例分析

目的观察奥沙利铂（L-OHP）联合亚叶酸钙（CF）和氟脲嘧啶（5-FU）组成的FOLFOX4方案治疗晚期大肠癌的疗效及不良反应。方法 28例患者,给予L-OHP85 mg/m2静脉滴注2 h,第1天;CF200 mg/m2静脉滴注2 h,第1～2天;5-FU500 mg/m2静推,然后600 mg/m2持续泵入22 h,第1～2天,2周重复。化疗3个周期后评价疗效。结果完全缓解（CR）1例,部分缓解（PR）10例,稳定（SD）12例,进展（PD）5例,总有效率（CR＋PR）39.3%,主要不良反应为外周神经系统毒性,消化道反应和骨髓抑制。结论 FOLFOX4方案治疗晚期大肠癌具有较好的疗效,不良反应可耐受,值得临床推广。     

奈达铂联合5-氟脲嘧啶治疗晚期食管癌的临床观察

目的观察奈达铂(NDP)联合5-氟脲嘧啶(5-FU)治疗晚期食管癌的疗效和毒副作用。方法将51例晚期食管癌病人随机分组,奈达铂治疗组采用方案:NDP 80 mg/m2,静滴,第1天;5-FU 500 mg/m2静滴,第1~5天;对照组采用方案:顺铂(PDD)20 mg/m2,静滴,第1~5天;5-FU 500 mg/m2静滴,第1-5天;两组方案均21天为一周期,2个周期结束后评价疗效。结果①NDP治疗组的近期有效率为50%,PDD对照组的近期有效率为43.48%,两组相比无差异性(P>0.05)。②NDP治疗组的毒副作用主要表现为血小板减少,发生率为42.86%;PDD对照组的毒副作用主要表现为恶心、呕吐,发生率为47.83%;两组相比有差异性(p<0.05)。结论NDP联合5-FU治疗晚期食管癌疗效肯定,毒副作用轻微,值得临床推广应用。     

奥沙利铂联合亚叶酸钙/5-氟脲嘧啶持续泵入治疗晚期胃肠癌的临床观察

目的观察奥沙利铂（L—OHP）联合亚叶酸钙（CF）、5-氟脲嘧啶（5-FU）方案对晚期胃肠癌病人的近期疗效。方法26例晚期胃肠癌患者化疗前经锁骨下静脉留置管内给药。L—OHP150mg／m^2，静滴3h，第1天；CF100mg／d，静滴2h，第1—5天；5-FU 1000mg／m^2，微量泵持续泵人，第1—2天，每14d为1个周期。结果全组26例骨髓抑制发生率为57．7％，KI／IV度者仅1例。胃肠道反应主要为口腔粘膜炎与腹泻，发生率为53．8％，无KI／IV度胃肠道反应。结论L—OHP联合CF/5-FU持续泵人治疗晚期胃肠癌的近期疗效较好，药物不良反应低，病人耐受性好，值得推广。     

恩度联合FOLFOX4方案治疗晚期结肠癌、直肠癌的多中心临床研究

目的评价重组人血管内皮抑素（恩度）联合FOLFOX4方案治疗晚期结肠癌、直肠癌的有效性和安全性。方法 2006年7月~2010年12月,58例晚期结肠癌、直肠癌患者接受恩度联合FOLFOX4方案：恩度7.5 mg/m2第1~7天,草酸铂85 mg/m2,静滴2 h,第1天;醛氢叶酸200 mg/m2,第1、2天;5-氟尿嘧啶（5-Fu）400 mg/m2,静推,第1、2天;5-Fu600 mg/m2,静滴22 h,第1、2天。2周重复,至少4周期。结果 17例获部分缓解,24例获病情稳定,总有效率为29.3%,临床受益率为70.7%,中位疾病进展时间（TTP）为8.6月,主要毒副反应为中性粒细胞减少（50.0%）,恶心/呕吐（39.7%）,神经毒性（39.7%）。结论恩度联合FOLFOX4方案治疗晚期结肠癌、直肠癌疗效确切,毒副反应可耐受。     

CPT-11联合5-FU/CF方案二线治疗晚期结直肠癌的临床研究

目的探讨伊立替康（CPT-11）联合5-氟尿嘧啶/甲酸四氢叶酸（5-FU/CF）（FOLFIRI）方案二线治疗晚期结直肠癌的疗效及不良反应。方法回顾分析42例晚期结直肠癌患者经5-FU和奥沙利铂类药物一线化疗失败后行FOLFIRI方案治疗。CPT-11 180 mg.m-2,静脉滴注90 min,第1天;CF400 mg.m-2,静脉滴注2 h,第1天;5-FU400 mg.m-2,静脉推注,随后5-FU2.4 g.m-2,静脉滴注46 h（泵入）,第1天。每14天重复。分析其近期疗效及不良反应。结果42例患者中41例可评价疗效,有效率RR为11.9%,无进展生存期（PFS）为3.7个月,总生存期（OS）为11.0个月。主要的Ⅲ/Ⅳ度不良反应是中性粒细胞减少（16.7%）、迟发性腹泻（9.5%）和恶心呕吐（7.2%）。结论FOLFIRI方案二线治疗5-FU和奥沙利铂类药物治疗失败的晚期结直肠癌是有效的,不良反应能控制。     

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.