溶栓治疗对急性心肌梗死患者QT离散度的影响

目的:探讨急性心肌梗死(AMI)患者静脉溶栓前后QT离散度(QTd)变化及其对预后的影响.方法:105例AMI患者分为溶栓再通组、未通组和未溶栓组.测定其溶栓前及溶栓治疗1、2周后QTd变化,并与未溶栓组比较.同时比较三组治疗2周时高危室性心律失常.结果:溶栓治疗再通治疗1、2周后QTd显著缩小(P皆＜0.01),高危室性心律失常的发生率低,其与未通组和未溶栓组比较,差异皆有显著性(P＜0.01).而未通组、未溶栓组治疗前后QTd变化和高危室性心律失常的发生率皆无差异(P＜0.05).结论:AMI后2周内QTd增大者,其溶栓再通的可能性小,发生高危室性心律失常的可能性增大.     

急性心肌梗死患者溶栓前后QT离散度的变化

目的:观察急性心肌梗死(AMI)患者溶栓前后QT离散度(QTdispersion,QTd)的变化及早期再灌注对QTd的影响。方法:对61例AMI患者给予尿激酶静脉溶栓治疗,予溶栓前及溶栓2h后同步记录18导联心电图,分别测量成功组及失败组的QTd,并进行前后比较。结果:溶栓后再通41例,溶栓后未通20例。血管未通组其QTd较前减少,但无统计学意义(P>0.05),溶栓后再通组其QTd较血管未通组降低程度更大,有统计学意义(P<0.01)。结论:QTd可作为评价AMI患者溶栓后判断溶栓成功与否的一项临床早期参考指标。     

早期溶栓治疗对急性心肌梗死患者QT间期离散度的影响

目的 :探讨早期溶栓治疗对急性心肌梗死患者QT间期离散度的影响。方法 :116例AMI患者 ,溶栓再通组 3 6例 ,未通组 16例 ,非溶栓组 64例 ,比较 3组QTd。结果 :溶栓再通组QTd值明显减少 ,未通组及非溶栓组QTd值增大 ,且后两组QTd值比较差异无显著性 (P >0 0 5 )。QTd增大者发生室性快速心律失常比率增大。结论 :溶栓再通后AMI患者QTd值明显降低 ,同时室性快速心律失常发生率降低     

急性心肌梗死患者静脉溶栓对QT间期离散度的影响

目的探讨急性心肌梗死(AM I)患者静脉溶栓对QT间期离散度(QTd)的影响。方法34例AM I患者分为溶栓再通组,未通组及非溶栓组,测定其溶栓前后的QTd,并与非溶栓组QTd比较。结果AM I患者溶栓前QTd溶栓组(83.28±11.15)ms,与非溶栓组(84.25±11.23)ms,两组差异无显著性(P>0.05),溶栓治疗再通后,QTd明显减少。溶栓未通组及非溶栓组(48.43±7.12)ms,(49.11±8.29)ms,显著高于溶栓再通组(39.21±6.23)ms(P<0.05),室性心动过速(VT),心室颤动(VF)及猝死组(95.81±9.52)ms的QTd明显长于无VT,VF及非猝死者(75.97±9.33)ms(P<0.05)。结论急性心肌梗死静脉溶栓再通后,随心肌缺血改善,QTd明显改善,室性快速心律失常发生率降低。     

影响老年急性心肌梗死溶栓疗效因素分析

目的:分析老年人急性心肌梗塞(AMI)溶栓疗效的影响因素.方法:106例AMI患者分为≥70岁组(31例)、＜70岁组(75例)均在发病6小时内接受尿激酶150万单位静脉溶栓治疗.结果:≥70岁组与＜70岁组血管再通率无差异(P＞0.05),血管再通与血管未通者比较病死率有差异(P＜0.05),溶栓开始越晚病死率越高.结论:AMI的溶栓疗效与年龄无关,与血管是否再通密切相关,疗效与溶栓时间呈显著依赖关系.     

不同方法治疗急性心肌梗死的疗效观察

目的比较直接经皮冠状动脉内介入治疗(PCI)、静脉溶栓 PCI(补救性PCI)、静脉溶栓与传统疗法治疗急性心肌梗死(AMI)的临床疗效。方法回顾分析AMI患者96例,其中25例患者接受静脉溶栓治疗,22例患者接受直接PCI治疗,31例行补救性PCI,18例接受传统疗法。比较4组患者梗死相关血管(IRA)再通率与住院死亡率。结果4组患者IRA再通率:直接PCI组IRA再通率达100%,与补救性PCI组比较没有显著性差异(P>0.05),但明显高于溶栓治疗组和传统治疗组(P<0.05)。溶栓治疗组IRA再通率显著高于传统治疗组;4组患者住院死亡率:补救性PCI组住院死亡率略低于直接PCI组,两组比较无显著性差异;补救性PCI组和直接PCI组住院死亡率均显著低于溶栓治疗组和传统治疗组(P<0.05);溶栓治疗组住院死亡率与传统治疗组相比差异有显著性,P<0.05。结论与传统治疗相比,尿激酶静脉溶栓IRA再通率高、死亡率低。与溶栓治疗比较,直接PCI能使IRA安全有效充分开通,可更好地改善患者心功能,降低住院死亡率。补救PCI也能有效地开通IRA,获得TIMI3级血流,挽救濒死心肌,改善心功能。     

急性心肌梗死患者静脉溶栓对QTd的影响及其临床意义

【目的】探讨急性心肌梗死（AMI）患者静脉溶栓对QT离散度（QTd）的影响,并评价其与近期恶性室性心律失常的相关性。【方法】将158例AMI静脉溶栓的患者分为再通组和未再通组,比较溶栓前、溶栓后24h的QTd变化,同时观察两组患者溶栓治疗后一周内恶性室性心律失常的发生情况,分析其与QTd的相关性。【结果】静脉溶栓再通组QTd明显减少（P〈0．01）,未再通组无明显变化（P〉0．05）;再通组恶性室性心律失常发生率明显低于未再通组（12．7％比32．1％,P〈0．01）。AMI伴恶性室性心律失常者的QTd明显大于无恶性室性心律失常者（P〈0．01）。【结论】成功的静脉溶栓能显著减少AMI患者的QTd,降低恶性室性心律失常的发生率;QTd对判断静脉溶栓疗效、评价AMI近期预后具有一定的临床参考价值。     

58例急性心肌梗死病人行静脉溶栓治疗的护理

[目的]总结急性心肌梗死(AMI)病人行静脉溶栓治疗的护理.[方法]对58例AMI病人行静脉溶栓治疗,同时加强一般护理、心理护理及溶栓治疗的护理配合等.[结果] 58例AMI病人再通50例,未通8例.[结论]加强AMI病人行静脉溶栓治疗护理是治疗成功的保证.     

急性心肌梗塞溶栓前后测定QT离散度的临床价值

对41例急性心肌梗塞（AMI）患者行静脉溶栓治疗，分别测定其溶栓治疗前后QT离散度（QTd），探讨QTd在判断急性心肌梗塞溶栓治疗疗效的临床应用价值。结果：溶栓成功血管再通组25例溶栓前QTd为78．10±21．62ms，溶栓后QTd为41．20±18．23ms，两者比较差异非常显著（P＜0．01）；溶栓失败血管未通组16例溶栓前QTd为79．10±22．31ms，溶栓后QTd为74．20±21．56ms，两者比较差异无显著性（P＞0．05）。作者认为：AMI溶栓后QTd的变化可作为临床判定溶栓疗效的一项无创性指标。     

急性心肌梗死介入治疗和溶栓治疗的临床疗效比较

[目的]比较直接经皮冠状动脉介入（PCI）治疗和静脉溶栓治疗急性心肌梗死患者（AMI）的临床疗效.[方法]132例AMI患者按不同治疗方法分为两组,其中75例患者直接行冠脉造影术和梗死相关动脉介入治疗（急诊PCI组） 57例行静脉溶栓（对照组）.比较两组患者梗死后冠脉再通率、心绞痛发生率、左室收缩功能（左室射血分数）、平均住院天数、主要不良心血管事件发生率的差别.[结果]急诊PCI组冠脉再通率高于对照组 平均住院天数、梗死后心绞痛、心源性休克发生率、总病死率和室性心律失常发生率明显低于对照组（P〈0.01）.[结论]AMI患者采取急诊冠脉介入治疗能及时有效的开通梗死相关血管,实现心肌再灌注,改善心功能,降低病死率,明显缩短住院时间,其效果优于静脉溶栓治疗.     

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.