低剂量内毒素对低血容量性休克兔前炎症细胞因子的影响

目的：观察急性失血致低血容量性休克后低剂量内毒素对血浆和肺泡灌洗液（ＢＡＬＦ）中前炎症细胞因子白介素－１β（ＩＬ－１β）和肿瘤坏死因子－α（ＴＮＦ－α）水平变化的影响。方法：２２只新西兰白免分成４组：①低血溶量性休克组６只：快速失血持续１小时，以心排血量低于基础值４０％为准，休克恢复６０分钟后再观察４小时；②内毒素组６只：以１ｕｇ／ｋｇ的低剂量内毒素（ＬＰＳ）静注；③休克加ＬＰＳ组（６只）；低血容     

急性低血容量性休克后低剂量内毒素致早期急性呼吸窘迫综合征动物模型研制

目的：模拟制作一种更接近临床早期急性呼吸窘迫综合征（ＡＲＤＳ）病理生理过程的动物模型。方法：２２只新西兰白兔分成４组：①低血容量性休克组（６只）：急性失血后休克过程持续１小时,以心排血量（ＣＯ）你于基础４０％为准。回输放出的血并抗休克处理９０分钟后再观察４小时;②内毒素组（６只）：静注内毒素（ＬＰＳ０１μｇ／ｋｇ,再观察４小时;③休克加内毒素组（６只）：急性低血容量性休克恢复９０分钟后再静注ＬＰＳ     

促甲状腺素释放激素与HSD伍用抗高原创伤低血容量性休克大鼠的作用

目的：在西藏拉萨进行现场实验,观察促甲状腺素释放激素（ＴＲＨ）与７．５％ＮａＣｌ和６．０％右旋糖酐７０复方溶液（ＨＳＤ）对高原创伤低血容量性休克大鼠的治疗作用。方法：初进高原大鼠２７只,分平衡盐液对照组（８只）,ＴＲＨ治疗组（７只）,ＨＳＤ治疗组（６只）和ＴＲＨ与ＨＳＤ合用组（６只）。大鼠右侧骨股粉碎性骨折加放血〔血压维持在６．０ｋＰａ（１ｋＰａ＝７．５ｍｍＨｇ）１小时〕复制创伤低血容量性休克模型,分别观察ＴＲＨ（５ｍｇ／ｋｇ）,ＨＳＤ（４ｍｌ／ｋｇ）和两者合用对创伤低血容量性休克大鼠血流动力学指标和动物存活时间的影响,以等容量平衡盐液作对照。结果：ＴＲＨ、ＨＳＤ单用或合用均能显著提升创伤低血容量性休克大鼠血压,改善其左室内压（ＬＶＳＰ）、左室内压最大变化速率（±ｄｐ／ｄｔｍａｘ）、实测心肌最大收缩速度（Ｖｐｍ）和心肌收缩向量环面积（Ｌｏ）,明显延长休克动物的存活时间,合用效果与ＴＲＨ单用效果相似。结论：ＴＲＨ、ＨＳＤ均具有较好的抗高原创伤低血容量性休克作用,两药单用即可,合用并不能增加各单药的效果。     

创伤低血容量性休克时血浆β内啡肽含量的变化及纳络酮的治疗作用

创伤引起的低血容量性休克是创伤致死的主要原因之一。本研究通过动态测定创伤致低血容量性休克时血浆β内啡肽（βＥＰ）的含量变化及观察纳络酮逆转休克时低血压的疗效,明确纳络酮在早期抗休克过程中的作用及意义,报告如下。１　资料与方法１．１　动物实验：１．１．１　实验动物：雄性中国大白兔２０只,由浙江医科大学实验动物中心提供。随机分成纳络酮治疗组（ＮＡＬ组,１０只）和生理盐水对照组（ＮＳ组,１０只）,２组动物平均体重比较,有可比性。１．１．２　实验方法：按文献〔１〕方法复制创伤致低血容量性休克动物模型。先…     

丙氨酰谷氨酰妥对创伤后肠粘膜屏障的修复作用研究

目的：利用ＳＰＦ大鼠模型，观察失血后低血容量性休克全胃肠外营养（ＴＰＮ）、ＴＰＮ液中添加Ａｌａ－Ｇｌｎ（ＴＰＮ加Ａｌａ－Ｇｌｎ）和经口进食（ＴＥＮ）３种营养模式对肠粘膜免疫系统、肠粘膜菌群双歧杆菌／大肠杆菌比值和血浆内毒素（ＬＰＳ）水平的影响，探讨Ａｌａ－Ｇｌｎ是否对损伤后肠粘膜屏障有修复作用。方法：２４只ＳＰＦ Ｗｉｓｔａｒ大鼠实施失血后低血容量性休克，复共后以ＴＰＮ、ＴＰＮ加Ａｌａ－Ｇｌｎ和Ｔ     

失血致低血容量性休克大鼠心脏G蛋白表达及纳络酮的影响

目的：探讨纳络酮对失血致低血容量性休克大鼠的治疗作用及其对休克大鼠心脏组织Ｇ蛋白含量的影响。方法：颈总动脉放血,使平均动脉压降至６ｋＰａ（１ｋＰａ＝７．５ｍｍＨｇ）稳定１小时完成失血致低血容量性休克大鼠模型。２１只大鼠随机均分为：休克组（ＨＳ组）、纳络酮治疗组（ＮＡＬ组）和正常对照组（ＮＳ组）。在观察动脉血压、血气等指标的同时,采用Ｗｅｓｔｅｒｎ ｂｌｏｔ技术测定大鼠伤后６小时心脏组织中Ｇｓａ、Ｇ     

促甲状腺素释放激素与多巴胺伍用抗高原创伤低血容量性休克大鼠的作用

目的：观察促甲状腺素释放激素（ＴＲＨ）与多巴胺（ＤＡ）伍用对高原创伤低血容量性休克大鼠的治疗作用。方法：初进高原大鼠２８只，分生理盐水对照组（８只），ＴＲＨ组（７只），ＤＡ组（６只）和ＴＲＨ与ＤＡ合用组（７只）。大鼠右侧股骨粉碎性骨折加放血（血压６．０ｋＰａ维持１小时）复制创伤低血容量性休克模型，观察ＴＲＨ（５ｍｇ／ｋｇ）、ＤＡ（１ｍｇ／ｋｇ）和ＴＲＨ与ＤＡ半量合用对创伤低血容量性休克大鼠血流动力学指标和大鼠存活时间的影响。结果：ＴＲＨ单用或与ＤＡ合用能显著提高休克大鼠的血压，改善心肌收缩向量环面积（Ｌｏ），两药单用或合用均能改善休克大鼠左心室收缩压（ＬＶＳＰ）、左心室收缩压最大变化速率（±ｄｐ／ｄｔｍａｘ）、心肌最大收缩速度（Ｖｐｍ）；ＴＲＨ单用及与ＤＡ合用可明显延长休克大鼠的存活时间，合用效果优于ＴＲＨ或ＤＡ单用效果，并显示出一定的协同作用。结论：ＴＲＨ与ＤＡ合用抗高原创伤低血容量性休克有一定的协同作用。     

低分子量肝素对大鼠内毒素休克的保护作用

用大鼠内毒素（ＬＰＳ）休克模型，观测其平均动脉压（ＭＡＰ）、血浆肿瘤坏死因子（ＴＮＦ）、组织因子（ＴＦ）、组织因子途径抑制物（ＴＦＰＩ）含量、抗凝血酶Ⅲ（ＡＴⅢ）活性的变化、血白细胞及血小板计数，探讨低分子量肝素（ＬＭＷＨ）对大鼠内毒素休克的作用。结果：ＬＰＳ组大鼠ＭＡＰ呈进行性下降，血浆ＴＮＦ和ＴＦ含量显著升高，ＡＴⅢ活性明显降低，ＴＦＰＩ／ＴＦ比值降低，血白细胞和血小板计数下降，与对照组比较差异显著；而ＬＭＷＨ＋ＬＰＳ组的以上指标变化与对照组比较均无显著性差异。证明ＬＭＷＨ对ＬＰＳ所致的大鼠休克有保护作用     

高渗氯化钠-醋酸钠溶液改善低血容量性休克大鼠白细胞粘附特性的作用研究

目的：探讨高渗氯化钠 醋酸钠溶液对低血容量性休克改善作用的机制。方法：成年ＳＤ大鼠随机分为３ 组：７．５％ ＮａＣｌ治疗组（ＨＳ组）、５％ ＮａＣｌ＋ ３．５％ ＮａＡｃ治疗组（ＨＳＡ 组）和０．９％ ＮａＣｌ对照组（ＮＳ组）。用高倍显微电视放大技术在体观察低血容量性休克时脊斜肌细静脉白细胞附壁数,用细胞液流室离体观察白细胞 内皮细胞粘附率的变化。结果：休克后各组细静脉白细胞附壁数显著增加,ＨＳＡ 显著减少细静脉白细胞附壁数,ＨＳ可短暂减少白细胞附壁数。在不同的壁切应力作用下,ＨＳＡ 组白细胞 内皮细胞粘附率显著低于ＨＳ组和ＮＳ组,ＨＳ组白细胞与内皮细胞的粘附率与ＮＳ组比较无显著差别。结论：ＨＳＡ 有改善低血容量性休克大鼠白细胞粘附特性的作用     

高渗盐水对低血容量性休克大鼠淋巴循环的影响

目的：探讨高渗盐水对失血致低血容量性休克大鼠淋巴循环的影响。方法：采用肠淋巴管引流术,在低血容量性休克大鼠模型的基础上,观察高渗盐水治疗低血容量性休克过程中肠淋巴流量及其蛋白含量的变化。结果：休克大鼠输入高渗盐水或生理盐水后,２ 组大鼠的血压、肠淋巴流量及其蛋白输出量均比休克期明显升高,高渗盐水治疗组显著高于生理盐水对照组（Ｐ均＜ ０．０１）,而且治疗组大鼠输液期肠淋巴流量及其蛋白输出量远远高于休克前水平（Ｐ均＜ ０．０１）。结论：高渗盐水可恢复休克大鼠的淋巴流量及其蛋白输出量,改善休克时肠淋巴循环障碍,对休克有良好的治疗作用     

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.