心脏型脂肪酸结合蛋白在急性心肌梗死早期诊断中的意义

目的通过早期连续测定急性心肌梗死（AMI）患者血浆心脏型脂肪酸结合蛋白（H-FABP）的变化,来探讨其在急性心肌梗死早期诊断中的意义。方法采用固相夹心酶联免疫法测定100例急性心肌梗死患者在发病后0．5、1、2、6 h 及12 h 血浆 H-FABP 浓度,同时应用常规实验室检测方法测定肌钙蛋白 I（cTnI）和肌酸磷酸肌酶同工酶（CK-MB）,比较不同检测方法的诊断敏感性及准确性。结果不同时间点的阳性率对比,6 h 以内 H-FABP 的阳性率明显高于 cTnI 及 CK-MB ,差异有统计学意义（P ＜0．05）;6 h 及6 h 以内对比,H-FABP 的准确率明显高于 cTnI 及 CK-MB ,差异有统计学意义（χ2＝7．54,P＜0．05）;H-FABP 浓度升高速度与 cTnI 及 CK-MB 相比,差异有统计学意义（P＜0．05）。结论 H-FABP 在 AMI 诊断中具有较高的敏感性,可作为 AMI 早期诊断的一个指标。     

心型脂肪酸结合蛋白在早期急性心肌梗死中的诊断价值

目的 探讨心型脂肪酸结合蛋白（H-FABP）在早期急性心肌梗死中的诊断价值.方法 选择我院收治的疑为AMI胸痛患者126例,进行H-FABP、cTnT及CK-MB检测.结果 34例AMI患者发病3h内血液H-FABP检测灵敏度和准确性显著高于cTnT和CK-MB,差异有统计学意义（P＜0.05）;48例AMI患者发病3-6 h血液HFABP检测灵敏度和准确性显著高于cTnT,差异有统计学意义（P＜0.05）,但与CK-MB比较,差异无统计学意义（P＞0.05）.非AMI患者H-FABP在以上两个时间段均为正常值.结论 H-FABP用于早期诊断急性心肌梗死准确性高,值得临床推广.     

血清心肌型脂肪酸结合蛋白检测在急性心肌梗死诊断中的应用

目的探讨血清心肌型脂肪酸结合蛋白（H-FABP）在急性心肌梗死（AMI）诊断中的应用价值。方法选择95例疑似急性心肌梗死的胸痛患者,用快速检测试剂盒检测患者发病0～3、3～6h和6h后血清的H-FABP,并和心肌肌钙蛋白I（cTnI）、肌酸激酶同工酶（CK-MB）的检测结果进行比较,分析3种心肌标志物在AMI不同发病时间段诊断中的敏感性和特异性。结果 3种指标在所有胸痛患者中检出率差异无统计学意义（P〉0.05）,但在AMI组患者中,H-FABP的阳性率为72.9%,显著高于cTnI（66.7%）及CK-MB（62.5%）,差异有统计学意义（P〈0.05）。H-FABP检测诊断AMI的敏感性在0～3h（70.00%）和3～6h（82.61%）时间段显著高于cTnT（20.00%与65.22%）和CK-MB（10.00%与65.22%）;在诊断特异性上,H-FABP高于CK-MB,但比cTnI低。结论 H-FABP对于诊断早期AMI具有较高的敏感性和良好的特异性,适合于临床AMI的早期诊断。     

联合检测三项血清水平对急性心肌梗死的诊断意义

目的：通过检测急性心肌梗死（AMI）患者的血清缺血修饰清蛋白（IMA）、肌红蛋白（Mb）和肌钙蛋白Ⅰ（cTnⅠ）水平的变化情况,探讨3者联合检测在AMI诊断中的重要意义。方法随机选择2013年6月至2014年1月入住该院且经心内科诊断为AMI的患者84例,其中,男43例、女41例,平均年龄（64．15±4．52）岁,作为AMI组;选择同期到该院体检的健康体检者81例,其中,男42例、女39例,平均年龄（62．53±5．24）岁,作为健康对照组。采用分光光度法测定IMA,采用化学发光法测定cTnⅠ、Mb。结果与健康对照组比较,AMI组血清IMA、Mb和cTnⅠ水平均有统计学意义（P＜0．05）。血清IMA在2～6h达高峰,24～48h恢复基础水平;Mb在AMI后1～2h就出现异常,6～12h达高峰,幅度可达数十倍;cTnⅠ在AMI发生后2～6h开始升高。联合检测IMA、Mb和cTnⅠ水平3者的敏感性（95．29％）、特异性（87．06％）、阳性预测值（82．35％）均明显高于单独检测IMA、Mb组相应值,差异有统计学意义（P＜0．05）;其中,敏感性也明显高于单独检测cTnⅠ组,差异具有统计学意义（P＜0．05）。结论IMA可以作为诊断AMI的重要指标,联合检测血清IMA、Mb和cTnⅠ水平对AMI具有重要诊断意义。     

心脏型脂肪酸结合蛋白对急性心肌梗死早期诊断价值的研究

目的 探讨心脏型脂肪酸结合蛋白(H-FABP)在临床诊断早期急性心肌梗死(AMI)中的优势及应用价值.方法 疑似AMI患者178例,按发病后就诊时间分为两组,分别在发病后0～3 h、3～ 6 h内检测H-FABP,同时对比临床检测肌钙蛋白T(cTnT)、肌酸激酶同功酶(CK-MB)及肌红蛋白(MYO),计算各项指标的灵敏度、特异性、准确度、阳性预测值及阴性预测值并进行比较分析.结果 H-FABP在发病0～3 h内诊断AMI的灵敏度为67.4%,高于cTnT及CK-MB,差异有统计学意义(P＜0.05);特异性为91.4%;准确度为78.2%.在发病3～6 h内诊断AMI的灵敏度为100.0%,高于cTnT,差异有统计学意义(P＜0.05),特异性88.9%,准确度为97.0%.结论 H-FABP是诊断早期(发病6 h以内)AMI最敏感的指标,具有非常重要的临床应用价值.     

缺血修饰清蛋白检测在急性冠状动脉综合征中的临床应用

目的 探讨急性冠状动脉综合征（ACS）患者血清缺血修饰清蛋白（IMA）及心肌损伤标志物的变化和临床应用价值.方法 对确诊的126例ACS患者和48例健康对照组进行IMA、肌钙蛋白I（cTnI）、肌红蛋白（Mb）、肌酸激酶同工酶（CK-MB）、C反应蛋白（CRP）、心电图（ECG）、冠脉造影（CAC）检测,并进行统计分析.结果除SA组以外,其余ACS患者的IMA与健康对照组比较,差异均有统计学意义（P〈0.01）.ECG与IMA、cTnI、Mb、CK-MB、CRP诊断SA、UA、AMI的敏感性比较：IMA〉Mb〉cTnI〉ECG〉CRP〉CK-MB,IMA在各组中敏感性均最高,在AMI组可达97.62%.ECG与IMA、cTnI、Mb、CK-MB、CRP诊断SA、UA、AMI的特异性比较：IMA〉cTnI〉Mb〉ECG〉CRP〉CK-MB,AMI组IMA特异性最高可达100.0%.结论 IMA与其他检测指标相比,能及时提示急性心肌缺血的发生,具有出现时间早、敏感性高、阴性预测值高等优点,是一种较理想的早期诊断心肌缺血的指标.     

缺血修饰白蛋白在急性心肌梗死早期诊断中的价值

目的 探讨缺血修饰白蛋白(IMA)对急性心肌梗死(AMI)的早期诊断价值.方法 103例胸痛发作患者分别于入院即刻及4、6、12、24h连续监测IMA、肌钙蛋白I(cTnI)、肌酸激酶同工酶MB(CK-MB)三项指标,观察其变化规律,同时选择30例健康对照进行检测.结果 23例患者最终诊断为AMI;入院即刻IMA、CK-MB、cTnI检测的敏感性、特异性分别为IMA 89.3％、91.3％,CK-MB 48.4％、92.3％,cTnI 30.6％、93.7％;入院6h内,IMA、CK-MB、cTnI的敏感性分别为91.3％、34.8％、52.2％,联合检测敏感性为100.0％,三者比较差异有统计学意义(x2=15.99,P＜0.01).结论 IMA对AMI的早期诊断有较高的价值,IMA联合cTnI、CK-MB检测诊断AMI,其敏感性明显优于单项检测,具有重要的临床应用价值.     

血清cTnI、CK-MB、Mb在急性心肌梗死诊断中的临床分析

目的分析血清cTnI、CK-MB、Mb在急性心肌梗死（AMI）诊断中的临床意义。方法选择AMI患者36例（观察组）与健康体检者30例（对照组）,分析观察组血清cTnI、CK-MB、Mb水平的动态变化并与对照组进行比较,分析在AMI发病的不同时间段,观察组血清cTnI、CK-MB、Mb敏感性及特异性的动态变化。结果观察组发病6-12h、12-18h和18h-24h的cTnI、CK-MB、Mb动态检测结果与对照组相比,差异有统计学意义（20〈0．05,P〈0．01）;三项联合检测的敏感性均优于单一检查（P〈0．05或P〈0．01）,且血清cTrd特异性最高。结论血清cTnI、CK．MB、Mb可作为AMI的早期诊断指标,动态检测可提示AMI的发生、发展;三项联合检测的敏感陛均优于单一检查的敏感眭,而特异眭以cTnI为高。     

心型脂肪酸结合蛋白与肌红蛋白联合检测在急性心肌梗死早期诊断中的价值

目的：探讨心型脂肪酸结合蛋白（H-FABP）和肌红蛋白（Mb）联合检测对急性心肌梗死（AMI）患者早期诊断的临床价值。方法对62例AMI患者和50例对照者进行H-FABP 、Mb和肌钙蛋白T（cTnT）水平检测,并计算各项指标单独及联合检测在诊断AMI方面的灵敏度和特异度。结果在胸痛发作6 h内的AMI患者,H-FABP 和Mb的灵敏度和特异度高于cTnT （P＜0.05）而且H-FABP 和Mb联合检测可显著提高检测的灵敏度和特异度。结论联合H-FABP 和Mb检测是早期AMI的灵敏与可靠指标,对AMI的早期诊断有着重要的意义。     

心肌肌钙蛋白Ⅰ肌红蛋白肌酸激酶在AMI中的应用

目的：对肌酸激酶（CK-MB），肌红蛋白（Mb）和心肌肌钙蛋白Ⅰ（cTnⅠ）进行比较，为急性心肌梗死（IMI）的早期诊断的检测指标。方法：对176例急性冠状动脉综合征患者（ACS）在入院后24h内检测cTnⅠ，Mb和CK-MB和Mb水平，比较它们对AMI的敏感性和特异性。结果：在入院后24h内cTnⅠ，CK-MB和MI对AMI的敏感性分别为96．6%，83．9%和76．3%，特异性分别为100％，100％和88．0%。cTnⅠ和Mb联合检AMI对AMI的敏感性为98．3%，特异性为88．0％，阳性预期值为95．0％，阴性预期值为88．0％；同时检测CK-MB。结果相同。结论：cTnⅠ和Mb联合检测对诊断AMI具有高度的敏感性和特异性，在此基础上再检测CK-MB不会增加其敏感性和特异性，对AMI有早期诊断价值。     

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.