盐酸氨溴索对新生大鼠高氧慢性肺损伤肺纤维化的干预研究

目的探讨盐酸氨溴索对高氧性肺损伤新生大鼠肺组织纤维化的干预作用。方法出生12 h内的清洁级SD大鼠30只作为研究对象,随机分成3组(每组10只):空气对照组(A组)、高氧组(B组)、高氧加盐酸氨溴索组(C组)。除A组外,B组和C组均建立高氧肺损伤动物模型。C组新生大鼠每天腹腔注射溶于9 g/L氯化钠溶液中的盐酸氨溴索[20 mg/(kg.d)],A、B组新生鼠每日腹腔注射等量9 g/L氯化钠溶液,持续14 d。第14 d处死,取其肺组织切片,伊红染色法(HE)观察其肺组织病理变化;Masson三色染色图像定量分析计算其胶原纤维阳性面积百分比,酶联免疫分析法(ELISA法)测定肺组织Ⅲ和Ⅳ型胶原蛋白,判断其肺纤维化程度。结果 B组第14天肺组织病理发现间质细胞增多,肺泡数目减少,肺组织出现纤维化改变;C组肺组织病理改变明显减轻。与A组比较,B组Ⅲ型胶原及Ⅳ型胶原表达明显增多,胶原纤维阳性面积百分比明显增高(P<0.05)。C组与B组比较,Ⅲ型胶原及Ⅳ型胶原表达及胶原纤维阳性面积百分比明显下降(P<0.05)。结论盐酸氨溴索早期干预可减轻高氧性肺损伤新生大鼠的肺组织纤维化程度。     

胰岛素样生长因子结合蛋白-2与足月及早产新生大鼠高氧肺损伤的关系

目的 探讨高浓度氧对足月及早产新生大鼠肺发育的影响及高氧肺损伤与胰岛素样生长因子结合蛋白-2(IGFBP-2)的关系.方法 将孕22 d自然出生(足月)及孕21 d行剖宫术提前娩出(早产)的新生大鼠在生后2 d随机分为足月空气组(I组)、足月高氧组(Ⅱ组)、早产空气组(Ⅲ组)、早产高氧组(Ⅳ组).Ⅱ、Ⅳ组持续暴露于氧含量为85%的氧箱中,I、Ⅲ组置于同室空气中.每日记录大鼠存活率,分别于出生后4、7、10、14和21 d活杀取肺组织标本,作病理学检查、辐射状肺泡计数(RAC).用蛋白质免疫印迹法(Western blotting)及逆转录-聚合酶链反应(RT-PCR)分别测定IGFBP-2肺表达浓度及mRNA表达.结果 高氧组自出生7 d后大鼠存活率较空气组显著下降(P均0.05).空气组肺组织无炎症病变;高氧组出生7 d和14 d时呈肺泡炎改变,21 d时肺泡炎改变明显加重,且肺泡生成受阻滞,肺泡结构囊泡化;Ⅱ、Ⅳ组各时间点RAC值较相应I、Ⅲ组显著减少(P均<0.01).高氧Ⅱ、Ⅳ组出生4 d和14 d IGFBP-2表达强度均较对应的I、Ⅲ组增强(P均<0.01);IGFBP-2 mRNA表达变化与其肽浓度变化相似.结论 长期高氧暴露可引起足月和早产新生大鼠亚急性肺损伤和肺发育阻滞,IGFBP-2异常表达;这可能是高氧导致亚急性肺损伤及肺发育阻滞的重要机制之一.     

α-平滑肌肌动蛋白在高氧肺损伤中的表达变化及意义

目的 探讨高氧暴露下大鼠肺损伤中肌成纤维细胞表面标志α-平滑肌肌动蛋白(α -SMA)的表达变化及意义.方法 将64只3周龄SD大鼠按随机数字表法分为正常对照组(置于空气中,吸入氧浓度0.21)和高氧暴露组(置于玻璃氧舱中,95％氧),每组于高氧暴露1、7、14、21d随机处死8只大鼠.苏木素-伊红(HE)染色观察肺组织病理改变,免疫组化法观察α -SMA在肺组织中的表达与分布,蛋白质免疫印迹法( Western blotting)检测肺组织α-SMA表达.结果 HE染色发现,早期高氧肺损伤时肺组织以炎症水肿表现为主,后期则以间质纤维增生为主.免疫组化结果显示,正常对照组α -SMA在细支气管上皮、肺泡表面及肺泡间隔上表达极为微弱;高氧暴露后随时间的延长α-SMA在肺泡表面及肺泡间隔上表达逐渐增强,以21d时最为明显.Western blotting检测发现,与正常对照组相比,高氧暴露1d、7d时肺组织α-SMA表达无明显差异(1.02±0.12比1.00±0.13,1.05±0.14比0.99±0.12,均P＞0.05),高氧暴露14d、21d时α-SMA表达明显增强(1.27±0.21比1.05±0.15,2.26±0.28比1.05±0.14,P＜0.05和P＜0.01).结论 大鼠高氧暴露后随时间延长,α-SMA在肺组织中的表达逐渐升高,肺纤维化逐渐加重,说明肌成纤维细胞在肺组织纤维化重构过程中起重要作用.     

基质金属蛋白酶-2及其抑制物-2在高氧致慢性肺疾病新生大鼠肺组织中的动态变化及意义

目的 探讨基质金属蛋白酶-2(MMP-2)及其抑制物-2(TIMP-2)mRNA和蛋白在高氧致慢性肺疾病(CLD)新生大鼠肺组织中的动态表达规律以及在CLD发生中的作用和意义.方法 足月新生大鼠出生后12 h内分别持续吸入0.90～0.95的高氧或空气,于1、3、7、14和21 d取肺组织进行苏木素-伊红(HE)染色,辐射状肺泡计数(RAC);用免疫组化和逆转录-聚合酶链反应(RT-PCR)方法分别检测肺组织MMP-2和TIMP-2的蛋白及mRNA表达.结果 病理观察高氧组早期炎症反应,7 d出现肺泡发育阻滞,最终纤维化;在7 d时高氧组RAC值较空气组降低(P＜0.05),14 d和21 d的差异更为显著(P均＜0.01);在高氧暴露3 d时,MMP-2的蛋白和mRNA表达均较空气组增强(P＜0.05和P＜0.01),14 d时MMP-2蛋白表达减弱(P＜0.05),而mRNA水平两组间差异无统计学意义;TIMP-2的蛋白和mRNA表达在两组中各时间点比较差异均无统计学意义.结论 高氧暴露后,肺组织中MMP-2/TIMP-2表达失衡,使细胞外基质降解异常,可能是高氧致肺早期炎性损伤和最终肺间质纤维化及发育障碍的机制之一.     

外源性TSG-6干预对支气管肺发育不良新生大鼠高氧肺损伤的保护作用及相关机制

目的 探讨外源性肿瘤坏死因子刺激蛋白6(TSG-6)干预对支气管肺发育不良新生大鼠高氧肺损伤的保护作用,并分析其机制。方法 将80只新生大鼠按照随机数字表法分为4组,分别为空气对照组、高氧肺损伤模型组、TSG-6预防组和TSG-6治疗组,每组各20只。空气对照组不建模,其他3组通过吸高氧建立高氧肺损伤新生大鼠模型。其中,高氧肺损伤模型组置于高氧箱内持续吸高氧14 d; TSG-6预防组在置于高氧箱前2 h实施气管内注入TSG-6剂量0.25μg/g TSG-6,然后进行高氧肺损伤吸氧; TSG-6治疗组进行高氧肺损伤吸氧,在吸高氧第5天开始在气管内注入剂量0.25μg/g TSG-6,直至14 d。分别于干预后7 d和14 d,苏木精-伊红染色观察各组大鼠肺组织病理学情况并进行放射状肺泡计数(RAC),酶联免疫吸附试验试剂盒检测大鼠肺组织中TSG-6、血管内皮生长因子(VEGF)和血清白细胞介素6(IL-6)水平,脂质过氧化丙二醛试剂盒检测血清丙二醛含量,总超氧化物歧化酶(SOD)活性试剂盒检测各血清SOD活性。结果 干预7～14 d后,相较于高氧肺损伤组,TSG-6预防组和治疗组支气...     

高氧诱导新生鼠急性肺损伤模型的制备及其机制探讨

目的 建立新生儿高氧急性肺损伤的动物模型，并探讨其发病机制。方法采用新生Sprague—Dawley（SD）大鼠持续暴露于90％-95％的常压氧气造成高氧急性肺损伤。实验3、7d时分别检测高氧模型组和对照组支气管肺泡灌洗液（BALF）中丙二醛（MDA）、超氧化物岐化酶（SOD）、肿瘤坏死因子-α（TNF—α），测定肺组织核因子-κB（NF—κB）染色强度，并观察肺组织病理表现。结果 与对照组比，高氧组3d时BALF中MDA、TNF-α含量升高（t分别=7．07、6．45，P均〈0．05），SOD活性下降（t=4．56，P〈0．05），肺组织NF—κB活性上升（t=50．08，P〈0．05），肺组织见小血管扩张、充血和肺泡内少量出血及以中性粒细胞、巨噬细胞为主的炎性细胞浸润；7d时，高氧组BALF中MDA、TNF-α含量进一步升高（t分别=9．70、7．20，P均〈0．05），SOD活性进一步下降（t=7．15，P〈0．05），NF—κB染色强度进一步升高（t=98．05，P〈0．05），肺组织充血、水肿，间质内浸润的中性粒细胞、巨噬细胞等增多，肺泡间隔轻度增宽，肺组织结构紊乱。结论新生鼠持续暴露于高浓度氧气可制备新生儿高氧急性肺损伤动物模型。高浓度氧致脂质过氧化，抗氧化酶系统活性降低，NF—κB过度活化，TNF-α过度释放，氧化／抗氧化系统失衡和过度炎症反应是肺损伤的重要发病机理。     

高氧致新生大鼠肺损伤中氧化应激与基质金属蛋白酶的关系

目的探讨氧化应激和基质金属蛋白酶-9（MMP-9）／基质金属蛋白酶抑制物-1（TIMP-1）在高氧肺损伤新生大鼠的肺组织中动态变化以及两者的相互关系。方法将足月新生大鼠在出生后,分别持续吸人90％～95％高氧或空气,于1、3、7、14、21d取肺组织进行HE染色,应用分光光度计比色法检测肺组织丙二醛（MDA）含量、免疫组化技术检测MMP-9和TIMP-1动态表达。结果病理观察高氧3d时出现炎症反应,7d时出现肺泡发育阻滞,最终纤维化;高氧3、7、14d后MDA含量高于空气组（P〈0．05,P〈0．01,P〈0．05）;MMP-9表达主要在上皮细胞胞浆,高氧3d时较空气组增强（P〈0．05）;TIMP-1表达主要在上皮细胞、内皮细胞和肺泡巨噬细胞胞浆,3d后各时间点的表达均高于空气组（P〈0．05,P〈0．05,P〈0．01,P〈0．01）;MDA含量与MMP-9、TIMP-1蛋白表达呈正相关（P〈0．05,P〈0．01）。结论高氧暴露后可能通过氧化应激上调MMP-9和TIMP-1表达引起基膜的破坏,从而导致毛细血管通透性的增加和以后呼吸道重塑的发生。     

长托宁对大鼠肢体缺血再灌注后远隔急性肺损伤的保护作用

[目的]探讨长托宁对大鼠肢体缺血再灌注后远隔急性肺损伤的保护作用.[方法]制备大鼠肢体缺血再灌注后远隔急性肺损伤模型.60只健康雄性SD大鼠随机分成6组（n=10）：空白对照组（C组）,缺血再灌注组（H组）和不同剂量长托宁组（R1组：0.01mg/kg,; R2组：0.05 mg/kg;R3组：0.1 mg/kg; R4组：0.5 mg/kg）.长托宁于肢体缺血前30 min尾静脉注入,术毕比较各组大鼠血浆中肿瘤坏死因子-α（TNF-α）和白介素10（IL-10）水平,肺组织过氧化物酶（MPO）活性,支气管肺泡灌洗液（BALF）中白细胞计数（WBC）和蛋白总量（Pr）,肺湿/干重比（W/D）以及肺组织病理学的改变.[结果]与C组相比,远隔缺血再灌注导致血浆中TNF-α 和IL-10水平及BALF内白细胞数量增多,蛋白总量和肺组织MPO活性增加,肺组织结构遭到破坏.与H组相比,静脉注入长托宁均使血浆中TNF-α水平显著降低,BALF内中性粒细胞浸润、蛋白总量减少,降低了肺组织MPO活性,以R3、R4组效果最为显著,肺组织病理破坏也最轻.[结论]长托宁能够剂量依赖性地减轻大鼠肢体缺血再灌注后远隔急性肺损伤.     

高浓度氧对未成年大鼠肺部炎症反应的影响

目的 探讨高浓度氧对未成年大鼠肺部炎症反应的影响.方法 将40只出生21 d的SD大鼠按随机数字表法分为空气对照组及高氧暴露12、24、48、72 h组,每组8只,分别将大鼠置于空气和常压高氧箱(氧含量达92%～94%)中.于相应时间点采用放血法处死大鼠后取肺组织,并行支气管肺泡灌洗.采用硫代巴比妥酸法和比色法分别测定肺组织丙二醛(MDA)含量及髓过氧化物酶(MPO)活性;采用酶联免疫吸附法(ELISA)检测支气管肺泡灌洗液(BALF)中肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)和IL-10含量;观察肺组织病理改变,并进行肺损伤评分.结果 与空气对照组比较,高氧暴露12 h肺组织MDA含量(mmol/g)即显著升高(2.24±0.43比1.57±0.31),MPO活性(U/g)于高氧暴露24 h显著升高(1.24±0.25比0.69±0.22),并均随高氧暴露时间延长逐渐增加(P<0.05或P<0.01).BALF中TNF-α、IL-6和IL-10含量于高氧暴露24 h时较空气对照组显著增加[TNF-α(ng/L):135.2±44.0比94.5±22.3,IL-6(ng/L):73.1±14.2比55.7±17.3,IL-10(ng/L):67.9±21.7比48.2±7.6,P<0.05或P<0.01];但高氧暴露48 h时较24 h时显著降低(48 h时BALF中TNF-α、IL-6、IL-10分别为105.4±17.0,54.3±17.4,50.9±6.9,均P<0.05).高氧暴露12 h时肺损伤评分(分)即较空气对照组显著升高(4.5±1.4比1.3±0.5),并随高氧暴露时间延长进一步升高(P<0.05或P<0.01).结论 高浓度氧可引起未成年大鼠肺部炎症损伤;炎症细胞因子的出现高峰均在高氧暴露24 h.     

上皮钠通道在高氧致新生大鼠支气管肺发育不良早期肺水肿发生中的作用

目的 探讨高氧致新生大鼠肺水肿阶段上皮钠通道(ENaC)蛋白表达及钠水转运功能的变化.方法 将新生大鼠随机分成高氧组和空气组,于实验后1、3、5、7d收集肺组织,计算肺湿、干质量比率以确定血管外肺水含量变化,应用Western blot方法检测高氧暴露后新生大鼠肺组织ENaC 3个主要亚基(α,β和γ)蛋白表达的变化规律.检测实验后5d肺泡液体清除率(AFC)及阿米洛利敏感性AFC的变化.结果 高氧暴露后新生大鼠肺组织血管外肺水含量增加(肺湿、干质量比率:3 d:6.37±0.64与5.56±0.15,=3.46;5 d:5.86±0.52与5.11±0.21,t=-3.82;7 d:5.56±0.45与4.80±0.09,t=-4.72;P均＜0.01),而AFC显著增加,阿米洛利非敏感性AFC无显著改变[AFC:(20.32±3.33)％与(12.97±2.46)％,t=-6.16,P＜0.01;阿米洛利非敏感性AFC:(10.42±3.44)％与(8.67±3.13)％,t=-1.30,P=0.21],高氧暴露使阿米洛利敏感性AFC增加;α,β和γ-ENaC蛋白表达在高氧 暴露后与空气组比较并无减低.结论 虽然在高氧诱导的支气管肺发育不良早期发生了肺水肿,但ENaC钠水主动转运障碍并非引起高氧暴露后肺水肿发生的主要因素.     

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.