标本保存温度与时间对血糖和血脂检测值的影响

目的分析保存温度与时间对血浆葡萄糖、血清胆固醇、三酰甘油、低密度脂蛋白胆固醇、极低密度脂蛋白胆固醇和高密度脂蛋白胆固醇测定结果的影响。方法采集20名自愿受试者空腹静脉血,将离心后的血浆和血清分装,分别放置室温（24℃）、4℃和-20℃,测定不同保存时间的血浆葡萄糖和血清胆固醇、甘油三酯、低密度脂蛋白胆固醇和高密度脂蛋白胆固醇的浓度。结果室温条件下Glu测定值随放置时间而显著降低（P〈0.001）,4℃放置2～6h和-20℃保存6d的Glu检测值差异无显著性。HDL-C室温、4℃放置不同时间测定值差异无统计学意义（P〉0.05）。TC、TG和LDL-C室温2h、4℃4h内的检测结果相对稳定,未见差异有显著性。但-20℃6d保存的标本,除LDL-C外,其他血脂3项均与即刻检测结果有差别。结论4℃条件下保存的分离标本,在2～4h内的血糖和血脂4项检测结果比较稳定,不会影响研究结果。     

标本放置时间与温度对血脂测试的影响

目的探讨标本放置时间与温度对血清血脂测定结果的影响。方法采集25名健康体检者的倥腹静脉血,将离心后的血浆和血清分装,分别放置室温22℃、4℃和-20℃,测定不同髁存时间的血清胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆回醇（LDL—C）和高密度脂蛋白胆固醇（HDL-C）的浓度。结果HDL—C22℃、4℃放置不同时间测定值差异无统计学意义（P〉0．05）。TC、TG和LDL-C22℃内的检测结果相对稳定,差异无统计学意义。但-20℃保存7d的标本,除LDL—C外,其他血脂3项均与即刻检测结果有差别。结论室温4℃条件下保存的分离标本在2～4h内的血脂4项检测结果比较稳定,不会影响研究结果。     

标本放置温度及时间对酶联化学发光法检测血清胸苷激酶1结果的影响

目的观察标本放置不同时间及温度对血清胸苷激酶1(STK1)结果的影响。方法采集42例血液标本,分别在室温[(23±2)℃]、4℃及-20℃放置不同时间后再测定STK1浓度,与即刻测定结果进行对比分析。结果标本放置室温2h及4℃24h后测定的STK1结果与即刻测定结果比较差异有统计学意义(P0.05),-20℃放置28d测定结果与即刻测定结果比较差异无统计学意义(P0.05)。结论温度与放置时间对标本STK1浓度有影响。室温环境下应在采血后2h内完成加样,标本于4℃冷藏最多放置24h,若置于-20℃可较长期保存。     

标本放置的时间和温度对血糖测定的影响

目的研究静脉血采集后放置的时间和温度对血糖测定的影响。方法空腹抽取5ml静脉血，分装于四支试管中，在1h内离心，并于1h测定血糖一次。然后把其中两支试管中的血清吸出，分别放于另两支试管中。把1支试管的血清标本和1支试管的全血标本放于4℃冰箱。另1支试管的血清标本和另1支试管的全血标本室温（15-18℃）保存。于2h，3h，4h．6h，32h，48h测定血糖。结果全血标本随着时间的延长结果明显减低．随着温度的升高减低尤为明显；分离血清的标本在4℃时，结果逐渐减低，在48h内结果无显著性差异（P〉0．01），在室温时，血糖的结果略低；室温时血清标本因没有密封措施，致使血清标本因室温干燥挥发而使结果偏高。结论全血标本在室温时应在1h内测定，放入4℃冰箱,也应在2h内测定完毕；血清标本在4℃和室温时，密封保存可放置较长时间。4℃时保存可集中到第二天或更长时间测定血糖。     

不同保存条件及反复冻融对血清HCV抗体检测的影响

目的探讨不同保存温度、保存时间及反复冻融对血清丙型肝炎病毒(HCV)抗体检测的影响。方法收集50份血清样本,以当天检测的HCV抗体结果作为基线水平,将检测后的血清均分成4份,分别置于常温、4℃、-20℃和-80℃保存1、3、5、7 d后再次检测HCV抗体水平。另收集61份血清样本,以当天检测的HCV抗体结果作为基线水平,将检测后的血清均分成2份,分别置于-20℃和-80℃保存,2 h后解冻并检测HCV抗体,测定完成后立即冻存2 h,反复冻融4次。结果与基线水平比较,常温和4℃保存1、3、5、7 d的HCV抗体水平差异均无统计学意义(P0.05);-20℃和-80℃保存1 d的HCV抗体水平显著降低(P0.05),且保存时间越长,HCV抗体水平下降幅度越大。对于基线S/CO值为1～2的HCV阳性样本,常温和4℃保存1、3、5、7d阳性率无变化,-20℃和-80℃保存1d即可使部分HCV抗体阳性样本转为阴性。61份血清样本的HCV抗体检测结果(S/CO值)随冻融次数的增加而逐渐降低(P0.001),基线S/CO值越低的样本反复冻融后S/CO值的下降百分比越大。在冻融次数相同的情况下,-20℃与-80℃保存的样本HCV抗体检测结果之间差异无统计学意义(P0.05)。结论用于HCV抗体检测的血清样本不宜冷冻保存,应在采血当天完成检测。若当天无法检测,宜4℃短期保存7 d。冷冻保存后复测会导致HCV抗体水平明显偏低。     

放置不同时间检测乙型肝炎表面抗原结果的影响

用ＥＬＩＳＡ法检测２００例ＨＢｓＡｇ阳性血清。结果表明，阳性标本转阴率（假阴性）随标本放置天数的增加而增加。提示在检测ＨＢｓＡｇ时，标本采集后应在２４小时内检测，如不能及时测定，可放置４℃冰箱保存，但不宜超过３天。     

血浆中丙型肝炎病毒核酸在不同保存条件下的稳定性

目的探讨不同保存条件和时间对丙型肝炎病毒(HCV)RNA稳定性的影响。方法将22份血浆样本置于-20℃保存4周,4℃保存12d,室温(20~25℃)保存7d,反复冻融5次,采用荧光定量聚合酶链反应测定HCV RNA水平,考察HCV RNA稳定性。结果样本在-20℃保存4周HCV RNA平均下降幅度小于或等于0.14lg,±95%CI≤0.20lg;4℃保存12dHCV RNA平均下降幅度小于或等于0.39lg,4℃保存12d时95%CI下限为-0.50lg,12d时±95%CI≤0.24lg;室温保存7dHCV RNA平均下降幅度小于或等于0.40lg,室温保存7d处理组95%CI下限为-0.53lg,7d时±95%CI≤0.29lg;反复冻融5次HCV RNA平均下降幅度小于或等于0.10lg,±95%CI≤0.15lg。结论血浆样本在-20℃保存4周、4℃保存9d、室温保存5d和反复冻融5次时,对HCV RNA水平影响不明显,但4℃保存12d或室温保存7d后,RNA水平显著降低,所以应避免在这种条件和时间下保存和运输血浆。     

不同的保存温度及放置时间对人血清胰岛素检测的影响

目的：研究人血清在不同的保存温度及放置时间条件下对胰岛素检测的影响，方法：使用胰岛素（INS）定量测定化学发光法（CLIA）分别对即时、室温、4℃冷藏、-20℃冷冻保存一定时间后血清中胰岛素含量测定，并与即时测得胰岛素含量进行统计学意义的显著性水平的差别比对，即样本均数差别的t检验。结果：室温放置条件下胰岛素降解非常快，仅1小时与即时检测结果相比已发生统计学意义的显著性差异（P〈0．05），放置2小时后有极显著性的差异（P〈0．01）；4℃冷藏12小时P〈0．05，4℃冷藏24小时后P〈0．01；-20％冷冻保存4周时P〈0．05，说明血清在4℃冷藏不超过12小时及-20％冷冻不超过4周时不会影响胰岛素检测的结果。     

血清胃蛋白酶原临床检测中的稳定性探讨

目的探讨血清胃蛋白酶原(PG)临床检测中的稳定性。方法本次研究选择来本院就诊的患者16例,每例患者标本分为5份,分别在5种条件下对标本进行保存:A组标本为新鲜血清组,将其立即置于-80℃条件下保存;B组标本为室温保存组,血清分离后在室温条件下放置7d后,置于-80℃冰箱中保存;C组标本为2~7℃保存7d组,在2~7℃条件下保存7d后,将血清放置于-80℃条件下保存。D组为2~7℃保存14d组,在2~7℃条件下保存14d后,将血清放置于-80℃条件下保存。E组为2~7℃保存30d组。PGⅠ、PGⅡ及PGⅠ/PGⅡ数值都进行方差齐性检验并进行方差分析。结果 PGⅠ、PGⅡ及PGⅠ/PGⅡ数值进行组间比较,差异均无统计学意义(P0.05)。结论血清PGⅠ、PGⅡ水平在各种保存条件下都具有良好的稳定性。     

血液标本不同条件下检测对血细胞分析结果的影响

目的：分析血液标本在室温和冰箱两种放置条件下不同时间段的血细胞检测结果。方法随机选择南京医科大学附属南京第一医院门诊40份血标本,每份标本稀释2管,第1管20℃室温放置（20℃组）,第2管4℃冰箱放置（4℃组）,分别在即刻,0．5、1．5、3．0h后用仪器对两组标本进行分析测定,取平均值。结果随放置时间的不同,两组各检测值与即刻值比较,差异有统计学意义（ P＜0．05）。血细胞分析20℃组与4℃组比较中,中间细胞、淋巴细胞和血小板计比较,差异有统计学意义（P＜0．05）,红细胞、平均红细胞体积、白细胞、中性粒细胞和平均血小板体积比较,差异无统计学意义（ P＞0．05）。结论标本放置在室温（20℃）条件下应在1 h内检测完毕,置于冰箱保存,可适当延长测定时间,但不适宜超过2h,这样才能保证检验结果的准确性。     

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.     

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.     

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.     

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.